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Li H, Yang T, Zhang J, Xue K, Ma X, Yu B, Jin X. Pyroptotic cell death: an emerging therapeutic opportunity for radiotherapy. Cell Death Discov 2024; 10:32. [PMID: 38228635 DOI: 10.1038/s41420-024-01802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024] Open
Abstract
Pyroptotic cell death, an inflammatory form of programmed cell death (PCD), is emerging as a potential therapeutic opportunity for radiotherapy (RT). RT is commonly used for cancer treatment, but its effectiveness can be limited by tumor resistance and adverse effects on healthy tissues. Pyroptosis, characterized by cell swelling, membrane rupture, and release of pro-inflammatory cytokines, has been shown to enhance the immune response against cancer cells. By inducing pyroptotic cell death in tumor cells, RT has the potential to enhance treatment outcomes by stimulating anti-tumor immune responses and improving the overall efficacy of RT. Furthermore, the release of danger signals from pyroptotic cells can promote the recruitment and activation of immune cells, leading to a systemic immune response that may target distant metastases. Although further research is needed to fully understand the mechanisms and optimize the use of pyroptotic cell death in RT, it holds promise as a novel therapeutic strategy for improving cancer treatment outcomes. This review aims to synthesize recent research on the regulatory mechanisms underlying radiation-induced pyroptosis and to elucidate the potential significance of this process in RT. The insights gained from this analysis may inform strategies to enhance the efficacy of RT for tumors.
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Affiliation(s)
- Hongbin Li
- School of Life Science and Engineering, Lanzhou University of Technology, Lanzhou, 730050, China
| | - Tiantian Yang
- School of Life Science and Engineering, Lanzhou University of Technology, Lanzhou, 730050, China
| | - Jialin Zhang
- School of Life Science and Engineering, Lanzhou University of Technology, Lanzhou, 730050, China
| | - Kai Xue
- School of Life Science and Engineering, Lanzhou University of Technology, Lanzhou, 730050, China
| | - Xiaoli Ma
- School of Life Science and Engineering, Lanzhou University of Technology, Lanzhou, 730050, China
| | - Boyi Yu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China
| | - Xiaodong Jin
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China.
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2
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Liu B, Wang Y, Han G, Zhu M. Tolerogenic dendritic cells in radiation-induced lung injury. Front Immunol 2024; 14:1323676. [PMID: 38259434 PMCID: PMC10800505 DOI: 10.3389/fimmu.2023.1323676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Radiation-induced lung injury is a common complication associated with radiotherapy. It is characterized by early-stage radiation pneumonia and subsequent radiation pulmonary fibrosis. However, there is currently a lack of effective therapeutic strategies for radiation-induced lung injury. Recent studies have shown that tolerogenic dendritic cells interact with regulatory T cells and/or regulatory B cells to stimulate the production of immunosuppressive molecules, control inflammation, and prevent overimmunity. This highlights a potential new therapeutic activity of tolerogenic dendritic cells in managing radiation-induced lung injury. In this review, we aim to provide a comprehensive overview of tolerogenic dendritic cells in the context of radiation-induced lung injury, which will be valuable for researchers in this field.
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Affiliation(s)
| | - Yilong Wang
- Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
| | | | - Maoxiang Zhu
- Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
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Zhang M, Lan H, Peng S, Zhou W, Wang X, Jiang M, Hong J, Zhang Q. MiR-223-3p attenuates radiation-induced inflammatory response and inhibits the activation of NLRP3 inflammasome in macrophages. Int Immunopharmacol 2023; 122:110616. [PMID: 37459784 DOI: 10.1016/j.intimp.2023.110616] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 08/25/2023]
Abstract
Macrophage pyroptosis plays an important role in the development of radiation-induced cell and tissue damage, leading to acute lung injury. However, the underlying mechanisms of NOD-like receptor thermal protein domain-associated protein 3 (NLRP3)-mediated macrophage pyroptosis and the regulatory factors involved in radiation-induced pyroptosis are unclear. In this study, the expression of the NLRP3 inflammasome and pyroptosis-associated factors in murine macrophage cell lines was investigated after ionizing radiation. High-throughput RNA sequencing was performed to identify and characterize miRNAs and mRNA transcripts associated with NLRP3-mediated cell death. Our results demonstrated that cleaved-caspase-1 (p10) and N-terminal domain of gasdermin-D (GSDMD-N) were upregulated, and the number of NLRP3 inflammasomes and pyroptotic cells increased in murine macrophage cell lines after irradiation (8 Gy). Comparativeprofiling of 300miRNAs revealed that 41 miRNAsexhibited significantly different expression after 8 Gy of irradiation. Granulocyte-specific microRNA-223-3p (miR-223-3p) is a negative regulator of NLRP3. In vitro experiments revealed that the expression of miR-223-3p was significantly altered by irradiation. Moreover, miR-223-3p decreased the expression of NLRP3 and proinflammatory factors, resulting in reduced pyroptosis in irradiated murine macrophages. Subsequently, in vivo experiments revealed the efficacy of miR-223-3p supplementation in ameliorating alveolar macrophage (AM) pyroptosis, attenuating the infiltration of inflammatory monocytes, and significantly alleviating the severity of acute radiation-induced lung injury (ARILI). Our findings suggest that the miR-223-3p/NLRP3/caspase-1 axis is involved in radiation-induced AM pyroptosis and ARILI.
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Affiliation(s)
- Mingwei Zhang
- Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China; Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hailin Lan
- Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shaoli Peng
- Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Weitong Zhou
- Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xuezhen Wang
- Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Meina Jiang
- Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jinsheng Hong
- Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
| | - Qiuyu Zhang
- Institute of Immunotherapy, Fujian Medical University, Fuzhou, China.
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Chen Z, Wang B, Wu Z, Xiao H, Yang Y, Fan J, Gu Y, Chen C, Wu J. The occurrence and development of radiation-induced lung injury after interstitial brachytherapy and stereotactic radiotherapy in SD rats. J Inflamm (Lond) 2023; 20:23. [PMID: 37430327 DOI: 10.1186/s12950-023-00348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/06/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND To compare the severity of radiation-induced lung injury (RILI) after the right lung of SD rats received interstitial brachytherapy and stereotactic radiotherapy (SBRT). METHODS RILI rat model was established using interstitial brachytherapy and SBRT methods, respectively. CT scan was performed to analyze the lung volume and the CT value difference between the left and right lungs in rats. Then the lung tissues were analyzed through H&E staining, peripheral blood was extracted to detect the expression levels of serum inflammatory cytokines, pro-fibrotic cytokines, and fibrotic-inhibiting cytokines by ELISA. RESULTS The difference between right and left lung CT values was significantly elevated in the SBRT group when compared with the control group and the interstitial brachytherapy group (P < 0.05). The IFN-γ expression in the interstitial brachytherapy group was significantly different from that in the SBRT group at week 1, 4, 8 and 16. Besides, the expressions of IL-2, IL-6 and IL-10 in SBRT group were significantly higher than that of interstitial brachytherapy group (P < 0.05). The TGF-β expression in interstitial brachytherapy group reached its peak with the increase of time from week 1 to week 16, and it was significantly lower than SBRT group (P < 0.05). The mortality rate in the SBRT group was 16.7%, which was significantly higher than that in the interstitial brachytherapy group. CONCLUSION The treatment method of interstitial brachytherapy is considered as an effective and safe tool by reducing the side effects of radiotherapy and increasing the radiation dose of radiotherapy.
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Affiliation(s)
- Zhuo Chen
- Department of Oncology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
- Department of Oncology, Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Luzhou, 646099, Sichuan, China
| | - Bin Wang
- Department of Oncology, the Seventh People's Hospital of Chongqing (Affiliated Central Hospital of Chongqing University of Technology), Banan District Lijiatuo Industry Federation No.1 Village, Chongqing, 401320, China
| | - Zhouxue Wu
- Department of Oncology, Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Luzhou, 646099, Sichuan, China
| | - Hua Xiao
- Department of Neurosurgery, Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Longmatan District, No. 182 Chunhui Road, Luzhou, 646099, Sichuan, China
| | - Yang Yang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Luzhou, 646099, Sichuan, China
| | - Junying Fan
- Department of Oncology, Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Luzhou, 646099, Sichuan, China
| | - Yingjiang Gu
- Department of Neurosurgery, Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Longmatan District, No. 182 Chunhui Road, Luzhou, 646099, Sichuan, China.
| | - Chuan Chen
- Department of Oncology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China.
| | - Jingbo Wu
- Department of Oncology, Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Luzhou, 646099, Sichuan, China.
- Key Laboratory of Nuclear Medicine and Molecular Imaging, Changzhi, 046099, Sichuan, China.
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Dong G, Li Y, Zhao Q, Pang B, Qi X, Wei J, Hou W. Effects of diabetes on the development of radiation pneumonitis. Respir Res 2021; 22:160. [PMID: 34030688 PMCID: PMC8147083 DOI: 10.1186/s12931-021-01754-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
Radiation pneumonia (RP) is a common adverse reaction to radiation therapy in patients with chest tumors. Recent studies have shown that diabetes mellitus (DM), which can cause systemic multisystem damage, specifically targets lungs, and the incidence of RP in patients with a history of diabetes is higher than that in other patients with tumors who have undergone radiotherapy. DM is an important risk factor for RP in tumor patients undergoing RT, and patients with DM should be treated with caution. This article reviews research on the clinical aspects, as well as the mechanism, of the effects of diabetes on RP and suggests future research needed to reduce RP.
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Affiliation(s)
- Guangtong Dong
- Department of Endocrinology, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, 6 Floors of Inpatients Building, 5 Beixiange Street, Xicheng, Beijing, 100053, China
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuxiao Li
- Department of Oncology, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, 7 Floors of Inpatients Building, 5 Beixiange Street, Xicheng, Beijing, 100053, China
| | - Qiyao Zhao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Bing Pang
- Department of Endocrinology, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, 6 Floors of Inpatients Building, 5 Beixiange Street, Xicheng, Beijing, 100053, China
| | - Xin Qi
- Department of Oncology, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, 7 Floors of Inpatients Building, 5 Beixiange Street, Xicheng, Beijing, 100053, China
| | - Junping Wei
- Department of Endocrinology, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, 6 Floors of Inpatients Building, 5 Beixiange Street, Xicheng, Beijing, 100053, China.
| | - Wei Hou
- Department of Oncology, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, 7 Floors of Inpatients Building, 5 Beixiange Street, Xicheng, Beijing, 100053, China.
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6
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Owen DR, Sun Y, Boonstra PS, McFarlane M, Viglianti BL, Balter JM, El Naqa I, Schipper MJ, Schonewolf CA, Ten Haken RK, Kong FMS, Jolly S, Matuszak MM. Investigating the SPECT Dose-Function Metrics Associated With Radiation-Induced Lung Toxicity Risk in Patients With Non-small Cell Lung Cancer Undergoing Radiation Therapy. Adv Radiat Oncol 2021; 6:100666. [PMID: 33817412 PMCID: PMC8010578 DOI: 10.1016/j.adro.2021.100666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/22/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose Dose to normal lung has commonly been linked with radiation-induced lung toxicity (RILT) risk, but incorporating functional lung metrics in treatment planning may help further optimize dose delivery and reduce RILT incidence. The purpose of this study was to investigate the impact of the dose delivered to functional lung regions by analyzing perfusion (Q), ventilation (V), and combined V/Q single-photon-emission computed tomography (SPECT) dose-function metrics with regard to RILT risk in patients with non-small cell lung cancer (NSCLC) patients who received radiation therapy (RT). Methods and Materials SPECT images acquired from 88 patients with locally advanced NSCLC before undergoing conventionally fractionated RT were retrospectively analyzed. Dose was converted to the nominal dose equivalent per 2 Gy fraction, and SPECT intensities were normalized. Regional lung segments were defined, and the average dose delivered to each lung region was quantified. Three functional categorizations were defined to represent low-, normal-, and high-functioning lungs. The percent of functional lung category receiving ≥20 Gy and mean functional intensity receiving ≥20 Gy (iV20) were calculated. RILT was defined as grade 2+ radiation pneumonitis and/or clinical radiation fibrosis. A logistic regression was used to evaluate the association between dose-function metrics and risk of RILT. Results By analyzing V/Q normalized intensities and functional distributions across the population, a wide range in functional capability (especially in the ipsilateral lung) was observed in patients with NSCLC before RT. Through multivariable regression models, global lung average dose to the lower lung was found to be significantly associated with RILT, and Q and V iV20 were correlated with RILT when using ipsilateral lung metrics. Through a receiver operating characteristic analysis, combined V/Q low-function receiving ≥20 Gy (low-functioning V/Q20) in the ipsilateral lung was found to be the best predictor (area under the curce: 0.79) of RILT risk. Conclusions Irradiation of the inferior lung appears to be a locational sensitivity for RILT risk. The multivariable correlation between ipsilateral lung iV20 and RILT, as well as the association of low-functioning V/Q20 and RILT, suggest that irradiating low-functioning regions in the lung may lead to higher toxicity rates.
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Affiliation(s)
- Daniel R Owen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Yilun Sun
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Philip S Boonstra
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Matthew McFarlane
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Benjamin L Viglianti
- Department of Radiology, University of Michigan, Ann Arbor, Michigan.,Veterans Administration, Nuclear Medicine Service, Ann Arbor Michigan
| | - James M Balter
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | | | - Randall K Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Feng-Ming S Kong
- Hong Kong University Shenzhen Hospital and Queen Mary Hospital, Hong Kong University Li Ka Shing Medical School, Department of Clinical Oncology, Hong Kong.,Department of Radiation Oncology, Case Western Reserve University, Cleveland, Ohio
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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7
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Tsoutsou P, Montay-Gruel P, Vozenin MC. The Era of Modern Radiation Therapy: Innovations to Spare Normal Tissues. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-52619-5_70-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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8
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Zhang C, Zeng W, Yao Y, Xu B, Wei X, Wang L, Yin X, Barman AK, Zhang F, Zhang C, Song Q, Liang W. Naringenin Ameliorates Radiation-Induced Lung Injury by Lowering IL-1 β Level. J Pharmacol Exp Ther 2018; 366:341-348. [PMID: 29866791 DOI: 10.1124/jpet.118.248807] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/31/2018] [Indexed: 02/06/2023] Open
Abstract
Radiation-induced lung injury (RILI) is the main complication of radiotherapy for thoracic malignancies. Since naringenin, a potent immune-modulator, has been found to relieve bleomycin-induced lung fibrosis by restoring the balance of disordered cytokines, we sought to determine whether naringenin would mitigate RILI and to investigate the underlying mechanism. Animals received fractionated irradiation in the thoracic area to induce RILI. Enzyme-linked immunosorbent assay and MILLIPLEX assays were used for serum and bronchoalveolar lavage fluid for cytokine analyses, hematoxylin and eosin staining for pathologic changes, and Masson trichrome staining for determination of lung fibrosis. Interleukin (IL)-1β was found significantly elevated after thoracic irradiation and it triggered production of profibrotic tumor growth factor β both in vivo and in vitro, suggesting the vital role of in IL-1β in the development of RILI. Furthermore, we found that naringenin was able to ameliorate RILI through downregulation of IL-1β and restoration of the homeostasis of inflammatory factors. Our results demonstrated that naringenin could serve as a potent immune-modulator to ameliorate RILI. More importantly, we suggest that a new complementary strategy of maintaining the homeostasis of inflammatory factors combined with radiation could improve the efficacy of thoracic radiotherapy.
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Affiliation(s)
- Chao Zhang
- Protein and Peptide Pharmaceutical Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Cha.Z., W.Z., X.W., L.W., X.Y., A.K.B., F.Z., Chu.Z., W.L.); University of Chinese Academy of Sciences, Beijing, China (Cha.Z., L.W., X.Y., A.K.B.); and Department of Oncology I (Y.Y., B.X., Q.S.) and Cancer Center (Y.Y., Q.S.), Wuhan University Renmin Hospital, Wuhan, China
| | - Wenfeng Zeng
- Protein and Peptide Pharmaceutical Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Cha.Z., W.Z., X.W., L.W., X.Y., A.K.B., F.Z., Chu.Z., W.L.); University of Chinese Academy of Sciences, Beijing, China (Cha.Z., L.W., X.Y., A.K.B.); and Department of Oncology I (Y.Y., B.X., Q.S.) and Cancer Center (Y.Y., Q.S.), Wuhan University Renmin Hospital, Wuhan, China
| | - Yi Yao
- Protein and Peptide Pharmaceutical Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Cha.Z., W.Z., X.W., L.W., X.Y., A.K.B., F.Z., Chu.Z., W.L.); University of Chinese Academy of Sciences, Beijing, China (Cha.Z., L.W., X.Y., A.K.B.); and Department of Oncology I (Y.Y., B.X., Q.S.) and Cancer Center (Y.Y., Q.S.), Wuhan University Renmin Hospital, Wuhan, China
| | - Bin Xu
- Protein and Peptide Pharmaceutical Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Cha.Z., W.Z., X.W., L.W., X.Y., A.K.B., F.Z., Chu.Z., W.L.); University of Chinese Academy of Sciences, Beijing, China (Cha.Z., L.W., X.Y., A.K.B.); and Department of Oncology I (Y.Y., B.X., Q.S.) and Cancer Center (Y.Y., Q.S.), Wuhan University Renmin Hospital, Wuhan, China
| | - Xiuli Wei
- Protein and Peptide Pharmaceutical Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Cha.Z., W.Z., X.W., L.W., X.Y., A.K.B., F.Z., Chu.Z., W.L.); University of Chinese Academy of Sciences, Beijing, China (Cha.Z., L.W., X.Y., A.K.B.); and Department of Oncology I (Y.Y., B.X., Q.S.) and Cancer Center (Y.Y., Q.S.), Wuhan University Renmin Hospital, Wuhan, China
| | - Luoyang Wang
- Protein and Peptide Pharmaceutical Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Cha.Z., W.Z., X.W., L.W., X.Y., A.K.B., F.Z., Chu.Z., W.L.); University of Chinese Academy of Sciences, Beijing, China (Cha.Z., L.W., X.Y., A.K.B.); and Department of Oncology I (Y.Y., B.X., Q.S.) and Cancer Center (Y.Y., Q.S.), Wuhan University Renmin Hospital, Wuhan, China
| | - Xiaozhe Yin
- Protein and Peptide Pharmaceutical Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Cha.Z., W.Z., X.W., L.W., X.Y., A.K.B., F.Z., Chu.Z., W.L.); University of Chinese Academy of Sciences, Beijing, China (Cha.Z., L.W., X.Y., A.K.B.); and Department of Oncology I (Y.Y., B.X., Q.S.) and Cancer Center (Y.Y., Q.S.), Wuhan University Renmin Hospital, Wuhan, China
| | - Apurba Kumar Barman
- Protein and Peptide Pharmaceutical Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Cha.Z., W.Z., X.W., L.W., X.Y., A.K.B., F.Z., Chu.Z., W.L.); University of Chinese Academy of Sciences, Beijing, China (Cha.Z., L.W., X.Y., A.K.B.); and Department of Oncology I (Y.Y., B.X., Q.S.) and Cancer Center (Y.Y., Q.S.), Wuhan University Renmin Hospital, Wuhan, China
| | - Fayun Zhang
- Protein and Peptide Pharmaceutical Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Cha.Z., W.Z., X.W., L.W., X.Y., A.K.B., F.Z., Chu.Z., W.L.); University of Chinese Academy of Sciences, Beijing, China (Cha.Z., L.W., X.Y., A.K.B.); and Department of Oncology I (Y.Y., B.X., Q.S.) and Cancer Center (Y.Y., Q.S.), Wuhan University Renmin Hospital, Wuhan, China
| | - Chunling Zhang
- Protein and Peptide Pharmaceutical Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Cha.Z., W.Z., X.W., L.W., X.Y., A.K.B., F.Z., Chu.Z., W.L.); University of Chinese Academy of Sciences, Beijing, China (Cha.Z., L.W., X.Y., A.K.B.); and Department of Oncology I (Y.Y., B.X., Q.S.) and Cancer Center (Y.Y., Q.S.), Wuhan University Renmin Hospital, Wuhan, China
| | - Qibin Song
- Protein and Peptide Pharmaceutical Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Cha.Z., W.Z., X.W., L.W., X.Y., A.K.B., F.Z., Chu.Z., W.L.); University of Chinese Academy of Sciences, Beijing, China (Cha.Z., L.W., X.Y., A.K.B.); and Department of Oncology I (Y.Y., B.X., Q.S.) and Cancer Center (Y.Y., Q.S.), Wuhan University Renmin Hospital, Wuhan, China
| | - Wei Liang
- Protein and Peptide Pharmaceutical Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Cha.Z., W.Z., X.W., L.W., X.Y., A.K.B., F.Z., Chu.Z., W.L.); University of Chinese Academy of Sciences, Beijing, China (Cha.Z., L.W., X.Y., A.K.B.); and Department of Oncology I (Y.Y., B.X., Q.S.) and Cancer Center (Y.Y., Q.S.), Wuhan University Renmin Hospital, Wuhan, China
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Qin M, Chen W, Cui J, Li W, Liu D, Zhang W. Protective efficacy of inhaled quercetin for radiation pneumonitis. Exp Ther Med 2017; 14:5773-5778. [PMID: 29285120 PMCID: PMC5740811 DOI: 10.3892/etm.2017.5290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 07/28/2017] [Indexed: 12/30/2022] Open
Abstract
Radiation pneumonitis is a clinical problem with a high incidence. Once the onset of radiation pneumonitis has occurred, the administration of antioxidants and anti-inflammatory agents is the most commonly used method of clinical treatment. Quercetin (Que) is a common flavonoid, with potent anti-inflammatory and anti-oxidant activities. In the present study, the therapeutic effect of inhaled Que on radiation-induced radiation pneumonitis in rats was investigated. Treatment with Que via inhalation was shown to increase the number of leukocytes and erythrocytes in the blood, and reduce the number of inflammatory cells in bronchoalveolar lavage fluid. Histological examination of lung tissue indicated that inhaled Que reduced hemorrhaging and the infiltration of inflammatory cells, and suppressed the expression of the proinflammatory cytokines transforming growth factor-β1 and interleukin-6. These results indicated that treatment with Que via inhalation ameliorates radiation pneumonitis by reducing the number of inflammatory cells, and attenuating the inflammatory response and pathological changes. This suggests that administration of Que via inhalation has the potential to become a novel treatment for radiation pneumonitis.
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Affiliation(s)
- Meng Qin
- Department of Pharmaceutics, College of Pharmacy, Weifang Medical University, Weifang, Shandong 261053, P.R. China
| | - Weijuan Chen
- Department of Pathology, People's Hospital of Shouguang, Weifang, Shandong 262700, P.R. China
| | - Juanjuan Cui
- Department of Pharmaceutics, College of Pharmacy, Weifang Medical University, Weifang, Shandong 261053, P.R. China
| | - Wentao Li
- Laboratory of Pharmacology, College of Clinical Medicine, Weifang Medical University, Weifang, Shandong 261053, P.R. China
| | - Dongmei Liu
- Department of Pharmaceutics, College of Pharmacy, Weifang Medical University, Weifang, Shandong 261053, P.R. China
| | - Weifen Zhang
- Department of Pharmaceutics, College of Pharmacy, Weifang Medical University, Weifang, Shandong 261053, P.R. China
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Alharbi M, Janssen S, Golpon H, Bremer M, Henkenberens C. Temporal and spatial dose distribution of radiation pneumonitis after concurrent radiochemotherapy in stage III non-small cell cancer patients. Radiat Oncol 2017; 12:165. [PMID: 29096667 PMCID: PMC5667443 DOI: 10.1186/s13014-017-0898-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/03/2017] [Indexed: 12/25/2022] Open
Abstract
Background and purpose Radiation pneumonitis (RP) is the most common subacute side effect after concurrent chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer. Several clinical and dose-volume (DV) parameters are associated with a distinct risk of symptomatic RP. The aim of this study was to assess the spatial dose distribution of the RP volume from first occurence to maximum volume expansion of RP. Material and methods Between 2007 and 2015, 732 patients with lung cancer were treated in an institution. Thirty-three patients met the following inclusion criteria: an RP grade II after CRT and a radiation dose ≥60 Gy and no prior medical history of cardiopulmonary comorbidities. The images of the first chest computed tomography (CT) confirming the diagnosis of RP and the CT images showing the maximum expansion of RP were merged with the treatment plan. The RP volume was delineated within the treatment plan, and a DV analysis was performed to evaluate the lung dose volume areas in which the RP manifested over time and whether dose volume changes within the RP volume occurred. Results A change from clinical diagnosis to maximum expansion of RP was observed as the RP at clinical appearance mainly manifested in the lower dose areas of the lung, whereas the RP volume at maximum expansion manifested in the higher dose areas, resulting in a significant shift of the assessed relative mean dose volume proportions within the RP volume. The mean relative dose volume proportion 0- ≤ 20 Gy decreased from 30.2% (range, 0–100) to 21.9% (range, 0–100; p = 0.04) at the expense of the dose volume > 40 Gy which increased from 39.2% (range, 0–100) to 49.8% (range, 0–100; p = 0.02), whereas the dose relative volume proportion > 20- ≤ 40 Gy showed no relevant change and slightly decreased from 30.6% (range, 0–85.7) to 28.3%, (range, 0–85.7; p = 0.34). Conclusion We observed a considerable increase in the relative dose proportions within the RP volume from diagnosis to maximum volume extent from low dose zones below 20 Gy to zones above 40 Gy. Although the clinical impact on RP remains unknown, a reduction of healthy healthy lung tissue receiving >40 Gy (V40) might be an additional parameter for irradiation planning in lung cancer patients.
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Affiliation(s)
- Mohammed Alharbi
- Department of Radio-Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefan Janssen
- Joint Practice Radiooncology Hannover, Rundestr. 10, 30161, Hannover, Germany.,Department of Radiation Oncology, University of Lübeck, Ratzeburger Ave. 160, 23562, Lübeck, Germany
| | - Heiko Golpon
- Department of Pneumology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Michael Bremer
- Department of Radio-Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christoph Henkenberens
- Department of Radio-Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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11
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Hung SK, Chen YC, Chiou WY, Lai CL, Lee MS, Lo YC, Chen LC, Huang LW, Chien NC, Li SC, Liu DW, Hsu FC, Tsai SJ, Chan MWY, Lin HY. Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study. BMJ Open 2017; 7:e015022. [PMID: 28963281 PMCID: PMC5623431 DOI: 10.1136/bmjopen-2016-015022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Pulmonary radiotherapy has been reported to increase a risk of pneumonopathy, including pneumonitis and secondary pneumonia, however evidence from population-based studies is lacking. The present study intended to explore whether postoperative irradiation increases occurrence of severe pneumonopathy in lung cancer patients. DESIGN, SETTING AND PARTICIPANTS The nationwide population-based study analysed the Taiwan National Health Insurance Research Database (covered >99% of Taiwanese) in a real-world setting. From 2000 to 2010, 4335 newly diagnosed lung cancer patients were allocated into two groups: surgery-RT (n=867) and surgery-alone (n=3468). With a ratio of 1:4, propensity score was used to match 11 baseline factors to balance groups. INTERVENTIONS/EXPOSURES Irradiation was delivered to bronchial stump and mediastinum according to peer-audited guidelines. OUTCOMES/MEASURES Hospitalised pneumonia/pneumonitis-free survival was the primary end point. Risk factors and hazard effects were secondary measures. RESULTS Multivariable analysis identified five independent risk factors for hospitalised pneumonopathy: elderly (>65 years), male, irradiation, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Compared with surgery-alone, a higher risk of hospitalised pneumonopathy was found in surgery-RT patients (HR, 2.20; 95% CI, 1.93-2.51; 2-year hospitalised pneumonia/pneumonitis-free survival, 85.2% vs 69.0%; both p<0.0001), especially in elderly males with COPD and CKD (HR, 13.74; 95% CI, 6.61-28.53; p<0.0001). Unexpectedly, we observed a higher risk of hospitalised pneumonopathy in younger irradiated-CKD patients (HR, 13.07; 95% CI, 5.71-29.94; p<0.0001) than that of elderly irradiated-CKD patients (HR, 4.82; 95% CI, 2.88-8.08; p<0.0001). CONCLUSIONS A high risk of hospitalised pneumonopathy is observed in irradiated patients, especially in elderly males with COPD and CKD. For these patients, close clinical surveillance and aggressive pneumonia/pneumonitis prevention should be considered. Further investigations are required to define underlying biological mechanisms, especially for younger CKD patients.
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Affiliation(s)
- Shih-Kai Hung
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Chun Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Nephrology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
| | - Wen-Yen Chiou
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chun-Liang Lai
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Chest Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
| | - Moon-Sing Lee
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yuan-Chen Lo
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Liang-Cheng Chen
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Li-Wen Huang
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Nai-Chuan Chien
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Thoracic Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
| | - Szu-Chi Li
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Haematology-Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
| | - Dai-Wei Liu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Radiation Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Feng-Chun Hsu
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
| | - Shiang-Jiun Tsai
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
| | - Michael WY Chan
- Institute of Molecular Biology, National Chung Cheng University, Chia-Yi, Taiwan
- Department of Life Science, National Chung Cheng University, Chia-Yi, Taiwan
- Human Epigenomics Centre, National Chung Cheng University, Chia-Yi, Taiwan
| | - Hon-Yi Lin
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Institute of Molecular Biology, National Chung Cheng University, Chia-Yi, Taiwan
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12
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Prévention médicale et traitement des complications pulmonaires secondaires à la radiothérapie. Cancer Radiother 2017; 21:411-423. [DOI: 10.1016/j.canrad.2017.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/13/2017] [Accepted: 03/24/2017] [Indexed: 12/12/2022]
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13
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Wang S, Campbell J, Stenmark MH, Zhao J, Stanton P, Matuszak MM, Ten Haken RK, Kong FMS. Plasma Levels of IL-8 and TGF-β1 Predict Radiation-Induced Lung Toxicity in Non-Small Cell Lung Cancer: A Validation Study. Int J Radiat Oncol Biol Phys 2017; 98:615-621. [PMID: 28581403 DOI: 10.1016/j.ijrobp.2017.03.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/02/2017] [Accepted: 03/07/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE AND OBJECTIVES We previously reported that the combination of mean lung dose (MLD) and inflammatory cytokines interleukin-8 (IL-8) and transforming growth factor-β1 (TGF-β1) may provide a more accurate model for radiation-induced lung toxicity (RILT) prediction in 58 patients with non-small cell lung cancer (NSCLC). This study is to validate the previous findings with new patients and to explore new models with more cytokines. METHODS AND MATERIALS One hundred forty-two patients with stage I-III NSCLC treated with definitive radiation therapy (RT) from prospective studies were included. Sixty-five new patients were used to validate previous findings, and all 142 patients were used to explore new models. Thirty inflammatory cytokines were measured in plasma samples before RT and 2 weeks and 4 weeks during RT (pre, 2w, 4w). Grade ≥2 RILT was defined as grade 2, and higher radiation pneumonitis or symptomatic pulmonary fibrosis was the primary endpoint. Logistic regression was performed to evaluate the risk factors of RILT. The area under the curve (AUC) for the receiver operating characteristic curves was used for model assessment. RESULTS Sixteen of 65 patients (24.6%) experienced RILT2. Lower pre IL-8 and higher TGF-β1 2w/pre ratio were associated with higher risk of RILT2. The AUC increased to 0.73 by combining MLD, pre IL-8, and TGF-β1 2w/pre ratio compared with 0.61 by MLD alone to predict RILT. In all 142 patients, 29 patients (20.4%) experienced grade ≥2 RILT. Among the 30 cytokines measured, only IL-8 and TGF-β1 were significantly associated with the risk of RILT2. MLD, pre IL-8 level, and TGF-β1 2w/pre ratio were included in the final predictive model. The AUC increased to 0.76 by combining MLD, pre IL-8, and TGF-β1 2w/pre ratio compared with 0.62 by MLD alone. CONCLUSIONS We validated that a combination of mean lung dose, pre IL-8 level, and TGF-β1 2w/pre ratio provided a more accurate model to predict the risk of RILT2 compared with MLD alone.
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Affiliation(s)
- Shulian Wang
- Department of Radiation Oncology, Georgia Regents University Cancer Center and Medical College of Georgia, Augusta, Georgia; Department of Radiation Oncology, Cancer Hospital and Cancer Institution, Chinese Academy of Medical Sciences, Beijing, China
| | - Jeff Campbell
- Department of Radiation Oncology, Georgia Regents University Cancer Center and Medical College of Georgia, Augusta, Georgia
| | - Matthew H Stenmark
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jing Zhao
- Department of Radiation Oncology, Georgia Regents University Cancer Center and Medical College of Georgia, Augusta, Georgia
| | - Paul Stanton
- Department of Radiation Oncology, Georgia Regents University Cancer Center and Medical College of Georgia, Augusta, Georgia
| | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Randall K Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, Georgia Regents University Cancer Center and Medical College of Georgia, Augusta, Georgia; Department of Radiation Oncology, Indiana University, Indianapolis, Indiana.
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14
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Henkenberens C, Janssen S, Lavae-Mokhtari M, Leni K, Meyer A, Christiansen H, Bremer M, Dickgreber N. Inhalative steroids as an individual treatment in symptomatic lung cancer patients with radiation pneumonitis grade II after radiotherapy - a single-centre experience. Radiat Oncol 2016; 11:12. [PMID: 26830686 PMCID: PMC4736495 DOI: 10.1186/s13014-016-0580-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/16/2015] [Indexed: 12/25/2022] Open
Abstract
Purpose To assess efficacy of our single-centre experience with inhalative steroids (IS) in lung cancer patients with symptomatic radiation pneumonitis (RP) grade II. Material and methods Between 05/09 and 07/10, 24 patients (female, n = 8; male, n = 16) with lung cancer (non-small cell lung carcinoma [NSCLC]: n = 19; small cell lung cancer [SCLC]: n = 3; unknown histology: n = 2) and good performance status (ECOG ≤1) received definitive radiotherapy to the primary tumour site and involved lymph nodes with concurrent chemotherapy (n = 18), sequential chemotherapy (n = 2) or radiation only (n = 4) and developed symptomatic RP grade II during follow-up. No patient presented with oxygen requiring RP grade III. The mean age at diagnosis was 66 years (range: 50–82 years). Nine patients suffered from chronic obstructive pulmonary disease (COPD) before treatment, and 18 patients had a smoking history (median pack years: 48). The mean lung dose was 15.5 Gy (range: 3.0–23.1 Gy). All patients were treated with IS. If a patient’s clinical symptoms did not significantly improve within two weeks of IS therapy initiation, their treatment was switched to oral prednisolone. Results All 24 patients were initially treated with a high dose IS (budesonide 800 μg 1-0-1) for 14 days. Of the patients, 18 showed a significant improvement of clinical symptoms and 6 patients did not show significant improvement of clinical symptoms and were classified as non-responders to IS. Their treatment was switched to oral steroids after two weeks (starting with oral prednisolone, 0.5 mg/kg bodyweight; at least 50 mg per day). All of these patients responded to the prednisolone. None of non-responders presented with increased symptoms of RP and required oxygen and / or hospitalization (RP grade III). The median follow-up after IS treatment initiation was 18 months (range: 4–66 months). The median duration of IS treatment and prednisolone treatment was 8.2 months (range: 3.0–48.3 months) and 11.4 months (range: 5.0–44.0 months), respectively. Of the 18 IS treatment responders, 2 (11.1 %) patients with pre-existing grade 2 COPD still required IS (400 μg twice a day) 45.0 and 48.3 months after radiotherapy, respectively. For the remaining 16 responders (88.9 %), IS therapy was stopped after 7.7 months (range: 3.0–18.2 months). None of the patients treated with IS developed any specific IS-related side effects such as oral candidiasis. Conclusion This single-centre experience shows that high-dose IS is an individual treatment option for radiation-induced pneumonitis grade II in patients with a good performance status.
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Affiliation(s)
- C Henkenberens
- Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Department of Radiotherapy and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - S Janssen
- Hannover Joint Practice in Radiooncology, Rundestr. 10, 30161, Hannover, Germany. .,Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
| | - M Lavae-Mokhtari
- Ibbenbüren Hospital Thoracic and Lung Center, Große Str. 41, 49477, Ibbenbüren, Germany.
| | - K Leni
- Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - A Meyer
- Hildesheim Goslar Joint Practice in Radiooncology, Senator-Braun-Allee, 31135, Hildesheim, Germany.
| | - H Christiansen
- Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - M Bremer
- Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - N Dickgreber
- Department of Pneumology, Thoracic Oncology and Respiratory Medicine, Frankenburgstr, 31, 48431, Rheine, Germany.
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15
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Shaverdian N, Veruttipong D, Wang J, Schaue D, Kupelian P, Lee P. Pretreatment Immune Parameters Predict for Overall Survival and Toxicity in Early-Stage Non-Small-Cell Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy. Clin Lung Cancer 2015; 17:39-46. [PMID: 26372098 DOI: 10.1016/j.cllc.2015.07.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/23/2015] [Accepted: 07/28/2015] [Indexed: 01/04/2023]
Abstract
INTRODUCTION We determined whether pretreatment immunologic parameters could predict the outcomes and toxicity in early-stage non-small-cell lung cancer (NSCLC) patients treated with stereotactic body radiation therapy (SBRT). PATIENTS AND METHODS The pretreatment leukocyte, lymphocyte, and neutrophil counts, serum albumin levels, neutrophil-to-lymphocyte ratio (NLR,) and platelet-to-lymphocyte ratio (PLR) were evaluated to determine the association with locoregional control, distant metastasis-free survival (DMFS), disease-specific survival (DSS), overall survival (OS), and treatment-related toxicity. The survival rates were estimated with Kaplan-Meier analysis and multivariate analysis using the Cox proportional hazards model. RESULTS The data from 118 patients with a median follow-up period of 28.9 months were assessed. The 3-year local control, regional control, and DMFS rates were 97%, 87%, and 92%, respectively. The 3-year OS and DSS rates were 77% and 85%, respectively. On univariate analysis, none of the pretreatment immune parameters predicted for disease control. A higher NLR (P = .008), PLR (P = .002), neutrophil count (P = .059), and the presence of lymphocytopenia (P = .032) independently prognosticated for poor OS. Receiver operating characteristic curve analysis found NLRs > 2.18 and PLRs > 187.27 optimally predicted for poor 3-year OS (P = .0262 and P = .0089, respectively). A higher NLR predicted against the development of any symptomatic toxicity and against the development of symptomatic (grade ≥ 2) radiation pneumonitis on univariate analysis, and a higher serum albumin level independently predicted for the development of symptomatic radiation pneumonitis (P = .0491). CONCLUSION In the setting of SBRT, an elevated pretreatment NLR, PLR, and neutrophil count and the presence of lymphocytopenia independently predicted for poor OS. Patients who presented with higher NLRs and lower serum albumin levels experienced less treatment-related symptomatic toxicity.
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Affiliation(s)
- Narek Shaverdian
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Darlene Veruttipong
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Jason Wang
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Dorthe Schaue
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Patrick Kupelian
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Percy Lee
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
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