The tardigrade Hypsibius exemplaris dramatically upregulates DNA repair pathway genes in response to ionizing radiation

Tardigrades can survive remarkable doses of ionizing radiation, up to about 1,000 times the lethal dose for humans. How they do so is incompletely understood. We found that the tardigrade Hypsibius exemplaris suffers DNA damage upon gamma irradiation, but the damage is repaired. We show that this species has a specific and robust response to ionizing radiation: irradiation induces a rapid upregulation of many DNA repair genes. This upregulation is unexpectedly extreme-making some DNA repair transcripts among the most abundant transcripts in the animal. By expressing tardigrade genes in bacteria, we validate that increased expression of some repair genes can suffice to increase radiation tolerance. We show that at least one such gene is important in vivo for tardigrade radiation tolerance. We hypothesize that the tardigrades' ability to sense ionizing radiation and massively upregulate specific DNA repair pathway genes may represent an evolved solution for maintaining DNA integrity.

Re-irradiation for recurrent/progressive pediatric brain tumors: from radiobiology to clinical outcomes

INTRODUCTION

Brain tumors are the most common solid tumors in children. Neurosurgical excision, radiotherapy, and/or chemotherapy represent the standard of care in most histopathological types of pediatric central nervous system (CNS) tumors. Even though the successful cure rate is reasonable, some patients may develop recurrence locally or within the neuroaxis.

AREA COVERED

The management of these recurrences is not easy; however, significant advances in neurosurgery, radiation techniques, radiobiology, and the introduction of newer biological therapies, have improved the results of their salvage treatment. In many cases, salvage re-irradiation is feasible and has achieved encouraging results. The results of re-irradiation depend upon several factors. These factors include tumor type, extent of the second surgery, tumor volume, location of the recurrence, time that elapses between the initial treatment, the combination with other treatment agents, relapse, and the initial response to radiotherapy.

EXPERT OPINION

Reviewing the radiobiological basis and clinical outcome of pediatric brain re-irradiation revealed that re-irradiation is safe, feasible, and indicated for recurrent/progressive different tumor types such as; ependymoma, medulloblastoma, diffuse intrinsic pontine glioma (DIPG) and glioblastoma. It is now considered part of the treatment armamentarium for these patients. The challenges and clinical results in treating recurrent pediatric brain tumors were highly documented.

Identification of predictive biomarkers for diagnosis and radiation sensitivity of uterine cervical cancer using wide-targeted metabolomics

AIM

Uterine cervical cancer (UCC) is the fourth most common cancer in women, responsible for more than 300 000 deaths worldwide. Its early detection, by cervical cytology, and prevention, by vaccinating against human papilloma virus, greatly contribute to reducing cervical cancer mortality in women. However, penetration of the effective prevention of UCC in Japan remains low. Plasma metabolome analysis is widely used for biomarker discovery and the identification of cancer-specific metabolic pathways. Here, we aimed to identify predictive biomarkers for the diagnosis and radiation sensitivity of UCC using wide-targeted plasma metabolomics.

METHODS

We analyzed 628 metabolites in plasma samples obtained from 45 patients with UCC using ultra-high-performance liquid chromatography with tandem mass spectrometry.

RESULTS

The levels of 47 metabolites were significantly increased and those of 75 metabolites were significantly decreased in patients with UCC relative to healthy controls. Increased levels of arginine and ceramides, and decreased levels of tryptophan, ornithine, glycosylceramides, lysophosphatidylcholine, and phosphatidylcholine were characteristic of patients with UCC. Comparison of metabolite profiles in groups susceptible and non-susceptible to radiation therapy, a treatment for UCC, revealed marked variations in polyunsaturated fatty acid, nucleic acid, and arginine metabolism in the group not susceptible to treatment.

CONCLUSIONS

Our findings suggest that the metabolite profile of patients with UCC may be an important indicator for distinguishing these patients from healthy cohorts, and may also be useful for predicting sensitivity to radiotherapy.

Prioritizing sufficient dose to gross tumor volume over normal tissue sparing in intensity-modulated radiotherapy treatment of T4 nasopharyngeal carcinoma

BACKGROUND

In intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), priority is often given minimize dose to the critical organs at risk (OARs) to avoid potential morbid sequelae. However, in T4 NPC, dosimetric inadequacy enforced by dose constraints on OARs may significantly impact tumor control.

METHODS

This was a single-institute cohort that patients diagnosed between July 2005 and December 2010 with T4 NPC treated with IMRT. All patients were re-classification according to the 7th-AJCC stage.

RESULTS

Overall, the average doses such as Dmax , D1% , D2% and D1cc for various Central nervous system (CNS) OARs including brainstem, optic nerve, chiasm, temporal lobes and spinal cord were found to exceed published guidelines as RTOG0225. However, no clinical toxicities were seen during the follow-up period except for 13% patients with temporal lobe necrosis.

CONCLUSION

Our retrospective review showed that its feasible to maximize gross tumor volume dose coverage while exceeding most CNS OAR constraint standards, with ideal local control and no obvious increase of craniocerebral toxicity.

Gross tumor volume margin and local control in p16-positive oropharynx cancer patients treated with intensity modulated proton therapy

BACKGROUND

To determine if the extent of high-dose gross tumor volume (GTV) to clinical target volume (CTV) expansion is associated with local control in patients with p16-positive oropharynx cancer (p16+ OPC) treated with definitive intensity modulated proton therapy (IMPT).

METHODS

We performed a retrospective analysis of patients with p16+ OPC treated with IMPT at a single institution between 2016 and 2021. Patients with a pre-treatment PET-CT and restaging PET-CT within 4 months following completion of IMPT were analyzed.

RESULTS

Sixty patients were included for analysis with a median follow-up of 17 months. The median GTV to CTV expansion was 5 mm (IQR: 2 mm). Thirty-three percent of patients (20 of 60) did not have a GTV to CTV expansion. There was one local failure within the expansion group (3%).

CONCLUSION

Excellent local control was achieved using IMPT for p16+ OPC independent of GTV expansion. IMPT with minimal target expansions represent a potential harm-minimization technique for p16-positive oropharynx cancer.

Evaluation of Radiation Sensitivity Differences in Mouse Liver Tumor Organoids Using CRISPR/Cas9-Mediated Gene Mutation

BACKGROUND

To assess the radiosensitivity of liver tumors harboring different genetic mutations, mouse liver tumors were generated in vivo through the hydrodynamic injection of clustered regularly interspaced short palindromic repeat/caspase 9 (CRISPR/Cas9) constructs encoding single-guide RNAs (sgRNAs) targeting Tp53, Pten, Nf1, Nf2, Tsc2, Cdkn2a, or Rb1.

METHODS

The plasmid vectors were delivered to the liver of adult C57BL/6 mice via hydrodynamic tail vein injection. The vectors were injected into 10 mice in each group. Organoids were generated from mouse liver tumors. The radiation response of the organoids was assessed using an ATP cell viability assay.

RESULTS

The mean survival period of mice injected with vectors targeting Nf2 (4.8 months) was lower than that of other mice. Hematoxylin and eosin staining, immunohistochemical (IHC) staining, and target sequencing analyses revealed that mouse liver tumors harbored the expected mutations. Tumor organoids were established from mouse liver tumors. Histological evaluation revealed marked morphological similarities between the mouse liver tumors and the generated tumor organoids. Moreover, IHC staining indicated that the parental tumor protein expression pattern was maintained in the organoids. The results of the ATP cell viability assay revealed that the tumor organoids with mutated Nf2 were more resistant to high-dose radiation than those with other gene mutations.

CONCLUSIONS

This study developed a radiation response assessment system for mouse tumors with mutant target genes using CRISPR/Cas9 and organoids. The Tp53 and Pten double mutation in combination with the Nf2 mutation increased the radiation resistance of tumors. The system used in this study can aid in elucidating the mechanism underlying differential intrinsic radiation sensitivity of individual tumors.

Ultra-Strong Comprehensive Radiation Effect Tolerance in Carbon Nanotube Electronics

Carbon nanotube (CNT) field-effect transistors (FETs) have been considered ideal building blocks for radiation-hard integrated circuits (ICs), the demand for which is exponentially growing, especially in outer space exploration and the nuclear industry. Many studies on the radiation tolerance of CNT-based electronics have focused on the total ionizing dose (TID) effect, while few works have considered the single event effects (SEEs) and displacement damage (DD) effect, which are more difficult to measure but may be more important in practical applications. Measurements of the SEEs and DD effect of CNT FETs and ICs are first executed and then presented a comprehensive radiation effect analysis of CNT electronics. The CNT ICs without special irradiation reinforcement technology exhibit a comprehensive radiation tolerance, including a 1 × 10⁴ MeVcm² mg^-1 level of the laser-equivalent threshold linear energy transfer (LET) for SEEs, 2.8 × 10¹³ MeV g^-1 for DD and 2 Mrad (Si) for TID, which are at least four times higher than those in conventional radiation-hardened ICs. The ultrahigh intrinsic comprehensive radiation tolerance will promote the applications of CNT ICs in high-energy solar and cosmic radiation environments.

Ultralow-Power and Radiation-Tolerant Complementary Metal-Oxide-Semiconductor Electronics Utilizing Enhancement-Mode Carbon Nanotube Transistors on Paper Substrates

The development of eco-friendly, ultralow-power and easy-to-process electronics is facing dominant challenges in emerging off-the-grid applications, such as the Internet of Things (IoTs) and extreme environment explorations at the south/north pole, in the deep sea, and in outer space. Eco-friendly, biodegradable, lightweight, and flexible paper-based electronics can provide many new possibilities for next-generation devices and circuits. Here, enhancement-mode (E-mode, remaining off state at zero gate voltages) carbon nanotube (CNT) complementary metal-oxide-semiconductor (CMOS) thin-film transistors (TFTs) are built on paper substrates through a printing-based process. Benefitting from the CMOS circuit style and E-mode transistors, the fabricated CMOS inverters exhibit high voltage gains (more than 11) and noise margins (up to 75% 1/2 V_DD at V_DD of 0.4 V), and rail-to-rail operation down to a V_DD as low as 0.2 V and record low power dissipation as low as 0.0124 pW μm^-1 . Furthermore, the transistors and integrated circuits (ICs) show an excellent radiation tolerance of a total ionizing dose (TID) exceeding 2 Mrad with a high dose rate of 365 rad s^-1 . The record power consumption and outstanding radiation tolerance behavior achieved in paper-based and easy-to-process CNT electronics are attractive for emerging energy-saving and environmentally friendly ICs in harsh environment (such as outer-space) applications.

Combination of Modern Radiotherapy and New Targeted Treatments for Breast Cancer Management

Simple Summary

Since the introduction of hormone therapy for the treatment of breast cancer (BC) three decades ago, many new targeted therapies have been developed. Some of them are currently used, such as HER2 inhibitors, while others are still under development, such as cell cycle (CDK) inhibitors, immune checkpoint (PD1/PDL1) inhibitors, or molecules acting on DNA damage (PARP) repair. Besides this, radiation therapy (RT) is commonly used either as adjuvant treatment for early BC after breast conservative surgery or in palliative intent for the treatment of metastatic sites. Our research has shown that the combinations of the most commonly used targeted treatments and RT were feasible with a few toxicities. Nevertheless, most of the knowledge on this subject is based on retrospective studies and a small number of patients and care should be taken in this setting until these results would be confirmed in prospective randomized studies.

Abstract

Background: The objective of the present study was to review the essential knowledge about the combinations of the most commonly used or under development targeted treatments and radiation therapy (RT). Methods: Preclinical and clinical studies investigating this combination were extensively reviewed. Results: Several studies showed that the combination of RT and tamoxifen increased the risk of radiation-induced pulmonary toxicity; therefore, both modalities should not be given concomitantly. The combination of HER2 inhibitors (trastuzumab, pertuzumab) and RT seems to be safe. However, trastuzumab emtansine (T-DM1) should not be administered concurrently with brain RT since this combination could increase the risk of brain radionecrosis. The combination of RT and other new target treatments such as selective estrogen receptor degradants, lapatinib, cell cycle inhibitors, immune checkpoint inhibitors, or molecules acting on DNA damage repair seems feasible but was essentially evaluated on retrospective or prospective studies with a small number of patients. Furthermore, there is considerable heterogeneity among these studies regarding the dose and fractionation of radiation, the dosage of drugs, and the sequence of treatments used. Conclusions: The combination of RT with most targeted therapies for BC appears to be well-tolerated, but these results need to be confirmed in prospective randomized studies.

Use of the Ferroelectric Ceramic Bismuth Titanate as an Ultrasonic Transducer for High Temperatures and Nuclear Radiation

Ultrasonic transducers are often used in the nuclear industry as sensors to monitor the health and process status of systems or the components. Some of the after-effects of the Fukushima Daiichi earthquake could have been eased if sensors had been in place inside the four reactors and sensed the overheating causing meltdown and steam explosions. The key element of ultrasonic sensors is the piezoelectric wafer, which is usually derived from lead-zirconate-titanate (Pb(Zr, Ti)O₃, PZT). This material loses its piezoelectrical properties at a temperature of about 200 °C. It also undergoes nuclear transmutation. Bismuth titanate (Bi₄Ti₃O₁₂, BiTi) has been considered as a potential candidate for replacing PZT at the middle of this temperature range, with many possible applications, since it has a Curie–Weiss temperature of about 650 °C. The aim of this article is to describe experimental details for operation in gamma and nuclear radiation concomitant with elevated temperatures and details of the performance of a BiTi sensor during and after irradiation testing. In these experiments, bismuth titanate has been demonstrated to operate up to a fast neutron fluence of 5 × 10²⁰ n/cm² and gamma radiation of 7.23 × 10²¹ (gamma/cm²). The results offer a perspective on the state-of the-art for a possible sensor for harsh environments of high temperature, Gamma radiation, and nuclear fluence.

A Study of the Radiation Tolerance of CVD Diamond to 70 MeV Protons, Fast Neutrons and 200 MeV Pions

We measured the radiation tolerance of commercially available diamonds grown by the Chemical Vapor Deposition process by measuring the charge created by a 120 GeV hadron beam in a 50 μm pitch strip detector fabricated on each diamond sample before and after irradiation. We irradiated one group of samples with 70 MeV protons, a second group of samples with fast reactor neutrons (defined as energy greater than 0.1 MeV), and a third group of samples with 200 MeV pions, in steps, to (8.8±0.9) × 10¹⁵ protons/cm², (1.43±0.14) × 10¹⁶ neutrons/cm², and (6.5±1.4) × 10¹⁴ pions/cm², respectively. By observing the charge induced due to the separation of electron–hole pairs created by the passage of the hadron beam through each sample, on an event-by-event basis, as a function of irradiation fluence, we conclude all datasets can be described by a first-order damage equation and independently calculate the damage constant for 70 MeV protons, fast reactor neutrons, and 200 MeV pions. We find the damage constant for diamond irradiated with 70 MeV protons to be 1.62±0.07(stat)±0.16(syst)× 10⁻¹⁸ cm²/(p μm), the damage constant for diamond irradiated with fast reactor neutrons to be 2.65±0.13(stat)±0.18(syst)× 10⁻¹⁸ cm²/(n μm), and the damage constant for diamond irradiated with 200 MeV pions to be 2.0±0.2(stat)±0.5(syst)× 10⁻¹⁸ cm²/(π μm). The damage constants from this measurement were analyzed together with our previously published 24 GeV proton irradiation and 800 MeV proton irradiation damage constant data to derive the first comprehensive set of relative damage constants for Chemical Vapor Deposition diamond. We find 70 MeV protons are 2.60 ± 0.29 times more damaging than 24 GeV protons, fast reactor neutrons are 4.3 ± 0.4 times more damaging than 24 GeV protons, and 200 MeV pions are 3.2 ± 0.8 more damaging than 24 GeV protons. We also observe the measured data can be described by a universal damage curve for all proton, neutron, and pion irradiations we performed of Chemical Vapor Deposition diamond. Finally, we confirm the spatial uniformity of the collected charge increases with fluence for polycrystalline Chemical Vapor Deposition diamond, and this effect can also be described by a universal curve.

Association Between Radiation Tolerance of Lymphocytes and Clinical Outcomes in Cervical Cancer

BACKGROUND/AIM

This study evaluated whether the lymphocyte tolerance factor (LTF) was an indicator of radiation tolerance of lymphocytes (RTL) using the relative lymphocyte count (RLC), and considering clinical outcomes.

PATIENTS AND METHODS

A total of 92 cervical cancer patients treated with concurrent chemoradiotherapy (CCRT) were analysed. RLC0 was pre-treatment RLC, and RLC1, and RLC2 were at the first and second week of CCRT, respectively. LTF1 was RLC1:RLC2. LTF2 was the dimension of the convex or concave shape comprising the three RLC vertexes. Patients were divided into three groups: good RTL group, low LTF1; moderate RTL group, high LTF1 and low LTF2; and poor RTL group, high LTF1 and high LTF2.

RESULTS

Patients with good tumour response to radiotherapy were mostly included in the good RTL group than in the other groups. The poor RTL group had lower 3-year progression-free survival (57.1% vs. 83.8% and 82%, p=0.01) and 5-year disease-specific survival (71.8% vs. 90.4% and 94.9%, p=0.062) rates than the moderate and good RTL groups. Multivariate analyses showed that poor RTL was a significant survival predictor.

CONCLUSION

The poor RTL group according to LTF is a potential predictor of clinical outcome.

In-Situ Helium Implantation and TEM Investigation of Radiation Tolerance to Helium Bubble Damage in Equiaxed Nanocrystalline Tungsten and Ultrafine Tungsten-TiC Alloy

The use of ultrafine and nanocrystalline materials is a proposed pathway to mitigate irradiation damage in nuclear fusion components. Here, we examine the radiation tolerance of helium bubble formation in 85 nm (average grain size) nanocrystalline-equiaxed-grained tungsten and an ultrafine tungsten-TiC alloy under extreme low energy helium implantation at 1223 K via in-situ transmission electron microscope (TEM). Helium bubble damage evolution in terms of number density, size, and total volume contribution to grain matrices has been determined as a function of He⁺ implantation fluence. The outputs were compared to previously published results on severe plastically deformed (SPD) tungsten implanted under the same conditions. Large helium bubbles were formed on the grain boundaries and helium bubble damage evolution profiles are shown to differ among the different materials with less overall damage in the nanocrystalline tungsten. Compared to previous works, the results in this work indicate that the nanocrystalline tungsten should possess a fuzz formation threshold more than one order of magnitude higher than coarse-grained tungsten.

Estimation of fetal radiation absorbed dose during the prophylactic use of aortic occlusion balloon for abnormally invasive placenta

PURPOSE

Abnormally invasive placenta is an important cause of maternal morbidity, and its primary complication is massive bleeding. Strategies for preventing bleeding include arterial endovascular occlusion. One concern with the use of intra-arterial occlusion balloons is radiation exposure to the fetus, which occurs while determining balloon position. In this study, we sought to determine the radiation absorbed dose by the fetus during intra-aortic occlusion balloon placement in patients with abnormally invasive placenta.

MATERIALS AND METHODS

We estimated the fetal absorbed dose and the entrance skin dose in the vaginal fundus and lumbar skin, respectively, using thermoluminescent dosimeter crystals, during intra-aortic balloon positioning using the mobile X-ray image intensifier system (C-arm) in digital radiography mode, directly in surgery room, without transfer to angiographic suite. We also performed a mannequin-based simulation to validate the entrance skin dose measurement technique.

RESULTS

Ten women undergoing surgical management of an abnormally invasive placenta, in whom the location of the intra-aortic occlusion balloon was verified using plain radiography with C-arm in the surgery room, were included in the study. Following maternal and fetal radiation exposure, the entrance skin dose and radiation absorbed dose by the fetus were 1.31 ± 0.96 mGy and 0.27 ± 0.28 mGy, respectively, with radiation exposure durations of <1 s.

CONCLUSIONS

There were no complications with the use of REBOA, the radiation absorbed dose by the fetus, entrance skin dose, and duration of radiation exposure during intra-aortic occlusion balloon placement were lower than those reported for other vascular occlusion techniques, being this a safe procedure.

Radiation Tolerance in Tardigrades: Current Knowledge and Potential Applications in Medicine

Tardigrades represent a phylum of very small aquatic animals in which many species have evolved adaptations to survive under extreme environmental conditions, such as desiccation and freezing. Studies on several species have documented that tardigrades also belong to the most radiation-tolerant animals on Earth. This paper gives an overview of our current knowledge on radiation tolerance of tardigrades, with respect to dose-responses, developmental stages, and different radiation sources. The molecular mechanisms behind radiation tolerance in tardigrades are still largely unknown, but omics studies suggest that both mechanisms related to the avoidance of DNA damage and mechanisms of DNA repair are involved. The potential of tardigrades to provide knowledge of importance for medical sciences has long been recognized, but it is not until recently that more apparent evidence of such potential has appeared. Recent studies show that stress-related tardigrade genes may be transfected to human cells and provide increased tolerance to osmotic stress and ionizing radiation. With the recent sequencing of the tardigrade genome, more studies applying tardigrade omics to relevant aspects of human medicine are expected. In particular, the cancer research field has potential to learn from studies on tardigrades about molecular mechanisms evolved to maintain genome integrity.

Enhanced Radiation Tolerance of Tungsten Nanoparticles to He Ion Irradiation

Materials exposed to plasmas in magnetic confinement nuclear reactors will accumulate radiation-induced defects and energetically implanted gas atoms (from the plasma and transmutations), of which insoluble helium (He) is likely to be the most problematic. The large surface-area-to-volume ratio exhibited by nanoporous materials provides an unsaturable sink with the potential to continuously remove both point defects and He. This property enhances the possibilities for these materials to be tailored for high radiation-damage resistance. In order to explore the potential effect of this on the individual ligaments of nanoporous materials, we present results on the response of tungsten (W) nanoparticles (NPs) to 15 keV He ion irradiation. Tungsten foils and various sizes of NPs were ion irradiated concurrently and imaged in-situ via transmission electron microscopy at 750 °C. Helium bubbles were not observed in NPs with diameters less than 20 nm but did form in larger NPs and the foils. No dislocation loops or black spot damage were observed in any NPs up to 100 nm in diameter but were found to accumulate in the W foils. These results indicate that a nanoporous material, particularly one made up of ligaments with characteristic dimensions of 30 nm or less, is likely to exhibit significant resistance to He accumulation and structural damage and, therefore, be highly tolerant to radiation.

miR-339-5p Increases Radiosensitivity of Lung Cancer Cells by Targeting Phosphatases of Regenerating Liver-1 (PRL-1)

BACKGROUND Radiotherapy is the most effective non-surgical modality in lung cancer treatment, and microRNAs (miRNAs) have been suggested as key regulators in radiosensitization. Herein, we explored the specific function of miR-339-5p in the radiosensitivity of lung cancer cells. MATERIAL AND METHODS Radiosensitivity was assessed by cell viability (CCK-8 assay), cell apoptosis, and cell cycle changes (flow cytometry). qRT-PCR and subsequent Western blot assays were used to determine the expression of miR-339-5p and other related proteins. RESULTS We demonstrated that ionizing radiation (IR) exposure impaired lung cancer cell viability, and found that miR-339-5p is a novel IR-inducible miRNA. Overexpression of miR-339-5p enhanced radiosensitivity of A549 and H460 cells by inhibiting cell viability, increasing apoptosis, inducing cell cycle arrest, and suppressing cell proliferation. Further exploration validated that miR-339-5p can target phosphatases of regenerating liver-1  (PRL-1) in lung cancer cells. Restoration of PRL-1 partially reverses the enhanced radiosensitivity of lung cancer cells induced by miR-339-5p. CONCLUSIONS Our data support that miR-339-5p has potential therapeutic value by sensitizing lung cancer cells to radiation via targeting of PRL-1.

Tolerance of combined radiochemotherapy in cervical cancer patients

BACKGROUND

Radiochemotherapy in cervical cancer was implemented to clinical practice based on 5 randomized clinical trials, published at the end of the 20th century, which showed improvement in the total and symptomless survivals by about 10-18%. The increase of therapeutic index of such treatment can take place only when the efficiency of the treatment outweighs the increase of its toxicity. Thus, it is necessary to monitor treatment reaction during radiochemotherapy.

OBJECTIVES

The aim of this study was to assess the acute post-radiation reaction during radiochemotherapy for cervical cancer and the to analyze the reasons of the unplanned course of combined treatment.

MATERIAL AND METHODS

A group of consecutive 176 cervical cancer patients in the clinical stage from IB to IIIB acc. to FIGO classification who underwent radiochemotherapy were taken under prospective observation in Clinical Gynecologic Radiotherapy Ward of the Lower Silesian Cancer Center in Wrocław between April 2010 and September 2012. Early post-radiation reaction was assessed in RTOG/EORTC scale once a week.

RESULTS

During the treatment early post-radiation reaction of upper part of alimentary duct was observed in 74.4% of the patients, the reaction of lower part of gastrointestinal tract in 51.2%, and in bladder 44.8%. The most frequent symptoms of post-radiation reaction are: nausea (73.3% of the patients), diarrhea (51.2%) and vomiting (20.9%). Leucopenia was observed in 97.1% of the patients, granulocytopenia in 70.4%, anemia in 69.2%, and thrombocytopenia in 25.5%. The planned dose of radiotherapy was administered completely in 90.1% of the patients. A break in radiotherapy was necessary in 15.7% of the patients. In total, 44.8% of the patients did not receive radiochemotherapy according to the plan, because of the side effects of the treatment (most often leucopenia, thrombocytopenia and gastrointestinal reaction).

CONCLUSIONS

The presented data shows that radiochemotherapy causes the intensification of acute side effects of treatment and may cause unplanned course of treatment and prolongation of the total treatment time.

Technical Note: System for evaluating local hypothermia as a radioprotector of the rectum in a small animal model

PURPOSE

The protective effects of induced or even accidental hypothermia on the human body are widespread with several medical uses currently under active research. In vitro experiments using human cell lines have shown hypothermia provides a radioprotective effect that becomes more pronounced at large, single-fraction doses common to stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS) treatments. This work describes the development of a system to evaluate local hypothermia for a radioprotective effect of the rat rectum during a large dose of radiation relevant to prostate SBRT. This includes the evaluation of a 3D-printed small animal rectal cooling device and the integration with a small animal irradiator.

METHODS

A 3-cm long, dual-lumen rectal temperature control apparatus (RTCA) was designed in SOLIDWORKS CAD for 3D printing. The RTCA was capable of recirculating flow in a device small enough for insertion into the rat rectum, with a metal support rod for strength as well as visibility during radiation treatment planning. The outer walls of the RTCA comprised of thin heat shrink plastic, achieving efficient heat transfer into adjacent tissues. Following leak-proof testing, fiber optic temperature probes were used to evaluate the temperature over time when placed adjacent to the cooling device within the rat rectum. MRI thermometry characterized the relative temperature distribution in concentric ROIs surrounding the probe. Integration with an image-guided small animal irradiator and associated treatment planning system included evaluation for imaging artifacts and effect of brass tubing on dose calculation.

RESULTS

The rectal temperature adjacent to the cooling device decreased from body temperature to 15°C within 10-20 min from device insertion and was maintained at 15 ± 3°C during active cooling for the evaluated time of one hour. MR thermometry revealed a steep temperature gradient with increasing distance from the cooling device with the desired temperature range maintained within the surrounding few millimeters.

CONCLUSIONS

A 3D-printed rectal cooling device was fabricated for the purpose of inducing local hypothermia in the rat rectum. The RTCA was simply integrated with an image-guided small animal irradiator and Monte Carlo-based treatment planning system to facilitate an in vivo investigation of the radioprotective effect of hypothermia for late rectal toxicity following a single large dose of radiation.

Role of Nrf2 signaling pathway in the radiation tolerance of patients with head and neck squamous cell carcinoma: an in vivo and in vitro study

We aimed to investigate the relationship between the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway and the radiation tolerance of patients with head and neck squamous cell carcinoma (HNSCC). From January 2015 to January 2016, 117 patients with HNSCC were enrolled in our study and assigned into the sensitive and tolerance groups based on curative effect. Immunohistochemistry (IHC) was conducted to measure protein expressions of Nrf2, heme oxygenase-1 (HO1), NADPH quinine oxidoreductase 1 (NQO1) and glutathione S-transferase (GST). Human squamous cell carcinoma cell line, HSC-4, was induced by radiation to construct the HSC-4-radiation resistance (RR) cell line. HSC-4 and HSC-4-RR were also assigned into the blank, negative control (NC) and Nrf2 siRNA groups. Cell Counting Kit-8 (CCK-8), quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting were employed to detect cell viability, mRNA expression and protein expression, respectively, of Nrf2, HO1, NQO1 and GST. A total of 40 nude mice were equally assigned into the untreated, Nrf2 siRNA, radiation therapy (RT) and RT + Nrf2 siRNA groups. Compared with the sensitive group, patients in the tolerance group had upregulated Nrf2, HO1, NQO1 and GST expressions. HSC-4-RR cell line had improved cell viability and higher protein and mRNA expressions of Nrf2, HO1, NQO1 and GST compared with HSC-4 cell line. Compared with the HSC-4-NC and HSC-4-blank groups, the HSC-4-Nrf2 siRNA group had downregulated cell viability. Compared with the HSC-4-RR-NC and HSC-4-RR-blank groups, the HSC-4-RR-Nrf2 siRNA group had lower cell viability. However, the HSC-4-RR-Nrf2 siRNA group had elevated cell viability than the HSC-4-Nrf2 siRNA group. Tumor volume and tumor weight in the RT and RT + Nrf2 siRNA groups decreased evidently. The RT + Nrf2 siRNA group exhibited decreased tumor volume and tumor weight in comparison with the RT group. Our data demonstrated that downregulation of HO1, NQO1 and GST via inhibiting Nrf2 signaling pathway reduces the radiation tolerance of patients with HNSCC.

Significant Radiation Tolerance and Moderate Reduction in Thermal Transport of a Tungsten Nanofilm by Inserting Monolayer Graphene

Tungsten-graphene multilayer composites are fabricated using a stacking method. The thermal resistance induced by the graphene interlayer is moderate. An ion-implantation method is used to verify the radiation tolerance. The results show that graphene inserted among tungsten films plays a dominant role in reducing radiation damage. Furthermore, the performance of different tungsten period-thicknesses in radiation tolerance is systematically analyzed.

Gamma radiation tolerance in different life stages of the fruit fly Drosophila melanogaster

PURPOSE

Insects are known to have higher levels of radiation tolerance than mammals. The fruit fly Drosophila provides opportunities for genetic analysis of radiation tolerance in insects. A knowledge of stage-specific sensitivity is required to understand the mechanisms and test the existing hypothesis of insect radiation tolerance.

MATERIALS AND METHODS

Drosophila melanogaster were irradiated using gamma rays at different life stages. Irradiation doses were chosen to start from 100-2200 Gy with increments of 100 Gy, with a dose rate of 12.5 and 25 Gy/min. The threshold of mortality, LD₅₀ and LD₁₀₀ 1 h post-irradiation was recorded for larvae and adults and 24 h post-irradiation for eggs and after 2-3 days for early and late pupae. Total antioxidant capacity for all the life stages was measured using the phosphomolybdenum method.

RESULTS

Twenty-four hours post-irradiation, 100% mortality was recorded for eggs at 1000 Gy. One hour post irradiation 100% mortality was recorded at 1300 Gy for first instar larvae, 1700 Gy for second instar larvae, 1900 Gy for feeding third instar larvae and 2200 Gy for non-feeding third instar larvae. Post-irradiation complete failure of emergence (100% mortality) was observed at 130 Gy for early pupae and 1500 Gy for late pupae; 100% mortality was observed at 1500 Gy for adults. The values of LD₅₀ were recorded as 452 Gy for eggs, 1049 Gy for first instar larvae, 1350 Gy for second instar larvae, 1265 Gy for feeding third instar larvae, 1590 Gy for non-feeding third instar larvae, 50 Gy for early pupae, 969 Gy for late pupae, 1228 Gy for adult males and 1250 Gy for adult females.

CONCLUSIONS

Early pupae were found to be prone to radiation, whereas the non-feeding third instar larvae were most resistant among all stages. The chromosome number being constant and total antioxidant capacity being nearly constant in all stages, we suggest that high rate of cell division during early pupae makes this stage sensitive to radiation.

Radiation-induced lower cranial nerve palsy in patients with head and neck carcinoma

Radiation-induced cranial nerve palsy (RICNP) is a severe long-term complication in patients with head and neck cancer following high-dose radiation therapy (RT). We present the case report of a patient with bilateral RICNP of the hypoglossal and vagus cranial nerves (XII/X) following postoperative RT in the era prior to the introduction of intensity-modulated RT (IMRT), and an analysis of our IMRT patient cohort at risk including the case of a XII RICNP. A total of 201 patients whose glosso-pharyngeal (IX), X and XII cranial nerves had been exposed to >65 Gy definitive IMRT in our institution between January, 2002 and December, 2012 with or without systemic therapy, were retrospectively identified. A total of 151 patients out of 201 fulfilling the following criteria were included in the analysis: Locoregionally controlled disease, with a follow-up (FU) of >24 months and >65 Gy exposure of the nerves of interest. So far, one of the assessed 151 IMRT patients at risk exhibited symptoms of RICNP after 6 years. The mean/median FU of the entire cohort was 71/68 months (range, 27-145). The results were compared with literature reports. In conclusion, RICNP appears to be a rare complication. However, a longer FU and a larger sample size are required to draw reliable conclusions on the incidence of RICNP in the era of IMRT.

Enhancement of radiosensitization by metal-based nanoparticles in cancer radiation therapy

Radiation therapy performs an important function in cancer treatment. However, resistance of tumor cells to radiation therapy still remains a serious concern, so the study of radiosensitizers has emerged as a persistent hotspot in radiation oncology. Along with the rapid advancement of nanotechnology in recent years, the potential value of nanoparticles as novel radiosensitizers has been discovered. This review summarizes the latest experimental findings both in vitro and in vivo and attempts to highlight the underlying mechanisms of response in nanoparticle radiosensitization.

Spinal cord tolerance in the age of spinal radiosurgery: lessons from preclinical studies

Clinical implementation of spinal radiosurgery has increased rapidly in recent years, but little is known regarding human spinal cord tolerance to single-fraction irradiation. In contrast, preclinical studies in single-fraction spinal cord tolerance have been ongoing since the 1970s. The influences of field length, dose rate, inhomogeneous dose distributions, and reirradiation have all been investigated. This review summarizes literature regarding single-fraction spinal cord tolerance in preclinical models with an emphasis on practical clinical significance. The outcomes of studies that incorporate uniform irradiation are surprisingly consistent among multiple small- and large-animal models. Extensive investigation of inhomogeneous dose distributions in the rat has demonstrated a significant dose-volume effect while preliminary results from one pig study are contradictory. Preclinical spinal cord dose-volume studies indicate that dose distribution is more critical than the volume irradiated suggesting that neither dose-volume histogram analysis nor absolute volume constraints are effective in predicting complications. Reirradiation data are sparse, but results from guinea pig, rat, and pig studies are consistent with the hypothesis that the spinal cord possesses a large capacity for repair. The mechanisms behind the phenomena observed in spinal cord studies are not readily explained and the ability of dose response models to predict outcomes is variable underscoring the need for further investigation. Animal studies provide insight into the phenomena and mechanisms of radiosensitivity but the true significance of animal studies can only be discovered through clinical trials.