 |
|
Identification of highly radiosensitive patients may lead to side effect-free radiotherapy
September 24, 2009Berlin, Germany: An international group of scientists has taken the first step on the road to targeting radiotherapy dosage to individual patients by means of their genetic characteristics, a radiation oncologist told Europe's largest cancer congress, ECCO 15 - ESMO 34 [1], in Berlin today (Thursday September 24). Professor Dirk de Ruysscher, from Maastricht University Medical Centre, Maastricht, The Netherlands, said that his team's work might provide the basis for personalised radiotherapy in which, with a simple blood test, doctors may be able to select the optimal radiation dose for a particular patient.
The team of scientists from The Netherlands, Belgium, Germany, and Canada studied a group of patients with hypersensitivity to radiation therapy, drawn from the largest world-wide database available - the European Union-funded Genetic pathways for the prediction of the effect of irradiation (GENEPI) study, which integrates biological material with patient data and treatment specifications. The database included information from more than 8000 European patients.
"Part of this project is the establishment of a sub-database in which very rare patient characteristics are brought together with the hypothesis that their genetic traits will enable the characterisation of molecular pathways related to radio-sensitivity," explained Professor de Ruysscher. "A major problem for radiation oncologists at present is that we are bound by the need to avoid damage to normal tissues. This means that the dose of radiation generally used is governed by the response of the most radiosensitive patients, and this may lead to many patients receiving lower than optimal doses, hence affecting the ability to deliver a higher dose that may result in better local tumour control."
A tissue bank including skin fibroblasts (the structural framework of skin cells), whole blood, lymphocytes (white blood cells involved in the immune system), plasma, and lymphoblastic (immature lymphocyte) cell lines from patients who were known to be hypersensitive to radiation was established from patients in Europe and Canada.
When compared with a control group, also drawn from the GENEPI study, the hypersensitive patients showed either severe side effects occurring at very low radiation levels, or severe side effects lasting for more than four weeks after the end of radiotherapy and/or requiring surgery, or severe late side effects occurring or persisting more than 90 days after the end of radiotherapy.
The scientists identified 33 such patients, 10 males and 23 females, of whom 11 (two males and nine females) ultimately proved to be really hypersensitive to radiation, underlining the rarity of this condition. Their mean age was 61.6  8.5 years (range 49 - 74). One patient had non-small cell lung cancer, six breast cancer, two head and neck cancer and one lymphoma. The radiation doses, the overall treatment times, and the follow-up times all fell within the usual parameters.
"The severe side effects included acute skin reactions, extreme skin thickening or fibrosis, lung tissue inflammation and blindness due to optical nerve damage," said Professor de Ruysscher. "Although radiotherapy is a highly effective way of treating cancer, it is important that we are able to identify the patients who will react badly to it and adjust their dosage accordingly."
Radiotherapy works by causing DNA damage in cells in a particular area so that they destroy themselves. Because cancer cells reproduce more and are undifferentiated (lacking the ability to become a more specialised cell type), they are less able to repair the damage caused by radiotherapy than are differentiated, normal cells which can usually repair themselves. However, some of the normal cells surrounding the treatment site may also be damaged during radiotherapy, and it is this damage that leads to side effects.
Scientists already know that different types of tumours respond differently to radiotherapy; highly radiosensitive cancer cells such as leukaemias can be killed by quite low radiation doses, whereas melanomas need such a high dose that it would be unsafe to use radiation therapy in this case. The finding that individuals, as well as tumours, react differently will enable doctors in the future to target doses even more carefully, taking into account not just the radiosensitivity of the tumour type but also the potential reaction of the particular patient to treatment.
"We hope that the EU will fund a successor project to elucidate genetic pathways in combination with other patient data so that we can make predictive models that can be implemented in standard clinical practice," said Professor de Ruysscher. "We believe that, if we can understand what it is going on at a molecular level, we may be able to develop a blood test that will allow us to know precisely how an individual patient will react to radiotherapy, and to target the dose accordingly. Such personalised treatment will be a major advance, allowing us to minimise both radiotherapy doses and unpleasant side effects, while treating the tumour in the most effective way possible. Perhaps even more importantly, it will enable us to give higher doses to many patients and hence improve control of their tumours."
###
Abstract no: 2007, Radiotherapy and Radiobiology session, Thursday 10.45 hrs CEST (Hall 15.3)
[1] ECCO 15 - ESMO 34 is the 15th congress of the European CanCer Organisation and the 34th congress of the European Society for Medical Oncology.
ECCO-the European CanCer Organisation
A tissue bank including skin fibroblasts (the structural framework of skin cells), whole blood, lymphocytes (white blood cells involved in the immune system), plasma, and lymphoblastic (immature lymphocyte) cell lines from patients who were known to be hypersensitive to radiation was established from patients in Europe and Canada.
When compared with a control group, also drawn from the GENEPI study, the hypersensitive patients showed either severe side effects occurring at very low radiation levels, or severe side effects lasting for more than four weeks after the end of radiotherapy and/or requiring surgery, or severe late side effects occurring or persisting more than 90 days after the end of radiotherapy.
The scientists identified 33 such patients, 10 males and 23 females, of whom 11 (two males and nine females) ultimately proved to be really hypersensitive to radiation, underlining the rarity of this condition. Their mean age was 61.6  8.5 years (range 49 - 74). One patient had non-small cell lung cancer, six breast cancer, two head and neck cancer and one lymphoma. The radiation doses, the overall treatment times, and the follow-up times all fell within the usual parameters.
"The severe side effects included acute skin reactions, extreme skin thickening or fibrosis, lung tissue inflammation and blindness due to optical nerve damage," said Professor de Ruysscher. "Although radiotherapy is a highly effective way of treating cancer, it is important that we are able to identify the patients who will react badly to it and adjust their dosage accordingly."
Radiotherapy works by causing DNA damage in cells in a particular area so that they destroy themselves. Because cancer cells reproduce more and are undifferentiated (lacking the ability to become a more specialised cell type), they are less able to repair the damage caused by radiotherapy than are differentiated, normal cells which can usually repair themselves. However, some of the normal cells surrounding the treatment site may also be damaged during radiotherapy, and it is this damage that leads to side effects.
Scientists already know that different types of tumours respond differently to radiotherapy; highly radiosensitive cancer cells such as leukaemias can be killed by quite low radiation doses, whereas melanomas need such a high dose that it would be unsafe to use radiation therapy in this case. The finding that individuals, as well as tumours, react differently will enable doctors in the future to target doses even more carefully, taking into account not just the radiosensitivity of the tumour type but also the potential reaction of the particular patient to treatment.
"We hope that the EU will fund a successor project to elucidate genetic pathways in combination with other patient data so that we can make predictive models that can be implemented in standard clinical practice," said Professor de Ruysscher. "We believe that, if we can understand what it is going on at a molecular level, we may be able to develop a blood test that will allow us to know precisely how an individual patient will react to radiotherapy, and to target the dose accordingly. Such personalised treatment will be a major advance, allowing us to minimise both radiotherapy doses and unpleasant side effects, while treating the tumour in the most effective way possible. Perhaps even more importantly, it will enable us to give higher doses to many patients and hence improve control of their tumours."
###
Abstract no: 2007, Radiotherapy and Radiobiology session, Thursday 10.45 hrs CEST (Hall 15.3)
[1] ECCO 15 - ESMO 34 is the 15th congress of the European CanCer Organisation and the 34th congress of the European Society for Medical Oncology.
ECCO-the European CanCer Organisation
Radiotherapy Current Events and Radiotherapy News RSSStudy of concurrent radiotherapy, chemotherapy shows promise in small cell lung cancer
Treating limited stage small cell lung cancer(LSCL) with a combination of accelerated high-dose radiotherapy and chemotherapy has shown encouraging results.
Blood vessels might predict prostate cancer behavior
A diagnosis of prostate cancer raises the question for patients and their physicians as to how the tumor will behave. Will it grow quickly and aggressively and require continuous treatment, or slowly, allowing therapy and its risks to be safely delayed?
Stereotactic radiotherapy offers noninvasive, effective treatment for frail patients with early-stage lung cancer
Stereotactic body radiation therapy (SBRT) should be considered a new standard of care for early-stage lung cancer treatment in patients with co-existing medical problems, according to results from a national clinical trial led by UT Southwestern Medical Center physicians.
Short-term hormone therapy and intermediate dose radiation increases survivial for early stage prostate cancer
Short-term hormone therapy given prior to and during intermediate dose radiation treatment for men with early stage prostate cancer increases their chance of living longer, compared to those who receive the same radiation alone.
Herbal tonic for radiotherapy
Antioxidant extracts of the leaves of the Gingko biloba tree may protect cells from radiation damage, according to a study published in the International Journal of Low Radiation.
Exercise reduces fatigue in cancer patients undergoing chemotherapy
Supervised exercise programmes that include high and low intense cardiovascular and resistance training can help reduce fatigue in patients with cancer who are undergoing adjuvant chemotherapy or treatment for advanced disease.
Although more older women receive breast-conserving therapy, gaps in treatment exist
According to a new study published in the October issue of the Journal of the American College of Surgeons, although breast-conserving surgery (BCS), commonly known as lumpectomy, is increasingly being used to treat older women with nonmetastatic invasive breast cancer, there are still significant socioeconomic and geographic disparities in the use of this type of therapy.
Prediction model superior to traditional criteria in bladder treatment decision
A statistical model can accurately predict which patients will have poor outcomes after bladder surgery and can determine the need for chemotherapy.
New Approach for the Treatment of Malignant Brain Tumors
Initial chemotherapy alone after surgery is just as successful as initial radiation therapy for patients from whom a very malignant brain tumor (anaplastic glioma) was removed. With this treatment, the patients survive on average > 30 months without a recurrence.
Mayo Clinic Researchers Find Few Side Effects from Radiation Treatment Given After Prostate Cancer Surgery
The largest single-institution study of its kind has found few complications in prostate cancer patients treated with radiotherapy after surgery to remove the prostate.
More Radiotherapy Current Events and Radiotherapy News Articles
 |
Practical Radiotherapy Planning by Ann, M.D. Barrette (Author), Jane Dobbs (Author), Stephen Morris (Author), Tom Roques (Author) Planning is a critical stage of radiotherapy. Careful consideration of the complex variables involved and critical assessment of the techniques available are fundamental to good and effective practice. First published in 1985, Practical Radiotherapy Planning has, over three editions, established itself as the popular choice for the trainee raditation oncologist and radiographer, providing the 'nuts and bolts' of planning in a practical and accessible manner. This fourth edition encompasses a wealth of new material, reflecting the radical change in the practice of radiotherapy in recent years. The information contained within the introductory chapters has been expanded and brought up to date, and a new chapter on patient management has been added. CT stimulators, MLC shieldings and dose... |
 |
Handbook of Radiation Oncology: Basic Principles and Clinical Protocols by Bruce Haffty (Author), Lynn Wilson (Author) Whether you are a practicing radiation oncologist, resident in radiation oncology, fellow in any oncology discipline, or a student of medicine, nursing, physics, dosimetry, or therapy, this handbook is a valuable resource covering the issues most pertinent to patients undergoing radiation therapy. Handbook of Radiation Oncology covers general oncologic principles, workup, staging, and multidisciplinary aspects of treatment, basic principles of physics and radiobiology, and specific technologies including brachytherapy, radiosurgery, and unsealed sources. Specific Topics Covered Include: Physics of Radiation Oncology Classic and Molecular Biolgical Basis of Radiation Oncology Clinical Principals of Radiation Oncology and Multidisciplinary Care Radiation Oncology Treatment of All... |
 |
Radiation Oncology: An Evidence-Based Approach (Medical Radiology / Radiation Oncology) by Jiade J. Lu (Editor), Jiade J. Lu (Editor), Luther W. Brady (Editor), Luther W. Brady (Editor), Luther W. Brady (Editor), Hans-Peter Heilmann (Editor), Michael Molls (Editor), Carsten Nieder (Editor) Radiation Oncology: An Evidence-Based Approach (ROEBA) is a reference book designed to enable radiation oncologists, including those in training, to make diagnostic and treatment decisions on the basis of the best available scientific evidence. Ease of use is ensured by a structured, reader-friendly format that offers rapid access to evidence-based recommendations. ROEBA’s orientation is entirely practical, in that the focus is solely on diagnostic/staging and treatment issues. Detailed diagnostic and therapeutic guidelines are provided for multidisciplinary cancer management as well as radiation therapy techniques. The evidence underlying each recommendation is clearly and concisely explained, and the strength of the recommendations and evidence is systemically graded. Furthermore,... |
 |
Perez and Brady's Principles and Practice of Radiation Oncology by Edward C Halperin (Editor), Carlos A Perez (Editor), Luther W Brady (Editor), David E Wazer (Editor), Carolyn Freeman (Editor) The thoroughly updated Fifth Edition of this landmark work has been completely overhauled to better represent the rapidly changing field of radiation oncology. This edition has an updated interior design including full-color throughout, and a new corresponding Website featuring the fully searchable text with all the images. This comprehensive textbook provides an understanding of every aspect of radiation oncology—the natural history of cancer, the physical methods of radiation application, the effects of irradiation on normal tissues, and site-specific applications of radiation therapy either as a single modality or as part of a multimodality treatment program. This edition places greater emphasis on use of radiation oncology in palliative and supportive care as well as therapy.... |
 |
Handbook of Evidence-based Radiation Oncology by Eric K. Hansen (Editor), Mack III Roach (Editor) This handbook serves as a portable reference that utilizes evidence-based medicine as the basis for practical treatment recommendations and guidelines. Organized by body site, concise clinical chapters provide easy access to critical information. Important "pearls" of epidemiology, anatomy, pathology, and clinical presentation are highlighted. Key facets of the work-up are listed, followed by staging and/or risk classification systems. Treatment recommendations are discussed based on stage, histology, and/or risk classification. Brief summaries of key trials and studies provide rationale for the recommendations. Practical guidelines for radiation techniques are described. Finally, complications and follow-up guidelines are outlined. Appendices are included as well to allow quick... |
 |
Radiotherapy in Practice: External Beam Therapy by Peter Hoskin (Editor) External beam therapy is the most common form of radiotherapy, delivering ionizing radiation such as high-energy x-rays, gamma rays or electron beams directly into the location of the patient's tumour. The beam is generated externally, with no radioactive sources placed within the patient's body. The beams aim at destroying the cancer cells with minimal impact on the surrounding healthy tissue. The radiation oncologist will choose between different ways of administering the beams, such as linear accelerators, cobalt machines, or ortho-voltage x-ray machines. The three distinct stages of simulation, planning and treatment are critical to ensuring the highest rate of success. This book is an essential, practical guide to the use of external beam radiotherapy, highlighting the rapid... |
 |
Radiotherapy for Head and Neck Cancers: Indications and Techniques by K. Kian Ang (Author), Adam S Garden (Author) Long established as a staple reference for all radiation oncologists, Radiotherapy for Head and Neck Cancers: Indications and Techniques is now in its Third Edition. This completely updated edition presents the state-of-the-art protocols currently used at the M.D. Anderson Cancer Center and thoroughly explains the principles, nomenclature, and clinical use of intensity-modulated radiotherapy (IMRT). New full-color illustrations have been added throughout the book. The first section discusses the practical aspects of external beam therapy, brachytherapy, and endocavitary beam therapy and offers guidelines on patient care before and during radiotherapy. The second section provides detailed coverage of site-specific indications and techniques. |
 |
Practical Radiotherapy: Physics and Equipment by Pam Cherry (Editor), Angela Duxbury (Editor) Practical Radiotherapy introduces the reader to the physics and equipment that is central to radiotherapy practice. This Second Edition has been extensively revised and is fully up to date with key developments in equipment and practice, namely: stereotacic radiosurgery, CT SIM and SIM CT, portal imaging, MLC and HDR brachytherapy. Practical Radiotherapy is written by an experienced team of practitioners and teachers who present a difficult and dry subject in a reader-friendly manner, covering all of the required core information. |
 |
Radiation Oncology: Rationale, Technique, Results (Expert Consult Title: Online + Print) by James D. Cox MD FACR (Author), Kie Kian Ang MD PhD (Author) Radiation Oncology: Rationale, Technique, Results, by James D. Cox, MD and K. Kian Ang, MD, PhD, provides you with authoritative guidance on the latest methods for using radiotherapy to treat patients with cancer. Progressing from fundamental principles through specific treatment strategies for the cancers of each organ system, it also addresses the effects of radiation on normal structures and the avoidance of complications. This 9th edition covers the most recent indications and techniques in the field, including new developments in proton therapy and intensity-modulated radiotherapy (IMRT). It also features, for the first time, full-color images throughout the text to match those that you see in practice, and uses new color-coded treatment plans to make targets, structures, and doses... |
 |
A Guide for Delineation of Lymph Nodal Clinical Target Volume in Radiation Therapy by Giampiero Ausili Cefaro (Editor), Carlos A. Perez (Editor), Domenico Genovesi (Editor), Annamaria Vinciguerra (Editor) Conformal radiotherapy offers the opportunity to enhance precise delivery of high dose radiation to the target volume while maintaining normal tissues doses at acceptable tolerance levels. This technique requires an exact definition of the treatment volumes: gross tumour volume (GTV), clinical target volume (CTV) and planning target volume (PTV). For this reason, it is important to have a very good knowledge of radiological anatomy and natural history of the disease. In particular, CTV is a tissue volume that contains the macroscopic disease with the surrounding areas suspected of subclinical involvement (CTV) and regional lymph nodes (CTV2). Delivery of adequate doses of irradiation to lymph nodes at risk, enhances treatment outcome and selective irradiation of them decreases... |
| © 2009 BrightSurf.com |