Malnutrition and cachexia in patients with head and neck cancer treated with (chemo)radiotherapy

AimTo highlight the problems associated with nutrition that occur in patients with squamous cell carcinoma of the head and neck (SCCHN).BackgroundSCCHN is associated with weight loss before, during and after radiotherapy or concurrent chemoradiotherapy. Because of serious consequences of malnutrition and cachexia on treatment outcome, mortality, morbidity, and quality of life, it is important to identify SCCHN patients with increased risk for the development of malnutrition and cachexia.Materials and methodsCritical review of the literature.ResultsThis review describes pathogenesis, diagnosis and treatment of malnutrition and cancer cachexia. Treatment of malnutrition and cancer cachexia includes nutritional interventions and pharmacological therapy. Advantages and disadvantages of different nutritional interventions and their effect on the nutritional status, quality of life and specific oncological treatment are presented.ConclusionsNutritional management is an essential part of care of these patients, including early screening, assessment of nutritional status and appropriate intervention.     

Dosimetric characterization of INTRABEAM® miniature accelerator flat and surface applicators for dermatologic applications

PurposeThis study aims at characterizing the dosimetric behavior of an INTRABEAM^® miniature accelerator equipped with flat and surface applicators, converting the spherical dose distribution into a flat one.MethodsDosimetric characterization was carried out in two steps. Firstly characterization was made in standard conditions for dermatologic applications, which is with the applicator directly on contact with the skin. Secondly, characterization was made in more clinical conditions, such as obliquities and heterogeneities.ResultsBehaviors of flat and surface applicators are different. Dose distribution for surface applicators is uniform at surface, whereas for flat applicator the maximum homogeneity is shown at a particular depth in water. Some results are different from previously published studies due to differences in the X-ray source design. The study showed that in the absence of a perfect contact between the applicator and the skin of the patient, there is a dose distribution spread on the edge of the irradiation field where the contact is not made. Dose loss due to lack of backscatter radiations is significant. By contrast, influence of a denser material behind the measurement point has no significant influence on the dose at this point. Thickness of tissue treated with flat and surface applicators is only a few millimeters, depending on the applicator's size, making these applicators ideal for superficial lesions, compared to high energy electrons and iridium brachytherapy.ConclusionsThe INTRABEAM^® miniature accelerator equipped with surface applicators is a reliable way of treating superficial cutaneous malignancies.     

肉毒毒素在肿瘤治疗和辅助治疗领域的研究进展

肉毒毒素是肉毒梭状芽胞杆菌生长繁殖过程中产生的一种细菌外毒素。它可以通过抑制相关神经递质的释放而抑制神经的生理作用,目前临床适应症涉及神经内科、整形外科、康复科、泌尿科等多领域。最新研究发现,肉毒毒素作为毒蕈碱受体拮抗剂可抑制迷走神经释放乙酰胆碱,从而抑制胃癌的发生与发展。同时发现肉毒毒素可通过阻断去甲肾上腺素等神经递质的释放引起神经性的血管舒张,从而打开肿瘤神经血管网来改善肿瘤的放射和化学治疗的疗效。现就其在肿瘤治疗及其辅助治疗相关领域的研究现状进行了综述。     

Involvement of the insulin-like growth factor binding proteins in the cancer cell response to DNA damage

The complex mechanisms that cells have evolved to meet the challenge of constant exposure to DNA-damaging stimuli, also serve to protect cancer cells from the cytotoxic effects of chemo- and radiotherapy. IGFBPs appear to be involved, directly or indirectly, in some of these protective mechanisms. Activation of p53 is an early response to genotoxic stress, and all six human IGFBP genes have predicted p53 response elements in their promoter and/or intronic regions, at least some of which are functional. IGFBP3 has been extensively characterized as a p53-inducible gene, but in some cases it is suppressed by mutant p53 forms. DNA double-strand breaks (DSBs), induced by radiotherapy and some chemotherapies, potentially lead to apoptotic cell death, senescence, or repair and recovery. DSB damage can be repaired by homologous recombination or non-homologous end-joining (NHEJ), depending on the cell cycle stage, availability of key repair proteins, and other factors. The epidermal growth factor receptor (EGFR) has been implicated in the NHEJ pathway, and EGFR inhibition may inhibit repair, promoting apoptosis and thus improving sensitivity to chemotherapy or radiotherapy. Both IGFBP-3 and IGFBP-6 interact with components of the NHEJ pathway, and IGFBP-3 can facilitate this process through direct interaction with both EGFR and the catalytic subunit of DNA-PK. Cell fate after DNA damage may in part be regulated by the balance between the sphingolipids ceramide and sphingosine-1-phosphate, and IGFBPs can influence the production of both lipids. A better understanding of the involvement of IGFBPs in the DNA damage response in cancer cells may lead to improved methods of sensitizing cancers to DNA-damaging therapies.     

Echinococcus multilocularis: The impact of ionizing radiation on metacestodes

Alveolar echinococcosis is caused by the metacestode stage of the fox tapeworm Echinococcus multilocularis. Current chemotherapeutical options for the treatment of echinococcosis are not satisfactory, and novel drugs and/or other potential means of therapy are needed. E. multilocularis metacestodes are characterized by almost potentially unlimited growth, and also display other features of cancerous tumours. In this study, we exposed metacestodes that were generated in vitro to 50–100 Gy ionizing irradiation, and subsequently investigated the short-term (10–12 days post-treatment) and long-term (14 weeks post-treatment) effects. We found, that in the short-term, no release of alkaline phosphatase (EmAP) activity as a measure for potentially induced damage and loss of viability could be detected, and that the protein expression pattern and protease activities in vesicle fluids and medium supernatants did not alter dramatically following irradiation. However, irradiation was associated with distinct morphological and ultrastructural alterations in the tissue of metacestodes, affecting most notably cell–cell contacts, mitochondrial shape, glycogen-storage cells and lipid droplet formation. These could be detected already at 10 days following treatment and remained as such also in the long-term. In addition, as determined after 14 weeks of culture, irradiation affected the proliferation and the growth of E. multilocularis metacestodes. Thus, we demonstrate that radiotherapy does not have a clear-cut parasitocidal effect, but can lead to metabolic impairment of E. multilocularis metacestodes, as reflected by the distinct morphological and structural alterations induced by irradiation treatment.     

New insights for pelvic radiation disease treatment: Multipotent stromal cell is a promise mainstay treatment for the restoration of abdominopelvic severe chronic damages induced by radiotherapy

Radiotherapy may induce irreversible damage on healthy tissues surrounding the tumor. It has been reported that the majority of patients receiving pelvic radiation therapy show early or late tissue reactions of graded severity as radiotherapy affects not only the targeted tumor cells but also the surrounding healthy tissues. The late adverse effects of pelvic radiotherapy concern 5% to 10% of them, which could be life threatening. However, a clear medical consensus concerning the clinical management of such healthy tissue sequelae does not exist. Although no pharmacologic interventions have yet been proven to efficiently mitigate radiotherapy severe side effects, few preclinical researches show the potential of combined and sequential pharmacological treatments to prevent the onset of tissue damage. Our group has demonstrated in preclinical animal models that systemic mesenchymal stromal cell (MSC) injection is a promising approach for the medical management of gastrointestinal disorder after irradiation. We have shown that MSCs migrate to damaged tissues and restore gut functions after irradiation. We carefully studied side effects of stem cell injection for further application in patients. We have shown that clinical status of four patients suffering from severe pelvic side effects resulting from an over-dosage was improved following MSC injection in a compationnal situation.     

血清微小RNA-141-3p、微小RNA-150-5p与鼻咽癌患者临床病理特征和放疗敏感性的关系研究

摘要 目的：探讨血清微小核糖核酸（miRNA）-141-3p、miR-150-5p与鼻咽癌（NPC）患者临床病理特征和放疗敏感性的关系。方法：收集2019年1月～2022年7月在我院接受放疗的92例NPC患者为NPC组,根据放疗疗效分为抵抗组和敏感组,另选取同期80名在我院体检的健康志愿者为对照组。比较对照组、NPC组血清miR-141-3p、miR-150-5p表达。分析NPC患者血清miR-141-3p、miR-150-5p表达与临床病理特征的关系。利用单因素和多因素Logistic回归分析NPC患者放疗抵抗的影响因素。结果：与对照组比较,NPC组血清miR-141-3p表达升高,miR-150-5p表达降低（P＜0.05）。NPC患者血清miR-141-3p、miR-150-5p表达在不同分化程度、TNM分期和淋巴结转移中比较有差异（P＜0.05）。92例NPC患者放疗抵抗发生率为22.83%（21/92）。单因素分析显示,抵抗组TNM分期Ⅲ～Ⅳa期和miR-141-3p ≥ 2.60比例高于敏感组,miR-150-5p ≥ 0.80比例低于敏感组（P＜0.05）。多因素Logistic回归分析显示,miR-141-3p ≥ 2.60为NPC患者放疗抵抗的独立危险因素,miR-150-5p ≥ 0.80为独立保护因素（P＜0.05）。结论：NPC患者血清miR-141-3p高表达,miR-150-5p低表达,与分化程度、TNM分期、淋巴结转移和放疗敏感性有关,有望成为NPC患者放疗抵抗的评价指标。     

应用KV-CBCT分析鼻咽癌调强放射治疗的摆位误差

目的:应用KV-CBCT分析鼻咽癌调强放射治疗时的摆位误差,为鼻咽癌调强放射治疗计划设计时CTV外扩PTV边界的大小提供参考。方法:选取30例IMRT的鼻咽癌患者,治疗过程中每周一次应用KV-CBCT采集患者治疗前的CT图像,将所得图像与定位CT图像进行匹配,分别测定X、Y、Z轴三个方向的摆位误差。结果:30例患者共拍摄168次KV-CBCT,获得168组摆位误差结果,群体摆位误差分别为X轴-0.15±1.43 mm,Y轴0.20±1.58 mm,Z轴-0.21±1.65 mm;根据Van Herk公式计算得到各方向的CTV-PTV外放边界值X、Y、Z轴分别为3.1 mm、3.3 mm和3.4 mm。结论:应用KV-CBCT影像系统可实时测量摆位误差并在线进行纠正,减小摆位误差,为CTV-PTV外放边界提供参考。