How Do Stem Cells Respond To Diagnostic Radiation Studies?

MedicalResearch.com Interview with:
http://www.insilico.com/
Andreyan Osipov PhD
Insilico Medicine and
Dmitry Klokov PhD
Canadian Nuclear Laboratories, Chalk River, Ontario, Canada 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cells and tissues can be damaged when exposed to ionizing radiation. In case of radiotherapy, it is a desirable effect in tumor cells. In case of occupational, medical and accidental exposures, typically to low-dose radiation, this may pose health risk to normal cells and tissues.

In both cases, short-term assays that quantify damage to DNA and help evaluate long-term outcome are key to treatment/risk management. One such short-term assay is based on quantification of a modified histone protein called gH2AX in exposed cells up to 24 hrs after exposure. This protein marks sites in DNA that have both strands of the DNA helix broken or damaged. This assay is also widely used for various applications, including determination of individual radiosensitivity, tumor response to radiotherapy and biological dosimetry. With the advent of regenerative medicine that is based on stem cell transplantation, the medical and research communities realized that there is a need to understand how stem cells respond to low-dose diagnostic radiation exposures, such as CT scans. Stem cell therapies may have to be combined with diagnostic imaging in recipient patients. The gH2AX assay comes in very handy here, or at least it seemed this way.

We exposed mesenchymal stem cells isolated from human patients to low or intermediate doses of X-rays (80 and 1000 mGy) and followed formation of gH2AX in their nuclei. First we found that residual gH2AX signal in cells exposed to a low dose was higher than in control non-irradiated cells. If the conventional assumptions about this assay that it is a surrogate for long-term detrimental effects was followed it would mean that the low-dose exposed cells were at a high risk of losing their functional properties. So we continued growing these cells for several weeks and assayed gH2AX levels, ability to proliferate and the level of cellular aging. Surprisingly, we found that low-dose irradiated cells did not differ from non-irradiated cells in any of the measured functional end-points. This was in contrast to 1000 mGy irradiated cells that did much worse at those long-term end points.

Continue reading

Thinking Abilities May Decline After Treatment For Head and Neck Cancers

MedicalResearch.com Interview with:

Lori J Bernstein, PhD, CPsych Neuropsychologist, Dept. of Supportive Care Core Member, Cancer Rehabilitation & Survivorship Program ELLICSR Centre for Health Wellness and Cancer Survivorship Princess Margaret Cancer Centre, UHN Clinical Research Unit Member, Princess Margaret Research Institute Assistant Professor, Dept. of Psychiatry, Faculty of Medicine University of Toronto Adjunct Faculty, Graduate Program in Psychology, York University

Dr. Bernstein

Lori J Bernstein, PhD, CPsych
Neuropsychologist, Dept. of Supportive Care
Core Member, Cancer Rehabilitation & Survivorship Program
ELLICSR Centre for Health Wellness and Cancer Survivorship
Princess Margaret Cancer Centre, UHN
Clinical Research Unit Member,
Princess Margaret Research Institute
Assistant Professor, Dept. of Psychiatry, Faculty of Medicine
University of Toronto
 

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Despite the increasing role of (chemo-)radiation treatment for head and neck cancer (HNC), and involvement of central nervous system structures in the radiation field, we don’t know a lot about whether there are short or long term consequences in thinking abilities in survivors. So our question was this: Do people treated for head and neck cancer with radiation or chemoradiation have short or long term neurocognitive deficits after treatment?

We assessed head and neck cancer patients and healthy non-cancer controls four times, first at baseline (after diagnosis but before treatment), and then again 6, 12, and 24 months later. We found that compared to the controls, patients decline over time in several different neurocognitive domains, including concentration, verbal memory, and executive function. We found that as many as 38% of patients suffered from impaired global neurocognitive functioning by two years after treatment compared to none of the controls.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: The findings indicate that some (but not all) head and neck cancer survivors are at risk of suffering from declines in thinking abilities such as attention and memory. These changes can be subtle and increase gradually. We didn’t follow people beyond 2 years after treatment, so we don’t know whether these deficits would improve, worsen, or stabilize after that.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Longer longitudinal follow-up is needed to determine if symptoms change after 2 years. More investigation of the relationships between treatment variables such as radiation dosing and long term neurocognitive function is important. Further research is also needed to find ways to avoid, reduce and compensate for declines.

MedicalResearch.com: Is there anything else you would like to add?

Response: We are extremely grateful to the people who participated in this study. We plan to reassess participants for several more years, so we hope to know more about even longer term cognitive function in people treated for head and neck cancer. In addition, I want to acknowledge that we could not have done this work without the support of the Princess Margaret Cancer Foundation and The Canadian Institutes of Health Research.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Alona Zer, Gregory R. Pond, Albiruni R. Abdul Razak, Kattleya Tirona, Hui K. Gan, Eric X. Chen, Brian O’Sullivan, John Waldron, David P. Goldstein, Ilan Weinreb, Andrew J. Hope, John J. Kim, Kelvin K. W. Chan, Andrew K. Chan, Lillian L. Siu, Lori J. Bernstein. Association of Neurocognitive Deficits With Radiotherapy or Chemoradiotherapy for Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. Published online November 22, 2017. doi:10.1001/jamaoto.2017.2235

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

 

Interventional Cardiologists Can Face Risks To Brain From Unprotected Radiation Exposure

MedicalResearch.com Interview with:

Dr. Maria Grazia Andreassi

Dr. Andreassi

Dr. Maria Grazia Andreassi, PhD
Director, Genetics Research Unit
CNR Institute of Clinical Physiology, Pisa- Italy

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In recent years, there has been a growing concern about the health risks for contemporary interventional cardiologists who have a high and unprecedented levels of occupational ionizing radiation (IR) exposure. Because dysregulation of microRNAs (miRNAs) have been shown in many human diseases, we investigated the differential expression of miRNAs in the plasma of interventional cardiologists professionally exposed to IR and unexposed controls.

In this study, our microarray analysis with 2,006 miRNAs and subsequent validation identified brain-specific miR-134 as one of the miRNAs that is highly dysregulated in the response to ionizing radiation exposure, supporting the notion that the brain damage is one of the main potential long-term risks of unprotected head irradiation in interventional cardiologists, with possible long-lasting cognitive consequences. Indeed, miR-134 was first identified as a brain-specific miRNA, which is involved in synapse development and directly implicated in learning and memory.

Continue reading

Prostate Cancer: Immune Content May Predict Response To Post-Op Radiation

MedicalResearch.com Interview with:

Dr. Shuang George Zhao, MD House Officer, Radiation Oncology University Hospital Ann Arbor, MI 48109-5010

Dr. Zhao

Dr. Shuang George Zhao, MD
House Officer, Radiation Oncology
University Hospital
Ann Arbor, MI 48109

MedicalResearch.com: What is the background for this study?

Response: Targeting cancer through the immune system has been a longstanding goal of cancer research, and with recent advances in immunotherapy, it is now a reality. However, the role of immunotherapy in prostate cancer is still being defined. Sipuleucel-T was the first FDA approved immunotherapy in prostate cancer, and is a personalized cellular therapy that has been shown to prolong survival in patients with metastatic prostate cancer. On the other hand, two recent phase III randomized trials looking at ipilimumab, a CTLA-4 checkpoint inhibitor in metastatic prostate cancer have both been negative for their primary endpoint of OS. Interestingly, there was a PSA response, suggesting that there may be some therapeutic effect in a subset of patients. Therefore, understanding the immune infiltrate is likely critical to selecting patients and therapeutic strategies utilizing the immune system. Unfortunately, it is difficult and laborious to histologically assess immune infiltrate directly. Therefore, we used existing high throughput transcriptomic data with new computational methods in order to more fully characterize the immune landscape of localized prostate cancer.

Continue reading

Early Breast Cancer: Radiation Before Surgery Reduce Risk of Second Tumors

MedicalResearch.com Interview with:

Heiko Enderling, Ph.D. Associate Member & Director for Education and Outreach Dept. of Integrated Mathematical Oncology Dept. of Radiation Oncology H. Lee Moffitt Cancer Center & Research Institute Tampa, FL 33612

Dr.Enderling

Heiko Enderling, Ph.D.
Associate Member & Director for Education and Outreach
Dept. of Integrated Mathematical Oncology
Dept. of Radiation Oncology
H. Lee Moffitt Cancer Center & Research Institute
Tampa, FL 33612

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although radiation therapy after breast-conserving surgery for early-stage breast cancer has significantly improved patient prognosis, many patients will face a second cancer diagnosis within 20 years of primary treatment. Experimental and clinical studies have shown that local radiation therapy can activate an immune response that can propagate systemically to attack distant untreated metastases. However, current radiotherapy practice has not specifically focused on enhancing immune responses.

We asked the question if pre-operative irradiation, when applied to the bulk of disease, could have potentially higher immune stimulatory effects. To study this, we analyzed historic outcomes of breast cancer patients treated with either adjuvant (radiation after surgery) or neoadjuvant (radiation before surgery) radiotherapies.

Our analysis showed that the risk of developing a second tumor after neoadjuvant compared with adjuvant RT was significantly lower, especially for estrogen receptor-positive women who underwent breast conserving surgery or mastectomy. Historic data revealed an increase in disease-free survival of 12% over 20 years after treatment of the original tumor.

Continue reading

Promising Study of Shorter Course of Radiation Therapy After Mastectomy

MedicalResearch.com Interview with:

Bruce G. Haffty, MD Professor and Chair, Department of Radiation Oncology Rutgers Cancer Institute of New Jersey Rutgers Robert Wood Johnson Medical School and Rutgers New Jersey Medical School

Dr. Haffty

Bruce G. Haffty, MD
Professor and Chair, Department of Radiation Oncology
Rutgers Cancer Institute of New Jersey
Rutgers Robert Wood Johnson Medical School and
Rutgers New Jersey Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Shorter courses of radiation for patients treated by lumpectomy are now commonly employed. For patients receiving radiation to the chest wall and lymph nodes after mastectomy, the standard 5 to 6 week course is used and shorter courses have not been adopted.

We initiated this trial of a shorter course of radiation to the chest wall and lymph nodes after mastectomy to test its feasibility, safety and outcome.
Continue reading

Radiation Exposure and Vascular Access in Acute Coronary Syndromes: The RADMatrix Trial

MedicalResearch.com Interview with: Dr. Marco Valgimigli,

Dr. Marco Valgimigli

MedicalResearch.com Interview with:
Dr. Marco Valgimigli, MD, PhD

Interventional Cardiology
Sandro Pertini Hospital, ASL RM2, Rome, Italy

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Every year millions of people with coronary artery disease are treated worldwide with percutaneous coronary intervention (PCI). Radial access as compared to femoral access reduces bleeding and mortality in patients with acute coronary syndrome (ACS) undergoing invasive management. However, prior studies have raised concerns over the increased risk of radiation exposure for both patients and operators with radial instead of femoral access and it remains still unclear whether radial access increases the risk of operator or patient radiation exposure in contemporary practice when performed by expert operators.

The MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial is the largest randomized trial comparing radial versus femoral access in ACS patients undergoing invasive management. In this radiation sub-study (RAD-MATRIX), we collected fluoroscopy time and dose area product (DAP) and equipped radial operators consenting to participate with dedicated dosimeters, each wearing a thorax (primary endpoint), wrist and head (secondary endpoints) lithium fluoride thermo luminescent dosimeter, during study conduct to establish non-inferiority of radial versus femoral access.

Among eighteen operators, performing 777 procedures in 767 patients, the non-inferiority primary endpoint was not achieved. Operator equivalent dose at the thorax was significantly higher with radial than femoral access. After normalization of operator radiation dose by fluoroscopy time or DAP, the difference remained significant. Radiation dose at wrist or head did not differ between radial and femoral access. Thorax operator dose did not differ in the right radial compared to the left radial access. In the overall MATRIX population, fluoroscopy time and DAP were higher with radial as compared to femoral access.

Continue reading

Shorter Term Precision Radiation Found Effective For Prostate Cancer

MedicalResearch.com Interview with:

Charles N Catton, MD, FRCPC Cancer Clinical Research Unit (CCRU) Princess Margaret Cancer Centre UHN

Dr. Catton

Charles N Catton, MD, FRCPC
Cancer Clinical Research Unit (CCRU)
Princess Margaret Cancer Centre
UHN 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prostate cancer is a very common malignancy which is frequently treated with external beam radiotherapy. A typical standard treatment course can extend over 7.5-8.5 weeks.

The introduction of high-precision radiotherapy treatment techniques provided the opportunity to compress treatment courses by delivering fewer, but more intensive daily treatments. The concerns with giving fewer and larger daily treatments (hypofractionation) is that toxicity may increase and that cancer control may become worse.

This international randomized trial enrolled 1206 men with intermediate risk prostate cancer and compared a standard 8 week course of external beam radiation treatment with a novel hypofractionated treatment course that was given over 4 weeks. Cancer control as measured by PSA control and clinical evidence of failure, bowel and bladder toxicity and quality of life were compared.

At a median follow-up of 6 years the hypofractionated regimen was found to be non-inferior to the standard regimen for cancer control. There was no difference early or late bladder toxicity between the two treatments. There was slightly worse early bowel toxicity during and immediately after treatment with the hypofractionated regimen, but there was actually slightly less long-term bowel toxicity with this same regimen.

Continue reading

Using a Spacer During Prostate Radiation May Help Preserve Sexual Function

MedicalResearch.com Interview with:

Daniel A. Hamstra, MD PhD The Texas Center for Proton Therapy Irving, TX

Dr. Hamstra

Daniel A. Hamstra, MD PhD
Radiation Oncologist
Beaumont Hospital
Dearborn Michigan

MedicalResearch.com: What is the background for the The SpaceOAR phase 3 trial study and the hydrogel spacer?

Response: External beam radiation therapy is commonly used to treat men with prostate cancer. As part of this treatment, side effects can occur involving bowel, urinary, and sexual symptoms.

This study was performed to test if an absorbable hydrogel placed between the prostate and rectum (using a simple outpatient procedure) could move the rectum away from the prostate and thus result in sparing of the rectum and decreased bowel toxicity. The study randomized 222 men and the three-year data were just published (The International Journal of Radiation Oncology Biology and Physics). With three years of follow-up, we saw that the spacer did improve the radiation plans and decreased both rectal toxicity and urinary toxicity.

Continue reading

Reduction in Radiation Has Reduced Second Tumors in Pediatric Cancer Patients

MedicalResearch.com Interview with:

Lucie Turcotte, MD, MPH University of Minnesota Masonic Children's Hospital Division of Pediatric Hematology-Oncology Assistant Professor Minneapolis, MN 55455

Dr. Lucie Turcotte

Lucie Turcotte, MD, MPH
University of Minnesota Masonic Children’s Hospital
Division of Pediatric Hematology-Oncology
Assistant Professor
Minneapolis, MN 55455

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have observed dramatic improvements in the number of survivors of childhood cancer over the last 60 years. As more children are surviving, we have identified many important late health consequences of cancer therapy. One of the most devastating of these late health consequences is the diagnosis of a second cancer. As we have identified late effects, such as second cancers, we have modified therapy in an effort to prevent long-term sequelae of therapy, while still maintaining superior survival rates.

For this study, we utilized data from the Childhood Cancer Survivor Study (CCSS), which is a cohort of more than 23,000 survivors of childhood cancer from multiple centers in North America, who were initially diagnosed between 1970 and 1999. Our analysis focused on elucidating whether survivors diagnosed more recently were experiencing fewer second cancers, and determining whether a reduction in second cancers could be associated with treatment modifications.

The most important finding from this study is that the reductions in therapeutic radiation exposure that occurred between 1970-1999 resulted in a significant reduction in the second cancers experienced by survivors of childhood cancer.

Continue reading

Factors That Expose Cardiologists To More Radiation During Procedures Outlined

MedicalResearch.com Interview with:

Alessandro Sciahbasi, MD, PhD  Sandro Pertini Hospital Rome, Italy

Dr. Sciahbasi

Alessandro Sciahbasi, MD, PhD
Sandro Pertini Hospital
Rome, Italy

MedicalResearch.com: What is the background for this study?

Response: Radiation exposure is an important issue for interventional cardiologists due to the deterministic and stochastic risks for operators, staff and patients. Consequently, it is important to know which are the determinants of operator radiation exposure during percutaneous coronary procedures in order to reduce radiation exposure. Despite different studies have already evaluated the radiation dose during percutaneous coronary procedures, most data were obtained using an indirect measure of the operator dose expressed in term of fluoroscopy time or dose area product (DAP) and only in a minority of studies dedicated operator dosimeters were used. The aim of our study was to evaluate operator radiation exposure during percutaneous coronary procedures with dedicated electronic dosimeters in a high volume center for transradial procedures.

Continue reading

Radiation Therapy Improves Pain and Quality of Life in Bone

MedicalResearch.com Interview with:
Rachel McDonald, MD(C)

Department of Radiation Oncology
Odette Cancer Centre
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Radiation treatment has been demonstrated in numerous studies to provide effective and timely pain relief to those suffering from painful bone metastases. However, as a palliative treatment, the goal should be not only to reduce pain but also to maintain and even improve quality of life. To date, studies have not effectively demonstrated this; most of these have included either small sample sizes or utilize questionnaires that aren’t tailored to the palliative cancer population with bone metastases.

We aimed to determine how soon after radiation treatment one can expect an improvement in quality of life. Our results showed that patients who had a pain response to radiation also had significantly greater improvements in pain, pain characteristics, functional interference, and psychosocial aspects of well-being at day 10 post-treatment. Further improvements in most domains of quality of life were found for responders at day 42.

Continue reading

Therapies That Target Accessory Cells in a Tumor May Enhance Standard Care

MedicalResearch.com Interview with:

Sudarshan Anand, PhD Department of Cell, Developmental and Cancer Biology Department of Radiation Medicine Oregon Health and Science University Portland, Oregon

Dr. Sudarshan Anand

Sudarshan Anand, PhD
Department of Cell, Developmental and Cancer Biology
Department of Radiation Medicine
Oregon Health and Science University
Portland, Oregon

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Almost half of all cancer patients receive radiation therapy during the course of their disease.

While the impact of radiation on the cancer cells has been well studied in experimental models, its effects on the accessory cells that are present in the tumor are not well known. One of the major interests of our lab is studying these accessory cells of the tumor aka “the tumor microenvironment”. These group of cells consists of blood vessel cells, fibroblasts and immune cells that are normal cells that have been recruited by the tumor and generally support tumor growth.

The goal of this study was to understand the impact of radiation (and broadly DNA damaging agents) on the blood vessel cells in the tumor. We focused on a specific type of molecule called microRNAs (miRs) in these cells. miRs are small RNA molecules that bind to dozens of messenger RNAs and the production of proteins.

We discovered a group of microRNAs that was induced in blood vessel cells by radiation, a chemotherapy agent cisplatin and peroxide an agent that mimics oxidative stress that is often present in cancers. We found that the top candidate on this list was a microRNA that mimicked radiation by inducing DNA damage and eventually killing the blood vessel cells. Administering this microRNA, either within a tumor or using a specific nanoparticle that delivers cargo to the tumor blood vessels, decreased tumor growth in mouse models of breast cancer, brain cancer and colorectal cancer. We found that the efficacy of this agent was a result of its ability to suppress a protein TREX1, that is often mutated in human lupus.

In other words, this microRNA was able to create some of the immune and inflammatory features of lupus within a tumor and induce proteins that triggered cell death on tumor cells. Overall, our work illustrates how the tumor accessory cells respond to radiation and highlights the cross-talk between different accessory cells and the tumor cells.

Continue reading

Localized Prostate Cancer: Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy

MedicalResearch.com Interview with:

Professor Jenny Donovan  PhD   OBE FMedSci NIHR-SI AcSS FFPHM Director, NIHR CLAHRC West (National Institute for Health Research Collaboration for  Leadership in Applied Health Research and Care West) at University Hospitals Bristol NHS Trust Bristol, UK

Prof. Jenny Donovan

Professor Jenny Donovan  PhD
OBE FMedSci NIHR-SI AcSS FFPHM
Director, NIHR CLAHRC West
(National Institute for Health Research Collaboration for
Leadership in Applied Health Research and Care West)
at University Hospitals Bristol NHS Trust
Bristol, UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: PSA testing identifies many men with prostate cancer, but they do not all benefit from treatment. Surgery, radiation therapy and various programs of active monitoring/surveillance can be given as treatments for fit men with clinically localized prostate cancer. Previous studies have not compared the most commonly used treatments in terms of mortality, disease progression and patient-reported outcomes. In the ProtecT study, we used a comprehensive set of validated measures, completed by the men at baseline (before diagnosis), at six and 12 months and then annually for six years.

The main finding is that each treatment has a particular pattern of side-effects and recovery which needs to be balanced against the findings from the paper reporting the clinical outcomes (Hamdy et al).

Continue reading

Knowledge of Risks From Imaging Radiation Has Room For Improvement

MedicalResearch.com Interview with:

David Leswick MD FRCPC Radiologist Saskatoon Health Region and the University of Saskatchewan

Dr. David Leswick

David Leswick MD FRCPC
Radiologist Saskatoon Health Region and the
University of Saskatchewan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for this study is that the use of computed tomography (CT) is increasing, and there is a significant radiation dose imparted to the population through imaging. There have been multiple prior studies showing limited knowledge of both dose levels and its associated risk from medical imaging procedures, and we wanted to evaluate local knowledge in our Health Region. We surveyed a total of 308 health care providers, including 217 referring physicians, 32 radiologists and 59 technologists. Overall, most respondents were aware of the risk of malignancy from CT, with only 23% of physicians, 3% of radiologists, and 25% of technologists believing there was no increased risk of malignancy from a single CT scan. Underestimating radiation dose levels from a procedure is more concerning than overestimating as it may lead to minimization of the perceived risk. Although relatively few respondents (20%) selected the most appropriate dose estimate for an abdominal CT scan in chest x-ray equivalents, the majority (54%) correctly or overestimated dose, with better knowledge amongst radiologists and imaging technologists than referring physicians. In general, respondents were appropriately more concerned regarding radiation dose when imaging pregnant and pediatric patients as risks from radiation are higher in those groups of patients.

Continue reading

Synergy Between Radiation and Chemotherapy Enhances Melanoma Treatment

MedicalResearch.com Interview with:

James S. Welsh, MS, MD, FACRO President, American College of Radiation Oncology Professor and Medical Director Director of Clinical & Translational Research Department of Radiation Oncology Stritch School of Medicine Loyola University- Chicago Cardinal Bernardin Cancer Center Maguire Center, Rm 2932 Maywood, IL 60153 Chief of Radiation Oncology Hines VA Medical Center

Dr. James Welsh

James S. Welsh, MS, MD, FACRO
President, American College of Radiation Oncology
Professor and Medical Director
Director of Clinical & Translational Research
Department of Radiation Oncology
Stritch School of Medicine Loyola University- Chicago
Cardinal Bernardin Cancer Center
Maywood, IL 60153
Chief of Radiation Oncology
Hines VA Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Welsh: Cancer immunotherapy could represent a truly powerful means of addressing cancer. Although immunotherapy itself is not new, there are new agents and combinations of older agents (including radiation therapy) that could prove more successful than anything we have seen in many years. The data in melanoma thus far is quite encouraging and this preliminary success could possibly extend to many other malignancies as well.

Continue reading

Intra-operative Radiation For Breast Cancer Better For Patients and Environment

MedicalResearch.com Interview with:
Jayant S Vaidya MBBS MS DNB FRCS PhD  Professor of Surgery and Oncology,  Scientific Director, Clinical Trials Group, Division of Surgery and Interventional Science, University College London Whittington Health - Clinical Lead for Breast Cancer Royal Free Hospital University College London Hospital
Jayant S Vaidya MBBS MS DNB FRCS PhD 
Professor of Surgery and Oncology,
Scientific Director, Clinical Trials Group,
Division of Surgery and Interventional Science,
University College London
Whittington Health – Clinical Lead for Breast Cancer
Royal Free Hospital
University College London Hospital

 MedicalResearch.com: What is the background for this study? What are the main findings?

Prof. Vaidya: TARGIT-A randomised clinical trial (ISRCTN34086741) compared giving TARGIT IORT during lumpectomy vs. traditional EBRT given over several weeks after lumpectomy for breast cancer; local-recurrence-free-survival was similar in the two arms of the trial, particularly when TARGIT was given simultaneously with lumpectomy. Also, there were significantly fewer deaths from other causes with TARGIT IORT.

This study calculated journeys made by patients with breast cancer to receive their radiotherapy, using the geographic and treatment data from a large randomised trial.

The study then assessed the same outcomes (travel distances, travel time and CO2emissions) in two semi-rural breast cancers—the results of this assessment confirm and reinforce the original results: the benefit of the use of TARGIT for patients from two semi=rural breast centres was even larger (753 miles (1212 km), 30 h, 215 kg CO2 per patient).

Continue reading

Chemotherapy Plus Radiation Demonstrated Control of Liver Metastases in Colon Cancer

MedicalResearch.com Interview with:

Dr Guy van Hazel Clinical Professor of Medicine, School of Medicine and Pharmacology, University of Western Australia

Dr. Guy van Hazel

Dr Guy van Hazel
Clinical Professor of Medicine,
School of Medicine and Pharmacology,
University of Western Australia 

Medical Research: What is the background for this study? What are the main findings?

Dr. van Hazel: The SIRFLOX study is based on original work by Dr Bruce Gray and myself almost two decades ago, when we studied the combination of Selective Internal Radiation Therapy (SIRT) with Y-90 resin microspheres – which was absolutely new at the time – with hepatic artery chemotherapy. This study showed an increase in liver control with the addition of SIRT [Gray B et al. Ann Oncol 2001; 12: 1711–1720.].

We then proceeded to initiate a trial comparing systemic SIRT plus 5-FU/LV according to the Mayo Clinic regimen compared to the Mayo Clinic regimen alone, but unfortunately this had to be abandoned because new chemotherapy became available which made it unethical to offer the control arm. However, in those patients who were treated up to that point with SIRT plus 5-FU/LV [van Hazel G et al. J Surg Oncol 2004; 88: 78–85.] we did see a very high response rates compared to the control arm, with an impressive survival of 29 months. We subsequently did a phase l/ll study of modified FOLFOX6 with or without SIRT and again found very high response rates [Sharma R et al. J Clin Oncol 2007; 25: 1099–1106.].  This led us to launch the SIRFLOX study in 2007.

Continue reading

Skipping Radiation Cancer Treatments Linked To Worse Outcomes

MedicalResearch.com Interview with:

Dr. Madhur Garg MD Professor, Clinical director, Department of Radiation Oncology Montefiore Einstein Center for Cancer Care Albert Einstein College of Medicine. Bronx, NY 10467

Dr. Madhur Garg

Dr. Madhur Garg MD
Professor, Clinical director, Department of Radiation Oncology
Montefiore Einstein Center for Cancer Care
Albert Einstein College of Medicine.
Bronx, NY 10467

Medical Research: What is the background for this study? What are the main findings?

Dr. Garg: In most curative settings, external beam radiotherapy (RT) for the treatment of solid tumors is delivered five days each week over multiple weeks in an outpatient setting. Unintended treatment prolongation, generally attributed to treatment toxicity or inter-current illness, has been associated with inferior tumor control in a number of disease sites. Montefiore Einstein Center for Cancer Care recently identified radiotherapy (RT) noncompliance as a prevalent issue among patients receiving RT with curative intent. Approximately 20% of patients were deemed to be noncompliant, and statistically significant predictors of noncompliance risk included diagnosis, treatment course length, and socioeconomic status (SES). In this report, we examined if radiotherapy noncompliance is associated with clinical outcomes in our patient population.

In this analysis, we have found that treatment noncompliance is associated with inferior clinical outcomes for patients receiving radiotherapy with curative intent. The associations we detected were both statistically significant and clinically meaningful and consistent across disease sites. This is a novel finding that may have significant implications for how cancer care delivery can be improved, particularly in disadvantaged patient populations. Our finding that  radiotherapy noncompliance is strongly associated with inferior outcomes, even after adjusting for confounders such as comorbidity index and SES, suggests to us that noncompliance may serve as a behavioral biomarker for other risk factors that contribute to poor outcomes. These may include noncompliance with other important clinician visits and procedures, lack of social support, and mood disorders.

Continue reading

Radiation Converts Some Resistant Head and Neck Cancer Cells Into Aggressive Stem Cells

MedicalResearch.com Interview with:

Erina Vlashi, PhD Assistant Professor Department of Radiation Oncology David Geffen School of Medicine at UCLA Los Angeles, CA 90095-1714

Dr. Erina Vlashi

Erina Vlashi, PhD
Assistant Professor
Department of Radiation Oncology
David Geffen School of Medicine at UCLA
Los Angeles, CA 90095-1714

Medical Research: What is the background for this study? What are the main findings?

Dr. Vlashi: It has been known for quite some time that head and neck squamous cell carcinomas (HNSCC) that test positive for human papilloma virus (HPV) respond to radiation therapy more favorably than HPV-negative HNSCCs. Our team reviewed a cohort of 162 patients with a head and neck squamous carcinoma diagnosis over a two-year period, and confirmed that the outcomes were correlated with the patient’s HPV status. The work that followed was prompted by a discovery we had made earlier in breast cancer suggesting that breast cancer cells that manage to survive radiation therapy have the capacity to convert into more de-differentiated, therapy-resistant cells with characteristics of cancer stem cells, and that the degree of this conversion depended on the type of breast cancer: the more aggressive types of breast cancer being more prone to the therapy-induced phenotype conversion. So, we hypothesized that this therapy-induced conversion phenomenon may especially be at play in  head and neck squamous cell carcinomas given the clinical observation that HPV-positive HNSCCs respond to radiation therapy much more favorably than HPV-negative HNSCCs, despite optimum treatment modalities. And indeed, that is what we found: tumor cells derived from a panel of  head and neck squamous cell carcinomas cell lines that do not respond well to radiation therapy have an enhanced ability to convert the cells that survive radiation into more aggressive cells, cancer stem-like cells that will resist the next round of radiation therapy.  Continue reading

Is Low Dose Radiation Exposure Really Harmful?

MedicalResearch.com Interview with:
Jeffry A. Siegel, PhD
President & CEO, Nuclear Physics Enterprises, Marlton, NJ
Charles W. Pennington, MS, MBA
NAC International, Norcross, GA, Retired; Executive Nuclear Energy Consultant
Bill Sacks, PhD, MD
Emeritus Medical Officer, FDA Center for Devices and Radiological Health
Silver Spring, MD
James S. Welsh, MS, MD, FACRO
Department of Radiation Oncology
Stritch School of Medicine Loyola University Chicago, Maywood, IL

Medical Research: What is the background for this study? What are the main findings?

Response: The background is the falsity of the widespread claim that all ionizing (high energy) radiation is harmful regardless of how low the dose.  This claim is expressed in the official policies of almost all radiation regulatory agencies around the world, as well as in many scientific journal papers.  It has been responsible for a common fear of radiation (radiophobia) among the public and members of the medical profession, including even most radiologists and nuclear medicine physicians.

The radiophobia resulting from this false allegation has been instrumental in the forced evacuations of hundreds of thousands of people near nuclear energy plants at Chernobyl and Fukushima that have produced thousands of deaths from the evacuations themselves of sick and/or elderly people, from consequent suicides, alcoholism, heart attacks, and strokes, as well as other health destroying reactions to the loss of homes, possessions, jobs, and communities.

This erroneous belief has acted to prevent many people from getting needed CT scans and x-ray studies, and to prevent many parents from permitting their children to get such imaging studies, with consequences such as surgical explorations that might have been otherwise unnecessary and carry risks of injury and mortality, or such as the foregoing of treatment that would otherwise be health restoring.

This unfounded proclamation and its resultant radiophobia have acted as obstacles to the development of clean and sustainable nuclear energy, and have underlain widespread irresponsible propaganda by all sorts of would-be anti-nuclear gurus.  There are other harmful effects of this unwarranted contention, including severe limitations on funding for further research into the beneficial effects of low-dose radiation.

The main findings in this article are that the very scientists whose experimental work gave rise to this false claim in the 1940s – Hermann Muller and Curt Stern and their colleagues – in fact demonstrated the exact opposite, namely that below certain threshold radiation doses there were no harmful effects at all and possible beneficial effects.  Even more importantly, there were no scientists at the time who realized that Muller and Stern’s conclusions flew in the face of their actual experimental results.  Or at least there were none who were inclined to point out the falsity of Muller and Stern’s unwarranted conclusions, perhaps intimidated by Muller’s status as a Nobel Prize winner (1946, for his earlier work on radiation-caused mutations in fruit flies).

Continue reading

Radiation Overutilized in Elderly Stage1 ER+ Breast Cancer Patients

MedicalResearch.com Interview with:

Quyen Chu, MD, MBA, FACS Charles Knight Professor in Surgery Professor of Surgery Chief, Surgical Oncology Director, Surface Malignancies Program Feist-Weiller Cancer Center Louisiana State University Health Sciences Center, Shreveport

Dr. Quyen Chu

Quyen Chu, MD, MBA, FACS
Charles Knight Professor in Surgery
Professor of Surgery
Chief, Surgical Oncology
Director, Surface Malignancies Program
Feist-Weiller Cancer Center
Louisiana State University
Health Sciences Center, Shreveport

Medical Research: What is the background for this study? What are the main findings?
Dr. Chu: In 2004, national treatment recommendations changed for a select group of elderly breast cancer patients with the Cancer and Leukemia Group B (CALGB) 9343 trial. Research found that postoperative radiation therapy was not needed to prolong survival in a select group of women 70 or older, mainly those with a small, estrogen receptor (ER) positive tumor, and receiving anti-hormone therapy.  Even with this information, nearly two thirds of the women who fit these criteria were still receiving radiation therapy after undergoing a lumpectomy although it has been proven to be safe to omit.

We found that as a nation, we are mostly not following the national guideline on breast cancer treatment and that the possible side effects of RT can be avoided.

Medical Research: What should clinicians and patients take away from your report?

Dr. Chu: Clinicians and patients should take away from this report that in U.S. women 70 or older with stage I, ER+ breast cancer and receiving anti-hormone therapy, radiation therapy is overly utilized as it is not needed to prolong survival.  

Continue reading

Lung Cancer: Intensity Modulated Radiation Therapy Linked to Improved Quality of Life

Benjamin Movsas, MD Chairman of Radiation Oncology Henry Ford Hospital Detroit, Michigan

Dr. Movsas

MedicalResearch.com Interview with:
Benjamin Movsas, MD

Chairman of Radiation Oncology
Henry Ford Hospital
Detroit, Michigan 

Medical Research: What is the background for this study? What are the main findings?

Dr. Movsas: The background is that a recent randomized lung cancer trial (RTOG 0617) showed a lower (rather than a higher) survival among the patients who received a higher dose of radiation (RT).  This unexpected finding was puzzling as there were few differences in toxicity between the radiation dose arms noted by health care providers.

The main finding of the quality of life (QOL) analysis was that there was indeed a large difference in QOL as reported by the patients themselves (with lower QOL on the high RT dose arm at 3 months).  Moreover, while this study was not randomized for RT technique, about half of the patients received intensity modulated RT (IMRT), a more sophisticated approach than the alternative (3D conformal RT), which can better protect normal tissues.  Despite the fact that patients with larger tumors received IMRT, their self reported QOL one year later was significantly better (ie, much less decline in QOL) relative to patients who received 3D conformal RT.  Finally, higher QOL at baseline significantly predicated for better survival.

Continue reading

Anti-VEGF Treatment Plus Radiation For Schwannoma Control

Dr-Lei-Xu.jpg

Dr. Lei Xu

MedicalResearch.com Interview with:
Lei Xu, MD, PhD
Steele Laboratory of Tumor Biology
Radiation Oncology Department
Massachusetts General Hospital

Medical Research: What is the background for this study?

Dr. Lei Xu: Neurofibromatosis 2 is characterized by benign tumors that develop throughout the nervous system. The most common site of these tumors is the eighth cranial nerve, which carries hearing and balance information from the ears to the brain. Although these vestibular schwannomas grow slowly, they usually lead to a significant or total hearing loss by young adulthood or middle age. The tumors can also press on the brain stem, leading to headaches, difficulty swallowing and other serious neurologic symptoms. While the tumors can be surgically removed or destroyed with radiation treatment, both approaches can also damage hearing.

Several previous investigations had suggested that – unlike other benign tumors – vestibular schwannomas induce the formation of new blood vessels, as malignant tumors do. A 2009 New England Journal of Medicine study led by Scott Plotkin, MD, PhD, at Massachusetts General Hospital reported that treatment with the antiangiogenesis drug bevacizumab caused shrinkage of NF2-schwannomas in most of the treated patients and improved hearing in more than half. But the limitations of that approach – the fact that not all patients responded, that the hearing improvement was often transient and that some patients could not tolerate long-term bevacizumab treatment – indicated the need to better understand the mechanisms of anti-angiogenesis on the function of tumor-bearing nerves.

Continue reading

Study Evaluates Cancer Risk From Occupational Radiation Exposure

David Richardson PhD Associate Professor Epidemiology Gillings School of Global Public Health UNC

Dr. David Richardson

MedicalResearch.com Interview with:,
David Richardson PhD
Associate Professor Epidemiology
Gillings School of Global Public Health
UNC

Medical Research: What is the background for this study?

Dr. Richardson:  The International Nuclear Workers Study (INWORKS) combines three cohorts from France, the United Kingdom, and the United States of America. INWORKS follows on from an earlier 15-Country Study but focuses on the three countries that provided the majority of the most informative data on early nuclear workers (1940’s onward). The use of data from just 3 countries, instead of 15, reduces the organisational requirements – and therefore financial burden – associated with the greater number of countries but the cohort selection (of the three main contributing countries) means that the power of the INWORKS study is not a concern. INWORKS uses information from the French, UK and US cohorts that has been updated since the 15-Country study was published.

The overall purpose of the study is to improve the understanding of health risks associated with protracted, low-level exposure to ionising radiation.
Continue reading

Radiation Protection Offered By Single Injection Post Exposure

Carla Kantara, Ph.D. Postdoctoral fellow Dept. of Biochemistry and Molecular Biology University of Texas Medical Branch at Galveston

MedicalResearch.com Interview with:
Carla Kantara, Ph.D.
Postdoctoral fellow
Dept. of Biochemistry and Molecular Biology
University of Texas Medical Branch at Galveston

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Kantara: The increasing threats of radiation exposure and nuclear disasters have become a significant concern for the United States and countries worldwide. Such concern has increased national and international recognition for the need to develop novel medicinal countermeasures that can prevent radiation-induced tissue damage and keep thousands of people alive, even if administered a day or more after nuclear exposure. To date, there are only a few mitigating or radioprotective agents that are approved by the FDA, however they are unsuccessful in treating the gastrointestinal toxicity induced by high-dose radiation exposures, and are ineffective as a post-exposure treatment for the thousands of potential exposed individuals.

In our study, we showed that a single injection of TP508, administered 24 hours post-radiation, significantly increased mice survival and effectively protected the gastrointestinal mucosa by delaying crypt dissociation and directly stimulating stem cell regeneration. This suggests that TP508 may be an effective post-exposure medicinal countermeasure for mitigating radiation-induced gastrointestinal damage and mortality following a nuclear incident and may provide exposed victims additional time to be evacuated so that they can receive additional life-saving medical treatment.

Continue reading

Radiation of Internal Mammary Nodes May Have Small Breast Cancer Survival Benefit

MedicalResearch.com Interview with: Philip M.P. Poortmans PhD MD Head of Department, Radiation Oncology ESTRO President Radboud university medical center The Netherlands  Medical Research: What is the background for this study?   Dr. Poortmans:  Based on the former hypothesis that breast cancer sequentially spreads from breast to lymph nodes and from there to distant organs, up to the eighties it was very custom to perform extended radical surgery and to irradiate extensively locoregional for most patients. With the growing interest in systemic treatments to prevent development (= from already present undetectable cancer cells to really visible and threatening metastases) of distant metastases, new information about possible late side effects and our increasing knowledge about the biological behaviour of breast cancer in the eighties and the nineties, the extend of especially locoregional treatment was gradually reduced. For radiation therapy, often the irradiation of the internal mammary lymph nodes was left aside, as this was linked to the delivery of radiation dose to the heart, possibly or probably leading to late side effects. At the start of the study, about half of the radiation oncology departments did include irradiation of the internal mammary lymph nodes in patients with risk factors, while the other half did not. Hereby we had an ideal base for the investigation of the value of treating the non-operated part of the regional lymph nodes.  Medical Research: What are the main findings?  Dr. Poortmans:  We found a decreased risk for development of distant metastases of 3% at 10 years, translated in a 3% overall improved overall disease free survival. Up to now, It leads to an improvement of 1.6% in overall survival at 10 years, which is, in contrast to the earlier 2 findings, just not statistically significant (borderline at p = 0.06). On the other hand, breast cancer related mortality is significantly improved and we did not see an increase in non breast cancer related causes of death. Overall toxicity was limited with only a significant increase in pulmonary toxicity, however to a low grade in the big majority of those patients. The benefit in overall survival is in a similar order of magnitude than adding for example taxanes to anthracycline-based adjuvant chemotherapy for a similar patient population as ours.  Medical Research: What should clinicians and patients take away from your report? Dr. Poortmans:     First, we should appreciated that the regional (lymph node) recurrence rate is a poor endpoint for evaluation of also locoregional treatment. This can be explained by the fact that once distant metastases are found, no further search for local (breast) or regional (lymph nodes) recurrences is performed any more, as this is not relevant anymore for treatment or prognosis. However, the spread of distant metastases might occur from cancer involvement of the lymph nodes, explaining why we saw the effect of the lymph node irradiation basically only on the rate of development of distant metastases.     As a second message, we can appreciate that the 3% decreased distant metastases rate did not yet fully translate into a survival benefit, which can be explained by the need for even longer follow-up than 10 years. The explanation lies simply in the fact that even after development of distant metastases, patients can live for quite some more years with, however, only very little chance for definitive cure.     Thirdly, we demonstrated with the quality assurance programme linked to this trial that radiation treatment as used those days (the accrual phase was from 1996 until January 2004) radiation therapy techniques should be nowadays considered as suboptimal with a lack of full coverage of the target volumes and delivery of a too high dose to the organs at risk. With modern techniques, we expect that the results will even be quite better.     And finally, that the overall outcome of breast cancer improved a lot: at the start of the trial, we estimated overall survival at 10 years being 50%, which we revised in 2000 to 75% and we ended up with more than 80%. Thereby, it becomes more of a challenge to demonstrate benefits of further improving treatment as the same relative improvement will be translated into a lower absolute improvement. Nevertheless, by more effectively preventing the development of distant metastases by improved systemic therapy (or even better by earlier detection with a lower basal rate of distant metastases) the importance of optimizing locoregional control becomes even higher.   Medical Research: What recommendations do you have for future research as a result of this study?  Dr. Poortmans:   o	First of all we have to improve our ability to define which patients will gain most from this treatment.  o	Secondly, we have to further investigate how to optimize the technical aspects of this loco regional treatment and … o	Thirdly how to optimally integrate all treatment aspects including locoregional ones and systemic ones.  o	Based on all this, we can develop and then provide the patients with shared decision making tools.    Citation: Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer Philip M. Poortmans, Ph.D., Sandra Collette, M.Sc., Carine Kirkove, Ph.D., Erik Van Limbergen, Ph.D., Volker Budach, Ph.D., Henk Struikmans, Ph.D., Laurence Collette, Ph.D., Alain Fourquet, Ph.D., Philippe Maingon, M.D., Mariacarla Valli, M.D., Karin De Winter, M.D., Simone Marnitz, M.D., Isabelle Barillot, Ph.D., Luciano Scandolaro, M.D., Ernest Vonk, M.D., Carla Rodenhuis, Ph.D., Hugo Marsiglia, Ph.D., Nicola Weidner, Ph.D., Geertjan van Tienhoven, Ph.D., Christoph Glanzmann, Ph.D., Abraham Kuten, M.D., Rodrigo Arriagada, M.D., Harry Bartelink, Ph.D., and Walter Van den Bogaert, Ph.D. for the EORTC Radiation Oncology and Breast Cancer Groups N Engl J Med 2015; 373:317-327 July 23, 2015 DOI: 10.1056/NEJMoa1415369       MedicalResearch.com is not a forum for the exchange of personal medical information, advice or the promotion of self-destructive behavior (e.g., eating disorders, suicide). While you may freely discuss your troubles, you should not look to the Website for information or advice on such topics. Instead, we recommend that you talk in person with a trusted medical professional. The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. Philip.Poortmans@radboudumc.nl

MedicalResearch.com Interview with:
Philip M.P. Poortmans PhD MD
Head of Department, Radiation Oncology
ESTRO President
Radboud university medical center
The Netherlands

 


Medical Research: What is the background for this study?

Dr. Poortmans: Based on the former hypothesis that breast cancer sequentially spreads from breast to lymph nodes and from there to distant organs, up to the eighties it was very custom to perform extended radical surgery and to irradiate extensively locoregional for most patients. With the growing interest in systemic treatments to prevent development (= from already present undetectable cancer cells to really visible and threatening metastases) of distant metastases, new information about possible late side effects and our increasing knowledge about the biological behaviour of breast cancer in the eighties and the nineties, the extend of especially locoregional treatment was gradually reduced. For radiation therapy, often the irradiation of the internal mammary lymph nodes was left aside, as this was linked to the delivery of radiation dose to the heart, possibly or probably leading to late side effects. At the start of the study, about half of the radiation oncology departments did include irradiation of the internal mammary lymph nodes in patients with risk factors, while the other half did not. Hereby we had an ideal base for the investigation of the value of treating the non-operated part of the regional lymph nodes.

Continue reading

Shorter Radiation Course For Early Breast Cancer Results In Better Quality of Life

Simona F. Shaitelman, MD, EdM Assistant Professor Department of Radiation Oncology University of  Texas MD Anderson Cancer Center Houston, TX 77030MedicalResearch.com Interview with:
Simona F. Shaitelman, MD, EdM

Assistant Professor
Department of Radiation Oncology
University of  Texas MD Anderson Cancer Center
Houston, TX 77030


Medical Research: What is the background for this study?

Dr. Shaitelman: Our study compared two different radiation therapy regimens for women with early stage breast cancer and examined the acute and short term toxicities associated with these two different treatments.  The treatments compared a shorter versus a longer course of whole breast irradiation, both delivered with a tumor bed boost.  Although prior published data supported giving a shorter course regimen, this was being used only in about one third of appropriate women in the United States, in part because of concerns regarding toxicities, restricted tumor enrollment in the earlier studies, as well as the earlier lack of incorporation of a tumor bed boost (which is standard and known to decrease the risk of tumor recurrence).

Medical Research: What are the main findings?

Dr. Shaitelman: A total of 287 patients were enrolled, age 40 years and older, with stage 0-II breast cancer.  76% of patients in the study were overweight or obese (in comparison with previous studies that had excluded patients with a larger body mass index).  We found that during radiation treatment, women with the shorter course regimen had less breast pain, dermatitis, hyperpigmentation, and fatigue.  At six months, by both physician assessment and patient report, patients treated with the shorter regimen had less fatigue.  Patients treated with the shorter course regimen also reported having a better ability to care for the needs of their family compared to those patients treated with the longer course regimen.

Medical Research: What should clinicians and patients take away from your report?

Dr. Shaitelman: We believe that for women with early stage breast cancer, the shorter course regimen should be the starting point for discussions about whole breast radiation.  As breast cancer outcomes continue to improve, focusing on how our treatments impact patients’ quality of life in both the short and long-term will be increasingly important.

Citation:

MedicalResearch.com is not a forum for the exchange of personal medical information, advice or the promotion of self-destructive behavior (e.g., eating disorders, suicide). While you may freely discuss your troubles, you should not look to the Website for information or advice on such topics. Instead, we recommend that you talk in person with a trusted medical professional.

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Simona F. Shaitelman, MD, EdM (2015). Shorter Radiation Course For Early Breast Cancer Results In Better Quality of Life 

Shorter Courses of Radiation For Breast Cancer Found Safe and Effective with Fewer Side Effects

Dr. Reshma Jagsi MD, DPhil Associate Professor and Deputy Chair for Faculty and Financial Operations in the Department of Radiation Oncology at the University of Michigan Health System Research Investigator at the Center for Bioethics and Social Sciences in Medicine University of MichiganMedicalResearch.com Interview with:
Reshma Jagsi, MD, DPhil
Associate Professor and Deputy Chair
Department of Radiation Oncology
University of Michigan

Medical Research: What is the background for this study? What are the main findings?

Response: In recent years, there has been accumulating evidence from clinical trials that have supported the long-term safety and effectiveness of shorter courses of radiation therapy—“hypofractionated radiation therapy”—for patients with breast cancer.  However, little has been known about the experiences of patients during treatment, especially when this new approach is administered outside the setting of closely controlled clinical trials.  Our study examined the side effects and patient-reported experiences during radiation treatment of over 2000 breast cancer patients in the state of Michigan.  It found that women who received hypofractionated treatment were less likely to report side effects (including skin reaction and fatigue) than patients treated with more traditional courses of radiation treatment, delivered daily over 5-6 weeks or longer.

Continue reading

Melanoma: Lymph Node Radiation After Lymphadenectomy Did Not Improve Survival

MedicalResearch.com Interview with:
Michael A Henderson
MBBS BMedSc MD FRACS
Professor of Surgery, University of Melbourne
Deputy Director Division of Cancer Surgery
Head Skin and Melanoma Service
Division of Cancer Surgery
Peter MacCallum Cancer Centre
East Melbourne Victoria  Australia

Medical Research: What is the background for this study? What are the main findings?

Dr. Henderson:  A number of retrospective reviews of adjuvant radiotherapy after lymphadenectomy for patients at high risk of further lymph node field relapse had all suggested that the risk of lymph node field relapse was reduced but there was controversy about whether there was any impact on survival. In addition many clinicians were concerned about the side effects of radiotherapy and in the absence of a proven survival benefit were reluctant to recommend it. Previously a phase 2 trial of adjuvant radiotherapy conducted by one of our co-authors Prof Bryan Burmiester confirmed that the morbidity of lymph node field radiotherapy was limited and the risks of recurrence was reduced. On that basis the current ANZMTG TROG randomised multicentre trial was initiated.

In summary this final report updates information on overall survival, lymph node field relapse etc and provides information for the first time on long term toxicity of treatment, quality of life and lymphedema. Adjuvant lymph node field radiotherapy for patients at high risk of further lymph node field relapse reduces the risk of further lymph node field relapse by 50% but it has no effect on survival. Although radiotherapy toxicity was common (3 in 4 patients), mostly involving skin and subcutaneous tissue it was mild-to-moderate in severity and had little impact upon the patient’s quality of life as measured by the FACT-G quality of life tool. Specific regional symptoms were more common in the radiated group. Limb volume measurements confirmed a significant but modest increase for patients receiving inguinal radiation (15%) but not for axillary radiation.

In the design of this trial, a decision was made to allow patients in the observation arm who developed an isolated lymph node field relapse to be salvaged by surgery and or radiotherapy. There were only two patients in the radiotherapy arm who developed an isolated lymph node field relapse and both died of metastatic disease. In the observation arm 26 patients developed an isolated lymph node field relapse and the majority (23) achieved lymph node field control with a combination of surgery and or radiotherapy. The five-year survival FROM development of a lymph node field relapse in this group was 34% which is comparable to the overall survival of the entire cohort (42% five-year overall survival). This information whilst a subset analysis suggests that if it would be reasonable in some patients to consider a policy of observation only, reserving further surgery and or radiotherapy for a second relapse.

Continue reading

Cognitive Function Decline Common After Whole Brain Radiotherapy For Brain Metastases

MB. Pinkham, Clinical Oncology Christie NHS Foundation Trust Manchester UKMedicalResearch.com Interview with:
MB. Pinkham, Clinical Oncology

Christie NHS Foundation Trust
Manchester UK

Medical Research: What is the background for this study?
Response: Brain metastases are a serious complication of advanced malignancy and for most patients the objective is to maximise quality of survival. As treatment decisions become increasingly tailored to the individual, patient-focussed measures of efficacy such as neurocognitive function (NCF) are an important consideration. This is illustrated by the NCCTG N0574 randomised study reported last month at the American Society of Clinical Oncology (ASCO) 2015 Annual Meeting. 208 patients with 1-3 brain metastases each <3cm were randomised to stereotactic radiosurgery (SRS) or SRS with whole brain radiotherapy (WBRT). The addition of WBRT improved intracranial disease control but did not translate into a survival benefit and was associated with a decline in neurocognitive function at 3 months.

The objective of our study was to describe the types of changes in neurocognitive function that can occur, summarise how they are assessed and review approaches used to mitigate their effects. We wanted to provide busy physicians with a clear and comprehensive overview of the topic that could be used to inform clinical decisions.

Medical Research: What are the main findings?

Response: Using sensitive tests, most patients with brain metastases have deficits in neurocognitive function at diagnosis. Evaluating and understanding changes after treatment is complex because neurocognitive function is a dynamic process that is influenced by a long list of inter-related factors.

For patients treated using whole brain radiotherapy alone, worsening neurocognitive function is observed in about two-thirds within 2-6 months. Deficits in verbal memory and fine motor control are most common. It is unclear what proportion relates to treatment toxicity as opposed to disease progression or pre-terminal decline because both are unfortunately also common events during this interval. By contrast, in other patients, NCF improves after WBRT due to treatment response.

For patients with 1-4 brain metastases treated using SRS, the addition of WBRT improves intracranial disease control at the expense of deficits in verbal memory at 4 months but the impact of recurrence and salvage therapy on neurocognitive function later than this is uncertain. Scant data suggests that some deficits in neurocognitive function after WBRT may improve with time in long term survivors. For patients with ≥5 brain metastases, SRS and/or systemic therapies may be considered in select patients instead of upfront whole brain radiotherapy but high quality evidence is lacking.

Advanced radiotherapy technologies, such as hippocampal-sparing WBRT and post-operative cavity SRS, can limit the dose delivered to unaffected areas of the brain in the hope of reducing toxicity. Randomised studies assessing their efficacy and cost-effectiveness in various clinical situations are underway prior to routine use. Small but statistically significant improvements in certain neurocognitive domains can also be achieved using medications such as memantine and donepezil. Preclinical data suggests that some commonly available drugs (such as ramipril, lithium and indomethacin) may have neuroprotective properties following WBRT; further evaluation is warranted.

Continue reading

Occupational Exposure To Low Dose Radiation Linked To Leukemia

MedicalResearch.com Interview with:
Dr Klervi Leuraud, Epidemiologist
Institute for Radiological Protection and Nuclear Safety
Cedex, France

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Leuraud: INWORKS was performed to quantify the risk of cancer mortality associated to protracted low doses of ionizing radiation typical of occupational or environmental exposures, as well as of diagnostic medical exposures. While such risks are well known for acute exposures as those experienced by the Japanese survivors of the A-bombs, there is still a lack of information for exposures experienced by the workers and the public. Our study confirms the existence of an association between leukemia mortality and chronic exposure to low doses received by nuclear workers.

Continue reading

Some Breast Cancer Patients Have Excellent Results With Partial Breast Radiation

Dr. Mitchell Kamrava MD Department of Radiation Oncology University of California Los Angeles Los Angeles, CAMedicalResearch.com Interview with:
Dr. Mitchell Kamrava MD
Department of Radiation Oncology
University of California Los Angeles
Los Angeles, CA

Medical Research: What is the background for this study? What are the main findings?

Dr. Kamrava: Breast conservation (lumpectomy followed by radiation) is known, based on multiple randomized trials with over 20 years of follow-up, to provided equivalent outcomes as mastectomy.  The radiation component of breast conservation has standardly been delivered to the whole breast.  Studies show that the majority of breast recurrences occur near the lumpectomy cavity causing some to ask whether it is necessary to treat the whole breast in order to reduce the risk of a recurrence.

Partial breast radiation delivers treatment just to the lumpectomy cavity with a small margin of 1-2 cm.  It’s delivered in a shorter time of 1 week compared with about 6 weeks for standard whole breast radiation and 3-4 weeks for hypofractionated whole breast radiation.

The original method developed to deliver partial breast radiation is interstitial tube and button brachytherapy.  This uses multiple small little tubes that are placed through the lumpectomy cavity to encompass the area at risk.  One end of these tubes can be connected to a high dose rate brachytherapy machine that allows a motorized cable with a very small radiation source welded to the end of it to be temporarily pushed in and out of each of the tubes so that the patient can be treated from “inside out”.  This helps concentrate the radiation to the area of the lumpectomy cavity while limiting exposure to normal tissues.  This treatment is most commonly delivered as an out-patient two times per day for a total of 10 treatments.

The main finding from our paper is that in reviewing the outcomes on over 1,000 women treated with this technique with an average follow-up of 6.9 years that the 10 year actuarial local recurrence rate was 7.6% and in women with more than 5 years of follow-up physician reported cosmetic outcomes were excellent/good in 84% of cases.

Continue reading

Long-Term Androgen Deprivation Plus Radiation For High Risk Prostate Cancer

Almudena Zapatero MD PhD Senior Consultant Dpt Radiation Oncology Instituto Investigación Sanitaria IIS-IP Hospital Universitario de la Princesa MadridMedicalResearch.com Interview with:
Almudena Zapatero MD PhD

Senior Consultant Dpt Radiation Oncology
Instituto Investigación Sanitaria IIS-IP
Hospital Universitario de la Princesa
Madrid


Medical Research: What is the background for this study? What are the main findings?

Dr. Zapatero: There is a significant body of evidence from randomized trials showing a significant improvement in clinical outcome with the combination of androgen deprivation and conventional-dose radiotherapy (≤70 Gy) in patients with high-risk and intermediate-risk prostate cancer. However, the optimal duration the optimum duration of androgen deprivation in the setting of high-dose radiotherapy remained to be determined.

The results of our trial (DART01/05) show that 2 years of adjuvant androgen deprivation is superior to 4 months androgen deprivation when combined with plus high-dose radiotherapy  in terms of biochemical control, freedom from metastasis and overall survival, particularly in patients with high-risk prostate cancer.

Continue reading

Non-Small Cell Lung Cancer: Stereotactic Radiation Plus Chemo Improved Survival

Dr. Puneeth Iyengar (left) and Dr. Robert Timmerman

Dr. Puneeth Iyengar (left) and Dr. Robert Timmerman

MedicalResearch.com Interview with:
Dr. Puneeth Iyengar, MD, PhD
.
Assistant Professor Director of Clinical Research
Dept of Radiation Oncology Co-leader, Thoracic Disease Oriented Team Harold Simmons Cancer Center
UT Southwestern Medical Center  Dallas, TX

Medical Research: What is the background for this study? What are the main findings?

Response: Stage IV Non-small cell lung cancer (NSCLC) remains a disease of limited survival, in the range of one year for a majority of patients who historically have gone on to receive systemic therapy only. Disease in this patient population most often recurs in the sites of original gross disease. With greater understanding of the biology and patterns of failure that occur in stage IV NSCLC, it is becomingly increasingly obvious that there are subsets of patients, those with limited sites of metastatic disease, who may benefit with more aggressive local therapy in addition to systemic agents to effectuate longer progression free survival (PFS) and potentially overall survival (OS). Since failures of treatment occur most commonly in original gross deposits, local non-invasive therapy in the form of stereotactic body radiation therapy (SBRT) may offer a means to curtail the recurrences, perhaps as a way to shift the time to and patterns of failure.

To address these concepts, a multi institutional single arm phase II study was conducted at UT Southwestern Medical Center in Dallas and University of Colorado Medical Center. Twenty-four patients with limited metastatic NSCLC (fewer than or equal to six sites of disease including the primary) who had progressed through at least one systemic therapy regimen were treated with SBRT to all sites of gross disease and the EGFR inhibitor erlotinib with progression free survival the primary end point. The results of the study were very significant, with a PFS in this study cohort of 14.7 months, compared to historical ranges of 2-4 months, and an OS of 20.4 months, compared to historical ranges of 6-9 months for this same patient population. The SBRT treatments were found to be very safe and efficacious – only 3 out of 47 measurable lesions irradiated recurred with a concomitant shift in failure patterns from local to distant sites. As importantly, EGFR status was evaluated in 13 patient tumors, with none harboring the most common mutations. One could, therefore, predict that with a mutation enriched population, the combination of EGFR inhibitor and SBRT may have offered even greater PFS and OS benefits. Our observations also suggest that the SBRT treatments probably contributed the most to the dramatic PFS and OS outcomes.

These findings were published in the Journal of Clinical Oncology in the December 1, 2014 print issue with an accompanying editorial.

Continue reading

Lung Cancer Survival Improved By Thoracic Radiotherapy

Prof. dr. B.J. Slotman VU University Medical Center Cancer Center Amsterdam NetherlandsMedicalResearch.com Interview wth:
Prof. dr. B.J. Slotman
VU University Medical Center Cancer Center
Amsterdam Netherlands

Medical Research: What are the main findings of this study?

Prof. Slotman: This randomized trial showed that the use of thoracic radiotherapy in patients with extensive stage small cell lung cancer reduces the risk of intrathoracic progression by about 50% and improves 2 years survival from 3 to 13%.

Continue reading

Nasal Cavity Malignancies: Charged Particle Therapy May Be Superior To Conventional Photon Therapy

Dr. Robert Foote MD Chair, Department of Radiation Oncology Mayo Clinic, Rochester, MNMedicalResearch.com Interview with:
Dr. Robert Foote MD
Chair, Department of Radiation Oncology
Mayo Clinic, Rochester, MN

MedicalResearch: What are the main findings of the study?

Dr. Foote: Charged particle therapy (mainly protons and carbon ions) provide superior overall survival, disease-free survival and tumor control when compared to conventional photon therapy.  In particular, it appears that proton beam therapy provides superior disease-free survival and tumor control when compared to the state of the art intensity modulated radiation therapy using photons.

Continue reading

Pediatric Oncology: Radiation Free Imaging Test as Alternative to PET/CT Scans

Dr Heike Daldrup-Link Associate Professor of Radiology Stanford University School of Medicine, Palo AltoMedicalResearch.com: Interview with:
Dr Heike Daldrup-Link
Associate Professor of Radiology
Stanford University School of Medicine, Palo Alto

 

MedicalResearch.com: What are the main findings of the study?

Answer: We use magnetic resonance imaging, a technology based on magnetic fields rather than radiotracers or x-rays. The underlying technology is not new – it has been used for tumor staging for many years. This is an advantage as MR scanners are available in nearly every major Children’s Hospital where children with cancer are treated. What is new about our approach is that we combined anatomical and functional images, similar to current approaches that use radiotracers and CT (PET/CT):  We first acquired scans that showed the anatomy of the patient very well and we then acquired scans that depict tumors as bright spots with little or no background information. We did that by using an iron supplement as a contrast agent: The iron supplement can be detected by the MRI magnet and improved tumor detection and vessel delineation MR scans. We then fused the anatomical scans with the tumor scans.
Continue reading

Proton Therapy Radiation: Decreased Need for Feeding Tubes in Oropharnygeal Cancer Patients

Steven J. Frank, M.D., associate professor of Radiation Oncology at The University of Texas MD Anderson Proton Therapy CenterMedicalResearch.com Interview with:

Steven J. Frank, M.D., associate professor of Radiation Oncology at The University of Texas MD Anderson Proton Therapy Center discusses the findings of his latest study, “Gastrostomy Tubes Decrease by Over 50% with Intensity Modulated Proton Therapy during the Treatment of Oropharyngeal Cancer Patients.”


MedicalResearch.com: What are the main findings of the study?

Dr. Frank: The study found that the use of feeding tubes in oropharyngeal carcinoma (OPC) cancer patients treated with intensity modulated proton therapy (IMPT) decreased by more than 50% percent compared to patients treated with intensity modulated radiation therapy (IMRT). This suggests that proton therapy may offer vital quality of life benefits for patients with tumors occurring at the back of the throat.

Of the 50 OPC patients enrolled in the study:

  • Twenty-five patients were treated with IMPT and 25 received IMRT.
  • Five patients treated with IMPT required the use of feeding tubes (20%) compared to 12 patients treated with IMRT (48%).
  • IMPT patients were spared from serious side effects, usually a result of IMRT, such as loss of taste, vomiting, nausea, pain, mouth and tongue ulcers, dry mouth, fatigue, and swallowing difficulty.
  • IMPT patients could better sustain their nutrition and hydration levels, often leading to faster recovery during and after treatment.

IMPT is an advanced form of proton radiation therapy and a treatment currently only offered in North America at The University of Texas MD Anderson Proton Therapy Center. It delivers protons to the most complicated tumors by focusing a narrow proton beam and essentially “painting” the radiation dose onto the tumor layer by layer. Unlike IMRT, which destroys both cancerous and healthy cells, IMPT has the ability to destroy cancer cells while sparing surrounding healthy tissue from damage. Therefore, important quality of life outcomes such as neurocognitive function, vision, swallowing, hearing, taste and speech can be preserved in head and neck patients.
Continue reading

Cancer Risk from Imaging Radiation in Ischemic Heart Disease

Prof. Dr. Gunnar Brix Division of Medical and Occupational Radiation Protection Federal Office for Radiation Protection Institut für Med. Strahlenhygiene 85764 NeuherbergMedicalResearch.com:
Prof. Dr. Gunnar Brix

Division of Medical and Occupational Radiation Protection
Federal Office for Radiation Protection
Institut für Med. Strahlenhygiene
85764 Neuherberg
MedicalResearch.com:  What are the main findings of the study?

Answer: We investigated the cumulative radiation exposure and cancer risk of more than 1200 patients with ischemic heart diseases (IHD) from diagnostic and therapeutic imaging procedures performed 3 month before and 12 month after the date of diagnosis. The major findings were:

  • ­    87% of patient exposure resulted from heart catheter procedures.
  • ­    The average cumulative effective dose was 13.3 mSv in males and 10.3 mSv in females. The highest dose was nearly 100 mSv.
  • ­    The estimated average attributable life-time risk of male and female patients to develop a radiation-induced cancer in their remaining life was 0.09 % and  0.07 %, respectively. This correspond to 1 excess cancer in about 1100 male and 1400 female IHD patients. The highest risk was 0.9 %.
  • ­ The effective dose is inadequate to characterize individual radiation risks, since neither the age nor the sex of the patient is taken into account. According to our results, cancer risks can vary by a factor of more than 10 for comparable values of the effective dose. Continue reading

Predictors of depression in breast cancer patients treated with radiation: Role of prior chemotherapy and nuclear factor kappa B

MedicalResearch.com Interview with Mylin A. Torres, M.D.
Assistant Professor
Department of Radiation Oncology
Emory University School of Medicine
Atlanta, GA 30322

MedicalResearch.com: What are the main findings of the study? 

Dr. Torres: Radiation treatment for breast cancer is not associated with increased depressive symptoms, but of disease and treatment-related factors, prior chemotherapy treatment is a significant predictor of depression before and after radiation treatment.  Prior chemotherapy treatment was associated with inflammatory mediators, including nuclear factor-kappa B DNA binding, soluble tumor necrosis factor-alpha receptor 2, and interleukin-6, which predicted for depressive symptoms after radiation on univariate analysis.
Continue reading