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Pepin A, Chesnokova A, Pishko A, Gysler S, Martin C, Smith E, Kassick M, Taunk NK. Hormone Replacement Therapy in Patients with Gynecologic Cancer and Radiation-Induced Premature Ovarian Insufficiency. Int J Radiat Oncol Biol Phys 2025; 121:1042-1052. [PMID: 39448037 DOI: 10.1016/j.ijrobp.2024.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/19/2024] [Accepted: 10/11/2024] [Indexed: 10/26/2024]
Abstract
Patients with gynecologic, gastrointestinal, or genitourinary malignancy are at elevated risk of developing premature ovarian insufficiency from the multimodality therapies used to treat their cancers. Premature ovarian insufficiency can result in long-term decrements to all-cause mortality, bone density, cardiovascular health, sexual health, cognitive health, and body mass. Hormone replacement therapy has been demonstrated to reverse these long-term sequalae with the goal of restoring estrogen concentrations to physiological levels. Here, we discuss a practical approach for initiation of hormone replacement therapy as well as challenges to consider.
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Affiliation(s)
- Abigail Pepin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Arina Chesnokova
- Division of Academic Specialists, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Allyson Pishko
- Division of Hematology/Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Stefan Gysler
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Caitlin Martin
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Emily Smith
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Megan Kassick
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Neil K Taunk
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Wei J, Wu G, Chang Y, Zhao Y. Radiotherapy and oncofertility: From physiological foundations to radiological perspectives. Chin Med J (Engl) 2025; 138:00029330-990000000-01417. [PMID: 39920898 PMCID: PMC11882269 DOI: 10.1097/cm9.0000000000003478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Indexed: 02/10/2025] Open
Affiliation(s)
- Jielin Wei
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Hubei Key Laboratory of Precision Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Gang Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Hubei Key Laboratory of Precision Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Yu Chang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Hubei Key Laboratory of Precision Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Yingchao Zhao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Hubei Key Laboratory of Precision Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
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Frank SJ, Das IJ, Simone CB, Davis BJ, Deville C, Liao Z, Lo SS, McGovern SL, Parikh RR, Reilly M, Small W, Schechter NR. ACR-ARS Practice Parameter for the Performance of Proton Beam Therapy. Int J Part Ther 2024; 13:100021. [PMID: 39347377 PMCID: PMC11437389 DOI: 10.1016/j.ijpt.2024.100021] [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: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 10/01/2024] Open
Abstract
Purpose This practice parameter for the performance of proton beam radiation therapy was revised collaboratively by the American College of Radiology (ACR) and the American Radium Society (ARS). This practice parameter was developed to serve as a tool in the appropriate application of proton therapy in the care of cancer patients or other patients with conditions in which radiation therapy is indicated. It addresses clinical implementation of proton radiation therapy, including personnel qualifications, quality assurance (QA) standards, indications, and suggested documentation. Materials and Methods This practice parameter for the performance of proton beam radiation therapy was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters - Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS. Results The qualifications and responsibilities of personnel, such as the proton center Chief Medical Officer or Medical Director, Radiation Oncologist, Radiation Physicist, Dosimetrist and Therapist, are outlined, including the necessity for continuing medical education. Proton therapy standard clinical indications and methodologies of treatment management are outlined by disease site and treatment group (e.g. pediatrics) including documentation and the process of proton therapy workflow and equipment specifications. Additionally, this proton therapy practice parameter updates policies and procedures related to a quality assurance and performance improvement program (QAPI), patient education, infection control, and safety. Conclusion As proton therapy becomes more accessible to cancer patients, policies and procedures as outlined in this practice parameter will help ensure quality and safety programs are effectively implemented to optimize clinical care.
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Affiliation(s)
- Steven J. Frank
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Indra J. Das
- Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | | | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Zhongxing Liao
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Simon S. Lo
- University of Washington Medical Center, Seattle, WA 98195, USA
| | - Susan L. McGovern
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rahul R. Parikh
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | | | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maguire Center, Maywood, IL 60153, USA
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Li Y, Mizumoto M, Nitta H, Fukushima H, Suzuki R, Hosaka S, Yamaki Y, Murakami M, Baba K, Nakamura M, Ishida T, Makishima H, Iizumi T, Saito T, Numajiri H, Nakai K, Kamizawa S, Kawano C, Oshiro Y, Sakurai H. Late Changes in Renal Volume and Function after Proton Beam Therapy in Pediatric and Adult Patients: Children Show Significant Renal Atrophy but Deterioration of Renal Function Is Minimal in the Long-Term in Both Groups. Cancers (Basel) 2024; 16:1634. [PMID: 38730586 PMCID: PMC11083097 DOI: 10.3390/cancers16091634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/13/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
To compare late renal effects in pediatric and adult patients with malignancies after PBT involving part of the kidney. A retrospective study was conducted to assess changes in renal volume and function in 24 patients, including 12 children (1-14 years old) and 12 adults (51-80 years old). Kidney volumes were measured from CT or MRI images during follow-up. Dose-volume histograms were calculated using a treatment planning system. In children, the median volume changes for the irradiated and control kidneys were -5.58 (-94.95 to +4.79) and +14.92 (-19.45 to +53.89) mL, respectively, with a relative volume change of -28.38 (-119.45 to -3.87) mL for the irradiated kidneys. For adults, these volume changes were -22.43 (-68.7 to -3.48) and -21.56 (-57.26 to -0.16) mL, respectively, with a relative volume change of -5.83 (-28.85 to +30.92) mL. Control kidneys in children exhibited a marked increase in size, while those in adults showed slight volumetric loss. The percentage of irradiated volume receiving 10 Gy (RBE) (V10) and 20 Gy (RBE) (V20) were significantly negatively associated with the relative volume change per year, especially in children. The CKD stage based on eGFR for all patients ranged from 1 to 3 and no cases with severe renal dysfunction were found before or after PBT. Late effects on the kidneys after PBT vary among age groups. Children are more susceptible than adults to significant renal atrophy after PBT. V10 and V20 might serve as predictors of the degree of renal atrophy after PBT, especially in children. PBT has a minimal impact on deterioration of renal function in both children and adults.
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Affiliation(s)
- Yinuo Li
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Hazuki Nitta
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Hiroko Fukushima
- Department of Child Health, Institute of Medicine, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (H.F.); (R.S.)
| | - Ryoko Suzuki
- Department of Child Health, Institute of Medicine, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (H.F.); (R.S.)
| | - Sho Hosaka
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (S.H.); (Y.Y.)
| | - Yuni Yamaki
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (S.H.); (Y.Y.)
| | - Motohiro Murakami
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Keiichiro Baba
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Masatoshi Nakamura
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Toshiki Ishida
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Hirokazu Makishima
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Takashi Iizumi
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Takashi Saito
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Kei Nakai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Satoshi Kamizawa
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Chie Kawano
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
| | - Yoshiko Oshiro
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba 305-8558, Ibaraki, Japan;
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan; (Y.L.); (H.N.); (M.M.); (M.N.); (T.I.); (H.M.); (T.I.); (T.S.); (H.N.); (K.N.); (S.K.); (C.K.); (H.S.)
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Dong R, Abazarikia A, Luan Y, Yu SY, Kim SY. Molecular Mechanisms Determining Mammalian Oocyte Quality with the Treatment of Cancer Therapy. ADVANCES IN ANATOMY, EMBRYOLOGY, AND CELL BIOLOGY 2024; 238:97-119. [PMID: 39030356 DOI: 10.1007/978-3-031-55163-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
Cancer is a global public health issue and remains one of the leading causes of death in the United States (Siegel et al. CA Cancer J Clin. 72:7-33, 2022). It is estimated in the US in 2022, about 935,000 new cases of cancer will be diagnosed in women, and the probability of developing invasive cancer is 5.8% for females younger than 50 years old (Siegel et al. CA Cancer J Clin. 72:7-33, 2022). However, advances in screening programs, diagnostic methods, and therapeutic options have greatly increased the five-year survival rate in reproductive-age women with a variety of cancers. Given the clinical consequences of gonadotoxic cancer therapies, young, female cancer survivors may face compromised fertility, premature ovarian insufficiency, early-onset menopause, and endocrine dysregulation (Bedoschi et al. Future Oncol. 12:2333-44, 2016). Gonadotoxic side effects may include decreased oocyte quality within surviving follicles, loss of ovarian follicles, and impaired ovarian function. In reproductive-age women, oocyte quality is an important element for successful clinical pregnancies and healthy offspring as poor-quality oocytes may be a cause of infertility (McClam et al. Biol Reprod. 106:328-37, 2022; Marteil et al. Reprod Biol. 9:203-24, 2009; Krisher. J Anim Sci. 82: E14-E23, 2004). Thus, it is critical to determine the quantity and quality of surviving follicles in the ovary after cancer treatment and to assess oocyte quality within those surviving follicles as these are markers for determining the capacity for ovarian function restoration and future fertility, especially for young cancer survivors (Xu et al. Nat Med. 17:1562-3, 2011). The long-term effects of cancer therapeutics on oocyte quality are influenced by factors including, but not limited to, individual patient characteristics (e.g. age, health history, comorbidities, etc.), disease type, or treatment regimen (Marci et al. Reprod Biol Endocrinol. 16:1-112, 2018). These effects may translate clinically into an impaired production of viable oocytes and compromised fertility (Garutti et al. ESMO Open. 6:100276, 2021).
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Affiliation(s)
- Rosemary Dong
- Department of Obstetrics and Gynecology, Olson Center for Women's Health, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- , Omaha, USA
| | - Amirhossein Abazarikia
- Department of Obstetrics and Gynecology, Olson Center for Women's Health, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- , Omaha, USA
| | - Yi Luan
- Department of Obstetrics and Gynecology, Olson Center for Women's Health, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- , Omaha, USA
| | - Seok-Yeong Yu
- Department of Obstetrics and Gynecology, Olson Center for Women's Health, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- , Omaha, USA
| | - So-Youn Kim
- Department of Obstetrics and Gynecology, Olson Center for Women's Health, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
- , Omaha, USA.
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Berlin E, Yegya-Raman N, Garver E, Li T, Lin LL, Taunk NK. Acute and long-term toxicity of whole pelvis proton radiation therapy for definitive or adjuvant management of gynecologic cancers. Gynecol Oncol 2023; 172:92-97. [PMID: 37003073 DOI: 10.1016/j.ygyno.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE To characterize long-term toxicity and disease outcomes with whole pelvis (WP) pencil beam scanning proton radiation therapy (PBS PRT) for gynecologic malignancies. METHODS We reviewed 23 patients treated from 2013 to 2019 with WP PBS PRT for endometrial, cervical, and vaginal cancer. We report acute and late Grade (G)2+ toxicities, graded by Common Terminology Criteria for Adverse Events, Version 5. Disease outcomes were assessed by Kaplan-Meier method. RESULTS Median age was 59 years. Median follow up was 4.8 years. 12 (52.2%) had uterine cancer, 10 (43.5%) cervical, 1 (4.3%) vaginal. 20 (86.9%) were treated post-hysterectomy. 22 (95.7%) received chemotherapy, 12 concurrently (52.2%). The median PBS PRT dose was 50.4GyRBE (range, 45-62.5). 8 (34.8% had para-aortic/extended fields. 10 (43.5%) received brachytherapy boost. Median follow up was 4.8 years. 5-year actuarial local control was 95.2%, regional control 90.9%, distant control 74.7%, both disease control and progression-free survival 71.2%. Overall survival was 91.3%. In the acute period, 2 patients (8.7%) had G2 genitourinary (GU) toxicity, 6 (26.1%) had gastrointestinal (GI) G2-3 toxicity, 17 (73.9%) had G2-4 hematologic (H) toxicity. In the late period, 3 (13.0%) had G2 GU toxicity, 1 (4.3%) had G2 GI toxicity, 2 (8.7%) had G2-3H toxicity. The mean small bowel V15Gy was 213.4 cc. Mean large bowel V15 Gy was 131.9 cc. CONCLUSIONS WP PBS PRT for gynecologic malignancies delivers favorable locoregional control. Rates of GU and GI toxicity are low. Acute hematologic toxicity was most common, which may be related to the large proportion of patients receiving chemotherapy.
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Circ-CPSF1 Worsens Radiation-Induced Oxidative Stress Injury in Caenorhabditis elegans. Biomolecules 2023; 13:biom13010102. [PMID: 36671487 PMCID: PMC9856148 DOI: 10.3390/biom13010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/06/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
Radioactive substances have been used in various aspects in daily life. However, high-energy radiation could cause environmental problems, which would damage the human body. Circular RNA (CircRNA) has great potential in the minimization of ionizing radiation damage. To find a potential diagnostic and therapeutic target for reducing the damage of ionizing radiation, we selected circRNA cleavage and polyadenylation specificity factor subunit 1 (circ-CPSF1) based on its up-regulated expression after X-ray radiation and explored its effect on response to ionizing radiation using Caenorhabditis elegans (C. elegans). Circ-CPSF1 was screened out and its up-regulated expression was verified. The measurement of lifespan and germ cell apoptosis showed that circ-CPSF1 RNAi treatment extended lifespan and reduced apoptotic germ cells. ROS levels were significantly reduced after the interference of circ-CPSF1 in C. elegans with radiation. Mitochondrial membrane potential assay showed that the suppression of circ-CPSF1 could alleviate mitochondrial damage after radiation. Relative genes expression showed the involvement of circ-CPSF1 in radiation mediated DNA damage response pathways and apoptosis pathways. In conclusion, circ-CPSF1 exerts deleterious effects on lifespan, eggs production and germ cell apoptosis of C. elegans through oxidative stress, the DNA damage response (DDR) pathway, and the core apoptotic pathway after ionizing radiation, indicating the potential of circ-CPSF1 to be an important therapeutic target of radiation damage.
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Unlaid Eggs: Ovarian Damage after Low-Dose Radiation. Cells 2022; 11:cells11071219. [PMID: 35406783 PMCID: PMC8997758 DOI: 10.3390/cells11071219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/24/2022] [Accepted: 04/02/2022] [Indexed: 11/17/2022] Open
Abstract
The total body irradiation of lymphomas and co-irradiation in the treatment of adjacent solid tumors can lead to a reduced ovarian function, premature ovarian insufficiency, and menopause. A small number of studies has assessed the radiation-induced damage of primordial follicles in animal models and humans. Studies are emerging that evaluate radiation-induced damage to the surrounding ovarian tissue including stromal and immune cells. We reviewed basic laboratory work to assess the current state of knowledge and to establish an experimental setting for further studies in animals and humans. The experimental approaches were mostly performed using mouse models. Most studies relied on single doses as high as 1 Gy, which is considered to cause severe damage to the ovary. Changes in the ovarian reserve were related to the primordial follicle count, providing reproducible evidence that radiation with 1 Gy leads to a significant depletion. Radiation with 0.1 Gy mostly did not show an effect on the primordial follicles. Fewer data exist on the effects of radiation on the ovarian microenvironment including theca-interstitial, immune, endothelial, and smooth muscle cells. We concluded that a mouse model would provide the most reliable model to study the effects of low-dose radiation. Furthermore, both immunohistochemistry and fluorescence-activated cell sorting (FACS) analyses were valuable to analyze not only the germ cells but also the ovarian microenvironment.
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Gay C, Raphael YR, Steers J, Lu DJ, Lewis JH, DeMarco J, Fraass B, Rimel BJ, Zakariaee R, Kamrava M, Atkins KM. Ovarian Transposition Before Pelvic Radiation Therapy: Spatial Distribution and Dose Volume Analysis. Adv Radiat Oncol 2022; 7:100804. [PMID: 35079662 PMCID: PMC8767263 DOI: 10.1016/j.adro.2021.100804] [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: 06/05/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose Methods and Materials Results Conclusions
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Affiliation(s)
| | | | | | | | | | | | | | - Bobbie J. Rimel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Katelyn M. Atkins
- Department of Radiation Oncology
- Corresponding author: Katelyn M. Atkins, MD, PhD
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Young Adult Populations Face Yet Another Barrier to Care With Insurers: Limited Access to Proton Therapy. Int J Radiat Oncol Biol Phys 2021; 110:1496-1504. [PMID: 33677051 DOI: 10.1016/j.ijrobp.2021.02.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/11/2021] [Accepted: 02/23/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Young patients, including pediatric, adolescent, and young adult (YA) patients, are most likely to benefit from the reduced integral dose of proton beam radiation therapy (PBT) resulting in fewer late toxicities and secondary malignancies. This study sought to examine insurance approval and appeal outcomes for PBT among YA patients compared with pediatric patients at a large-volume proton therapy center. METHODS AND MATERIALS We performed a cross-sectional cohort study of 284 consecutive patients aged 0 to 39 years for whom PBT was recommended in 2018 through 2019. Pediatric patients were defined as aged 0 to 18 years and YA patients 19 to 39 years. Rates of approval, denials, and decision timelines were calculated. Tumor type and location were also evaluated as factors that may influence insurance decisions. RESULTS A total of 207 patients (73%) were approved for PBT at initial request. YA patients (n = 68/143, 48%) were significantly less likely to receive initial approval compared with pediatric patients (n = 139/141; 99%) (P < .001). Even after 47% (n = 35 of 75) of the PBT denials for YA patients were overturned, YAs had a significantly lower final PBT approval (72% vs pediatric 99%; P < .001). The median wait time was also significantly longer for YA patients (median, 8 days; interquartile range [IQR] 3-17 vs median, 2 days; IQR, 0-6; P < .001). In those patients requiring an appeal, the median wait time was 16 days (IQR, 9-25). CONCLUSION Given the decades of survivorship of YA patients, PBT is an important tool to reduce late toxicities and secondary malignancies. Compared with pediatric patients, YA patients are significantly less likely to receive insurance approval for PBT. Insurance denials and subsequent appeal requests result in significant delays for YA patients. Insurers need to re-examine their policies to include expedited decisions and appeals and removal of arbitrary age cutoffs so that YA patients can gain easier access to PBT. Furthermore, consensus guidelines encouraging greater PBT access for YA may be warranted from both medical societies and/or AYA experts.
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