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Marcu LG. Circadian rhythm-based cancer therapy in randomised clinical trials. Expert Rev Anticancer Ther 2024; 24:29-39. [PMID: 38127132 DOI: 10.1080/14737140.2023.2298835] [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: 09/13/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Since the 2017 Nobel Prize awarded to J. Hall, M. Rosbash and M.W. Young for their discoveries of molecular mechanisms behind the biological clock, circadian rhythm-based therapy, also known as chronotherapy, is receiving more attention in oncology and the number of anatomical sites of interest in this field is increasing. This observation is in line with the clinical evidence provided by trials on head and neck, lung, colorectal and cervical cancers, as well as the presently ongoing chronotherapy trials for breast and brain cancers. AREAS COVERED The aim of this review was to collate all randomized trials conducted on chronotherapy for various tumor sites and to appraise the evidence for chrono-oncology to advance personalized therapy. Relevant literature was collected from Pubmed/Medline databases and from clinicatrials.gov. EXPERT OPINION Current randomized clinical trials offer a certain level of evidence for the potential of chronotherapy to personalize oncologic treatment. However, comparison of trial results is hindered by the differences in timing of radiation/chemotherapy, the absence of harmonized recommendations for treatment outcome evaluation and not ultimately, the general lack of considering gender as a matched variable in trials, which was found to be a powerful factor influencing response to treatment.
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Affiliation(s)
- Loredana G Marcu
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, Australia
- Faculty of Informatics and Science, University of Oradea, Oradea, Romania
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Marcu LG, Dell’Oro M, Bezak E. Opportunities in Cancer Therapies: Deciphering the Role of Cancer Stem Cells in Tumour Repopulation. Int J Mol Sci 2023; 24:17258. [PMID: 38139085 PMCID: PMC10744048 DOI: 10.3390/ijms242417258] [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: 11/18/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Tumour repopulation during treatment is a well acknowledged yet still challenging aspect of cancer management. The latest research results show clear evidence towards the existence of cancer stem cells (CSCs) that are responsible for tumour repopulation, dissemination, and distant metastases in most solid cancers. Cancer stem cell quiescence and the loss of asymmetrical division are two powerful mechanisms behind repopulation. Another important aspect in the context of cancer stem cells is cell plasticity, which was shown to be triggered during fractionated radiotherapy, leading to cell dedifferentiation and thus reactivation of stem-like properties. Repopulation during treatment is not limited to radiotherapy, as there is clinical proof for repopulation mechanisms to be activated through other conventional treatment techniques, such as chemotherapy. The dynamic nature of stem-like cancer cells often elicits resistance to treatment by escaping drug-induced cell death. The aims of this scoping review are (1) to describe the main mechanisms used by cancer stem cells to initiate tumour repopulation during therapy; (2) to present clinical evidence for tumour repopulation during radio- and chemotherapy; (3) to illustrate current trends in the identification of CSCs using specific imaging techniques; and (4) to highlight novel technologies that show potential in the eradication of CSCs.
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Affiliation(s)
- Loredana G. Marcu
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA 5001, Australia;
- Faculty of Informatics and Science, University of Oradea, 410087 Oradea, Romania
| | - Mikaela Dell’Oro
- Australian Centre for Quantitative Imaging, School of Medicine, The University of Western Australia, Perth, WA 6009, Australia;
| | - Eva Bezak
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA 5001, Australia;
- Faculty of Chemistry & Physics, University of Adelaide, Adelaide, SA 5000, Australia
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Buciuman N, Marcu LG. Dosimetric and clinical aspects of head and neck cancer reirradiation with intensity modulated radiotherapy techniques over the last decade. Phys Med 2023; 112:102650. [PMID: 37556868 DOI: 10.1016/j.ejmp.2023.102650] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Tumor recurrence in head and neck cancer (HNC) is very common, given that locoregional disease relapse occurs in up to 50% of patients. The clinical approach towards cancer recurrence is either by surgery and/or chemo-radiotherapy. Irrespective of the treatment, the management of HNC recurrence is highly challenging and often administered with palliative intent only. The aim of this work was to analyze clinical and dosimetric aspects, such as dose prescription, organ at risk sparing, overall survival and locoregional control of HNC after reirradiation with intensity modulated radiotherapy techniques based on studies published over the last decade, due to the wide clinical implementation of the intensity modulated radiotherapy and particularly of volumetric modulated arc therapy (VMAT) for this malignancy. METHODS A systematic search of the literature was conducted within Pub-med/Medline databases to find relevant studies. Of the 130 articles fulfilling the initial search criteria, 15 were selected for final analysis that encompassed all set requirements. RESULTS Clinical studies revealed the multitude of factors influencing treatment outcome, including anatomical location, histological tumor type, patient-related factors (smoking / comorbidities), cumulative dose and fractionation schedule, reirradiated volume and time between the irradiation of primary and recurrent tumor. CONCLUSIONS Since the literature reports no specific data related to the type of intensity modulation used in reirradiation or any correlation with treatment outcome, IMRT and VMAT might offer comparable result after HNC reirradiation. Patient selection is potentially the main factor leading to an efficient outcome.
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Affiliation(s)
- Nikolett Buciuman
- Faculty of Physics, West University of Timisoara, Timisoara, Romania; OncoHelp Foundation, Timisoara, Romania
| | - Loredana G Marcu
- Faculty of Physics, West University of Timisoara, Timisoara, Romania; Faculty of Informatics & Science, University of Oradea, Oradea, Romania; UniSA Allied Health & Human Performance, University of South Australia, Adelaide SA 5001, Australia.
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Ghemiș DM, Marcu LG, Virag V, Virag A. Dosimetric characteristics of 6MV flattening filter free and flattened beams among beam-matched linacs: a three-institutional study. Radiat Oncol 2023; 18:126. [PMID: 37507741 PMCID: PMC10375603 DOI: 10.1186/s13014-023-02313-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Beam matching is a concept in radiotherapy applied to clinics where more than one linac is employed to harmonise beam characteristics across linacs for allowing patients interchange without replanning. In view of this, the current study analyzes and compares dosimetric characteristics of 6MV flattening filter free and flattened beams of three beam-matched linear accelerators (linacs) from three different clinics with the aim to evaluate the matching under tight criteria for gamma analysis. METHODS Three Elekta linacs from three different clinics were included. The linacs have the same collimator assembly, Elekta Agility. Beam data were collected during commissioning process using PTW dosimetry systems. Dose profiles and percentage depth doses (PDD) were analyzed using 1D gamma analysis (1 mm/1%) as well as the following parameters: depth of maximum dose, PDD10, flatness, unflattnes, symmetry, penumbra, output factors. Additionally, five stereotactic treatment plans were optimized in one clinic and calculated by all three planning systems (Monaco) for a dosimetric comparison. RESULTS Gamma analysis of dose profiles and PDDs showed clinically acceptable results of 96.3% passing rate for profiles and 100% passing rate for PDDs. All dosimetric parameters were in good agreement with the reference data. Furthermore, dosimetric comparisons between stereotactic treatment plans showed a maximum standard deviation of 0.48 Gy for the maximum dose to PTV, and a maximum standard deviation of 0.1 Gy for the dose to the organs at risk. CONCLUSIONS All three linacs showed a strong agreement between parameters and passed the gamma analysis using 1% DD/1mm DTA criteria. This study confirmed the matching between linacs, offering the possibility to interchange patients with no replanning.
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Affiliation(s)
- Diana M Ghemiș
- Faculty of Physics, West University of Timisoara, Timisoara, Romania.
- MedEuropa, Oradea, 410191, Romania.
| | - Loredana G Marcu
- Faculty of Physics, West University of Timisoara, Timisoara, Romania
- Faculty of Informatics & Science, University of Oradea, Oradea, 410087, Romania
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA, 5001, Australia
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Bezak E, Borrás C, Hasford F, Karmaker N, Keyser A, Stoeva M, Trauernicht C, Yeong HC, Marcu LG. Science diplomacy in medical physics - an international perspective. Health Technol (Berl) 2023; 13:495-503. [PMID: 37303976 PMCID: PMC10162897 DOI: 10.1007/s12553-023-00756-0] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 06/13/2023]
Abstract
Purpose Science diplomacy in medical physics is a relatively young research field and translational practice that focuses on establishing international collaborations to address some of the questions biomedical professionals face globally. This paper aims to present an overview of science diplomacy in medical physics, from an international perspective, illustrating the ways collaborations within and across continents can lead to scientific and professional achievements that advance scientific growth and improve patients care. Methods Science diplomacy actions were sought that promote collaborations in medical physics across the continents, related to professional and scientific aspects alike. Results Several science diplomacy actions have been identified to promote education and training, to facilitate research and development, to effectively communicate science to the public, to enable equitable access of patients to healthcare and to focus on gender equity within the profession as well as healthcare provision. Scientific and professional organizations in the field of medical physics across all continents have adopted a number of efforts in their aims, many of them with great success, to promote science diplomacy and to foster international collaborations. Conclusions Professionals in medical physics can advance through international cooperation, by building strong communication across scientific communities, addressing rising demands, exchange scientific information and knowledge.
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Affiliation(s)
- Eva Bezak
- Medical Radiations, University of South Australia, Adelaide, SA Australia
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5001 Australia
- International Organisation for Medical Physics (IOMP), York, UK
- Asia-Oceania Federation of Organizations for Medical Physics (AFOMP), Bangkok, Thailand
| | - Cari Borrás
- Radiological Physics and Health Services, Washington, DC USA
| | - Francis Hasford
- Department of Medical Physics, University of Ghana, Accra, Ghana
- Federation of African Medical Physics Organizations (FAMPO), Accra, Ghana
- International Organisation for Medical Physics (IOMP), York, UK
| | - Nupur Karmaker
- Department of Medical Physics and Biomedical Engineering, Gono Bishwabidyalay) University, Savar, Dhaka, Bangladesh
| | - Angela Keyser
- American Association of Physicists in Medicine (AAPM), Richmond, USA
| | - Magdalena Stoeva
- Department of Diagnostic Imaging, Medical University of Plovdiv, Plovdiv, Bulgaria
- International Organisation for Medical Physics (IOMP), York, UK
| | - Christoph Trauernicht
- Federation of African Medical Physics Organizations (FAMPO), Accra, Ghana
- Division of Medical Physics, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Hong Chai Yeong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, 47500 Malaysia
- South-East Asian Federation of Organizations for Medical Physics (SEAFOMP), Subang Jaya, Malaysia
| | - Loredana G. Marcu
- Medical Radiations, University of South Australia, Adelaide, SA Australia
- Faculty of Informatics and Science, University of Oradea, Oradea, 410087 Romania
- European Federation of Organisations for Medical Physics (EFOMP), Utrecht, The Netherlands
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Marcu LG, Moghaddasi L, Bezak E. Cannot Target What Cannot Be Seen: Molecular Imaging of Cancer Stem Cells. Int J Mol Sci 2023; 24:ijms24021524. [PMID: 36675033 PMCID: PMC9864237 DOI: 10.3390/ijms24021524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/27/2022] [Revised: 12/29/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Cancer stem cells are known to play a key role in tumour development, proliferation, and metastases. Their unique properties confer resistance to therapy, often leading to treatment failure. It is believed that research into the identification, targeting, and eradication of these cells can revolutionise oncological treatment. Based on the principle that what cannot be seen, cannot be targeted, a primary step in cancer management is the identification of these cells. The current review aims to encompass the state-of-the-art functional imaging techniques that enable the identification of cancer stem cells via various pathways and mechanisms. The paper presents in vivo molecular techniques that are currently available or await clinical implementation. Challenges and future prospects are highlighted to open new research avenues in cancer stem cell imaging.
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Affiliation(s)
- Loredana G. Marcu
- Faculty of Informatics and Science, University of Oradea, 1 Universitatii Str., 410087 Oradea, Romania
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
- Correspondence:
| | - Leyla Moghaddasi
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - Eva Bezak
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
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Irazola L, Marcu LG, Koutsouveli E. Early career medical physicists' section at the 4th European Congress of Medical Physics. Phys Med 2022; 103:74-75. [PMID: 36252523 DOI: 10.1016/j.ejmp.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/27/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Leticia Irazola
- Servicio Vasco de Salud, Osakidetza, Spain; European Federation of Organisations for Medical Physics (EFOMP)
| | - Loredana G Marcu
- Faculty of Informatics & Science, University of Oradea, Oradea 410087, Romania; Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia; European Federation of Organisations for Medical Physics (EFOMP).
| | - Efi Koutsouveli
- Department of Medical Physics, Hygeia Hospital, Athens, Greece; European Federation of Organisations for Medical Physics (EFOMP)
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Marcu LG. Developments on tumour site-specific chrono-oncology towards personalised treatment. Crit Rev Oncol Hematol 2022; 179:103803. [PMID: 36058443 DOI: 10.1016/j.critrevonc.2022.103803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/15/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Abstract
Research into chronotherapy has seen notable developments over the past decades, with a clear focus on the identification of circadian clock genes as potential treatment targets. Moreover, new factors are investigated, such as gender and the role of cancer stem cells in influencing the outcome of chronomodulated treatments. These factors could add to the arsenal of parameters that assist with patient stratification and treatment personalisation. Literature analysis showed that certain anatomical sites received more attention and the associated studies reported clinically significant results, even though some findings are contradictory. The aim of this work was to review the existing studies on chrono-oncology using a tumour site-specific approach and to highlight the status of research in various cancers. Inconsistencies in data reporting, the nature of the studies and the highly heterogeneous patient characteristics, highlight the need for well-designed randomised controlled trials to elucidate the real potential of chronotherapy in oncology.
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Affiliation(s)
- Loredana G Marcu
- Faculty of Informatics and Science, University of Oradea, Oradea 410087, Romania; School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
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Costin IC, Marcu LG. Factors impacting on patient setup analysis and error management during breast cancer radiotherapy. Crit Rev Oncol Hematol 2022; 178:103798. [PMID: 36031175 DOI: 10.1016/j.critrevonc.2022.103798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/28/2022] [Accepted: 08/21/2022] [Indexed: 12/24/2022] Open
Abstract
Radiotherapy is required to deliver an accurate dose to the tumor while protecting surrounding normal tissues. Breast cancer radiotherapy involves a number of factors that can influence patient setup and error management, including the immobilization device used, the verification system and the patient's treatment position. The aim of this review is to compile and discuss the setup errors that occur due to the above-mentioned factors. In view of this, a systematic search of the scientific literature in the Medline/PubMed databases was performed over the 1990-2021 time period, with 93 articles found to be relevant for the study. To be accessible to all, this study not only aims to identify factors impacting on patient setup analysis, but also seeks to evaluate the role of each verification device, board immobilization and position in influencing these errors.
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Affiliation(s)
- Ioana-Claudia Costin
- West University of Timisoara, Faculty of Physics, Timisoara, Romania; "Dr. Gavril Curteanu" County Hospital, Oradea 410469, Romania
| | - Loredana G Marcu
- West University of Timisoara, Faculty of Physics, Timisoara, Romania; Faculty of Informatics & Science, University of Oradea, Oradea 410087, Romania; Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia.
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Marcu LG, Bezak E, Sykes PJ. Radiation Research Journals Need to Stipulate Minimal Dosimetry Requirements for Publishing Research Using X-Radiation Exposures. Radiat Res 2022; 198:204-206. [PMID: 35640161 DOI: 10.1667/rade-22-00063.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Loredana G Marcu
- Faculty of Informatics and Science, University of Oradea, 1 Universitatii str, 410087 Oradea, Romania.,Medical Radiation, University of South Australia, Adelaide, South Australia, Australia
| | - Eva Bezak
- Medical Radiation, University of South Australia, Adelaide, South Australia, Australia.,School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Pamela J Sykes
- Flinders Health and Medical Research Institute - Cancer Program, Flinders University, Bedford Park, South Australia, Australia
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Buciuman N, Marcu LG. Is there a dosimetric advantage of volumetric modulated arc therapy over intensity modulated radiotherapy in head and neck cancer? Eur Arch Otorhinolaryngol 2022; 279:5311-5321. [DOI: 10.1007/s00405-022-07452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
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Frize M, Tsapaki V, Lhotska L, da Silva AMM, Ibrahim F, Bezak E, Stoeva M, Barabino G, Lim S, Kaldoudi E, Tan PH, Marcu LG. Women in Medical Physics and Biomedical Engineering: past, present and future. Health Technol 2022; 12:655-662. [PMID: 35399289 PMCID: PMC8980510 DOI: 10.1007/s12553-022-00658-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 02/23/2022] [Accepted: 03/12/2022] [Indexed: 11/25/2022]
Abstract
Women in Medical Physics and Biomedical Engineering (WiMPBME) is a Task Group established in 2014 under the International Union of Physical and Engineering Scientists in Medicine (IUPESM). The group’s main role is to identify, develop, implement, and coordinate various tasks and projects related to women’s needs and roles in medical physics and biomedical engineering around the world. The current paper summarizes the past, present and future goals and activities undertaken or planned by the Task group in order to motivate, nurture and support women in medical physics and biomedical engineering throughout their professional careers. In addition, the article includes the historical pathway followed by various women’s groups and subcommittees from 2004 up to the present day and depicts future aims to further these professions in a gender-balanced manner.
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Affiliation(s)
- Monique Frize
- Department of Systems and Computer Engineering, Carleton University, K1S 5B6 Ottawa, ON Canada
| | - Virginia Tsapaki
- Medical Physics Department, Konstantopoulio General Hospitals, Athens, Greece
| | - Lenka Lhotska
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague 6, Czech Republic
| | | | - Fatimah Ibrahim
- Department of Biomedical Engineering and Centre for Innovation in Medical Engineering, Faculty of Engineering, University Malaya, 50603 Kuala Lumpur, Malaysia
| | - Eva Bezak
- Cancer Research Institute, University of South Australia, 5001 Adelaide, SA Australia
| | - Magdalena Stoeva
- Department of Diagnostic Imaging, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Sierin Lim
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 637457 Singapore, Singapore
| | - Eleni Kaldoudi
- School of Medicine, Democritus University of Thrace, Alexandroupoli, Greece
| | - Peck Ha Tan
- School of Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - Loredana G. Marcu
- Cancer Research Institute, University of South Australia, 5001 Adelaide, SA Australia
- Faculty of Informatics and Science, University of Oradea, 1 Universitatii str, 410087 Oradea, Bihor, Romania
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Moghaddasi L, Reid P, Bezak E, Marcu LG. Radiobiological and Treatment-Related Aspects of Spatially Fractionated Radiotherapy. Int J Mol Sci 2022; 23:3366. [PMID: 35328787 PMCID: PMC8954016 DOI: 10.3390/ijms23063366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
The continuously evolving field of radiotherapy aims to devise and implement techniques that allow for greater tumour control and better sparing of critical organs. Investigations into the complexity of tumour radiobiology confirmed the high heterogeneity of tumours as being responsible for the often poor treatment outcome. Hypoxic subvolumes, a subpopulation of cancer stem cells, as well as the inherent or acquired radioresistance define tumour aggressiveness and metastatic potential, which remain a therapeutic challenge. Non-conventional irradiation techniques, such as spatially fractionated radiotherapy, have been developed to tackle some of these challenges and to offer a high therapeutic index when treating radioresistant tumours. The goal of this article was to highlight the current knowledge on the molecular and radiobiological mechanisms behind spatially fractionated radiotherapy and to present the up-to-date preclinical and clinical evidence towards the therapeutic potential of this technique involving both photon and proton beams.
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Affiliation(s)
- Leyla Moghaddasi
- Department of Medical Physics, Austin Health, Ballarat, VIC 3350, Australia;
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5001, Australia;
| | - Paul Reid
- Radiation Health, Environment Protection Authority, Adelaide, SA 5000, Australia;
| | - Eva Bezak
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5001, Australia;
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
| | - Loredana G. Marcu
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
- Faculty of Informatics and Science, University of Oradea, 1 Universitatii Str., 410087 Oradea, Romania
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Bezak E, Carson-Chahhoud KV, Marcu LG, Stoeva M, Lhotska L, Barabino GA, Ibrahim F, Kaldoudi E, Lim S, Marques da Silva AM, Tan PH, Tsapaki V, Frize M. The Biggest Challenges Resulting from the COVID-19 Pandemic on Gender-Related Work from Home in Biomedical Fields—World-Wide Qualitative Survey Analysis. IJERPH 2022; 19:ijerph19053109. [PMID: 35270801 PMCID: PMC8910706 DOI: 10.3390/ijerph19053109] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: This paper aims to present and discuss the most significant challenges encountered by STEM professionals associated with remote working during the COVID-19 lockdowns. (2) Methods: We performed a qualitative analysis of 921 responses from professionals from 76 countries to the open-ended question: “What has been most challenging during the lockdown for you, and/or your family?” (3) Findings: Participants reported challenges within the immediate family to include responsibilities for school, childcare, and children’s wellbeing; and the loss of social interactions with family and friends. Participants reported increased domestic duties, blurred lines between home and work, and long workdays. Finding adequate workspace was a problem, and adaptations were necessary, especially when adults shared the same setting for working and childcare. Connectivity issues and concentration difficulties emerged. While some participants reported employers’ expectations did not change, others revealed concerns about efficiency. Mental health issues were expressed as anxiety and depression symptoms, exhaustion and burnout, and no outlets for stress. Fear of becoming infected with COVID-19 and uncertainties about the future also emerged. Pressure points related to gender, relationship status, and ethnicities were also evaluated. Public policies differed substantially across countries, raising concerns about the adherence to unnecessary restrictions, and similarly, restrictions being not tight enough. Beyond challenges, some benefits emerged, such as increased productivity and less time spent getting ready for work and commuting. Confinement resulted in more quality time and stronger relationships with family. (4) Interpretation: Viewpoints on positive and negative aspects of remote working differed by gender. Females were more affected professionally, socially, and personally than males. Mental stress and the feeling of inadequate work efficiency in women were caused by employers’ expectations and lack of flexibility. Working from home turned out to be challenging, primarily due to a lack of preparedness, limited access to a dedicated home-office, and lack of previous experience in multi-layer/multi-scale environments.
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Affiliation(s)
- Eva Bezak
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia; (E.B.); (K.V.C.-C.)
| | - Kristin V. Carson-Chahhoud
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia; (E.B.); (K.V.C.-C.)
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA 5001, Australia
- School of Medicine, University of Adelaide, Adelaide, SA 5001, Australia
| | - Loredana G. Marcu
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia; (E.B.); (K.V.C.-C.)
- Faculty of Informatics and Science, University of Oradea, 1 Universitatii Str., 410087 Oradea, Romania
- Correspondence:
| | - Magdalena Stoeva
- Department of Diagnostic Imaging, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Lenka Lhotska
- Faculty of Biomedical Engineering, Czech Technical University in Prague, 160 00 Prague 6, Czech Republic;
| | | | - Fatimah Ibrahim
- Department of Biomedical Engineering, Centre for Innovation in Medical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | - Eleni Kaldoudi
- School of Medicine, Democritus University of Thrace, 69100 Alexandroupoli, Greece;
| | - Sierin Lim
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 637457, Singapore;
| | - Ana Maria Marques da Silva
- School of Technology, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre 90619-900, Brazil;
| | - Peck Ha Tan
- School of Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore;
| | - Virginia Tsapaki
- Medical Physics Department, Konstantopoulio General Hospitals, Nea Ionia, 14233 Athens, Greece;
| | - Monique Frize
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON K1S 5B6, Canada;
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15
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Marcu LG, Caruana CJ, Lopez-Medina A, Mazzoni LN, Polycarpou I, Manetou A, Koutsouveli E. Early career medical physicist groups in Europe: An EFOMP survey. Phys Med 2022; 95:89-93. [DOI: 10.1016/j.ejmp.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/01/2022] [Indexed: 10/19/2022] Open
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16
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Marcu LG. Gender and Sex-Related Differences in Normal Tissue Effects Induced by Platinum Compounds. Pharmaceuticals (Basel) 2022; 15:255. [PMID: 35215367 PMCID: PMC8876358 DOI: 10.3390/ph15020255] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/18/2022] Open
Abstract
Gender medicine in the field of oncology is an under-researched area, despite the existing evidence towards gender-dependent response to therapy and treatment-induced adverse effects. Oncological treatment aims to fulfil its main goal of achieving high tumour control by also protecting normal tissue from acute or chronic damage. Chemotherapy is an important component of cancer treatment, with a large number of drugs being currently in clinical use. Cisplatin is one of the most commonly employed chemotherapeutic agents, used either as a sole drug or in combination with other agents. Cisplatin-induced toxicities are well documented, and they include nephrotoxicity, neurotoxicity, gastrointestinal toxicity, ototoxicity, just to name the most frequent ones. Some of these toxicities have short-term sequelae, while others are irreversible. Furthermore, research showed that there is a strong gender-dependent aspect of side effects caused by the administration of cisplatin. While evidence towards sex differences in animal models is substantial, clinical studies considering sex/gender as a variable factor are limited. This work summarises the current knowledge on sex/gender-related side effects induced by platinum compounds and highlights the gaps in research that require more attention to open new therapeutic possibilities and preventative measures to alleviate normal tissue toxicity and increase patients' quality of life in both males and females.
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Affiliation(s)
- Loredana G. Marcu
- Faculty of Informatics & Science, Department of Physics, University of Oradea, 410087 Oradea, Romania;
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
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17
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Marcu LG, Marcu DC. Current Omics Trends in Personalised Head and Neck Cancer Chemoradiotherapy. J Pers Med 2021; 11:jpm11111094. [PMID: 34834445 PMCID: PMC8625829 DOI: 10.3390/jpm11111094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022] Open
Abstract
Chemoradiotherapy remains the most common management of locally advanced head and neck cancer. While both treatment components have greatly developed over the years, the quality of life and long-term survival of patients undergoing treatment for head and neck malignancies are still poor. Research in head and neck oncology is equally focused on the improvement of tumour response to treatment and on the limitation of normal tissue toxicity. In this regard, personalised therapy through a multi-omics approach targeting patient management from diagnosis to treatment shows promising results. The aim of this paper is to discuss the latest results regarding the personalised approach to chemoradiotherapy of head and neck cancer by gathering the findings of the newest omics, involving radiotherapy (dosiomics), chemotherapy (pharmacomics), and medical imaging for treatment monitoring (radiomics). The incorporation of these omics into head and neck cancer management offers multiple viewpoints to treatment that represent the foundation of personalised therapy.
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Affiliation(s)
- Loredana G. Marcu
- Faculty of Informatics & Science, University of Oradea, 410087 Oradea, Romania
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
- Correspondence:
| | - David C. Marcu
- Faculty of Electrical Engineering & Information Technology, University of Oradea, 410087 Oradea, Romania;
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18
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Buciuman N, Marcu LG. Dosimetric justification for the use of volumetric modulated arc therapy in head and neck cancer-A systematic review of the literature. Laryngoscope Investig Otolaryngol 2021; 6:999-1007. [PMID: 34667842 PMCID: PMC8513433 DOI: 10.1002/lio2.642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/08/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Radiotherapy for head and neck cancer (HNC) has evolved rapidly in the past decades from conformal three-dimensional technique (3D-CRT) to intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT). This paper presents a dosimetric comparative study between VMAT and IMRT delivery based on current literature, while also presenting the potential challenges encountered with volumetric arc therapy. METHODS A systematic search of the scientific literature was conducted within Medline/Pubmed databases. A number of 13 papers fulfilled the search criteria which was based on the main objective to evaluate dosimetric characteristics of comparative treatment delivery with VMAT vs IMRT in HNC. RESULTS Overall, from a dosimetric perspective, dose delivery via VMAT and IMRT present comparable results. Beside the delivery technique, target volume coverage also depends on the planner's expertise as well as the employed planning algorithm. At times, the superiority of VMAT emerges from the improved sparing of normal tissue, reduction of monitor units (MU) and of treatment delivery time. Similar to IMRT, one of the most important challenges of VMAT is the risk of developing secondary cancer due to the higher number of MUs compared to 3D-CRT. CONCLUSIONS Based on the comparative results with the more established IMRT, VMAT in HNC can be safely delivered either as a single treatment or combined with other techniques.
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Affiliation(s)
- Nikolett Buciuman
- Faculty of PhysicsWest University of TimisoaraTimisoaraRomania
- OncoHelp FoundationTimisoaraRomania
| | - Loredana G. Marcu
- Faculty of PhysicsWest University of TimisoaraTimisoaraRomania
- Faculty of Informatics & ScienceUniversity of OradeaOradeaRomania
- Cancer Research InstituteUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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19
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Reid P, Staudacher AH, Marcu LG, Olver I, Moghaddasi L, Brown MP, Bezak E. Characteristic differences in radiation-induced DNA damage response in human papillomavirus-negative and human papillomavirus-positive head and neck cancers with accumulation of fractional radiation dose. Head Neck 2021; 43:3086-3096. [PMID: 34235809 DOI: 10.1002/hed.26802] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/23/2021] [Accepted: 06/28/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Superior treatment responses by patients with human papillomavirus (HPV) positive head and neck squamous cell carcinoma (HNSCC), compared to patients with HNSCC from other causes, drive biomarker research to optimize treatment. Most HNSCC patients receive radiation therapy delivered as a fractionated course. Changing HPV status in HNSCC from a positive prognostic marker to a predictive one requires biomarkers that capture cellular radiation response to cumulative dose. METHODS Nuclear enlargement, γH2AX expression and micronuclei count, were studied in six HNSCC cell lines after 4 Gy fractionated X-irradiation. RESULTS All HNSCC cell lines displayed altered cellular responses, indicating increasing inability to repair radiation damage with subsequent radiation fractions. Increases in nuclear area were significantly greater among HPV positive cell lines (207% and 67% for the HPV positive and HPV negative groups, respectively). CONCLUSIONS A different character of DNA repair dysfunction in the HPV positive group suggests greater chromosomal translocation with accumulated radiation dose.
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Affiliation(s)
- Paul Reid
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Alexander H Staudacher
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Loredana G Marcu
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.,Faculty of Science, University of Oradea, Oradea, Romania
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Leyla Moghaddasi
- Genesis Care, Adelaide Radiotherapy Centre, Adelaide, South Australia, Australia.,Department of Physics, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael P Brown
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Eva Bezak
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.,Department of Physics, University of Adelaide, Adelaide, South Australia, Australia
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20
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Ghemiş DM, Marcu LG. Progress and prospects of flattening filter free beam technology in radiosurgery and stereotactic body radiotherapy. Crit Rev Oncol Hematol 2021; 163:103396. [PMID: 34146680 DOI: 10.1016/j.critrevonc.2021.103396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/25/2022] Open
Abstract
The aim of this work is to summarize and evaluate the current status of knowledge on flattening filter free (FFF) beams and their applications in stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). A PubMed search was undertaken in order to identify relevant publications using FFF and stereotactic radiotherapy as keywords. On a clinical aspect, lung tumors treated with FFF SBRT show promising results in terms of local control and overall survival with acute toxicities consistent with those that occur with standard radiotherapy. Beside lung, SBRT is suitable for different anatomical sites such as liver, prostate, cervix, etc. offering similar results: reduced treatment time, good tumor control and mild acute toxicities. Regarding brain tumors, the employment of SRS with FFF beams significantly reduces treatment time and provides notable normal tissue sparing due to the sharp dose fall-off outside the tumor.
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Affiliation(s)
- Diana M Ghemiş
- West University of Timisoara, Faculty of Physics, Timisoara, Romania; MedEuropa, Oradea, Romania
| | - Loredana G Marcu
- West University of Timisoara, Faculty of Physics, Timisoara, Romania; Faculty of Informatics & Science, University of Oradea, Oradea, 410087, Romania; Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia.
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21
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Li Y, Marcu LG, Hull A, Bezak E. Radioimmunotherapy of glioblastoma multiforme - Current status and future prospects. Crit Rev Oncol Hematol 2021; 163:103395. [PMID: 34119657 DOI: 10.1016/j.critrevonc.2021.103395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/29/2021] [Accepted: 06/08/2021] [Indexed: 01/21/2023] Open
Abstract
Glioblastoma multiforme (GBM) or grade IV astrocytoma is the most diagnosed form of primary brain tumours in adults. Radioimmunotherapy (RIT), mostly in combination with conventional therapies, is presented in the current review as a therapeutic strategy of high potential in the management of GBM. A systematic literature search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to identify clinical studies that employed a form of radioimmunotherapy using alpha- or beta-emitting radioisotopes. The available literature on RIT in GBM and high-grade gliomas is presented and discussed. The results suggest that this promising treatment approach merits further investigation in future clinical studies.
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Affiliation(s)
- Yanrui Li
- Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia
| | - Loredana G Marcu
- Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia; Faculty of Informatics and Science, University of Oradea, Oradea, 410087, Romania
| | - Ashleigh Hull
- Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia
| | - Eva Bezak
- Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia; Department of Physics, University of Adelaide, Adelaide, SA, 5005, Australia.
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22
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Marcu LG. The Ever-Changing Role of Medical Physicists in the Era of Personalized Medicine. J Med Phys 2021; 45:197-198. [PMID: 33953493 PMCID: PMC8074720 DOI: 10.4103/jmp.jmp_113_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Loredana G Marcu
- Department of Physics, Faculty of Informatics and Science, University of Oradea, Oradea, Romania.,Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
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23
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Frize M, Lhotska L, Marcu LG, Stoeva M, Barabino G, Ibrahim F, Lim S, Kaldoudi E, Marques da Silva AM, Tan PH, Tsapaki V, Bezak E. The impact of COVID-19 pandemic on gender-related work from home in STEM fields-Report of the WiMPBME Task Group. Gend Work Organ 2021; 28:378-396. [PMID: 34230783 PMCID: PMC8251105 DOI: 10.1111/gwao.12690] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022]
Abstract
The COVID-19 pandemic has forced many people, including those in the fields of science and engineering, to work from home. The new working environment caused by the pandemic is assumed to have a different impact on the amount of work that women and men can do from home. Particularly, if the major burden of child and other types of care is still predominantly on the shoulders of women. As such, a survey was conducted to assess the main issues that biomedical engineers, medical physicists (academics and professionals), and other similar professionals have been facing when working from home during the pandemic. A survey was created and disseminated worldwide. It originated from a committee of International Union for Physical and Engineering Sciences in Medicine (IUPESM; Women in Medical Physics and Biomedical Engineering Task Group) and supported by the Union. The ethics clearance was received from Carleton University. The survey was deployed on the Survey Monkey platform and the results were analyzed using IBM SPSS software. The analyses mainly consisted of frequency of the demographic parameters and the cross-tabulation of gender with all relevant variables describing the impact of work at home. A total of 921 responses from biomedical professions in 76 countries were received: 339 males, 573 females, and nine prefer-not-to-say/other. Regarding marital/partnership status, 85% of males were married or in partnership, and 15% were single, whereas 72% of females were married or in partnership, and 26% were single. More women were working from home during the pandemic (68%) versus 50% of men. More men had access to an office at home (68%) versus 64% for women. The proportion of men spending more than 3 h on child care and schooling per day was 12%, while for women it was 22%; for household duties, 8% of men spent more than 3 h; for women, this was 12.5%. It is interesting to note that 44% of men spent between 1 and 3 h per day on household duties, while for women, it was 55%. The high number of survey responses can be considered excellent. It is interesting to note that men participate in childcare and household duties in a relatively high percentage; although this corresponds to less hours daily than for women. It is far more than can be found 2 and 3 decades ago. This may reflect the situation in the developed countries only-as majority of responses (75%) was received from these countries. It is evident that the burden of childcare and household duties will have a negative impact on the careers of women if the burden is not more similar for both sexes. It is important to recognize that a change in policies of organizations that hire them may be required to provide accommodation and compensation to minimize the negative impact on the professional status and career of men and women who work in STEM fields.
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Affiliation(s)
- Monique Frize
- Department of Systems and Computer Engineering Carleton University Ottawa Ontario Canada
| | - Lenka Lhotska
- Faculty of Biomedical Engineering Czech Technical University in Prague Prague Czech Republic
| | - Loredana G Marcu
- Faculty of Science University of Oradea Oradea Romania.,Cancer Research Institute University of South Australia Adelaide South Australia Australia
| | - Magdalena Stoeva
- Department of Diagnostic Imaging Medical University of Plovdiv Plovdiv Bulgaria
| | | | - Fatimah Ibrahim
- Department of Biomedical Engineering and Centre for Innovation in Medical Engineering Faculty of Engineering, Universiti Malaya Kuala Lumpur Malaysia
| | - Sierin Lim
- School of Chemical and Biomedical Engineering Nanyang Technological University Singapore
| | - Eleni Kaldoudi
- School of Medicine Democritus University of Thrace Alexandroupoli Greece
| | | | - Peck Ha Tan
- School of Engineering Ngee Ann Polytechnic Singapore
| | - Virginia Tsapaki
- Department of Medical Physics Konstantopoulio General Hospitals Athens Greece
| | - Eva Bezak
- Cancer Research Institute University of South Australia Adelaide South Australia Australia
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24
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Marcu LG, Chau M, Bezak E. How much is too much? Systematic review of cumulative doses from radiological imaging and the risk of cancer in children and young adults. Crit Rev Oncol Hematol 2021; 160:103292. [DOI: 10.1016/j.critrevonc.2021.103292] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/20/2021] [Accepted: 02/27/2021] [Indexed: 01/18/2023] Open
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25
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Bodale M, Marcu LG. 140 years of medical physics in Romania. Phys Med 2021; 82:46-53. [PMID: 33581617 DOI: 10.1016/j.ejmp.2021.01.074] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 11/26/2022] Open
Abstract
In 2020 the Romanian College of Medical Physicists celebrated 140 years of medical physics in Romania. The article presents a short historical perspective of medical physics teaching and education in the country, focusing on the current situation and challenges that we are facing in regards to staffing, training and accreditation. While certain aspects concerning the procurement of radiotherapy / medical imaging devices and staffing are improving over the years, others, related to clinical training and education, as well as the national recognition of the profession continue to pose a challenge.
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Affiliation(s)
- Marin Bodale
- Medical Physics Center Iasi, Iasi 700063, Romania
| | - Loredana G Marcu
- Faculty of Informatics & Science, University of Oradea, Oradea 410087, Romania; Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia.
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26
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Marcu LG, Bezak E, Peukert DD, Wilson P. Translational Research in FLASH Radiotherapy-From Radiobiological Mechanisms to In Vivo Results. Biomedicines 2021; 9:181. [PMID: 33670409 PMCID: PMC7918545 DOI: 10.3390/biomedicines9020181] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/18/2023] Open
Abstract
FLASH radiotherapy, or the administration of ultra-high dose rate radiotherapy, is a new radiation delivery method that aims to widen the therapeutic window in radiotherapy. Thus far, most in vitro and in vivo results show a real potential of FLASH to offer superior normal tissue sparing compared to conventionally delivered radiation. While there are several postulations behind the differential behaviour among normal and cancer cells under FLASH, the full spectra of radiobiological mechanisms are yet to be clarified. Currently the number of devices delivering FLASH dose rate is few and is mainly limited to experimental and modified linear accelerators. Nevertheless, FLASH research is increasing with new developments in all the main areas: radiobiology, technology and clinical research. This paper presents the current status of FLASH radiotherapy with the aforementioned aspects in mind, but also to highlight the existing challenges and future prospects to overcome them.
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Affiliation(s)
- Loredana G Marcu
- Faculty of Informatics & Science, Department of Physics, University of Oradea, 410087 Oradea, Romania
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
| | - Eva Bezak
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
- School of Physical Sciences, Department of Physics, University of Adelaide, North Terrace, Adelaide, SA 5005, Australia
| | - Dylan D Peukert
- School of Civil, Environmental & Mining Engineering, University of Adelaide, North Terrace, Adelaide, SA 5005, Australia
- STEM, University of South Australia, Adelaide, SA 5001, Australia
| | - Puthenparampil Wilson
- STEM, University of South Australia, Adelaide, SA 5001, Australia
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
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27
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Marcu LG. Imaging Biomarkers of Tumour Proliferation and Invasion for Personalised Lung Cancer Therapy. J Pers Med 2020; 10:jpm10040222. [PMID: 33198090 PMCID: PMC7711676 DOI: 10.3390/jpm10040222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 12/28/2022] Open
Abstract
Personalised treatment in oncology has seen great developments over the last decade, due to both technological advances and more in-depth knowledge of radiobiological processes occurring in tumours. Lung cancer therapy is no exception, as new molecular targets have been identified to further increase treatment specificity and sensitivity. Yet, tumour resistance to treatment is still one of the main reasons for treatment failure. This is due to a number of factors, among which tumour proliferation, the presence of cancer stem cells and the metastatic potential of the primary tumour are key features that require better controlling to further improve cancer management in general, and lung cancer treatment in particular. Imaging biomarkers play a key role in the identification of biological particularities within tumours and therefore are an important component of treatment personalisation in radiotherapy. Imaging techniques such as PET, SPECT, MRI that employ tumour-specific biomarkers already play a critical role in patient stratification towards individualized treatment. The aim of the current paper is to describe the radiobiological challenges of lung cancer treatment in relation to the latest imaging biomarkers that can aid in the identification of hostile cellular features for further treatment adaptation and tailoring to the individual patient’s needs.
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Affiliation(s)
- Loredana G. Marcu
- Faculty of Informatics and Science, University of Oradea, 410087 Oradea, Romania;
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
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28
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Marcu LG, Forster JC, Bezak E. The Potential Role of Radiomics and Radiogenomics in Patient Stratification by Tumor Hypoxia Status. J Am Coll Radiol 2020; 16:1329-1337. [PMID: 31492411 DOI: 10.1016/j.jacr.2019.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/14/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite the clinical knowledge accumulated over a century about tumor hypoxia, this biologic parameter remains a major challenge in cancer treatment. Patients presenting with hypoxic tumors are more resistant to radiotherapy and often poor responders to chemotherapy. Treatment failure because of hypoxia is, therefore, very common. Several methods have been trialed to measure and quantify tumor hypoxia, with varied success. Over the last couple of decades, hypoxia-specific functional imaging has started to play an important role in personalized treatment planning and delivery. Yet, there are no gold standards in place, owing to inter- and intrapatient phenotypic variations that further complicate the overall picture. The aim of the current article is to analyze, through the review of the literature, the potential role of radiomics and radiogenomics in patient stratification by tumor hypoxia status. METHODS Search of literature published in English since 2000 was conducted using Medline. Additional articles were retrieved via pearling of identified literature. Publications were reviewed and summarized in text and in a tabulated format. RESULTS Although still an immature area of science, radiomics has shown its potential in the quantification of hypoxia within the heterogeneous tumor, quantification of changes regarding the degree of hypoxia after radiotherapy and drug delivery, monitoring tumor response to anti-angiogenic therapy, and assisting with patient stratification and outcome prediction based on the hypoxic status. CONCLUSIONS The lack of technique standardization to measure and quantify tumor hypoxia presents an opportunity for data mining and machine learning in radiogenomics.
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Affiliation(s)
- Loredana G Marcu
- Faculty of Science, University of Oradea, Oradea, Romania; Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, Australia.
| | - Jake C Forster
- Department of Physics, University of Adelaide, North Terrace, Adelaide, Australia; SA Medical Imaging, Department of Nuclear Medicine, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Eva Bezak
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, Australia; Department of Physics, University of Adelaide, North Terrace, Adelaide, Australia
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29
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Reid P, Staudacher AH, Marcu LG, Olver I, Moghaddasi L, Brown MP, Li Y, Bezak E. Intrinsic Radiosensitivity Is Not the Determining Factor in Treatment Response Differences between HPV Negative and HPV Positive Head and Neck Cancers. Cells 2020; 9:E1788. [PMID: 32727072 PMCID: PMC7464531 DOI: 10.3390/cells9081788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/18/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCC) resulting from human papillomavirus (HPV) are increasing in incidence but demonstrate significantly better treatment response than HNSCC from other causes such as tobacco and alcohol. This study sought to identify differences in HNSCC, intrinsic to HPV status, in their response to radiation dose. Previously unexamined changes in radio-responsiveness following fractionated X-ray irradiation were compared between HPV positive and negative statuses of HNSCC. Six HNSCC cell lines, 3 of each HPV status, were investigated for radiosensitivity by clonogenic assay and modelled by response as a function of dose. Generational cultures of each cell line were developed to follow changes in radiosensitivity after repeated irradiations simulating fractionated radiation therapy. As a group, the HPV positive cell lines were more radiosensitive, but with changes following repeated fractions of dose, and modelling of response as a function of dose, both statuses displayed large radiobiological heterogeneity. These findings challenge current radiobiological assumptions of head and neck cancers as early responding tissue to radiation and may go some way in explaining difficulties reaching consensus in stratification of treatment by HPV status. Consequently, results from this study do not support stratifying radiation therapy by HPV status.
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Affiliation(s)
- Paul Reid
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (L.G.M.); (E.B.)
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia;
| | - Alexander H. Staudacher
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, SA 5000, Australia; (A.H.S.); (M.P.B.)
- School of Psychology, University of Adelaide, Adelaide, SA 5000, Australia;
| | - Loredana G. Marcu
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (L.G.M.); (E.B.)
- Faculty of Science, University of Oradea, 410087 Oradea, Romania
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, SA 5000, Australia;
| | - Leyla Moghaddasi
- Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia;
- Genesis Care, Adelaide Radiotherapy Centre, Adelaide, SA 5000, Australia
| | - Michael P. Brown
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, SA 5000, Australia; (A.H.S.); (M.P.B.)
- School of Medicine, University of Adelaide, Adelaide, SA 5000, Australia
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Yanrui Li
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia;
| | - Eva Bezak
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (L.G.M.); (E.B.)
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia;
- Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia;
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Wong HY, Marcu LG, Bezak E, Parange NA. Review of Health Economics of Point-of-Care Testing Worldwide and Its Efficacy of Implementation in the Primary Health Care Setting in Remote Australia. Risk Manag Healthc Policy 2020; 13:379-386. [PMID: 32440241 PMCID: PMC7212773 DOI: 10.2147/rmhp.s247774] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022] Open
Abstract
There are important differences concerning health outcomes between the Australian population living in rural/remote regions and the urban population. Health care provision in remote areas, particularly in regions with a low number of inhabitants, is not without challenges. Aboriginal, rural and remote communities are therefore affected, as they face various obstacles in accessing health services, owing to geographical settings, difficulties in transportation to nearby hospitals, limited or inexistent local qualified personnel. The implementation of point-of-care testing could be a plausible solution to these challenges, as various point-of-care services that have been successfully put into action worldwide indicate towards positive clinical outcomes. Point-of-care units have a real potential in reducing morbidity and mortality in all population groups. This article aims to review the published literature on point-of-care testing around the world, with a focus on health economics and the feasibility of its implementation in Australian rural and remote regions.
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Affiliation(s)
- Hoi Yan Wong
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Loredana G Marcu
- Faculty of Informatics & Science, University of Oradea, Oradea 410087, Romania.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
| | - Eva Bezak
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.,Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia
| | - Nayana Anupam Parange
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
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Reid P, Staudacher AH, Marcu LG, Olver I, Moghaddasi L, Brown MP, Bezak E. Influence of the human papillomavirus on the radio-responsiveness of cancer stem cells in head and neck cancers. Sci Rep 2020; 10:2716. [PMID: 32066820 PMCID: PMC7026429 DOI: 10.1038/s41598-020-59654-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/31/2020] [Indexed: 12/25/2022] Open
Abstract
A growing proportion of head and neck cancers (HNC) result from HPV infection. Between HNC aetiological groups (HPV positive and HPV negative) clinical evidence demonstrates significantly better treatment response among HPV positive cancers. Cancer stem cells (CSCs) are identified in HNC tumour populations as agents of treatment resistance and a target for tumour control. This study examines dynamic responses in populations of a CSC phenotype in HNC cell lines following X-irradiation at therapeutic levels, and comparing between HPV statuses. Variations in CSC density between HPV groups showed no correlation with better clinical outcomes seen in the HPV positive status. CSC populations in HPV positive cell lines ranged from 1.9 to 4.8%, and 2.6 to 9.9% for HPV negative. Following 4 Gy X- irradiation however, HPV negative cell lines demonstrated more frequent and significantly greater escalation in CSC proportions, being 3-fold that of the HPV positive group at 72 hours post irradiation. CSC proportions of tumour populations are not fixed but subject to change in response to radiation at therapeutic dose levels. These findings imply a potential effect of aetiology on radio-responsiveness in CSCs, illustrating that clonogen treatment response may be more informative of therapy outcomes than inherent population density alone.
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Affiliation(s)
- Paul Reid
- School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia. .,Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia.
| | - Alexander H Staudacher
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, SA, 5000, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Loredana G Marcu
- School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia.,Faculty of Science, University of Oradea, Oradea, 410087, Romania
| | - Ian Olver
- Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Leyla Moghaddasi
- Department of Physics, University of Adelaide, Adelaide, SA, 5005, Australia.,Department of Medical Physics, GenesisCare, Adelaide, SA, 5000, Australia
| | - Michael P Brown
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, SA, 5000, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia.,Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Eva Bezak
- School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia.,Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia.,Department of Physics, University of Adelaide, Adelaide, SA, 5005, Australia
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Affiliation(s)
- Loredana G Marcu
- Faculty of Informatics & Science, University of Oradea, Oradea, 410087, Romania.,School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
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De Courcy L, Bezak E, Marcu LG. Gender-dependent radiotherapy: The next step in personalised medicine? Crit Rev Oncol Hematol 2020; 147:102881. [PMID: 31991224 DOI: 10.1016/j.critrevonc.2020.102881] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/03/2019] [Accepted: 01/17/2020] [Indexed: 12/11/2022] Open
Abstract
Individuals do not react to radiation in a homogeneous manner. Recent radiogenomic research has proven that individual polymorphisms can correlate with treatment response most likely due to variation in the ability to recognise and repair DNA breaks. The difference in radiosensitivity between genders has been well documented, yet most radiotherapeutic guidelines are based solely on population averages rather than demographic subgroups such as age, race and gender. This paper is a review of the burgeoning literature available on the differences in efficacy and outcome of radiotherapy between genders. The work examines the effect of radiation on gender both from a tumour control as well as normal tissue toxicity perspective. While the literature reporting such findings is limited, the results show a small but significant difference in response to radiotherapy between sexes. Prospective and retrospective studies for evaluating these gender-specific differences are encouraged as a next step in personalised medicine.
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Affiliation(s)
- Louis De Courcy
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Eva Bezak
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia; Department of Physics, University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia
| | - Loredana G Marcu
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia; Faculty of Informatics & Science, University of Oradea, Oradea, 410087, Romania.
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Marcu LG, Marcu D. The role of hypofractionated radiotherapy in the management of head and neck cancer - a modelling approach. J Theor Biol 2019; 482:109998. [PMID: 31493484 DOI: 10.1016/j.jtbi.2019.109998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Cancer stem cells (CSCs) and hypoxia are key contributors towards radioresistance and they influence the choice of radiotherapy schedule for optimal tumour control. Since hypofractionation is becoming more popular in head and neck cancer (HNC) management, the aim of this work is to use a modelling approach to evaluate the efficacy of hypofractionated radiotherapy on both early stage and advanced tumours. METHODS An in silico HNC was developed starting from one CSC. For a biologically indorsed tumour, CSCs generate all heterogeneous cell lineages with a 1.9% probability of symmetrical division, 33 h mean cell cycle time and 52 days volume doubling time. The simulated schedules include conventional, hyperfractionated, and hypofractionated radiotherapy and they target tumours with various oxygenation levels. RESULTS Oxic and mildly hypoxic tumours can benefit from hypofractionation, which reduces treatment time without increasing adverse events. Advanced tumours are only controlled by hyperfractionation, however a tumour with oxygen levels below 6 mmHg and 5.9% pre-treatment CSCs, needs either a dose greater than 81.6 Gy to be eradicated or the addition of adjuvant therapies. CONCLUSIONS Hypofractionation is suited for early stage tumours, whereas aggressive HNC require hyperfractionation. The interplay between CSCs and hypoxia dictates the optimal treatment strategy.
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Affiliation(s)
- Loredana G Marcu
- Faculty of Science, University of Oradea, Oradea 410087, Romania; Division of Health Sciences, University of South Australia, SA 5005, Australia.
| | - David Marcu
- Faculty of Science, University of Oradea, Oradea 410087, Romania
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Forster JC, Marcu LG, Bezak E. Approaches to combat hypoxia in cancer therapy and the potential for in silico models in their evaluation. Phys Med 2019; 64:145-156. [PMID: 31515013 DOI: 10.1016/j.ejmp.2019.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/17/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023] Open
Abstract
AIM The negative impact of tumour hypoxia on cancer treatment outcome has been long-known, yet there has been little success combating it. This paper investigates the potential role of in silico modelling to help test emerging hypoxia-targeting treatments in cancer therapy. METHODS A Medline search was undertaken on the current landscape of in silico models that simulate cancer therapy and evaluate their ability to test hypoxia-targeting treatments. Techniques and treatments to combat tumour hypoxia and their current challenges are also presented. RESULTS Hypoxia-targeting treatments include tumour reoxygenation, hypoxic cell radiosensitization with nitroimidazoles, hypoxia-activated prodrugs and molecular targeting. Their main challenges are toxicity and not achieving adequate delivery to hypoxic regions of the tumour. There is promising research toward combining two or more of these techniques. Different types of in silico therapy models have been developed ranging from temporal to spatial and from stochastic to deterministic models. Numerous models have compared the effectiveness of different radiotherapy fractionation schedules for controlling hypoxic tumours. Similarly, models could help identify and optimize new treatments for overcoming hypoxia that utilize novel hypoxia-targeting technology. CONCLUSION Current therapy models should attempt to incorporate more sophisticated modelling of tumour angiogenesis/vasculature and vessel perfusion in order to become more useful for testing hypoxia-targeting treatments, which typically rely upon the tumour vasculature for delivery of additional oxygen, (pro)drugs and nanoparticles.
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Affiliation(s)
- Jake C Forster
- SA Medical Imaging, Department of Nuclear Medicine, The Queen Elizabeth Hospital, Woodville South, SA 5011, Australia; Department of Physics, University of Adelaide, North Terrace, Adelaide SA 5005, Australia
| | - Loredana G Marcu
- Faculty of Science, University of Oradea, Oradea 410087, Romania; Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide SA 5001, Australia.
| | - Eva Bezak
- Department of Physics, University of Adelaide, North Terrace, Adelaide SA 5005, Australia; Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide SA 5001, Australia
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Reid P, Marcu LG, Olver I, Moghaddasi L, Staudacher AH, Bezak E. Diversity of cancer stem cells in head and neck carcinomas: The role of HPV in cancer stem cell heterogeneity, plasticity and treatment response. Radiother Oncol 2019; 135:1-12. [PMID: 31015153 DOI: 10.1016/j.radonc.2019.02.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 11/22/2018] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 12/15/2022]
Abstract
Head and neck squamous cell carcinomas (HNSCC) resulting from oncogenic transformations following human papillomavirus (HPV) infection consistently demonstrate better treatment outcomes than HNSCC from other aetiologies. Squamous cell carcinoma of the oropharynx (OPSCC) shows the highest prevalence of HPV involvement at around 70-80%. While strongly prognostic, HPV status alone is not sufficient to predict therapy response or any potential dose de-escalation. Cancer stem cell (CSC) populations within these tumour types represent the most therapy-resistant cells and are the source of recurrence and metastases, setting a benchmark for tumour control. This review examines clinical and preclinical evidence of differences in response to treatment by the HPV statuses of HNSCC and the role played by CSCs in treatment resistance and their repopulation from non-CSCs. Evidence was collated from literature searches of PubMed, Scopus and Ovid for differential treatment response by HPV status and contribution by critical biomarkers including CSC fractions and chemo-radiosensitivity. While HPV and CSC are yet to fulfil promise as biomarkers of treatment response, understanding how HPV positive and negative aetiologies affect CSC response to treatment and tumour plasticity will facilitate their use for greater treatment individualisation.
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Affiliation(s)
- Paul Reid
- School of Health Sciences, University of South Australia, Adelaide, Australia; Cancer Research Institute, University of South Australia, Adelaide, Australia.
| | - Loredana G Marcu
- School of Health Sciences, University of South Australia, Adelaide, Australia; Faculty of Science, University of Oradea, Romania
| | - Ian Olver
- Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Leyla Moghaddasi
- Department of Physics, University of Adelaide, Australia; Genesis Care, Department of Medical Physics, Adelaide, Australia
| | - Alexander H Staudacher
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia; School of Medicine, University of Adelaide, Australia
| | - Eva Bezak
- School of Health Sciences, University of South Australia, Adelaide, Australia; Cancer Research Institute, University of South Australia, Adelaide, Australia; Department of Physics, University of Adelaide, Australia
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Marcu LG, Reid P, Bezak E. The Promise of Novel Biomarkers for Head and Neck Cancer from an Imaging Perspective. Int J Mol Sci 2018; 19:E2511. [PMID: 30149561 PMCID: PMC6165113 DOI: 10.3390/ijms19092511] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/18/2018] [Accepted: 08/23/2018] [Indexed: 01/25/2023] Open
Abstract
It is an agreed fact that overall survival among head and neck cancer patients has increased over the last decade. Several factors however, are still held responsible for treatment failure requiring more in-depth evaluation. Among these, hypoxia and proliferation-specific parameters are the main culprits, along with the more recently researched cancer stem cells. This paper aims to present the latest developments in the field of biomarkers for hypoxia, stemness and tumour proliferation, from an imaging perspective that includes both Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT) as well as functional magnetic resonance imaging (MRI). Quantitative imaging of biomarkers is a prerequisite for accurate treatment response assessment, bringing us closer to the highly needed personalised therapy.
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Affiliation(s)
- Loredana G Marcu
- Faculty of Science, University of Oradea, 410087 Oradea, Romania.
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | - Paul Reid
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | - Eva Bezak
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
- Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia.
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Reid P, Wilson P, Li Y, Marcu LG, Staudacher AH, Brown MP, Bezak E. Experimental investigation of radiobiology in head and neck cancer cell lines as a function of HPV status, by MTT assay. Sci Rep 2018; 8:7744. [PMID: 29773816 PMCID: PMC5958086 DOI: 10.1038/s41598-018-26134-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 05/02/2018] [Indexed: 12/11/2022] Open
Abstract
Head and neck cancers (HNCs) are aggressive epithelial tumours frequently treated using radiation. HNC biology shows distinctions dependent on the oncologic involvement of the human papilloma virus (HPV). Clinically, HPV positive HNCs respond better to radiotherapy but few in vitro data demonstrate radiobiological differences explaining differences in clinical outcomes. This pilot study examined radiobiological responses to irradiation and subsequent regeneration in two HNC cell lines (HPV positive and negative). A novel approach was taken to develop generational cultures of HNC cell lines, UM-SCC-1 (HPV negative) and UM-SCC-47 (HPV positive). MTT assays were used to determine surviving metabolic activity as a function of dose following 6 MV X-ray irradiation. Parallel cultures surviving 4 Gy irradiation (not analysed) were re-cultured and passaged to develop subsequent generations which were re-irradiated and analysed for generational change in radiation response. Second and 3rd generations of UM-SCC-1 showed decreasing metabolic activity with dose but little difference was evident in surviving fractions between these generations. Significantly lower metabolic activity in the 3rd generation at <6 Gy, compared to the 2nd generation, showed UM-SCC-47 becoming progressively more radiosensitive. HPV positive UM-SCC-47 showed generational progression in radiosensitisation not seen in the HPV negative UM-SCC-1.
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Affiliation(s)
- Paul Reid
- School of Health Sciences, University of South Australia, Adelaide, Australia. .,Cancer Research Institute, University of South Australia, Adelaide, Australia.
| | - Puthenparampil Wilson
- School of Engineering, University of South Australia, Adelaide, Australia.,Department of Medical Physics, Royal Adelaide Hospital, Adelaide, Australia
| | - Yanrui Li
- Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Loredana G Marcu
- School of Health Sciences, University of South Australia, Adelaide, Australia.,Faculty of Science, University of Oradea, Oradea, 410087, Romania
| | - Alexander H Staudacher
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology, University of South Australia, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | - Michael P Brown
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology, University of South Australia, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia.,Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Eva Bezak
- School of Health Sciences, University of South Australia, Adelaide, Australia.,School of Physical Sciences, University of Adelaide, Adelaide, Australia.,Cancer Research Institute, University of South Australia, Adelaide, Australia
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Reid P, Wilson P, Li Y, Marcu LG, Staudacher AH, Brown MP, Bezak E. In vitro investigation of head and neck cancer stem cell proportions and their changes following X-ray irradiation as a function of HPV status. PLoS One 2017; 12:e0186186. [PMID: 29028842 PMCID: PMC5640219 DOI: 10.1371/journal.pone.0186186] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/27/2017] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Some head and neck squamous cell carcinomas (HNSCC) have a distinct aetiology, which depends on the presence of oncogenic human papilloma virus (HPV). Also, HNSCC contains cancer stem cells (CSCs) that have greater radioresistance and capacity to change replication dynamics in response to irradiation compared to non-clonogenic cells. Since there is limited data on CSCs in HNSCC as a function of HPV status, better understanding of their radiobiology may enable improved treatment outcome. METHODS Baseline and post-irradiation changes in CSC proportions were investigated by flow cytometry in a HPV-negative (UM-SCC-1) and a HPV-positive (UM-SCC-47) HNSCC cell line, using fluorescent staining with CD44/ALDH markers. CSC proportions in both irradiated and unirradiated cultures were compared for the two cell lines at various times post-irradiation. To assess repopulation of CSCs, untreated cultures were depleted of CD44+/ALDH+ cells and re-cultured for 3 weeks before flow cytometry analysis. RESULTS CSC proportions in untreated cell lines were 0.57% (UM-SCC-1) and 2.87% (UM-SCC-47). Untreated cell lines depleted of CD44+/ALDH+ repopulated this phenotype to a mean of 0.15% (UM-SCC-1) and 6.76% (UM-SCC-47). All UM-SCC-47 generations showed elevated CSC proportions after irradiation, with the most significant increase at 2 days post-irradiation. The highest elevation in UM-SCC-1 CSCs was observed at 1 day post-irradiation in the 2nd generation and at 3 days after irradiation in the 3rd generation. When measured after 10 days, only the 3rd generation of UM-SCC-1 showed elevated CSCs. CONCLUSIONS CSC proportions in both cell lines were elevated after exposure and varied with time post irradiation. UM-SCC-47 displayed significant plasticity in repopulating the CSC phenotype in depleted cultures, which was not seen in UM-SCC-1.
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Affiliation(s)
- Paul Reid
- School of Health Sciences, University of South Australia, Adelaide, Australia
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
- * E-mail:
| | - Puthenparampil Wilson
- School of Engineering, University of South Australia, Adelaide, Australia
- Department of Medical Physics, Royal Adelaide Hospital, Adelaide, Australia
| | - Yanrui Li
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Loredana G. Marcu
- School of Health Sciences, University of South Australia, Adelaide, Australia
- Faculty of Science, University of Oradea, Oradea, Romania
| | - Alexander H. Staudacher
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology, and University of South Australia, Adelaide, Australia
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Michael P. Brown
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology, and University of South Australia, Adelaide, Australia
- School of Medicine, University of Adelaide, Adelaide, Australia
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Eva Bezak
- School of Health Sciences, University of South Australia, Adelaide, Australia
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
- School of Physical Sciences, University of Adelaide, Adelaide, Australia
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Marcu LG. Photons – Radiobiological issues related to the risk of second malignancies. Phys Med 2017; 42:213-220. [DOI: 10.1016/j.ejmp.2017.02.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/21/2017] [Accepted: 02/14/2017] [Indexed: 12/23/2022] Open
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Marcu LG, Marcu D. The effect of targeted therapy on recruited cancer stem cells in a head and neck carcinoma model. Cell Prolif 2017; 50. [PMID: 28857306 DOI: 10.1111/cpr.12380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/04/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Head and neck cancers (HNC) are known for their repopulation ability driven by cancer stem cells (CSCs). While a small fraction of CSCs proliferates, there are quiescent CSCs that are long-lived and reside outside the cell cycle. Recruitment of quiescent CSCs into the cycle occurs as a response to cell loss and their proliferation may lead to treatment failure. Therefore, CSCs require a more targeted approach to be destroyed. An agent that sensitizes CSC response to treatment is all-trans-retinoic acid (ATRA). The aim of this work is to assess the impact of ATRA combined with radiotherapy on HNC and to analyse the interplay between these agents and cell recruitment. METHODS An in silico model is employed to grow a HNC consisting of all cancer cell lineages, with biologically valid kinetic and dynamic parameters. The fate of both cycling and quiescent cancer stem cells is assessed. The Linear Quadratic model is used to simulate radiotherapy, while cellular recruitment and the effects of ATRA on cancer stem cells are modelled based on literature data. RESULTS A Dose Enhancement Factor (DEF) was determined in order to undertake a quantitative assessment of the effect of ATRA on tumour control. Without recruitment, DEF for the tumour population is 1.06, indicating a slight radiosensitizing effect. Yet, when CSCs are being recruited, the dose enhancement factor is significantly greater (DEF = 1.89). Radiation-induced cell arrest and CSC sensitization by ATRA significantly decreases the dose required for CSC eradication in the cycling population. However, the tumour as a whole is not notably affected as the quiescent cells appear to dictate the shape of the survival curve. CONCLUSIONS The model shows that ATRA exhibits a powerful effect on CSCs when combined with radiotherapy. However, the more radioresistant quiescent cell population should not be ignored, as it can be a potential threat to treatment outcome when cells are recruited into the cell cycle.
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Affiliation(s)
- Loredana G Marcu
- Faculty of Science, University of Oradea, Romania.,School of Health Sciences, University of South Australia, SA, Australia
| | - David Marcu
- Faculty of Science, University of Oradea, Romania
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So B, Marcu LG, Olver I, Gowda R, Bezak E. Cocktail without hangover: in search for the optimal chemotherapy in the combined management of non-operable esophageal carcinomas. Acta Oncol 2017; 56:899-908. [PMID: 28375694 DOI: 10.1080/0284186x.2017.1307518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The worldwide incidence of esophageal cancer has greatly increased over the past few decades making it the sixth deadliest cancer. The disease is often detected in advanced stages when surgery is no longer an option. The standard treatment in these situations is combined chemoradiotherapy, by employing drug cocktails that lead to optimal treatment outcomes both from the perspective of tumor control and normal tissue toxicity. METHODS The aim of this work was to collate the existing trials and clinical studies reported on non-operable esophageal cancer and to analyze the results based on treatment outcomes after various drug combinations. RESULTS Of all drug combinations, cisplatin/5-FU is the most well established chemotherapy regimen for esophageal cancer as both neoadjuvant therapy, an alternative option to surgery, and for palliative purposes. Although this regimen is associated with the most toxicity, it also appears to have the best survival benefit and relief of symptoms. CONCLUSIONS More research is warranted to further increase the therapeutic ratio in non-operable esophageal cancers.
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Affiliation(s)
- Bianca So
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Loredana G. Marcu
- Department of Physics, Faculty of Science, University of Oradea, Oradea, Romania
- School of Physical Sciences, University of Adelaide, Adelaide, Australia
| | - Ian Olver
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Raghu Gowda
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - Eva Bezak
- School of Health Sciences, University of South Australia, Adelaide, Australia
- Department of Physics, Faculty of Science, University of Oradea, Oradea, Romania
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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Abstract
AIMS There is evidence towards the induction of second primary cancers (SPCs) after breast radiotherapy (RT). Organs, such as the lungs and the esophagus, have been identified as common sites for SPC formation. As a result, the current study investigated the risk of secondary carcinogenesis associated with particular RT techniques for breast cancer; including whole breast, segmented breast, partial breast and mammosite brachytherapy. METHODS In this study, seven breast cancer patients had all major organs contoured on their planning computed tomography (CT) images. Whole breast, segmented breast, accelerated partial breast irradiation (APBI) and mammosite boost treatment plans were generated for each patient using Pinnacle3 treatment planning system. Differential dose-volume histograms were generated for a number of critical structures: bladder, brain and central nervous system (CNS), breast, colon, liver, lung, mouth and pharynx, esophagus, ovary, salivary gland, small intestine, stomach, and uterus. The lifetime attributed risk (LAR) of cancer induction was estimated using the Schneider et al. excess absolute risk models and dose-volume histograms for the above organs. RESULTS The sites with the highest LAR estimates were the ipsilateral and contralateral lungs, and contralateral breast for all treatment techniques. For all sites, the LAR estimates for the segmented breast and mammosite treatments were lower than those for the whole breast and APBI treatments. For right-sided target volumes the liver also resulted in high LAR estimates, with all techniques having a LAR greater than 20 per 10 000 person-years (PY), except for mammosite with a mean LAR estimate of 13.2 per 10 000 PY. For left-sided target volumes the stomach also resulted in high LAR estimates, with both whole breast and APBI having a LAR greater than 20 per 10 000 PY, and mammosite the lowest with a LAR of 8.3 per 10 000 PY. CONCLUSION It is concluded that the lungs and contralateral breast showed high LAR estimates.
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Affiliation(s)
- Alexandre M. C. Santos
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Department of Medical Physics, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Loredana G. Marcu
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Faculty of Science, University of Oradea, Oradea, Romania
| | - Chia M. Wong
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Eva Bezak
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- International Centre for Allied Health Evidence and Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Marcu LG, Marcu D. Radiobiological effects of cancer stem cell-targeting therapy in a head and neck cancer model. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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45
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Marcu LG, Marcu D. In silico modelling of a cancer stem cell-targeting agent and its effects on tumour control during radiotherapy. Sci Rep 2016; 6:32332. [PMID: 27573059 PMCID: PMC5004146 DOI: 10.1038/srep32332] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/03/2016] [Indexed: 11/16/2022] Open
Abstract
Head and neck cancers (HNC), like most solid tumours, contain a subpopulation of cancer stem cells (CSC) that are commonly responsible for treatment failure. Conventional therapies are unsuccessful in controlling CSCs, thus novel, targeting therapies are needed. A promising agent is ATRA (All-trans-retinoic acid) that was shown to induce CSC differentiation, cell cycle redistribution and CSCs radiosensitisation. To add to the limited data, this work simulated the effects of ATRA on a virtual HNC and evaluated tumour response to radiotherapy. A Monte Carlo technique was employed to grow a HNC consisting of all lineages of cancer cells. The biologically realistic input parameters led to a pre-treatment CSC population of 5.9%. The Linear Quadratic model was employed to simulate radiotherapy. ATRA-induced differentiation, cell arrest and apoptosis were modelled, based on literature data. While the effect of differentiation was marginal, the strongest influence on CSC subpopulation was displayed by ATRA’s cell arrest effect via an exponential behaviour of the dose-response curve. The apoptotic effect induced by ATRA shows linear correlation between the percentage of apoptotic cells and dose required to eradicate CSCs. In conclusion, ATRA is a potent CSC-targeting agent with viable impact on tumour control when combined with radiotherapy.
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Affiliation(s)
- Loredana G Marcu
- Faculty of Science, University of Oradea, Oradea 410087, Romania.,School of Physical Sciences, The University of Adelaide, SA 5005, Australia
| | - David Marcu
- Faculty of Science, University of Oradea, Oradea 410087, Romania
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46
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Marcu LG. Future treatment directions for HPV-associated head and neck cancer based on radiobiological rationale and current clinical evidence. Crit Rev Oncol Hematol 2016; 103:27-36. [DOI: 10.1016/j.critrevonc.2016.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/11/2016] [Accepted: 05/10/2016] [Indexed: 12/30/2022] Open
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Marcu LG, Marcu D, Filip SM. In silico study of the impact of cancer stem cell dynamics and radiobiological hypoxia on tumour response to hyperfractionated radiotherapy. Cell Prolif 2016; 49:304-14. [PMID: 27079860 DOI: 10.1111/cpr.12251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/10/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Advanced head and neck carcinomas (HNCs) are aggressive tumours, mainly due to hypoxia and a cancer stem cell (CSC) subpopulation. The aim of this study was to simulate tumour growth and behaviour during radiotherapy of three HNC groups (governed by different growth kinetics, hypoxia levels and CSC division pattern) to determine correlation between resistance factors and responses to hyperfractionated radiotherapy. METHODS An in silico HNC model was developed based on biologically realistic input parameters. During radiotherapy simulation, three parameters were studied: growth kinetics, hypoxia and probability of CSC symmetrical division. Both independent and combined effects on tumour response to hyperfractionated radiotherapy were assessed. RESULTS Oxic and very mildly hypoxic HNCs were revealed to be controlled by hyperfractionated radiotherapy, irrespective of growth kinetics and CSC division pattern. Moderately hypoxic tumours had different responses to radiotherapy: while slowly proliferating HNCs were still controllable, tumours with higher cell turnover were more resistant. In rapidly proliferating tumours, the number of fractions needed for tumour control increased exponentially with the probability of CSC symmetrical division, whereas in moderately growing HNC, this behaviour was linear. Severely hypoxic tumours could not be controlled by radiotherapy alone. Tumours with CSCs in a severely hypoxic niche required adjuvant therapies to be eradicated. CONCLUSIONS Growth kinetics strongly influence tumour responses to treatment. Slowly growing tumours showed linear dependence between dose and hypoxia/CSC, whereas rapidly growing tumours followed exponential behaviour.
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Affiliation(s)
- L G Marcu
- Faculty of Science, University of Oradea, Oradea, 410087, Romania.,School of Physical Sciences, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - D Marcu
- Faculty of Science, University of Oradea, Oradea, 410087, Romania
| | - S M Filip
- Faculty of Science, University of Oradea, Oradea, 410087, Romania
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Chirla R, Marcu LG. PET-based quantification of statistical properties of hypoxic tumor subvolumes in head and neck cancer. Phys Med 2016; 32:23-35. [DOI: 10.1016/j.ejmp.2015.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/29/2015] [Accepted: 12/13/2015] [Indexed: 11/30/2022] Open
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Bezak E, Takam R, Marcu LG. Peripheral photon and neutron doses from prostate cancer external beam irradiation. Radiat Prot Dosimetry 2015; 167:591-601. [PMID: 25564673 DOI: 10.1093/rpd/ncu362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/28/2014] [Indexed: 06/04/2023]
Abstract
Peripheral photon and neutron doses from external beam radiotherapy (EBRT) are associated with increased risk of carcinogenesis in the out-of-field organs; thus, dose estimations of secondary radiation are imperative. Peripheral photon and neutron doses from EBRT of prostate carcinoma were measured in Rando phantom. (6)LiF:Mg,Cu,P and (7)LiF:Mg,Cu,P glass-rod thermoluminescence dosemeters (TLDs) were inserted in slices of a Rando phantom followed by exposure to 80 Gy with 18-MV photon four-field 3D-CRT technique. The TLDs were calibrated using 6- and 18-MV X-ray beam. Neutron dose equivalents measured with CR-39 etch-track detectors were used to derive readout-to-neutron dose conversion factor for (6)LiF:Mg,Cu,P TLDs. Average neutron dose equivalents per 1 Gy of isocentre dose were 3.8±0.9 mSv Gy(-1) for thyroid and 7.0±5.4 mSv Gy(-1) for colon. For photons, the average dose equivalents per 1 Gy of isocentre dose were 0.2±0.1 mSv Gy(-1) for thyroid and 8.1±9.7 mSv Gy(-1) for colon. Paired (6)LiF:Mg,Cu,P and (7)LiF:Mg,Cu,P TLDs can be used to measure photon and neutron doses simultaneously. Organs in close proximity to target received larger doses from photons than those from neutrons whereas distally located organs received higher neutron versus photon dose.
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Affiliation(s)
- Eva Bezak
- Department of Medical Physics, Royal Adelaide Hospital, Adelaide, Australia School of Chemistry and Physics, Adelaide University, Adelaide, Australia
| | - Rundgham Takam
- Department of Medical Physics, Royal Adelaide Hospital, Adelaide, Australia School of Chemistry and Physics, Adelaide University, Adelaide, Australia
| | - Loredana G Marcu
- Department of Medical Physics, Royal Adelaide Hospital, Adelaide, Australia School of Chemistry and Physics, Adelaide University, Adelaide, Australia Faculty of Science, University of Oradea, Oradea 410087, Romania
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