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Touraine C, Winter A, Castan F, Azria D, Gourgou S. Time-Dependent ROC Curve Analysis for Assessing the Capability of Radiation-Induced CD8 T-Lymphocyte Apoptosis to Predict Late Toxicities after Adjuvant Radiotherapy of Breast Cancer Patients. Cancers (Basel) 2023; 15:4676. [PMID: 37835370 PMCID: PMC10571898 DOI: 10.3390/cancers15194676] [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: 08/10/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Late fibrosis can occur in breast cancer patients treated with curative-intent radiotherapy. Predicting this toxicity is of clinical interest in order to adapt the irradiation dose delivered. Radiation-induced CD8 T-lymphocyte apoptosis (RILA) had been proven to be associated with less grade ≥2 late radiation-induced toxicities in patients with miscellaneous cancers. Tobacco smoking status and adjuvant hormonotherapy were also identified as potential factors related to late-breast-fibrosis-free survival. This article evaluates the predictive performance of the RILA using a ROC curve analysis that takes into account the dynamic nature of fibrosis occurrence. This time-dependent ROC curve approach is also applied to evaluate the ability of the RILA combined with the other previously identified factors. Our analysis includes a Monte Carlo cross-validation procedure and the calculation of an expected cost of misclassification, which provides more importance to patients who have no risk of late fibrosis in order to be able to treat them with the maximal irradiation dose. Performance evaluation was assessed at 12, 24, 36 and 50 months. At 36 months, our results were comparable to those obtained in a previous study, thus underlying the predictive power of the RILA. Based on specificity and cost, RILA alone seemed to be the most performant, while its association with the other factors had better negative predictive value results.
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Affiliation(s)
- Célia Touraine
- Biometrics Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France; (C.T.); (F.C.); (S.G.)
- French National Platform Quality of Life and Cancer, 34090 Montpellier, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), University Montpellier, INSERM, 34090 Montpellier, France
| | - Audrey Winter
- Biometrics Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France; (C.T.); (F.C.); (S.G.)
- French National Platform Quality of Life and Cancer, 34090 Montpellier, France
| | - Florence Castan
- Biometrics Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France; (C.T.); (F.C.); (S.G.)
| | - David Azria
- Radiotherapy Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France;
| | - Sophie Gourgou
- Biometrics Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France; (C.T.); (F.C.); (S.G.)
- French National Platform Quality of Life and Cancer, 34090 Montpellier, France
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Beddok A, Cottu P, Fourquet A, Kirova Y. [Radiotherapy and targeted therapy for the management of breast cancer: A review]. Cancer Radiother 2023; 27:447-454. [PMID: 37173174 DOI: 10.1016/j.canrad.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 05/15/2023]
Abstract
The purpose of this study was to review the current knowledge regarding combinations of the most commonly used targeted therapies or those under development for the management of breast cancer with radiation therapy. Several studies have shown that the combination of radiation therapy and tamoxifen increased the risk of radiation-induced lung toxicity; therefore, the two modalities are generally not given concurrently. The combination of HER2 inhibitors (trastuzumab, pertuzumab) and radiation therapy appeared to be safe. However, trastuzumab emtansine (T-DM1) should not be given concomitantly with brain radiation therapy because this combination may increase the risk of brain radionecrosis. The combination of radiation therapy with other new targeted therapies such as new selective estrogen receptor modulators (SERDs), lapatinib, cell cycle inhibitors, immune checkpoint inhibitors, or molecules acting on DNA damage repair seems feasible but has been mainly evaluated on retrospective or prospective studies with small numbers of patients. Moreover, there is a great heterogeneity between these studies regarding the dose and fractionation used in radiotherapy, the dosage of systemic treatments and the sequence of treatments used. Therefore, the combination of these new molecules with radiotherapy should be proposed sparingly, under close monitoring, pending the ongoing prospective studies cited in this review.
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Affiliation(s)
- A Beddok
- Laboratoire d'imagerie translationnelle en oncologie (Lito), Institut Curie, université PSL, université Paris Saclay, Inserm, 91898 Orsay, France; Département de radiothérapie oncologique, institut Curie, université PSL, Centre de protonthérapie, centre universitaire, 91898 Orsay, France.
| | - P Cottu
- Département d'oncologie médicale, institut Curie, Paris, France
| | - A Fourquet
- Département de radiothérapie oncologique, institut Curie, université PSL, Paris, France
| | - Y Kirova
- Département de radiothérapie oncologique, institut Curie, université PSL, Paris, France
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3
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Petit C, Escande A, Sarrade T, Vaugier L, Kirova Y, Tallet A. Radiation therapy in the thoracic region: Radio-induced cardiovascular disease, cardiac delineation and sparing, cardiac dose constraints, and cardiac implantable electronic devices. Cancer Radiother 2023; 27:588-598. [PMID: 37648559 DOI: 10.1016/j.canrad.2023.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/01/2023]
Abstract
Radiation therapy in the thoracic region may deliver incidental ionizing radiation to the surrounding healthy structures, including the heart. Radio-induced heart toxicity has long been a concern in breast cancer and Hodgkin's lymphoma and was deemed a long-term event. However, recent data highlight the need to limit the dose to the heart in less favorable thoracic cancers too, such as lung and esophageal cancers in which incidental irradiation led to increased mortality. This article will summarize available cardiac dose constraints in various clinical settings and the types of radio-induced cardiovascular diseases encountered as well as delineation of cardiac subheadings and management of cardiac devices. Although still not completely deciphered, heart dose constraints remain intensively investigated and the mean dose to the heart is no longer the only dosimetric parameter to consider since the left anterior descending artery as well as the left ventricle should also be part of dosimetry constraints.
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Affiliation(s)
- C Petit
- Radiation Oncology Department, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille cedex 09, France
| | - A Escande
- Service de radiothérapie, centre Léonard-de-Vinci, Dechy, France; UMR 9189, laboratoire Cristal, université de Lille, Villeneuve-d'Ascq, France
| | - T Sarrade
- Department of Radiation Oncology, hôpital Tenon, Sorbonne université, 75020 Paris, France
| | - L Vaugier
- Department of Radiation Oncology, institut de cancérologie de l'Ouest, Saint-Herblain, France
| | - Y Kirova
- Department of Radiation Oncology, institut Curie, Paris, France
| | - A Tallet
- Radiation Oncology Department, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille cedex 09, France; UMR 1068, CRCM Inserm, Marseille, France.
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Kerns SL, Hall WA, Marples B, West CML. Normal Tissue Toxicity Prediction: Clinical Translation on the Horizon. Semin Radiat Oncol 2023; 33:307-316. [PMID: 37331785 DOI: 10.1016/j.semradonc.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Improvements in radiotherapy delivery have enabled higher therapeutic doses and improved efficacy, contributing to the growing number of long-term cancer survivors. These survivors are at risk of developing late toxicity from radiotherapy, and the inability to predict who is most susceptible results in substantial impact on quality of life and limits further curative dose escalation. A predictive assay or algorithm for normal tissue radiosensitivity would allow more personalized treatment planning, reducing the burden of late toxicity, and improving the therapeutic index. Progress over the last 10 years has shown that the etiology of late clinical radiotoxicity is multifactorial and informs development of predictive models that combine information on treatment (eg, dose, adjuvant treatment), demographic and health behaviors (eg, smoking, age), co-morbidities (eg, diabetes, collagen vascular disease), and biology (eg, genetics, ex vivo functional assays). AI has emerged as a useful tool and is facilitating extraction of signal from large datasets and development of high-level multivariable models. Some models are progressing to evaluation in clinical trials, and we anticipate adoption of these into the clinical workflow in the coming years. Information on predicted risk of toxicity could prompt modification of radiotherapy delivery (eg, use of protons, altered dose and/or fractionation, reduced volume) or, in rare instances of very high predicted risk, avoidance of radiotherapy. Risk information can also be used to assist treatment decision-making for cancers where efficacy of radiotherapy is equivalent to other treatments (eg, low-risk prostate cancer) and can be used to guide follow-up screening in instances where radiotherapy is still the best choice to maximize tumor control probability. Here, we review promising predictive assays for clinical radiotoxicity and highlight studies that are progressing to develop an evidence base for clinical utility.
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Affiliation(s)
- Sarah L Kerns
- Department of Radiation Oncology, the Medical College of Wisconsin, Milwaukee, WI.
| | - William A Hall
- Department of Radiation Oncology, the Medical College of Wisconsin, Milwaukee, WI
| | - Brian Marples
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - Catharine M L West
- Division of Cancer Sciences, the University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
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Aguado-Flor E, Fuentes-Raspall MJ, Gonzalo R, Alonso C, Ramón Y Cajal T, Fisas D, Seoane A, Sánchez-Pla Á, Giralt J, Díez O, Gutiérrez-Enríquez S. Cell Senescence-Related Pathways Are Enriched in Breast Cancer Patients With Late Toxicity After Radiotherapy and Low Radiation-Induced Lymphocyte Apoptosis. Front Oncol 2022; 12:825703. [PMID: 35686103 PMCID: PMC9170959 DOI: 10.3389/fonc.2022.825703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Radiation-induced late effects are a common cause of morbidity among cancer survivors. The biomarker with the best evidence as a predictive test of late reactions is the radiation-induced lymphocyte apoptosis (RILA) assay. We aimed to investigate the molecular basis underlying the distinctive RILA levels by using gene expression analysis in patients with and without late effects and in whom we had also first identified differences in RILA levels. Patients and Methods Peripheral blood mononuclear cells of 10 patients with late severe skin complications and 10 patients without symptoms, selected from those receiving radiotherapy from 1993 to 2007, were mock-irradiated or irradiated with 8 Gy. The 48-h response was analyzed in parallel by RILA assay and gene expression profiling with Affymetrix microarrays. Irradiated and non-irradiated gene expression profiles were compared between both groups. Gene set enrichment analysis was performed to identify differentially expressed biological processes. Results Although differentially expressed mRNAs did not reach a significant adjusted p-value between patients suffering and not suffering clinical toxicity, the enriched pathways indicated significant differences between the two groups, either in irradiated or non-irradiated cells. In basal conditions, the main differentially expressed pathways between the toxicity and non-toxicity groups were the transport of small molecules, interferon signaling, and transcription. After 8 Gy, the differences lay in pathways highly related to cell senescence like cell cycle/NF-κB, G-protein-coupled receptors, and interferon signaling. Conclusion Patients at risk of developing late toxicity have a distinctive pathway signature driven by deregulation of immune and cell cycle pathways related to senescence, which in turn may underlie their low RILA phenotype.
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Affiliation(s)
- Ester Aguado-Flor
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Ricardo Gonzalo
- Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carmen Alonso
- Medical Oncology Department, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - David Fisas
- Medical Oncology Department, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Alejandro Seoane
- Medical Physics Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Álex Sánchez-Pla
- Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Genetics, Microbiology and Statistics Department, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Giralt
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Radiation Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Orland Díez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Area of Clinical and Molecular Genetics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Lapierre A, Bourillon L, Larroque M, Gouveia T, Bourgier C, Ozsahin M, Pèlegrin A, Azria D, Brengues M. Improving Patients’ Life Quality after Radiotherapy Treatment by Predicting Late Toxicities. Cancers (Basel) 2022; 14:cancers14092097. [PMID: 35565227 PMCID: PMC9099838 DOI: 10.3390/cancers14092097] [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: 02/24/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Over 50% of patients with cancer will receive radiotherapy treatment. Five to ten percent of patients who received radiotherapy will develop side effects. Identifying these patients before treatment start would allow for treatment modification to minimize these effects and improve the life quality of these patients. Our team developed a test, which allows predicting these secondary effects before starting the treatment. This will help in proposing personalized treatments to improve the outcome. This review presents how this test is performed, its results, as well as its modification in order to be used in hospitals. Abstract Personalized treatment and precision medicine have become the new standard of care in oncology and radiotherapy. Because treatment outcomes have considerably improved over the last few years, permanent side-effects are becoming an increasingly significant issue for cancer survivors. Five to ten percent of patients will develop severe late toxicity after radiotherapy. Identifying these patients before treatment start would allow for treatment adaptation to minimize definitive side effects that could impair their long-term quality of life. Over the last decades, several tests and biomarkers have been developed to identify these patients. However, out of these, only the Radiation-Induced Lymphocyte Apoptosis (RILA) assay has been prospectively validated in multi-center cohorts. This test, based on a simple blood draught, has been shown to be correlated with late radiation-induced toxicity in breast, prostate, cervical and head and neck cancer. It could therefore greatly improve decision making in precision radiation oncology. This literature review summarizes the development and bases of this assay, as well as its clinical results and compares its results to the other available assays.
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Affiliation(s)
- Ariane Lapierre
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
- Department of Radiotherapy-Oncology, Lyon-Sud Hospital Center, 69310 Pierre-Bénite, France
| | - Laura Bourillon
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - Marion Larroque
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - Tiphany Gouveia
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - Céline Bourgier
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | | | - André Pèlegrin
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - David Azria
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - Muriel Brengues
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
- Correspondence: ; Tel.: +33-411-283-182
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Chen K, Liu JQ, Wu W, Su FX, Zou Q, Song EW. Clinical practice guideline for breast-conserving surgery in patients with early-stage breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021. Chin Med J (Engl) 2021; 134:2143-2146. [PMID: 34133359 PMCID: PMC8478397 DOI: 10.1097/cm9.0000000000001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
- Department of Breast Surgery, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Jie-Qiong Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
- Department of Breast Surgery, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Wei Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
- Department of Breast Surgery, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Feng-Xi Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
- Department of Breast Surgery, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Qiang Zou
- Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Er-Wei Song
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
- Department of Breast Surgery, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
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8
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Witt JS, Wisinski KB, Anderson BM. Concurrent Radiation and Modern Systemic Therapies for Breast Cancer: An Ever-Expanding Frontier. Clin Breast Cancer 2021; 21:120-127. [PMID: 34030859 DOI: 10.1016/j.clbc.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/28/2020] [Indexed: 11/29/2022]
Abstract
Radiotherapy is a critical tool for reducing locoregional recurrence, extending survival, and palliating symptoms in patients with breast cancer. With an ever-expanding armamentarium of systemic agents available, and an increasing trend toward the use of hypofractionated radiation regimens, it can be difficult to determine the safety of concurrent therapy. In particular, new targeted agents in both the adjuvant and metastatic setting have limited prospective or long-term data demonstrating safety when delivered concurrently with radiotherapy. Other systemic agents, including chemotherapy and endocrine therapy, are also important components of the overall treatment strategy for localized and metastatic breast cancer, and are often delivered concurrently with radiation in certain clinical scenarios. This review explores the safety, efficacy, and pitfalls of delivering radiation in conjunction with systemic therapies for breast cancer.
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Affiliation(s)
- Jacob S Witt
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Kari B Wisinski
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Bethany M Anderson
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI; Carbone Cancer Center, University of Wisconsin, Madison, WI.
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Benitez CM, Knox SJ. Harnessing genome-wide association studies to minimize adverse radiation-induced side effects. Radiat Oncol J 2020; 38:226-235. [PMID: 33233031 PMCID: PMC7785837 DOI: 10.3857/roj.2020.00556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/22/2020] [Indexed: 12/19/2022] Open
Abstract
Radiotherapy is used as definitive treatment in approximately two-thirds of all cancers. However, like any treatment, radiation has significant acute and long-term side effects including secondary malignancies. Even when similar radiation parameters are used, 5%–10% of patients will experience adverse radiation side effects. Genomic susceptibility is thought to be responsible for approximately 40% of the clinical variability observed. In the era of precision medicine, the link between genetic susceptibility and radiation-induced side effects is further strengthening. Genome-wide association studies (GWAS) have begun to identify single-nucleotide polymorphisms (SNPs) attributed to overall and tissue-specific toxicity following radiation for treatment of breast cancer, prostate cancer, and other cancers. Here, we review the use of GWAS in identifying polymorphisms that are predictive of acute and long-term radiation-induced side effects with a focus on chest, pelvic, and head-and-neck irradiation. Integration of GWAS with “omic” data, patient characteristics, and clinical correlates into predictive models could decrease radiation-induced side effects while increasing therapeutic efficacy.
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Affiliation(s)
- Cecil M Benitez
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Susan J Knox
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
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10
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Faut-il moduler les contraintes de dose dans les organes à risque lors d’une irradiation en association avec un traitement anticancéreux systémique ? Cancer Radiother 2020; 24:594-601. [DOI: 10.1016/j.canrad.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 11/23/2022]
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11
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Upadhyay R, Pandey R, Nand Sharma D, Gupta S, Parambath HK, Nair O, Pandey RM, Kumar Julka P, Rath GK. Concurrent or sequential hormonal therapy in era of hypofractionation in early breast cancer: A single‐institution prospective study. Breast J 2020; 26:1885-1887. [DOI: 10.1111/tbj.13825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Rambha Pandey
- Department of Radiation Oncology AIIMS New Delhi India
| | | | - Subhash Gupta
- Department of Radiation Oncology AIIMS New Delhi India
| | | | - Omana Nair
- Department of Radiation Oncology AIIMS New Delhi India
| | | | | | - Goura K. Rath
- Department of Radiation Oncology AIIMS New Delhi India
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12
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Thanthong S, Nanthong R, Kongwattanakul S, Laebua K, Trirussapanich P, Pitiporn S, Nantajit D. Prophylaxis of Radiation-Induced Dermatitis in Patients With Breast Cancer Using Herbal Creams: A Prospective Randomized Controlled Trial. Integr Cancer Ther 2020; 19:1534735420920714. [PMID: 32406284 PMCID: PMC7238795 DOI: 10.1177/1534735420920714] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Radiation-induced toxicity is a major limiting factor for prescribing radiation dose in cancer radiotherapy. Skin reaction to radiation is one of the primary concerns, which could affect quality of life of the patients both physically and mentally. Reviews of the literature show limited number of effective reagents for its prophylaxis. In this study, we attempted to determine whether prophylactic treatment of the 3 different herbal creams containing Centella asiatica, Cucumis sativus, and Thunbergia laurifolia extracts as well as a commercial moisturizing cream could reduce acute skin reaction in breast cancer patients undergoing radiotherapy. A total of 153 breast cancer patients undergoing radiotherapy were randomly assigned into 5 different groups with one group receiving no treatment. The patients were instructed to apply their designated creams once daily from their first radiotherapy session until 1-month post-irradiation. Their skins were graded by a radiation oncologist on a weekly basis until 1-month post-irradiation to identify any skin reactions. The results showed that the administration of the herbal creams or the moisturizing cream could neither reduce the severity nor delay the onset of dermatitis compared with the no treatment group. However, despite the limited benefits from the prophylaxis, the Cucumis sativus cream was shown to help with the skin recovery post-irradiation. These results suggested that breast cancer patients undergoing radiotherapy should be advised to apply moisturizing cream to the area of irradiated skin.
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Affiliation(s)
- Saengrawee Thanthong
- HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Rattanaporn Nanthong
- HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Sirikorn Kongwattanakul
- HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Kanyanee Laebua
- HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | - Supaporn Pitiporn
- Chaopraya Abhaibhubejhr Hospital; Chaopraya Abhaiphubejhr Hospital Foundation, Prachinburi, Thailand
| | - Danupon Nantajit
- HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
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Abdemanafi M, Tavakoli MB, Akhavan A, Abedi I. Changes in lung volume parameters regarding the received dose in the lobes of the lungs after locoregional radiotherapy of breast cancer. Rep Pract Oncol Radiother 2019; 24:556-562. [PMID: 31660048 DOI: 10.1016/j.rpor.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/16/2019] [Accepted: 09/21/2019] [Indexed: 12/25/2022] Open
Abstract
Aim The purpose of this study was to evaluate ΔLVP and correlate them with MLD and V20 in the lobes of the lung. Background Radiation-induced lung injury after breast irradiation is controversial. The incidence of such an injury could have negative consequences on breast cancer patients. Materials and Methods Twenty-three women treated with Breast-conserving surgery, chemotherapy, and locoregional RT underwent body plethysmography pre-RT and 3 and 6 months post-RT. Statistical analysis was used to evaluate ΔLVP over time and relate them with MLD, V20, age, and concurrent hormonal therapy. Results LVP decreased after 3 months and then showed a slight improvement by returning partially to their pre-RT values after 6 months. The mean ΔLVP was -0.64% for one Gy increase of MLD and -0.34% for one percent increase of V20 after 3 months. After 6 months, only ΔVC showed 0.45% reduction with MLD in the upper lobe. Finally, there was no significant correlation between ΔLVP with respect to age and concurrent hormonal therapy. Conclusions The results of this study showed that lung volume changes were not a cause for concern in breast cancer patients. There are three reasons to support this conclusion. Lung volume changes and percentage reductions in LVP for each Gy increase of MLD and each percentage increase of V20 in each lobe were small; patients were asymptomatic during the follow-up period; and LVP showed partial improvements after 6 months.
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Affiliation(s)
- Mahsa Abdemanafi
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Bagher Tavakoli
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Akhavan
- Department of Radiotherapy Oncology, Seyed Alshohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iraj Abedi
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Pommier P. Long term results of the NRG/RTOG 9413: a key study but one of the most confusing study in prostate cancer radiotherapy! Transl Androl Urol 2019; 8:S257-S260. [PMID: 31392138 DOI: 10.21037/tau.2019.04.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Pascal Pommier
- Radiotherapy Department, Centre Leon Berard, Lyon Cedex 08, France
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15
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Bourgier C, Lemanski C, Draghici R, Castan F, Fenoglietto P, Bons F, Farcy-Jacquet MP, Brengues M, Gourgou S, Ozsahin M, Azria D. [Individual modification of the dose, volume and fractionation of breast radiotherapy]. Cancer Radiother 2019; 23:778-783. [PMID: 31378461 DOI: 10.1016/j.canrad.2019.06.004] [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: 06/05/2019] [Accepted: 06/26/2019] [Indexed: 11/26/2022]
Abstract
Randomized trials demonstrated similar overall survival between mastectomy and breast-conservative surgery followed by adjuvant radiation therapy. Breast-conservative surgery, with adjuvant radiation therapy, with or without neoadjuvant systemic therapy has become the standard of care for women with early or locally advanced breast cancer. Nevertheless, certain cardiac, lung or cutaneous toxicities may alter the long-term body image and the quality of life of a limited number of patients who consider having had "overtreatment" or treatment outside the best knowledge of science. In case of low-risk breast cancer, several trials have evaluated the carcinologic outcome in absence of radiation therapy after breast-conservative surgery. Local recurrences increased in case of breast-conservative surgery alone but without impact on overall survival. Multiple debates have emerged in order to select the most appropriate evaluation criteria. Finally, a large consensus has considered that reducing local recurrences is important but with modern technologies and after identifying patients of individual radiosensitivity. Indeed, in case of a low absolute risk of local recurrence, radiation therapy techniques have been developed to allow a focal treatment especially for patients with high risk of developing late effects. This kind of compromise takes into account the reduction risk of local recurrences but also the probability of developing radiation-induced cutaneous sequelae. In the same way, for patients considered at high risk of recurrence, the huge volumes need specific techniques to better cover the targets while protecting the surrounding critic organs such as heart and lung. Intensity-modulated radiation therapy and the local high boost may help to decrease local recurrences of these more extended and aggressive diseases while considering the individual radiosensitivity that paves the way of long-term sequelae. In this article, we detail a personalized approach of breast radiation therapy considering the absolute risk of local recurrences and the probability of radiation-induced toxicity appearance.
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Affiliation(s)
- C Bourgier
- Institut de recherche en cancérologie de Montpellier (IRCM), rue Croix-Verte, 34298 Montpellier, cedex 5, France; Inserm U1194, rue Croix-Verte, 34298 Montpellier, cedex 5, France; Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, cedex 5, France
| | - C Lemanski
- Institut de recherche en cancérologie de Montpellier (IRCM), rue Croix-Verte, 34298 Montpellier, cedex 5, France; Inserm U1194, rue Croix-Verte, 34298 Montpellier, cedex 5, France; Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, cedex 5, France
| | - R Draghici
- Institut de recherche en cancérologie de Montpellier (IRCM), rue Croix-Verte, 34298 Montpellier, cedex 5, France; Inserm U1194, rue Croix-Verte, 34298 Montpellier, cedex 5, France; Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, cedex 5, France
| | - F Castan
- Unité de biométrie, Institut régional du cancer Montpellier (ICM), rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - P Fenoglietto
- Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, cedex 5, France
| | - F Bons
- Fédération universitaire d'oncologie radiothérapie, institut de cancérologie du Gard, CHU de Nîmes, rue Henri-Pujol, 30000 Nîmes, France
| | - M-P Farcy-Jacquet
- Fédération universitaire d'oncologie radiothérapie, institut de cancérologie du Gard, CHU de Nîmes, rue Henri-Pujol, 30000 Nîmes, France
| | - M Brengues
- Institut de recherche en cancérologie de Montpellier (IRCM), rue Croix-Verte, 34298 Montpellier, cedex 5, France; Inserm U1194, rue Croix-Verte, 34298 Montpellier, cedex 5, France; Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - S Gourgou
- Unité de biométrie, Institut régional du cancer Montpellier (ICM), rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - M Ozsahin
- Service de radio-oncologie, Centre hospitalier universitaire vaudois, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - D Azria
- Institut de recherche en cancérologie de Montpellier (IRCM), rue Croix-Verte, 34298 Montpellier, cedex 5, France; Inserm U1194, rue Croix-Verte, 34298 Montpellier, cedex 5, France; Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, cedex 5, France; Fédération universitaire d'oncologie radiothérapie, institut de cancérologie du Gard, CHU de Nîmes, rue Henri-Pujol, 30000 Nîmes, France.
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16
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Fhoghlú MN, Barrett S. A Review of Radiation-Induced Lymphocyte Apoptosis as a Predictor of Late Toxicity After Breast Radiotherapy. J Med Imaging Radiat Sci 2019; 50:337-344. [PMID: 31176443 DOI: 10.1016/j.jmir.2019.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/28/2019] [Accepted: 02/20/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Improved survivorship in patients with breast cancer means many are currently living with the late effects of radiotherapy, particularly fibrosis. Personalized treatment is not currently considered for patients with breast cancer. Radiation-induced lymphocyte apoptosis (RILA), a predictive assay, could offer a novel approach in predicting patients at a higher risk of developing this late toxicity and therefore improving informed decision-making. MATERIALS AND METHODS A systematic search of PubMed and Embase was performed and eight clinical trials were identified that investigate RILA as a predictor of late breast fibrosis after radiotherapy. RESULTS Median RILA scores were lower in patients who experienced ≥ grade 2 fibrosis than in patients who experienced ≥ grade 1. A clear inverse relationship between RILA scores and late toxicity was reported in the literature; however, there were several other confounding factors involved in the development of fibrosis. CD8 lymphocytes were reported to have superior sensitivity and specificity over CD4 lymphocytes. CONCLUSION RILA was reported to be an effective biomarker in predicting fibrosis in breast cancer but other factors also need to be considered before clinical implementation.
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Affiliation(s)
- Meadhbh Ní Fhoghlú
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sarah Barrett
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.
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Physician Survey of Timing of Adjuvant Endocrine Therapy Relative to Radiotherapy in Early Stage Breast Cancer Patients. Clin Breast Cancer 2019; 19:e40-e47. [DOI: 10.1016/j.clbc.2018.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/04/2018] [Accepted: 08/27/2018] [Indexed: 01/02/2023]
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18
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Veldwijk MR, Seibold P, Botma A, Helmbold I, Sperk E, Giordano FA, Gürth N, Kirchner A, Behrens S, Wenz F, Chang-Claude J, Herskind C. Association of CD4 + Radiation-Induced Lymphocyte Apoptosis with Fibrosis and Telangiectasia after Radiotherapy in 272 Breast Cancer Patients with >10-Year Follow-up. Clin Cancer Res 2019; 25:562-572. [PMID: 30327309 DOI: 10.1158/1078-0432.ccr-18-0777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/10/2018] [Accepted: 10/11/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Radiation-induced lymphocyte apoptosis (RILA) has been suggested as a predictive assay for adverse late reactions after radiotherapy. Thus, low RILA values of T-lymphocyte subpopulations have been associated with increased risk for various endpoints at 2 to 3 years of follow-up. The purpose was to test if such associations persist for specific endpoints (subcutaneous fibrosis, telangiectasia) in breast cancer patients with at least 10 years of follow-up.Experimental Design: Two hundred and seventy-two female patients who had received breast-conserving therapy within the German ISE study were included (median follow-up: 11.6 years). Radiotherapy-induced side effects were scored according to the Late Effects in Normal Tissues-Subjective, Objective, Management, and Analytic (LENT-SOMA) classification system. RILA in the CD4+, CD8+, and natural killer (NK) subpopulations from peripheral blood was analyzed by flow cytometry. Multivariate predictive modeling was performed including relevant clinical risk factors. RESULTS Low CD4+ RILA was associated with increased risk for both fibrosis (P = 0.011) and telangiectasia (P < 0.001). For fibrosis, the association was stronger outside the surgical area (Fibout; P = 0.004) than within (Fibin; P = 0.17). Predictive multivariate modeling including clinical risk factors yielded OR of 3.48 (95% confidence interval, 1.84-6.58) for any fibrosis and 8.60 (2.71-27.3) for telangiectasia. Addition of CD4+ RILA to the clinical variables improved discrimination (c statistics) from 0.62 to 0.68 for any fibrosis, 0.62 to 0.66 for Fibin, 0.61 to 0.69 for Fibout, and from 0.65 to 0.76 for telangiectasia. CD8+ and NK RILA were not significantly associated with radiotherapy-related late reactions. CONCLUSIONS The results provide first evidence that low CD4+ RILA is associated with increased subcutaneous fibrosis and telangiectasia even after 10 years. This supports the potential usefulness for predicting individual clinical risk.
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Affiliation(s)
- Marlon R Veldwijk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Akke Botma
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Irmgard Helmbold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Gürth
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anne Kirchner
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Germany
| | - Carsten Herskind
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Tang S, Zhang Q, Tang X, Chen D, Zhang F, Liu J, Wei W, Liu D. Long-term comparisons of the efficacy, safety, and pregnancy outcomes of adjuvant tamoxifen plus ovarian function suppression in premenopausal Han and Zhuang Chinese patients with hormone receptor-positive early breast cancer. J Int Med Res 2018; 47:641-652. [PMID: 30354917 PMCID: PMC6381485 DOI: 10.1177/0300060518807100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective To compare the efficacy, safety, and pregnancy outcomes of tamoxifen plus ovarian function suppression (OFS) between Han and Zhuang women with hormone receptor-positive breast cancer. Methods A total of 236 Han and 101 Zhuang women with hormone receptor-positive breast cancer who received tamoxifen plus OFS were analyzed retrospectively. Long-term disease-free survival (DFS) and overall survival (OS) were evaluated by Kaplan–Meier analysis, and adverse events and pregnancy outcomes were assessed by χ2 and Fisher’s exact-probability tests. Results There was no significant difference in DFS or OS between Han and Zhuang women (5-year DFS 74.57% and 77.23%, OS 85.59% and 90.01%, respectively). The incidences of endometrial hyperplasia, ovarian cysts, nausea and vomiting, fatty liver, retinitis, and thrombocytopenic purpura were similar in both groups, but Zhuang women had significantly more allergic reactions (6.93% vs. 2.12%). Pregnancy rates among women who attempted pregnancy were similar (Han, 7/138, 5.07%; Zhuang, 2/46, 4.35%). Conclusions OFS plus tamoxifen resulted in similar DFS and OS among premenopausal Han and Zhuang women with hormone receptor-positive breast cancer. However, Zhuang women were more likely to experience an allergic reaction. For women with fertility concerns, OFS plus tamoxifen was associated with similar pregnancy rates in Zhuang and Han women.
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Affiliation(s)
- Shicong Tang
- 1 Department of Breast Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan, Kunming, Yunnan, People's Republic of China
| | - Qiong Zhang
- 2 Department of Reproductive Medicine, the Second People's Hospital of Yunnan, Kunming, Yunnan, People's Republic of China
| | - Xianghui Tang
- 2 Department of Reproductive Medicine, the Second People's Hospital of Yunnan, Kunming, Yunnan, People's Republic of China
| | - Dong Chen
- 3 Department of Ultrasound, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan, Kunming, Yunnan, People's Republic of China
| | - Fan Zhang
- 4 Department of Thyroid Breast and Vascular Surgery, the First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, People's Republic of China
| | - Jianlun Liu
- 5 Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Wei Wei
- 5 Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Dequan Liu
- 1 Department of Breast Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan, Kunming, Yunnan, People's Republic of China
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20
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Yee C, Wang K, Asthana R, Drost L, Lam H, Lee J, Vesprini D, Leung E, DeAngelis C, Chow E. Radiation-induced Skin Toxicity in Breast Cancer Patients: A Systematic Review of Randomized Trials. Clin Breast Cancer 2018; 18:e825-e840. [DOI: 10.1016/j.clbc.2018.06.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/05/2018] [Accepted: 06/29/2018] [Indexed: 11/25/2022]
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21
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McGee SF, Mazzarello S, Caudrelier JM, Lima MAG, Hutton B, Sienkiewicz M, Stober C, Fernandes R, Ibrahim MFK, Vandermeer L, Hilton J, Shorr R, Fergusson D, Clemons M. Optimal sequence of adjuvant endocrine and radiation therapy in early-stage breast cancer - A systematic review. Cancer Treat Rev 2018; 69:132-142. [PMID: 30014951 DOI: 10.1016/j.ctrv.2018.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Clinical equipoise exists around the optimal time to start adjuvant endocrine therapy in patients who will receive post-operative radiotherapy for breast cancer. Concerns continue to exist regarding potential reduced efficacy, or increased toxicity, when radiation, and endocrine therapy are administered concurrently. OBJECTIVE To perform a systematic review of studies comparing outcomes between sequential and concurrent adjuvant radiation and endocrine therapy in early-stage breast cancer. All modalities of radiation therapy were considered, and endocrine therapy could be either tamoxifen or an aromatase inhibitor. Outcomes of interest included; local, regional or distant recurrence, overall survival and treatment-related toxicities. EVIDENCE REVIEWED PubMed, Ovid Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from 1946 to December 2017. Two reviewers independently assessed each citation using the criteria outlined above. Study quality was assessed using the Cochrane Collaboration's tool for prospective studies, and the Newcastle-Ottawa scale for retrospective studies. FINDINGS Of 2137 unique citations identified, 13 met eligibility criteria. Eleven were unique studies (7569 patients), while 2 of the studies were updated analyses of previous studies. Studies evaluated the timing of adjuvant radiation, and tamoxifen (5 studies, 1550 patients), or aromatase inhibitors (6 studies, 6019 patients). We identified 1 complete randomized clinical trial (150 patients), and 5 retrospective studies (1580 patients), in addition to conference abstracts (5 studies, 5839 patients). Overall, none of the studies showed a significant difference in efficacy, or toxicity, with concurrent versus sequential treatment. However, given the significant heterogeneity of the study populations, it was not possible to conduct a meta-analysis. CONCLUSIONS AND RELEVANCE In the absence of high quality data, adequately powered randomized trials are required to answer this important clinical question.
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Affiliation(s)
- S F McGee
- Department of Medicine and Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada
| | - S Mazzarello
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - J M Caudrelier
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - M A G Lima
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - B Hutton
- Clinical Epidemiology Department, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Sienkiewicz
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - C Stober
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - R Fernandes
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - M F K Ibrahim
- Department of Medicine and Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada
| | - L Vandermeer
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - J Hilton
- Department of Medicine and Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - R Shorr
- The Ottawa Hospital, Ottawa, ON, Canada
| | - D Fergusson
- Clinical Epidemiology Department, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Clemons
- Department of Medicine and Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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Bourgier C, Castan F, Riou O, Nguyen TD, Peignaux K, Lemanski C, Lagrange JL, Kirova Y, Lartigau E, Belkacemi Y, Rivera S, Noël G, Clippe S, Mornex F, Hennequin C, Gourgou S, Brengues M, Fenoglietto P, Ozsahin EM, Azria D. Impact of adjuvant hormonotherapy on radiation-induced breast fibrosis according to the individual radiosensitivity: results of a multicenter prospective French trial. Oncotarget 2018; 9:15757-15765. [PMID: 29644007 PMCID: PMC5884662 DOI: 10.18632/oncotarget.24606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/25/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To evaluate risk of severe breast fibrosis occurrence in patients treated by breast-conserving surgery, adjuvant radiotherapy and hormonotherapy (HT) according to individual radiosensitivity (RILA assay). RESULTS HT- and RILAhigh were the two independent factors associated with improved breast-fibrosis free survival (BFFS). BFFS rate at 36 months was lower in patients with RILAlow and HT+ than in patients with RILAhigh and HT- (75.8% and 100%, respectively; p = 0.004, hazard ratio 5.84 [95% confidence interval (CI) 1.8-19.1]). Conversely, BFFS at 36 months was comparable in patients with RILAhigh and HT+ and in patients with RILAlow and HT- (89.8% and 93.5%, respectively; p = 0.39, hazard ratio 1.7 [95% CI 0.51-5.65]), showing that these two parameters influenced independently the occurrence of severe breast fibrosis. BFFS rate was not affected by the HT type (tamoxifen or aromatase inhibitor) and timing (concomitant or sequential with radiotherapy). CONCLUSIONS HT and RILA score independently influenced BFFS rate at 36 months. Patients with RILAhigh and HT- presented an excellent BFFS at 36 months (100%). MATERIALS AND METHODS Breast Fibrosis-Free Survival (BFFS) rate was assessed relative to RILA categories and to adjuvant HT use (HT+ and HT-, respectively) in a prospective multicentre study (NCT00893035) which enrolled 502 breast cancer patients (456 evaluable patients). Breast fibrosis was recorded according to CTCAE v3.0 grading scale; RILA score was defined according to two categories (<12%: RILAlow; ≥12%: RILAhigh).
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Affiliation(s)
- Céline Bourgier
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Florence Castan
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Olivier Riou
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | | | - Claire Lemanski
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | | | | | | | | | | | | | | | | | - Sophie Gourgou
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Muriel Brengues
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Pascal Fenoglietto
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | - David Azria
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
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23
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Flippot R, Massard C, Auclin E, Azria D, Bourien H, Rochigneux P, Schernberg A, Verlingue L, Zafrani L, Vignot S. Quelle vision des biomarqueurs en 2017 ? Promesses et défis de la médecine personnalisée en oncologie. Bull Cancer 2017; 104:735-743. [DOI: 10.1016/j.bulcan.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
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24
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Brengues M, Lapierre A, Bourgier C, Pèlegrin A, Özsahin M, Azria D. T lymphocytes to predict radiation-induced late effects in normal tissues. Expert Rev Mol Diagn 2016; 17:119-127. [DOI: 10.1080/14737159.2017.1271715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Muriel Brengues
- Immunotargeting and Radiobiology in Oncology, IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM, U1194, Montpellier, France
- Department of Radiation Oncology, Institut Cancer Montpellier, Montpellier, France
| | - Ariane Lapierre
- Immunotargeting and Radiobiology in Oncology, IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM, U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Department of Radiation Oncology, Institut Cancer Montpellier, Montpellier, France
| | - Céline Bourgier
- Immunotargeting and Radiobiology in Oncology, IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM, U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Department of Radiation Oncology, Institut Cancer Montpellier, Montpellier, France
| | - André Pèlegrin
- Immunotargeting and Radiobiology in Oncology, IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM, U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Department of Radiation Oncology, Institut Cancer Montpellier, Montpellier, France
| | | | - David Azria
- Immunotargeting and Radiobiology in Oncology, IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM, U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Department of Radiation Oncology, Institut Cancer Montpellier, Montpellier, France
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25
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Andreassen CN, Rosenstein BS, Kerns SL, Ostrer H, De Ruysscher D, Cesaretti JA, Barnett GC, Dunning AM, Dorling L, West CML, Burnet NG, Elliott R, Coles C, Hall E, Fachal L, Vega A, Gómez-Caamaño A, Talbot CJ, Symonds RP, De Ruyck K, Thierens H, Ost P, Chang-Claude J, Seibold P, Popanda O, Overgaard M, Dearnaley D, Sydes MR, Azria D, Koch CA, Parliament M, Blackshaw M, Sia M, Fuentes-Raspall MJ, Ramon Y Cajal T, Barnadas A, Vesprini D, Gutiérrez-Enríquez S, Mollà M, Díez O, Yarnold JR, Overgaard J, Bentzen SM, Alsner J. Individual patient data meta-analysis shows a significant association between the ATM rs1801516 SNP and toxicity after radiotherapy in 5456 breast and prostate cancer patients. Radiother Oncol 2016; 121:431-439. [PMID: 27443449 PMCID: PMC5559879 DOI: 10.1016/j.radonc.2016.06.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/18/2016] [Accepted: 06/29/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Several small studies have indicated that the ATM rs1801516 SNP is associated with risk of normal tissue toxicity after radiotherapy. However, the findings have not been consistent. In order to test this SNP in a well-powered study, an individual patient data meta-analysis was carried out by the International Radiogenomics Consortium. MATERIALS AND METHODS The analysis included 5456 patients from 17 different cohorts. 2759 patients were given radiotherapy for breast cancer and 2697 for prostate cancer. Eight toxicity scores (overall toxicity, acute toxicity, late toxicity, acute skin toxicity, acute rectal toxicity, telangiectasia, fibrosis and late rectal toxicity) were analyzed. Adjustments were made for treatment and patient related factors with potential impact on the risk of toxicity. RESULTS For all endpoints except late rectal toxicity, a significantly increased risk of toxicity was found for carriers of the minor (Asn) allele with odds ratios of approximately 1.5 for acute toxicity and 1.2 for late toxicity. The results were consistent with a co-dominant pattern of inheritance. CONCLUSION This study convincingly showed a significant association between the ATM rs1801516 Asn allele and increased risk of radiation-induced normal tissue toxicity.
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Affiliation(s)
| | - Barry S Rosenstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Sarah L Kerns
- Department of Radiation Oncology, University of Rochester Medical Center, USA; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Harry Ostrer
- Departments of Pathology and Pediatrics, Albert Einstein College of Medicine, New York, USA
| | - Dirk De Ruysscher
- Department of Radiotherapy (Maastro Clinic), Maastricht University Medical Center, The Netherlands
| | | | - Gillian C Barnett
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, UK; Centre for Cancer Genetic Epidemiology, Strangeways Research Laboratory, University of Cambridge, UK
| | - Alison M Dunning
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, UK; Centre for Cancer Genetic Epidemiology, Strangeways Research Laboratory, University of Cambridge, UK
| | - Leila Dorling
- Centre for Cancer Genetic Epidemiology, Strangeways Research Laboratory, University of Cambridge, UK
| | - Catharine M L West
- Institute of Cancer Sciences, University of Manchester, The Christie NHS Foundation Trust, UK
| | - Neil G Burnet
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Rebecca Elliott
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Charlotte Coles
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Emma Hall
- Clinical Trials & Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Laura Fachal
- Fundacion Publica Galega de Medicina Xenomica-SERGAS, Grupo de Medicina Xenomica-USC, IDIS, CIBERER, Santiago de Compostela, Spain
| | - Ana Vega
- Fundacion Publica Galega de Medicina Xenomica-SERGAS, Grupo de Medicina Xenomica-USC, IDIS, CIBERER, Santiago de Compostela, Spain
| | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | | | - R Paul Symonds
- Department of Cancer Studies, University of Leicester, UK
| | - Kim De Ruyck
- Department of Basic Medical Sciences, Ghent University, Belgium
| | - Hubert Thierens
- Department of Basic Medical Sciences, Ghent University, Belgium
| | - Piet Ost
- Department of Radiotherapy, Ghent University Hospital, Belgium
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; University Cancer Center Hamburg, University (UCCH), University Medical Center Hamburg-Eppendorf, Germany
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Odilia Popanda
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marie Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - David Dearnaley
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | - David Azria
- Department of Radiation Oncology and Medical Physics, Institut regional du Cancer Montpellier, France
| | - Christine Anne Koch
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Matthew Parliament
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Canada
| | - Michael Blackshaw
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Canada
| | - Michael Sia
- Department of Radiation Oncology, British Columbia Cancer Agency Abbotsford Clinic, Canada
| | | | - Teresa Ramon Y Cajal
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Agustin Barnadas
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Danny Vesprini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sara Gutiérrez-Enríquez
- Oncogenetics Group, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Spain
| | - Meritxell Mollà
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Orland Díez
- Oncogenetics Group, Vall d'Hebron Institute of Oncology (VHIO), Area of Clinical and Molecular Genetics, Vall d'Hebron University Hospital, Barcelona, Spain
| | - John R Yarnold
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Søren M Bentzen
- Greenebaum Cancer Center and Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
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Yavas C, Yavas G, Toy H, Ata O. The use of concurrent hormonotherapy and radiotherapy does not deteriorate radiation-induced cardiac toxicity. Hum Exp Toxicol 2016; 36:795-801. [PMID: 27596072 DOI: 10.1177/0960327116666648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postmenopausal patients with breast cancer have two options for adjuvant endocrine therapy, tamoxifen and aromatase inhibitors (AIs) as well as radiotherapy (RT) and chemotherapy. However, there is limited data regarding the optimal sequencing of RT and tamoxifen/AIs. Thus, we aimed to evaluate the effects of tamoxifen and AIs on radiation-induced cardiotoxicity. Eighty ovariectomized rats were divided into eight groups (G). G1 was defined as a control group; G2, G3, G4, and G5 were RT, tamoxifen, anastrozle, and letrozole groups, respectively; G6, G7, and G8 were RT plus tamoxifen, anastrozle, and letrozole groups, respectively. Drugs were started 1 week before RT and continued until the animals were killed 16 weeks after RT. The heart tissues were then dissected and examined with light microscopy to determine endocardial thickness and cardiac fibrosis. The endocardial thickness scores of both RT alone and the tamoxifen groups as well as the cardiac fibrosis score of RT alone were higher than that the control group ( p < 0.05 for all). There was no difference in the endocardial thickness and cardiac fibrosis scores of the RT-only group and the RT plus hormonotherapy groups ( p > 0.05 for all). Concurrent administration of RT and hormonal therapy with either tamoxifen or AIs did not further amplify radiation-induced cardiac toxicity. This issue warrants further study.
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Affiliation(s)
- C Yavas
- 1 Department of Radiation Oncology, Selcuk University, Konya, Turkey
| | - G Yavas
- 1 Department of Radiation Oncology, Selcuk University, Konya, Turkey
| | - H Toy
- 2 Department of Pathology, Necmettin Erbakan University, Konya, Turkey
| | - O Ata
- 3 Department of Medical Oncology, Selcuk University, Konya, Turkey
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27
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Altinok A, Yildirim S, Altug T, Sut N, Ober A, Ozsahin E, Azria D, Bese N. Aromatase inhibitors decrease radiation-induced lung fibrosis: Results of an experimental study. Breast 2016; 28:174-7. [DOI: 10.1016/j.breast.2016.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/16/2016] [Accepted: 04/09/2016] [Indexed: 11/26/2022] Open
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