Radiotherapy and New Biological Paradigms in Cancer Treatments

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (23 May 2023) | Viewed by 8344

Special Issue Editors


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Guest Editor
Department of Radiation Oncology and Nuclear Medicine, AULSS 9 Scaligera, Verona, Italy
Interests: combination of immune checkpoint inhibitors and radiotherapy; radiation oncology and immunity; radiation oncology; immunotherapy; inflammation
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Oncology and Experimental Biology, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
Interests: combination of immune checkpoint inhibitors and radiotherapy; radiation oncology and immunity; radiation oncology; immunotherapy; inflammation

Special Issue Information

Dear Colleagues,

Radiotherapy is an important modality used in the treatment of more than 50% of cancer patients. However, despite sophisticated techniques for radiation delivery, as well as the combination of radiation with chemotherapy, tumors can recur.

In a cancer cell-centric view, radiotherapy is used against tumors because it determines a cell injury and, so, a cell death. The central dogma of traditional radiobiology states that the cytotoxic effects of radiation on tumor cells are primarily due to the production of DNA double-strand breaks followed by some form of cell death, including apoptosis, necrosis, autophagy, mitotic catastrophe, or replicative senescence. In accordance, DNA damage and subsequent tumor cell kill has been ascribed to 4 basic principles (known as the 4 “Rs” of radiobiology): reassortment of tumor cells into radiosensitive phases of the cell cycle (G2/M), reoxygenation of hypoxic areas within a tumor, repair of sublethal DNA damage, and repopulation of surviving tumor cells; whereby, the manipulation of each factor alters tumor cell radiosensitivity.

Against this background, there is an abscopal effect (defined as “an action at a distance from the irradiated volume but within the same organism”) that it is not explainable within the aforementioned traditional radiotherapy view.  

Nowadays, there is more information about cancer and, above all, the interaction between the tumor and host is considered essential on all sides. Tumor cells must interact with the host microenvironment and avoid immune destruction.

In most patients, however, radiation therapy can convert the tumor into an “in situ vaccine” able to induce a de novo anticancer immune response. The radiation-induced cell death is followed by the release of tumor antigens together with pro-inflammatory signals. First, it was demonstrated that cell death is an efficient process to transfer antigens from tumor cells to dendritic cells which, in turn, are required to activate tumor-specific T cells. Moreover, in recent years, a functional redefinition of cell death, based on its effects on immune cells (ie, tolerance or activation), has emerged as the “immunogenic cell death”.

This Special Issue will highlight the current state of the art in the immunostimulatory activity of radiotherapy, its role on tumor microenvironment and new paradigm of action.

Dr. Francesco Fiorica
Dr. Carlotta Giorgi
Guest Editors

Manuscript Submission Information

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Keywords

  • radiobiology
  • immunity
  • immunogenic cell death
  • cancer therapy

Published Papers (5 papers)

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Research

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17 pages, 1189 KiB  
Article
Results of a 20 Year Retrospective Analysis of Early-Stage Cervical Cancer: Should 3 cm Be Considered the New Ariadne’s Thread in Early Cervical Cancer Treatment?
by Benjamin Serouart, Abel Cordoba, Carlos Martinez-Gomez, Emilie Bogart, Marie Cecile Le Deley, Éric Leblanc, Delphine Hudry, Alexandre Escande, Florence Le Tinier, Camille Pasquesoone, Sophie Taieb, Houssein El Hajj and Fabrice Narducci
Cancers 2023, 15(5), 1570; https://doi.org/10.3390/cancers15051570 - 02 Mar 2023
Cited by 1 | Viewed by 1688
Abstract
(1) This study aims to evaluate the overall survival (OS) and recurrence-free survivals (RFS) and assess disease recurrence of early-stage cervical cancer (ESCC) patients treated with minimally invasive surgery (MIS). (2) This single-center retrospective analysis was performed between January 1999 and December 2018, [...] Read more.
(1) This study aims to evaluate the overall survival (OS) and recurrence-free survivals (RFS) and assess disease recurrence of early-stage cervical cancer (ESCC) patients treated with minimally invasive surgery (MIS). (2) This single-center retrospective analysis was performed between January 1999 and December 2018, including all patients managed with MIS for ESCC. (3) All 239 patients included in the study underwent pelvic lymphadenectomy followed by radical hysterectomy without the use of an intrauterine manipulator. Preoperative brachytherapy was performed in 125 patients with tumors measuring 2 to 4 cm. The 5-year OS and RFS rates were 92% and 86.9%, respectively. Multivariate analysis found two significant factors associated with recurrence: previous conization with HR = 0.21, p = 0.01, and tumor size > 3 cm with HR = 2.26, p = 0.031. Out of the 33 cases of disease recurrence, we witnessed 22 disease-related deaths. Recurrence rates were 7.5%, 12.9%, and 24.1% for tumors measuring ≤ 2 cm, 2 to 3 cm, and > 3 cm, respectively. Tumors ≤ 2 cm were mostly associated with local recurrences. Tumors > 2 cm were frequently associated with common iliac or presacral lymph node recurrences. (4) MIS may still be considered for tumors ≤ 2 cm subject to first conization followed by surgery with the Schautheim procedure and extended pelvic lymphadenectomy. Due to the increased rate of recurrence, a more aggressive approach might be considered for tumors > 3 cm. Full article
(This article belongs to the Special Issue Radiotherapy and New Biological Paradigms in Cancer Treatments)
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11 pages, 2553 KiB  
Article
Region-Specific Effects of Fractionated Low-Dose Versus Single-Dose Radiation on Hippocampal Neurogenesis and Neuroinflammation
by Zoé Schmal and Claudia E. Rübe
Cancers 2022, 14(22), 5477; https://doi.org/10.3390/cancers14225477 - 08 Nov 2022
Cited by 2 | Viewed by 1440
Abstract
Background: Despite technical advances in hippocampus-sparing radiotherapy, radiation-induced injury to neural stem cell compartments may affect neurocognitive functions. In pre-clinical mouse models with fractionated low-dose radiation (FLDR) and single-dose radiation (SDR), the accurate response to radiation-induced injury was analyzed in different hippocampal subregions. [...] Read more.
Background: Despite technical advances in hippocampus-sparing radiotherapy, radiation-induced injury to neural stem cell compartments may affect neurocognitive functions. In pre-clinical mouse models with fractionated low-dose radiation (FLDR) and single-dose radiation (SDR), the accurate response to radiation-induced injury was analyzed in different hippocampal subregions. Methods: Adult and juvenile C57BL/6NCrl mice were exposed to FLDR (20 × 0.1 Gy, daily exposure from Monday to Friday for 4 weeks) or SDR (1 × 2 Gy). In addition, 72 h after the last exposure, neuroglia (astrocytes and microglia) and neuroprogenitor cells were characterized and quantified in the hippocampal cornu ammonis (CA) and dentate gyrus (DG) by immunofluorescence studies. Results: After analyzing different hippocampal subregions, it was observed that radiation responses varied between non-neurogenic CA, with no detectable inflammatory alterations, and neurogenic DG, characterized by impaired neurogenesis and subsequent neuroinflammation. Age-dependent differences in radiosensitivity appeared to depend on the varying proliferative potential of neural stem cell niches. Using the same overall dose for FLDR and SDR (2 Gy), both the cumulative dose over time and also the single dose fraction have decisive impacts on hippocampal damage. Conclusion: Region-specific effects of radiation-induced hippocampal injury relies primarily on cell deaths of proliferating neuroprogenitors. Dose per fraction defines the extent of neuronal injury, and subsequently activated microglia and reactive astrocytes modulate dynamic processes of neuroinflammation. Thus, limiting both cumulative doses and dose fractions to hippocampal DG is an important issue of clinical radiotherapy to preserve neurocognitive functions. Full article
(This article belongs to the Special Issue Radiotherapy and New Biological Paradigms in Cancer Treatments)
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11 pages, 1590 KiB  
Article
Risk of Diabetes Mellitus after Radiotherapy for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma
by Joongyo Lee, Hong In Yoon, Jihun Kim, Jaeho Cho, Kyung Hwan Kim and Chang-Ok Suh
Cancers 2022, 14(17), 4110; https://doi.org/10.3390/cancers14174110 - 25 Aug 2022
Cited by 1 | Viewed by 1198
Abstract
The long-term effect of radiation on the pancreas in pediatric patients has been studied without individual radiation dosimetric data. This study investigated the effect of radiotherapy on the risk of developing diabetes mellitus (DM) in patients with gastric mucosa-associated lymphoid tissue lymphoma (GML), [...] Read more.
The long-term effect of radiation on the pancreas in pediatric patients has been studied without individual radiation dosimetric data. This study investigated the effect of radiotherapy on the risk of developing diabetes mellitus (DM) in patients with gastric mucosa-associated lymphoid tissue lymphoma (GML), using individual radiation dosimetric analysis. Retrospective analysis reviewed the data of 225 patients without a history of DM receiving curative treatment for stage IE GML. Involved-site radiotherapy was delivered to the whole stomach in 83 patients. The pancreas was delineated in each patient’s computed tomography scan for dosimetric analysis. At a median follow-up of 49.0 months, the 5-year cumulative incidence of DM was 4.5%, 9.6%, and 1.6% in all patients, patients who received radiotherapy, and patients who did not receive radiotherapy, respectively (p = 0.009). Mean pancreatic dose (Dmean; p = 0.009), sex (p = 0.043), and body mass index (BMI; p = 0.008) were independently associated with DM. Using recursive partitioning analysis, patients were classified into low, intermediate, and high-risk groups, with 5-year DM incidence rates of 0.0%, 3.1%, and 15.6%, respectively (p < 0.001). Incidental irradiation of the pancreas can increase the risk of DM, which may be stratified according to patient sex and BMI. Full article
(This article belongs to the Special Issue Radiotherapy and New Biological Paradigms in Cancer Treatments)
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13 pages, 1309 KiB  
Article
Escalated Maximum Dose in the Planning Target Volume Improves Local Control in Stereotactic Body Radiation Therapy for T1-2 Lung Cancer
by Takaya Inagaki, Hiroshi Doi, Naoko Ishida, Aritoshi Ri, Saori Tatsuno, Yutaro Wada, Takuya Uehara, Masahiro Inada, Kiyoshi Nakamatsu, Makoto Hosono and Yasumasa Nishimura
Cancers 2022, 14(4), 933; https://doi.org/10.3390/cancers14040933 - 13 Feb 2022
Cited by 11 | Viewed by 2199
Abstract
Stereotactic body radiotherapy (SBRT) is a treatment option for early-stage lung cancer. The purpose of this study was to investigate the optimal dose distribution and prognostic factors for local control (LC) after SBRT for lung cancer. A total of 104 lung tumors from [...] Read more.
Stereotactic body radiotherapy (SBRT) is a treatment option for early-stage lung cancer. The purpose of this study was to investigate the optimal dose distribution and prognostic factors for local control (LC) after SBRT for lung cancer. A total of 104 lung tumors from 100 patients who underwent SBRT using various treatment regimens were analyzed. Dose distributions were corrected to the biologically effective dose (BED). Clinical and dosimetric factors were tested for association with LC after SBRT. The median follow-up time was 23.8 months (range, 3.4–109.8 months) after SBRT. The 1- and 3-year LC rates were 95.7% and 87.7%, respectively. In univariate and multivariate analyses, pathologically confirmed squamous cell carcinoma (SQ), T2 tumor stage, and a Dmax < 125 Gy (BED10) were associated with worse LC. The LC rate was significantly lower in SQ than in non-SQ among tumors that received a Dmax < 125 Gy (BED10) (p = 0.016). However, there were no significant differences in LC rate between SQ and non-SQ among tumors receiving a Dmax ≥ 125 Gy (BED10) (p = 0.198). To conclude, SQ, T2 stage, and a Dmax < 125 Gy (BED10) were associated with poorer LC. LC may be improved by a higher Dmax of the planning target volume. Full article
(This article belongs to the Special Issue Radiotherapy and New Biological Paradigms in Cancer Treatments)
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24 pages, 18665 KiB  
Review
TP53 and the Ultimate Biological Optimization Steps of Curative Radiation Oncology
by Anders Brahme
Cancers 2023, 15(17), 4286; https://doi.org/10.3390/cancers15174286 - 27 Aug 2023
Cited by 2 | Viewed by 1017
Abstract
The new biological interaction cross-section-based repairable–homologically repairable (RHR) damage formulation for radiation-induced cellular inactivation, repair, misrepair, and apoptosis was applied to optimize radiation therapy. This new formulation implies renewed thinking about biologically optimized radiation therapy, suggesting that most TP53 intact normal tissues are [...] Read more.
The new biological interaction cross-section-based repairable–homologically repairable (RHR) damage formulation for radiation-induced cellular inactivation, repair, misrepair, and apoptosis was applied to optimize radiation therapy. This new formulation implies renewed thinking about biologically optimized radiation therapy, suggesting that most TP53 intact normal tissues are low-dose hypersensitive (LDHS) and low-dose apoptotic (LDA). This generates a fractionation window in LDHS normal tissues, indicating that the maximum dose to organs at risk should be ≤2.3 Gy/Fr, preferably of low LET. This calls for biologically optimized treatments using a few high tumor dose-intensity-modulated light ion beams, thereby avoiding secondary cancer risks and generating a real tumor cure without a caspase-3-induced accelerated tumor cell repopulation. Light ions with the lowest possible LET in normal tissues and high LET only in the tumor imply the use of the lightest ions, from lithium to boron. The high microscopic heterogeneity in the tumor will cause local microscopic cold spots; thus, in the last week of curative ion therapy, when there are few remaining viable tumor clonogens randomly spread in the target volume, the patient should preferably receive the last 10 GyE via low LET, ensuring perfect tumor coverage, a high cure probability, and a reduced risk for adverse normal tissue reactions. Interestingly, such an approach would also ensure a steeper rise in tumor cure probability and a higher complication-free cure, as the few remaining clonogens are often fairly well oxygenated, eliminating a shallower tumor response due to inherent ion beam heterogeneity. With the improved fractionation proposal, these approaches may improve the complication-free cure probability by about 10–25% or even more. Full article
(This article belongs to the Special Issue Radiotherapy and New Biological Paradigms in Cancer Treatments)
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