Inhalation anesthesia in experimental radiotherapy: a reliable and time-saving system for multifractionation studies in a clinical department

Irradiation combined with SU5416: microvascular changes and growth delay in a human xenograft glioblastoma tumor line

PURPOSE

The combination of irradiation and the antiangiogenic compound SU5416 was tested and compared with irradiation alone in a human glioblastoma tumor line xenografted in nude mice. The aim of this study was to monitor microenvironmental changes and growth delay.

METHODS AND MATERIALS

A human glioblastoma xenograft tumor line was implanted in nude mice. Irradiations consisted of 10 Gy or 20 Gy with and without SU5416. Several microenvironmental parameters (tumor cell hypoxia, tumor blood perfusion, vascular volume, and microvascular density) were analyzed after imunohistochemical staining. Tumor growth delay was monitored for up to 200 days after treatment.

RESULTS

SU5416, when combined with irradiation, has an additive effect over treatment with irradiation alone. Analysis of the tumor microenvironment showed a decreased vascular density during treatment with SU5416. In tumors regrowing after reaching only a partial remission, vascular characteristics normalized shortly after cessation of SU5416. However, in tumors regrowing after reaching a complete remission, permanent microenvironmental changes and an increase of tumor necrosis with a subsequent slower tumor regrowth was found.

CONCLUSIONS

Permanent vascular changes were seen after combined treatment resulting in complete remission. Antiangiogenic treatment with SU5416 when combined with irradiation has an additive effect over treatment with irradiation or antiangiogenic treatment alone.

Modulation of rodent spinal cord radiation tolerance by administration of platelet-derived growth factor

PURPOSE

To examine the role of platelet-derived growth factor (PDGF) for ameliorating radiation myelopathy of the cervical spinal cord in a rodent model.

METHODS AND MATERIALS

After developing the technique for cannulation of the basal cistern, initial animal experiments were conducted to test the feasibility of intrathecal continuous infusion of PDGF in a model of cervical spinal cord irradiation in adult Fisher F-344 rats and to determine the most effective dose level of PDGF. Subsequently, the dose-modification factor was determined in a larger group of rats. Irradiation was given in 2 fractions (16 Gy followed by 14-24 Gy) and animals were examined for the development of paresis.

RESULTS

The initial dose-finding experiment revealed significant differences in the incidence of radiation myelopathy (100% in saline-treated control rats, 25% with the most effective dose of PDGF, up to 100% with less effective doses). The most effective dose of PDGF was 0.014 mug per day. Subsequent experiments revealed a median effective dose (ED(50)) of 35.6 Gy (95% confidence interval, 34.7-36.5 Gy) for animals receiving this dose of PDGF in contrast to 33.8 Gy (33.4-34.3 Gy) for the control group (p = 0.003). The dose-modification factor obtained with this dose of PDGF was 1.05.

CONCLUSIONS

Intrathecal administration of PDGF concomitant to irradiation of the cervical spinal cord in rats was feasible. Treatment with PDGF significantly increased the tolerance of the spinal cord. The PDGF experiments should be viewed as a proof of principle that brief therapeutic intervention in the earliest phase of damage induction can reduce late effects in the spinal cord. They form the basis for further studies of growth factor administration in this particular model.

Radiation Tolerance of the Rat Spinal Cord after Single and Split Doses of Photons and Carbon Ions1

The sensitivity of the rat spinal cord to single and split doses of radiation and the resulting relative biological effectiveness (RBE) were determined for carbon-ion irradiations (12C) in the plateau and Bragg-peak regions. The cranial part of the cervical and thoracic spinal cords of 180 rats were irradiated with one or two fractions of 12C ions or photons, respectively. Dose-response curves for the end point symptomatic myelopathy were established, and the resulting values for the ED50 (dose for 50% complication probability) were used to determine the RBEs. A median latency for myelopathy of 167 days (range, 121-288 days) was found. The ED50 values were 17.1 +/- 0.8 Gy, 24.9 +/- 0.7 Gy (one and two fractions, 12C plateau) and 13.9 +/- 0.8, 15.8 +/- 0.7 Gy (one and two fractions, 12C Bragg peak), respectively. For photons we obtained ED50 values of 24.5 +/- 0.8 Gy for single doses and 34.2 +/- 0.7 Gy when two fractions were applied. The corresponding RBEs were 1.43 +/- 0.08, 1.37 +/- 0.12 (one and two fractions, 12C plateau) and 1.76 +/- 0.05, 2.16 +/- 0.11 (one and two fractions, 12C Bragg peak), respectively. Hematoxylin and eosin staining revealed necrosis of the white matter in the spinal cord in all symptomatic animals. In summary, from one- and two-fraction photon, 12C plateau and Bragg-peak irradiation of the rat spinal cord, we have established RBEs as well as the individual ED50's. From the latter there is a clear indication of repair processes for fractionated photons and 12C plateau ions which are significantly reduced by using Bragg-peak ions. Additional studies are being carried with 6 and 18 fractions to further refine and define the RBE and ED50 values and estimate the alpha/beta ratios.

Erythropoietin restores the anemia-induced reduction in radiosensitivity of experimental human tumors in nude mice

PURPOSE

The effect of recombinant human erythropoietin (rhEPO) on the radiosensitivity of human tumor xenografts growing in anemic and nonanemic nude mice was studied.

METHODS AND MATERIALS

Anemia was induced by total body irradiation ([TBI], 2 x 4 Gy) of mice before tumor implantation into the subcutis of the hind leg. The development of anemia was prevented by rhEPO (750 U/kg s.c.) given 3 times weekly starting 2 weeks before TBI. Fourteen days after fractionated TBI (tumor volume of approx. 40 mm(3)), single-dose irradiation of the tumor with varying doses was performed so that in full dose-response relationship for the probability of tumor cure was obtained.

RESULTS

Radiation-induced anemia (hemoglobin concentration [cHb] = 9.9 g/dl) led to a reduced radiosensitivity compared to controls [49.4 vs. 40.1 Gy radiation dose to control 50% of the tumors (TCD50)]. Upon rhEPO treatment for anemia prevention (cHb = 13.3 g/dl), the TCD50 was 39.8 Gy, illustrating restored radiosensitivity compared to anemic mice.

CONCLUSION

These data provide further experimental evidence for restored radiosensitivity upon prevention of anemia with rhEPO.

Changes in blood perfusion and hypoxia after irradiation of a human squamous cell carcinoma xenograft tumor line

The effect of irradiation depends on the oxygenation status of the tissue, while irradiation itself also changes the oxygenation and perfusion status of tissues. A better understanding of the changes in tumor oxygenation and perfusion over time after irradiation will allow a better planning of fractionated radiotherapy in combination with modifiers of blood flow and oxygenation. Vascular architecture (endothelial marker), perfusion (Hoechst 33342) and oxygenation (pimonidazole) were studied in a human laryngeal squamous cell carcinoma tumor line grown as xenografts in nude mice. The effect of a single dose of 10 Gy X rays on these parameters was evaluated from 2 h to 11 days after irradiation. Shortly after irradiation, there was an 8% increase in perfused blood vessels (from 57% to 65%) followed by a significant decrease, with a minimum value of 42% at 26 h after irradiation, and a subsequent increase to control levels at 7 to 11 days after irradiation. The hypoxic fraction showed a decrease at 7 h after treatment from 13% to 5% with an increase to 19% at 11 days after irradiation. These experiments show that irradiation causes rapid changes in oxygenation and perfusion which may have consequences for the optimal timing of radiotherapy schedules employing multiple fractions per day and the introduction of oxygenation- and perfusion-modifying drugs.

Quiescent S-phase cells as indicators of extreme physiological conditions in human tumor xenografts

PURPOSE

During the last 20 years, evidence has been accumulating for the existence in animal and human tumors of quiescent S-phase cells, i.e. cells with an S-phase DNA content that do not actively synthesize DNA. In cell culture studies, quiescent S-phase cells have been observed under physiological conditions typical for poorly vascularized regions of tumors such as reduced pH, hypoxia, and glucose deprivation. Therefore, we studied the possible correlation between the frequency of quiescent S-phase cells and the oxygenation status as determined polarographically in a number of human tumor xenografts.

METHODS AND MATERIALS

Five human tumor xenografts on nude mice were used. Oxygenation was measured polarographically with an Eppendorf pO2-Histograph in 24 to 30 individual tumors for each entity. Mice were injected intraperitoneally with 1 mg/30 g bodyweight bromodeoxyuridine (BrdU), tumors were excised 30 min later and prepared into a single-cell suspension. After immunofluorescence staining with an antibody against BrdU and staining of the DNA with propidium iodide, cells were measured in a FACScan flow cytometer and the frequency of cells in the S-phase compartment that did not incorporate BrdU was determined.

RESULTS

In most cases, the frequency of measurements of an oxygen partial pressure <5 mm Hg in the tumor tissue increased with tumor volume. Likewise, the frequency of quiescent S-phase cells was generally higher in larger tumors. Taking all five tumor entities together, there was a highly significant correlation between tumor oxygenation and the occurrence of quiescent S-phase cells.

CONCLUSIONS

Our data confirm earlier findings that inactive S-phase cells do exist in vivo. Because their frequency seems to be dependent (directly or indirectly) on the degree of oxygenation and has been shown to increase not only with hypoxia, but also with reduced pH and glucose deprivation in vitro, the frequency of inactive S-phase cells may be considered a summary indicator for extreme physiological conditions in tumors.

Tumour oxygenation during fractionated radiotherapy--comparison with size-matched controls

The effect of fractionated irradiation on the oxygenation status of experimental tumours was investigated using polarographic assessment of the pO2 distribution. Since an improvement in tumour oxygenation could simply be the result of tumour shrinkage, a comparison of pO2 readings of untreated size-matched control tumours was performed. Irradiation was carried out using 6 fractions of 6 Gy applied within 11 days. A comparison of polarographic pO2 data with size-matched untreated tumours revealed a significant improvement in oxygenation after the irradiation. The median pO2 was 0.9+/-0.1 mm Hg for unirradiated tumours at a volume of 180 mm3, while the corresponding data for irradiated tumours of comparable size were 2.3+/-0.5 mm Hg on day 21 and 4.8+/-0.9 mm Hg on day 28 after start of irradiation. From these results it can be concluded that the improvement of oxygenation after fractionated irradiation is not solely the result of a reduced tumour volume.

Small intestinal dysmotility following abdominal irradiation in the rat small intestine

Abdominal symptoms such as diarrhoea, abdominal cramps and vomiting are common during and after abdominal radiotherapy for gynaecological and pelvic malignancy. It has recently been recognized that small intestinal dysmotility may contribute to these symptoms but the underlying mechanisms are unclear in part because of the technical difficulties inherent in performing studies in irradiated small intestine. The aim of the current study was to evaluate small intestinal motor activity using perfused micromanometric techniques in 6-8-cm segments of ileum during arterial perfusion with isotonic oxygenated fluorocarbon solution. Intestinal segments from six rats were studied 4 days after treatment with 10 Gy abdominal irradiation. Ileal segments from nine nonirradiated animals acted as controls. For each experiment the total number of pressure waves, high-amplitude (> 20 mmHg, long-duration > 6 sec) pressure waves, and long (> 20 associated) bursts of pressure waves were determined. Irradiation had no effect on the overall number of pressure waves, but increased high-amplitude long-duration (HALD) pressure waves (248 vs 7, P < 0.01). In control animals HALD waves were localized to a single recording site but after radiotherapy 74% of HALD waves were temporally associated with similar pressure waves in other manometric channels. Forty-seven per cent of associated HALD waves migrated aborally. Retrograde migration of HALD waves was seen in five segments following irradiation. Irradiation abolished bursts of > 20 pressure waves.

Experimental studies on the possible influence of invasive oxygen measurements on tumour radiosensitivity

The effects of tissue damage associated with invasive pO2 measurements on radiation sensitivity were investigated using a xenografted squamous cell carcinoma model. For the tumour cure experiments, single dose irradiations were given following different regimens of polarographic pO2 measurements associated with different degrees of mechanical tissue damage. With a dose of 32 Gy, 57% of animals were cured. Following 3 tracks of needle measurements, 73% of tumours were locally controlled, and 75% were cured after 8 needle tracks. The polarographic measurements gave virtually identical oxygenation data for recurrent or cured tumours (both median pO2 1.0 mmHg), respectively. There was thus no evidence of decreased radiosensitivity associated with tissue damage after invasive pO2 measurements. The pre-therapeutic oxygenation status gave no evidence for a prediction of radiation response on an individual basis.

The effect of combined nicotinamide and carbogen treatments in human tumour xenografts: oxygenation and tumour control studies

BACKGROUND AND PURPOSE

This was an investigation to study the effect of giving carbogen and nicotinamide (CON) on pO2 and the radiation response of human xenografted tumours.

MATERIALS AND METHODS

The human xenografts were two sarcomas (ENE2 and ES3) and a glioblastoma (HTZ17). Nicotinamide (500 mg/ kg, i.p.) was administered 60 min before PO2 measurements and irradiation, while carbogen was given for 5 min before and during these treatments. Tumour pO2 was measured with an Eppendorf electrode and radiation response was assessed by local tumour control following irradiation with 10 daily fractions.

RESULTS

All three xenografts were found to be poorly oxygenated (about 80% of all pO2 values were < or =2.5 mmHg). CON treatment improved the oxygenation status in all three tumours such that 65, 52 and 71% of the pO2 values were < or =2.5 mmHg in ENE2, ES3 and HTZ17, respectively. However, only in ES3 was this decrease significant. The TCD50 doses for all tumours were around 52-54 Gy. No significant improvement was seen with CON in ENE2 (TCD50 = 48 Gy) and HTZ17 (TCD50 = 56 Gy), but for the ES3 xenograft a significant decrease to 42 Gy was found.

CONCLUSIONS

The three tumours used in this study appeared to show the same level of hypoxia as measured both by pO2 and radiation response. However, only one tumour showed a significant improvement after CON treatment, suggesting that not all hypoxic human tumours might benefit from this type of therapy.

Kinetics of repair in the spinal cord of the rat

PURPOSE

Split dose experiments were carried out with two 2 Gy fractions per day at intervals ranging from 0.5 to 24 h, in order to investigate both the time to complete repair and the detailed kinetics of repair of sublethal damage in the cervical spine of rats.

MATERIALS AND METHODS

Male rats of the WAG/Rij strain were irradiated at 2 Gy/min with 18 MV photons to a length of 18 mm of cervical spinal cord. Four hundred twenty-three rats were irradiated without top-up doses to investigate whether repair was complete by 24 h or whether any slow repair or proliferation occurred up to 50 days after irradiation. Three hundred seventy-nine rats were also irradiated in split dose (2 Gy + delta t + 2 Gy each day) experiments, with intervals of 0.5, 1, 2, 4, 8 and 24 h. The split dose irradiations were followed by a single top-up dose of 15 Gy (producing about half the total damage).

RESULTS

Repair was complete by 24 h as the ED50 values were the same at 1, 11 and 50 day intervals for two large fractions, and for 10 fractions in 10 or 50 days. A mono-exponential component of repair of T1/2 = 0.25 (95% CI 0.16-0.48) h was determined by direct analysis using all the data and T1/2 = 0.37 (0.28-0.53) h for the split 2 Gy doses with top-up only. A bi-exponential analysis did not fit better. The presence of a second component was demonstrated graphically, with T1/2 of about 6.5 h but with a wide confidence interval from near 0 to 13 h. However, the 24 h ED50 was significantly different from all ED50s except the 8 h value. Considering all data together, an upper limit of about 7 h could be placed on any long component, or else repair could not be complete by 24 h.

DISCUSSION AND CONCLUSIONS

Two components of repair (0.7 and 3.8 h) have been reported by Ang et al. (Ang, K.K., Jiang, G.L., Guttenberger, R., Thames, H.D., Stephens, L.C., Smith, C.D. and Feng, Y. Impact of spinal cord repair kinetics on the practice of altered fractionation schedules. Radiother. Oncol. 25: 287-294, 1992) in the spinal cord of Sprague-Dawley rats. Two components have also been reported by others more recently. The present results could, with its graphical interpretation, agree in principle, but with a shorter fast component and a longer slow component. A slow component of 5.5 h was reported by Ruifrok et al. (Ruifrok, A.C.C., Kleiboer, B.J. and van der Kogel, A.J. Fractionation sensitivity of rat cervical spinal cord during radiation retreatment. Radiother. Oncol. 25: 295-300, 1992) in a related strain of WAG/Rij rats. The possible presence of a slower component than Ang et al.'s 3.8 h might help to explain the four myelopathies observed in the pilot studies for the CHART clinical trial. The presence of the definite fast component (< 0.5 h) could have important consequences when pulsed brachytherapy is used to replace continuous low dose rate irradiation.

Is pulsed dose rate more damaging to spinal cord of rats than continuous low dose rate?

BACKGROUND AND PURPOSE

Theoretical calculations suggest that pulsed dose-rate irradiation (PDR) should have approximately the same effectiveness as continuous low dose-rate (CLDR) when the same total dose is given in the same overall time, unless large doses per pulse (> 2 Gy) are used and/or non-exponential or very short half-times of repair (< 0.5 h) are present in the irradiated tissues. However, few animal experiments have been reported to test this theory, and some of them gave contradictory results. We have carried out experiments to determine whether PDR irradiation of 18 mm of cervical spinal cord in the rat was more or less effective than CLDR at 0.5-1 Gy/h, when the overall average dose rate during each day of PDR was close to the overall CLDR average dose rate.

MATERIALS AND METHODS

PDR was simulated at a within-pulse dose rate of 4 Gy/h by filtered 18 MV X-rays from a linear accelerator. Two PDR schedules were used, 0.69 Gy at 1 h repetition (9 pulses per day) and 2 Gy at 3 h repetition (4 pulses per day), with overnight intervals of 16 and 15 h, respectively. The CLDR was delivered from iridium-192 wires in two concentric rings around a collar designed to fit the necks of rats so that they could eat and drink during the 72 h that was always the duration of the CLDR. Dose rate was then proportional to total CLDR dose. A range of doses was used to obtain dose response-curves, with a 15 Gy top-up dose (at 2 Gy/min, HDR) given on the day after the end of the PDR or CLDR irradiations. Animals were observed for at least 9 months to see whether fore-limb myelopathy developed. A total of 6-8 rats was irradiated per dose point, in two sets of experiments at an interval of 12 months.

RESULTS

A set of 2 Gy fractions (at HDR) given daily, followed by the same top-up dose of 15 Gy at HDR, was available from a previous experiment for planning. Its ED50 was 61.2 Gy. The ED50 values found for the PDR schedules with 2 Gy at 3 h and 0.69 Gy at 1 h were 59.9 and 60.2 Gy, respectively. These were just 2% more effective than the daily HDR fractions, similar to expectations from theory if two components of repair are present. However, the CLDR irradiations resulted in no myelopathy even after doses up to 68 Gy at 0.94 Gy/h.. Thus PDR over 7 days (not at nights) appears to be more effective than CLDR over 3 days, with an effective dose-modifying factor of at least 1.1 to 1.17.

DISCUSSION AND CONCLUSIONS

Reasons for this absence of effect with CLDR in these experiments are discussed, the most likely explanation being that a substantial component of repair with very short T1/2 (< 0.5 h) was present in spinal cord of these rats. There is evidence from other experiments elsewhere and in our laboratory for such a fast component of repair.

The influence of platinum drugs on the radiation response of rat kidneys

The influence of a single bolus injection of platinum drugs on the radiation sensitivity of the kidneys was investigated in WAG/Rij rats. Drugs employed were cis-diammine-dichloroplatinum(II) (cisplatin, CDDP), cis-diammine-1,1-cyclobutanedicarboxylate platinum(II) (carboplatin, CBDCA) and cis-dichloro,trans- dihydroxy-bis-isopropylamine platinum(IV) (iproplatin, CHIP). Both kidneys were irradiated with a range of single X-ray doses while drugs were administered at 1 day or 1 week before irradiation. Maximum tolerated drug doses (defined as the LD1, the dose resulting in a mortality of 1%) were given. Damage inflicted upon the kidneys was monitored by determination of several parameters indicative of kidney function. Isoeffective radiation doses were calculated from these data for each treatment group at 4-8-week intervals up to 80 weeks following treatment. At each assay time, dose modifying factors (DMF) were calculated for each drug/radiation combination. The mean DMFs were highest for CDDP: approximately 1.6. Those for CBDCA and CHIP were lower: approximately 1.1 and 1.2, respectively. The CHIP DMFs were significantly different from unity. When the radiation was given in 4 or 8 daily fractions (4 fractions/week) the DMFs for CDDP were identical to those obtained with single doses. For CBDCA and CHIP, however, the DMFs after fractionated treatments were not significantly different from unity. Analysis in terms of the linear-quadratic (LQ) model indicated that not one of the three drugs had an effect on the alpha/beta ratio, and hence on the fractionation sensitivity of the rat kidney. Consequently, if these data are extrapolated to the clinical setting, the administration of these drugs at the maximum tolerated dose preceding a fractionated radiation treatment should not be expected to result in extra, unexpected, radiation toxicity of the kidney.

Influence of combined use of nicotinamide and carbogen on rat spinal cord radiation tolerance

The effect of combining oxygen or carbogen breathing with the systemic administration of nicotinamide (NA) on spinal cord tolerance in Ethrane anesthetised male WAG/Rij rats has been investigated. Ten fraction experiments were carried out with daily (24 h between fractions) and twice a day fractionation (8 h between fractions). Nicotinamide (500 mg/kg) was injected 1 h prior to each irradiation. In addition, a 10-fraction experiment with daily intervals was carried out in which NA was added immediately after irradiation under carbogen breathing conditions. Single dose irradiations showed a minimal decrease in ED50 from 21 Gy in oxygen conditions to 19.9 Gy in carbogen conditions and 19.4 Gy when combined with NA. In the fractionation experiments, comparing the response to irradiation in oxygen (O) and nicotinamide oxygen (NO) conditions for the 24-h interval experiment, the ED50 for O was 61.6 Gy compared with 54.5 Gy for NO. When carbogen (C) was compared with nicotinamide carbogen (NC), the ED50 for C was 62.3 Gy and 53.9 Gy for NC. When NA was administered immediately after irradiation under carbogen breathing conditions the ED50 increased to 57.8 Gy. For twice a day fractionation the modifying effect of nicotinamide was similar to that observed for daily fractionation (ED50 of 57.9 Gy for O, 57 Gy for C and 50.9 Gy for CN), when corrected for incomplete repair in between the two fractions given on 1 day.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiation response of the rat cervical spinal cord after irradiation at different ages: tolerance, latency and pathology

PURPOSE

The investigation of the age dependent single-dose radiation tolerance, latency to radiation myelopathy, and the histopathological changes after irradiation of the rat cervical spinal cord.

METHODS AND MATERIALS

Rats, ages 1-18 weeks, were irradiated with graded single doses of 4 MV photons to the cervical spinal cord. When the rats showed definite signs of paresis of the forelegs, they were killed and processed for histological examination.

RESULTS

The radiation dose in paresis due to white matter damage in 50% of the animals (ED50) after single dose irradiation was about 21.5 Gy at all ages > or = 2 weeks (mean 21.4 (mean 21.4 Gy; 95% CI 21.0, 21.7 Gy). Only the ED50 at 1 week was significantly lower (19.5 Gy; 18.7, 20.3 Gy). The latency to the development of paresis clearly changed with the age at irradiation, from about 2 weeks after irradiation at 1 week to 6-8 months after irradiation at age > or = 8 weeks. The white matter damage was similar in all symptomatic animals studied. The most prominent were areas with diffuse demyelination and swollen axons, often with focal necrosis, accompanied by glial reaction. This was observed in all symptomatic animals, irrespective of the age at irradiation. Expression of vascular damage appeared to depend on the age at irradiation. No vascular damage was observed in the rats irradiated at 1 week, clearly altered blood vessels were seen in animals symptomatic 10 weeks after irradiation at > or = 3 weeks, and vascular necrosis occurred after > or = 6 months in some rats irradiated at > or = 8 weeks.

CONCLUSION

Although the latency to myelopathy is clearly age dependent, single dose tolerance is not age dependent at age > or = 2 weeks in the rat cervical spinal cord. The white matter damage is similar in all symptomatic animals studied, but the vasculopathies appear to be influenced by the age at irradiation. It is concluded that white matter damage and vascular damage are separate phenomena contributing to the development of radiation myelopathy, expression of which may depend on the radiation dose applied and the age at irradiation.

Irradiation and responsiveness to pain stimuli in rats

This study evaluates whether irradiation inhibits responses to pain in an animal model. We found that irradiation with doses of 10 Gy, 15 Gy and 17.5 Gy of the lumbar enlargement of the spinal cord inhibits the behavioural responses to the stimulus of the hot-plate. These doses were otherwise without effects. This data is discussed in view of the effects of irradiation of living cells, and we propose that a modification of pain signal processing is accomplished. Similar considerations apply to the human condition.

Repair capacity of adult rat glial progenitor cells determined by an in vitro clonogenic assay after in vitro or in vivo fractionated irradiation

Demyelination is one of the pathological conditions identified as a late response of the central nervous system (CNS) to irradiation. We have proposed that radiation-induced depletion of glial stem cells, which are the source of myelinating cells in the CNS, would lead to a lack of replacement of senescent or otherwise damaged oligodendrocytes. This impaired process of cell renewal would result in a decline of oligodendrocytes, i.e. demyelination. In the present study the repair capacity of glial stem cells was investigated and compared with the repair capacity of the CNS in vivo using functional endpoints. For this purpose, glial stem cells, derived from the adult rat optic nerve, were subjected to fractionated irradiation in vivo and in vitro and their survival was quantified with an in vitro clonogenic assay. The data were analysed by three different methods, all based on the LQ-model (single dose survival curve; 'beta RR', 'Fe-plot'). The resulting value of the beta-parameter of adult glial stem cells is consistent with values obtained for functional endpoints after irradiation of the CNS in vivo. The alpha/beta-ratio (4.9-7.3 Gy) of adult glial stem cells, however, is higher than the alpha/beta-ratio (approximately 2 Gy) obtained for CNS in vivo and is closer to that of an acute responding tissue.

Radiation response of mouse lip mucosal epithelium: a cell kinetic study

Changes in the cell proliferation kinetics of the epithelium of mouse lip mucosa have been assessed after local irradiation with a single dose of 18 Gy of 60Co gamma-rays. By the fifth day after irradiation, two distinct sub-populations of epithelial cells could be discerned. The larger of the two populations consisted of cells exhibiting varying degrees of radiation-induced damage, and the smaller population was composed of cells of normal size and appearance, intermingled between the radiation-damaged cells. There was a progressive decline in the epithelial cell density with time after irradiation, and focal denudation was seen after 11 days. Cell colonies were evident in the remnants of the epithelium by day 7. Degenerate cells could be identified in the basal layer of the mucosal epithelium, both before and after irradiation. The proportion of degenerate cells was increased 5 days after irradiation with the maximum number, approximately 3.6% being counted on days 7 and 8. In the first 2 days after irradiation, there was a reduction in the labelling index (LI) of basal cells in the epithelium. This was followed by recovery to control values on day 3. The LIs of both the radiation-damaged cells and those with a normal appearance remained relatively constant between days 5 and 11, at approximately 10 and approximately 60%, respectively. The LI of basal cells in the cell colonies was very high (approximately 70%). The estimated turnover time (TT) for the basal cell population with a normal appearance and for those in cell colonies (groups of normal cells with a cord length > or = 10 cells), was extremely short < 1 day. There was some fluctuation in TT values for basal cells exhibiting radiation-induced damage, with the shortest value (approximately 3 days) at 7 and 8 days after irradiation. It was concluded from the cell kinetic data that repopulation of the lip mucosal epithelium started between 3 and 5 days after irradiation and the overall response of the mucosa to irradiation was consistent with that predicted by a hierarchical model of cell proliferative organization.

Repair kinetics of radiation damage in the developing rat cervical spinal cord

The kinetics of repair of sublethal radiation damage was examined in the cervical spinal cord of developing, 1-week-old rats. Split-dose irradiation treatments were given with time intervals of 0.5-96 h. The data, supplemented with fractionation data from previous experiments, were analysed using direct analysis based on the incomplete repair (IR) model. The best fit to the monoexponential repair model resulted in an estimated half-time of repair (T1/2) of 1.5 (1.3-1.8) h. No indications of a slow or second component of repair could be detected in the 1-week-old cervical spinal cord. This is in contrast with literature reports of experiments with the adult rat cervical spinal cord, suggesting bi-exponential repair, with 65% of the damage repaired with a slow repair T1/2 of about 4 h. Two-step methods, although statistically inferior to direct analysis, are still in use for analysis of repair experiments. A number of two-step methods used for data analysis in previous reports concerning sublethal damage repair, are dose (un)repaired, proportion of dose unrepaired, and proportion of damage unrepaired. It is argued that of the methods discussed, only analysis of the data expressing the results as proportion unrepaired damage (delta Eu) and using split-dose experiments, does not result in introduction of an artificial second repair T1/2 in tissues with a high fractionation sensitivity. Two-step analysis of the present data using delta Eu suggested monoexponential repair with a T1/2 value of 1.5 (SE 0.2) h.

The effect of intraspinal cytosine arabinoside on the re-irradiation tolerance of the cervical spinal cord of young and adult rats

Intrathecal treatment with cytosine arabinoside (ara-C) in combination with radiation has been used as prophylactic treatment in children with acute lymphatic leukaemia. Animal experiments have shown that ara-C enhances the effect of radiation on the spinal cord when administered shortly before irradiation, and that the long-term recovery after a combined treatment may be impaired. In the present experiments immature, 3-week-old rats, were treated with ara-C and radiation on the cervical spinal cord, and the long-term recovery was examined by reirradiation after different intervals. The endpoint of the study was paresis due to radiation myelopathy. The results showed a clear enhancement of the radiation effect with a dose-modifying factor of 1.2, when ara-C was administered before irradiation. However, no indications for impaired long-term recovery were observed. Additional experiments in adult rats with ara-C treatments during a 6-month interval between two radiation doses also did not suggest any interference between ara-C treatment and long-term recovery of radiation induced injury. It is concluded that for both the adult and immature nervous tissue, only when ara-C is administered intraspinally shortly before irradiation, interaction between ara-C and radiation results in a significant reduction of the isoeffective radiation dose by a factor of 1.2 (1.13-1.37, 95% confidence interval).

Fractionation sensitivity of the rat cervical spinal cord during radiation retreatment

Data concerning the fractionation sensitivity of normal tissues during radiation retreatment are limited. Experiments were performed to investigate whether the fractionation sensitivity of the rat cervical spinal cord is changed during retreatment 6 months after a first dose of 15 Gy, representing about half the biologically effective dose for induction of paresis. After a 6 months interval, the long-term recovery from the first treatment was about 45%. The fractionation sensitivity of the rat cervical spinal cord during reirradiation was not significantly different from the fractionation sensitivity of not previously irradiated control rats, with an alpha/beta ratio of 2.3 Gy in control rats and 1.9 Gy during reirradiation of the spinal cord. An additional observation from these experiments was the presence of incomplete repair after fractionated treatment with 2 fractions of 3 Gy per day with 10-h intervals.

Reirradiation tolerance of the immature rat spinal cord

The dose dependence and time course of long-term recovery in the cervical spinal cord of 3-week-old rats was investigated, and compared with the recovery in adults rats. At intervals of 1 to 168 days after initial irradiation of the cervical spinal cord at the age of 3 weeks, reirradiation experiments were performed to test the pattern of long-term recovery in immature spinal cord. The single dose ED50 for white matter mediated paresis was about 21 Gy for 3-week-old as well as adult rats, although the latency to paresis development increased from about 90 days in 3-week-old rats to about 250 days in adult rats. The main long-term recovery was seen during the first month after the initial radiation treatment at 3 weeks. This is in contrast to long-term recovery in adult rats, in which the main recovery took place between 2 and 6 months after the first irradiation. Calculations according to the LQ model showed that the extra dose that can be given to the cervical spinal cord after a 1-6 months interval in the 3-week-old rats reaches a maximum of about 20% of the total biological effect resulting in paresis. In adult rats the extra dose that can be given to the cervical spinal cord after a 6 months interval represents about 40% of the total biological effect. These studies show that time course as well as extent of long-term recovery from radiation treatment not only depends on tissue and species, but also on age.

Linear-quadratic model underestimates sparing effect of small doses per fraction in rat spinal cord

The application of the linear-quadratic (LQ) model to describe iso-effective fractionation schedules for dose fraction sizes less than 2 Gy has been controversial. This paper describes experiments in which the effect of daily fractionated irradiation given with a wide range of fraction sizes was assessed in rat cervical spinal cord. The first group of rats were given doses in 1, 2, 4, 8 and 40 daily fractions. The second group of animals received three initial "top-up" doses of 9 Gy given once daily, representing three-quarters of tolerance, followed by doses in 1, 2, 10, 20, 30 and 40 daily fractions. The fractionated portion of the irradiation schedule therefore constituted only the final quarter of the tolerance dose. The endpoint of the experiments was paralysis of the forelimbs secondary to white matter necrosis. Direct analysis of data from experiments with full course fractionation up to 40 daily fractions (25.0-1.98 Gy per fraction) indicated consistency with the LQ model yielding an alpha/beta value of 2.41 Gy. Analysis of data from experiments in which the three "top-up" doses were followed by up to 10 fractions (10.0-1.64 Gy per fraction) gave an alpha/beta value of 3.41 Gy. However, data from "top-up" experiments with 20, 30 and 40 fraction (1.60-0.55 Gy per fraction) were inconsistent with the LQ model and gave a very small alpha/beta value of 0.48 Gy. It is concluded that the LQ model based on data from large doses per fraction underestimates the sparing effect of small doses per fraction provided sufficient time is allowed between each fraction for repair of sublethal damage.

Radiation tolerance and fractionation sensitivity of the developing rat cervical spinal cord

To investigate the influence of age at irradiation on single dose radiation tolerance and fractionation sensitivity, the cervical spinal cord of rats was irradiated at the age of 1 week and at 15-18 weeks (adult). While the main histological lesions seem to be comparable after irradiation at the two ages, differences were found in single dose tolerance, latency to paresis due to white matter lesions, and fractionation sensitivity. The 50% effect dose (ED50) for single dose irradiation at one week was 19.5 Gy, which is only 10%, but significantly (p < 0.05), lower than the ED50 of about 21.5 Gy at 3 weeks and above. The latency to paresis was clearly influenced by the age at irradiation. The latency in the rats irradiated at 1 week was about 2 weeks, while for adult rats a latency of about 8 months was observed. The fractionation sensitivity for irradiation at 1 week was lower than the fractionation sensitivity of the adult rats; the alpha/beta value at 1 week was estimated to be 4.5 Gy, while for the adult rats an alpha/beta value of 1.8 Gy was found. As a consequence, the observed small difference in tolerance to single doses between 1 week-old and adult rats is further enhanced after fractionated irradiation. During prolonged irradiation treatments this decreased tolerance may be compensated by a higher proliferation rate in the immature central nervous system. The results of the present experiments indicate that, for a single tissue and endpoint, paresis due to white matter lesions in the rat cervical spinal cord, the latency to expression of damage and the fractionation sensitivity clearly change with age at irradiation.

The influence of neonatal thymectomy on the development of radiation myelopathy in rats

To investigate the possible contribution of cellular immunity in the development of radiation injury of the central nervous system, Wag/Rij rats were thymectomized at birth and irradiated to the cervical spinal cord at the age of 3 months. At the time of paralysis or at the end of the follow-up period (when rats were 1-year-old) the animals were sacrificed and the mediastinum was examined histologically. In 95% of the neonatally thymectomized animals no thymus was left. These rats showed a firm impairment of the cellular immunity, as they had a 40% reduction of the T-lymphocytes in the spleen, and a 70% reduction of the mixed lymphocyte reaction, compared to age-matched controls. Both single dose and two-fraction irradiation experiments were performed. No modification of the latency time to develop paralysis was observed comparing thymectomized and age-matched controls. The incidence of foreleg paralysis after cervical spine irradiation (single dose or two-fraction) was identically distributed in the follow-up period for both neonatally thymectomized and control Wag/Rij rats. The ED50 value derived in the single dose experiments was 20.3 Gy for the control animals, and 20.9 Gy for thymectomized rats, and in the two fraction experiments 29 Gy for controls and 29.6 Gy for thymectomized rats. None of these differences are significant. It appears that neonatal thymectomy, in spite of its firm suppression of the cellular immunity, has no major influence on the development of radiation myelopathy in rats.

Time- and sequence-dependent responses to cisplatin and radiation in the rat kidney

The influence of time interval and sequence between administration of cisplatin and a radiation dose was studied in the rat kidney. A dose of 10.5 Gy X-rays was given to both kidneys, preceded or followed by a single dose of cisplatin. Two separate experiments were performed. In the first experiment 6.0 mg/kg cisplatin was given, in the second experiment the drug dose was 5.5 mg/kg. A range of time intervals was introduced between administration of drug and radiation, from 7 to 1 days, 12 to 1 h, and 30 to 0 min. Control animals received either modality alone, or were left untreated. Cisplatin alone caused tubular function to decrease very quickly and to remain permanently altered. Changes in glomerular function were only detected after 30 weeks following the higher drug dose. X-rays alone caused measurable alterations in both glomerular and tubular function after 16 weeks. In the combined treatment the influence of time and sequence was significant. If cisplatin was given at 7 to 1 days before X-rays the effect of time was minimal. Administration of cisplatin 12 h to 15 min before irradiation resulted in an increase of radiation damage with decreasing time interval. Total damage sharply decreased when both modalities were given at the same time, and decreased further with increasing time between irradiation and drug administration. It is suggested that in the tubular cells free cisplatin or one of its hydrolysis products may interact with radiation-induced damage, e.g. by interference with repair of sublethal or potentially lethal damage.

Estimation of repair parameters in mouse lip mucosa during continuous and fractionated low dose-rate irradiation

The present study investigated the effect of fractionated low dose-rate (FLDR) treatments in mouse lip mucosa, a typically early reacting tissue. The relation between dose-rate and fractionation effect has been assessed with various interfraction intervals and dose-rates. A fixed overall treatment time of 10 h has been used for the present continuous and fractionated irradiation experiments with corresponding dose-rates of 3.1-84 Gy/h. Sophisticated mathematical models are now available to estimate repair parameters from data derived with different fraction numbers, fraction sizes and dose-rates. These formulas, allowing the calculations of isoeffect relationships are based on the incomplete repair model and assume that repair can operationally be described by a monoexponential function. A further assumption of these models is that repair of sublethal damage follows the same kinetics during irradiation and between fractions. The present FLDR experiments with small interfraction spacing were performed to investigate the validity of these assumptions and consequently the applicability of the models. In addition, it has been assessed whether the experimental approach of investigating repair kinetics as such [high dose-rate (HDR) split-course vs. continuous low dose-rate (CLDR) or FLDR] influences the estimation of these parameters, as has been suggested from the analysis of in vitro studies. Using the mucosal desquamation endpoint, virtually identical repair parameters have however been estimated with different approaches (alpha/beta = 14.1-18.2 Gy, T1/2 = 28-37 min). The available isoeffect models seem to be applicable to the present experimental data and might after further experimental tests also involving late reacting tissues, be a useful tool for clinical isoeffect calculations.

Mechanisms involved in the differential recovery of CD4 and CD8 T-lymphocytes after local irradiation in mice

The mechanisms involved in the differential recovery of CD4 (helper/inducer phenotype) and CD8 (cytotoxic/suppressor phenotype) T-lymphocytes after fractionated local irradiation were investigated. In mice, a better recovery of CD4 cells than of CD8 cells was found, while the reverse has been described in humans. Differences in radiosensitivity between CD4 and CD8 mouse splenocytes could not be found. No sequestration of CD8 cells in irradiated tissues could be demonstrated. Irradiation of the thymus did not influence the observed immune changes. Altered thymic production of CD4 and CD8 cells could be excluded by intrathymic injection of FITC (fluorescein isothiocyanate). Hindlimb and tail irradiation did not induce changes in the morphology of the thymus and the phenotype of the thymocytes. These results suggest that the differential recovery of CD4 and CD8 T-lymphocytes after local irradiation is determined by extrathymic factors in man and mice, and that the observed differences in immune recovery between man and mice are due to defective thymic function in the former and normal function in the latter.

Fractionation effects and repair kinetics in rat kidney

Rat kidneys were unilaterally irradiated with up to 40 fractions of X rays. Fractionation regimens were given either with long intervals of 6-24 hr between fractions, resulting in complete recovery from sublethal damage, or with 1-hr intervals, resulting in largely incomplete repair. The non-irradiated kidney was surgically removed 4 weeks after the last fraction. The development of radiation-induced kidney damage was monitored by regular assessment of three different parameters indicative of kidney function: serum urea, the total volume of urine excreted in 24 hr and urine osmolality. At the end of the observation period, 18 months after treatment, the kidney was removed. The hydroxyproline content was determined and a histopathological analysis was performed. Since the 20 and 40-fraction data indicated a higher effectiveness of these regimens than would be expected on the basis of the LQ model, the data were divided in two subsets, 2-10 fractions (high doses per fraction) and 10-40 fractions (low doses per fraction), and analyzed separately. The time course of alpha/beta and T1/2 values was determined for each functional parameter separately, and for the data from the three parameters combined. A complex pattern was found, with the values for alpha/beta as well as T1/2 differing between the two data subsets between about 20 and 40 weeks after treatment. For the lower doses per fraction the alpha/beta values were generally higher and the repair half-times longer. After 40 weeks no significant differences were observed between the two data subsets. If the differences found earlier are ignored, overall alpha/beta and T1/2 values can be calculated. For early endpoints the alpha/beta was 1.69 (1.45, 1.90) Gy (95% confidence limits in parentheses), for late endpoints it was 1.77 (1.56, 2.00) Gy. The corresponding T1/2 values were 1.57 (1.44, 1.73) hr for early endpoints, and 2.10 (1.90, 2.34) hr for late endpoints. Hence, the alpha/beta values do not alter in time, but the T1/2 value for late damage might be higher than that for early damage.

Early and late effects of fractionated irradiation and the kinetics of repair in rat lung

The thorax of WAG/Rij rats was irradiated with fractionated doses of X rays. Irradiation schedules were designed either to allow virtually complete repair of sublethal damage between subsequent fractions by fractionating at 6-h intervals, or to result in incomplete repair by allowing only 1-h intervals between subsequent fractions. Combination of the data from both experimental series permitted the calculation of alpha/beta ratios and values for the repair halftime T1/2. The animals were monitored by assessment of the breathing frequency and by recording deaths. At the end of the experiments, 18 months after treatment, the hydroxyproline content of the lung tissue was determined as a biochemical indicator of radiation-induced fibrosis, and an histopathological analysis was performed. Early endpoints, indicative of radiation-induced pneumonitis, resulted in an alpha/beta ratio of 3.5 Gy and a T1/2 value of 0.95 h. Late endpoints were presumed to be indicative of radiation-induced fibrosis. Based on the combined analysis of data from three different late endpoints, the mean alpha/beta ratio was 2.3 Gy, and the T1/2 value was 1.13 h. The difference in alpha/beta ratio and T1/2 value between early and late endpoints was not significant, since the 95% confidence limits were overlapping. For each individual early or late endpoint as well as for the two early or the three late endpoints combined, there was a trend for lower alpha/beta ratios and higher T1/2 values associated with low doses per fraction. However, widely overlapping confidence limits indicated that again the differences were not significant.

Radiobiology of pions in comparison with other heavy particles

Our recent data on late effects of pions in spinal cord, lung and rectum in rodents is presented with reference to other high-LET radiations. Unlike high-LET radiations such as neutrons and neon ions, the RBE for late effects of pions (up to 1.5) is not found to be significantly different from acute effects. Because of the potential of matching treatment volume (especially by using dynamic treatments) to the target volume by using pions and heavy ions, it is of utmost importance to study the tolerance of normal tissues to late effects as a function of volume. Such knowledge combined with pion and heavy ion dynamic treatment could lead to a further step in heavy particle radiotherapy.

Immunologic changes after loco-regional radiotherapy and fractionated total body irradiation (TBI) in mice

The immunologic effects of fractionated irradiation to both hind limbs and the tail of adult (2.5-3 months old) male Balb/c mice were investigated. A dose of 34 Gy given in 17 fractions of 2 Gy, 1 fraction per day, 5 days per week, was delivered with a 60Co source. A significant decrease of the total splenocyte count (29% of control value) and of the PHA(phytohemagglutinin)-induced proliferation of T cells (22% of control value) was found immediately after irradiation. Both parameters normalized within 30 days after irradiation. Immediately after irradiation, the MLC (mixed lymphocyte culture) was supranormal (126% of control value), dropped to 45% 1 week later, and normalized within 1 month after radiotherapy. The NK (natural killer) activity was significantly decreased only the first week after loco-regional irradiation, while the LAK (lymphokine activated killer) activity was not altered at all. The percentage of goat-anti-mouse+ cells (mainly B lymphocytes) was not changed immediately after loco-regional irradiation, but rose to supranormal values (175% of control level) 3 months after irradiation. A persistent decrease of the percentage and the absolute numbers of the Lyt2+ cells (= CD8+ cells, suppressor/cytotoxic phenotype) was observed up to 3 months after irradiation, while the percentage of L3T4+ cells (= CD4+ cells, helper phenotype) remained normal for the total follow-up. No differences in allogeneic skin graft survival could be demonstrated between irradiated and control animals. The observed immunological effects could not be explained by the scatter irradiation to the whole body as total body irradiation (TBI) administered in a dose and dose rate similar to the scatter dose did not result in persistent immunologic changes. No dose-rate effect could be demonstrated in a low dose fractionated total body irradiation schedule. A total body irradiation similar to the scatter dose in humans did not result in significant immunologic changes.

Effects of high dose intraperitoneal cytosine arabinoside on the radiation tolerance of the rat spinal cord

The effect of intraperitoneal high dose (9 g/kg) Cytosine Arabinoside (Ara-C) on the early delayed radiation response of the rat cervical spinal cord has been studied. When given 2 hrs before irradiation, systemically administered Ara-C significantly reduces the isoeffect doses for the induction of paralysis due to white matter necrosis by a factor of approximately 1.2 for both a single irradiation treatment and for a two fraction irradiation with 24 hr interval. No effect on the latency time to develop paralysis was recorded.

The influence of cisplatin and unilateral nephrectomy on the response of the rat kidney to irradiation

Cisplatin was administered as a single i.p. dose of 5 mg/kg to WAG/Rij rats at intervals of 7 days or 0.5 h before, or 7 days after graded X-ray doses to the left kidney. The right kidney was surgically removed 4 weeks after irradiation. Renal function was determined by measuring total urine volume excreted in 24 h, urine osmolality and serum urea. The severity of alterations in the various anatomic compartments of the kidney induced by the various treatments were graded histologically. The administration of 2 or 5 mg/kg cisplatin alone did not alter any of the kidney function parameters. Isoeffective radiation doses calculated for each of the functional parameters continuously decreased with increasing time after treatment. Differences between the isoeffective doses for the three combined treatments and for treatment with irradiation alone were only observed for urine osmolality and urine volume which primarily are tubular-related functional parameters. The histopathological grading studies also indicated that enhancement by cisplatin of radiation-induced damage was almost entirely confined to the tubules. The results of this study indicate that the sequence and length of time between treatments is an important variable in the development of cisplatin plus radiation-induced renal injury, but that none of the tested combinations showed a more than additive toxicity.

Repair kinetics as a determining factor for late tolerance of central nervous system to low dose rate irradiation

The effect of continuous irradiation, delivered at four different dose rates (107.6, 14.7, 3.9 and 2 Gy.h-1) has been investigated using the rat cervical spinal cord biological system. The endpoint was the induction of foreleg paralysis at 9 months which corresponds, as has been described before, to white matter necrosis. Paralysis occurring in 50% of the animals was taken as the isoeffect, and the ED50 (radiation dose leading to paralysis in 50% of the animals) was calculated by probit analysis. There was a constant increase in the ED50 with the decrease in the dose rate, resulting from the repair of sublethal damage (SLD) occurring during irradiation. A comparison was made with the previously published results of high dose rate (100-120 Gy.h-1) fractionated irradiations (2, 4 and 10 fractions). alpha/beta (1.6 Gy for the pooled fractionation and dose rate data) and the half-time of SLD repair (82 min) were derived.

Effects of multifraction irradiation on the rat kidney

Wag/Rij female rats were irradiated to the left kidney with single doses or 2, 4, 10, 20, or 40 equal dose fractions. The right kidney was removed 4 weeks after the last fraction. The kidney function was determined using three different parameters. The serum urea content indicated glomerular function. Urine osmolality and the total volume of urine excreted in 24 hr indicated tubular function. The onset as well as the rate of expression of radiation-induced kidney damage was dose-dependent. The kidney function decreased continuously. Differences in expression of damage between glomerular and tubular parameters were not observed. All parameters indicated marked sparing of the kidney by fractionation. In general, the data could be fitted to the linear-quadratic model, if the single dose data were not included in the analyses. However, the fit greatly improved when data obtained with high and low doses per fraction were analyzed separately. The Direct Analysis method was used to determine the alpha/beta ratios. No significant differences were observed between the alpha/beta ratios calculated for the different parameters. The ratios also did not change with increasing time after treatment. The alpha/beta for high doses per fraction was between 0.6 and 2.7 Gy, and that for low doses per fraction, with fractional doses in the clinical range, was between 0.5 and 3.8 Gy. The alpha/beta values for low doses per fraction were generally lower than those for high doses per fraction. These observations indicate a strong dependence of radiation-induced damage in the rat kidney on the size of the dose per fraction.

Treatment of murine lupus nephritis with cyclophosphamide or total lymphoid irradiation

Untreated 9 to 11 month-old, female NZB/W F1 mice all died within six weeks (wks) after the occurrence of nephrotic range proteinuria (greater than or equal to 3 g/liter). Significant prolonged survival could be obtained in similar groups of animals either by weekly i.v. pulses of cyclophosphamide (CY, 25 mg/kg, 40% survival 20 wks after start of treatment) or by administering total lymphoid irradiation (TLI, 17 daily fractions of 2 Gy, 70% survival at 20 wks). All surviving animals in both groups showed remission of the nephrotic range proteinuria. In all treated mice, light microscopy examination of the kidneys revealed a decrease of inflammation and a stabilization of proliferation and sclerosis, yet immunofluorescence for IgM, IgG and C3 was not significantly altered. The better survival of the TLI- as compared to the CY-treated mice (P less than 0.001) was due to a lower incidence of lymphomas or viral infections. IgG anti-DNA auto-antibodies were significantly lowered by CY but not by TLI treatment. It is concluded that CY pulse therapy and TLI are both efficient treatment modalities for high grade lupus like NZB/W disease. In this model TLI is safer than CY when used in a dose regimen of 25 mg/kg/wk and interferes with the course of the disease without lowering the IgG anti-DNA antibodies.

From 2 Gy to 1 Gy per fraction: sparing effect in rat spinal cord?

Recently published results, from this group, on rat cervical spinal cord, a late responding tissue, indicated no further sparing with lowering the fraction size from 2 to 1.8, 1.5, and 1.3 Gy. In the present experiments a small but probably significant rise in tolerance is suggested, when the dose per fraction was decreased from 2 Gy down to 1 Gy. This rise would however still be much less than what is predicted by the linear quadratic model, based on the experimental data obtained with fraction sizes larger than 2 Gy.

Effect of simultaneous administration of bleomycin on the acute skin reactions of mice after single and fractionated doses of radiation

The effect of bleomycin on the acute mouse foot skin reactions, occurring after irradiation, was investigated. Bleomycin was delivered simultaneously with the irradiation treatment, either by intraperitoneal injection or by subcutaneous continuous infusion. Experiments were carried out to investigate (a) the modification by bleomycin of the response to single doses of radiation (b) the effect of total drug dose on this modification (c) the influence of the drug on repair of sublethal radiation damage and (d) the interference by the drug with compensatory repopulation after irradiation. In none of the experiments could any influence of the drug on these radiation induced reactions and recovery processes be demonstrated. These results are in direct contrast to what we have observed previously for similar types of experiments in another epithelial system, the mouse lip mucosa.

Unilateral kidney irradiation and late retreatment with cis-dichlorodiammineplatinum (II): functional measurements with 99mtechnetium-dimercaptosuccinic acid

A rat model was used to study renal function after unilateral kidney irradiations. The left kidney was irradiated with a single dose (6-14 Gy), 2 equal sized fractions (10-16 Gy total dose) or 4 equal sized fractions (12 to 21 Gy total dose). At regular time intervals after treatment, the left kidney function was assessed with the use of 99mTc-Dimercaptosuccinic acid for a period of about 1 year. It was found that renal function declined in a dose- and time-dependent manner. The threshold dose for detecting functional impairment was 8 Gy for 1 fraction, 12 Gy for 2 fraction and 15 Gy for 4 fraction irradiations, demonstrating the sensitivity of the isotope tracer test used in these experiments. Retreatment of the rats with a single i.p. dose of 5 mg/kg cis-Dichlorodiammineplatinum (II) (cis-DDP) given at about 1 year after X ray exposure revealed an important relative decrease in the function of the irradiated compared to the unirradiated kidney. Reductions in function of 11 to 70% (depending on radiation dose and schedule) compared with control values were observed at 11 weeks after drug injection. These results demonstrate that a previously irradiated kidney is more sensitive to a subsequent treatment with cis-DDP than the contralateral hypertrophied kidney in the same animal.

Late functional, biochemical and histological changes in the rat lung after fractionated irradiation to the whole thorax

The influence of fractionation of the radiation dose in up to 16 fractions on late occurring effects in rat lungs was studied. Measurement of the breathing frequency (BF) was used to monitor changes in lung function during the 76-wk follow-up period. At the end of this period the lungs were examined histologically and the hydroxyproline (HP) content of the lung tissue was determined as a biochemical indicator of the amount of fibrosis. Dose-response curves for BF could only be made at 76 wk post-irradiation. No dose-response curves could be constructed for HP/mg dry tissue; dose-related increases observed in HP/total left lung were entirely attributable to increases in lung dry weight. Histopathology data indicated a dose-related increase in two histological alterations, septal fibrosis and granulomatous pneumonia. The alpha/beta ratios were calculated for each of the endpoints using both the Fe-plot and Direct Analysis method. The calculated values for alpha/beta were in the range of 1.1 to 3.6 Gy, corresponding well to published data obtained in mouse lungs. The number of tissue rescuing units (TRU's) was also calculated. It was smaller for BF than for the histopathology endpoints, suggesting different target structures. However, the difference was not significant due to large confidence intervals.

Evaluation of mouse lip mucosa reactions after combinations of cis-diammine-1,1-cyclobutanedicarboxylate platinum (II) (CBDCA) and irradiation: single and fractionated treatments

The influence of CBDCA (JM8) on the radiation-induced mouse lip mucosal reactions has been tested. Both single and fractionated drug doses were used intraperitoneally at 60 mg/kg and 5 X 25 mg/kg respectively. A single injection of CBDCA did not alter the response to a single radiation dose, whether the drug was given at different time intervals from 24 hr prior, to 96 hr after irradiation. A concomitant treatment of daily CBDCA injections and irradiations for 5 consecutive days demonstrated no change of the capacity to repair sublethal radiation damage. When two equal sized radiation doses were separated by 10 days and CBDCA was administered daily from day 3 to 7, the ability to repopulate the lip mucosa epithelium during the radiation-free period was not influenced.

Irradiation of murine lip mucosa in combination with 5-fluorouracil, administered by single dose injection or continuous infusion

The possible interaction of 5-fluorouracil (5-FU) and irradiation on mouse lip mucosa was studied, with special interest for the influence of the route of administration of the drug, either by single intraperitoneal (i.p.) injection or by 7 days continuous subcutaneous infusion. Apart from the possible modification by the drug of radiation-induced damage to the lip mucosa assessment was made of the systemic toxicity. No modification of the radiosensitivity of mouse lip mucosa nor of its repair capacity was observed with the use of 5-FU given either by i.p. injection or by continuous infusion. However, the combination of 5-FU and irradiation resulted in an increased systemic toxicity which was only seen when 5-FU was administered by an i.p. injection in close timing with irradiation. It is suggested that this increased systemic toxicity is caused by the combined effects of irradiation and 5-FU on the alimentary tract, although we could not demonstrate the mechanism of it.

Combined interstitial 125I and external X-irradiation on a rat rhabdomyosarcoma

The effect of graded external radiation doses and a dose administered by an implanted 125I seed on growth delay and cure rate of a rat rhabdomyosarcoma was investigated. One 125I seed (0.40 or 0.50 mCi) was implanted per tumour when the tumours had grown to a predetermined size. The irradiation by the 125I seed did not cause significant tumour growth delay. When implantation of an 125I seed was combined with graded external radiation doses, the growth delay observed after these combined regimens was significantly greater than that observed after treatment with external doses alone. The same was observed for tumour cure rates. The effectiveness of the 125I seed could be assessed as being equivalent to a single dose of external radiation of about 6-20 Gy, depending on the external dose applied. The application of 125I seeds combined with external irradiation to obtain local control might be recommended in those cases where the total dose of external radiation alone is limited by normal tissue reactions.

Is the rate of repair of radiation-induced sublethal damage in rat spinal cord dependent on the size of dose per fraction?

In the present study the possible dependency of the kinetics of repair of sublethal damage in rat spinal cord on the fraction size has been further investigated. A wide range of sizes of dose per fraction (1.7-17.5 Gy) has been given with interfraction intervals varying from 0.5 to 24 hr. A direct method for analysis of quantal response and an incomplete-repair (IR) model for survival after fractionated exposures with short intervals were used to interpret the data. The half time of repair (T1/2) was found to be 1.6, 1.6 and 1.9 hrs for fraction sizes of approximately 4, 9, and 14 Gy respectively. There appears to be no significant effect of fraction size on the rate of repair. A clinically relevant feature observed from these experimental data is that in this tissue it takes more than 4 hrs for repair of sublethal damage, induced by a dose of approximately 4 Gy, to approach completion (i.e., sparing beyond the limit of the experimental resolution). This has to be taken into account when several fractions are to be given each day. Another feature noted from the analysis of these results is that the alpha/beta determined from the complete repair data is considerably smaller than that estimated from the incomplete repair data (interval less than or equal to 4 hrs). The nature of the inconsistency is discussed.

The effect of small radiation doses per fraction on mouse lip mucosa assessed using the concept of partial tolerance

The acute effect of small radiation doses per fraction on mouse lip mucosa was investigated in the present study. In order to minimize the amount of additional sparing by regeneration during fractionated irradiations in this rapidly proliferating tissue, the overall treatment time had to be limited to at most 4 days, so that the number of irradiations that could be delivered was limited. Therefore, the concept of partial tolerance, established in the rat spinal cord model, was applied. The present experimental data confirm the validity of using this concept for assessing the effect of small radiation doses on tissues. The results of experiments covering a wide range of fraction sizes show that the isoeffective dose for a given mucosal reaction increases when the dose per fraction is progressively decreased to about 2 Gy per fraction. Further reduction of the size of dose per fraction, however, does not result in a detectable extra increase in the total dose to produce the same level of biological effect. It seems that the dose limit of sparing by fractionation in this rapidly proliferating normal tissue might be situated at larger fraction sizes than 0.6 Gy as estimated on basis of the mathematical linear-quadratic model, using an alpha/beta ratio of 6 Gy measured from data with doses per fraction in the range of 2 to 10 Gy.

Effect of combined AZQ and radiation on the tolerance of the rat spinal cord

The effect of combined AZQ (aziridinylbenzoquinone) and ionizing radiation on the rat spinal cord has been investigated. The highest dose of AZQ (3 mg/kg) tolerated by rats weighing 250 g was injected intravenously 15 min before a single dose of radiation or the first of 2 fractional doses. The development of paralysis due to white-matter necrosis in rats of each dose group was scored and dose-response curves were constructed. It has been found that a combination of AZQ with radiation did not lead to a significant shift of the dose-response curve as compared to that of radiation alone. Thus, AZQ administered according to the schedule used in the present study did not seem to reduce the radiation tolerance of the central nervous system.

Combinations of single doses and fractionated treatments of cis-dichlorodiammineplatinum (II) and irradiation: effect on mouse lip mucosa

Tolerance of the lip mucosa of NMRI mice to single and fractionated irradiation combined with cis-diamminedichloroplatinum (II) (cis-DDP) was investigated. For the various combination schedules total drug doses varying from 6 mg kg-1 to 13 mg kg-1 were injected i.p. It was found that cis-DDP did not alter the radiation sensitivity of this tissue at any of the time intervals tested (ranging from 24 h before to 72 h after single dose irradiations). When 5 daily drug injections were given concomitantly with 5 daily radiation treatments, a slight reduction of the lip mucosal reactions occurred, possibly due to partial synchronisation during treatment. No effect was seen when a single injection of cis-DDP preceded two irradiations given with increasing intervals up to 4 h. Both these combined fractionated treatment data suggest no inhibitory effect on repair of sublethal radiation damage. When repeated daily injections of cis-DDP were given in between 2 radiation doses separated by 10 days, no interference with repopulation could be detected. The present study also demonstrated an increase in systemic drug toxicity when cis-DDP was combined with irradiation, compared with that seen with either agent alone.

The combined effect of bleomycin and irradiation on mouse lip mucosa. 2. Influence on the accumulation and repair of sublethal damage during fractionated irradiation

The effect on the mouse lip mucosa of different fractionated irradiation schedules (with respectively 1, 2, 4 10 and 20 equal fractions) with and without a simultaneous constant drug regimen (bleomycin 40 mg/kg in a continuous subcutaneous infusion over seven days) was investigated. Lowering the fraction size resulted in a progressive increase of both the dose modification factors (DMF) and the absolute dose reduction (ADR), i.e. from 1.19 and 2.8 Gy respectively for single doses to 1.86 and 21.5 Gy respectively for 20 fractions (at isoeffect level 3.5). The mechanisms involved are most probably a direct cell kill by bleomycin, together with a reduced capacity to accumulate and/or to repair sublethal damage, although the influence of redistribution in the cell cycle during bleomycin infusion can not be excluded. Such large differences in the interaction between chemotherapy and irradiation as a function of the fractionation schedule could lead to a significant underestimate of response if data from single dose or 2-fraction experiments are extrapolated to regimens used in clinical practice.