Science Current Events | Science News | Brightsurf.com
 

Researchers discover how to overcome poor response to radiotherapy caused by low haemoglobin levels

May 11, 2012
Results from a randomized trial in head and neck cancer

Barcelona, Spain: Patients with head and neck cancer and a low haemoglobin (Hb) level do not respond well to radiotherapy and therefore both control of their tumour and disease-free survival are compromised. Now researchers from The Netherlands have found that the problems caused by low Hb in these patients can be overcome by the use of a treatment known as ARCON therapy, in which accelerated radiotherapy is combined with carbogen (a mixture of carbon dioxide and oxygen) and the water-soluble vitamin nicotinamide [1].

Hans Kaanders, a professor of translational radiation oncology at Radboud University Nijmegen Medical Centre, Nijmegen, will tell the 31st conference of the European Society for Radiotherapy and Oncology [2] today (Friday) that the ARCON regime is the first to show a positive effect in patients with low Hb levels.

The researchers recruited 345 patients with squamous cell laryngeal cancer to a randomised trial: 174 received only accelerated radiotherapy (where two fractions per day are administered during the last week of radiotherapy in order to reduce the overall length of treatment), and 171 ARCON. Patients receiving ARCON inhaled carbogen during radiotherapy and took nicotinamide tablets prior to treatment. Pre-treatment Hb levels in the experimental group were measured and subsequently compared with the treatment outcomes in the accelerated radiotherapy alone arm.

They found that patients treated with accelerated radiotherapy alone who had normal Hb levels before treatment had significantly better control of the cancer at its primary site (76% as opposed to 56%), disease-free survival (72% and 48% respectively), and metastasis-free survival (90% and 70%) than those with low Hb levels.

"However, when we looked at the ARCON group, in cases where the patients had low Hb levels before treatment, we found that ARCON improved control of the cancer at its primary site, and improved disease-free and metastasis-free survival, so that the differences between them and patients with normal Hb levels were no longer significant," says Professor Kaanders' colleague Dr. Geert Janssens. The difference in local control between this low Hb group and the normal Hb accelerated radiotherapy (AR) alone group was only 1% (81% in the ARCON group versus 82% in the AR-only group); for disease-free survival, the difference was 77% (ARCON) as opposed to 70% (AR); and for metastasis-free survival 93% (ARCON) versus 89% (AR).

However, patients in both groups with low Hb levels pre-treatment still had a worse overall survival irrespective of which treatment they received. This is most likely due the fact that many patients with head and neck cancer also have other health problems that cannot be treated by radiotherapy, the researchers say.

"In the past, a number of investigators have tried to improve the outcome for patients with low Hb levels by giving erythropoietin, which stimulates red blood cell production, and red cell blood transfusion before and during treatment, but without success. ARCON is the first treatment to be found to correct for low Hb and therefore to improve prognosis in these patients," says Dr. Janssens. "We know that a decrease in Hb levels is associated with a reduced sensitivity to radiotherapy, and that this can switch the tumour microenvironment into a more aggressive subtype with a higher risk of loco-regional failure and of the development of distant metastases."

The lack of success with transfusion of red blood cells or erythropoietin suggests underlying adaptive mechanisms. Accelerated radiotherapy to counteract tumour cell repopulation during radiotherapy, combined with carbogen and nicotinamide, administered immediately before irradiation to increase the oxygen level, ensures that adaptive mechanisms cannot erode the effect, and this is probably the key to success of the ARCON regime in patients with low HB levels at presentation, the researchers say.

"We believe that, at a time when healthcare systems are under increasing pressure to introduce expensive targeted treatments, the use of such a low cost, effective therapy should only be encouraged," Professor Kaanders will conclude.

Prof Vincenzo Valentini, radiation oncologist at the Policlinico Universitario A. Gemelli in Rome, Italy, and President of ESTRO, said: "We know that the degree of oxygenation of tumours in laryngeal cancer patients is directly related to the damage that can be caused to them by radiotherapy. This important study shows that, in patients with low haemoglobin levels, it is possible to reoxygenate the tumour by using the simple and cost-effective ARCON regime, and therefore increase the effectiveness of radiation treatment."

###

Abstract no: OC 217, 10.30 hrs, Friday 11 May, Auditorium

[1] When carbogen is inhaled, the increased level of carbon dioxide causes the brain to react to potential suffocation because it interprets the increase in blood carbon dioxide as a decrease in oxygen level, and the body compensates by reducing hypoxia. Nicotinamide also reduces hypoxia by increasing blood flow.

[2] This year the ESTRO conference is held in parallel with the World Congress of Brachytherapy, both taking place in Barcelona from May 9-13.

European Society for Radiotherapy and Oncology (ESTRO)


Related Radiotherapy Current Events and Radiotherapy News Articles


Blocking DNA repair mechanisms could improve radiation therapy for brain cancer
UT Southwestern Medical Center researchers have demonstrated in both cancer cell lines and in mice that blocking critical DNA repair mechanisms could improve the effectiveness of radiation therapy for highly fatal brain tumors called glioblastomas.

Trastuzumab emtansine: indication of major added benefit in metastatic breast cancer with previous anthracycline therapy
The antibody-drug conjugate trastuzumab emtansine (trade name: Kadcyla) has been approved since November 2013 for the treatment of patients with unresectable, locally advanced or metastatic breast cancer that is HER2-positive, i.e. that overexpresses the human epidermal growth factor receptor 2.

Prognosis of tumors positive for human papilloma virus in head and neck cancers varies according to the site
Patients with cancer of the throat and who are positive for the Human Papilloma virus (HPV+) have a good prognosis, but until now the effect of being HPV+ on the prognosis of tumours located elsewhere in the head and neck was unknown.

Helium ions may provide superior, better-targeted treatment in pediatric radiotherapy
For the first time, researchers have been able to demonstrate that the use of helium ions in radiation therapy could provide accurate treatment to tumours while helping to spare healthy organs.

Increased risk of developing lung cancer after radiotherapy for breast cancer
Women who have radiotherapy for breast cancer have a small but significantly increased risk of subsequently developing a primary lung tumour, and now research has shown that this risk increases with the amount of radiation absorbed by the tissue.

Six months hormone therapy in addition to radiotherapy improves prostate cancer survival
Men with prostate cancer that is small and confined to the prostate gland but that is at risk of growing and spreading, do better if they are treated with radiotherapy combined with androgen deprivation therapy, which lowers their levels of the male hormone, testosterone, according to new research.

Call for more awareness of sexual dysfunction in lung cancer patients
Many lung cancer patients suffer difficulties with sexual expression and intimacy, yet for too long the topic has been ignored by doctors and researchers, experts have said at the 4th European Lung Cancer Conference (ELCC).

Radiation therapy and cancer vaccines: Timing is everything
Radiation therapy fights cancer in more ways than one. Not only does it force cancer cells to self-destruct, but several studies demonstrate that it also activates the immune system to attack tumor cells.

Increased risk of early relapse when radiotherapy is omitted for early PET negative patients with stage I/II Hodgkin lymphoma
Interim analysis of the intergroup EORTC-LYSA-FIL 20051 H10 trial published in the Journal of Clinical Oncology indicates an increased risk of early relapse when omitting radiotherapy in early PET scan negative patients with stage I/II Hodgkin's lymphoma.

Primary androgen deprivation therapy ineffective for most men with early prostate cancer
A study of more than 15,000 men with early stage prostate cancer finds that those who received androgen deprivation as their primary treatment instead of surgery or radiation did not live any longer than those who received no treatment.
More Radiotherapy Current Events and Radiotherapy News Articles

Radiotherapy for Head and Neck Cancers: Indications and Techniques

Radiotherapy for Head and Neck Cancers: Indications and Techniques
by K. Kian Ang MD PhD (Author), Adam S. Garden MD (Author)


Long established as a staple reference for all radiation oncologists, Radiotherapy for Head and Neck Cancers: Indications and Techniques is now in its Fourth Edition. This completely updated edition presents the state-of-the-art protocols currently used at the MD Anderson Cancer Center and thoroughly explains the principles, nomenclature, and clinical use of intensity-modulated radiotherapy (IMRT). 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.

CT Anatomy for Radiotherapy

CT Anatomy for Radiotherapy
by Pete Bridge (Author)


Knowledge of CT anatomy is increasingly vital in daily radiotherapy practice, especially with more widespread use of cross-sectional image-guided radiotherapy (IGRT) techniques. Existing CT anatomy texts are predominantly written for the diagnostic practitioner and do not always address the radiotherapy issues while emphasising structures that are not common to radiotherapy practice. “CT Anatomy for Radiotherapy” is a new radiotherapy-specific text that is intended to prepare the reader for CT interpretation for both IGRT and treatment planning. It is suitable for undergraduate students, qualified therapy radiographers, dosimetrists and may be of interest to oncologists and registrars engaged in treatment planning. All essential structures relevant to radiotherapy are described...

Perez & Brady's Principles and Practice of Radiation Oncology (Perez and Bradys Principles and Practice of Radiation Oncology)

Perez & Brady's Principles and Practice of Radiation Oncology (Perez and Bradys Principles and Practice of Radiation Oncology)
by Edward C. Halperin MD (Author), Luther W. Brady MD (Author), Carlos A. Perez MD (Author), David E. Wazer MD (Author)


Inside the Sixth Edition of this now-classic reference, you will discover encyclopedic coverage of topics ranging from basic science to sophisticated computer-based radiation therapy treatment planning and supportive care. The book’s comprehensive scope and abundantly illustrated format provide you with better understanding of the natural history of cancer, the physical methods of radiation application, the effects of radiation on normal tissues, and the most judicious ways in which you can employ radiation therapy in patient care. Traditionally available as a printed textbook, now it comes with a completely revamped digital experience, powered by Inkling! NEW to the Sixth Edition…• Site-specific chapters include relevant background information on each tumor—including...

Practical Radiotherapy Planning Fourth Edition

Practical Radiotherapy Planning Fourth Edition
by Ann Barrett (Author), Jane Dobbs (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...

External Beam Therapy (Radiotherapy in Practice)

External Beam Therapy (Radiotherapy in Practice)
by Peter Hoskin (Author)


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. External Beam Therapy, Second Edition is an essential, practical guide to the use of external beam radiotherapy, highlighting the rapid technological advances made in recent years. It provides a firm background to the physics of external beam radiotherapy, taking the reader through the basic principles and discussing issues such as quality assurance.

Experts within each field then expand upon techniques for treatment delivery within each anatomical site, covering indications, treatment and planning. This new edition also includes information on Stereotactic radiotherapy and coverage...

Target Volume Delineation and Field Setup: A Practical Guide for Conformal and Intensity-Modulated Radiation Therapy

Target Volume Delineation and Field Setup: A Practical Guide for Conformal and Intensity-Modulated Radiation Therapy
by Nancy Y. Lee (Editor), Jiade J. Lu (Editor)


This handbook will enable radiation oncologists to appropriately and confidently select and delineate tumor volumes/fields for conformal radiation therapy, including intensity-modulated radiation therapy (IMRT), in patients with commonly encountered cancers. The orientation of this handbook  is entirely practical, in that the focus is on the illustration of clinical target volume (CTV) delineation for each major malignancy. Each chapter provides guidelines and concise knowledge on treatment planning and CTV selection, explains how the anatomy of lymphatic drainage shapes target volume selection, and presents detailed illustrations of delineations, slice by slice, on planning CT images. While the emphasis is on target volume delineation for three-dimensional conformal therapy and IMRT,...

Handbook of Evidence-Based Radiation Oncology

Handbook of Evidence-Based Radiation Oncology
by Eric Hansen (Editor), Mack Roach III (Editor)


Building on the success of this book's first edition, Dr. Eric Hansen and Dr. Mack Roach have updated, revised, and expanded the Handbook of Evidence-based Radiation Oncology, 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...

Treatment Planning in Radiation Oncology

Treatment Planning in Radiation Oncology
by Faiz M Khan PhD (Author), Bruce J. Gerbi PhD (Author)


Updated specifically for the latest in sophisticated radiation oncology treatment modalities, the Third Edition of Treatment Planning in Radiation Oncology provides a comprehensive discussion of the clinical, physical, and technical aspects of treatment planning.

The Physics of Radiation Therapy

The Physics of Radiation Therapy
by Faiz M. Khan PhD (Author)


Dr. Khan's classic textbook on radiation oncology physics is now in its thoroughly revised and updated Fourth Edition. It provides the entire radiation therapy team—radiation oncologists, medical physicists, dosimetrists, and radiation therapists—with a thorough understanding of the physics and practical clinical applications of advanced radiation therapy technologies, including 3D-CRT, stereotactic radiotherapy, HDR, IMRT, IGRT, and proton beam therapy. These technologies are discussed along with the physical concepts underlying treatment planning, treatment delivery, and dosimetry. This Fourth Edition includes brand-new chapters on image-guided radiation therapy (IGRT) and proton beam therapy. Other chapters have been revised to incorporate the most recent developments in the field....

Delineating Organs at Risk in Radiation Therapy

Delineating Organs at Risk in Radiation Therapy
by Giampiero Ausili Cèfaro (Author), Domenico Genovesi (Author), Carlos A. Perez (Author)


Defining organs at risk is a crucial task for radiation oncologists when aiming to optimize the benefit of radiation therapy, with delivery of the maximum dose to the tumor volume while sparing healthy tissues. This book will prove an invaluable guide to the delineation of organs at risk of toxicity in patients undergoing radiotherapy. The first and second sections address the anatomy of organs at risk, discuss the pathophysiology of radiation-induced damage, and present dose constraints and methods for target volume delineation. The third section is devoted to the radiological anatomy of organs at risk as seen on typical radiotherapy planning CT scans, with a view to assisting the radiation oncologist to recognize and delineate these organs for each anatomical region – head and neck,...

© 2014 BrightSurf.com