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Sora S, Sukhbaatar A, Fukushige S, Mori S, Sakamoto M, Kodama T. Combination therapy of lymphatic drug delivery and total body irradiation in a metastatic lymph node and lung mouse model. Cancer Sci 2022; 114:227-235. [PMID: 36056924 PMCID: PMC9807513 DOI: 10.1111/cas.15562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023] Open
Abstract
Chemotherapy using a lymphatic drug delivery system (LDDS) targeting lymph nodes (LNs) in the early stage of metastasis has a superior antitumor effect to systemic chemotherapy. An LDDS produces a higher drug retention rate and tissue selectivity in LNs. To expand the therapeutic coverage of LDDS from local treatment of metastatic LNs to prevention of distant metastases, the combination of treatment with therapies that enhance systemic tumor immune effects is an important therapeutic strategy. Recently, total body irradiation (TBI) has been shown to activate immune responses and alter the tumor microenvironment. Here we show that combination therapy with TBI and LDDS improves the antitumor effect of metastatic LNs and lung metastasis. Tumor cells were inoculated into the subiliac LN (SiLN) to induce metastasis into the proper axillary LN (PALN) and lung in a mouse model. TBI was carried out on day 4 after inoculation using a gamma irradiator. Lymphatic drug delivery into the accessory axillary LN was used to treat PALN. In vivo bioluminescence imaging, high-frequency ultrasound, and histology showed that combination therapy using TBI (total dose 1.0 Gy once) and the LDDS suppressed tumor growth in LNs and lung metastases and was more effective than using LDDS or TBI alone. Quantitative RT-PCR of spleens after combination therapy revealed increased expression of CD4, CD8, and IL-12b, indicating an activated immune response. The results show that combination therapy with TBI and LDDS is a method to improve the efficacy of LN metastases and distant metastases therapy and is a promising novel approach to treat cancer patients.
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Affiliation(s)
- Shota Sora
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical EngineeringTohoku UniversitySendaiJapan
| | - Ariunbuyan Sukhbaatar
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical EngineeringTohoku UniversitySendaiJapan,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical EngineeringTohoku UniversitySendaiJapan
| | - Shinichi Fukushige
- Department of Metabolism and Diabetes, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Shiro Mori
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical EngineeringTohoku UniversitySendaiJapan,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical EngineeringTohoku UniversitySendaiJapan
| | - Maya Sakamoto
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical EngineeringTohoku UniversitySendaiJapan,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical EngineeringTohoku UniversitySendaiJapan
| | - Tetsuya Kodama
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical EngineeringTohoku UniversitySendaiJapan,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical EngineeringTohoku UniversitySendaiJapan
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Arrichiello G, Pirozzi M, Facchini BA, Facchini S, Paragliola F, Nacca V, Nicastro A, Canciello MA, Orlando A, Caterino M, Ciardiello D, Della Corte CM, Fasano M, Napolitano S, Troiani T, Ciardiello F, Martini G, Martinelli E. Beyond N staging in colorectal cancer: Current approaches and future perspectives. Front Oncol 2022; 12:937114. [PMID: 35928863 PMCID: PMC9344134 DOI: 10.3389/fonc.2022.937114] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Traditionally, lymph node metastases (LNM) evaluation is essential to the staging of colon cancer patients according to the TNM (tumor–node–metastasis) system. However, in recent years evidence has accumulated regarding the role of emerging pathological features, which could significantly impact the prognosis of colorectal cancer patients. Lymph Node Ratio (LNR) and Log Odds of Positive Lymph Nodes (LODDS) have been shown to predict patients’ prognosis more accurately than traditional nodal staging and it has been suggested that their implementation in existing classification could help stratify further patients with overlapping TNM stage. Tumor deposits (TD) are currently factored within the N1c category of the TNM classification in the absence of lymph node metastases. However, studies have shown that presence of TDs can affect patients’ survival regardless of LNM. Moreover, evidence suggest that presence of TDs should not be evaluated as dichotomic but rather as a quantitative variable. Extranodal extension (ENE) has been shown to correlate with presence of other adverse prognostic features and to impact survival of colorectal cancer patients. In this review we will describe current staging systems and prognostic/predictive factors in colorectal cancer and elaborate on available evidence supporting the implementation of LNR/LODDS, TDs and ENE evaluation in existing classification to improve prognosis estimation and patient selection for adjuvant treatment.
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Affiliation(s)
- Gianluca Arrichiello
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mario Pirozzi
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Bianca Arianna Facchini
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Sergio Facchini
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fernando Paragliola
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Valeria Nacca
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonella Nicastro
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Maria Anna Canciello
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Adele Orlando
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marianna Caterino
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Davide Ciardiello
- Oncology Unit, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Carminia Maria Della Corte
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Morena Fasano
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Stefania Napolitano
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Teresa Troiani
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fortunato Ciardiello
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giulia Martini
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Erika Martinelli
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
- *Correspondence: Erika Martinelli,
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Yang H, Zeng M, Cao S, Jin L. Nomograms predicting prognosis for locally advanced hypopharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2021; 279:3041-3052. [PMID: 34648051 DOI: 10.1007/s00405-021-07109-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to construct nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) for patients with locally advanced hypopharyngeal squamous cell carcinoma (HSCC). METHODS 864 patients with locally advanced HSCC during 2010-2015 from the surveillance, epidemiology and end results (SEER) database were selected. After classifying continuous data by risk, Cox regression analyses were applied to detect significant independent prognostic factors, with which nomograms were established. To evaluate the value of nomograms, concordance index (C-index), area under the receiver-operating characteristic (ROC) curve (AUC), calibration curves, and decision curve analysis (DCA), Kaplan-Meier analysis was adopted. The efficacy of surgery in different risk groups was also studied to figure out people who can benefit from surgery. RESULTS A total of 864 locally advanced HSCC patients were randomized into the training cohort (n = 608) and the validation cohort (n = 256). Age, race, tumor size, T stage, N stage, primary site, radiotherapy, and chemotherapy were independent prognostic factors for OS and CSS (except race) and formed the nomograms. The nomograms revealed satisfied performance in C-index, AUC, DCA, and calibration curves, and prevailed over American Joint Committee on Cancer (AJCC) TNM staging system in predicting OS and CSS. After risk stratification, patients of low-risk group resulted in the best outcomes. Patients in moderate-risk may benefit from surgery. CONCLUSIONS Convenient and well-calibrated nomograms to predict OS and CSS for III/IVA/IVB-stage HSCC patients were set up and assessed and may do a favor to make clinical decisions.
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Affiliation(s)
- Huiyun Yang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Mengsi Zeng
- Department of Oncology, The First People's Hospital of Changde, Changde, 415000, China
| | - Sudan Cao
- Department of Oncology, Third Xiangya Hospital, Central South University, Changsha, 410000, China
| | - Long Jin
- Department of Oncology, Third Xiangya Hospital, Central South University, Changsha, 410000, China.
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