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Nicholson J, O'Neill BD, Thirion P, Cunningham M, McVey G, Coffey J, Mihai AM, Kelly PJ, Elbeltagi N, Dunne M, Noone E, Parker I, Shannon AM, McCague M, Alvarez-Iglesias A, Kelly H, O'Donovan R, Hajdaraj D, Lawler G, Armstrong JG. A Prospective Phase II Dose Escalation Study Using IMRT for High Risk N0M0 Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e422. [PMID: 37785387 DOI: 10.1016/j.ijrobp.2023.06.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Published data supports the use of very high dose intensity modulated radiotherapy (IMRT) in achieving high efficacy and low toxicity for high-risk prostate cancer (HRPCa). This phase II multi-institutional non-randomized prospective dose escalation study using intensity modulated radiotherapy (IMRT) for high risk N0M0 prostate cancer was designed to investigate dose escalation using 1.8 Gy increments from baseline 75.6 Gy up to maximum 81 Gy, once dose volume constraints were adhered to. MATERIALS/METHODS Inclusion criteria were patients undergoing a radical course of RT for high and very high-risk disease, defined as one or more of the criteria ≥ T3*, ≥ Gleason 8, Prostate specific antigen (PSA) > 20ng/ml. All patients received Androgen Deprivation Therapy (ADT) and none had radiological evidence of distant metastatic disease. The primary objective was to determine if dose escalated IMRT for high risk localized prostate cancer could provide freedom from biochemical relapse (BR; PSA rising > nadir +2ng/mL or initiation of salvage hormone therapy) similar to that reported in the literature. The Kaplan-Meier method was used to estimate survival times. Secondary objectives included OS, Disease Free Survival (DFS), and the incidence and severity of Genito-urinary (GU), Gastro-intestinal (GI) and erectile dysfunction (ED) toxicities (CTCAE v.3). Toxicities and performance status were collected and graded weekly during RT, 2 months after completing RT, 8 months' post RT, and 6 monthly thereafter to year five and annually thereafter to year nine. RESULTS A total of 230 evaluable patients were enrolled between April 2009 and June 2016. The median follow-up was 7.3 years. The cumulative proportion of patients surviving without BR at 5 years was 91% (95% Confidence Interval (CI): 86% to 94%). Overall survival at 5 and 7 years was 92% (88% to 95%) and 89% (83% to 92%) respectively, while the cumulative proportion of patients free from disease was 89% (84% to 93%) at 5 years and 81% (75% to 86%) at 7 years. The incidence of acute G2 and G3 toxicities were; GU; 57.8% G2, 12.6% G3, GI; 15.2% G2, 0.4% G3, ED; 30.0% G2 and 61.7% G3. The incidence of late G2, G3 and G4 toxicities were; GU; 40.9% G2, 8.7% G3, GI; 36.5% G2, 2.2% G3, 0.4% G4, ED; 11.7% G2 and 86.1% G3. The percentage of patients receiving each dose level was; 3.5% received 75.6Gy in 42 fractions, 2.2% received 77.4Gy in 43 fractions, 93% received 81Gy in 45 fractions. CONCLUSION The findings indicate that high-dose IMRT is well tolerated and is associated with excellent long-term tumor-control outcomes in patients with localized high and very high-risk prostate cancer, with 91% of patients surviving at 5 years without biochemical relapse. The rates of long term G3 GU and GI toxicity were low at 8.7% and 0.4% respectively.
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Affiliation(s)
- J Nicholson
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - B D O'Neill
- St.Luke's Radiation Oncology Network, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland
| | - P Thirion
- Beacon Hospital, Dublin, Ireland; St Luke's Radiation Oncology Network, Dublin, Ireland
| | - M Cunningham
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - G McVey
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - J Coffey
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | | | - P J Kelly
- Cork University Hospital, Cork, Ireland
| | - N Elbeltagi
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - M Dunne
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - E Noone
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - I Parker
- Cancer Trials Ireland, Dublin, Ireland
| | | | - M McCague
- HRB Clinical Research Facility, NUI Galway, Galway, Ireland
| | | | - H Kelly
- HRB Clinical Research Facility, NUI Galway, Galway, Ireland
| | - R O'Donovan
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - D Hajdaraj
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - G Lawler
- Beacon Hospital, Dublin, Ireland
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Nugent K, Browne D, Dunne M, Osullivan L, Shannon AM, Sharma D, Bradshaw S, McArdle O, Salib O, Lavan N, Gillham C. Acute Gastrointestinal and Genitourinary Toxicity Results from a Prospective Randomized Phase II Trial Evaluating Adjuvant Pelvic Radiotherapy Using Either IMRT or 3-Dimensional Planning for Endometrial Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e702. [PMID: 37786059 DOI: 10.1016/j.ijrobp.2023.06.2189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To compare the incidence of grade ≥2 gastrointestinal (GI) or genitourinary (GU) toxicity for patients undergoing 3DRT versus IMRT in the post-operative setting for endometrial cancer. MATERIALS/METHODS Patients were post-operatively enrolled in a prospective randomized phase II trial from 2010 to 2020. Those eligible were adults aged ≥18 scheduled to receive adjuvant pelvic radiotherapy (RT) for histologically confirmed endometrial carcinoma with the following AJCC 2009 grade/stage: Grade 2: stage IB (LVSI +/or >60 yrs); Grade 3: stage IA and IB; or Grade 1-3: Stage II and IIIA, IIIB and IIIC1; who had an ECOG-PS 0-2, and who had surgery consisting of total hysterectomy, +/- bilateral salpingo-oophorectomy, +/- lymph node sampling. Exclusion criteria included previous irradiation to the pelvic region, patients in whom concurrent chemotherapy was planned, a history of inflammatory bowel disease, and previous bowel surgery. Patients were randomly assigned to one of two parallel groups in 1:1 ratio, to have their RT delivered using either a 3DRT technique or using IMRT. Prescription dose was 45 Gy in 25 fractions over 5 weeks followed by 11 Gy in 2 fractions vaginal vault brachytherapy. Toxicity was graded according to CTCAE ver. 3.0. Acute toxicity was assessed weekly during RT. Fisher's exact tests were used to test for associations between toxicity and arm. Differences in dosimetric parameters for patients with or without toxicity were tested using Mann-Whitney U-tests. RESULTS Ninety-two patients with a median age of 63 were enrolled, with 8 patients not evaluable for primary outcome. The median follow-up was 52 months. 14 (35%) participants from the 3DRT arm and 15 (34%) from the IMRT arm experienced acute grade ≥2 GI toxicity. 20 (50%) participants from the 3DRT arm and 25 (57%) from the IMRT arm experienced acute grade ≥2 GI or GU toxicity (p = .662). Grade 3 GI toxicity was 5 (12%) and 4 (9%) for 3DRT and IMRT, respectively. 12 (30%) patients from the 3DRT arm and 17 (39%) from the IMRT arm experienced acute grade ≥2 GU toxicity (p = .493). Rates for grade 3 GU toxicity were 4 (10%) and 4 (9%) for 3DRT and IMRT, respectively. Those with acute grade ≥2 GU toxicity had a median PTV D99% of 43.2 Gy (35.5-44.6) compared with a median of 43.4 Gy (41.5-44.6; p = 0.042) for those who did not have a grade ≥2 GU toxicity. CONCLUSION No statistically significant differences in the incidence of acute GI or GU toxicity were found between patients treated with adjuvant IMRT versus 3DRT radiotherapy for endometrial cancer. Although IMRT can reduce dose to normal tissue, in this study no benefit in acute toxicity outcome was seen.
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Affiliation(s)
- K Nugent
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - D Browne
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - M Dunne
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | | | | | - D Sharma
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - S Bradshaw
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - O McArdle
- St.Luke's Radiation Oncology Network, Dublin, Ireland; Faculty of Radiologists and Radiation Oncologists, RCSI, Dublin, Ireland
| | - O Salib
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | - N Lavan
- St. Luke's Hospital, Dublin 6, Ireland
| | - C Gillham
- St Luke's Radiation Oncology Network, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland
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Nugent K, Browne D, Dunne M, O Sullivan L, Shannon AM, Sharma D, Bradshaw S, McArdle O, Salib O, Lavan N, Gillham C. Prospective randomised phase II trial evaluating adjuvant pelvic radiotherapy using either IMRT or 3-Dimensional planning for endometrial cancer. Acta Oncol 2023; 62:907-914. [PMID: 37493622 DOI: 10.1080/0284186x.2023.2238555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/04/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To compare the incidence of grade ≥2 gastrointestinal (GI) or genitourinary (GU) toxicity for patients undergoing 3DRT versus IMRT in the postoperative setting for endometrial cancer. METHODS Eligible patients were post-operatively randomly assigned to one of two parallel groups in a 1:1 ratio, to have their RT delivered using either a 3DRT technique or using IMRT. The prescription dose was 45 Gy in 25 fractions over 5 weeks followed by vaginal vault brachytherapy. Toxicity was graded according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version (v) 3.0. Fisher's exact tests were used to test for associations between toxicity and arm. Differences in dosimetric parameters for patients with or without toxicity were tested using Mann-Whitney U-tests. RESULTS 84 patients with a median age of 62 were evaluable for primary outcome. The median follow-up was 52 months. 14 (35%) participants from the 3DRT arm and 15 (34%) from the IMRT arm experienced acute grade ≥2 GI toxicity with older patients having a statistically higher risk of grade ≥2 acute GI toxicity. 20 (50%) participants from the 3DRT arm and 25 (57%) from the IMRT arm experienced acute grade ≥2 GI or GU toxicity (p = .662). 12 (30%) patients from the 3DRT arm and 17 (39%) from the IMRT arm experienced acute grade ≥2 GU toxicity (p = .493). CONCLUSION Although IMRT can reduce dose to normal tissue, in this study no benefit in acute GI or GU toxicity outcome was seen.
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Affiliation(s)
- Killian Nugent
- St Luke's Radiation Oncology Network, Dublin, Ireland
- Cancer Trials Ireland, Dublin, Ireland
| | | | - Mary Dunne
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | | | | | - Deepti Sharma
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | | | - Orla McArdle
- St Luke's Radiation Oncology Network, Dublin, Ireland
- Faculty of Radiologists and Radiation Oncologists, RCSI, Dublin, Ireland
| | - Osama Salib
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Naomi Lavan
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Charles Gillham
- St Luke's Radiation Oncology Network, Dublin, Ireland
- Cancer Trials Ireland, Dublin, Ireland
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Wallace ND, Dunne MT, McArdle O, Small C, Parker I, Shannon AM, Clayton-Lea A, Parker M, Collins CD, Armstrong JG, Gillham C, Coffey J, Fitzpatrick D, Salib O, Moriarty M, Stevenson MR, Alvarez-Iglesias A, McCague M, Thirion PG. Efficacy and toxicity of primary re-irradiation for malignant spinal cord compression based on radiobiological modelling: a phase II clinical trial. Br J Cancer 2023; 128:576-585. [PMID: 36482188 PMCID: PMC9938159 DOI: 10.1038/s41416-022-02078-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The efficacy and safety of primary re-irradiation for MSCC are not known. Our aim was to establish the efficacy and safety of biologically effective dose-based re-irradiation. METHODS Patients presenting with MSCC at a previously irradiated spine segment, and not proceeding with surgical decompression, were eligible. A 3 Gray per fraction experimental schedule (minimum 18 Gy/6 fractions, maximum 30 Gy/10 fractions) was used, delivering a maximum cumulative spinal dose of 100 Gy2 if the interval since the last radiotherapy was within 6 months, or 130 Gy2 if longer. The primary outcome was a change in mobility from week 1 to week 5 post-treatment, as assessed by the Tomita score. The RTOG SOMA score was used to screen for spinal toxicity, and an MRI performed to assess for radiation-induced myelopathy (RIM). RESULTS Twenty-two patients were enroled, of whom eleven were evaluable for the primary outcome. Nine of eleven (81.8%) had stable or improved Tomita scores at 5 weeks. One of eight (12.5%) evaluable for late toxicity developed RIM. CONCLUSIONS Re-irradiation is an efficacious treatment for MSCC. There is a risk of RIM with a cumulative dose of 120 Gy2. CLINICAL TRIAL REGISTRATION Cancer Trials Ireland (ICORG 07-11); NCT00974168.
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Affiliation(s)
| | - Mary T Dunne
- St Luke's Radiation Oncology Network, Dublin, Ireland.
| | - Orla McArdle
- St Luke's Radiation Oncology Network, Dublin, Ireland
- Cancer Trials Ireland (formerly All-Ireland Cooperative Oncology Research Group (ICORG)), Dublin, Ireland
| | | | - Imelda Parker
- Cancer Trials Ireland (formerly All-Ireland Cooperative Oncology Research Group (ICORG)), Dublin, Ireland
| | - Aoife M Shannon
- Cancer Trials Ireland (formerly All-Ireland Cooperative Oncology Research Group (ICORG)), Dublin, Ireland
| | | | - Michael Parker
- Statistics and Data Management Office for Cancer Trials Ireland (formerly ICORG), Clinical Research Support Centre, Belfast, Ireland
| | | | | | | | - Jerome Coffey
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | | | - Osama Salib
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | | | - Michael R Stevenson
- Statistics and Data Management Office for Cancer Trials Ireland (formerly ICORG), Clinical Research Support Centre, Belfast, Ireland
| | | | | | - Pierre G Thirion
- St Luke's Radiation Oncology Network, Dublin, Ireland
- Cancer Trials Ireland (formerly All-Ireland Cooperative Oncology Research Group (ICORG)), Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
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O'Reilly S, Murphy V, Mulroe E, Tucker L, Carragher F, Marron J, Shannon AM, Rogan K, Connolly RM, Hennessy BT, McDermott RS. The SARS-CoV-2 Pandemic and Cancer Trials Ireland: Impact, Resolution and Legacy. Cancers (Basel) 2022; 14:2247. [PMID: 35565375 PMCID: PMC9101172 DOI: 10.3390/cancers14092247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cancer Trials Ireland (CTI) is the national cooperative group in Ireland. The SARS-CoV-2 pandemic led to significant ongoing disruptive change in healthcare from March 2020 to the present day. Its impact and legacy on a national clinical trials organisation was assessed. METHODS A review was conducted of prospectively acquired communications, team logs and time sheets, trial activation, closure and accrual, for the period 2019 to September 2021. An online survey of the impact of the pandemic on clinical investigators and of clinical trials units was performed. A National Cancer Retreat was organised on 21 May 2021 to identify and address pandemic related disruption and develop adaptive strategies. RESULTS In the weeks after the pandemic was declared, remote working was initiated by all central office staff. Nationally, clinical trial accrual fell by 54% compared to the same period in 2019, radiotherapy trial accrual by 90%, and translational studies by 36%. Staff reassignment of research nurse staff occurred in 60% of units, trial monitoring was reduced in 42%, and trial initiations fell by 67%. Extreme fluctuations in monitoring hours were noted paralleling lockdown measures. Significant impact on all clinical trials units was noted including staff reassignments, reduced access to diagnostic imaging and reduced institutional supports. Remote clinic visits and remote monitoring was widely adopted. The National Cancer Retreat identified flexibility in trial conduct, staff recruitment and retention, the need for harmonisation of processes, and research staff support in the context of remote working as priorities. CONCLUSION The pandemic has had a significant ongoing negative impact on cancer clinical trial activity in Ireland. Adaptive strategies including trial flexibility, expanded telehealth and remote monitoring, harmonisation of processes and staff support have been identified as priorities to ameliorate this impact, and develop a more sustainable clinical trial ecosystem.
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Affiliation(s)
- Seamus O'Reilly
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
- Department of Medical Oncology, Cork University Hospital and Cancer Research @ UCC University College Cork, T12 DCA4 Cork, Ireland
| | | | | | - Lisa Tucker
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
| | | | | | | | - Ken Rogan
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
| | - Roisin M Connolly
- Department of Medical Oncology, Cork University Hospital and Cancer Research @ UCC University College Cork, T12 DCA4 Cork, Ireland
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Medipally DKR, Cullen D, Untereiner V, Sockalingum GD, Maguire A, Nguyen TNQ, Bryant J, Noone E, Bradshaw S, Finn M, Dunne M, Shannon AM, Armstrong J, Meade AD, Lyng FM. Vibrational spectroscopy of liquid biopsies for prostate cancer diagnosis. Ther Adv Med Oncol 2020; 12:1758835920918499. [PMID: 32821294 PMCID: PMC7412923 DOI: 10.1177/1758835920918499] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/18/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Screening for prostate cancer with prostate specific antigen and digital rectal examination allows early diagnosis of prostate malignancy but has been associated with poor sensitivity and specificity. There is also a considerable risk of over-diagnosis and over-treatment, which highlights the need for better tools for diagnosis of prostate cancer. This study investigates the potential of high throughput Raman and Fourier Transform Infrared (FTIR) spectroscopy of liquid biopsies for rapid and accurate diagnosis of prostate cancer. Methods: Blood samples (plasma and lymphocytes) were obtained from healthy control subjects and prostate cancer patients. FTIR and Raman spectra were recorded from plasma samples, while Raman spectra were recorded from the lymphocytes. The acquired spectral data was analysed with various multivariate statistical methods, principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA) and classical least squares (CLS) fitting analysis. Results: Discrimination was observed between the infrared and Raman spectra of plasma and lymphocytes from healthy donors and prostate cancer patients using PCA. In addition, plasma and lymphocytes displayed differentiating signatures in patients exhibiting different Gleason scores. A PLS-DA model was able to discriminate these groups with sensitivity and specificity rates ranging from 90% to 99%. CLS fitting analysis identified key analytes that are involved in the development and progression of prostate cancer. Conclusions: This technology may have potential as an alternative first stage diagnostic triage for prostate cancer. This technology can be easily adaptable to many other bodily fluids and could be useful for translation of liquid biopsy-based diagnostics into the clinic.
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Affiliation(s)
- Dinesh K R Medipally
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
| | - Daniel Cullen
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
| | - Valérie Untereiner
- Université de Reims Champagne-Ardenne, BioSpecT EA 7506, UFR Pharmacie, Reims, France
| | - Ganesh D Sockalingum
- Université de Reims Champagne-Ardenne, BioSpecT EA 7506, UFR Pharmacie, Reims, France
| | - Adrian Maguire
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
| | - Thi Nguyet Que Nguyen
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
| | - Jane Bryant
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
| | - Emma Noone
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Shirley Bradshaw
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Marie Finn
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Mary Dunne
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | | | | | - Aidan D Meade
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Kevin Street, Dublin, Dublin D08 NF82, Ireland
| | - Fiona M Lyng
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Dublin D08 NF82, Ireland
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Medipally DKR, Cullen D, Untereiner V, Bryant J, Sockalingum GD, Nguyen TNQ, Noone E, Bradshaw S, Finn M, Dunne M, Shannon AM, Armstrong J, Meade AD, Lyng FM. Effect of hemolysis on Fourier transform infrared and Raman spectra of blood plasma. J Biophotonics 2020; 13:e201960173. [PMID: 32162465 DOI: 10.1002/jbio.201960173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/19/2020] [Accepted: 03/09/2020] [Indexed: 06/10/2023]
Abstract
Hemolysis is a very common phenomenon and is referred as the release of intracellular components from red blood cells to the extracellular fluid. Hemolyzed samples are often rejected in clinics due to the interference of hemoglobin and intracellular components in laboratory measurements. Plasma and serum based vibrational spectroscopy studies are extensively applied to generate spectral biomarkers for various diseases. However, no studies have reported the effect of hemolysis in blood based vibrational spectroscopy studies. This study was undertaken to evaluate the effect of hemolysis on infrared and Raman spectra of blood plasma. In this study, prostate cancer plasma samples (n = 30) were divided into three groups (nonhemolyzed, mildly hemolyzed, and moderately hemolyzed) based on the degree of hemolysis and FTIR and Raman spectra were recorded using high throughput (HT)-FTIR and HT-Raman spectroscopy. Discrimination was observed between the infrared and Raman spectra of nonhemolyzed and hemolyzed plasma samples using principal component analysis. A classical least square fitting analysis showed differences in the weighting of pure components in nonhemolyzed and hemolyzed plasma samples. Therefore, it is worth to consider the changes in spectral features due to hemolysis when comparing the results within and between experiments.
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Affiliation(s)
- Dinesh K R Medipally
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Daniel Cullen
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Valérie Untereiner
- BioSpecT EA 7506, Université de Reims Champagne-Ardenne, UFR Pharmacie, Reims, France
- Plateforme en Imagerie Cellulaire et Tissulaire (PICT), Université de Reims Champagne-Ardenne, Reims, France
| | - Jane Bryant
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
| | - Ganesh D Sockalingum
- BioSpecT EA 7506, Université de Reims Champagne-Ardenne, UFR Pharmacie, Reims, France
| | - Thi N Q Nguyen
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Emma Noone
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Shirley Bradshaw
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Marie Finn
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Mary Dunne
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | | | - John Armstrong
- Cancer Trials Ireland, Dublin, Ireland
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Aidan D Meade
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Fiona M Lyng
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
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8
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Cullen D, Bryant J, Maguire A, Medipally D, McClean B, Shields L, Noone E, Bradshaw S, Finn M, Dunne M, Shannon AM, Armstrong J, Howe O, Meade AD, Lyng FM. Raman spectroscopy of lymphocytes for the identification of prostate cancer patients with late radiation toxicity following radiotherapy. Translational Biophotonics 2020. [DOI: 10.1002/tbio.201900035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Daniel Cullen
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Jane Bryant
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
| | - Adrian Maguire
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Dinesh Medipally
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Brendan McClean
- Department of Medical Physics Saint Luke's Radiation Oncology Network Dublin Ireland
| | - Laura Shields
- Department of Medical Physics Saint Luke's Radiation Oncology Network Dublin Ireland
| | - Emma Noone
- Clinical Trials Unit Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | - Shirley Bradshaw
- Clinical Trials Unit Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | - Marie Finn
- Clinical Trials Unit Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | - Mary Dunne
- Clinical Trials Unit Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | | | - John Armstrong
- Cancer Trials Ireland Dublin Ireland
- Department of Radiation Oncology Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | - Orla Howe
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Biological and Health Sciences Technological University Dublin Dublin Ireland
| | - Aidan D. Meade
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Fiona M. Lyng
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
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Medipally DKR, Nguyen TNQ, Bryant J, Untereiner V, Sockalingum GD, Cullen D, Noone E, Bradshaw S, Finn M, Dunne M, Shannon AM, Armstrong J, Lyng FM, Meade AD. Monitoring Radiotherapeutic Response in Prostate Cancer Patients Using High Throughput FTIR Spectroscopy of Liquid Biopsies. Cancers (Basel) 2019; 11:E925. [PMID: 31269684 PMCID: PMC6679106 DOI: 10.3390/cancers11070925] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 02/08/2023] Open
Abstract
Radiation therapy (RT) is used to treat approximately 50% of all cancer patients. However, RT causes a wide range of adverse late effects that can affect a patient's quality of life. There are currently no predictive assays in clinical use to identify patients at risk of normal tissue radiation toxicity. This study aimed to investigate the potential of Fourier transform infrared (FTIR) spectroscopy for monitoring radiotherapeutic response. Blood plasma was acquired from 53 prostate cancer patients at five different time points: prior to treatment, after hormone treatment, at the end of radiotherapy, two months post radiotherapy and eight months post radiotherapy. FTIR spectra were recorded from plasma samples at all time points and the data was analysed using MATLAB software. Discrimination was observed between spectra recorded at baseline versus follow up time points, as well as between spectra from patients showing minimal and severe acute and late toxicity using principal component analysis. A partial least squares discriminant analysis model achieved sensitivity and specificity rates ranging from 80% to 99%. This technology may have potential to monitor radiotherapeutic response in prostate cancer patients using non-invasive blood plasma samples and could lead to individualised patient radiotherapy.
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Affiliation(s)
- Dinesh K R Medipally
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, D08 NF82 Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, D08 NF82 Dublin, Ireland
| | - Thi Nguyet Que Nguyen
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, D08 NF82 Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, D08 NF82 Dublin, Ireland
| | - Jane Bryant
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, D08 NF82 Dublin, Ireland
| | - Valérie Untereiner
- BioSpecT EA 7506, Université de Reims Champagne-Ardenne, UFR Pharmacie, 51097 Reims, France
- Plateforme en Imagerie Cellulaire et Tissulaire (PICT), Université de Reims Champagne-Ardenne, 51097 Reims, France
| | - Ganesh D Sockalingum
- BioSpecT EA 7506, Université de Reims Champagne-Ardenne, UFR Pharmacie, 51097 Reims, France
| | - Daniel Cullen
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, D08 NF82 Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, D08 NF82 Dublin, Ireland
| | - Emma Noone
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, D06 HH36 Dublin, Ireland
| | - Shirley Bradshaw
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, D06 HH36 Dublin, Ireland
| | - Marie Finn
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, D06 HH36 Dublin, Ireland
| | - Mary Dunne
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, D06 HH36 Dublin, Ireland
| | | | - John Armstrong
- Cancer Trials Ireland, D11 KXN4 Dublin, Ireland
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, St Luke's Hospital, D06 HH36 Dublin, Ireland
| | - Fiona M Lyng
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, D08 NF82 Dublin, Ireland.
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, D08 NF82 Dublin, Ireland.
| | - Aidan D Meade
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, D08 NF82 Dublin, Ireland.
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, D08 NF82 Dublin, Ireland.
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Meade AD, Maguire A, Bryant J, Cullen D, Medipally D, White L, McClean B, Shields L, Armstrong J, Dunne M, Noone E, Bradshaw S, Finn M, Shannon AM, Howe O, Lyng FM. Prediction of DNA damage and G2 chromosomal radio-sensitivity ex vivo in peripheral blood mononuclear cells with label-free Raman micro-spectroscopy. Int J Radiat Biol 2018. [DOI: 10.1080/09553002.2018.1451006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Aidan D. Meade
- School of Physics, Dublin Institute of Technology, Dublin, Ireland
- DIT Centre for Radiation and Environmental Science, Focas Research Institute, Dublin Institute of Technology, Dublin, Ireland
| | - Adrian Maguire
- School of Physics, Dublin Institute of Technology, Dublin, Ireland
- DIT Centre for Radiation and Environmental Science, Focas Research Institute, Dublin Institute of Technology, Dublin, Ireland
| | - Jane Bryant
- DIT Centre for Radiation and Environmental Science, Focas Research Institute, Dublin Institute of Technology, Dublin, Ireland
| | - Daniel Cullen
- DIT Centre for Radiation and Environmental Science, Focas Research Institute, Dublin Institute of Technology, Dublin, Ireland
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Dinesh Medipally
- DIT Centre for Radiation and Environmental Science, Focas Research Institute, Dublin Institute of Technology, Dublin, Ireland
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Lisa White
- DIT Centre for Radiation and Environmental Science, Focas Research Institute, Dublin Institute of Technology, Dublin, Ireland
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Brendan McClean
- Department of Medical Physics, Saint Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Laura Shields
- Department of Medical Physics, Saint Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - John Armstrong
- Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
- Cancer Trials Ireland, Dublin, Ireland
| | - Mary Dunne
- Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Emma Noone
- Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Shirley Bradshaw
- Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Marie Finn
- Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | | | - Orla Howe
- DIT Centre for Radiation and Environmental Science, Focas Research Institute, Dublin Institute of Technology, Dublin, Ireland
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Fiona M. Lyng
- School of Physics, Dublin Institute of Technology, Dublin, Ireland
- DIT Centre for Radiation and Environmental Science, Focas Research Institute, Dublin Institute of Technology, Dublin, Ireland
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Keen HG, Ricketts SA, Maynard J, Logie A, Odedra R, Shannon AM, Wedge SR, Guichard SM. Examining Changes in [18 F]FDG and [18 F]FLT Uptake in U87-MG Glioma Xenografts as Early Response Biomarkers to Treatment with the Dual mTOR1/2 Inhibitor AZD8055. Mol Imaging Biol 2013; 16:421-30. [DOI: 10.1007/s11307-013-0705-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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12
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Morrissey B, O'Shea C, Armstrong J, Rooney C, Staunton L, Sheehan M, Shannon AM, Pennington SR. Development of a label-free LC-MS/MS strategy to approach the identification of candidate protein biomarkers of disease recurrence in prostate cancer patients in a clinical trial of combined hormone and radiation therapy. Proteomics Clin Appl 2013; 7:316-26. [DOI: 10.1002/prca.201300004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/20/2013] [Accepted: 04/16/2013] [Indexed: 02/06/2023]
Affiliation(s)
- Brian Morrissey
- Conway Institute of Biomolecular and Biomedical Research; University College Dublin; Belfield Dublin Ireland
| | - Carmel O'Shea
- St. Luke's Institute of Cancer Research; St. Luke's Hospital; Rathgar Dublin Ireland
| | - John Armstrong
- St. Luke's Institute of Cancer Research; St. Luke's Hospital; Rathgar Dublin Ireland
| | - Cathy Rooney
- Conway Institute of Biomolecular and Biomedical Research; University College Dublin; Belfield Dublin Ireland
| | - Lisa Staunton
- Conway Institute of Biomolecular and Biomedical Research; University College Dublin; Belfield Dublin Ireland
| | - Martina Sheehan
- St. Luke's Institute of Cancer Research; St. Luke's Hospital; Rathgar Dublin Ireland
| | - Aoife M. Shannon
- All Ireland Co-operative Oncology Research Group; Dublin Ireland
| | - Stephen R. Pennington
- Conway Institute of Biomolecular and Biomedical Research; University College Dublin; Belfield Dublin Ireland
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Abstract
Abstract
Antiangiogenic therapies are one of the fore-runners of the new generation of anticancer drugs aimed at tumour-specific molecular targets. Up until the beginning of this century, the general opinion was that targeted agents should show antitumour activity when used as single agents. However, it has now become clear that much greater improvements in therapeutic activity may be achieved by combining the novel agents with conventional cytotoxic therapies already in use in the clinic. Radiotherapy is currently used to treat half of all cancer patients at some stage in their therapy, although the development of radioresistance is an ongoing problem. It is therefore reasonable to expect that any novel molecularly-targeted agent which reaches the clinic will be used in combination with radiotherapy. The rationale for combining antiangiogenics in particular with radiotherapy exists, as radiotherapy has been shown to kill proliferating endothelial cells, suggesting that inhibiting angiogenesis may sensitise endothelial cells to the effects of radiation. Furthermore, targeting the vasculature may paradoxically increase oxygenation within tumours, thereby enhancing radiotherapy efficacy. In this review we present an update on the use of antiangiogenic methods in combination with radiotherapy.
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Affiliation(s)
- Aoife M Shannon
- University of Manchester, Department of Pharmacy, Manchester M13 9PT, UK
| | - Kaye J Williams
- University of Manchester, Department of Pharmacy, Manchester M13 9PT, UK
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Shannon AM, Telfer BA, Smith PD, Babur M, Logie A, Wilkinson RW, Debray C, Stratford IJ, Williams KJ, Wedge SR. The mitogen-activated protein/extracellular signal-regulated kinase kinase 1/2 inhibitor AZD6244 (ARRY-142886) enhances the radiation responsiveness of lung and colorectal tumor xenografts. Clin Cancer Res 2009; 15:6619-29. [PMID: 19843666 DOI: 10.1158/1078-0432.ccr-08-2958] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Novel molecularly targeted agents, given in combination with radiotherapy, have the potential to increase tumor response rates and the survival of patients with lung cancer. AZD6244 is a potent and selective inhibitor of mitogen-activated protein kinase (MAPK) kinase 1/2 (MEK1/2), a critical enzyme within the MAPK/extracellular signal-regulated kinase (ERK) signaling pathway that regulates the proliferation and survival of tumor cells. EXPERIMENTAL DESIGN This study examined the potential benefit of combining AZD6244 with fractionated radiotherapy using human lung and colon carcinoma xenograft models. RESULTS AZD6244 reduced ERK phosphorylation in Calu-6 lung cancer cells in vitro. Administration of AZD6244 for 10 days (25 mg/kg twice daily p.o.) inhibited the tumor growth of Calu-6 xenografts, with regrowth occurring on cessation of drug treatment. When fractionated tumor-localized radiotherapy (5 x 2 Gy) was combined with AZD6244 treatment, the tumor growth delay was enhanced significantly when compared with either modality alone, and this effect was also seen in a colon tumor model. We examined the effect of inhibiting MEK1/2 on the molecular responses to hypoxia, a potential interaction that could contribute to radioresponsiveness. AZD6244 reduced hypoxia-inducible factor-specific transactivation in vivo, shown using Calu-6 dual clone cells that stably express a Firefly luciferase gene under the control of a hypoxia-driven promoter. Furthermore, hypoxia-inducible factor-1 alpha, GLUT-1, and vascular endothelial growth factor levels were reduced by AZD6244, and there was a significant decrease in vascular perfusion in the tumors given combination treatment when compared with the other treatment groups. CONCLUSIONS These data provide support for the clinical development of AZD6244 in combination with radiotherapy and indicate a potential role for AZD6244 in inhibiting the tumor hypoxia response.
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Affiliation(s)
- Aoife M Shannon
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester, United Kingdom
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15
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Williams KJ, Telfer BA, Shannon AM, Babur M, Stratford IJ, Wedge SR. Inhibition of vascular endothelial growth factor signalling using cediranib (RECENTIN; AZD2171) enhances radiation response and causes substantial physiological changes in lung tumour xenografts. Br J Radiol 2008; 81 Spec No 1:S21-7. [PMID: 18819995 DOI: 10.1259/bjr/59853976] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A number of pre-clinical studies have suggested that blocking vascular endothelial growth factor (VEGF) signalling can be beneficial in combination with radiotherapy. This study investigated the effects of cediranib, a highly potent orally available inhibitor of VEGF receptor tyrosine kinase activity in combination with radiation in Calu-6 lung xenografts. In nude mice, Calu-6 tumours were established and treatments initiated at a volume of 250 mm(3). Tumour-localized radiotherapy was given as three or five daily fractions of 2 Gy. Cediranib (3 mg kg(-1)) was administered 2 h prior to each fraction and continued post radiotherapy (concomitant regimen) or was initiated immediately after the completion of radiotherapy (sequential regimen). The endpoint was the time taken for tumour volume to quadruple (RTV4). Combined treatments resulted in a significantly enhanced growth delay compared with either modality alone. The therapeutic benefit was the same irrespective of the scheduling regimen. Tumour regression was observed post radiotherapy, which was associated with high levels of apoptosis and necrosis, and pronounced antivascular effects in histological samples. The amplified antivascular effect of cediranib when given after radiation suggests that pre-irradiated endothelium is sensitized to cediranib. Concomitant 5-day treatment with both cediranib and radiation reduced vessel density, perfusion and increased in tumour hypoxia. This was not associated with an acquired radioresistance suggesting that the maintenance of cediranib treatment post radiotherapy prevents the contribution of hypoxic cells to tumour regrowth. Collectively, these data support the contention that VEGFR inhibition can enhance radiation response in pre-clinical models and provide a rationale to develop cediranib in combination with radiotherapy in the clinical setting.
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Affiliation(s)
- K J Williams
- University of Manchester, School of Pharmacy, Manchester M13 9PT, UK.
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Williams KJ, Telfer BA, Shannon AM, Babur M, Stratford IJ, Wedge SR. Combining radiotherapy with AZD2171, a potent inhibitor of vascular endothelial growth factor signaling: pathophysiologic effects and therapeutic benefit. Mol Cancer Ther 2007; 6:599-606. [PMID: 17308057 DOI: 10.1158/1535-7163.mct-06-0508] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AZD2171 is a highly potent, orally active inhibitor of vascular endothelial growth factor receptor signaling. The potential for AZD2171 to enhance the antitumor effects of radiotherapy was investigated in lung (Calu-6) and colon (LoVo) human tumor xenograft models. Combined treatment resulted in a significantly enhanced growth delay compared with either modality alone. The enhancement was independent of whether chronic once daily AZD2171 treatment was given 2 h prior to each radiation fraction (2 Gy daily for 3 or 5 consecutive days), and daily thereafter, or commenced immediately following the course of radiotherapy. Histologic assessments revealed that 5 days of radiation (2 Gy) or AZD2171 (3 or 6 mg/kg/d) reduced vessel density and perfusion. Concomitant AZD2171 and radiation enhanced this effect and produced a significant increase in tumor hypoxia. Concomitant AZD2171 (6 mg/kg/d) was also found to reduce tumor growth significantly during the course of radiotherapy (5 x 2 Gy). However, the extent and duration of tumor regression observed postradiotherapy was similar to sequentially treated tumors, suggesting that preirradiated tumors were sensitized to AZD2171 treatment. An enhanced antivascular effect of administering AZD2171 postradiotherapy was observed in real-time in Calu-6 tumors grown in dorsal window chambers. Collectively, these data support the clinical development of AZD2171 in combination with radiotherapy.
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Affiliation(s)
- Kaye J Williams
- Department of Pharmacy, University of Manchester, Coupland Street, Manchester M13 9PL, United Kingdom.
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17
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O'Donnell JL, Joyce MR, Shannon AM, Harmey J, Geraghty J, Bouchier-Hayes D. Oncological implications of hypoxia inducible factor-1alpha (HIF-1alpha) expression. Cancer Treat Rev 2006; 32:407-16. [PMID: 16889900 DOI: 10.1016/j.ctrv.2006.05.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 05/01/2006] [Accepted: 05/03/2006] [Indexed: 01/23/2023]
Abstract
Solid tumours contain regions of hypoxia, which may be a prognostic indicator and determinant of malignant progression, metastatic development and chemoradio-resistance. The degree of intra-tumoural hypoxia has been shown to be positively correlated with the expression of the transcription factor hypoxia-inducible factor 1. HIF-1 is composed of 2 sub-units, namely HIF-1alpha and HIF-1beta. The production of hypoxia inducible factor 1-alpha has been identified as a key element in allowing cells to adapt and survive in a hostile hypoxic environment via a variety of pathways. HIF-1alpha is stabilised by hypoxia at the protein level, and also by the oncogenes HER2neu, v-src and ras. There are over 60 target genes for HIF-1, many of which are activated in cancers in comparison to equivalent normal tissues. Chemotherapeutic modulation of HIF-1 pathways has shown promise for patients with chemo-radio resistant or recurrent tumours in Phase II clinical trials. We herein review the existing literature on hypoxia inducible factor-1alpha, particularly its role in carcinogenesis and clinical implications of its over-expression.
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Affiliation(s)
- Jill L O'Donnell
- RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
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18
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Shannon AM, Bouchier-Hayes DJ, Condron CM, Toomey D. Correction of anaemia through the use of darbepoetin alfa improves chemotherapeutic outcome in a murine model of Lewis lung carcinoma. Br J Cancer 2005; 93:224-32. [PMID: 15999100 PMCID: PMC2361545 DOI: 10.1038/sj.bjc.6602685] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Darbepoetin alfa (Aranesp®, Amgen) is a novel erythropoiesis-stimulating protein with a serum half-life longer than recombinant human erythropoietin (Epo), used in the treatment of cancer-associated anaemia. Anaemia is known to adversely affect prognosis and response to treatment in cancer patients. Solid tumours contain regions of hypoxia due to poor vascular supply and cellular compaction. Although hypoxic stress usually results in cell death, hypoxia-resistant tumour cells are genetically unstable and often acquire a drug-resistant phenotype. Increasing tumour oxygenation and perfusion during treatment could have the doubly beneficial outcome of reducing the fraction of treatment-resistant cells, while increasing drug delivery to previously hypoxic tissue. In this study, we examined the effect of darbepoetin alfa on chemotherapy sensitivity and delivery in an in vivo model of Lewis lung carcinoma, shown here to express the Epo receptor (EpoR). We identified that weekly darbepoetin alfa treatment, commencing 10 days before chemotherapy, resulted in a significant reduction in tumour volume compared to chemotherapy alone. This was mediated by the prevention of anaemia, a reduction in tumour hypoxia and a concomitant increase in drug delivery. Darbepoetin alfa treatment alone did not modulate the growth of the EpoR-expressing tumour cells. This study identifies an important role for darbepoetin alfa in increasing the therapeutic index of chemotherapy.
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Affiliation(s)
- A M Shannon
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - D J Bouchier-Hayes
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - C M Condron
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - D Toomey
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
- Department of Biochemistry, Trinity College, Dublin 2, Ireland. Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland. E-mail:
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Abstract
Tissue hypoxia occurs where there is an imbalance between oxygen supply and consumption. Hypoxia occurs in solid tumours as a result of an inadequate supply of oxygen, due to exponential cellular proliferation and an inefficient vascular supply. It is an adverse prognostic indicator in cancer as it is associated with tumour progression and resistance to therapy. The expression of several genes controlling tumour cell survival are regulated by hypoxia, e.g., growth factors governing the formation of new blood vessels, and hypoxia-responsive transcription factors modulating the expression of genes, which promote tumour cell survival. This review outlines some of the pathways by which tumour hypoxia leads to chemotherapeutic resistance, directly due to lack of oxygen availability, and indirectly due to alterations in the proteome/genome, angiogenesis and pH changes. Some innovative therapies are also detailed which may potentially minimise or eliminate these problems associated with targeting solid tumours.
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Affiliation(s)
- Aoife M Shannon
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, 9, Dublin, Ireland.
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Abstract
This qualitative descriptive study explored nurses' views of patient advocacy. Seventeen hospital and community nurses were interviewed to determine whether and how they exercise the advocacy role and what they believe promotes or impedes the practice of advocacy. Findings suggested that the advocacy role was not uppermost in the minds of many of the respondents. However, when queried, the nurse-patient relationship emerged as a salient feature of advocacy; teaching, informing, and supporting were frequent activities of nurses in what they described as advocacy; and interpersonal relatedness, rather than issues of accountability and ethics, were central to the advocacy process. Work environment barriers--such as time, economics, acuity, and power hierarchies--combined with factors, such as lack of autonomy and fatigue, to create reasons not to advocate. Physicians contributed to nurses' willingness or unwillingness to advocate depending on their availability, openness to patients and nurses, and their personal demeanor. A conceptual model of client advocacy emerged from the data to guide further explorations of advocacy. The advocacy role is a critical, perhaps unique dimension of professional nursing that is changing rapidly and may be diverging from the usual role prescribed in the professional literature and taught in baccalaureate nursing curricula.
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Affiliation(s)
- K Chafey
- College of Nursing, Montana State University, Bozeman 59717-3560, USA
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Shannon AM. UKCC fuels HIV/AIDS controversy. Br J Nurs 1993; 2:507. [PMID: 8324345 DOI: 10.12968/bjon.1993.2.10.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
While welcoming and supporting the reiterated position of the UKCC on anonymous testing for human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) and their opposition to routine testing of health care professionals, I have been dismayed over some of the expanded clauses in the Registrar's letter (UKCC, 1993).
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Tompkins DS, Shannon AM. Clinical value of microbiological investigations in general practice. Br J Gen Pract 1993; 43:155-8. [PMID: 8323802 PMCID: PMC1372359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The clinical value of many laboratory tests has frequently been queried. A short questionnaire was attached to individual microbiology reports issued to general practitioners in Bradford for an eight week period. Of the 2386 questionnaires sent out 1847 (77%) were returned. The general practitioners indicated that 34% of reports gave unexpected findings, 28% resulted in a change of therapy and most of the investigations (83%) were seen as beneficial to the patients. The majority of the specimens (56%) were mid-stream urine samples of which 77% gave negative findings. This study indicates that conventional microbiology test results are more valuable in general practice than previous hospital based surveys might suggest. Alternative strategies for investigation to reduce the number of tests of low value are discussed.
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Affiliation(s)
- D S Tompkins
- Microbiology Department, Bradford Royal Infirmary
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23
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Shannon AM. The NLN accreditation study: its relation to the CBHDP accreditation process. NLN Publ 1983:11-25. [PMID: 6553228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Shannon AM. Health policy and research: revisited. West J Nurs Res 1981; 3:79-82. [PMID: 6914101 DOI: 10.1177/019394598100300318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Shannon AM. Critique of "Supportive measures for relatives of the fatally ill". Commun Nurs Res 1973; 6:129-35. [PMID: 4499878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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27
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Shannon AM. Facial expression of emotion: recognition patterns in schizophrenics and depressives. Nurs Res Conf 1971; 7:131-46. [PMID: 5210567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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28
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Getty C, Shannon AM. Co-therapy as an egalitarian relationship. Am J Nurs 1969; 69:767-71. [PMID: 5191177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Getty C, Shannon AM. Nurses as co-therapists in a family-therapy setting. Perspect Psychiatr Care 1967; 5:38-46. [PMID: 5180853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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