CyberKnife固定与可变准直器颅内SRT计划质量及执行效率应用评价

目的 探讨与评价运用第5代CyberKnife VSI系统中固定(Fixed)和可变(Iris)准直器实施颅内肿瘤SRT时计划质量的剂量学特性。方法 选择20例颅内肿瘤患者分为A、B两组,A、B组分别为小、大体积靶区组,每组10例,统一靶区剂量21 Gy分3次。分别对每例患者选择Fixed和Iris准直器进行治疗计划设计。通过靶区CI、HI、GI、GSI与OAR等剂量学参数,分析评估SRT计划优化质量及实施效率,从而评价两套准直器的束流特性情况。采用配对t检验分析其差异。结果 Iris计划执行的平均时间明显优于Fixed计划(A组P=0.001;B组P=0.000)。B组中低剂量区(20%、10%处方剂量)体积Fixed计划明显低于Iris计划(P=0.001、0.009)。对于OAR,B组中视通路Dmin及眼球Dmean、Dmin具有统计学差异(P均<0.05),A组中仅视交叉Dmin具有统计学意义(P=0.043)。对于靶区相关参数两组均相近(P均>0.05)。结论 利用第5代CyberKnife VSI系统治疗颅内小体积肿瘤时,Iris与Fixed准直器相比,除治疗时间明显缩短外无明显剂量学特性差异。对体积较大且形状复杂的肿瘤靶区,Iris计划虽然正常器官限量在允许范围内,但其低剂量区体积要明显略高于Fixed计划。而对于两种准直器更深层次剂量学特性,仍需更多病例进一步研究可能。     

自动uARC计划在食管癌同步推量放疗中的可行性研究

目的比较联影计划系统中食管癌同步推量自动uARC计划与人工计划的剂量学和放射生物学参数差异, 为临床应用提供参考。方法选取100例同步推量食管癌患者的优质uARC计划, 统计靶区和危及器官的剂量学参数均值, 建立联影计划系统uRT-TPOIS智能计划的优化目标表。另选取21例食管癌病例作为测试病例, 使用uRT-TPOIS计划系统分别设计人工计划和自动uARC计划。比较两种计划靶区的平均剂量Dmean、PTV的近似最小剂量D98%和近似最大剂量D2%、均匀性指数(HI)、适形指数(CI)、危及器官剂量、平均计划时间、机器跳数(MU)、肿瘤控制概率(TCP)和正常组织并发症概率(NTCP)的差异。符合正态分布的数据采用配对t检验比较两组数据的差异, 不符合的采用非参数Wilcoxon检验。结果自动uARC计划的靶区D98%(PTV60 Gy:P<0.001, PTV54 Gy:P=0.001)、CI(PTV60 Gy:P<0.001, PTV54 Gy:P=0.002)和处方剂量覆盖靶区体积(V54 Gy:P<0.001)均优于人工计划, 而Dmean和HI的差异无统计...     

IMRT和SRT大分割治疗肺部肿瘤的剂量分布研究

目的 比较肺部肿瘤调强放疗(IMRT)和立体定向放疗(SRT)的大分割治疗计划的剂量分布特点,为临床治疗优选方案提供依据.方法 对近1年内收治的16例采用大分割IMRT的肺部肿瘤(非小细胞肺癌6例和肺转移癌lO例)患者设计处方剂量与治疗间隔相似的SRT计划,采用剂量体积直方图评价IMRT和SRT计划对靶区和正常组织照射剂量等以及适形指数(CI)和不均匀指数(HI).结果 患者采用大分割IMRT和SRT计划时PTV接受的平均剂量分别为6282.1 cGy和6340.6 cGy(t=-0.93,P>0.05),均一化剂量分别为6366.7 cGy和6246.8 cGy(t=-1.18,P>0.05),CI平均值分别为0.78和0.57(t=2.77,P<0.05),HI平均值分别为1.12和1.32(t=-4.38,P<0.01).IMRT和SRT计划的平均全肺组织受照剂量分别为(492.4±368.5)cGy和(310.0±73.1)cGy(t=1.68,P>0.05),全肺V20分别为6.9%±2.1%和4.2%±1.9%(t=3.30,P<0.01).IMRT和SRT计划的心脏和脊髓平均受照剂量无差别.结论 PTV最大径<4.7 cm、靶体积<57 cm3、靶区呈圆形或类圆形时,SRT靶区剂量与大分割IMRT接近并可满足临床要求;SRT计划正常肺组织受照剂量低于大分割IMRT计划.     

容积旋转调强放疗中射野等中心选择对宫颈癌剂量学的影响

目的:采用容积旋转调强技术设计放疗计划,选择不同的射野等中心进行优化,讨论射野等中心的改变对宫颈癌容积旋转调强放疗剂量学的影响。方法:随机选取宫颈癌术后患者15例,在同一套CT图像上设计不同的VMAT计划,根据宫颈癌病例靶区几何形状特点,选择不同等中心位置制定四组不同计划,分别为:计划等中心为靶区几何中心,称为Center计划;计划等中心为靶区几何中心y方向上移9 cm,称为Y计划,计划等中心为靶区几何中心x方向左移7 cm,称为X计划,计划靶区几何中心y方向上移9 cm再向x方向左移7 cm,称为X-Y计划。比较分析四种方案的靶区及危及器官的剂量学参数。结果:Center和Y计划能够满足临床靶区及危及器官限量。相较于Center计划, Y、X、X-Y计划靶区覆盖率分别降低了0.36%、15.48%和6.52%;Y计划的适形度指数（CI）、均匀性指数（HI）、脊髓的Dmax、膀胱的V40、直肠的V40均优于 X计划和X-Y计划,差异具有统计学意义（P＜0.05）。结论:宫颈癌术后病例的VMAT计划设计中,使用不同等中心设计计划,与等中心位置在几何中心相比,向y轴方向偏移,对靶区和危及器官的影响较小,变化范围在临床可接受范围之内;而等中心位置向x轴方向偏移,对靶区和危及器官影响较大。     

双侧乳腺癌保乳术后单射野中心与双射野中心容积旋转调强放疗的剂量学比较

目的∶研究双侧乳腺癌保乳术后采用单射野中心与双射野中心容积旋转调强放射治疗的剂量学差异。方法∶ 随机选取2017年1月1日至2020年6月30日云南省肿瘤医院双侧乳腺癌保乳术后患者8例,女性,年龄33～ 65 岁,中位年龄49岁。用 Monaco计划系统为每例患者分别设计单射野中心和双射野中心放射治疗计划,双侧乳腺癌双靶区处方剂量均给予50Gy/25次。比较两组计划靶区（planning target volume,PTV）的覆盖率、适形指数（cn- formiy index,C）、均匀性指数（homgeneity index,HI）以及危及器官（orgams a rik,OAR）的剂量分布和放疗计划设计时间和机器跳数（moito units,MU）的差异。结果∶双射野中心组与单射野中心组相比,PTV的Dg、D.差别不大,双射野中心CI劣于单射野中心组,但差异均无统计学意义（P>0.05）,而双射野中心组PTV的其他剂量学指标包括D。、Ds。、D2、D_和HI均明显优于单射野中心组,差异均有统计学意义（P<0.05）;在OAR保护方面,双射野中心组的计划方案能降低脊髓的最大剂量,明显降低肺、心脏和肝脏等危及器官受照体积和平均剂量,差异均有统计学意义（P<0.05）;单射野中心组放疗计划设计时间较双射野中心组缩短（P<0.05）、机器跳数MU 稍低（P>0. 05）。结论∶两组放疗计划均能满足临床要求,两组计划 PTV的靶区覆盖率、平均剂量差别不大。双射野中心组PTV的适形度稍差一些,但剂量分布更均匀、对 OAR 的保护更有优势。单射野中心组放疗实施效率高一些,但该类型患者太少,优势可以忽略。对于双侧乳腺癌保乳术后的容积旋转调强放疗建议优先考虑双射野中心技术。     

多发性肝癌质子放射治疗剂量学研究

目的 被动散射质子治疗(passive-scattering proton therapy,PSPT)是临床最常用的质子放疗方式.调强质子治疗(intensity modulated proton therapy,IMPT)实现了剂量强度的调制,能进一步优化剂量分布,但在多发性肝癌中是否有优势尚不明确.本研究比较PSPT和IMPT在多发性肝癌中靶区剂量分布和正常肝脏受量的差异,为临床应用提供剂量学参考.方法 2013-08-10-2015-11-25淄博万杰肿瘤医院诊断为多发性肝癌患者10例,CT定位扫描,勾画靶区和周围正常组织,分别制定PSTP计划和IMPT计划,两个计划的处方剂量均为60 Gy.应用剂量体积直方图(dosevolume histogram,DVH)比较2种不同质子治疗技术靶区的剂量分布和正常肝脏组织的受照剂量.结果 IMPT计划靶区的均匀性指数(homogeneity index,HI,t=3.563,P=0.006)和适形指数(conformal index,CI,t=-7.444,P＜0.001)均优于PSPT计划,差异均有统计学意义.IMPT计划正常肝脏V5(t=6.751,P＜0.001)、V10(Z=-2.803,P-0.005)、V15(t=7.232,P＜0.001)、V20(t=9.694,P＜0.001)、V25(Z=-2.803,P=0.005)、V30(t=8.407,P＜0.001)、V35(t=11.667,P＜0.001)、V40(Z=-2.803,P=0.005)和正常肝脏平均剂量(mean dose to normal liver,MDTNL,Z=-2.803,P=0.005)均明显低于PSPT计划,差异有统计学意义.结论 IMPT能改善多发性肝癌靶区的剂量分布,并降低正常肝脏的受照剂量,为临床应用提供了重要依据.IMPT有望提高多发性肝癌放疗疗效并降低并发症.     

3D打印非共面模版引导125I粒子植入治疗头颈部肿瘤个体化设计与应用

目的 对比3D打印非共面模板引导¹²⁵I粒子植入治疗头颈部肿瘤的术前、术后计划的物理剂量学参数,探索头颈部肿瘤放射性粒子植入治疗用个体化模板设计方法的安全性、可行性、精确性。方法 2016年1月-2016年12月于北京大学第三医院接受3D打印模板辅助CT引导放射性¹²⁵I粒子植入的头颈部复发/转移恶性肿瘤的患者42例。处方剂量110~160Gy,设计制作3D打印非共面模板42块,对比术前、术后物理剂量学参数,包括D90、最小周边剂量(mPD)、V100、V150、V200、适形指数(CI)、靶区外体积指数(EI)、均匀性指数(HI)。结果 为42例患者设计、制作的42块导板术中就位良好,与术前计划相比,术后D90、V100、CI、EI、HI均相近(P=0.490、0.407、0.893、0.143、0.079),mPD、V150、V200不同(P=0.036、0.007、0.000)。结论 术后验证的主要剂量学指标较好地达到了术前计划要求,有良好的治疗精确性,可以满足临床需求。     

3D打印非共面模版引导125I粒子植入治疗头颈部肿瘤个体化设计与应用

目的 对比3D打印非共面模板引导¹²⁵I粒子植入治疗头颈部肿瘤的术前、术后计划的物理剂量学参数,探索头颈部肿瘤放射性粒子植入治疗用个体化模板设计方法的安全性、可行性、精确性。方法 2016年1月-2016年12月于北京大学第三医院接受3D打印模板辅助CT引导放射性¹²⁵I粒子植入的头颈部复发/转移恶性肿瘤的患者42例。处方剂量110~160Gy,设计制作3D打印非共面模板42块,对比术前、术后物理剂量学参数,包括D90、最小周边剂量(mPD)、V100、V150、V200、适形指数(CI)、靶区外体积指数(EI)、均匀性指数(HI)。结果 为42例患者设计、制作的42块导板术中就位良好,与术前计划相比,术后D90、V100、CI、EI、HI均相近(P=0.490、0.407、0.893、0.143、0.079),mPD、V150、V200不同(P=0.036、0.007、0.000)。结论 术后验证的主要剂量学指标较好地达到了术前计划要求,有良好的治疗精确性,可以满足临床需求。     

五种光子放疗设备在胰腺癌立体定向放疗中剂量学比较

目的 比较射波刀、螺旋断层治疗(Tomo)、Edge加速器、Trilogy加速器和伽马刀5种设备在胰腺癌立体定向放疗中剂量学上的优劣。方法 回顾分析10例射波刀治疗的胰腺癌患者临床资料,分别由5家单位5种设备按照统一计划设计要求进行计划设计。完成后的计划统一导入MIM软件平台提取评估参数。主要参数包括计划靶区的Dmin、Dmean、Dmax、适形指数(CI和nCI)、均匀指数(HI)、梯度指数(GI)、覆盖率和胃肠Dmax及体积剂量等。结果 Trilogy获得最优CI和nCI (P<0.001);伽马刀HI最差(P<0.001);GI射波刀最优,伽马刀次之,Tomo和Edge相对最弱(P<0.001);Edge加速器和Trilogy加速器获得最大PTV Dmin值,射波刀和Tomo组获得较小PTV Dmin值(P<0.001);伽马刀组获得了最大的PTV Dmax、Dmean(P<0.001)。危及器官方面,射波刀组获得最低的空回肠Dmax及D5cm³(P<0.001)、胃Dmax(P=0.003)、十二指肠Dmax(P=0.001)、D5cm³(P<0.001)及D10cm³(P=0.005)、脊髓Dmax及D0.35cm³(P<0.001);伽马刀组空回肠Dmax最大;Edge加速器组十二指肠D5cm³最高(P<0.001);Tomo组脊髓Dmax及D0.35cm³最高(P<0.001)。结论 5种放疗设备均能很好地完成满足临床要求的胰腺癌立体定向放疗计划。射波刀和伽马刀拥有更优的剂量跌落梯度,Trilogy加速器和Edge加速器拥有更优的靶区适形性,射波刀胃肠道剂量保护相对更优。     

局部晚期鼻咽癌诱导化疗后勾画靶区对危及器官剂量及疗效影响

目的 局部晚期鼻咽癌按照诱导化疗后肿瘤体积勾画靶区安全性仍存在争议,研究局部晚期鼻咽癌诱导化疗后勾画靶区和危及器官(organs at risk,OAR),分析大体肿瘤靶区(gross tumor volume,GTV)变化对靶区适形性指数(conformity index,CI)、均匀性指数(homogeneity index,HI)和OAR剂量的影响,并观察近期疗效与不良反应,为局部晚期鼻咽癌诱导化疗后勾画靶区安全性进行临床研究.方法 收集2012-01-01-2012-12-31钦州市第一人民医院肿瘤科收治的46例局部晚期鼻咽癌患者,采用紫杉醇(paclitaxel,PTX)联合顺铂(DDP)诱导化疗2个周期,按化疗后影像勾画GTV及OAR,逆向5野调强适形(intensity-modulated radiotherapy,IMRT)设野,对2次放疗计划靶体积差值及剂量学差异行配对检验;同期DDP每周方案化疗,观察不良反应与近期疗效.结果 诱导化疗前后原发灶鼻咽部GTV(GTVnx)平均体积分别为(83.85±22.64)和(42.87±15.41) cm3,t=-5.905,P=0.001;颈淋巴结GTV(GTVnd)分别为(85.93±31.20)和(44.96±19.01) cm3,t=--5.905,P=0.001;化疗后GTVnx靶区CI(t=-2.311,P=0.021)和HI(t=-3.297,P=0.001)均好于化疗前靶区;化疗后GTVnd靶区CI(t=-2.907,P=0.001)和HI(t=-4.643,P=0.001)均好于化疗前靶区.诱导化疗后脑干、脊髓、眼球、颞叶、腮腺所受最大剂量(t=-5.905,P=0.001)和平均剂量(t=-5.834,P=0.001)降低,差异有统计学意义;3年局部控制率(local control rate,LCR)、无远处转移生存率(distantmetastasis free survival,DMFS)、无瘤生存率(disease-free survival,DFS)和总生存率(overall survival,OS)分别为91.3％、86.9％、80.4％和89.1％.诱导化疗后同步放化疗白细胞减少发生率为100.0％,Ⅲ～Ⅳ级者54.2％;口腔黏膜炎发生率为100.0％,Ⅲ级者30.4％;皮肤反应发生率为97.9％,Ⅲ级者54.2％;恶心呕吐发生率为93.5％,Ⅲ级者19.6％.结论 鼻咽癌TP方案诱导化疗后肿瘤体积缩小,按化疗后病灶勾画GTV的IMRT,CI和HI可接受;OAR最大剂量和平均剂量减小,OAR得到较好保护;诱导化疗后同步放化疗不良反应发生率高、程度略重,可耐受;近期疗效较好,远期疗效需进一步观察.     

New and emerging radiosensitizers and radioprotectors

The combination of chemotherapy and radiation has led to clinical breakthroughs in several disease sites, and current work continues to define optimum combinations of proven chemotherapy as well as more recently available, noncytotoxic agents. Administration of systemic therapies allows modulation of radiation response to improve tumor control (radiosensitization) or to prevent normal tissue toxicity (radioprotection). Substantial progress has been made in identifying the targets of standard chemotherapeutic radiation sensitizers and protectors as well as in the introduction of a new generation of molecularly targeted therapies in combination with radiation. We have reviewed the most recent, predominantly early phase clinical trials combining systemic agents with radiation. Although the proof of an improved schedule ultimately needs to come from well-run Phase III trials, the search among schedules could be shortened by the use of surrogate endpoints such as presence of active drug metabolites in the tumor. This has been accomplished only in a few cases and needs to become a more standard part of radiation sensitizer and protector trials.     

Fruit and vegetables and cancer risk

The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established. For cancers of the upper gastrointestinal tract, epidemiological studies have generally observed that people with a relatively high intake of fruit and vegetables have a moderately reduced risk, but these observations must be interpreted cautiously because of potential confounding by smoking and alcohol. For lung cancer, recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and reduced risk. For other common cancers, including colorectal, breast and prostate cancer, epidemiological studies suggest little or no association between total fruit and vegetable consumption and risk. It is still possible that there are benefits to be identified: there could be benefits in populations with low average intakes of fruit and vegetables, such that those eating moderate amounts have a lower cancer risk than those eating very low amounts, and there could also be effects of particular nutrients in certain fruits and vegetables, as fruit and vegetables have very varied composition. Nutritional principles indicate that healthy diets should include at least moderate amounts of fruit and vegetables, but the available data suggest that general increases in fruit and vegetable intake would not have much effect on cancer rates, at least in well-nourished populations. Current advice in relation to diet and cancer should include the recommendation to consume adequate amounts of fruit and vegetables, but should put most emphasis on the well-established adverse effects of obesity and high alcohol intakes.     

Occupational and environmental radiation and cancer

Epidemiologic evidence on the relation between occupational and environmental radiation and cancer is reviewed. Studies of pioneering radiation workers, underground miners, and radium dial painters revealed excess cancer deaths and contributed to the setting of radiation protection standards and to theories of carcinogenesis. Occupational exposures today are generally much lower than in the past, thus any associated increases in cancer will be difficult to detect. Pooling investigations of these more recently exposed workers, however, has the potential to validate current estimates of risk used in radiation protection. New information on the effects of chronic radiation exposure also may come from studies in the former Soviet Union of Chernobyl clean-up workers and of workers at the Mayak nuclear facilities. Studies of environmental radiation exposures, other than radon, are largely inconclusive, due mainly to the difficulties in detecting the low risks associated with low dose exposures. Thyroid cancer, however, has been linked to environmental radiation from the Chernobyl accident and from nuclear weapons tests. Low-level radiation released during normal operations at nuclear plants has not been found to increase cancer rates in surrounding populations. Radon, a human carcinogen, is the most ubiquitous exposure to human populations; remediating high residential-radon levels is recommended, recognizing that the exposure can never be removed completely because it occurs naturally.     

VEGF及KDR在大肠腺瘤和腺癌中的表达及意义

目的：探讨VEGF和KDR在大肠腺瘤和大肠腺癌中的表达及临床病理特征的关系。方法：大肠腺瘤和大肠腺癌组织标本各100例,采用免疫组织化学染色法检测VEGF和KDR在标本中的表达情况。结果：VEGF和KDR在大肠腺癌组中的阳性表达明显高于大肠腺瘤组（P〈0.05）;在正常大肠黏膜均未见VEGF和KDR表达的阳性染色;VEGF阳性表达组中KDR的阳性表达率为70%,显著高于VEGF阴性表达组中KDR的阳性表达率16%,两组比较有统计学意义（P〈0.01）。结论：大肠腺癌组织中KDR的表达与肿瘤大小、转移情况、浸润深度密切相关;VEGF和KDR在大肠腺瘤中的表达与患者的年龄、性别及分型均无相关性,而与增生程度相关（P〈0.05）。在大肠腺癌患者中VEGF及KDR表达更高,二者具有协同效应。     

Vitamin D and melanoma and non-melanoma skin cancer risk and prognosis: A comprehensive review and meta-analysis

Vitamin D is formed mainly in the skin upon exposure to sunlight and can as well be taken orally with food or through supplements. While sun exposure is a known risk factor for skin cancer development, vitamin D exerts anti-proliferative and pro-apoptotic effects on melanocytes and keratinocytes in vitro. To clarify the role of vitamin D in skin carcinogenesis, we performed a review of the literature and meta-analysis to evaluate the association of vitamin D serum levels and dietary intake with cutaneous melanoma (CM) and non-melanoma skin cancer (NMSC) risk and melanoma prognostic factors. Twenty papers were included for an overall 1420 CM and 2317 NMSC. The summary relative risks (SRRs) from random effects models for the association of highest versus lowest vitamin D serum levels was 1.46 (95% confidence interval (CI) 0.60–3.53) and 1.64 (95% CI 1.02–2.65) for CM and NMSC, respectively. The SRR for the highest versus lowest quintile of vitamin D intake was 0.86 (95% CI 0.63–1.13) for CM and 1.03 (95% CI 0.95–1.13) for NMSC. Data were suggestive of an inverse association between vitamin D blood levels and CM thickness at diagnosis. Further research is needed to investigate the effect of vitamin D on skin cancer risk in populations with different exposure to sunlight and dietary habits, and to evaluate whether vitamin D supplementation is effective in improving CM survival.     

Religiosity and Physical and Emotional Functioning Among African American and White Colorectal and Lung Cancer Patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

肾上腺素能β受体与肿瘤生长及转移

大量研究表明肿瘤细胞可表达β受体，而一些神经递质、药物和社会心理因素可能通过β受体影响肿瘤的生长和转移，β受体激动剂、β受体阻滞剂以及抑郁等社会心理因素可加强或削弱这种作用。这为表达β受体肿瘤的治疗开辟了新的道路，提供了新的治疗靶点。     

Cell and tissue interactions in carcinogenesis and metastasis and their clinical significance

This review describes a new vision for future directions in the study of metastatic cancer biology and pathology. It is based upon clinical and experimental observations on the constituent cell lineages within a neoplasm and on tumour-host interactions. The vision incorporates information from studies in population biology, developmental biology and experimental pathology as well as investigations upon human malignant disease. The assembled information reveals that invasion and metastasis are supra-cellular manifestations of "emergent behavior" among combinations of normal and malignant cell lineages in vivo. Emergent behavior is a combinatorial interactive process in which a population displays new traits which cannot be achieved by individuals acting separately and which subside when the specific population mix disaggregates. Disruption of such pathological interactions in the field of a developing primary or secondary tumour is, therefore, required to disable the malignant population and arrest progression without tissue destruction. These conclusions originate, in part, from principles which govern the sociobiology and group behavior of bees, ants, fish, birds and human societies. In all these social organisms, external factors can disrupt signaling mechanisms and induce expanding self-perpetuating rogue behavior, leading to social disintegration. These principles also apply to cellular societies composing higher animals, which likewise need intrinsic rules to maintain social order and avoid anarchy, and recognition of this is essential for advancing future research on the mechanisms involved in carcinogenesis and metastasis. Summarised evidence is presented here to support the conclusion that miscommunications between cells and tissues in the region of the developing tumour and its metastases are the main direct perpetrators of malignant disease. Genetic lesions (mutations, deletions, translocations, reduplications, etc.), commonly seen in cancers, can significantly disrupt important molecular pathways in the networks of communications needed to sustain orderly tissue/organ structure and function. However, genetic lesions can also, themselves, be induced by abnormal cell interactions initiated by extrinsic carcinogenic agents such as chemicals, viruses, hormones and radiation. The evidence shows that, irrespective of the initiating cause, it is this miscommunication in the region of a developing tumour and its metastases that is ultimately responsible for the emergence and progression of the disease. The article describes how this information collectively, provides a framework for designing specific novel therapeutic approaches targeting the cell and tissue interactions driving tumour metastasis and its manifold effects on the whole body.