1
|
Eling L, Kefs S, Keshmiri S, Balosso J, Calvet S, Chamel G, Drevon-Gaud R, Flandin I, Gaudin M, Giraud L, Laissue JA, Pellicioli P, Verry C, Adam JF, Serduc R. Neuro-Oncologic Veterinary Trial for the Clinical Transfer of Microbeam Radiation Therapy: Acute to Subacute Radiotolerance after Brain Tumor Irradiation in Pet Dogs. Cancers (Basel) 2024; 16:2701. [PMID: 39123429 PMCID: PMC11311398 DOI: 10.3390/cancers16152701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/08/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Synchrotron Microbeam Radiation Therapy (MRT) has repeatedly proven its superiority compared with conventional radiotherapy for glioma control in preclinical research. The clinical transfer phase of MRT has recently gained momentum; seven dogs with suspected glioma were treated under clinical conditions to determine the feasibility and safety of MRT. We administered a single fraction of 3D-conformal, image-guided MRT. Ultra-high-dose rate synchrotron X-ray microbeams (50 µm-wide, 400 µm-spaced) were delivered through five conformal irradiation ports. The PTV received ~25 Gy peak dose (within microbeams) per port, corresponding to a minimal cumulated valley dose (diffusing between microbeams) of 2.8 Gy. The dogs underwent clinical and MRI follow-up, and owner evaluations. One dog was lost to follow-up. Clinical exams of the remaining six dogs during the first 3 months did not indicate radiotoxicity induced by MRT. Quality of life improved from 7.3/10 [±0.7] to 8.9/10 [±0.3]. Tumor-induced seizure activity decreased significantly. A significant tumor volume reduction of 69% [±6%] was reached 3 months after MRT. Our study is the first neuro-oncologic veterinary trial of 3D-conformal Synchrotron MRT and reveals that MRT does not induce acute to subacute radiotoxicity in normal brain tissues. MRT improves quality of life and leads to remarkable tumor volume reduction despite low valley dose delivery. This trial is an essential step towards the forthcoming clinical application of MRT against deep-seated human brain tumors.
Collapse
Affiliation(s)
- Laura Eling
- Institut National de la Santé et de la Recherche Médicale UA7 Synchrotron Radiation for Biomedicine, Université Grenoble Alpes, 38400 Saint-Martin-d’Hères, France; (S.K.); (J.-F.A.); (R.S.)
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| | - Samy Kefs
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| | - Sarvenaz Keshmiri
- Institut National de la Santé et de la Recherche Médicale UA7 Synchrotron Radiation for Biomedicine, Université Grenoble Alpes, 38400 Saint-Martin-d’Hères, France; (S.K.); (J.-F.A.); (R.S.)
| | - Jacques Balosso
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| | - Susan Calvet
- Argos Clinique Vétérinaire Pierre du Terrail, 38530 Pontcharra, France;
| | - Gabriel Chamel
- Clinical Oncology Unit, Small Animal Internal Medicine Department, University of Lyon, VetAgro Sup Campus Vétérinaire, 69280 Marcy l’Etoile, France;
- Unité de Recherche Interaction Cellules Environnement, University of Lyon, VetAgro Sup Campus Vétérinaire, 69280 Marcy l’Etoile, France
| | | | - Isabelle Flandin
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| | - Maxime Gaudin
- OnlyVet, Centre Hospitalier Vétérinaire, 69800 Saint Priest, France; (M.G.); (L.G.)
| | - Lucile Giraud
- OnlyVet, Centre Hospitalier Vétérinaire, 69800 Saint Priest, France; (M.G.); (L.G.)
| | | | - Paolo Pellicioli
- European Synchrotron Radiation Facility, 38000 Grenoble, France;
| | - Camille Verry
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| | - Jean-François Adam
- Institut National de la Santé et de la Recherche Médicale UA7 Synchrotron Radiation for Biomedicine, Université Grenoble Alpes, 38400 Saint-Martin-d’Hères, France; (S.K.); (J.-F.A.); (R.S.)
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| | - Raphaël Serduc
- Institut National de la Santé et de la Recherche Médicale UA7 Synchrotron Radiation for Biomedicine, Université Grenoble Alpes, 38400 Saint-Martin-d’Hères, France; (S.K.); (J.-F.A.); (R.S.)
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| |
Collapse
|
2
|
Grams MP, Mateus CQ, Mashayekhi M, Mutter RW, Djonov V, Fazzari JM, Xiao H, Frechette KM, Wentworth AJ, Morris JM, Klebel B, Thull JC, Guenzel RM, Wismayer DJS, Lucien F, Park SS, Lester SC. Minibeam Radiation Therapy Treatment (MBRT): Commissioning and First Clinical Implementation. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)02948-1. [PMID: 39002850 DOI: 10.1016/j.ijrobp.2024.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/22/2024] [Accepted: 06/29/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Minibeam radiation therapy (MBRT) is characterized by the delivery of submillimeter-wide regions of high "peak" and low "valley" doses throughout a tumor. Preclinical studies have long shown the promise of this technique, and we report here the first clinical implementation of MBRT. METHODS AND MATERIALS A clinical orthovoltage unit was commissioned for MBRT patient treatments using 3-, 4-, 5-, 8-, and 10-cm diameter cones. The 180 kVp output was spatially separated into minibeams using a tungsten collimator with 0.5 mm wide slits spaced 1.1 mm on center. Percentage depth dose (PDD) measurements were obtained using film dosimetry and plastic water for both peak and valley doses. PDDs were measured on the central axis for offsets of 0, 0.5, and 1 cm. The peak-to-valley ratio was calculated at each depth for all cones and offsets. To mitigate the effects of patient motion on delivered dose, patient-specific 3-dimensional-printed collimator holders were created. These conformed to the unique anatomy of each patient and affixed the tungsten collimator directly to the body. Two patients were treated with MBRT; both received 2 fractions. RESULTS Peak PDDs decreased gradually with depth. Valley PDDs initially increased slightly with depth, then decreased gradually beyond 2 cm. The peak-to-valley ratios were highest at the surface for smaller cone sizes and offsets. In vivo film dosimetry confirmed a distinct delineation of peak and valley doses in both patients treated with MBRT with no dose blurring. Both patients experienced prompt improvement in symptoms and tumor response. CONCLUSIONS We report commissioning results, treatment processes, and the first 2 patients treated with MBRT using a clinical orthovoltage unit. While demonstrating the feasibility of this approach is a crucial first step toward wider translation, clinical trials are needed to further establish safety and efficacy.
Collapse
Affiliation(s)
- Michael P Grams
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | | | | | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | | | | | - Huaping Xiao
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Brandon Klebel
- Division of Engineering, Mayo Clinic, Rochester, Minnesota
| | - Jack C Thull
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Fabrice Lucien
- Department of Urology, Mayo Clinic, Rochester, Minnesota; Division of Immunology, Mayo Clinic, Rochester, Minnesota
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
3
|
Li H, Mayr NA, Griffin RJ, Zhang H, Pokhrel D, Grams M, Penagaricano J, Chang S, Spraker MB, Kavanaugh J, Lin L, Sheikh K, Mossahebi S, Simone CB, Roberge D, Snider JW, Sabouri P, Molineu A, Xiao Y, Benedict SH. Overview and Recommendations for Prospective Multi-institutional Spatially Fractionated Radiation Therapy Clinical Trials. Int J Radiat Oncol Biol Phys 2024; 119:737-749. [PMID: 38110104 PMCID: PMC11162930 DOI: 10.1016/j.ijrobp.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/30/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE The highly heterogeneous dose delivery of spatially fractionated radiation therapy (SFRT) is a profound departure from standard radiation planning and reporting approaches. Early SFRT studies have shown excellent clinical outcomes. However, prospective multi-institutional clinical trials of SFRT are still lacking. This NRG Oncology/American Association of Physicists in Medicine working group consensus aimed to develop recommendations on dosimetric planning, delivery, and SFRT dose reporting to address this current obstacle toward the design of SFRT clinical trials. METHODS AND MATERIALS Working groups consisting of radiation oncologists, radiobiologists, and medical physicists with expertise in SFRT were formed in NRG Oncology and the American Association of Physicists in Medicine to investigate the needs and barriers in SFRT clinical trials. RESULTS Upon reviewing the SFRT technologies and methods, this group identified challenges in several areas, including the availability of SFRT, the lack of treatment planning system support for SFRT, the lack of guidance in the physics and dosimetry of SFRT, the approximated radiobiological modeling of SFRT, and the prescription and combination of SFRT with conventional radiation therapy. CONCLUSIONS Recognizing these challenges, the group further recommended several areas of improvement for the application of SFRT in cancer treatment, including the creation of clinical practice guidance documents, the improvement of treatment planning system support, the generation of treatment planning and dosimetric index reporting templates, and the development of better radiobiological models through preclinical studies and through conducting multi-institution clinical trials.
Collapse
Affiliation(s)
- Heng Li
- Department of Radiation Oncology, John Hopkins University, Baltimore, Maryland.
| | - Nina A Mayr
- College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Hualin Zhang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Damodar Pokhrel
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky
| | - Michael Grams
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jose Penagaricano
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Sha Chang
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | | | - James Kavanaugh
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Liyong Lin
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Khadija Sheikh
- Department of Radiation Oncology, John Hopkins University, Baltimore, Maryland
| | - Sina Mossahebi
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - David Roberge
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - James W Snider
- South Florida Proton Therapy Institute, 5280 Linton Blvd, Delray Beach, Florida
| | - Pouya Sabouri
- Department of Radiation Oncology, University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Andrea Molineu
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stanley H Benedict
- Department of Radiation Oncology, University of California, Davis, Sacramento, California
| |
Collapse
|
4
|
Prezado Y, Grams M, Jouglar E, Martínez-Rovira I, Ortiz R, Seco J, Chang S. Spatially fractionated radiation therapy: a critical review on current status of clinical and preclinical studies and knowledge gaps. Phys Med Biol 2024; 69:10TR02. [PMID: 38648789 DOI: 10.1088/1361-6560/ad4192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/22/2024] [Indexed: 04/25/2024]
Abstract
Spatially fractionated radiation therapy (SFRT) is a therapeutic approach with the potential to disrupt the classical paradigms of conventional radiation therapy. The high spatial dose modulation in SFRT activates distinct radiobiological mechanisms which lead to a remarkable increase in normal tissue tolerances. Several decades of clinical use and numerous preclinical experiments suggest that SFRT has the potential to increase the therapeutic index, especially in bulky and radioresistant tumors. To unleash the full potential of SFRT a deeper understanding of the underlying biology and its relationship with the complex dosimetry of SFRT is needed. This review provides a critical analysis of the field, discussing not only the main clinical and preclinical findings but also analyzing the main knowledge gaps in a holistic way.
Collapse
Affiliation(s)
- Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, F-91400, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, F-91400, Orsay, France
- New Approaches in Radiotherapy Lab, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Instituto de investigación Sanitaria de Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, A Coruña, E-15706, Spain
- Oportunius Program, Galician Agency of Innovation (GAIN), Xunta de Galicia, Santiago de Compostela, A Coruña, Spain
| | - Michael Grams
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America
| | - Emmanuel Jouglar
- Institut Curie, PSL Research University, Department of Radiation Oncology, F-75005, Paris and Orsay Protontherapy Center, F-91400, Orsay, France
| | - Immaculada Martínez-Rovira
- Physics Department, Universitat Auto`noma de Barcelona, E-08193, Cerdanyola del Valle`s (Barcelona), Spain
| | - Ramon Ortiz
- University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero Street, San Francisco, CA 94143, United States of America
| | - Joao Seco
- Division of Biomedical physics in Radiation Oncology, DKFZ-German Cancer Research Center, Heidelberg, Germany
- Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Sha Chang
- Dept of Radiation Oncology and Department of Biomedical Engineering, University of North Carolina School of Medicine, United States of America
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolin State University, United States of America
| |
Collapse
|
5
|
Song CW, Terezakis S, Park WY, Paek SH, Kim MS, Cho LC, Griffin RJ. Preferential Tumor Vascular Damage Is the Common Antitumor Mechanism of High-Dose Hypofractionated Radiation Therapy: SABR, Spatially Fractionated Radiation Therapy, and FLASH Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:701-704. [PMID: 37196835 DOI: 10.1016/j.ijrobp.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Chang W Song
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota.
| | - Stephanie Terezakis
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Woo-Yoon Park
- Department of Radiation Oncology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sun-Ha Paek
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - L Chinsoo Cho
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| |
Collapse
|
6
|
Laderach DJ, Compagno D. Inhibition of galectins in cancer: Biological challenges for their clinical application. Front Immunol 2023; 13:1104625. [PMID: 36703969 PMCID: PMC9872792 DOI: 10.3389/fimmu.2022.1104625] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Galectins play relevant roles in tumor development, progression and metastasis. Accordingly, galectins are certainly enticing targets for medical intervention in cancer. To date, however, clinical trials based on galectin inhibitors reported inconclusive results. This review summarizes the galectin inhibitors currently being evaluated and discusses some of the biological challenges that need to be addressed to improve these strategies for the benefit of cancer patients.
Collapse
Affiliation(s)
- Diego José Laderach
- Molecular and Functional Glyco-Oncology Laboratory, Instituto de Química Biológica de la Facutad de Ciencias Exactas y Naturales (IQUIBICEN-CONICET), Buenos Aires, Argentina,Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina,Departamento de Ciencias Básicas, Universidad Nacional de Luján, Luján, Argentina,*Correspondence: Diego José Laderach,
| | - Daniel Compagno
- Molecular and Functional Glyco-Oncology Laboratory, Instituto de Química Biológica de la Facutad de Ciencias Exactas y Naturales (IQUIBICEN-CONICET), Buenos Aires, Argentina,Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
7
|
Longitudinally Heterogeneous Tumor Dose Optimizes Proton Broadbeam, Interlaced Minibeam, and FLASH Therapy. Cancers (Basel) 2022; 14:cancers14205162. [PMID: 36291946 PMCID: PMC9601234 DOI: 10.3390/cancers14205162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/09/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary The aim of any kind of external radiation therapy is to control a tumor with the highest possible probability of the lowest possible side effects. Here, we study further opportunities of reducing the side effects of proton therapy by applying longitudinally heterogeneous dose distributions in the tumor respecting the delivery of a minimum prescribed dose. In our simulations, the longitudinally heterogeneous dose distributions show a reduced dose in the healthy tissue already in the case of proton broadbeam irradiations, but a much higher (calculated) mean cell survival in the case of proton minibeam irradiation. This demonstrates its potential to substantially reduce side effects at a simultaneously higher tumor control probability, opening new opportunities of easier application when striving for high dose-rate applications of proton beams (>~10 Gy/s), in order to additionally profit from the so-called FLASH effects. Abstract The prerequisite of any radiation therapy modality (X-ray, electron, proton, and heavy ion) is meant to meet at least a minimum prescribed dose at any location in the tumor for the best tumor control. In addition, there is also an upper dose limit within the tumor according to the International Commission on Radiation Units (ICRU) recommendations in order to spare healthy tissue as well as possible. However, healthy tissue may profit from the lower side effects when waving this upper dose limit and allowing a larger heterogeneous dose deposition in the tumor, but maintaining the prescribed minimum dose level, particularly in proton minibeam therapy. Methods: Three different longitudinally heterogeneous proton irradiation modes and a standard spread-out Bragg peak (SOBP) irradiation mode are simulated for their depth-dose curves under the constraint of maintaining a minimum prescribed dose anywhere in the tumor region. Symmetric dose distributions of two opposing directions are overlaid in a 25 cm-thick water phantom containing a 5 cm-thick tumor region. Interlaced planar minibeam dose distributions are compared to those of a broadbeam using the same longitudinal dose profiles. Results and Conclusion: All longitudinally heterogeneous proton irradiation modes show a dose reduction in the healthy tissue compared to the common SOBP mode in the case of broad proton beams. The proton minibeam cases show eventually a much larger mean cell survival and thus a further reduced equivalent uniform dose (EUD) in the healthy tissue than any broadbeam case. In fact, the irradiation mode using only one proton energy from each side shows better sparing capabilities in the healthy tissue than the common spread-out Bragg peak irradiation mode with the option of a better dose fall-off at the tumor edges and an easier technical realization, particularly in view of proton minibeam irradiation at ultra-high dose rates larger than ~10 Gy/s (so-called FLASH irradiation modes).
Collapse
|
8
|
Schneider T, Fernandez-Palomo C, Bertho A, Fazzari J, Iturri L, Martin OA, Trappetti V, Djonov V, Prezado Y. Combining FLASH and spatially fractionated radiation therapy: The best of both worlds. Radiother Oncol 2022; 175:169-177. [PMID: 35952978 DOI: 10.1016/j.radonc.2022.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/23/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022]
Abstract
FLASH radiotherapy (FLASH-RT) and spatially fractionated radiation therapy (SFRT) are two new therapeutical strategies that use non-standard dose delivery methods to reduce normal tissue toxicity and increase the therapeutic index. Although likely based on different mechanisms, both FLASH-RT and SFRT have shown to elicit radiobiological effects that significantly differ from those induced by conventional radiotherapy. With the therapeutic potential having been established separately for each technique, the combination of FLASH-RT and SFRT could therefore represent a winning alliance. In this review, we discuss the state of the art, advantages and current limitations, potential synergies, and where a combination of these two techniques could be implemented today or in the near future.
Collapse
Affiliation(s)
- Tim Schneider
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | | | - Annaïg Bertho
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Lorea Iturri
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Olga A Martin
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland; Division of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; University of Melbourne, Parkville, VIC 3010, Australia
| | - Verdiana Trappetti
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France.
| |
Collapse
|
9
|
Allignet B, Sunyach MP, Geets X, Waissi W. Is there a place for definitive radiotherapy in the treatment of unresectable soft-tissue sarcoma? A systematic review. Acta Oncol 2022; 61:720-729. [PMID: 35574815 DOI: 10.1080/0284186x.2022.2066983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Definitive external beam radiotherapy (EBRT) is an unusual treatment of unresectable soft-tissue sarcomas (STS). Recent technical innovations and physical advantages of particle therapies may improve results of this therapeutic option. The role of this review was to report the clinical results of photon- and particle-based EBRT in unresectable STS. MATERIAL AND METHODS We performed a systematic review of the literature on Pubmed database to identify studies investigating the efficacy and safety of EBRT. The primary endpoint was local control (LC) and secondary endpoints were progression-free survival (PFS), overall survival (OS) and adverse events in a subset of patients with gross disease STS. RESULTS We identified 29 studies involving 1409 patients (pts) evaluating photon (n = 18; 956 pts), proton (n = 1; 21 pts), carbon ion (n = 2; 152 pts), neutron (n = 7; 259 pts) or pion (n = 1; 21 pts) therapy. Definitive EBRT achieves valuable 5-year LC rates of 28-73% with photon and 52-69% with particle therapies. Most local failures (66-100%) occurred within 3 years. Long-term disease control can be achieved in a fraction of patients, with 5-year PFS and OS of 0-39% and 24.7-63%, respectively. The rate of severe adverse events was highly variable with photons, <15% in proton and carbon ion therapy, whereas 25 to 50% of patients treated with neutrons and pions presented severe AE. While a dose higher or equal 64 Gy seem to improve the prognosis, delivering a dose higher or equal 68 Gy dramatically increases severe adverse events. CONCLUSION Definitive EBRT with dose 64-66 Gy seems to be a safe and efficient treatment for unresectable STS. Future clinical trials should assess the potential of biomarkers of response, thus identifying patients that could benefit from local treatment.
Collapse
Affiliation(s)
- Benoît Allignet
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | | | - Xavier Geets
- Department of Radiation Oncology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Waisse Waissi
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| |
Collapse
|
10
|
Kundapur V, Mayer M, Auer RN, Alexander A, Weibe S, Pushie MJ, Cranmer-Sargison G. Is Mini Beam Ready for Human Trials? Results of Randomized Study of Treating De-Novo Brain Tumors in Canines Using Linear Accelerator Generated Mini Beams. Radiat Res 2022; 198:162-171. [PMID: 35536992 DOI: 10.1667/rade-21-00093.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
The main challenge in treating malignant brain neoplasms lies in eradicating the tumor while minimizing treatment-related damage. Conventional radiation treatments are associated with considerable side effects. Synchrotron generated micro-beam radiation (SMBRT) has shown to preserve brain architecture while killing tumor cells, however physical characteristics and limited facility access restrict its use. We have created a new clinical device which produces mini beams on a linear accelerator, to provide a new type of treatment called mini-beam radiation therapy (MBRT). The objective of this study is to compare the treatment outcomes of linear accelerator based MBRT versus standard radiation treatment (SRT), to evaluate the tumor response and the treatment-related changes in the normal brain with respect to each treatment type. Pet dogs with de-novo brain tumors were accrued for treatment. Dogs were randomized between standard fractionated stereotactic (9 Gy in 3 fractions) radiation treatment vs. a single fraction of MBRT (26 Gy mean dose). Dogs were monitored after treatment for clinical assessment and imaging. When the dogs were euthanized, a veterinary pathologist assessed the radiation changes and tumor response. We accrued 16 dogs, 8 dogs in each treatment arm. In the MBRT arm, 71% dogs achieved complete pathological remission. The radiation-related changes were all confined to the target region. Structural damage was not observed in the beam path outside of the target region. In contrast, none of the dogs in control group achieved remission and the treatment related damage was more extensive. Therapeutic superiority was observed with MBRT, including both tumor control and the normal structural preservation. The MBRT findings are suggestive of an immune related mechanism which is absent in standard treatment. These findings together with the widespread availability of clinical linear accelerators make MBRT a promising research topic to explore further treatment and clinical trial opportunities.
Collapse
Affiliation(s)
- V Kundapur
- Radiation Oncology, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - M Mayer
- Veterinary Radiation Oncology, Department of Small Animal clinical Sciences, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - R N Auer
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - A Alexander
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - S Weibe
- Department of Clinical Imaging, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - M J Pushie
- Department of Surgery, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - G Cranmer-Sargison
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| |
Collapse
|
11
|
Moghaddasi L, Reid P, Bezak E, Marcu LG. Radiobiological and Treatment-Related Aspects of Spatially Fractionated Radiotherapy. Int J Mol Sci 2022; 23:3366. [PMID: 35328787 PMCID: PMC8954016 DOI: 10.3390/ijms23063366] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
The continuously evolving field of radiotherapy aims to devise and implement techniques that allow for greater tumour control and better sparing of critical organs. Investigations into the complexity of tumour radiobiology confirmed the high heterogeneity of tumours as being responsible for the often poor treatment outcome. Hypoxic subvolumes, a subpopulation of cancer stem cells, as well as the inherent or acquired radioresistance define tumour aggressiveness and metastatic potential, which remain a therapeutic challenge. Non-conventional irradiation techniques, such as spatially fractionated radiotherapy, have been developed to tackle some of these challenges and to offer a high therapeutic index when treating radioresistant tumours. The goal of this article was to highlight the current knowledge on the molecular and radiobiological mechanisms behind spatially fractionated radiotherapy and to present the up-to-date preclinical and clinical evidence towards the therapeutic potential of this technique involving both photon and proton beams.
Collapse
Affiliation(s)
- Leyla Moghaddasi
- Department of Medical Physics, Austin Health, Ballarat, VIC 3350, Australia;
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5001, Australia;
| | - Paul Reid
- Radiation Health, Environment Protection Authority, Adelaide, SA 5000, Australia;
| | - Eva Bezak
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5001, Australia;
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
| | - Loredana G. Marcu
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
- Faculty of Informatics and Science, University of Oradea, 1 Universitatii Str., 410087 Oradea, Romania
| |
Collapse
|
12
|
Abstract
AbstractSpatially fractionated radiation therapy (SFRT) challenges some of the classical dogmas in conventional radiotherapy. The highly modulated spatial dose distributions in SFRT have been shown to lead, both in early clinical trials and in small animal experiments, to a significant increase in normal tissue dose tolerances. Tumour control effectiveness is maintained or even enhanced in some configurations as compared with conventional radiotherapy. SFRT seems to activate distinct radiobiological mechanisms, which have been postulated to involve bystander effects, microvascular alterations and/or immunomodulation. Currently, it is unclear which is the dosimetric parameter which correlates the most with both tumour control and normal tissue sparing in SFRT. Additional biological experiments aiming at parametrizing the relationship between the irradiation parameters (beam width, spacing, peak-to-valley dose ratio, peak and valley doses) and the radiobiology are needed. A sound knowledge of the interrelation between the physical parameters in SFRT and the biological response would expand its clinical use, with a higher level of homogenisation in the realisation of clinical trials. This manuscript reviews the state of the art of this promising therapeutic modality, the current radiobiological knowledge and elaborates on future perspectives.
Collapse
|
13
|
Bertho A, Iturri L, Prezado Y. Radiation-induced immune response in novel radiotherapy approaches FLASH and spatially fractionated radiotherapies. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2022; 376:37-68. [PMID: 36997269 DOI: 10.1016/bs.ircmb.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The last several years have revealed increasing evidence of the immunomodulatory role of radiation therapy. Radiotherapy reshapes the tumoral microenvironment can shift the balance toward a more immunostimulatory or immunosuppressive microenvironment. The immune response to radiation therapy appears to depend on the irradiation configuration (dose, particle, fractionation) and delivery modes (dose rate, spatial distributions). Although an optimal irradiation configuration (dose, temporal fractionation, spatial dose distribution, etc.) has not yet been determined, temporal schemes employing high doses per fraction appear to favor radiation-induced immune response through immunogenic cell death. Through the release of damage-associated molecular patterns and the sensing of double-stranded DNA and RNA breaks, immunogenic cell death activates the innate and adaptive immune response, leading to tumor infiltration by effector T cells and the abscopal effect. Novel radiotherapy approaches such as FLASH and spatially fractionated radiotherapies (SFRT) strongly modulate the dose delivery method. FLASH-RT and SFRT have the potential to trigger the immune system effectively while preserving healthy surrounding tissues. This manuscript reviews the current state of knowledge on the immunomodulation effects of these two new radiotherapy techniques in the tumor, healthy immune cells and non-targeted regions, as well as their therapeutic potential in combination with immunotherapy.
Collapse
|
14
|
Cahoon P, Giacometti V, Casey F, Russell E, McGarry C, Prise KM, McMahon SJ. Investigating spatial fractionation and radiation induced bystander effects: a mathematical modelling approach. Phys Med Biol 2021; 66. [PMID: 34666318 DOI: 10.1088/1361-6560/ac3119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/19/2021] [Indexed: 11/12/2022]
Abstract
Radiation induced bystander effects (RIBEs) have been shown to cause death in cells receiving little or no physical dose. In standard radiotherapy, where uniform fields are delivered and all cells are directly exposed to radiation, this phenomenon can be neglected. However, the role of RIBEs may become more influential when heterogeneous fields are considered. Mathematical modelling can be used to determine how these heterogeneous fields might influence cell survival, but most established techniques account only for the direct effects of radiation. To gain a full appreciation of how non-uniform fields impact cell survival, it is also necessary to consider the indirect effects of radiation. In this work, we utilise a mathematical model that accounts for both the direct effects of radiation on cells and RIBEs. This model is used to investigate how spatially fractionated radiotherapy plans impact cell survivalin vitro. These predictions were compared to survival in normal and cancerous cells following exposure to spatially fractionated plans using a clinical linac. The model is also used to explore how spatially fractionated radiotherapy will impact tumour controlin vivo. Results suggest that spatially fractionated plans are associated with higher equivalent uniform doses than conventional uniform plans at clinically relevant doses. The model predicted only small changes changes in normal tissue complication probability, compared to the larger protection seen clinically. This contradicts a central paradigm of radiotherapy where uniform fields are assumed to maximise cell kill and may be important for future radiotherapy optimisation.
Collapse
Affiliation(s)
- Paul Cahoon
- Patrick G Johnson Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Valentina Giacometti
- Patrick G Johnson Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.,Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Francis Casey
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom.,Nottingham Radiotherapy Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Emily Russell
- Patrick G Johnson Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Conor McGarry
- Patrick G Johnson Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.,Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Kevin M Prise
- Patrick G Johnson Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Stephen J McMahon
- Patrick G Johnson Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| |
Collapse
|
15
|
Wright MD, Romanelli P, Bravin A, Le Duc G, Brauer-Krisch E, Requardt H, Bartzsch S, Hlushchuk R, Laissue JA, Djonov V. Non-conventional Ultra-High Dose Rate (FLASH) Microbeam Radiotherapy Provides Superior Normal Tissue Sparing in Rat Lung Compared to Non-conventional Ultra-High Dose Rate (FLASH) Radiotherapy. Cureus 2021; 13:e19317. [PMID: 35223216 PMCID: PMC8864723 DOI: 10.7759/cureus.19317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 12/12/2022] Open
Abstract
Conventional radiotherapy is a widely used non-invasive form of treatment for many types of cancer. However, due to a low threshold in the lung for radiation-induced normal tissue damage, it is of less utility in treating lung cancer. For this reason, surgery is the preferred treatment for lung cancer, which has the detriment of being highly invasive. Non-conventional ultra-high dose rate (FLASH) radiotherapy is currently of great interest in the radiotherapy community due to demonstrations of reduced normal tissue toxicity in lung and other anatomy. This study investigates the effects of FLASH microbeam radiotherapy, which in addition to ultra-high dose rate incorporates a spatial segmentation of the radiation field, on the normal lung tissue of rats. With a focus on fibrotic damage, this work demonstrates that FLASH microbeam radiotherapy provides an order of magnitude increase in normal tissue radio-resistance compared to FLASH radiotherapy. This result suggests FLASH microbeam radiotherapy holds promise for much improved non-invasive control of lung cancer.
Collapse
Affiliation(s)
- Michael D Wright
- Ginzton Technology Center, Varian Medical Systems, Palo Alto, USA.,Research & Development Center, Avail Medical Devices, Roseville, USA
| | | | - Alberto Bravin
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, FRA
| | - Geraldine Le Duc
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, FRA.,Pharmaceutics, NH TherAguix, Lyon, FRA
| | - Elke Brauer-Krisch
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, FRA
| | - Herwig Requardt
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, FRA
| | - Stefan Bartzsch
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Munich, DEU.,Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, DEU
| | | | | | | |
Collapse
|
16
|
Price LS, Rivera JN, Madden AJ, Herity LB, Piscitelli JA, Mageau S, Santos CM, Roques JR, Midkiff B, Feinberg NN, Darr D, Chang SX, Zamboni WC. Minibeam radiation therapy enhanced tumor delivery of PEGylated liposomal doxorubicin in a triple-negative breast cancer mouse model. Ther Adv Med Oncol 2021; 13:17588359211053700. [PMID: 34733359 PMCID: PMC8558804 DOI: 10.1177/17588359211053700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 09/29/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Minibeam radiation therapy is an experimental radiation therapy utilizing an array of parallel submillimeter planar X-ray beams. In preclinical studies, minibeam radiation therapy has been shown to eradicate tumors and cause significantly less damage to normal tissue compared to equivalent radiation doses delivered by conventional broadbeam radiation therapy, where radiation dose is uniformly distributed. METHODS Expanding on prior studies that suggested minibeam radiation therapy increased perfusion in tumors, we compared a single fraction of minibeam radiation therapy (peak dose:valley dose of 28 Gy:2.1 Gy and 100 Gy:7.5 Gy) and broadbeam radiation therapy (7 Gy) in their ability to enhance tumor delivery of PEGylated liposomal doxorubicin and alter the tumor microenvironment in a murine tumor model. Plasma and tumor pharmacokinetic studies of PEGylated liposomal doxorubicin and tumor microenvironment profiling were performed in a genetically engineered mouse model of claudin-low triple-negative breast cancer (T11). RESULTS Minibeam radiation therapy (28 Gy) and broadbeam radiation therapy (7 Gy) increased PEGylated liposomal doxorubicin tumor delivery by 7.1-fold and 2.7-fold, respectively, compared to PEGylated liposomal doxorubicin alone, without altering the plasma disposition. The enhanced tumor delivery of PEGylated liposomal doxorubicin by minibeam radiation therapy is consistent after repeated dosing, is associated with changes in tumor macrophages but not collagen or angiogenesis, and nontoxic to local tissues. Our study indicated that the minibeam radiation therapy's ability to enhance the drug delivery decreases from 28 to 100 Gy peak dose. DISCUSSION Our studies suggest that low-dose minibeam radiation therapy is a safe and effective method to significantly enhance the tumor delivery of nanoparticle agents.
Collapse
Affiliation(s)
- Lauren S.L. Price
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
- Translational Oncology and Nanoparticle Drug Development (TOND2I) Lab, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Judith N. Rivera
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Andrew J. Madden
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
- Translational Oncology and Nanoparticle Drug Development (TOND2I) Lab, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leah B. Herity
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
- Translational Oncology and Nanoparticle Drug Development (TOND2I) Lab, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph A. Piscitelli
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
- Translational Oncology and Nanoparticle Drug Development (TOND2I) Lab, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Savannah Mageau
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
- UNC Advanced Translational Pharmacology and Analytical Chemistry (ATPAC) Lab, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charlene M. Santos
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- The Animal Studies Core, UNC at Chapel Hill, Chapel Hill, NC, USA
| | - Jose R. Roques
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- The Animal Studies Core, UNC at Chapel Hill, Chapel Hill, NC, USA
| | - Bentley Midkiff
- Translational Pathology Lab, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Nana N. Feinberg
- Translational Pathology Lab, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - David Darr
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Sha X. Chang
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Department of Radiation Oncology, UNC at Chapel Hill, Chapel Hill, NC, USA
| | - William C. Zamboni
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, 1022B Genetic Medicine Building, 120 Mason Farm Road, Campus Box 7361, Chapel Hill, NC 27599-7361, USA
- Translational Oncology and Nanoparticle Drug Development (TOND2I) Lab, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Carolina Center of Cancer Nanotechnology Excellence (C-CCNE), Chapel Hill, NC, USA
- North Carolina Biomedical Innovation Network, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
17
|
Trappetti V, Fazzari JM, Fernandez-Palomo C, Scheidegger M, Volarevic V, Martin OA, Djonov VG. Microbeam Radiotherapy-A Novel Therapeutic Approach to Overcome Radioresistance and Enhance Anti-Tumour Response in Melanoma. Int J Mol Sci 2021; 22:7755. [PMID: 34299373 PMCID: PMC8303317 DOI: 10.3390/ijms22147755] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 12/19/2022] Open
Abstract
Melanoma is the deadliest type of skin cancer, due to its invasiveness and limited treatment efficacy. The main therapy for primary melanoma and solitary organ metastases is wide excision. Adjuvant therapy, such as chemotherapy and targeted therapies are mainly used for disseminated disease. Radiotherapy (RT) is a powerful treatment option used in more than 50% of cancer patients, however, conventional RT alone is unable to eradicate melanoma. Its general radioresistance is attributed to overexpression of repair genes in combination with cascades of biochemical repair mechanisms. A novel sophisticated technique based on synchrotron-generated, spatially fractionated RT, called Microbeam Radiation Therapy (MRT), has been shown to overcome these treatment limitations by allowing increased dose delivery. With MRT, a collimator subdivides the homogeneous radiation field into an array of co-planar, high-dose microbeams that are tens of micrometres wide and spaced a few hundred micrometres apart. Different preclinical models demonstrated that MRT has the potential to completely ablate tumours, or significantly improve tumour control while dramatically reducing normal tissue toxicity. Here, we discuss the role of conventional RT-induced immunity and the potential for MRT to enhance local and systemic anti-tumour immune responses. Comparative gene expression analysis from preclinical tumour models indicated a specific gene signature for an 'MRT-induced immune effect'. This focused review highlights the potential of MRT to overcome the inherent radioresistance of melanoma which could be further enhanced for future clinical use with combined treatment strategies, in particular, immunotherapy.
Collapse
Affiliation(s)
- Verdiana Trappetti
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (V.T.); (J.M.F.); (C.F.-P.); (M.S.); (O.A.M.)
| | - Jennifer M. Fazzari
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (V.T.); (J.M.F.); (C.F.-P.); (M.S.); (O.A.M.)
| | - Cristian Fernandez-Palomo
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (V.T.); (J.M.F.); (C.F.-P.); (M.S.); (O.A.M.)
| | - Maximilian Scheidegger
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (V.T.); (J.M.F.); (C.F.-P.); (M.S.); (O.A.M.)
| | - Vladislav Volarevic
- Department of Genetics, Department of Microbiology and Immunology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Olga A. Martin
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (V.T.); (J.M.F.); (C.F.-P.); (M.S.); (O.A.M.)
- Peter MacCallum Cancer Centre, Division of Radiation Oncology, Melbourne, VIC 3000, Australia
- University of Melbourne, Parkville, VIC 3010, Australia
| | - Valentin G. Djonov
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (V.T.); (J.M.F.); (C.F.-P.); (M.S.); (O.A.M.)
| |
Collapse
|
18
|
The role of the spatially fractionated radiation therapy in the management of advanced bulky tumors. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2021. [DOI: 10.2478/pjmpe-2021-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Spatially fractionated radiation therapy (SFRT) refers to the delivery of a single large dose of radiation within the target volume in a heterogeneous pattern using either a custom GRID block, multileaf collimators, and virtual methods such as helical tomotherapy or synchrotron-based microbeams. The potential impact of this technique on the regression of bulky deep-seated tumors that do not respond well to conventional radiotherapy has been remarkable. To date, a large number of patients have been treated using the SFRT techniques. However, there are yet many technical and medical challenges that have limited their routine use to a handful of clinics, most commonly for palliative intent. There is also a poor understanding of the biological mechanisms underlying the clinical efficacy of this approach. In this article, the methods of SFRT delivery together with its potential biological mechanisms are presented. Furthermore, technical challenges and clinical achievements along with the radiobiological models used to evaluate the efficacy and safety of SFRT are highlighted.
Collapse
|
19
|
Laissue JA. Elke Bräuer-Krisch: dedication, creativity and generosity: May 17, 1961-September 10, 2018. Int J Radiat Biol 2021; 98:280-287. [PMID: 34129423 DOI: 10.1080/09553002.2021.1941385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This extraordinary woman worked her professional way from a radiation protection engineer to become the successful principal investigator of a prestigious international European project for a new radiation therapy (ERC Synergy grant, HORIZON 2020). The evaluation of the submitted proposal was very positive. The panel proposed that it be funded. Elke tragically passed away a few days before this conclusion of the panel. The present account describes her gradual career development; it includes many episodes that Elke personally chronicled in her curriculum of 2017. METHODS An internet literature search was performed using Google Scholar and other sources to assist in the writing of this narrative review and account. CONCLUSIONS In parallel to the development of the new Biomedical Beamline ID17 at the European Synchrotron Radiation Facility in Grenoble in the late nineties, Elke focused her interest and her personal and professional priorities on MRT, particularly on its clinical goals. She outlined her main objectives in several documents: (1) develop a new paradigm of cancer care by broadening the foundation for MRT. (2) Filling the gaps in basic biological knowledge about the mechanisms of MRT effects on normal and neoplastic tissues. (3) Broaden the preclinical level of evidence for the low normal organ toxicity of MRT versus standard X-ray irradiations; preclinical experiments involved the application of MRT to animal tumor patients, to animals of larger size than laboratory rodents, using larger radiation field sizes, and irradiating in a real-time scenario comparable to the one planned for human patients. (4) To foster the specific purpose of radiosurgical MRT of tumor patients at the ESRF that required development of new, specific state of the art modalities and tools for treatment planning, dosimetry, dose calculation, patient positioning and, of particular importance, redundant levels of patient safety. Just as she was about to take responsibility as principal investigator for a prestigious international European project on a new radiation therapy, death called Elke in.
Collapse
Affiliation(s)
- Jean A Laissue
- Institute of Pathology, University of Bern, Bern, Switzerland
| |
Collapse
|
20
|
Sabatasso S, Fernandez-Palomo C, Hlushchuk R, Fazzari J, Tschanz S, Pellicioli P, Krisch M, Laissue JA, Djonov V. Transient and Efficient Vascular Permeability Window for Adjuvant Drug Delivery Triggered by Microbeam Radiation. Cancers (Basel) 2021; 13:cancers13092103. [PMID: 33925455 PMCID: PMC8123803 DOI: 10.3390/cancers13092103] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Microbeam Radiation Therapy (MRT) induces a transient vascular permeability window, which offers a novel drug-delivery system for the preferential accumulation of therapeutic compounds in tumors. MRT is a preclinical cancer treatment modality that spatially fractionates synchrotron X-rays into micrometer-wide planar microbeams which can induce transient vascular permeability, especially in the immature tumor vessels, without compromising vascular perfusion. Here, we characterized this phenomenon using Chicken Chorioallantoic Membrane (CAM) and demonstrated its therapeutic potential in human glioblastoma xenografts in mice. METHODS the developing CAM was exposed to planar-microbeams of 75 Gy peak dose with Synchrotron X-rays. Similarly, mice harboring human glioblastoma xenografts were exposed to peak microbeam doses of 150 Gy, followed by treatment with Cisplatin. Tumor progression was documented by Magnetic Resonance Imaging (MRI) and caliper measurements. RESULTS CAM exposed to MRT exhibited vascular permeability, beginning 15 min post-irradiation, reaching its peak from 45 min to 2 h, and ending by 4 h. We have deemed this period the "permeability window". Morphological analysis showed partially fragmented endothelial walls as the cause of the increased transport of FITC-Dextran into the surrounding tissue and the extravasation of 100 nm microspheres (representing the upper range of nanoparticles). In the human glioblastoma xenografts, MRI measurements showed that the combined treatment dramatically reduced the tumor size by 2.75-fold and 5.25-fold, respectively, compared to MRT or Cisplatin alone. CONCLUSIONS MRT provides a novel mechanism for drug delivery by increasing vascular transpermeability while preserving vessel integrity. This permeability window increases the therapeutic index of currently available chemotherapeutics and could be combined with other therapeutic agents such as Nanoparticles/Antibodies/etc.
Collapse
Affiliation(s)
- Sara Sabatasso
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
| | - Cristian Fernandez-Palomo
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
| | - Ruslan Hlushchuk
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
| | - Stefan Tschanz
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
| | - Paolo Pellicioli
- Biomedical Beamline ID17, European Synchrotron Radiation Facility, 38043 Grenoble, France; (P.P.); (M.K.)
| | - Michael Krisch
- Biomedical Beamline ID17, European Synchrotron Radiation Facility, 38043 Grenoble, France; (P.P.); (M.K.)
| | - Jean A. Laissue
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
- Correspondence: ; Tel.: +41-31-631-84-32
| |
Collapse
|
21
|
Pellicioli P, Donzelli M, Davis JA, Estève F, Hugtenburg R, Guatelli S, Petasecca M, Lerch MLF, Bräuer-Krisch E, Krisch M. Study of the X-ray radiation interaction with a multislit collimator for the creation of microbeams in radiation therapy. JOURNAL OF SYNCHROTRON RADIATION 2021; 28:392-403. [PMID: 33650550 DOI: 10.1107/s1600577520016811] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
Microbeam radiation therapy (MRT) is a developing radiotherapy, based on the use of beams only a few tens of micrometres wide, generated by synchrotron X-ray sources. The spatial fractionation of the homogeneous beam into an array of microbeams is possible using a multislit collimator (MSC), i.e. a machined metal block with regular apertures. Dosimetry in MRT is challenging and previous works still show differences between calculated and experimental dose profiles of 10-30%, which are not acceptable for a clinical implementation of treatment. The interaction of the X-rays with the MSC may contribute to the observed discrepancies; the present study therefore investigates the dose contribution due to radiation interaction with the MSC inner walls and radiation leakage of the MSC. Dose distributions inside a water-equivalent phantom were evaluated for different field sizes and three typical spectra used for MRT studies at the European Synchrotron Biomedical beamline ID17. Film dosimetry was utilized to determine the contribution of radiation interaction with the MSC inner walls; Monte Carlo simulations were implemented to calculate the radiation leakage contribution. Both factors turned out to be relevant for the dose deposition, especially for small fields. Photons interacting with the MSC walls may bring up to 16% more dose in the valley regions, between the microbeams. Depending on the chosen spectrum, the radiation leakage close to the phantom surface can contribute up to 50% of the valley dose for a 5 mm × 5 mm field. The current study underlines that a detailed characterization of the MSC must be performed systematically and accurate MRT dosimetry protocols must include the contribution of radiation leakage and radiation interaction with the MSC in order to avoid significant errors in the dose evaluation at the micrometric scale.
Collapse
Affiliation(s)
- P Pellicioli
- ID17 Biomedical Beamline, ESRF - The European Synchrotron, 71 avenue des Martyrs, Grenoble, France
| | - M Donzelli
- ID17 Biomedical Beamline, ESRF - The European Synchrotron, 71 avenue des Martyrs, Grenoble, France
| | - J A Davis
- School of Physics, University of Wollongong, Wollongong, Australia
| | - F Estève
- STROBE - Synchrotron Radiation for Biomedicine, Grenoble, France
| | - R Hugtenburg
- Swansea University Medical School, Singleton Park, Swansea, United Kingdom
| | - S Guatelli
- School of Physics, University of Wollongong, Wollongong, Australia
| | - M Petasecca
- School of Physics, University of Wollongong, Wollongong, Australia
| | - M L F Lerch
- School of Physics, University of Wollongong, Wollongong, Australia
| | - E Bräuer-Krisch
- ID17 Biomedical Beamline, ESRF - The European Synchrotron, 71 avenue des Martyrs, Grenoble, France
| | - M Krisch
- ID17 Biomedical Beamline, ESRF - The European Synchrotron, 71 avenue des Martyrs, Grenoble, France
| |
Collapse
|
22
|
Balestrieri K, Kew K, McDaniel M, Ramez M, Pittman HK, Murray G, Vohra NA, Verbanac KM. Proteomic identification of tumor- and metastasis-associated galectin-1 in claudin-low breast cancer. Biochim Biophys Acta Gen Subj 2021; 1865:129784. [PMID: 33166603 DOI: 10.1016/j.bbagen.2020.129784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/01/2020] [Accepted: 11/04/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Metastasis and mortality remain high among breast cancer patients with the claudin-low subtype because these tumors are aggressive, chemoresistant, and lack targeted therapies. Our objective was to utilize discovery-based proteomics to identify proteins associated with claudin-low primary and metastatic tumors to gain insight into pathways and mechanisms of tumor progression. METHODS We used nano-LC-MS/MS proteomics to analyze orthotopic and metastatic tumors from the syngeneic murine T11 tumor model, which displays gene expression profiles mirroring human claudin-low tumors. Galectin-1 identity, expression and spatial distribution were investigated by biochemical and immunochemical methods and MALDI/IMS. RNA seq data from mouse and human tumors in our study and publicly available microarray data were analyzed for differential galectin-1 expression across breast cancer subtypes. RESULTS Galectin-1, an N-acetyllactosamine-binding protein, exhibited the highest sequence coverage and high abundance rank order among nano-LC-MS/MS-identified proteins shared by T11 claudin-low tumors but not normal tissue. Label-free quantitation, Western immunoblot and ELISA confirmed galectin-1 identity and significant differential expression. MALDI/IMS spatial mapping and immunohistochemistry detected galectin-1 in T11 metastatic lung foci. Immunohistochemistry of human claudin-low tumors demonstrated intermediate-to-high intensity galectin-1 staining of tumor and stroma. Gene expression analysis of mouse and human tumors found the highest galectin-1 levels in the claudin-low breast cancer subtype. CONCLUSIONS Proteomics and genomics reveal high expression of galectin-1 protein and RNA in primary and metastatic claudin-low breast cancer. GENERAL SIGNIFICANCE This work endorses proteomic approaches in cancer research and supports further investigations of the function and significance of galectin-1 overexpression in claudin-low tumor progression.
Collapse
Affiliation(s)
- Kassondra Balestrieri
- Brody School of Medicine, East Carolina University, Department of Surgery, 600 Moye Boulevard, Greenville, NC 27834, United States of America
| | - Kimberly Kew
- Brody School of Medicine, East Carolina University, Department of Biochemistry and Molecular Biology, 600 Moye Boulevard, Greenville, NC 27834, United States of America
| | - Moses McDaniel
- Brody School of Medicine, East Carolina University, Department of Surgery, 600 Moye Boulevard, Greenville, NC 27834, United States of America
| | - Mohamed Ramez
- Brody School of Medicine, East Carolina University, Department of Surgery, 600 Moye Boulevard, Greenville, NC 27834, United States of America
| | - H Keith Pittman
- Brody School of Medicine, East Carolina University, Department of Surgery, 600 Moye Boulevard, Greenville, NC 27834, United States of America
| | - Gina Murray
- Brody School of Medicine, East Carolina University, Department of Pathology, 600 Moye Boulevard, Greenville, NC 27834, United States of America
| | - Nasreen A Vohra
- Brody School of Medicine, East Carolina University, Department of Surgery, 600 Moye Boulevard, Greenville, NC 27834, United States of America
| | - Kathryn M Verbanac
- Brody School of Medicine, East Carolina University, Department of Surgery, 600 Moye Boulevard, Greenville, NC 27834, United States of America.
| |
Collapse
|
23
|
Mazal A, Vera Sanchez JA, Sanchez-Parcerisa D, Udias JM, España S, Sanchez-Tembleque V, Fraile LM, Bragado P, Gutierrez-Uzquiza A, Gordillo N, Garcia G, Castro Novais J, Perez Moreno JM, Mayorga Ortiz L, Ilundain Idoate A, Cremades Sendino M, Ares C, Miralbell R, Schreuder N. Biological and Mechanical Synergies to Deal With Proton Therapy Pitfalls: Minibeams, FLASH, Arcs, and Gantryless Rooms. Front Oncol 2021; 10:613669. [PMID: 33585238 PMCID: PMC7874206 DOI: 10.3389/fonc.2020.613669] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/02/2020] [Indexed: 12/28/2022] Open
Abstract
Proton therapy has advantages and pitfalls comparing with photon therapy in radiation therapy. Among the limitations of protons in clinical practice we can selectively mention: uncertainties in range, lateral penumbra, deposition of higher LET outside the target, entrance dose, dose in the beam path, dose constraints in critical organs close to the target volume, organ movements and cost. In this review, we combine proposals under study to mitigate those pitfalls by using individually or in combination: (a) biological approaches of beam management in time (very high dose rate “FLASH” irradiations in the order of 100 Gy/s) and (b) modulation in space (a combination of mini-beams of millimetric extent), together with mechanical approaches such as (c) rotational techniques (optimized in partial arcs) and, in an effort to reduce cost, (d) gantry-less delivery systems. In some cases, these proposals are synergic (e.g., FLASH and minibeams), in others they are hardly compatible (mini-beam and rotation). Fixed lines have been used in pioneer centers, or for specific indications (ophthalmic, radiosurgery,…), they logically evolved to isocentric gantries. The present proposals to produce fixed lines are somewhat controversial. Rotational techniques, minibeams and FLASH in proton therapy are making their way, with an increasing degree of complexity in these three approaches, but with a high interest in the basic science and clinical communities. All of them must be proven in clinical applications.
Collapse
Affiliation(s)
| | | | - Daniel Sanchez-Parcerisa
- Grupo de Física Nuclear and IPARCOS, U. Complutense Madrid, CEI Moncloa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Sedecal Molecular Imaging, Madrid, Spain
| | - Jose Manuel Udias
- Grupo de Física Nuclear and IPARCOS, U. Complutense Madrid, CEI Moncloa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Samuel España
- Grupo de Física Nuclear and IPARCOS, U. Complutense Madrid, CEI Moncloa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Victor Sanchez-Tembleque
- Grupo de Física Nuclear and IPARCOS, U. Complutense Madrid, CEI Moncloa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Mario Fraile
- Grupo de Física Nuclear and IPARCOS, U. Complutense Madrid, CEI Moncloa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Paloma Bragado
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Department of Biochemistry and Molecular Biology. U. Complutense, Madrid, Spain
| | - Alvaro Gutierrez-Uzquiza
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Department of Biochemistry and Molecular Biology. U. Complutense, Madrid, Spain
| | - Nuria Gordillo
- Department of Applied Physics, U. Autonoma de Madrid, Madrid, Spain.,Center for Materials Microanalysis, (CMAM), U. Autonoma de Madrid, Madrid, Spain
| | - Gaston Garcia
- Center for Materials Microanalysis, (CMAM), U. Autonoma de Madrid, Madrid, Spain
| | | | | | | | | | | | - Carme Ares
- Centro de Protonterapia Quironsalud, Madrid, Spain
| | | | | |
Collapse
|
24
|
Griffin RJ, Prise KM, McMahon SJ, Zhang X, Penagaricano J, Butterworth KT. History and current perspectives on the biological effects of high-dose spatial fractionation and high dose-rate approaches: GRID, Microbeam & FLASH radiotherapy. Br J Radiol 2020; 93:20200217. [PMID: 32706989 DOI: 10.1259/bjr.20200217] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The effects of various forms of ionising radiation are known to be mediated by interactions with cellular and molecular targets in irradiated and in some cases non-targeted tissue volumes. Despite major advances in advanced conformal delivery techniques, the probability of normal tissue complication (NTCP) remains the major dose-limiting factor in escalating total dose delivered during treatment. Potential strategies that have shown promise as novel delivery methods in achieving effective tumour control whilst sparing organs at risk involve the modulation of critical dose delivery parameters. This has led to the development of techniques using high dose spatial fractionation (GRID) and ultra-high dose rate (FLASH) which have translated to the clinic. The current review discusses the historical development and biological basis of GRID, microbeam and FLASH radiotherapy as advanced delivery modalities that have major potential for widespread implementation in the clinic in future years.
Collapse
Affiliation(s)
- Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kevin M Prise
- Patrick G Johnston Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Stephen J McMahon
- Patrick G Johnston Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Xin Zhang
- Department of Radiation Oncology, Boston University Medical Centre, Boston, MA, USA
| | - Jose Penagaricano
- Department of Radiation Oncology, Moffitt Cancer Centre, Tampa, FL, USA
| | - Karl T Butterworth
- Patrick G Johnston Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| |
Collapse
|
25
|
Chicilo F, Hanson AL, Geisler FH, Belev G, Edgar A, Ramaswami KO, Chapman D, Kasap SO. Dose profiles and x-ray energy optimization for microbeam radiation therapy by high-dose, high resolution dosimetry using Sm-doped fluoroaluminate glass plates and Monte Carlo transport simulation. Phys Med Biol 2020; 65:075010. [PMID: 32242527 DOI: 10.1088/1361-6560/ab7361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Microbeam radiation therapy (MRT) utilizes highly collimated synchrotron generated x-rays to create narrow planes of high dose radiation for the treatment of tumors. Individual microbeams have a typical width of 30-50 µm and are separated by a distance of 200-500 µm. The dose delivered at the center of the beam is lethal to cells in the microbeam path, on the order of hundreds of Grays (Gy). The tissue between each microbeam is spared and helps aid in the repair of adjacent damaged tissue. Radiation interactions within the peak of the microbeam, such as the photoelectric effect and incoherent (atomic Compton) scattering, cause some dose to be delivered to the valley areas adjacent to the microbeams. As the incident x-ray energy is modified, radiation interactions within a material change and affect the probability of interactions, as well as the directionality and energy of ionizing particles (electrons) that deposit energy in the valley regions surrounding the microbeam peaks. It is crucial that the valley dose between microbeams be minimal to maintain the effectiveness of MRT. Using a monochromatic x-ray source with x-ray energies ranging from 30 to 150 keV, a detailed investigation into the effect of incident x-ray energy on the dose profiles of microbeams was performed using samarium doped fluoroaluminate (FA) glass as the medium. All dosimetric measurements were carried out using a purpose-built fluorescence confocal microscope dosimetric technique that used Sm-doped FA glass plates as the irradiated medium. Dose profiles are measured over a very a wide range of x-ray energies at micrometer resolution and dose distribution in the microbeam are mapped. The measured microbeam profiles at different energies are compared with the MCNP6 radiation transport code, a general transport code which can calculate the energy deposition of electrons as they pass through a given material. The experimentally measured distributions can be used to validate the results for electron energy deposition in fluoroaluminate glass. Code validation is necessary for using transport codes in future treatment planning for MRT and other radiation therapies. It is shown that simulated and measured micro beam-profiles are in good agreement, and micrometer level changes can be observed using this high-resolution dosimetry technique. Full width at 10% of the maximum peak (FW@10%) was used to quantify the microbeam width. Experimental measurements on FA glasses and simulations on the dependence of the FW@10% at various energies are in good agreement. Simulations on energy deposited in water indicate that FW@10% reaches a local minimum around energies 140 keV. In addition, variable slit width experiments were carried out at an incident x-ray energy of 100 keV in order to determine the effect of the narrowing slit width on the delivered peak dose. The microbeam width affects the peak dose, which decreases with the width of the microbeam. Experiments suggest that a typical microbeam width for MRT is likely to be between 20-50 µm based on this work.
Collapse
Affiliation(s)
- F Chicilo
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, Canada
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Dombrowsky AC, Burger K, Porth AK, Stein M, Dierolf M, Günther B, Achterhold K, Gleich B, Feuchtinger A, Bartzsch S, Beyreuther E, Combs SE, Pfeiffer F, Wilkens JJ, Schmid TE. A proof of principle experiment for microbeam radiation therapy at the Munich compact light source. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2020; 59:111-120. [PMID: 31655869 DOI: 10.1007/s00411-019-00816-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
Microbeam radiation therapy (MRT), a preclinical form of spatially fractionated radiotherapy, uses an array of microbeams of hard synchrotron X-ray radiation. Recently, compact synchrotron X-ray sources got more attention as they provide essential prerequisites for the translation of MRT into clinics while overcoming the limited access to synchrotron facilities. At the Munich compact light source (MuCLS), one of these novel compact X-ray facilities, a proof of principle experiment was conducted applying MRT to a xenograft tumor mouse model. First, subcutaneous tumors derived from the established squamous carcinoma cell line FaDu were irradiated at a conventional X-ray tube using broadbeam geometry to determine a suitable dose range for the tumor growth delay. For irradiations at the MuCLS, FaDu tumors were irradiated with broadbeam and microbeam irradiation at integral doses of either 3 Gy or 5 Gy and tumor growth delay was measured. Microbeams had a width of 50 µm and a center-to-center distance of 350 µm with peak doses of either 21 Gy or 35 Gy. A dose rate of up to 5 Gy/min was delivered to the tumor. Both doses and modalities delayed the tumor growth compared to a sham-irradiated tumor. The irradiated area and microbeam pattern were verified by staining of the DNA double-strand break marker γH2AX. This study demonstrates for the first time that MRT can be successfully performed in vivo at compact inverse Compton sources.
Collapse
Affiliation(s)
- Annique C Dombrowsky
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Karin Burger
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Ann-Kristin Porth
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Marlon Stein
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Martin Dierolf
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Benedikt Günther
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Bernhard Gleich
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Annette Feuchtinger
- Research Unit Analytical Pathology, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
| | - Stefan Bartzsch
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Elke Beyreuther
- Helmholtz-Zentrum Dresden-Rossendorf, 01328, Dresden, Germany
- OncoRay, National Center for Radiation Research in Oncology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01328, Dresden, Germany
| | - Stephanie E Combs
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
- German Consortium for Translational Cancer Research, Deutsches Konsortium für Translationale Krebsforschung (dktk), Technical University Munich, 81675, Munich, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiobiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
| | - Thomas E Schmid
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany.
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany.
| |
Collapse
|
27
|
A comparative dosimetry study of an alanine dosimeter with a PTW PinPoint chamber at ultra-high dose rates of synchrotron radiation. Phys Med 2020; 71:161-167. [DOI: 10.1016/j.ejmp.2020.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 01/01/2023] Open
|
28
|
Fernandez-Palomo C, Fazzari J, Trappetti V, Smyth L, Janka H, Laissue J, Djonov V. Animal Models in Microbeam Radiation Therapy: A Scoping Review. Cancers (Basel) 2020; 12:cancers12030527. [PMID: 32106397 PMCID: PMC7139755 DOI: 10.3390/cancers12030527] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Microbeam Radiation Therapy (MRT) is an innovative approach in radiation oncology where a collimator subdivides the homogeneous radiation field into an array of co-planar, high-dose beams which are tens of micrometres wide and separated by a few hundred micrometres. OBJECTIVE This scoping review was conducted to map the available evidence and provide a comprehensive overview of the similarities, differences, and outcomes of all experiments that have employed animal models in MRT. METHODS We considered articles that employed animal models for the purpose of studying the effects of MRT. We searched in seven databases for published and unpublished literature. Two independent reviewers screened citations for inclusion. Data extraction was done by three reviewers. RESULTS After screening 5688 citations and 159 full-text papers, 95 articles were included, of which 72 were experimental articles. Here we present the animal models and pre-clinical radiation parameters employed in the existing MRT literature according to their use in cancer treatment, non-neoplastic diseases, or normal tissue studies. CONCLUSIONS The study of MRT is concentrated in brain-related diseases performed mostly in rat models. An appropriate comparison between MRT and conventional radiotherapy (instead of synchrotron broad beam) is needed. Recommendations are provided for future studies involving MRT.
Collapse
Affiliation(s)
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
| | - Verdiana Trappetti
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
| | - Lloyd Smyth
- Department of Obstetrics & Gynaecology, University of Melbourne, 3057 Parkville, Australia;
| | - Heidrun Janka
- Medical Library, University Library Bern, University of Bern, 3012 Bern, Switzerland;
| | - Jean Laissue
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
- Correspondence: ; Tel.: +41-31-631-8432
| |
Collapse
|
29
|
Bartzsch S, Corde S, Crosbie JC, Day L, Donzelli M, Krisch M, Lerch M, Pellicioli P, Smyth LML, Tehei M. Technical advances in x-ray microbeam radiation therapy. Phys Med Biol 2020; 65:02TR01. [PMID: 31694009 DOI: 10.1088/1361-6560/ab5507] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In the last 25 years microbeam radiation therapy (MRT) has emerged as a promising alternative to conventional radiation therapy at large, third generation synchrotrons. In MRT, a multi-slit collimator modulates a kilovoltage x-ray beam on a micrometer scale, creating peak dose areas with unconventionally high doses of several hundred Grays separated by low dose valley regions, where the dose remains well below the tissue tolerance level. Pre-clinical evidence demonstrates that such beam geometries lead to substantially reduced damage to normal tissue at equal tumour control rates and hence drastically increase the therapeutic window. Although the mechanisms behind MRT are still to be elucidated, previous studies indicate that immune response, tumour microenvironment, and the microvasculature may play a crucial role. Beyond tumour therapy, MRT has also been suggested as a microsurgical tool in neurological disorders and as a primer for drug delivery. The physical properties of MRT demand innovative medical physics and engineering solutions for safe treatment delivery. This article reviews technical developments in MRT and discusses existing solutions for dosimetric validation, reliable treatment planning and safety. Instrumentation at synchrotron facilities, including beam production, collimators and patient positioning systems, is also discussed. Specific solutions reviewed in this article include: dosimetry techniques that can cope with high spatial resolution, low photon energies and extremely high dose rates of up to 15 000 Gy s-1, dose calculation algorithms-apart from pure Monte Carlo Simulations-to overcome the challenge of small voxel sizes and a wide dynamic dose-range, and the use of dose-enhancing nanoparticles to combat the limited penetrability of a kilovoltage energy spectrum. Finally, concepts for alternative compact microbeam sources are presented, such as inverse Compton scattering set-ups and carbon nanotube x-ray tubes, that may facilitate the transfer of MRT into a hospital-based clinical environment. Intensive research in recent years has resulted in practical solutions to most of the technical challenges in MRT. Treatment planning, dosimetry and patient safety systems at synchrotrons have matured to a point that first veterinary and clinical studies in MRT are within reach. Should these studies confirm the promising results of pre-clinical studies, the authors are confident that MRT will become an effective new radiotherapy option for certain patients.
Collapse
Affiliation(s)
- Stefan Bartzsch
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany. Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Sammer M, Teiluf K, Girst S, Greubel C, Reindl J, Ilicic K, Walsh DWM, Aichler M, Walch A, Combs SE, Wilkens JJ, Dollinger G, Schmid TE. Beam size limit for pencil minibeam radiotherapy determined from side effects in an in-vivo mouse ear model. PLoS One 2019; 14:e0221454. [PMID: 31483811 PMCID: PMC6726230 DOI: 10.1371/journal.pone.0221454] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 08/06/2019] [Indexed: 11/29/2022] Open
Abstract
Side effects caused by radiation are a limiting factor to the amount of dose that can be applied to a tumor volume. A novel method to reduce side effects in radiotherapy is the use of spatial fractionation, in which a pattern of sub-millimeter beams (minibeams) is applied to spare healthy tissue. In order to determine the skin reactions in dependence of single beam sizes, which are relevant for spatially fractionated radiotherapy approaches, single pencil beams of submillimeter to 6 millimeter size were applied in BALB/c mice ears at a Small Animal Radiation Research Platform (SARRP) with a plateau dose of 60 Gy. Radiation toxicities in the ears were observed for 25 days after irradiation. Severe radiation responses were found for beams ≥ 3 mm diameter. The larger the beam diameter the stronger the observed reactions. No ear swelling and barely reddening or desquamation were found for the smallest beam sizes (0.5 and 1 mm). The findings were confirmed by histological sections. Submillimeter beams are preferred in minibeam therapy to obtain optimized tissue sparing. The gradual increase of radiation toxicity with beam size shows that also larger beams are capable of healthy tissue sparing in spatial fractionation.
Collapse
Affiliation(s)
- Matthias Sammer
- Institut für Angewandte Physik und Messtechnik (LRT2), Universität der Bundeswehr München, Neubiberg, Germany
- * E-mail:
| | - Katharina Teiluf
- Department of Radiation Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Institut für innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany
- Deutches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Stefanie Girst
- Institut für Angewandte Physik und Messtechnik (LRT2), Universität der Bundeswehr München, Neubiberg, Germany
| | - Christoph Greubel
- Institut für Angewandte Physik und Messtechnik (LRT2), Universität der Bundeswehr München, Neubiberg, Germany
| | - Judith Reindl
- Institut für Angewandte Physik und Messtechnik (LRT2), Universität der Bundeswehr München, Neubiberg, Germany
| | - Katarina Ilicic
- Department of Radiation Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Institut für innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany
- Deutches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Dietrich W. M. Walsh
- Institut für Angewandte Physik und Messtechnik (LRT2), Universität der Bundeswehr München, Neubiberg, Germany
- Department of Radiation Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Michaela Aichler
- Research Unit Analytical Pathology, Helmholtz Zentrum München, German Research Center for Environmental Health, Oberschleißheim, Germany
| | - Axel Walch
- Research Unit Analytical Pathology, Helmholtz Zentrum München, German Research Center for Environmental Health, Oberschleißheim, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Institut für innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany
- Deutches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Jan J. Wilkens
- Department of Radiation Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Institut für innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany
| | - Günther Dollinger
- Institut für Angewandte Physik und Messtechnik (LRT2), Universität der Bundeswehr München, Neubiberg, Germany
| | - Thomas E. Schmid
- Department of Radiation Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Institut für innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany
| |
Collapse
|
31
|
Jenkins SV, Nedosekin DA, Shaulis BJ, Wang T, Jamshidi-Parsian A, Pollock ED, Chen J, Dings RP, Griffin RJ. Enhanced Photothermal Treatment Efficacy and Normal Tissue Protection via Vascular Targeted Gold Nanocages. Nanotheranostics 2019; 3:145-155. [PMID: 31008023 PMCID: PMC6470343 DOI: 10.7150/ntno.32395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/14/2019] [Indexed: 01/22/2023] Open
Abstract
A major challenge in photothermal treatment is generating sufficient heat to eradicate diseased tissue while sparing normal tissue. Au nanomaterials have shown promise as a means to achieve highly localized photothermal treatment. Toward that end, the synthetic peptide anginex was conjugated to Au nanocages. Anginex binds to galectin-1, which is highly expressed in dividing endothelial cells found primarily in the tumor vasculature. The skin surface temperature during a 10 min laser exposure of subcutaneous murine breast tumors did not exceed 43°C and no normal tissue damage was observed, yet a significant anti-tumor effect was observed when laser was applied 24 h post-injection of targeted nanocages. Untargeted particles showed little effect in immunocompetent, tumor-bearing mice under these conditions. Photoacoustic, photothermal, and ICP-MS mapping of harvested tissue showed distribution of particles near the vasculature throughout the tumor. This uptake pattern within the tumor combined with a minimal overall temperature rise were nonetheless sufficient to induce marked photothermal efficacy and evidence of tumor control. Importantly, this evidence suggests that bulk tumor temperature during treatment does not correlate with treatment outcome, which implies that targeted nanomedicine can be highly effective when closely bound/distributed in and around the tumor endothelium and extensive amounts of direct tumor cell binding may not be a prerequisite of effective photothermal approaches.
Collapse
Affiliation(s)
- Samir V. Jenkins
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR,✉ Corresponding author: Dr. Samir V. Jenkins, , Department of Radiation Oncology, University of Arkansas for Medical Sciences, 4301 W. Markham, Mail Slot #771, Little Rock, AR 72205, USA
| | - Dmitry A. Nedosekin
- Department of Otolaryngology and Phillips Classic Laser and Nanomedicine Laboratories, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Barry J. Shaulis
- Trace Element and Radiogenic Isotope Lab, University of Arkansas, Fayetteville, AR
| | - Tengjiao Wang
- Department of Chemistry and Biochemistry, University of Arkansas, Fayetteville, AR
| | - Azemat Jamshidi-Parsian
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Erik D. Pollock
- Trace Element and Radiogenic Isotope Lab, University of Arkansas, Fayetteville, AR
| | - Jingyi Chen
- Department of Chemistry and Biochemistry, University of Arkansas, Fayetteville, AR
| | - Ruud P.M. Dings
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Robert J. Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR
| |
Collapse
|
32
|
Jenkins SV, Vang KB, Gies A, Griffin RJ, Jun SR, Nookaew I, Dings RPM. Sample storage conditions induce post-collection biases in microbiome profiles. BMC Microbiol 2018; 18:227. [PMID: 30591021 PMCID: PMC6307155 DOI: 10.1186/s12866-018-1359-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/28/2018] [Indexed: 01/12/2023] Open
Abstract
Background Here we investigated the influence of different stabilization and storage strategies on the quality and composition of the fecal microbial community. Namely, same-day isolated murine DNA was compared to samples stored for 1 month in air at ambient temperature, with or without preservative buffers (i.e. EDTA and lysis buffer), different temperatures (i.e. 4 °C, − 20 °C, and − 80 °C), and hypoxic conditions. Results Only storage in lysis buffer significantly reduced DNA content, yet without integrity loss. Storage in EDTA affected alpha diversity the most, which was also reflected in cluster separation. Distinct changes were also seen in the phyla and bacterial species abundance per storage strategy. Metabolic function analysis showed 22 pathways not significantly affected by storage conditions, whereas the tyrosine metabolism pathway was significantly changed in all strategies except by EDTA. Conclusion Each long-term storage strategy introduced a unique post-collection bias, which is important to take into account when interpreting data. Electronic supplementary material The online version of this article (10.1186/s12866-018-1359-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Samir V Jenkins
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kieng B Vang
- Center for Integrative Nanotechnology Sciences, University of Arkansas, Little Rock, AR, USA
| | - Allen Gies
- Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Se-Ran Jun
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Intawat Nookaew
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ruud P M Dings
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| |
Collapse
|
33
|
Dings RPM, Miller MC, Griffin RJ, Mayo KH. Galectins as Molecular Targets for Therapeutic Intervention. Int J Mol Sci 2018; 19:ijms19030905. [PMID: 29562695 PMCID: PMC5877766 DOI: 10.3390/ijms19030905] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 02/06/2023] Open
Abstract
Galectins are a family of small, highly conserved, molecular effectors that mediate various biological processes, including chemotaxis and angiogenesis, and that function by interacting with various cell surface glycoconjugates, usually targeting β-galactoside epitopes. Because of their significant involvement in various biological functions and pathologies, galectins have become a focus of therapeutic discovery for clinical intervention against cancer, among other pathological disorders. In this review, we focus on understanding galectin structure-function relationships, their mechanisms of action on the molecular level, and targeting them for therapeutic intervention against cancer.
Collapse
Affiliation(s)
- Ruud P M Dings
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Michelle C Miller
- Department of Biochemistry, Molecular Biology & Biophysics, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Kevin H Mayo
- Department of Biochemistry, Molecular Biology & Biophysics, University of Minnesota, Minneapolis, MN 55455, USA.
| |
Collapse
|
34
|
Sammer M, Greubel C, Girst S, Dollinger G. Optimization of beam arrangements in proton minibeam radiotherapy by cell survival simulations. Med Phys 2017; 44:6096-6104. [PMID: 28880369 DOI: 10.1002/mp.12566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Proton minibeam radiotherapy using submillimeter beam dimensions allows to enhance tissue sparing in the entrance channel by spatial fractionation additionally to advantageous proton depth dose distribution. In the entrance channel, spatial fractionation leads to reduced side effects compared to conventional proton therapy. The submillimeter sized beams widen with depth due to small angle scattering and enable therefore, in contrary to x-ray microbeam radiation therapy (MRT), the homogeneous irradiation of a tumor. Proton minibeams can either be applied as planar minibeams or pencil shaped with an additional possibility to vary between a quadratic and a hexagonal arrangement for pencil minibeams. The purpose of this work is to deduce interbeam distances to achieve a homogeneous dose distribution for different tumor depths and tumor thicknesses. Furthermore, we aim for a better understanding of the sparing effect on the basis of surviving cells calculated by the linear-quadratic model. METHODS Two-dimensional dose distributions are calculated for proton minibeams of different shapes and arrangements. For a tumor in 10-15 cm depth, treatment plans are calculated with initial beam size of σ0 = 0.2 mm in a water phantom. Proton minibeam depth dose distributions are finally converted into cell survival using a linear-quadratic model. RESULTS Inter proton beam distances are maximized under the constraint of dose homogeneity in the tumor for tumor depths ranging from 4 to 15 cm and thickness ranging from 0.5 to 10 cm. Cell survival calculations for a 5 cm thick tumor covered by 10 cm healthy tissue show less cell death by up to 85%, especially in the superficial layers, while keeping the cell death in the tumor as in conventional therapy. In the entrance channel, the pencil minibeams result in higher cell survival in comparison to the planar minibeams while all proton minibeam irradiations show higher cell survival than conventional broadbeam irradiation. CONCLUSION The deduced constraints for interbeam distances simplify treatment planning for proton minibeam radiotherapy applications in future studies. The cell survival results indicate that proton minibeam radiotherapy reduces side effects but keeps tumor control as in conventional proton therapy. It makes proton minibeam, especially pencil minibeam radiotherapy a potentially attractive new approach for radiation therapy.
Collapse
|
35
|
Narayanasamy G, Zhang X, Meigooni A, Paudel N, Morrill S, Maraboyina S, Peacock L, Penagaricano J. Therapeutic benefits in grid irradiation on Tomotherapy for bulky, radiation-resistant tumors. Acta Oncol 2017; 56:1043-1047. [PMID: 28270018 DOI: 10.1080/0284186x.2017.1299219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Spatially fractionated radiation therapy (SFRT or grid therapy) has proven to be effective in management of bulky tumors. The aim of this project is to study the therapeutic ratio (TR) of helical Tomotherapy (HT)-based grid therapy using linear-quadratic cell survival model. MATERIAL AND METHODS HT-based grid (or HT-GRID) plan was generated using a patient-specific virtual grid pattern of high-dose cylindrical regions using MLCs. TR was defined as the ratio of normal tissue surviving fraction (SF) under HT-GRID irradiation to an open debulking field of an equivalent dose that result in the same tumor cell SF. TR was estimated from DVH data on ten HT-GRID patient plans with deep seated, bulky tumor. Dependence of the TR values on radiosensitivity of the tumor cells and prescription dose was analyzed. RESULTS The mean ± standard deviation (SD) of TR was 4.0 ± 0.7 (range: 3.1-5.5) for the 10 patients with single fraction maximum dose of 20 Gy to GTV assuming a tumor cell SF at 2 Gy (SF2t) value of 0·5. In addition, the mean ± SD of TR values for SF2t values of 0.3 and 0.7 were found to be 1 ± 0.1 and 18.0 ± 5.1, respectively. Reducing the prescription dose to 15 and 10 Gy lowered the respective TR values to 2.0 ± 0.2 and 1.2 ± 0.04 for a SF2t value of 0.5. CONCLUSION HT-GRID therapy demonstrates a significant therapeutic advantage over uniform dose from an open field irradiation for the same tumor cell kill. TR increases with the radioresistance of the tumor cells and with prescription dose.
Collapse
Affiliation(s)
- Ganesh Narayanasamy
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Xin Zhang
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ali Meigooni
- Comprehensive Cancer Center of Nevada, Las Vegas, NV, USA
- Department of Radiation Oncology, University of Nevada Las Vegas, NV, USA
| | - Nava Paudel
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Steven Morrill
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sanjay Maraboyina
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Loverd Peacock
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jose Penagaricano
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
36
|
Schültke E, Balosso J, Breslin T, Cavaletti G, Djonov V, Esteve F, Grotzer M, Hildebrandt G, Valdman A, Laissue J. Microbeam radiation therapy - grid therapy and beyond: a clinical perspective. Br J Radiol 2017; 90:20170073. [PMID: 28749174 PMCID: PMC5853350 DOI: 10.1259/bjr.20170073] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Microbeam irradiation is spatially fractionated radiation on a micrometer scale. Microbeam irradiation with therapeutic intent has become known as microbeam radiation therapy (MRT). The basic concept of MRT was developed in the 1980s, but it has not yet been tested in any human clinical trial, even though there is now a large number of animal studies demonstrating its marked therapeutic potential with an exceptional normal tissue sparing effect. Furthermore, MRT is conceptually similar to macroscopic grid based radiation therapy which has been used in clinical practice for decades. In this review, the potential clinical applications of MRT are analysed for both malignant and non-malignant diseases.
Collapse
Affiliation(s)
- Elisabeth Schültke
- 1 Department of Radiooncology, Rostock University Medical Center, Rostock, Germany
| | - Jacques Balosso
- 2 Departement of Radiation Oncology and Medical Physics, University Grenoble Alpes (UGA) and Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Grenoble, France
| | - Thomas Breslin
- 3 Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden.,4 Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Guido Cavaletti
- 5 Experimental Neurology Unit and Milan Center for Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Valentin Djonov
- 6 Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Francois Esteve
- 2 Departement of Radiation Oncology and Medical Physics, University Grenoble Alpes (UGA) and Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Grenoble, France
| | - Michael Grotzer
- 7 Department of Oncology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Guido Hildebrandt
- 1 Department of Radiooncology, Rostock University Medical Center, Rostock, Germany
| | - Alexander Valdman
- 8 Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Jean Laissue
- 6 Institute of Anatomy, University of Bern, Bern, Switzerland
| |
Collapse
|
37
|
Jenkins SV, Nedosekin DA, Miller EK, Zharov VP, Dings RPM, Chen J, Griffin RJ. Galectin-1-based tumour-targeting for gold nanostructure-mediated photothermal therapy. Int J Hyperthermia 2017; 34:19-29. [PMID: 28540812 DOI: 10.1080/02656736.2017.1317845] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To demonstrate delivery of Au nanocages to cells using the galectin-1 binding peptide anginex (Ax) and to demonstrate the value of this targeting for selective in vitro photothermal cell killing. MATERIALS AND METHODS Au nanocages were synthesised, coated with polydopamine (PDA), and conjugated with Ax. Tumour and endothelial cell viability was measured with and without laser irradiation. Photoacoustic (PA) mapping and PA flow cytometry were used to confirm cell targeting in vitro and in tissue slices ex vivo. RESULTS Cell viability was maintained at ≥50% at 100 pM suggesting low toxicity of the nanocage alone. Combining the targeted construct (25 pM) with low power 808 nm laser irradiation for 10-20 min (a duration previously shown to induce rapid and sustained heating of Au nanocages [AuNC] in solution), resulted in over 50% killing of endothelial and tumour cells. In contrast, the untargeted construct combined with laser irradiation resulted in negligible cell killing. We estimate approximately 6 × 104 peptides were conjugated to each nanocage, which also resulted in inhibition of cell migration. Binding of the targeted nanocage reached a plateau after three hours, and cell association was 20-fold higher than non-targeted nanocages both in vitro and ex vivo on tumour tissue slices. A threefold increase in tumour accumulation was observed in preliminary in vivo studies. CONCLUSIONS These studies demonstrate Ax's potential as an effective targeting agent for Au-based theranostics to tumour and endothelial cells, enabling photothermal killing. This platform further suggests potential for multimodal in vivo therapy via next-generation drug-loaded nanocages.
Collapse
Affiliation(s)
| | - Dmitry A Nedosekin
- b Otolaryngology and Phillips Classic Laser and Nanomedicine Laboratories , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Emily K Miller
- c Department of Chemistry and Biochemistry , University of Arkansas , Fayetteville , AR , USA
| | - Vladimir P Zharov
- b Otolaryngology and Phillips Classic Laser and Nanomedicine Laboratories , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | | | - Jingyi Chen
- c Department of Chemistry and Biochemistry , University of Arkansas , Fayetteville , AR , USA
| | | |
Collapse
|
38
|
Bouchet A, Bräuer-Krisch E, Prezado Y, El Atifi M, Rogalev L, Le Clec'h C, Laissue JA, Pelletier L, Le Duc G. Better Efficacy of Synchrotron Spatially Microfractionated Radiation Therapy Than Uniform Radiation Therapy on Glioma. Int J Radiat Oncol Biol Phys 2016; 95:1485-1494. [DOI: 10.1016/j.ijrobp.2016.03.040] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/23/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
|
39
|
Hong Z, Zenkoh J, Le B, Gerelchuluun A, Suzuki K, Moritake T, Washio M, Urakawa J, Tsuboi K. Generation of low-flux X-ray micro-planar beams and their biological effect on a murine subcutaneous tumor model. JOURNAL OF RADIATION RESEARCH 2015; 56:768-776. [PMID: 26141370 PMCID: PMC4577006 DOI: 10.1093/jrr/rrv037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/20/2015] [Accepted: 06/07/2015] [Indexed: 06/04/2023]
Abstract
We generated low-flux X-ray micro-planar beams (MPBs) using a laboratory-scale industrial X-ray generator (60 kV/20 mA) with custom-made collimators with three different peak/pitch widths (50/200 μm, 100/400 μm, 50/400 μm). To evaluate normal skin reactions, the thighs of C3H/HeN mice were exposed to 100 and 200 Gy MPBs in comparison with broad beams (20, 30, 40, 50, 60 Gy). Antitumor effects of MPBs were evaluated in C3H/HeN mice with subcutaneous tumors (SCCVII). After the tumors were irradiated with 100 and 200 Gy MPBs and 20 and 30 Gy broad beams, the tumor sizes were measured and survival analyses were performed. In addition, the tumors were excised and immunohistochemically examined to detect γ-H2AX, ki67 and CD34. It was shown that antitumor effects of 200 Gy MPBs at 50/200 μm and 100/400 μm were significantly greater than those of 20 Gy broad beams, and were comparable with 30 Gy broad beams. γ-H2AX-positive cells demonstrated clear stripe-patterns after MPB irradiation; the pattern gradually faded and intermixed over 24 h. The chronological changes in ki67 positivity did not differ between MPBs and broad beams, whereas the CD34-positive area decreased significantly more in MPBs than in broad beams. In addition, it was shown that skin injury after MPB irradiation was significantly milder when compared with broad-beam irradiation at equivalent doses for achieving the same tumor control effect. Bystander effect and tumor vessel injury may be the mechanism contributing to the efficacy of MPBs.
Collapse
Affiliation(s)
- Zhengshan Hong
- Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Junko Zenkoh
- Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Biao Le
- Ningbo M&J Biotechnologies Co. Ltd, 299 GuangHua Road, Building C6, Suite 1, High-tech Zone, Ningbo City, China
| | - Ariungerel Gerelchuluun
- Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kenshi Suzuki
- Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Takashi Moritake
- Department of Radiological Health Science, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan
| | - Masakazu Washio
- Research Institute for Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo 169-8555, Japan
| | - Junji Urakawa
- High Energy Accelerator Research Organization, 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - Koji Tsuboi
- Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| |
Collapse
|
40
|
Bräuer-Krisch E, Adam JF, Alagoz E, Bartzsch S, Crosbie J, DeWagter C, Dipuglia A, Donzelli M, Doran S, Fournier P, Kalef-Ezra J, Kock A, Lerch M, McErlean C, Oelfke U, Olko P, Petasecca M, Povoli M, Rosenfeld A, Siegbahn EA, Sporea D, Stugu B. Medical physics aspects of the synchrotron radiation therapies: Microbeam radiation therapy (MRT) and synchrotron stereotactic radiotherapy (SSRT). Phys Med 2015; 31:568-83. [PMID: 26043881 DOI: 10.1016/j.ejmp.2015.04.016] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 11/19/2022] Open
Abstract
Stereotactic Synchrotron Radiotherapy (SSRT) and Microbeam Radiation Therapy (MRT) are both novel approaches to treat brain tumor and potentially other tumors using synchrotron radiation. Although the techniques differ by their principles, SSRT and MRT share certain common aspects with the possibility of combining their advantages in the future. For MRT, the technique uses highly collimated, quasi-parallel arrays of X-ray microbeams between 50 and 600 keV. Important features of highly brilliant Synchrotron sources are a very small beam divergence and an extremely high dose rate. The minimal beam divergence allows the insertion of so called Multi Slit Collimators (MSC) to produce spatially fractionated beams of typically ∼25-75 micron-wide microplanar beams separated by wider (100-400 microns center-to-center(ctc)) spaces with a very sharp penumbra. Peak entrance doses of several hundreds of Gy are extremely well tolerated by normal tissues and at the same time provide a higher therapeutic index for various tumor models in rodents. The hypothesis of a selective radio-vulnerability of the tumor vasculature versus normal blood vessels by MRT was recently more solidified. SSRT (Synchrotron Stereotactic Radiotherapy) is based on a local drug uptake of high-Z elements in tumors followed by stereotactic irradiation with 80 keV photons to enhance the dose deposition only within the tumor. With SSRT already in its clinical trial stage at the ESRF, most medical physics problems are already solved and the implemented solutions are briefly described, while the medical physics aspects in MRT will be discussed in more detail in this paper.
Collapse
Affiliation(s)
- Elke Bräuer-Krisch
- ESRF-The European Synchrotron, 71, Avenue des Martyrs, Grenoble, France.
| | | | - Enver Alagoz
- University of Bergen Department of Physics and Technology, PB 7803 5020, Norway
| | - Stefan Bartzsch
- The Institute of Cancer Research, 15 Cotswold Rd, Sutton SM2 5NG, United Kingdom
| | - Jeff Crosbie
- RMIT University, Melbourne, VIC, 3001, Australia
| | | | - Andrew Dipuglia
- Centre for Medical Radiation Physics, University of Wollongong, Northfields Ave, NSW, Australia
| | - Mattia Donzelli
- ESRF-The European Synchrotron, 71, Avenue des Martyrs, Grenoble, France
| | - Simon Doran
- CRUK Cancer Imaging Centre, Institute of Cancer Research, 15 Cotswold Rd, Sutton Surrey, UK
| | - Pauline Fournier
- ESRF-The European Synchrotron, 71, Avenue des Martyrs, Grenoble, France; Centre for Medical Radiation Physics, University of Wollongong, Northfields Ave, NSW, Australia
| | - John Kalef-Ezra
- Medical Physics Laboratory, University of Ioannina, 451.10, Ioannina, Greece
| | - Angela Kock
- Sintef Minalab, Gaustadalléen 23C, 0373, Oslo, Norway
| | - Michael Lerch
- Centre for Medical Radiation Physics, University of Wollongong, Northfields Ave, NSW, Australia
| | - Ciara McErlean
- CRUK Cancer Imaging Centre, Institute of Cancer Research, 15 Cotswold Rd, Sutton Surrey, UK
| | - Uwe Oelfke
- The Institute of Cancer Research, 15 Cotswold Rd, Sutton SM2 5NG, United Kingdom
| | - Pawel Olko
- Institute of Nuclear Physics PAN, Radzikowskiego 152, 31-342, Krawkow, Poland
| | - Marco Petasecca
- Centre for Medical Radiation Physics, University of Wollongong, Northfields Ave, NSW, Australia
| | - Marco Povoli
- University of Oslo, Department of Physics, 0316, Oslo, Norway
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Northfields Ave, NSW, Australia
| | - Erik A Siegbahn
- Department of Oncolgy-Pathology, Karolinska Institutet, S-177176, Stockholm, Sweden
| | - Dan Sporea
- National Institute for Laser, Plasma and Radiation Physics, Magurele, RO-077125, Romania
| | - Bjarne Stugu
- University of Bergen, Department of Physics and Technology, PB 7803, 5020, Bergen, Norway
| |
Collapse
|
41
|
Bouchet A, Serduc R, Laissue JA, Djonov V. Effects of microbeam radiation therapy on normal and tumoral blood vessels. Phys Med 2015; 31:634-41. [DOI: 10.1016/j.ejmp.2015.04.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/22/2015] [Accepted: 04/25/2015] [Indexed: 10/23/2022] Open
|
42
|
Koonce NA, Levy J, Hardee ME, Jamshidi-Parsian A, Vang KB, Sharma S, Raleigh JA, Dings RPM, Griffin RJ. Targeting Artificial Tumor Stromal Targets for Molecular Imaging of Tumor Vascular Hypoxia. PLoS One 2015; 10:e0135607. [PMID: 26308944 PMCID: PMC4550408 DOI: 10.1371/journal.pone.0135607] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 07/23/2015] [Indexed: 11/28/2022] Open
Abstract
Developed and tested for many years, a variety of tumor hypoxia detection methods have been inconsistent in their ability to predict treatment outcomes or monitor treatment efficacy, limiting their present prognostic capability. These variable results might stem from the fact that these approaches are based on inherently wide-ranging global tumor oxygenation levels based on uncertain influences of necrotic regions present in most solid tumors. Here, we have developed a novel non-invasive and specific method for tumor vessel hypoxia detection, as hypoxemia (vascular hypoxia) has been implicated as a key driver of malignant progression, therapy resistance and metastasis. This method is based on high-frequency ultrasound imaging of α-pimonidazole targeted-microbubbles to the exogenously administered hypoxia marker pimonidazole. The degree of tumor vessel hypoxia was assessed in three mouse models of mammary gland carcinoma (4T1, SCK and MMTV-Wnt-1) and amassed up to 20% of the tumor vasculature. In the 4T1 mammary gland carcinoma model, the signal strength of α-pimonidazole targeted-microbubbles was on average 8-fold fold higher in tumors of pimonidazole-injected mice than in non-pimonidazole injected tumor bearing mice or non-targeted microbubbles in pimonidazole-injected tumor bearing mice. Overall, this provides proof of principle for generating and targeting artificial antigens able to be ‘created’ on-demand under tumor specific microenvironmental conditions, providing translational diagnostic, therapeutic and treatment planning potential in cancer and other hypoxia-associated diseases or conditions.
Collapse
Affiliation(s)
- Nathan A. Koonce
- Department of Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Joseph Levy
- Department of Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Matthew E. Hardee
- Department of Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Azemat Jamshidi-Parsian
- Department of Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Kieng B. Vang
- Center for Integrative Nanotechnology Sciences, University of Arkansas at Little Rock, Arkansas, United States of America
| | - Sunil Sharma
- Department of Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - James A. Raleigh
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Ruud P. M. Dings
- Department of Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Robert J. Griffin
- Department of Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- * E-mail:
| |
Collapse
|
43
|
Girst S, Marx C, Bräuer-Krisch E, Bravin A, Bartzsch S, Oelfke U, Greubel C, Reindl J, Siebenwirth C, Zlobinskaya O, Multhoff G, Dollinger G, Schmid TE, Wilkens JJ. Improved normal tissue protection by proton and X-ray microchannels compared to homogeneous field irradiation. Phys Med 2015; 31:615-20. [PMID: 25936621 DOI: 10.1016/j.ejmp.2015.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/02/2015] [Accepted: 04/10/2015] [Indexed: 11/30/2022] Open
Abstract
The risk of developing normal tissue injuries often limits the radiation dose that can be applied to the tumour in radiation therapy. Microbeam Radiation Therapy (MRT), a spatially fractionated photon radiotherapy is currently tested at the European Synchrotron Radiation Facility (ESRF) to improve normal tissue protection. MRT utilizes an array of microscopically thin and nearly parallel X-ray beams that are generated by a synchrotron. At the ion microprobe SNAKE in Munich focused proton microbeams ("proton microchannels") are studied to improve normal tissue protection. Here, we comparatively investigate microbeam/microchannel irradiations with sub-millimetre X-ray versus proton beams to minimize the risk of normal tissue damage in a human skin model, in vitro. Skin tissues were irradiated with a mean dose of 2 Gy over the irradiated area either with parallel synchrotron-generated X-ray beams at the ESRF or with 20 MeV protons at SNAKE using four different irradiation modes: homogeneous field, parallel lines and microchannel applications using two different channel sizes. Normal tissue viability as determined in an MTT test was significantly higher after proton or X-ray microchannel irradiation compared to a homogeneous field irradiation. In line with these findings genetic damage, as determined by the measurement of micronuclei in keratinocytes, was significantly reduced after proton or X-ray microchannel compared to a homogeneous field irradiation. Our data show that skin irradiation using either X-ray or proton microchannels maintain a higher cell viability and DNA integrity compared to a homogeneous irradiation, and thus might improve normal tissue protection after radiation therapy.
Collapse
Affiliation(s)
- S Girst
- Universität der Bundeswehr München, Neubiberg, Germany
| | - C Marx
- Department of Radiation Oncology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - E Bräuer-Krisch
- European Synchrotron Radiation Facility, Grenoble Cedex, France
| | - A Bravin
- European Synchrotron Radiation Facility, Grenoble Cedex, France
| | - S Bartzsch
- German Cancer Research Centre (DKFZ), Heidelberg, Germany; The Institute of Cancer Research, Sutton, United Kingdom
| | - U Oelfke
- German Cancer Research Centre (DKFZ), Heidelberg, Germany; The Institute of Cancer Research, Sutton, United Kingdom
| | - C Greubel
- Universität der Bundeswehr München, Neubiberg, Germany
| | - J Reindl
- Universität der Bundeswehr München, Neubiberg, Germany
| | - C Siebenwirth
- Universität der Bundeswehr München, Neubiberg, Germany; Department of Radiation Oncology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - O Zlobinskaya
- Universität der Bundeswehr München, Neubiberg, Germany
| | - G Multhoff
- Department of Radiation Oncology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - G Dollinger
- Universität der Bundeswehr München, Neubiberg, Germany
| | - T E Schmid
- Department of Radiation Oncology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - J J Wilkens
- Department of Radiation Oncology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
| |
Collapse
|
44
|
Grotzer MA, Schültke E, Bräuer-Krisch E, Laissue JA. Microbeam radiation therapy: Clinical perspectives. Phys Med 2015; 31:564-7. [PMID: 25773883 DOI: 10.1016/j.ejmp.2015.02.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 11/19/2022] Open
Abstract
Microbeam radiation therapy (MRT), a novel form of spatially fractionated radiotherapy (RT), uses arrays of synchrotron-generated X-ray microbeams (MB). MRT has been identified as a promising treatment concept that might be applied to patients with malignant central nervous system (CNS) tumours for whom, at the current stage of development, no satisfactory therapy is available yet. Preclinical experimental studies have shown that the CNS of healthy rodents and piglets can tolerate much higher radiation doses delivered by spatially separated MBs than those delivered by a single, uninterrupted, macroscopically wide beam. High-dose, high-precision radiotherapies such as MRT with reduced probabilities of normal tissue complications offer prospects of improved therapeutic ratios, as extensively demonstrated by results of experiments published by many international groups in the last two decades. The significance of developing MRT as a new RT approach cannot be understated. Up to 50% of cancer patients receive conventional RT, and any new treatment that provides better tumour control whilst preserving healthy tissue is likely to significantly improve patient outcomes.
Collapse
Affiliation(s)
- M A Grotzer
- University Children's Hospital of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
| | - E Schültke
- Rostock University Medical Center, Department of Radiotherapy, Südring 75, 18059 Rostock, Germany
| | - E Bräuer-Krisch
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, F-38043 Grenoble Cedex 9, France
| | | |
Collapse
|
45
|
Yang Y, Crosbie JC, Paiva P, Ibahim M, Stevenson A, Rogers PAW. In vitro study of genes and molecular pathways differentially regulated by synchrotron microbeam radiotherapy. Radiat Res 2015; 182:626-39. [PMID: 25409126 DOI: 10.1667/rr13778.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The aim of this study was to identify genes and molecular pathways differentially regulated by synchrotron-generated microbeam radiotherapy (MRT) versus conventional broadbeam radiotherapy (CRT) in vitro using cultured EMT6.5 cells. We hypothesized (based on previous findings) that gene expression and molecular pathway changes after MRT are different from those seen after CRT. We found that at 24 h postirradiation, MRT exerts a broader regulatory effect on multiple pathways than CRT. MRT regulated those pathways involved in gene transcription, translation initiation, macromolecule metabolism, oxidoreductase activity and signaling transduction in a different manner compared to CRT. We also found that MRT/CRT alone, or when combined with inflammatory factor lipopolysaccharide, upregulated expression of Ccl2, Ccl5 or Csf2, which are involved in host immune cell recruitment. Our findings demonstrated differences in the molecular pathway for MRT versus CRT in the cultured tumor cells, and were consistent with the idea that radiation plays a role in recruiting tumor-associated immune cells to the tumor. Our results also suggest that a combination of MRT/CRT with a treatment targeting CCL2 or CSF2 could repress the tumor-associated immune cell recruitment, delay tumor growth and/or metastasis and yield better tumor control than radiation alone.
Collapse
Affiliation(s)
- Yuqing Yang
- a Department of Obstetrics and Gynaecology, The University of Melbourne, Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | | | | | | | | | | |
Collapse
|
46
|
Fontanella AN, Boss MK, Hadsell M, Zhang J, Schroeder T, Berman KG, Dewhirst MW, Chang S, Palmer GM. Effects of high-dose microbeam irradiation on tumor microvascular function and angiogenesis. Radiat Res 2015; 183:147-58. [PMID: 25574586 DOI: 10.1667/rr13712.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Microbeam radiation therapy (MRT) is a form of cancer treatment in which a single large dose of radiation is spatially fractionated in-line or grid-like patterns. Preclinical studies have demonstrated that MRT is capable of eliciting high levels of tumor response while sparing normal tissue that is exposed to the same radiation field. Since a large fraction of the MRT-treated tumor is in the dose valley region that is not directly irradiated, tumor response may be driven by radiation bystander effects, which in turn elicit a microvascular response. Differential alterations in hemodynamics between the tumor and normal tissue may explain the therapeutic advantages of MRT. Direct observation of these dynamic responses presents a challenge for conventional ex vivo analysis. Furthermore, knowledge gleaned from in vitro studies of radiation bystander response has not been widely incorporated into in vivo models of tumor radiotherapy, and the biological contribution of the bystander effect within the tumor microenvironment is unknown. In this study, we employed noninvasive, serial observations of the tumor microenvironment to address the question of how tumor vasculature and HIF-1 expression are affected by microbeam radiotherapy. Tumors (approximately 4 mm in diameter) grown in a dorsal window chamber were irradiated in a single fraction using either a single, microplanar beam (300 micron wide swath) or a wide-field setup (whole-window chamber) to a total dose of 50 Gy. The tumors were optically observed daily for seven days postirradiation. Microvascular changes in the tumor and surrounding normal tissue differed greatly between the wide-field and microbeam treatments. We present evidence that these changes may be due to dissimilar spatial and temporal patterns of HIF-1 expression induced through radiation bystander effects.
Collapse
Affiliation(s)
- Andrew N Fontanella
- a Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Kuo P, Bratman SV, Shultz DB, von Eyben R, Chan C, Wang Z, Say C, Gupta A, Loo BW, Giaccia AJ, Koong AC, Diehn M, Le QT. Galectin-1 mediates radiation-related lymphopenia and attenuates NSCLC radiation response. Clin Cancer Res 2014; 20:5558-69. [PMID: 25189484 DOI: 10.1158/1078-0432.ccr-14-1138] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Radiotherapy can result in lymphopenia, which has been linked to poorer survival. Here, we test the hypothesis that radiotherapy-induced lymphopenia is mediated by a tumor-secreted factor, Galectin-1 (Gal-1), which possesses T-cell proapoptotic activities. EXPERIMENTAL DESIGN Matched Gal-1 wild-type (WT) or null mice were implanted with Lewis lung carcinoma (LLC-1) that either expressed Gal-1 or had Gal-1 stably downregulated. Tumors were irradiated locally and circulating Gal-1 and T cells were measured. Tumor growth, lung metastasis, intratumoral T-cell apoptosis, and microvessel density count were quantified. Thiodigalactoside (TDG), a Gal-1 inhibitor, was used to inhibit Gal-1 function in another group of mice to validate the observations noted with Gal-1 downregulation. Lymphocyte counts, survival, and plasma Gal-1 were analyzed in cohorts of radiotherapy-treated lung [non-small cell lung cancer (NSCLC)] and head and neck cancer patients. RESULTS LLC irradiation increased Gal-1 secretion and decreased circulating T cells in mice, regardless of host Gal-1 expression. Inhibition of tumor Gal-1 with either shRNA or thiodigalactoside ablated radiotherapy-induced lymphopenia. Irradiated shGal-1 tumors showed significantly less intratumoral CD8(+) T-cell apoptosis and microvessel density, which led to marked tumor growth delay and reduced lung metastasis compared with controls. Similar observations were made after thiodigalactoside treatment. Radiotherapy-induced lymphopenia was associated with poorer overall survival in patients with NSCLC treated with hypofractionated radiotherapy. Plasma Gal-1 increased whereas T-cell decreased after radiation in another group of patients. CONCLUSIONS Radiotherapy-related systemic lymphopenia appeared to be mediated by radiotherapy-induced tumor Gal-1 secretion that could lead to tumor progression through intratumoral immune suppression and enhanced angiogenesis.
Collapse
Affiliation(s)
- Peiwen Kuo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Scott V Bratman
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - David B Shultz
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Cato Chan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Ziwei Wang
- University of California, San Diego School of Medicine, La Jolla, California
| | - Carmen Say
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Aparna Gupta
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Bill W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Amato J Giaccia
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Albert C Koong
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
48
|
Abstract
Radiation therapy is a main stay in treating solid tumors and plays a significant role in definitive and adjuvant therapy. Unfortunately, local control remains a challenge, in which the success of radiotherapy is largely dictated by tumor hypoxia, DNA damage repair and the antitumor immune response. Extensive efforts have therefore been devoted to targeting the factors that attenuate tumor radiosensitivity, although with limited success. Mounting evidence suggests that tumor and endothelial cells may utilize galectin-1 (Gal-1) for protection against radiation through several mechanisms. Targeting Gal-1 in combination with radiotherapy provides an exciting approach to address several radiation-prohibitive mechanisms.
Collapse
Affiliation(s)
- Peiwen Kuo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
49
|
Kim SR, Kim EH. Effect of acidic environment on the response of endothelial cells to irradiation: implications for microbeam radiation therapy. Int J Radiat Biol 2014; 90:325-33. [PMID: 24467329 DOI: 10.3109/09553002.2014.887867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Microbeam radiation therapy (MRT) is a novel experimental radiotherapy regimen, which delivers high doses of synchrotron-generated X-rays in the form of quasi-parallel arrays of microbeam separated by microplanar spaces. The repair or healing of irradiated regions (Peak) via migration of endothelial cells (EC) from unirradiated regions (Valley) plays an important role in the response of tumors and normal tissues to MRT. It is known that intratumor microenvironment is acidic. We investigated the influence of environmental acidity on the response of EC to ionizing radiation. MATERIALS AND METHODS Effects of irradiation on the viability, clonogenicity and migration rate of endothelial cells were studied using human umbilical vascular endothelial cells and mouse endothelial cells in pH 7.3 and 6.4 environments. RESULTS An exposure to acidic environment (pH 6.4) for 2-4 days exerted little effect on the viability of EC. On the other hand, acidic environment significantly retarded the migration of control and irradiated EC. The migration of EC into 2000 μm-wide wound was slower than that into 1000 μm-side wounds. CONCLUSION The microenvironmental acidity and the size of beam opening in MRT may greatly affect the repair of irradiated peak regions via migration of EC from unirradiated valley regions.
Collapse
Affiliation(s)
- So-Ra Kim
- Radiation Bioengineering Laboratory, Department of Nuclear Engineering, Seoul National University , Seoul , Republic of Korea
| | | |
Collapse
|
50
|
Asur R, Butterworth KT, Penagaricano JA, Prise KM, Griffin RJ. High dose bystander effects in spatially fractionated radiation therapy. Cancer Lett 2013; 356:52-7. [PMID: 24246848 DOI: 10.1016/j.canlet.2013.10.032] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/24/2013] [Accepted: 10/28/2013] [Indexed: 12/25/2022]
Abstract
Traditional radiotherapy of bulky tumors has certain limitations. Spatially fractionated radiation therapy (GRID) and intensity modulated radiotherapy (IMRT) are examples of advanced modulated beam therapies that help in significant reductions in normal tissue damage. GRID refers to the delivery of a single high dose of radiation to a large treatment area that is divided into several smaller fields, while IMRT allows improved dose conformity to the tumor target compared to conventional three-dimensional conformal radiotherapy. In this review, we consider spatially fractionated radiotherapy approaches focusing on GRID and IMRT, and present complementary evidence from different studies which support the role of radiation induced signaling effects in the overall radiobiological rationale for these treatments.
Collapse
Affiliation(s)
- Rajalakshmi Asur
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Karl T Butterworth
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Jose A Penagaricano
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Kevin M Prise
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States.
| |
Collapse
|