Phenomenological modeling of tumor diameter growth based on a mixed effects model

Over the last few years, taking advantage of the linear kinetics of the tumor growth during the steady-state phase, tumor diameter-based rather than tumor volume-based models have been developed for the phenomenological modeling of tumor growth. In this study, we propose a new tumor diameter growth model characterizing early, late and steady-state treatment effects. Model parameters consist of growth rhythms, growth delays and time constants and are meaningful for biologists. Biological experiments provide in vivo longitudinal data. The latter are analyzed using a mixed effects model based on the new diameter growth function, to take into account inter-mouse variability and treatment factors. The relevance of the tumor growth mixed model is firstly assessed by analyzing the effects of three therapeutic strategies for cancer treatment (radiotherapy, concomitant radiochemotherapy and photodynamic therapy) administered on mice. Then, effects of the radiochemotherapy treatment duration are estimated within the mixed model. The results highlight the model suitability for analyzing therapeutic efficiency, comparing treatment responses and optimizing, when used in combination with optimal experiment design, anti-cancer treatment modalities.     

Integration of autologous dendritic cell-based immunotherapy in the standard of care treatment for patients with newly diagnosed glioblastoma: results of the HGG-2006 phase I/II trial

Purpose

Dendritic cell (DC)-based tumor vaccination has rendered promising results in relapsed high-grade glioma patients. In the HGG-2006 trial (EudraCT 2006-002881-20), feasibility, toxicity, and clinical efficacy of the full integration of DC-based tumor vaccination into standard postoperative radiochemotherapy are studied in 77 patients with newly diagnosed glioblastoma.

Patients and methods

Autologous DC are generated after leukapheresis, which is performed before the start of radiochemotherapy. Four weekly induction vaccines are administered after the 6-week course of concomitant radiochemotherapy. During maintenance chemotherapy, 4 boost vaccines are given. Feasibility and progression-free survival (PFS) at 6?months (6mo-PFS) are the primary end points. Overall survival (OS) and immune profiling, rather than monitoring, as assessed in patients’ blood samples, are the secondary end points. Analysis has been done on intent-to-treat basis.

Results

The treatment was feasible without major toxicity. The 6mo-PFS was 70.1?% from inclusion. Median OS was 18.3?months. Outcome improved significantly with lower EORTC RPA classification. Median OS was 39.7, 18.3, and 10.7?months for RPA classes III, IV, and V, respectively. Patients with a methylated MGMT promoter had significantly better PFS (p?=?0.0027) and OS (p?=?0.0082) as compared to patients with an unmethylated status. Exploratory “immunological profiles” were built to compare to clinical outcome, but no statistical significant evidence was found for these profiles to predict clinical outcome.

Conclusion

Full integration of autologous DC-based tumor vaccination into standard postoperative radiochemotherapy for newly diagnosed glioblastoma seems safe and possibly beneficial. These results were used to power the currently running phase IIb randomized clinical trial.     

Quantitative Susceptibility Mapping Differentiates between Blood Depositions and Calcifications in Patients with Glioblastoma

Objectives

The application of susceptibility weighted imaging (SWI) in brain tumor imaging is mainly used to assess tumor-related “susceptibility based signals” (SBS). The origin of SBS in glioblastoma is still unknown, potentially representing calcifications or blood depositions. Reliable differentiation between both entities may be important to evaluate treatment response and to identify glioblastoma with oligodendroglial components that are supposed to present calcifications. Since calcifications and blood deposits are difficult to differentiate using conventional MRI, we investigated whether a new post-processing approach, quantitative susceptibility mapping (QSM), is able to distinguish between both entities reliably.

Materials and Methods

SWI, FLAIR, and T1-w images were acquired from 46 patients with glioblastoma (14 newly diagnosed, 24 treated with radiochemotherapy, 8 treated with radiochemotherapy and additional anti-angiogenic medication). Susceptibility maps were calculated from SWI data. All glioblastoma were evaluated for the appearance of hypointense or hyperintense correlates of SBS on the susceptibility maps.

Results

43 of 46 glioblastoma presented only hyperintense intratumoral SBS on susceptibility maps, indicating blood deposits. Additional hypointense correlates of tumor-related SBS on susceptibility maps, indicating calcification, were identified in 2 patients being treated with radiochemotherapy and in one patient being treated with additional anti-angiogenic medication. Histopathologic reports revealed an oligodendroglial component in one patient that presented calcifications on susceptibility maps.

Conclusions

QSM provides a quantitative, local MRI contrast, which reliably differentiates between blood deposits and calcifications. Thus, quantitative susceptibility mapping appears promising to identify rare variants of glioblastoma with oligodendroglial components non-invasively and may allow monitoring the role of calcification in the context of different therapy regimes.     

An Analysis of the Role of Bioenergetic Processes under Radioprotective Effects Mediated by Alpha1-Adrenergic Agonists

Biophysics - An analysis of modern concepts of the mechanism of the antiradiation effect of alpha1-adrenergic agonists, which are of great interest in clinical practice of radiochemotherapy in...     

Current treatment of rectal cancer adapted to the individual patient

Preoperative radiochemotherapy and total mesorectal excision surgery is a recommended standard therapy for patients with locally advanced rectal cancer. However, some subgroups of patients benefit more than others from this approach. In order to avoid long-term complications of radiation and chemotherapy, efforts are being made to subdivide T3N0 stage using advanced imaging techniques, and to analyze prognostic factors that help to define subgroup risk patients. Long-course radiochemotherapy has the potential of downsizing the tumor before surgery and may increase the chance of sphincter preservation in some patients. Short-course radiotherapy (SCRT), on the other hand, is a practical schedule that better suits patients with intermediated risk tumors, located far from the anal margin. SCRT is also increasingly being used among patients with disseminated disease, before resection of the rectal tumor. Improvements in radiation technique, such as keeping the irradiation target below S2/S3 junction, and the use of IMRT, can reduce the toxicity associated with radiation, specially long-term small bowel toxicity.     

Degree of tumor regression after preoperative chemo-radiotherapy in locally advanced rectal cancer—Preliminary results

Aim

The aim of this investigation is to determine the degree of tumor regression by histopathological evaluation of surgical specimen after neoadjuvant chemo-radiotherapy for patients with stage IIIB rectal cancer.

Background

The standard therapy for rectal carcinoma is surgical, however, preoperative radiochemotherapy will play an increasing role especially in locally advanced disease. To estimate the prognosis and the effect of radiochemotherapy the postradiochemotherapeutical pathological features are important to assess.

Materials and methods

Ten patients with cT3–4, cN1 stage rectal cancer received preoperative chemo-radiotherapy. A total tumor dose of 50 Gy was applied to all patients, with a daily fraction of 2 Gy, 5 times a week, with concomitant Capecitabine 1650 mg/m². A pathomorphologic assessment of the therapeutic response of the residual tumor volumes and estimation of tumor control were performed using Dworak''s system of tumor regression grading (TRD) from no regression (0) to a complete tumor control (4).

Results

Dworak''s TRD for the examined patients is as follows: in 20% of the patients no tumor regression was observed – Grade 0, in 30% – Grade 1, in 20% – Grade 2 and in 30% a complete tumor regression was achieved – Grade 4. Four of the patients (40%) presented with borderline resectable tumors before the neoadjuvant chemo-radiotherapy. Nine of the patients (90%) underwent radical surgery. In one case (10%) a radical surgery was not possible. One patient (10%) developed severe radiation enteritis in both the early and late postoperative period, with her tumor regression evaluated as Grade 4.

Conclusion

Accurate evaluation of local tumor control using Dworak''s tumor regression grading scale after preoperative chemo-radiotherapy gives the basis for a larger investigation and search for a correlation with the prognosis of the disease and individual choice of adjuvant treatment.     

肿瘤微环境应激因子乳酸在肿瘤发展中的作用

肿瘤微环境应激主要包括:缺氧、胞外酸环境、葡萄糖缺乏等。乳酸堆积也是肿瘤微环境应激中一个重要特征。长期以来,乳酸一直被认为是代谢废物,但随着研究深入,发现乳酸作为癌代谢物与肿瘤增殖、转移、血管生成、免疫逃逸以及放化疗效果等肿瘤生物学功能密切相关,此外乳酸还可促进缺氧诱导因子稳定、作为"替代燃料"供能等进一步促进肿瘤恶性进展。因此,本文就肿瘤微环境中乳酸代谢与调控、乳酸对肿瘤生物学功能的影响等方面作一综述,旨在为针对乳酸这一异常代谢特征的抗肿瘤药物开发及临床治疗提供必要依据。     

他汀类药物对消化系统肿瘤作用的临床研究进展

他汀类药物作为一种降血脂药物在临床上大量应用,其药物种类多,并具有多效性。近年来许多体外及动物研究证明他汀类药物对肿瘤细胞具有抑制增殖、促进凋亡、增强放化疗效果的作用。随着体外及动物研究的不断深入,越来越多的临床研究相继展开,通过这些研究发现他汀类药物在人体中也可能具有阻断肿瘤的发生发展、辅助肿瘤放化疗的功效。本文对他汀类药物的作用机制及他汀类药物对不同消化系统肿瘤种类防治作用的临床研究进展进行综述。     

Diagnostics différentiels d’une lésion de la mandibule chez un patient aux antécédents de cancer ORL localement avancé

Eighteen months after completion of a radiochemotherapy treatment for a T4 tonsil cancer, a patient presented with a piece of bone coming out through a submandibular fistula and increasing pain. A CT scan, a bone scintigraphy and an 18-fluorodeoxyglucose positron-emission tomography were performed. Both diagnoses of osteoradionecrosis and tumor recurrence were suspected and then confirmed after mandibulectomy.     

Correlation between amino acid metabolism and self-renewal of cancer stem cells: Perspectives in cancer therapy

Cancer stem cells (CSCs) possess self-renewal and differentiation potential, which may be related to recurrence, metastasis, and radiochemotherapy resistance during tumor treatment. Understanding the mechanisms via which CSCs maintain self-renewal may reveal new therapeutic targets for attenuating CSC resistance and extending patient life-span. Recent studies have shown that amino acid metabolism plays an important role in maintaining the self-renewal of CSCs and is involved in regulating their tumorigenicity characteristics. This review summarizes the relationship between CSCs and amino acid metabolism, and discusses the possible mechanisms by which amino acid metabolism regulates CSC characteristics particularly self-renewal, survival and stemness. The ultimate goal is to identify new targets and research directions for elimination of CSCs.     

Therapeutic effect of gene-therapy in combination with local X-irradiation in a mouse malignant melanoma model

Plasmid containing mIL-18 and B7.1 genes downstream of Egr-1 promoter was constructed and used in gene-radiotherapy on malignant melanoma in C57BL/6J mice implanted with B16 cells followed by exploration of the immunologic mechanism of the therapeutic effect. The treatment with plasmid pEgr-IL-18-B7.1 plus local X-irradiation showed more effective suppression of tumor growth than the treatment with radiation alone, pEgr-IL-18-B7.1 alone, or single gene pEgr-IL-18 (or pEgr-B7.1) combined with local X-irradiation. Anticancer immunity was found to be significantly upregulated in tumor-bearing mice treated with pEgr-IL-18-B7.1 plus local X-irradiation. IL-18 showed no direct killing effect on malignant melanoma cells in vitro, and the mechanism of the combined therapy with pEgr-IL-18-B7.1 and local X-irradiation was apparently related with the stimulation of host anticancer immunity by increased secretion of IL-18 and upregulated immunogenicity of the tumor cells by increased expression of B7.1 on their surface in addition to the direct effect of local X-irradiation on the tumor cells.     

Radiochemotherapy of bladder cancer with/without tissue-organ protection

The authors report the results of radiochemotherapy for bladder cancer, both advanced and early with a poor prognosis, on the basis of their own material as well as based on the literature. More than half of the patients received radioprotective madication at the same time. The short follow-up does not allow for far-reaching conclusions, but early results and limited complications appear hopeful. The authors emphasise that, if indicated, radiochemotherapy can serve as an alternative to cystectomy.     

Relevance of tumor microbiome in cancer incidence,prognosis, and its clinical implications in therapeutics

The microbiota is garnering progressively greater consideration as an essential facet of the tumor microenvironment that regulates tumor proliferation and affects cancer prognosis. Microbial populations that inhabit different body locations are involved in the carcinogenesis and tumor progression of their corresponding malignancies. It has been learned that the microbial populations primarily thriving within tumors are tumor-type specific. Mechanistic studies have revealed that the tumor-associated microbiota contributes to playing a pivotal role in the establishment of the tumor microenvironment, regulation of local immunity, modulation of tumor cell biology, and directly influences the therapeutic efficacy of drug treatment for tumors. This review article incorporates the pertinent studies on recent advancements in tumor microbiome studies, the interplay between the intratumor microbiota and cancer, and, discusses their role and mechanism of action in the emergence and treatment of cancer, and their relationship to clinical characteristics.     

Cortactin phosphorylation regulates cell invasion through a pH-dependent pathway

Invadopodia are invasive protrusions with proteolytic activity uniquely found in tumor cells. Cortactin phosphorylation is a key step during invadopodia maturation, regulating Nck1 binding and cofilin activity. The precise mechanism of cortactin-dependent cofilin regulation and the roles of this pathway in invadopodia maturation and cell invasion are not fully understood. We provide evidence that cortactin-cofilin binding is regulated by local pH changes at invadopodia that are mediated by the sodium-hydrogen exchanger NHE1. Furthermore, cortactin tyrosine phosphorylation mediates the recruitment of NHE1 to the invadopodium compartment, where it locally increases the pH to cause the release of cofilin from cortactin. We show that this mechanism involving cortactin phosphorylation, local pH increase, and cofilin activation regulates the dynamic cycles of invadopodium protrusion and retraction and is essential for cell invasion in 3D. Together, these findings identify a novel pH-dependent regulation of cell invasion.     

Enhanced effectiveness of radiochemotherapy with tirapazamine by local application of electric pulses to tumors

Tumor hypoxia is associated with resistance to radiotherapy and anticancer chemotherapy. However, it can be exploited to therapeutic advantage by concomitantly using hypoxic cytotoxins, such as tirapazamine (TPZ). Tumor electroporation offers the means to further increase tumor hypoxia by temporarily reducing tumor blood flow and therefore increase the cytotoxicity of TPZ. The primary objective of this work was to determine whether electric pulses combined with TPZ and radiotherapy (electroradiochemotherapy) was more efficacious than radiochemotherapy (TPZ + radiation). In these studies using the SCCVII tumor model in C3H mice, electroradiochemotherapy produced up to sixfold more tumor growth delay (TGD) than TPZ + radiation. In these studies, (1) large tumors (280 +/- 15 mm3) responded better to electroradiochemotherapy than small tumors (110 +/- 10 mm3), (2) TGD correlated linearly with tumor volume at the time of electroradiochemotherapy, (3) electric pulses induced a rapid but reversible reduction in O2 saturation, and (4) the electric field was highest near the periphery of the tumor in a 3D computer model. The findings suggested that electroradiochemotherapy gained its therapeutic advantage over TPZ + radiation by enhancing the cytotoxic action of TPZ through reduced tumor oxygenation. The greater antitumor effect achieved in large tumors may be related to tumor morphology and the electric-field distribution. These results suggest that electro-pulsation of large solid tumors may be of benefit to patients treated with radiation in combination with agents that kill hypoxic cells.     

Combined radiation therapy and dendritic cell vaccine for treating solid tumors with liver micro-metastasis

BACKGROUND: Tumor metastasis and relapse are major obstacles in combating human malignant diseases. Neither radiotherapy alone nor injection of dendritic cells (DCs) can successfully overcome this problem. Radiation induces tumor cell apoptosis and necrosis, resulting in the release of tumor antigen and danger signals, which are favorable for DC capturing antigens and maturation. Hence, the strategy of combined irradiation and DC vaccine may be a novel approach for treating human malignancies and early metastasis. METHODS: To develop an effective combined therapeutic approach, we established a novel concomitant local tumor and liver metastases model through subcutaneous (s.c.) and intravenous (i.v.) injection. We selected the optimal time for DC injection after irradiation and investigated the antitumor effect of combining irradiation with DC intratumoral injection and the related mechanism. RESULTS: Combined treatment with radiotherapy and DC vaccine could induce a potent antitumor immune response, resulting in a significant decrease in the rate of local tumor relapse and the numbers of liver metastases. The related mechanisms for this strong antitumor immunity of this combined therapy might be associated with the production of apoptotic and necrotic tumor antigens and heat shock proteins after irradiation, phagocytosis, migration and maturation of DCs, and induction of more efficient tumor-specific cytotoxic T lymphocyte activity through a cross-presentation pathway. CONCLUSIONS: Co-administration of local irradiation and intratumoral DC injection may be a promising strategy for treating radiosensitive tumors and eliminating metastasis in the clinic.     

Cellular senescence: putting the paradoxes in perspective

Cellular senescence arrests the proliferation of potential cancer cells, and so is a potent tumor suppressive mechanism, akin to apoptosis. Or is it? Why did cells evolve an anti-cancer mechanism that arrests, rather than kills, would-be tumor cells? Recent discoveries that senescent cells secrete growth factors, proteases and cytokines provide a shifting view--from senescence as a cell autonomous suppressor of tumorigenesis to senescence as a means to mobilize the systemic and local tissue milieu for repair. In some instances, this mobilization benefits the organism, but in others it can be detrimental. These discoveries provide potential mechanisms by which cellular senescence might contribute to the diverse, and seemingly incongruent, processes of tumor suppression, tumor promotion, tissue repair, and aging.     

PET-based quantification of statistical properties of hypoxic tumor subvolumes in head and neck cancer

PurposePET hypoxia imaging of head and neck cancer (HNC) has the potential to stratify the response to radiochemotherapy. The aim of this work was to quantify the statistical properties of hypoxic tumor subvolumes measured by PET, and their impact on failure rate of standard chemoradiation.MethodsA PubMed search was undertaken to identify relevant publications between 2001 and July 2015, containing original data regarding the properties of HNC hypoxic subvolumes and their evolution during therapy, measured using specific PET tracers.ResultsThe number and intensity of hypoxic voxels is significantly reduced during therapy. Patients are 4.2 times more likely to have negative outcome if baseline hypoxic. The change of the hypoxic volume during therapy, as well as the statistical distribution of the hypoxic fraction (HF), is quantified and analyzed. HF strongly correlates with the median T/M (tumor-to-muscle) SUV (standard uptake value) ratio, but not with gross tumor volume. Hypoxia is 2.2 times more frequently manifest in T3 + T4 than in T1 + T2 primary tumors. Calculated quantities are presented for primary and nodal tumors separately, where available.ConclusionsAlthough hypoxia diminishes during chemoradiation, it is a major predictor of outcome. HF, if large enough, can be predicted from the median T/M SUV ratio. CT-delineated gross tumor size does not influence the percentage of hypoxic voxels. Primary tumors are less likely hypoxic at an earlier stage.     

Kaposi's sarcoma-associated herpesvirus infection promotes differentiation and polarization of monocytes into tumor-associated macrophages

Tumor associated macrophages (TAMs) promote angiogenesis, tumor invasion and metastasis, and suppression of anti-tumor immunity. These myeloid cells originate from monocytes, which differentiate into TAMs upon exposure to the local tumor microenvironment. We previously reported that Kaposi's sarcoma-associated herpes virus (KSHV) infection of endothelial cells induces the cytokine angiopoietin-2 (Ang-2) to promote migration of monocytes into tumors. Here we report that KSHV infection of endothelial cells induces additional cytokines including interleukin-6 (IL-6), interleukin-10 (IL-10), and interleukin-13 (IL-13) that drive monocytes to differentiate and polarize into TAMs. The KSHV-induced TAMs not only express TAM-specific markers such as CD-163 and legumain (LGMN) but also display a gene expression profile with characteristic features of viral infection. More importantly, KSHV-induced TAMs enhance tumor growth in nude mice. These results are consistent with the strong presence of TAMs in Kaposi's sarcoma (KS) tumors. Therefore, KSHV infection of endothelial cells generates a local microenvironment that not only promotes the recruitment of monocytes but also induces their differentiation and polarization into TAMs. These findings reveal a new mechanism of KSHV contribution to KS tumor development.