Dose-dependence of radiotherapy-induced changes in serum levels of choline-containing phospholipids; the importance of lower doses delivered to large volumes of normal tissues

BACKGROUND

Conformal radiotherapy is a primary treatment in head and neck cancer, which putative adverse effects depend on relatively low doses of radiation delivered to increased volumes of normal tissues. Systemic effects of such treatment include radiation-induced changes in serum lipid profile, yet dose- and volume-dependence of these changes remain to be established.

METHODS

Here we analyzed levels of choline-containing phospholipids in serum samples collected consecutively during the radiotherapy used as the only treatment modality. The liquid chromatography-mass spectrometry (LC-MS) approach applied in the study enabled the detection and quantitation of 151 phospholipids, including (lyso)phosphatidylcholines and sphingomyelins.

RESULTS

No statistically significant differences were found in the pretreatment samples from patients with different locations and stages of cancer. To compensate for potential differences between schemes of radiotherapy, the biologically effective doses were calculated and used in the search of correlations with specific lipid levels. We found that the levels of several phospholipids depended on the maximum dose delivered to the gross tumor volume and total radiation energy absorbed by the patient's body. Increased doses correlated with increased levels of sphingomyelins and reduced levels of phosphatidylcholines. Furthermore, we observed several phospholipids whose serum levels correlated with the degree of acute radiation toxicity.

CONCLUSION

Noteworthy, serum phospholipid levels were associated mainly with volumes of normal tissues irradiated with relatively low doses (i.e., total accumulated dose 20 Gy), which indicated the importance of such effects on the systemic response of the patient's organism to intensity-modulated radiotherapy (IMRT).

Comparison of different models of motion in a crowded environment: a Monte Carlo study

In this paper we investigate the motion of molecules in crowded environments for two dramatically different types of molecular transport. The first type is realized by the dynamic lattice liquid model, which is based on a cooperative movement concept and thus, the motion of molecules is highly correlated. The second one corresponds to a so-called motion of a single agent where the motion of molecules is considered as a random walk without any correlation with other moving elements. The crowded environments are modeled as a two-dimensional triangular lattice with fixed impenetrable obstacles. Our simulation results indicate that the type of transport has an impact on the dynamics of the system, the percolation threshold, critical exponents, and on molecules' trajectories.

Identification of serum proteome signatures of locally advanced and metastatic gastric cancer: a pilot study

BACKGROUND

The gastric cancer is one of the most common and mortal cancer worldwide. The initial asymptomatic development and further nonspecific symptoms result in diagnosis at the advanced stage with poor prognosis. Yet, no clinically useful biomarkers are available for this malignancy, and invasive gastrointestinal endoscopy remains the only reliable option at the moment. Hence, there is a need for discovery of clinically useful noninvasive diagnostic and/or prognostic tool as an alternative (or complement) for current diagnostic tools. Here we aimed to search for serum proteins characteristic for local and invasive gastric cancer.

METHODS

Pre-treatment blood samples were collected from patients with diagnosed gastric adenocarcinoma at the different stage of disease: 35 patients with locally advanced cancer and 18 patients with metastatic cancer; 50 healthy donors were also included as a control group. The low-molecular-weight fraction of serum proteome (i.e., endogenous peptidome) was profiled by the MALDI-ToF mass spectrometry, and the whole proteome components were identified and quantified by the LC-MS/MS shotgun approach.

RESULTS

Multicomponent peptidome signatures were revealed that allowed good discrimination between healthy controls and cancer patients, as well as between patients with locally advanced and metastatic cancer. Moreover, a LC-MS/MS approach revealed 49 serum proteins with different abundances between healthy donors and cancer patients (predominantly proteins associated with inflammation and acute phase response). Furthermore, 19 serum proteins with different abundances between patients with locally advanced and metastatic cancer were identified (including proteins associated with cytokine/chemokine response and metabolism of nucleic acids). However, neither peptidome profiling nor shotgun proteomics approach allowed detecting serum components discriminating between two subgroups of patients with local disease who either developed or did not develop metastases during follow-up.

CONCLUSIONS

The molecular differences between locally advanced and metastatic gastric cancer, as well as more obvious differences between healthy individuals and cancer patients, have marked reflection at the level of serum proteome. However, we have no evidence that features of pre-treatment serum proteome could predict a risk of cancer dissemination in patients treated due to local disease. Nevertheless, presented data confirmed potential applicability of a serum proteome signature-based biomarker in diagnostics of gastric cancer.

Influence of interfraction motion on margins for radiotherapy of gastric cancer

OBJECTIVE

The aim of this study was to evaluate interfraction uncertainties using kilovoltage (kV) radiographs for patients with gastric cancer during chemoradiotherapy and to calculate the planning target volume (PTV) margins.

METHODS

1284 measurements of set-up errors were analysed for treated patients. The measurements of craniocaudal (axis y), laterolateral (axis x) and anteroposterior (axis z) shifts in kV radiographs were performed. Interfraction clinical target volume (CTV)-PTV margins for all directions were calculated using the van Herk formula.

RESULTS

The main shift for the y-axis was 0.7 mm [standard deviation (SD), ±7.6], for the x-axis was 0.4 mm (SD, ±3.7) and for the z-axis was 0.6 mm (SD, ±3.5). The CTV-PTV margin in the x, y and z directions was 8.3, 15.5 and 8.0 mm, respectively. We observed that the interfractional motion for patients increased approximately 0.0034 cm along the x direction with each subsequent fraction, whereas a 0.0058-cm reduction in length along the y-axis was observed. No time effects for the z direction were noticed.

CONCLUSION

According to our experience, a PTV margin of 9 mm along the x-axis, 16 mm along the y-axis and 8 mm along the z direction should be considered in the absence of image-guided radiotherapy.

ADVANCES IN KNOWLEDGE

This knowledge concerning PTV set-up margins could be particularly useful for centres without a kV on-board imaging system.

Radiotherapy and chemoradiotherapy as a novel option for the treatment of locally advanced inoperable gastric adenocarcinoma: A phase II study

This phase II trial aimed to evaluate the tolerance and efficacy of radical radiotherapy or chemoradiotherapy in patients with primarily inoperable gastric cancer. The analysis was based on 13 patients with primarily inoperable gastric cancer. A total of 6 (46.2%) patients refused surgery and 7 (53.8%) had contraindications to anesthesia due to cardiological or respiratory reasons (4 and 3 patients, respectively). The treatment regimen consisted of radiotherapy and chemotherapy based on 5-fluorouracil. Half of the patients were not qualified to receive chemotherapy due to the presence of comorbidities. A total dose of 45 Gy was administered in 25 fractions. Of the 13 patients who started treatment, 12 (92.3%) completed radiotherapy. Local treatment response was observed in 6/12 patients (50%), with 5/12 (41.7%) displaying clinical complete response and 1/12 (8.3%) partial response. The 1- and 3-year overall survival rates and the median survival were 59 and 48% and 17.1 months, respectively. In conclusion, radical radiotherapy, either alone or in combination with chemotherapy, is safe for patients with inoperable locally advanced gastric cancer and may prolong survival.