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Pierik AS, Poell JB, Brink A, Stigter-van Walsum M, de Roest RH, Poli T, Yaromin A, Lambin P, Leemans CR, Brakenhoff RH. Intratumor genetic heterogeneity and head and neck cancer relapse. Radiother Oncol 2024; 191:110087. [PMID: 38185257 DOI: 10.1016/j.radonc.2024.110087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
BACKGROUND Head and neck squamous cell carcinomas are treated by surgery, radiotherapy (RT), chemoradiotherapy (CRT) or combinations thereof, but locoregional recurrences (LRs) occur in 30-40% of treated patients. We have previously shown that in approximately half of the LRs after CRT, cancer driver mutations are not shared with the index tumor. AIM To investigate two possible explanations for these genetically unrelated relapses, treatment-induced genetic changes and intratumor genetic heterogeneity. METHODS To investigate treatment-induced clonal DNA changes, we compared copy number alterations (CNAs) and mutations between primary and recurrent xenografted tumors after treatment with (C)RT. Intratumor genetic heterogeneity was studied by multi-region sequencing on DNA from 31 biopsies of 11 surgically treated tumors. RESULTS Induction of clonal DNA changes by (C)RT was not observed in the xenograft models. Multi-region sequencing demonstrated variations in CNA profiles between paired biopsies of individual tumors, with copy number heterogeneity scores varying from 0.027 to 0.333. In total, 32 cancer driver mutations could be identified and were shared in all biopsies of each tumor. Remarkably, multi-clonal mutations in these same cancer driver genes were observed in 6 of 11 tumors. Genetically distinct heterogeneous cell cultures could also be established from single tumors, with different biomarker profiles and drug sensitivities. CONCLUSION Intratumor genetic heterogeneity at the level of the cancer driver mutations might explain the discordant mutational profiles in LRs after CRT, while there are no indications in xenograft models that these changes are induced by CRT.
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Affiliation(s)
- A S Pierik
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Otolaryngology/Head and Neck Surgery, Head and Neck Cancer Biology and Immunology laboratory, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Biology and Immunology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - J B Poell
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Otolaryngology/Head and Neck Surgery, Head and Neck Cancer Biology and Immunology laboratory, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Biology and Immunology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - A Brink
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Otolaryngology/Head and Neck Surgery, Head and Neck Cancer Biology and Immunology laboratory, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Biology and Immunology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - M Stigter-van Walsum
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Otolaryngology/Head and Neck Surgery, Head and Neck Cancer Biology and Immunology laboratory, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Biology and Immunology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - R H de Roest
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Otolaryngology/Head and Neck Surgery, Head and Neck Cancer Biology and Immunology laboratory, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Biology and Immunology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - T Poli
- Maxillofacial Surgery Unit, Department of Medicine and Surgery - University of Parma, University Hospital of Parma, Via Gramsci 14, Parma, Italy
| | - A Yaromin
- Maastricht University, Department of Precision Medicine-UM & Radiology-MUMC, Universiteitssingel 40, Maastricht, the Netherlands
| | - P Lambin
- Maastricht University, Department of Precision Medicine-UM & Radiology-MUMC, Universiteitssingel 40, Maastricht, the Netherlands
| | - C R Leemans
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Otolaryngology/Head and Neck Surgery, Head and Neck Cancer Biology and Immunology laboratory, De Boelelaan 1117, Amsterdam, the Netherlands
| | - R H Brakenhoff
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Otolaryngology/Head and Neck Surgery, Head and Neck Cancer Biology and Immunology laboratory, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Biology and Immunology, De Boelelaan 1117, Amsterdam, the Netherlands.
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