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Alexandru M, Rodica A, Dragos-Eugen G, Mihai-Teodor G. Assessing the Spleen as an Organ at Risk in Radiation Therapy and Its Relationship With Radiation-Induced Lymphopenia: A Retrospective Study and Literature Review. Adv Radiat Oncol 2021; 6:100761. [PMID: 34934857 PMCID: PMC8655387 DOI: 10.1016/j.adro.2021.100761] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose We conducted a systematic review and a retrospective study to investigate the relationship between spleen irradiation and lymphocyte toxicity. Methods and Materials Forty-six patients diagnosed with locally advanced gastric, esophageal, and pancreatic cancer who underwent radiation therapy were included in this study. The spleen was contoured for each patient. Volumes that received 5 up to 40 Gy (5 Gy increments), minimum, mean, and maximum dose were considered along with lymphocyte count to determine toxicity. Comprehensive and systematic literature searches were performed using PubMed, SCOPUS, Cochrane Central Databases, and Google Scholar. Results Literature review on spleen unintended irradiation and lymphocyte toxicity resulted in 408 patients from 5 studies. In our study, univariate and multivariate linear regressions found an association between V15 (chemotherapy as controlling factor) and nadir lymphocyte count (P = .04) and between DMAX and nadir lymphocyte count (P = .046). An increase of 1 Gy in mean splenic dose was associated with a 1% decrease in absolute lymphocyte count at nadir. Conclusions Although there is no consensus regarding lymphopenia spleen dose volume threshold, all studies found that higher splenic dose increases the risk of lymphopenia. Our study's results suggest that spleen unintentional V15 and maximum dose irradiation were associated with lymphopenia during chemoradiation therapy.
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Affiliation(s)
- Michire Alexandru
- Prof. Dr. Al. Trestioreanu Institute of Oncology, Bucharest, Romania.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Anghel Rodica
- Prof. Dr. Al. Trestioreanu Institute of Oncology, Bucharest, Romania.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Georgescu Dragos-Eugen
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Dr. I. Cantacuzino Hospital, Bucharest, Romania
| | - Georgescu Mihai-Teodor
- Prof. Dr. Al. Trestioreanu Institute of Oncology, Bucharest, Romania.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Kagami T, Yamade M, Suzuki T, Uotani T, Tani S, Hamaya Y, Iwaizumi M, Osawa S, Sugimoto K, Miyajima H, Baba S, Sugimura H, Murai J, Pommier Y, Furuta T. The first evidence for SLFN11 expression as an independent prognostic factor for patients with esophageal cancer after chemoradiotherapy. BMC Cancer 2020; 20:1123. [PMID: 33218331 PMCID: PMC7678160 DOI: 10.1186/s12885-020-07574-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
Background Schlafen 11 (SLFN11) was recently identified as a dominant determinant of sensitivity to DNA-targeting agents including platinum-based drugs. SLFN11 also reportedly enhances cellular radiosensitivity. In this study, we examined the prognostic value of SLFN11 expression in esophageal squamous cell carcinoma (ESCC) patients treated with definitive chemoradiotherapy (dCRT), including the platinum derivative nedaplatin. Methods Seventy-three patients with ESCC who received dCRT were examined. SLFN11 expression was analyzed in pre-dCRT biopsies using immunohistochemistry and evaluated using a histo-score (H-score). Correlation between the H-score and overall survival was analyzed. An H-score ≥ 51 was provisionally defined as indicating high SLFN11 expression. Viability assays were performed using previously established isogenic human cell lines differentially expressing SLFN11 to test the usefulness of SLFN11 as marker of response to the dCRT regimen. Results High SLFN11 expression was independently associated with better prognosis in ESCC patients (hazard ratio = 0.295, 95% CI = 0.143–0.605, p = 0.001 for multivariate analysis). Kaplan-Meier survival curves showed that the prognostic value of high SLFN11 expression was most evident in patients at clinical stages II and III (p = 0.004). In in vitro study, SLFN11-proficient cells were highly sensitive to platinum derivatives compared to SLFN11-deficient cells. Conclusion SLFN11 expression is an independent prognostic factor for ESCC patients treated with dCRT and a potential biomarker for treatment selection of ESCC. Examination of SLFN11 may be particularly useful for clinical Stage II–III patients who wish to choose dCRT (instead of surgery) to preserve esophageal function. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07574-x.
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Affiliation(s)
- Takuma Kagami
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Mihoko Yamade
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Takahiro Suzuki
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Takahiro Uotani
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Shinya Tani
- Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasushi Hamaya
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Moriya Iwaizumi
- Department of Clinical Laboratory Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Satoshi Osawa
- Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ken Sugimoto
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Hiroaki Miyajima
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Satoshi Baba
- Department of Diagnostic Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Haruhiko Sugimura
- Department of Tumor Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Junko Murai
- Institute of Advanced Biosciences, Keio University, Turuoka, Yamagata, Japan
| | - Yves Pommier
- Developmental Therapeutics Branch and Laboratory of Molecular Pharmacology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Takahisa Furuta
- Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Pumpalova Y, Kozak MM, von Eyben R, Kunz P, Fisher G, Chang DT, Haraldsdottir S. Comparison of definitive chemoradiation with 5-fluorouracil versus capecitabine in anal cancer. J Gastrointest Oncol 2019; 10:605-615. [PMID: 31392040 DOI: 10.21037/jgo.2019.02.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Capecitabine (Cap) is an established treatment alternative to 5-fluorouracil (5-FU) for chemoradiation in rectal cancer. Few studies have compared the two agents in anal cancer. We compared outcomes and toxicities using Cap versus 5-FU in non-metastatic anal cancer patients at Stanford. METHODS All non-metastatic anal cancer patients treated with definitive chemoradiation at Stanford from 1997-2016 were included. Fisher's exact and Mann-Whitney U tests were used to compare nominal and continuous variables. Gray's test was used to compare incidence of recurrence and colostomy, and Log-rank test was used to compare survival. RESULTS Sixty-eight patients were included. Thirty-six patients received Cap and 32 received 5-FU (12 received standard 5-FU and 20 received low-dose continuous 5-FU). Patient characteristics were similar between the two groups. There was no difference in the 3-year overall and disease-specific survival between Cap and 5-FU (94% vs. 80%, P=0.197; 100% vs. 86%, P=0.051). Overall incidence of recurrence was equivalent between Cap and 5-FU (11% vs. 13%, P=0.703), but incidence of locoregional recurrence was higher in the 5-FU group (0% vs. 13%, P=0.042); patients treated with Cap had longer recurrence-free intervals (18 vs. 6 months, P=0.400), and all recurrences were distant. More colostomies were needed with 5-FU (3% vs. 13%, P=0.133). Toxicities were similar between the two groups. The most common grade ≥2 toxicities were dermatitis (77%), anal pain (78%), and diarrhea (56%). CONCLUSIONS Overall survival (OS), cancer-specific survival and incidence of recurrence were equivalent between Cap and 5-FU in anal cancer. Patients treated with Cap had statistically significant lower incidence of loco-regional relapses.
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Affiliation(s)
- Yoanna Pumpalova
- Department of Internal Medicine, Department of Internal Medicine, Stanford University, Stanford, CA, USA
| | - Margaret M Kozak
- Department of Radiation Oncology, Department of Internal Medicine, Stanford University, Stanford, CA, USA
| | - Rie von Eyben
- Department of Radiation Oncology, Department of Internal Medicine, Stanford University, Stanford, CA, USA
| | - Pamela Kunz
- Division of Medical Oncology, Department of Internal Medicine, Stanford University, Stanford, CA, USA
| | - George Fisher
- Division of Medical Oncology, Department of Internal Medicine, Stanford University, Stanford, CA, USA
| | - Daniel T Chang
- Department of Radiation Oncology, Department of Internal Medicine, Stanford University, Stanford, CA, USA
| | - Sigurdis Haraldsdottir
- Division of Medical Oncology, Department of Internal Medicine, Stanford University, Stanford, CA, USA
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Nie YH, Liu XD, Huang R, Xie DF, Yin WJ, Guan H, Yu ZJ, Zhou PK. Analysis of mRNA Expression Patterns in Peripheral Blood Cells of 3 Patients With Cancer After the First Fraction of 2 Gy Irradiation: An Integrated Case Report and Systematic Review. Dose Response 2019; 17:1559325819833474. [PMID: 30833875 PMCID: PMC6393837 DOI: 10.1177/1559325819833474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/12/2018] [Accepted: 01/02/2019] [Indexed: 11/15/2022] Open
Abstract
Background Radiation therapy induces acute and chronic radiological toxicity, in particular hematological toxicity (HT). This study aimed to explore the mechanistic clue and potential predictors at the messenger RNA (mRNA) level. Materials and Methods Peripheral blood was collected from 3 patients with cervical cancer (CC), nasopharynx cancer (NC), and tongue cancer (TC) after the first 2 Gy fraction of radiotherapy (RT). High-throughput sequencing was used to assess mRNA profiles. Results Eleven genes, such as ALAS2(5-aminolevulinate synthase), SLC4A1(solute carrier family 4 member 1), HBG2(hemoglobin subunit gamma 2), TNFAIP3 (TNF α-induced protein 3), PER1 (period circadian clock 1), CCDC136 (coiled-coil domain containing 136), C9orf84 (chromosome 9 open reading frame 84), IL1B (interleukin 1β), FOSB (FosB protooncogene), NR4A2 (nuclear receptor subfamily 4), PARP15 (polymerase family member 15), had overlapping expression changes in all 3 cancers of which 3 (ALAS2, FOSB, and HBG2) are suggested as potential predictors for the early diagnosis of HT after RT. Conclusions ALAS2, FOSB, and HBG2 may be useful predictors of HT in patients after RT. Eleven overlapping expression mRNAs among 3 cancers might be potential predictors for early diagnosis of radiation toxicity in patients.
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Affiliation(s)
- Yue-Hua Nie
- Department of Tumor Radiotherapy, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Xiao-Dan Liu
- Department of Radiation Biology, Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Ruixue Huang
- Department of Occupational and Environmental Health, Central South University, Changsha, China
| | - Da-Fei Xie
- Department of Radiation Biology, Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Wen-Jun Yin
- Department of Tumor Radiotherapy, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Hua Guan
- Department of Radiation Biology, Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Zi-Jian Yu
- Department of Tumor Radiotherapy, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Ping-Kun Zhou
- Department of Radiation Biology, Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China.,Institute for Chemical Carcinogenesis, State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
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