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Fang YY, Huang JM, Wen JY, Li JD, Shen JH, Zeng DT, Pan YF, Huang HQ, Huang ZG, Liu LM, Chen G. AZGP1 Up-Regulation is a Potential Target for Andrographolide Reversing Radioresistance of Colorectal Cancer. Pharmgenomics Pers Med 2022; 15:999-1017. [DOI: 10.2147/pgpm.s360147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
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2
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Parisi S, Lillo S, Cacciola A, Ferini G, Valenti V, Viola A, Santacaterina A, Platania A, Brogna A, Tamburella C, Pergolizzi S. Non-stereotactic radiotherapy in older cancer patients. Heliyon 2022; 8:e09593. [PMID: 35706953 PMCID: PMC9189877 DOI: 10.1016/j.heliyon.2022.e09593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/19/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022] Open
Abstract
Old or very old oncological patients represent a heterogeneous and frail population due to concomitant comorbidities. Whether radiotherapy alone or in combination with novel cancer drugs may provide a clear benefit in this setting of patients is still a matter of debate. The aim of our review is to analyze the evaluation process and the different therapeutic possibilities in older cancer patients, focusing on the different and most disparate applications of radiotherapy. We reviewed the most recent literature on radiotherapy in older patients providing clinical evidence of treatment related toxicity, tolerance and outcomes using standard fractionated and/or hypofractionated irradiation alone or in combination with chemotherapy, targeted and immunotherapy. In older cancer patients unfit for systemic therapy or surgery, radiotherapy represents a valid therapeutic approach, both with curative and palliative intents, ensuring excellent patient compliance in terms of local toxicity and adherence to therapy.
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Affiliation(s)
- Silvana Parisi
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Sara Lillo
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alberto Cacciola
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Gianluca Ferini
- Radiation Oncology Unit - REM Radioterapia, Viagrande, Italy
| | - Vito Valenti
- Radiation Oncology Unit - REM Radioterapia, Viagrande, Italy
| | - Anna Viola
- Radiation Oncology Unit - REM Radioterapia, Viagrande, Italy
| | | | | | - Anna Brogna
- Medical Physics Unit, A.O.U. "G. Martino", Messina, Italy
| | - Consuelo Tamburella
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
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3
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van Aken ES, van der Linden YM, van Thienen JV, de Langen AJ, Marijnen CA, de Jong MC. Hypofractionated radiotherapy combined with targeted therapy or immunotherapy: Dutch survey on current practice, knowledge and challenges. Clin Transl Radiat Oncol 2022; 33:93-98. [PMID: 35243019 PMCID: PMC8885401 DOI: 10.1016/j.ctro.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 11/27/2022] Open
Abstract
Radiotherapy referral during targeted therapy or immunotherapy occurs regularly. There is a knowledge gap regarding the implications of combined therapy. There is no consensus on expected toxicity of combined therapy. Multidisciplinary protocols regarding combined therapy are often not available. The application of radiotherapy treatment adaptations varies widely when combined with different systemic treatments.
Introduction With the introduction of tyrosine kinase inhibitors and systemic antibodies, including immune checkpoint inhibitors, the survival of advanced-stage cancer patients has improved for many tumor types. These patients are increasingly referred for radiotherapy, but it is unclear whether radiotherapy combined with these drugs is safe. No international guidelines exist on whether or how to combine these drugs with radiotherapy. Therefore, we investigated the current clinical practice in the Netherlands regarding hypofractionated radiotherapy in patients using targeted drugs and immunotherapy. Materials and methods We sent a survey to all 21 Dutch radiotherapy institutes. Dedicated radiation oncologists, medical oncologists and pulmonologists were asked to fill out the survey. The questions explored their familiarity with the combination of targeted drugs and immunotherapy with radiotherapy, the encountered clinical difficulties and factors influencing treatment decisions. Results The survey was filled out by 54 respondents from 19 different institutes. The median annual number of patients per radiation oncologist referred for radiotherapy when using targeted drugs or immunotherapy was 10 and 15, respectively. Despite this high number, only 11% of the radiation oncologists stated that they had sufficient information (resources) for adequate treatment decision making. Among all physicians, 44% stated that there was insufficient knowledge within their institute regarding this topic. Only 17% stated that there was a multidisciplinary protocol available. The application of radiotherapy treatment adaptations (technique, dose, fractionation, field size) varied widely. Generally, there seemed to be no consensus regarding the expected toxicity of combined drug-radiotherapy treatments and the expected risk of tumor flare upon temporary drug discontinuation. Conclusion There is no consensus amongst involved medical specialties on expected toxicity. Consequently, it is necessary to perform clinical studies examining the safety of combined drug-radiotherapy treatments, to add radiotherapy to phase I-III clinical trials for new drugs and to incorporate outcomes into multidisciplinary, evidence-based guidelines.
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Affiliation(s)
- Evert S.M. van Aken
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Yvette M. van der Linden
- Department of Radiation Oncology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands
| | - Johannes V. van Thienen
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Adrianus J. de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Corrie A.M. Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands
| | - Monique C. de Jong
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
- Corresponding author.
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4
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Tian W, Hao S, Wang L, Chen Y, Li Z, Luo D. Pyrotinib treatment enhances the radiosensitivity in HER2-positive brain metastatic breast cancer patients. Anticancer Drugs 2022; 33:e622-e627. [PMID: 34407046 DOI: 10.1097/cad.0000000000001199] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Brain metastasis is a common cause of death in HER2-positive breast cancer patients. Currently, it is mainly treated by whole-brain radiotherapy. Pyrotinib is an irreversible pan-ErbB inhibitor, which has demonstrated promising tumor-suppressing activity and acceptable tolerance in previous phase trials. In the present study, we evaluated the efficacy of pyrotinib on HER2-positive brain metastatic breast cancer patients treated with whole-brain radiotherapy. A total of 20 such patients were separated into pyrotinib plus capecitabine and capecitabine-only groups in a 1:1 ratio. All patients met either the primary or secondary endpoints. Oral admission of pyrotinib together with radiotherapy can significantly increase the overall response rate, progression-free survival, time to progression and duration of response of HER2+ brain metastatic breast cancer patients, without causing extra adverse events. In addition, pyrotinib can enhance the radiosensitivity of in-vitro cultured HER2+ breast cancer cell lines. The outcome of our study suggests that pyrotinib might be an effective medication to enhance the tumor radiosensitivity of HER2-positive brain metastatic breast cancer patients.
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Affiliation(s)
- Wuguo Tian
- Department of Breast, Thyroid surgery, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
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5
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Maddalo M, D'Angelo E, Fiorica F, Argenone A, Scricciolo M, Cozzi S, Nardangeli A, Dionisi F, Costantino G, Vagge S, Pontoriero A, Donato V, Massaccesi M. Thoracic re-irradiation with 3D-conformal or more advanced techniques: A systematic review of treatment safety by the Re-irradiation Study Group of the Italian Association of Radiation and Oncology AIRO. Crit Rev Oncol Hematol 2021; 167:103500. [PMID: 34688894 DOI: 10.1016/j.critrevonc.2021.103500] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/20/2021] [Accepted: 10/10/2021] [Indexed: 12/25/2022] Open
Abstract
Re-irradiation (re-RT) is a treatment modality that has been actively investigated in recurrent lung cancer or in lung metastases appeared in previously irradiated areas. A literature search, according PRISMA recommendations and a meta-analysis technique were performed with the aims to identify possible factors related to the toxicity incidence and severity of ≥ G3 acute toxicity. 1243 patients and 36 studies, met inclusion criteria. Our results, showed that there was no difference in ≥ G3 acute (10,5%) toxicity rate with respect to different radiation techniques, cumulative dose and re-irradiation total dose and fractionation. Factors eventually related to severe toxicity were described. The frequent lack of a sufficient description of the treatment's intent, the heterogeneity in technique and radiotherapy regimen, makes balancing risk and benefit of re-RT based on published data even more difficult.
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Affiliation(s)
- Marta Maddalo
- Department of Radiation Oncology, ASST Spedali Civili of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Elisa D'Angelo
- Department of Radiotherapy, University Hospital of Modena, L. del Pozzo 71, 41121, Modena, Italy.
| | - Francesco Fiorica
- Department of Radiation Oncology and Nuclear Medicine, State Hospital Mater Salutis AULSS 9, 37045, Legnago (VR), Italy.
| | - Angela Argenone
- Radiotherapy Unit, AORN San PIO, Via dell'Angelo, 82100, Benevento, Italy.
| | - Melissa Scricciolo
- Radiation Therapy Unit, Ospedale dell'Angelo, Via Paccagnella 11, 30174, Venezia, Italy.
| | - Salvatore Cozzi
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, 42122, Reggio Emilia, Italy.
| | - Alessia Nardangeli
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, L. Gemelli 1, 00168, Roma, Italy.
| | - Francesco Dionisi
- Department of Research and Advanced Technology, Radiation Oncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Roma, Italy.
| | - Gianluca Costantino
- Department of Radiation Oncology, ASST Spedali Civili of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Stefano Vagge
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria San Martino di Genova-IST, Istituto Nazionale Ricerca sul Cancro, Genoa, Italy.
| | - Antonio Pontoriero
- Dept. of Radiation Oncology, University of Messina, 98125, Messina, Italy.
| | - Vittorio Donato
- Radiation Oncology Division, Oncology and Speciality Medicine Department, San Camillo-Forlanini Hospital, 00152, Roma, Italy.
| | - Mariangela Massaccesi
- Radiation Oncology Department, Gemelli-ART, Università Cattolica S. Cuore, L. Gemelli 1, 00168, Roma, Italy.
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6
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Billiet C, Joye I, Mercier C, Depuydt L, De Kerf G, Vermeulen P, Van Laere S, Van de Kelft E, Meijnders P, Verellen D, Dirix P. Outcome and toxicity of hypofractionated image-guided SABR for spinal oligometastases. Clin Transl Radiat Oncol 2020; 24:65-70. [PMID: 32642561 PMCID: PMC7334439 DOI: 10.1016/j.ctro.2020.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 05/03/2020] [Accepted: 06/21/2020] [Indexed: 12/31/2022] Open
Abstract
Hypofractionated stereotactic ablative radiotherapy (SABR) in patients with spinal oligometastases. High rates of efficacy and minimal toxicity. Oligometastatic patients with metachronous spinal metastases seem to benefit the most.
Background To investigate progression free survival (PFS), local control (LC) and overall survival (OS) outcomes for patients treated with spine hypofractionated stereotactic ablative radiotherapy (SABR) and to evaluate possible predictors of rapid progression in view of a correct patient selection for this potentially curative SABR. Materials and methods A cohort of 59 patients with spinal metastases were treated with SABR. Patient selection criteria were the following: histologically proven diagnosis of a solid tumor, a World Health Organization (WHO) score ≤ 2, life expectancy > 6 months, Spinal Instability Neoplastic Score (SINS) ≤ 12 points and presenting with radically treated oligometastatic disease (≤5 lesions) or stable polymetastatic disease with an oligoprogressive lesion. Results From March 2015 to June 2019, 59 patients were treated with Linac-based SABR to 64 spinal metastases with a median follow-up of 55 months. SABR was standard delivered every other day in 3 to 10 fractions with median prescription dose of 27 Gy (range 21–49 Gy). The 1-,2- and 5-year PFS was 98%, 85% and 75% for all patients. OS at 5 years for all patients was 92%. Metachronous lesions (p < 0.01; HR = 7.1) and oligometastatic (vs. oligoprogressive) lesions (p = 0.02; HR = 0.3) were associated with higher PFS in uni- and multivariate Cox regression analysis. No significant predictors in multivariate analysis were demonstrated for rapid progressors. Vertebral compression fractures developed de novo in 6.3% (4/64) of cases. The median time to fracture was 11 months (range 7–15) after treatment. No other adverse events ≥ 3 grade were observed. Conclusions Tumor control and toxicity after high-dose hypofractionated SABR was evaluated in patients with spinal oligometastases. High rates of efficacy and minimal toxicity were demonstrated. Oligometastatic patients with metachronous spinal metastases seem to benefit the most from SABR.
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Affiliation(s)
- Charlotte Billiet
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk (Antwerp), Belgium.,University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Building S, Universiteitsplein 1, 2610 Wilrijk-Antwerp, Belgium
| | - Ines Joye
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk (Antwerp), Belgium.,University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Building S, Universiteitsplein 1, 2610 Wilrijk-Antwerp, Belgium
| | - Carole Mercier
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk (Antwerp), Belgium.,University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Building S, Universiteitsplein 1, 2610 Wilrijk-Antwerp, Belgium
| | - Lieselotte Depuydt
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk (Antwerp), Belgium
| | - Geert De Kerf
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk (Antwerp), Belgium
| | - Peter Vermeulen
- University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Building S, Universiteitsplein 1, 2610 Wilrijk-Antwerp, Belgium.,Oncologisch Centrum GZA, Translation Cancer Research Unit, Antwerp, Belgium
| | - Steven Van Laere
- University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Building S, Universiteitsplein 1, 2610 Wilrijk-Antwerp, Belgium.,Oncologisch Centrum GZA, Translation Cancer Research Unit, Antwerp, Belgium
| | - Erik Van de Kelft
- Department of Neurosurgery, Gen Hospital Nikolaas, Sint-Niklaas, Belgium.,University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Building S, Universiteitsplein 1, 2610 Wilrijk-Antwerp, Belgium
| | - Paul Meijnders
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk (Antwerp), Belgium.,University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Building S, Universiteitsplein 1, 2610 Wilrijk-Antwerp, Belgium
| | - Dirk Verellen
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk (Antwerp), Belgium.,University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Building S, Universiteitsplein 1, 2610 Wilrijk-Antwerp, Belgium
| | - Piet Dirix
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk (Antwerp), Belgium.,University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Building S, Universiteitsplein 1, 2610 Wilrijk-Antwerp, Belgium
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7
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Cacciola A, Parisi S, Tamburella C, Lillo S, Ferini G, Molino L, Iatì G, Pontoriero A, Bottari A, Mazziotti S, Cicero G, Minutoli F, Blandino A, Pergolizzi S. Stereotactic body radiation therapy and radiofrequency ablation for the treatment of liver metastases: How and when? Rep Pract Oncol Radiother 2020; 25:299-306. [PMID: 32194349 DOI: 10.1016/j.rpor.2020.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 02/19/2020] [Indexed: 02/07/2023] Open
Abstract
Limited liver metastases represent a clinical challenge. Surgical approach is the most frequently reported treatment option, however, some patients are not eligible for surgical interventions. Relatively recent technologic advances have permitted the safe use of ablative techniques employed in the cure of hepatic metastases. Among these, radiofrequency ablation (RFA) and stereotactic body radiotherapy (SBRT) have emerged as valid treatments in a significant proportion of patients with intrahepatic oligometastatic disease. This review offers an up-to-date of current available literature on this issue focusing on the use and outcomes of RFA and SBRT, according to the PICO (Population, Intervention, Comparison and Outcomes) criteria.
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Affiliation(s)
- Alberto Cacciola
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Silvana Parisi
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Consuelo Tamburella
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Sara Lillo
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Gianluca Ferini
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Laura Molino
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Giuseppe Iatì
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Bottari
- Radiology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Silvio Mazziotti
- Radiology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Giuseppe Cicero
- Radiology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Fabio Minutoli
- Nuclear Medicine Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alfredo Blandino
- Radiology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
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