Effects of x-irradiation on parameters of tumor growth, histology, and ultrastructure

Effects of radiation on the metastatic process

Radiotherapy remains one of the corner stones in the treatment of various malignancies and often leads to an improvement in overall survival. Nonetheless, pre-clinical evidence indicates that radiation can entail pro-metastatic effects via multiple pathways. Via direct actions on cancer cells and indirect actions on the tumor microenvironment, radiation has the potential to enhance epithelial-to-mesenchymal transition, invasion, migration, angiogenesis and metastasis. However, the data remains ambiguous and clinical observations that unequivocally prove these findings are lacking. In this review we discuss the pre-clinical and clinical data on the local and systemic effect of irradiation on the metastatic process with an emphasis on the molecular pathways involved.

Prodding the Beast: Assessing the Impact of Treatment-Induced Metastasis

The arsenal of treatments for most cancers fit broadly into the categories of surgery, chemotherapy, radiation, and targeted therapy. All represent proven and successful strategies, yet each can trigger local (tumor) and systemic (host) processes that elicit unwanted, often opposing, influences on cancer growth. Under certain conditions, nearly all cancer treatments can facilitate metastatic spread, often in parallel (and sometimes in clear contrast) with tumor reducing benefits. The paradox of treatment-induced metastasis (TIM) is not new. Supporting preclinical studies span decades, but are often overlooked. With recent evidence of prometastatic effects following treatment with targeted agents blocking the tumor microenvironment, a closer inspection of this literature is warranted. The TIM phenomena may diminish the impact of effective therapies and play a critical role in eventual resistance. Alternatively, it may simply exemplify the gap between animal and human studies, and therefore have little impact for patient disease and treatment. This review will focus on the preclinical model systems used to evaluate TIM and explore the mechanisms that influence overall treatment efficacy. Understanding the role of TIM in established and emerging drug treatment strategies may help provide rationales for future drug combination approaches with antimetastatic agents to improve outcomes and reduce resistance.

Radiation to stromal fibroblasts increases invasiveness of pancreatic cancer cells through tumor-stromal interactions

Radiotherapy represents a major treatment option for patients with pancreatic cancer, but recent evidence suggests that radiation can promote invasion and metastasis of cancer cells. Interactions between cancer cells and surrounding stromal cells may play an important role in aggressive tumor progression. In the present study, we investigated the invasive phenotype of pancreatic cancer cells in response to coculture with irradiated fibroblasts. Using in vitro invasion assay, we demonstrated that coculture with nonirradiated fibroblasts significantly increased the invasive ability of pancreatic cancer cells and, surprisingly, the increased invasiveness was further accelerated when they were cocultured with irradiated fibroblasts. The hepatocyte growth factor (HGF) secretion from fibroblasts remained unchanged after irradiation, whereas exposure of pancreatic cancer cells to supernatant from irradiated fibroblasts resulted in increased phosphorylation of c-Met (HGF receptor) and mitogen-activated protein kinase activity, possibly or partially via increased expression of c-Met. We also demonstrated that scattering of pancreatic cancer cells was accelerated by the supernatant from irradiated fibroblasts. The enhanced invasiveness of pancreatic cancer cells induced by coculture with irradiated fibroblasts was completely blocked by NK4, a specific antagonist of HGF. These data suggest that invasive potential of certain pancreatic cancer cells is enhanced by soluble mediator(s) released from irradiated fibroblasts possibly through up-regulation of c-Met expression/phosphorylation and mitogen-activated protein kinase activity in pancreatic cancer cells. Our present findings further support the potential use of NK4 during radiotherapy for patients with pancreatic cancer.

The role of fibronectin in tumor implantation at surgical sites

Fibronectins are a family of glycoproteins with modular functional domains. They mediate cell-cell and cell-matrix interactions which are important in embryogenesis, wound healing, metastasis and other processes. We present data on the influence of fibronectin on wound implantation of a murine mammary carcinoma line, TA3Ha. Fibronectin used in these studies was derived from bovine plasma, human serum, human foreskin fibroblasts, and mouse embryo cultures. TA3Ha cells rarely form tumors in the liver of syngeneic mice when injected intravenously but after hepatic wedge resection, 45% (107/240) of the mice develop tumors in the hepatic wound. Wound implantation is markedly reduced when the cells are pre-exposed to 200 micrograms/ml bovine plasma fibronectin (13%, P = 0.007), human serum fibronectin (0%, P = 0.02), human cellular fibronectin (0%, P = 0.02), or mouse cellular fibronectin (0%, P = 0.04). Lung colonization is also reduced by these fibronectins. These effects are not due to a cytotoxic action of fibronectin, since intraperitoneally injected fibronectin-treated cells form ascites tumor as effectively as do control untreated cells. Local application of a solution containing 0.25 mg/ml mouse cellular fibronectin to the hepatic wound reduces the frequency of tumor implantation from 45% to 5% (1/21, P = 0.001). No tumor implantation inhibition is seen when only suspending medium or albumin in suspending medium is used. The mechanism by which topical application of fibronectin reduces hepatic wound implantation of tumor cells is unclear, but this finding raises an exciting possibility of preventing local recurrence of cancer.

Inhibition of tumor implantation at sites of trauma by Arg-Gly-Asp containing proteins and peptides

We report on the inhibition of wound implantation by TA3Ha mammary carcinoma cells by Arg-Gly-Asp containing proteins and peptides using a hepatic wedge resection model. Intravenously injected TA3Ha cells rarely form tumor in the liver of syngeneic mice, but after hepatic wedge resection, 45% (107/240) of the mice develop tumors in the hepatic wound. Hepatic wound implantation is significantly (P = 0.01) inhibited by pretreating the cells with whole mouse plasma, but not with fibrinogen-depleted plasma or serum. Tumor inhibition is also achieved by pretreatment of cells with fibrinogen (P = 0.05-0.0004), fibronectin (P = 0.007) and laminin, but not by albumin. The active domain appears to be the RGDS sequence since the deca- and tetrapeptides containing RGDS inhibit wound implantation (P less than 0.05). However, the tetrapeptide Arg-Gly-Glu-Ser has no such activity. None of these agents affects ascites tumor formation by the intraperitoneally injected cells, suggesting that anchorage independent growth of cells is not affected. We propose that proteins and peptides containing RGD occupy the binding sites and prevent the cells from interacting with cell adhesion proteins in healing wounds. Proteins and/or peptides containing RGD may be useful for preventing local recurrence in postsurgical cancer patients.

Effects of gamma irradiation on cultured rat and mouse microvessel endothelial cells: metastatic tumor cell adhesion, subendothelial matrix degradation, and secretion of tumor cell growth factors

The effects of gamma-irradiation on the properties of microvessel endothelial cells were studied in vitro. After incubating confluent endothelial cell monolayers in low serum-containing medium for 24 h, the monolayers were irradiated with 137Cs. Survival of rat lung microvessel endothelial (RLE) and mouse brain microvessel endothelial (MBE) cells were similar after irradiation (Do = 2.17 and 1.75 Gy, Dq = 4.44 and 5.67 Gy, and n = 7.8 and 25 for RLE and MBE cells, respectively). We examined the effects of gamma-irradiation on endothelial cell morphology, adhesion of syngeneic rat lung or mouse brain metastasizing tumor cells, release of the subendothelial matrix-degrading enzyme heparanase, and secretion of soluble mitogenic factors that stimulated the growth of syngeneic metastatic tumor cells. The effects of gamma-irradiation were not apparent until several hours after irradiation, and by 24 h doses of greater than or equal to 10 Gy caused limited endothelial cell retraction and reorganization of the endothelial monolayer. By 24 h after irradiation there was also increased adhesion of metastatic tumor cells to RLE but not MBE cells. We also examined the effects of gamma-irradiation on the release from endothelial cells of enzymes that solubilize the subendothelial matrix. Radiation resulted in a significant increase in the release of matrix-degrading enzyme (heparanase) that solubilized [35S]-labeled heparan sulfate from subendothelial matrix. This was most pronounced in the 24 h sample from gamma-irradiated endothelial cells. Finally, we examined the gamma-irradiation-induced release of mitogenic factors from endothelial cells that could stimulate the growth of metastatic cells in serum-limiting medium. The medium from RLE but not MBE cells stimulated the growth of a rat mammary carcinoma cell line. The results suggest that gamma-irradiation of microvessel endothelial cells can affect the interactions of tumor cells with endothelial cells and their subendothelial matrix; these processes could facilitate metastasis formation in irradiated tissues such as the lung.

Development of lymph node and pulmonary metastases after local irradiation and hyperthermia of footpad melanomas

C57BL/6 mice with syngeneic B16-F10 melanomas were treated 7 days after tumor inoculation into the footpad with local hyperthermia (HT) of 43.5 degrees C for 90 min. A combination of local 30 Gy X-irradiation (XRT) given 2, 4 or 12 h after HT cured the primary tumor in 34/35 mice, with irreversible damage to normal foot tissues in most of the animals. When 7.5, 10 or 15 Gy XRT were delivered 4, 18 or 24 h after HT, there were only a small number of cures and also a much smaller incidence of irreversible normal tissue damage. HT alone resulted in a significant (P less than 0.001) increase in metastases to regional lymph nodes (RLN) and the lungs. The 'curative' doses of combined XRT and HT resulted in a significant (P less than 0.001) decrease in metastasis to RLN and to the lungs. Conversely, subcurative doses of combined therapy resulted in an increase in RLN and lung metastasis (P less than 0.001). Abdominal lymph node metastasis, not usually seen in control mice, is markedly increased after HT alone or in combination with subcurative XRT (P less than 0.001). The overall survival of mice treated with HT alone is decreased (P less than 0.0028). The survival of mice treated with HT followed 4, 18 or 24 h later with 10 Gy XRT is further decreased (P less than 0.0025). These data show that subcurative HT, or XRT plus HT, increases the incidence of spontaneous metastasis in this syngeneic mouse melanoma model. Curative doses prevent this effect on metastasis, but there is an unacceptable incidence of irreversible damage to the tumor-bearing foot. The cause(s) of this phenomenon are not known.

Radiation enhancement of metastasis: a review

Virtually every modality employed in the treatment of cancer has demonstrated an adverse effect upon metastasis under some conditions. This review surveys the experimental and clinical literature pertaining to the untoward effects of ionizing radiation upon metastatic processes. Two processes are described: (1) enhancement of metastases following local tumor irradiation; (2) localization of metastasis in previously irradiated normal tissues. In the first process the experimental evidence indicates a local effect of irradiation upon the tumor-stroma interface. It predominates under conditions of non-curative radiation doses. There is no proof that this process occurs in clinical practice, but a review of data provides suggestive evidence for its existence following non-curative therapy. The second process is documented both experimentally and clinically. It requires the presence of viable, circulating tumor cells and appears mediated through vascular damage. The few clinical reports suggest that this effect is rare in practice. The clinical significance of both processes appears small under conditions of effective tumor therapy, but it is speculated that inadequate tumor irradiation, or irradiation of normal tissues with uncontrolled tumor elsewhere, may be deleterious.

Influence of irradiation of a primary tumor on the labeling index and estrogen receptor index in a distant tumor focus

The present investigation reaffirms our observation that removal of a C3H mouse mammary adenocarcinoma results in a perturbation of tumor cells in a metastatic focus. An increase occurs in the proportion of cells undergoing DNA synthesis (labeling index, LI), and a decrease occurs in the proportion demonstrating estrogen receptor (ER index; ERI). The changes are transient but of sufficient duration and magnitude to produce an increase in the size of a distant tumor. This study was conducted to determine whether cytoreduction of a primary tumor by irradiation would produce a similar change in metastatic tumor cells and whether preoperative radiation would obtund the effect of primary tumor removal. The administration of a maximum tolerated dose of radiation (50 Gy) to a primary tumor produced a significant (p less than 0.001) increase in LI and decrease in ERI of a lesser magnitude than that observed following surgical removal of the primary tumor, but still sufficient to enhance the growth of a metastatic focus. Whereas, there was almost a 50% increase in LI in a metastasis 1 and 3 days following removal of a primary tumor the increase was only 13% three days after radiation. There was a 20% decrease in ERI 3 days following radiation and a 37% decrease at that time following tumor removal. Preoperative irradiation of a primary tumor 1, 3, or 5 days prior to tumor removal, obtunds the increase in LI and decrease in ERI following operation. Radiation the day before surgery was most effective because the changes in a distant focus occurring as a result of the radiation and of the surgery were prevented. The clinical relevance of these observations deserves further consideration.

Metastasis and the excision of irradiated LMCI tumours in the rat

Lymph node metastases occurring within 150 days of local non-curative irradiation and excision of a transplantable mammary adenocarcinoma (LMCI) have been scored and their growth measured in isogeneic rats. Single doses (5-40 Gy) of 60Co gamma-rays were given to the primary at 8-10 mm diameter and these were excised either immediately or up to 30 days later. From the results it is concluded that approximately half of all rats have occult dissemination at the time of irradiation. Only these form metastases after the early excision of 10-40 Gy treated tumours but the number of positive sites per animal is significantly reduced. Delayed excision of the irradiated primary permits the further seeding of metastases and, with its regrowth, the incidence of positive rats and the mean number of metastases per animal is restored to that observed after control surgery. This process was dependent on the radiation-induced delay in growth of the primary tumour. However, all metastases, irrespective of site, radiation dose, and time of primary tumour excision showed a growth rate characteristic of the untreated LMCI tumour. No evidence was obtained for an enhancement in the dissemination of metastatic cells from the irradiated but regrowing primary tumour. However, an alteration in the pathways of lymphatic dissemination leading to an increased number of metastases seeding the mediastinum and abdominal lymph nodes may have occurred.

Skin metastases confined to a field of previous irradiation. Report of two cases and review of the literature

Two cases of tumor recurrence within a previously irradiated skin area are reported. Typical lesions evolve from an erythematous base and progress to induration and tumor papules. A review of clinical literature indicates that irradiation does not increase the frequency of metastases. Experimental data suggest that irradiation does increase metastases as a result of both local mechanical factors and increased tumor-cell survival.

Immunology of metastasis. Can the immune response cope with disseminated tumor?

The application of immunologic methods to the treatment of neoplasia has been a goal of research in tumor immunology. Unfortunately, no clearly defined success for such therapy has been achieved. However, the most recent advances in tumor biology have provided for a more valid conceptual framework upon which to plan further research in this area. The more general awareness of tumor progression and heterogeneity, particularly in the context of tumor metastasis, while imposing a sense of gloom regarding all therapeutic modalities, shifted immunologic thinking toward the development of nonspecific modalities. We herein propose that this 'shift' may be premature and that immunotherapy using cytolygic T cells could still be feasible. Our views are based on newer approaches for selecting immunogenic variants of malignant tumors and a better understanding of the relationship of the immune response to metastases.

Comparison of metastatic disease after local tumour treatment with radiotherapy or surgery in various tumour models

Spontaneous metastases in lymph nodes and/or the lung were obtained after tumour cell inoculation of four mouse tumours and one rat tumour into the foot-pads of syngeneic animals or their F1 hybrids. Following local radiotherapy with doses of 45-80 Gy, significantly more mice died with metastases than following local amputation of the tumour-bearing foot when the 2661 carcinoma was involved. No significant difference was observed after these treatments for the other tumours. The enhancement of metastastic growth after local radiotherapy in the 2661 carcinoma seems not to be due to incomplete killing of tumour cells in the foot. The presence of irradiated normal structures and tumour tissue after radiotherapy promoted the outgrowth of 261 carcinoma cells which were outside the radiation field at the time of treatment. Evidently, even under similar experimental conditions, radiotherapy may enhance the growth of metastases from some tumours and not from others.

Circadian variations in 32P uptake of DMBA-induced mammary tumour and Walker carcinosarcoma in rats

The 32P uptake in a mammary tumour induced by DMBA and in the Walker 256 carcinosarcoma was measured by external GM -tubes. The uptake was significantly higher than in the skin. During exposure to a synchronized light regime a circadian variation was present in the 32P uptake of the hormone-dependent DMBA-induced tumour. The maximal 32P uptake was in the dark period, in which the highest temperature in the tumour has also been found (Møoller and Bojsen, 1975). In the hormone-independent Walker 256 carcinosarcoma there was no periodicity in 32P uptake. No variation in 32P uptake was registered in the skin of normal controls or in tumour-bearing rats.

Effect of lung irradiation on the incidence of pulmonary metastases and its mechanism

LP-12 cells injected intravenously into ddY mice result in the formation of visible lung colonies which are introduced as a model for pulmonary metastases. Localized irradiation before tumour cell transplantation significantly increased the incidence of pulmonary metastases in the irradiated lung only. The changes of the vascular permeability of the lung indicate that dilatation of capillaries or increased permeability may be one of the main mechanisms of this phenomenon.

Enhancement by drugs of metastatic lung nodule formation after intravenous tumour cell injection

In studies on a model of induced pulmonary metastasis in mice a tumour host system was analysed which was not affected by immunogenicity of the tumour for the host; neither intensive immunosuppression nor immunization caused a significant change in the quantity of pulmonary metastatic nodules. In contrast the application of cytostatic drugs and of Corynebacterium parvum could modify the pulmonary resistance to the formation of tumour nodules by a factor greater than 100 in either direction. This finding confirms the observation of others that major modification of the resistance to metastatic tumour formation can occur independently of classical immunological mechanisms. Special attention is drawn to the fact that cyclophosphamide enhances the formation of metastatic nodules in this model by factors of 100 to more than 1,000 whereas other cytostatic drugs including the cyclophosphamide congeners iphosphamide and trophosphamide are active only factors between 2 and 12. The possible practical significance of these findings is discussed.