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Caroprese M, Cella L, Barillaro A, Oliviero C, Clemente S, Mainenti P, Pacelli R, Conson M. Bronchiolitis Obliterans Organizing Pneumonia After Breast Radiation Therapy. Pract Radiat Oncol 2024; 14:e443-e448. [PMID: 39032596 DOI: 10.1016/j.prro.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/15/2024] [Accepted: 06/28/2024] [Indexed: 07/23/2024]
Abstract
Presented here is a case report of a 77-year-old woman affected by rheumatoid arthritis who underwent breast-conserving surgery followed by radiation therapy (RT) for left-breast cancer and developed bronchiolitis obliterans organizing pneumonia (BOOP) after RT and during a COVID-19 vaccination campaign. BOOP incidence is an uncommon morbidity after breast RT (1.2%-2.9%); however, specific predisposing factors can play a role. In this patient, both rheumatoid arthritis and the vaccine may have predisposed her to an increased risk of organizing pneumonia, probably by triggering a proinflammatory cascade. Our report highlights the importance of factors that influence the occurrence of uncommon radiation-induced morbidities, such as BOOP, in specific subsets of patients. Further studies are necessary to evaluate factors increasing radiation sensitivity.
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Affiliation(s)
- Mara Caroprese
- Department of Advanced Biomedical Sciences, University Federico II, Napoli, Italy.
| | - Laura Cella
- National Research Council (CNR), Institute of Biostructures and Bioimaging, Napoli, Italy
| | - Angela Barillaro
- Department of Advanced Biomedical Sciences, University Federico II, Napoli, Italy
| | - Caterina Oliviero
- Unit of Medical Physics and Radioprotection, University Hospital Federico II, Napoli, Italy
| | - Stefania Clemente
- Unit of Medical Physics and Radioprotection, University Hospital Federico II, Napoli, Italy
| | - Pierpaolo Mainenti
- National Research Council (CNR), Institute of Biostructures and Bioimaging, Napoli, Italy
| | - Roberto Pacelli
- Department of Advanced Biomedical Sciences, University Federico II, Napoli, Italy
| | - Manuel Conson
- Department of Advanced Biomedical Sciences, University Federico II, Napoli, Italy
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2
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Feakins RM. Inflammatory disorders of the large intestine. MORSON AND DAWSON'S GASTROINTESTINAL PATHOLOGY 2024:709-857. [DOI: 10.1002/9781119423195.ch35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Yun JS, McCracken J, Wadhwa V. Radiation-induced angiosarcoma-An unusual cause of recurrent pleural effusion. Respirol Case Rep 2024; 12:e70013. [PMID: 39253318 PMCID: PMC11381914 DOI: 10.1002/rcr2.70013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 08/23/2024] [Indexed: 09/11/2024] Open
Abstract
Although rare, radiotherapy can induce secondary malignancies, such as radiation-induced angiosarcoma (RIAS), which is associated with a poor prognosis. Early detection is crucial for improving outcomes. The modified Cahan criteria are instrumental in diagnosing RIAS, which is ultimately confirmed through histological examination. We present a case of a middle-aged woman who developed RIAS after undergoing radiotherapy post-surgery and adjuvant chemotherapy for right-sided breast cancer. The patient presented with a rapidly reaccumulating right-sided pleural effusion, and RIAS was confirmed through pleural biopsy and aspirate. This case report highlights the pathway for establishing a diagnosis of RIAS and the need for early detection through clinical examination and surveillance imaging for patients following radiotherapy.
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Affiliation(s)
- Jenny Sw Yun
- Department of Medical Oncology Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | - James McCracken
- Department of Medical Oncology Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Vikas Wadhwa
- Department of Medical Oncology Peter MacCallum Cancer Centre Melbourne Victoria Australia
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Dou CB, Ma SR, Zhang SL, Su H, Yu ZL, Jia J. Algorithm for the reconstruction of the parotid region: a single institution experience. BMC Oral Health 2024; 24:106. [PMID: 38238723 PMCID: PMC10795291 DOI: 10.1186/s12903-024-03872-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/07/2024] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE This study aims to discuss the characteristics and treatment methods of malignant tumors in the parotid region, as well as the therapeutic effects of immediate free flap reconstruction of soft tissue for postoperative defects. MATERIALS AND METHODS A retrospective review was conducted on 11 cases of soft tissue flap reconstruction for postoperative defects following the resection of malignant tumors in the parotid region. Statistical analysis was performed based on clinical data. RESULTS Among the 11 cases of malignant tumors in the parotid region, there were 2 cases of secretory carcinoma (SC) of the salivary gland, 2 cases of squamous cell carcinoma (SCC), 2 cases of carcinosarcoma, 1 case of mucoepidermoid carcinoma (MEC), 1 case of epithelial-myoepithelial carcinoma (EMC), 1 case of salivary duct carcinoma (SDC), 1 case of basal cell carcinoma (BCC), and 1 case of osteosarcoma. Among these cases, 4 were initial diagnoses and 7 were recurrent tumors. The defect repairs involved: 8 cases with anterolateral thigh free flap (ALTF), 2 cases with pectoralis major muscle flaps, and 1 case with forearm flap. The size of the flaps ranged from approximately 1 cm × 3 cm to 7 cm × 15 cm. The recipient vessels included: 4 cases with the facial artery, 4 cases with the superior thyroid artery, and 1 case with the external carotid artery. The ratio of recipient vein anastomosis was: 57% for branches of the internal jugular vein, 29% for the facial vein, and 14% for the external jugular vein. Among the 8 cases that underwent neck lymph node dissection, one case showed lymph node metastasis on pathological examination. In the initial diagnosis cases, 2 cases received postoperative radiotherapy, and 1 case received 125I seed implantation therapeutic treatment after experiencing two recurrences. Postoperative follow-up revealed that 2 cases underwent reoperation due to local tumor recurrence, and there were 2 cases lost to follow-up. The survival outcomes after treatment included: one case of distant metastasis and one case of death from non-cancerous diseases. CONCLUSION Immediate soft tissue flap reconstruction is an important and valuable option to address postoperative defects in patients afflicted with malignant tumors in the parotid region.
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Affiliation(s)
- Chun-Bo Dou
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
- Dongfeng Stomatological Hospital, Hubei University of Medicine, Shiyan, China
| | - Si-Rui Ma
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Shi-Long Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
- Dongfeng Stomatological Hospital, Hubei University of Medicine, Shiyan, China
| | - Heng Su
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Zi-Li Yu
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
| | - Jun Jia
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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Kao EY, McEwen AE, Aden JK, Schaub SK, Ricciotti RW, Mantilla JG. Clinical and Pathologic Characterization of 94 Radiation-Associated Sarcomas: Our Institutional Experience. Int J Surg Pathol 2022:10668969221105626. [PMID: 35695212 DOI: 10.1177/10668969221105626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radiation-associated sarcomas are an uncommon complication of therapeutic radiation. However, their prevalence has increased with the more widespread use of this treatment modality. The clinical, pathologic and genetic characteristics of radiation-associated sarcomas are not fully understood. In this study we describe the features of 94 radiation-associated sarcomas reviewed at our institution between 1993 and 2018, evaluate their overall survival (OS) and progression-free survival (PFS) outcomes, and compare them with their sporadic counterparts reviewed within the same time period. Histologic subtypes of all radiation-associated sarcomas included 31 (33%) undifferentiated sarcomas, 20 (21%) osteosarcomas, 17 (18%) angiosarcomas, 10 (11%) malignant peripheral nerve sheath tumor (MPNST), 9 (10%) leiomyosarcomas, 4 (4%) myxofibrosarcomas, and 3 (3%) rhabdomyosarcomas. Six patients had a documented cancer predisposition syndrome. The most common preceding neoplasms included adenocarcinoma (47%) and squamous cell carcinoma (19%), with a mean latency of 13 years. Multivariable Cox survival analysis demonstrated that advanced stage at diagnosis based on pT category (AJCC eighth edition) and fragmented resection were associated with worse survival outcomes. In addition, there was a statistically significant difference in PFS between radiation-associated undifferentiated sarcomas and MPNST when compared to their sporadic counterparts using the Kaplan-Meier method and Log-rank analysis. Overall, our study shows that radiation-associated sarcomas comprise a wide clinico-pathologic spectrum of disease, with a tendency for aggressive clinical behavior. This study further delineates the understanding of these uncommon diseases. Future studies are necessary to better understand the genetic and epigenetic changes that drive the differences in behavior between these tumors and their sporadic counterparts, and to offer better treatment options.
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Affiliation(s)
- Erica Y Kao
- Department of Pathology, 377811San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
| | - Abbye E McEwen
- Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| | - James K Aden
- Graduate Medical Education, 377811San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
| | - Stephanie K Schaub
- Department of Radiation Oncology, 7284University of Washington, Seattle, WA, USA
| | - Robert W Ricciotti
- Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| | - Jose G Mantilla
- Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
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Genetic alterations associated with malignant transformation of sporadic vestibular schwannoma. Acta Neurochir (Wien) 2022; 164:343-352. [PMID: 34816314 PMCID: PMC8854236 DOI: 10.1007/s00701-021-05062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022]
Abstract
Introduction Malignant peripheral nerve sheath tumor of the vestibulocochlear nerve (VN-MPNST) is exceedingly rare and carries a poor prognosis. Little is known about its underlying genetics and in particular the process of malignant transformation. There is an ongoing debate on whether the transformation is initiated by ionizing radiation. We present here the analysis and comparison of two post-radiation VN-MPNST and one undergoing spontaneous transformation. Methods Four tumors from three patients (radiation-naïve vestibular schwannoma before (VS) and after (VN-MPNST) malignant transformation in addition to two post-radiation VN-MPNST) were subjected to DNA whole-genome microarray and whole-exome sequencing and tumor-specific mutations were called. Mutational signatures were characterized using MuSiCa. Results The tumor genomes were characterized predominantly by copy-number aberrations with 36–81% of the genome affected. Even the VS genome was grossly aberrated. The spontaneous malignant transformation was characterized by a near-total whole-genome doubling, disappearance of NF2 mutation and new mutations in three cancer-related genes (GNAQ, FOXO4 and PDGFRB). All tumors had homozygous loss of the tumor suppressor CDKN2A. Neither mutational signature nor copy number profile was associated with ionizing radiation. Conclusion The VN-MPNST genome in our cases is characterized by large copy-number aberrations and homozygous deletion of CDKN2A. Our study demonstrates a VS with genetic alterations similar to its malignant counterpart, suggesting the existence of premalignant VS. No consistent mutational signature was associated with ionizing radiation.
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Poland SG, Guth AA, Feinberg JA, Ebina W, Chiu E, Levine J, Gonzalez LM, Muggia F. Basal cell carcinoma after breast radiation: An uncommon disease with varying clinical presentations. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2021.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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Possible Mechanisms of Subsequent Neoplasia Development in Childhood Cancer Survivors: A Review. Cancers (Basel) 2021; 13:cancers13205064. [PMID: 34680213 PMCID: PMC8533890 DOI: 10.3390/cancers13205064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
Advances in medicine have improved outcomes in children diagnosed with cancer, with overall 5-year survival rates for these children now exceeding 80%. Two-thirds of childhood cancer survivors have at least one late effect of cancer therapy, with one-third having serious or even life-threatening effects. One of the most serious late effects is a development of subsequent malignant neoplasms (histologically different cancers, which appear after the treatment for primary cancer), which occur in about 3-10% of survivors and are associated with high mortality. In cancers with a very good prognosis, subsequent malignant neoplasms significantly affect long-term survival. Therefore, there is an effort to reduce particularly hazardous treatments. This review discusses the importance of individual factors (gender, genetic factors, cytostatic drugs, radiotherapy) in the development of subsequent malignant neoplasms and the possibilities of their prediction and prevention in the future.
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Comprehensive molecular characterization of pediatric radiation-induced high-grade glioma. Nat Commun 2021; 12:5531. [PMID: 34545084 PMCID: PMC8452624 DOI: 10.1038/s41467-021-25709-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/05/2021] [Indexed: 11/09/2022] Open
Abstract
Radiation-induced high-grade gliomas (RIGs) are an incurable late complication of cranial radiation therapy. We performed DNA methylation profiling, RNA-seq, and DNA sequencing on 32 RIG tumors and an in vitro drug screen in two RIG cell lines. We report that based on DNA methylation, RIGs cluster primarily with the pediatric receptor tyrosine kinase I high-grade glioma subtype. Common copy-number alterations include Chromosome (Ch.) 1p loss/1q gain, and Ch. 13q and Ch. 14q loss; focal alterations include PDGFRA and CDK4 gain and CDKN2A and BCOR loss. Transcriptomically, RIGs comprise a stem-like subgroup with lesser mutation burden and Ch. 1p loss and a pro-inflammatory subgroup with greater mutation burden and depleted DNA repair gene expression. Chromothripsis in several RIG samples is associated with extrachromosomal circular DNA-mediated amplification of PDGFRA and CDK4. Drug screening suggests microtubule inhibitors/stabilizers, DNA-damaging agents, MEK inhibition, and, in the inflammatory subgroup, proteasome inhibitors, as potentially effective therapies. Radiation-induced high-grade gliomas (RIGs) are an incurable late complication of cranial radiation therapy. In the largest study to date, we report the results of DNA methylation profiling, RNA-Seq and genomic sequencing of 32 RIG tumors, and an in vitro drug screen in two RIG cell lines.
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Zhao GC, Ke CX. Haemangiomas in the urinary bladder: Two case reports. World J Clin Cases 2021; 9:3927-3935. [PMID: 34141749 PMCID: PMC8180229 DOI: 10.12998/wjcc.v9.i16.3927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/25/2020] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Urinary bladder haemangioma is a benign nonurothelial tumour that rarely occurs in paediatric and adolescent patients. Clinical and radiological examinations are not adequate for an accurate diagnosis. The purpose of this serial case report is to raise awareness of urinary bladder haemangioma and appropriate management.
CASE SUMMARY We described two rare cases of urinary bladder haemangioma that were confirmed by histopathology followed by immunohistochemistry and reviewed the literature on the diagnosis and treatment of patients with this disease. The radical cystectomy was performed with open method surgery associated with an abdominal wall ostomy of the ileal outlet tract for case 1. Case 2 underwent a laparoscopic partial cystectomy. Postoperative pathology confirmed the diagnosis of urinary bladder haemangioma. Haematuria resolved postoperatively, and there was no evidence of tumour recurrence in 3 years follow-up for case 1. Postoperative urinary and pelvic ultrasonography showed no signs of recurrence in 3 mo follow-up for case 2.
CONCLUSION Careful histopathological and immunohistochemical studies are required to establish the correct diagnosis. There is no “gold standard” treatment for urinary bladder haemangioma, and treatment options are varied for individuals with favourable follow-ups.
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Affiliation(s)
- Gui-Cheng Zhao
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
| | - Chang-Xing Ke
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
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Abstract
Exposure of aircrew to cosmic radiation has been recognized as an occupational health risk for several decades. Based on the recommendations by the International Commission on Radiological Protection (ICRP), many countries and their aviation authorities, respectively have either stipulated legal radiation protection regulations, e.g., in the European Union or issued corresponding advisory circulars, e.g., in the United States of America. Additional sources of ionizing and non-ionizing radiation, e.g., due to weather phenomena have been identified and discussed in the scientific literature in recent years. This article gives an overview of the different generally recognized sources due to weather as well as space weather phenomena that contribute to radiation exposure in the atmosphere and the associated radiation effects that might pose a risk to aviation safety at large, including effects on human health and avionics. Furthermore, potential mitigation measures for several radiation sources and the prerequisites for their use are discussed.
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Rangel-Pozzo A, Sisdelli L, Cordioli MIV, Vaisman F, Caria P, Mai S, Cerutti JM. Genetic Landscape of Papillary Thyroid Carcinoma and Nuclear Architecture: An Overview Comparing Pediatric and Adult Populations. Cancers (Basel) 2020; 12:E3146. [PMID: 33120984 PMCID: PMC7693829 DOI: 10.3390/cancers12113146] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
Thyroid cancer is a rare malignancy in the pediatric population that is highly associated with disease aggressiveness and advanced disease stages when compared to adult population. The biological and molecular features underlying pediatric and adult thyroid cancer pathogenesis could be responsible for differences in the clinical presentation and prognosis. Despite this, the clinical assessment and treatments used in pediatric thyroid cancer are the same as those implemented for adults and specific personalized target treatments are not used in clinical practice. In this review, we focus on papillary thyroid carcinoma (PTC), which represents 80-90% of all differentiated thyroid carcinomas. PTC has a high rate of gene fusions and mutations, which can influence the histologic subtypes in both children and adults. This review also highlights telomere-related genomic instability and changes in nuclear organization as novel biomarkers for thyroid cancers.
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Affiliation(s)
- Aline Rangel-Pozzo
- Cell Biology, Research Institute of Oncology and Hematology, University of Manitoba, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Luiza Sisdelli
- Genetic Bases of Thyroid Tumors Laboratory, Division of Genetics, Department of Morphology and Genetics, Universidade Federal de São Paulo/EPM, São Paulo, SP 04039-032, Brazil; (L.S.); (M.I.V.C.); (J.M.C.)
| | - Maria Isabel V. Cordioli
- Genetic Bases of Thyroid Tumors Laboratory, Division of Genetics, Department of Morphology and Genetics, Universidade Federal de São Paulo/EPM, São Paulo, SP 04039-032, Brazil; (L.S.); (M.I.V.C.); (J.M.C.)
| | - Fernanda Vaisman
- Instituto Nacional do Câncer, Rio de Janeiro, RJ 22451-000, Brazil;
| | - Paola Caria
- Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy
| | - Sabine Mai
- Cell Biology, Research Institute of Oncology and Hematology, University of Manitoba, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Janete M. Cerutti
- Genetic Bases of Thyroid Tumors Laboratory, Division of Genetics, Department of Morphology and Genetics, Universidade Federal de São Paulo/EPM, São Paulo, SP 04039-032, Brazil; (L.S.); (M.I.V.C.); (J.M.C.)
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Garcia M, Hernandez DL, Mendoza S, Buelvas N, Alvarez A, Esguerra J, Díaz S. Tumors associated with radiotherapy: a case series. J Med Case Rep 2020; 14:179. [PMID: 33019945 PMCID: PMC7537103 DOI: 10.1186/s13256-020-02482-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 08/05/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer is the cancer with the highest incidence and mortality worldwide. Its treatment is multidisciplinary with surgery, systemic therapy, and radiotherapy. In Colombia, according to Globocan 2018, there is an age-standardized incidence rate of 44 per 100,000 women. Radiotherapy improves local and regional control in patients with breast cancer, and it could even improve relapse-free survival and overall survival in patients with nodal disease. The toxicity of this treatment in most cases is mild and transient, but in a low percentage of patients, radiotherapy-induced tumors may develop. CASE PRESENTATION Seven Colombian patients treated for breast cancer at our institution developed radiotherapy-induced tumors between 2008 and 2018. The median age was 54.4 (range 35-72) years. Six patients had locally advanced tumors at the time breast cancer was diagnosed, and all of them received neoadjuvant or adjuvant chemotherapy and radiotherapy. The radiotherapy-induced tumors were five sarcomas, one of which was a well-differentiated angiosarcomatous vascular lesion with negative c-Myc (benign lesion), and the remaining patient had basal cell carcinoma associated with radiotherapy. CONCLUSIONS Sarcomas are the most common radiotherapy-induced tumors after breast cancer treatment. These are rare, aggressive tumors and represent between 0.5% and 5.5% of all sarcomas. Basal cell carcinoma has also been associated with breast cancer treatment. The management is individualized and multimodal, including surgical resection and chemotherapy. Different studies have shown that radiation therapy is a risk factor for the development of soft tissue tumors.
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Affiliation(s)
- Mauricio Garcia
- Oncologic Surgery Service, National Cancer Institute, Street 1 # 9-85, Bogota, Colombia
| | - Dary L Hernandez
- Oncologic Surgery Service, National Cancer Institute, Street 1 # 9-85, Bogota, Colombia.
| | - Sara Mendoza
- Breast and Soft Tissue Surgery Service, National Cancer Institute, Bogota, Colombia
| | - Nelson Buelvas
- Breast and Soft Tissue Surgery Service, National Cancer Institute, Bogota, Colombia
| | - Angelina Alvarez
- Radiotherapy Oncology Service, National Cancer Institute, Bogota, Colombia
| | - Jose Esguerra
- Radiotherapy Oncology Service, National Cancer Institute, Bogota, Colombia
| | - Sandra Díaz
- Breast and Soft Tissue Surgery Service, National Cancer Institute, Bogota, Colombia
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Ramseier JY, Ferreira MN, Leventhal JS. Dermatologic toxicities associated with radiation therapy in women with breast cancer. Int J Womens Dermatol 2020; 6:349-356. [PMID: 33898697 PMCID: PMC8060663 DOI: 10.1016/j.ijwd.2020.07.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/24/2020] [Accepted: 07/29/2020] [Indexed: 12/24/2022] Open
Abstract
Breast-conserving surgery with adjuvant radiation therapy has become the standard of care for women with early stage breast cancer, and as a result, a large number of patients are affected by the cutaneous sequelae of radiation therapy. These dermatologic toxicities may present during treatment or years later and can significantly impact patients’ quality of life. In this review, we discuss the clinical presentation, prevention, and management of radiation-induced cutaneous toxicities in women with breast cancer, including radiation dermatitis, radiation recall, radiation-induced morphea, radiation-induced fibrosis, and cutaneous malignancies in irradiated skin.
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Affiliation(s)
- Julie Y Ramseier
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Michelle N Ferreira
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Jonathan S Leventhal
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
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Gamma Knife Radiosurgery does not alter the copy number aberration profile in sporadic vestibular schwannoma. J Neurooncol 2020; 149:373-381. [PMID: 32980934 PMCID: PMC7609431 DOI: 10.1007/s11060-020-03631-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/03/2022]
Abstract
Introduction Ionizing radiation is a known etiologic factor in tumorigenesis and its role in inducing malignancy in the treatment of vestibular schwannoma has been debated. The purpose of this study was to identify a copy number aberration (CNA) profile or specific CNAs associated with radiation exposure which could either implicate an increased risk of malignancy or elucidate a mechanism of treatment resistance. Methods 55 sporadic VS, including 18 treated with Gamma Knife Radiosurgery (GKRS), were subjected to DNA whole-genome microarray and/or whole-exome sequencing. CNAs were called and statistical tests were performed to identify any association with radiation exposure. Hierarchical clustering was used to identify CNA profiles associated with radiation exposure. Results
A median of 7 (0–58) CNAs were identified across the 55 VS. Chromosome 22 aberration was the only recurrent event. A median aberrant cell fraction of 0.59 (0.25–0.94) was observed, indicating several genetic clones in VS. No CNA or CNA profile was associated with GKRS. Conclusion
GKRS is not associated with an increase in CNAs or alteration of the CNA profile in VS, lending support to its low risk. This also implies that there is no major issue with GKRS treatment failure being due to CNAs. In agreement with previous studies, chromosome 22 aberration is the only recurrent CNA. VS consist of several genetic clones, addressing the need for further studies on the composition of cells in this tumor.
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Dalwadi SM, Dorman C, Fisher SB, Bonnen M, Grubbs E, Ludwig MS. Risk of thyroid cancer after therapeutic irradiation in adult patients: An Age-Based surveillance, epidemiology, and end results analysis. Laryngoscope 2020; 130:2081-2086. [PMID: 31747075 DOI: 10.1002/lary.28407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/12/2019] [Accepted: 10/28/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES/HYPOTHESIS One risk of radiation therapy exposure (XRTe) is second primary thyroid cancer (SPTC). Previous reports examined this in children, but no population-based studies have explored XRTe and SPTC across all ages or stratified by histological subtypes. STUDY DESIGN Database study. METHODS We report patient characteristics of a Surveillance, Epidemiology, and End Results (SEER) dataset of SPTC (n = 4,669) using χ2 and t tests. Odds ratio (OR) for SPTC was determined based on age, histology, and XRTe compared to expected values in the SEER database. Kaplan-Meier survival and Cox proportional hazard ratios were reported to determine factors influencing latent survival (LS; time from initial diagnosis to SPTC) and overall survival in univariate and multivariate models. RESULTS Extrathyroid extension and node status based on XRTe were similar (P = .684 and P = .776, respectively). XRTe patients were more likely to have smaller tumors (17.6 vs. 19.3 mm, P = .007). XRTe patients were diagnosed with SPTC at younger ages (59.8 vs. 62.7 years, P < .001) without a difference in LS (7.45 vs. 7.50 years, P = .426). Patients aged 1 to 14 years and 15 to 29 years at diagnosis of first cancer are at higher risk of SPTC after XRTe (OR = 1.89, P = .005 and OR = 2.35, P = .001, respectively), unlike patients age 30 to 44 years and 45+ years (OR = 1.03, P = .823 and OR = 0.97, P = .624, respectively). This difference is not present for follicular and medullary SPTC. CONCLUSIONS Patients aged 30+ years receiving radiation therapy (XRT) do not have an increased risk of SPTC. Deliberation is necessary in recommending, planning, and delivering XRT to minimize risk of subsequent malignancy in younger patients. LEVEL OF EVIDENCE NA Laryngoscope, 130: 2081-2086, 2020.
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Affiliation(s)
- Shraddha M Dalwadi
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Clark Dorman
- College of Medicine, UT Health McGovern School of Medicine, Houston, Texas, U.S.A
| | - Sarah B Fisher
- Department of Surgery, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Mark Bonnen
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Elizabeth Grubbs
- Department of Surgery, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Michelle S Ludwig
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, U.S.A
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Ashack KA, Kuritza V, Visconti MJ, Ashack L. Dermatologic Sequelae Associated with Radiation Therapy. Am J Clin Dermatol 2020; 21:541-555. [PMID: 32410134 DOI: 10.1007/s40257-020-00519-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Radiation therapy is a mainstay for the treatment of primary malignancies and metastatic disease and is associated with several dermatological adverse events that are underreported in the literature. The objective of this paper was to review the literature regarding cutaneous manifestations associated with radiation therapy in order to promote awareness of the cutaneous radiation therapy-associated adverse effects. This extensive literature review was performed using the Pubmed and Embase databases. Studies were reviewed for relevance and critical evidence pertaining to cutaneous manifestations of radiation therapy. The most commonly reported cutaneous sequelae associated with radiation therapy include radiation dermatitis, non-melanoma skin cancer, radiation-associated angiosarcoma, morphea, bullous pemphigoid, lymphangioma circumscriptum, and pseudosclerodermatous panniculitis. For many of these conditions, only case reports or case series exist and there is an absence of large-scale cohort studies. Despite these limitations, this review describes the wide range of dermatological adverse events associated with radiation therapy.
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Lukowiak T, Perz A, Aizman L, Etzkorn JR. Cells to Surgery Quiz: March 2020. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Chao YH, Wu KH, Yeh CM, Su SC, Reiter RJ, Yang SF. The potential utility of melatonin in the treatment of childhood cancer. J Cell Physiol 2019; 234:19158-19166. [PMID: 30945299 DOI: 10.1002/jcp.28566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 12/21/2022]
Abstract
Childhood cancer management has improved considerably, with the overall objective of preventing early-life cancers completely. However, cancer remains a major cause of death in children, with the survivors developing anticancer treatment-specific health problems. Therefore, the anticancer treatment needs further improvement. Melatonin is a effective antioxidant and circadian pacemaker. Through multiple mechanisms, melatonin has significant positive effects on multitude adult cancers by increasing survival and treatment response rates, and slowing disease progression. In addition, melatonin appears to be safe for children. As an appealing therapeutic agent, we herein address several key concerns regarding melatonin's potential for treating children with cancer.
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Affiliation(s)
- Yu-Hua Chao
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Kang-Hsi Wu
- Division of Pediatric Hematology-Oncology, Children's Hospital, China Medical University, Taichung, Taiwan.,School of Post-baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Ming Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shih-Chi Su
- Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Russel J Reiter
- Department of Cellular and Structural Biology, The University of Texas Health Science Center, San Antonio, Texas
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
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20
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Vollstedt A, Ingimarsson J, Dagrosa L, Pais V. Increasing stone complexity does not affect fluoroscopy time in percutaneous nephrolithotomy. Ther Adv Urol 2019; 11:1756287219840218. [PMID: 31057670 PMCID: PMC6452585 DOI: 10.1177/1756287219840218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/04/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The aim of this work was to assess whether stone complexity with the Guy's stone score (GSS) is associated with increased intraoperative fluoroscopy time. METHODS We retrospectively reviewed records of 261 consecutive patients undergoing percutaneous nephrolithotomy between 2007 and 2015. Of these, 203 had both preoperative computed tomography for accurate staging and full intraoperative fluoroscopy and radiation dosimetry data were available. Stone complexity was assessed using GSS. A correlation between fluoroscopy time (FT) and GSS was assessed in a univariate and multivariate fashion, including parameters such as age, sex, body mass index (BMI), and number of accesses. RESULTS The overall mean FT was 3.69 min [standard deviation (SD) 2.77]. The overall mean Guy's score was 2.5 (SD 1). There was a statistically significant correlation between operative time and FT (r = 0.34, p < 0.0001). There was a trend towards increasing operative time with increasing GSS (r = 0.12, p = 0.08), but there was no statistically significant correlation. There was no correlation between FT and GSS (r = 0.04, p = 0.55). On multivariable regression, accounting for sex, BMI, age, and singular versus multiple accesses, there was no significant correlation between stone complexity and FT (p = 0.893). CONCLUSIONS In the setting of conscious efforts to reduce intraoperative radiation exposure, increasing stone complexity, as classified by GSS, did not correlate with FT on univariate or multivariate analysis. Thus, treatment of more complex stones may be undertaken without concern that there is an inevitable need for significantly increased fluoroscopy exposure to the patient or operating room staff.
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Affiliation(s)
- Annah Vollstedt
- Dartmouth Hitchcock Medical Center, One Medical Center Drive, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
| | | | - Lawrence Dagrosa
- One Medical Center Drive, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Vernon Pais
- One Medical Center Drive, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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21
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Parada Domínguez D, Peña Gonzalez KB. Radiotherapy-associated intra-abdominal angiosarcoma after prostatic adenocarcinoma: Case reports. Mol Clin Oncol 2018; 9:592-596. [PMID: 30546886 PMCID: PMC6256091 DOI: 10.3892/mco.2018.1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 07/13/2018] [Indexed: 11/05/2022] Open
Abstract
Angiosarcoma is a rare soft tissue neoplasm, which accounts for <1% of all soft tissue tumours. It has been previously reported that the incidence rate of angiosarcomas increases following radiotherapy. The present study reports two cases of intra-abdominal angiosarcoma associated with previous radiotherapy treatment. To the best of our knowledge, these associations have not been previously described in English literature. The patients aged 71 and 83 years were admitted to the center for abdominal pain and diarrhea. Each patient had previously had treatment with radiotherapy for prostate adenocarcinoma. During their hospitalization, biopsies were obtained and the diagnosis of angiosarcoma was reached. In each patient the tumors had irregular proliferating vascular channels, lined by atypical endothelial cells, which varied from elongated and spindle-shaped to large and plump. Immunocytochemistry revealed that the tumor cells were positive for the cytoplasmic endothelial markers cluster of differentiation (CD)31 and CD34. The recognition of these associations is important and their occurrence in this rare type of neoplasm should not mislead the pathologist and cause a misdiagnosis of the sarcoma.
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Affiliation(s)
- David Parada Domínguez
- Pathology Service, University Hospital of Saint Joan, Faculty of Medicine, IISPV, 'Rovira i Virgili' University, Reus, 43204 Tarragona, Spain
| | - Karla B Peña Gonzalez
- Pathology Service, University Hospital of Saint Joan, Faculty of Medicine, IISPV, 'Rovira i Virgili' University, Reus, 43204 Tarragona, Spain
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22
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Hu X, Deng K. Bladder cavernous hemangioma after pelvic radiotherapy in a female patient: A case report and literature review. Int J Surg Case Rep 2018; 53:479-482. [PMID: 30567074 PMCID: PMC6277215 DOI: 10.1016/j.ijscr.2018.11.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Hemangiomas are benign tumor formations of capillaries and blood vessels which are commonly found in various organs. However they are extremely rare in urinary bladder accounting for only 0.6% of all urinary bladder tumors. The differentiating of these benign tumors from malignant neoplasms are important since they have extremely different prognostic features as well as therapeutic strategies. Here we reported a female patient diagnosed with bladder cavernous hemangioma (BCH) after recent pelvic radiotherapy for the cervical cancer and reviewed relevant literatures. CASE PRESENTATION We reported a case of 49 years old female patient with persistent painless hematuria for 12 days. Computed tomography revealed a small lesion on the superior wall of the urinary bladder with acute clot retention. Cystoscopy confirmed a solid papillary pedunculated mass with a measuring of 1.0 × 0.5 cm located on the superior posterior wall and surrounded by distended vessels. Transurethral resection of the mass was then performed and the pathological report indicated a cavernous hemangioma of the urinary bladder. In a one and half year follow-up, no tumor recurrence or bleeding was found. CONCLUSIONS The cavernous hemangioma in urinary bladder is rare and cystoscopic is a gold standard for diagnosis. Treatment options are vary for individuals and pathologic findings are vital for differentiating it from malignant potential tumors. A history of cancer related radiation therapy seems to be a risk factor for BCH.
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Affiliation(s)
- Xinming Hu
- Department of Urology, The Second Affiliated Hospital of Hainan Medical University, Haikou, 570100, PR China
| | - Kangli Deng
- Department of Urology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430079, PR China.
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Hamacher R, Kämpfe D, Reuter-Jessen K, Pöttgen C, Podleska LE, Farzaliyev F, Steinau HU, Schuler M, Schildhaus HU, Bauer S. Dramatic Response of a PD-L1-Positive Advanced Angiosarcoma of the Scalp to Pembrolizumab. JCO Precis Oncol 2018; 2:1-7. [PMID: 35135124 DOI: 10.1200/po.17.00107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rainer Hamacher
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Dietrich Kämpfe
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Kirsten Reuter-Jessen
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Christoph Pöttgen
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Lars E Podleska
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Farhad Farzaliyev
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Hans-Ulrich Steinau
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Martin Schuler
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Hans-Ulrich Schildhaus
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Sebastian Bauer
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
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Radiation-Induced Sarcoma following Prolonged Coronary Stent Placement. Case Rep Surg 2018; 2018:2903801. [PMID: 30174980 PMCID: PMC6098899 DOI: 10.1155/2018/2903801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/19/2018] [Indexed: 11/17/2022] Open
Abstract
Radiation exposure for the average coronary stent placement varies based on a number of factors but typically amounts to 6-11 mSv per patient (compared to 3 mSv background). As with all procedures which utilize radiation, there is an inherent risk of genetic mutation and the possible development of malignancy. Here, we present the case of a 75-year-old male who presented with an exophytic mass on his back following prolonged coronary catheterization with a radiation burn seven years prior. Biopsy of the lesion revealed the mass was consistent with an undifferentiated pleomorphic sarcoma emanating from the site of the radiation burn. After staging studies demonstrated no evidence of metastatic disease, radical excision with negative margins was performed. This case demonstrates that despite the rarity of radiation injury, each incidence necessitates strict monitoring of radiation exposure and continual follow-up due to the risk of malignancy.
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25
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Orbital Extranodal Marginal Zone Lymphoma Following Radiotherapy: A Report of 2 Cases. Ophthalmic Plast Reconstr Surg 2018; 34:443-448. [DOI: 10.1097/iop.0000000000001043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Fu X, Chen S, Chen W, Yang Z, Song M, Li H, Zhang H, Yao F, Su X, Liu T, Yang AK. Clinical analysis of second primary gingival squamous cell carcinoma after radiotherapy. Oral Oncol 2018; 84:20-24. [PMID: 30115471 DOI: 10.1016/j.oraloncology.2018.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/17/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Clinically, we have observed that some oral cancer patients have a history of radiotherapy for head and neck cancer; we have named this condition radiotherapy-associated cancer (RAC). Gingival cancer, which is usually juxtaposed with other oral cancer subtypes, is seldom reported individually, and there are few reports on the association between the incidence of oral cancer and history of radiation therapy. Therefore, this study aimed to elucidate the clinicopathological features and prognosis of second primary gingival squamous cell carcinoma after head and neck radiotherapy. MATERIALS AND METHODS The data collected included 450 patients diagnosed with gingival squamous cell carcinoma from 1964 to 2012 at Sun Yat-sen University Cancer, among whom 52 patients had a history of radiotherapy for head and neck cancer. We retrospectively analysed the differences in the clinicopathological characteristics and prognosis between sporadic gingival squamous cell carcinoma and radiation-associated gingival carcinoma, with an emphasis on gingival carcinoma. RESULTS Sporadic gingival squamous cell carcinoma is less likely to have more advanced T stage, and the second primary tumour is more likely to be located in the molar area of the maxillary gingiva than in the mandibular gingiva (75.6% vs 24.4%, P < 0.05). The 5-year overall survival of patients with second primary gingival carcinoma was influenced by age distribution, T classification, N classification, clinical TNM stage, histological grade and radiation history in head and neck. Mandibular gingival carcinoma was more likely to have an increased neck lymph node metastasis than maxillary gingival carcinoma (P = 0.001), but there was no significant difference in 5-year overall survival between these two groups (P = 0.828). The main therapy for gingiva carcinoma is surgery or comprehensive treatment based on surgery. CONCLUSIONS Second primary gingival squamous cell carcinoma after radiotherapy demonstrated particular clinicopathologic features, such as prominent sites and TNM stage; and there was statistically significant difference in 5-year overall survival and prognosis between second primary gingival carcinoma after radiotherapy and sporadic gingival carcinoma.
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Affiliation(s)
- Xiaoyan Fu
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, People's Republic of China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Shuwei Chen
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, People's Republic of China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Weichao Chen
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, People's Republic of China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Zhongyuan Yang
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, People's Republic of China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Ming Song
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, People's Republic of China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Hao Li
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, People's Republic of China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Huayong Zhang
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, People's Republic of China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Fan Yao
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, People's Republic of China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Xuan Su
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, People's Republic of China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Tianrun Liu
- Department of Otorhinolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510655, People's Republic of China.
| | - An-Kui Yang
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, People's Republic of China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China.
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Nakamura T, Kusuzaki K, Matsubara T, Murata H, Hagi T, Asanuma K, Sudo A. Long-term clinical outcome in patients with high-grade soft tissue sarcoma who were treated with surgical adjuvant therapy using acridine orange after intra-lesional or marginal resection. Photodiagnosis Photodyn Ther 2018; 23:165-170. [PMID: 29885811 DOI: 10.1016/j.pdpdt.2018.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated the long-term clinical efficacy of acridine orange (AO) therapy on the inhibition of local recurrence after marginal or intra-lesional tumor resection in high-grade soft tissue sarcomas (STSs). METHODS Our study consisted of 48 patients with STSs who received AO therapy after marginal or intra-lesional resection. The median and mean follow-up durations were 76 and 78 months, respectively. Our AO therapy procedure was combined with photodynamic surgery, photodynamic therapy, and radiodynamic therapy. RESULTS There were 25 men and 23 women, with a mean age of 46 years. The average tumor size at surgery was 8.5 cm. At the last follow-up, 11 patients developed local recurrence. The 5- and 10-year local recurrence-free rates were 78.9% and 73.3%, respectively. In multivariate analysis, tumor size remained significant for local control. None of the patients developed systemic or local complications. All patients recovered activities of daily life before AO therapy. CONCLUSION AO therapy can be performed in safety and may be a useful therapy for acquiring long-term local control in patients with high-grade STSs. Tumor size is an important factor for the indication of AO therapy.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Postgraduate School of Medicine, Edobashi 2-174, Tsu-city, 514-8507, Japan.
| | - Katsuyuki Kusuzaki
- Department of Musculoskeletal Oncology, Takai Hospital, Kuranosho 470-8, Tenri, 632-0006, Japan
| | - Takao Matsubara
- Matsubara Orthopaedic Clinic. Shiroyama 3-4-25, Tsu-city, 514-0818, Japan
| | - Hiroaki Murata
- Department of Orthopaedic Surgery, Matsushita Memorial Hospital, Moriguchi-City, 570-8540, Japan
| | - Tomohito Hagi
- Department of Orthopaedic Surgery, Mie University Postgraduate School of Medicine, Edobashi 2-174, Tsu-city, 514-8507, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Postgraduate School of Medicine, Edobashi 2-174, Tsu-city, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Postgraduate School of Medicine, Edobashi 2-174, Tsu-city, 514-8507, Japan
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Thaung C. Orbital pathology - Iatrogenic findings and artefacts. Saudi J Ophthalmol 2018; 32:17-22. [PMID: 29755266 PMCID: PMC5944018 DOI: 10.1016/j.sjopt.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/01/2018] [Accepted: 02/08/2018] [Indexed: 12/01/2022] Open
Abstract
The relationship between the ophthalmologist and ophthalmic pathologist is particularly important in orbital disease, as diagnosis is heavily dependent on correlation with clinical context. If the patient has previously had treatment to the orbit or an adjacent area, whether for the same or a different condition, tissue changes may occur which affect the histological appearance of any specimen taken. This article is an overview of therapeutic interventions which may cause either orbital pathology or an altered appearance of the tissue, either of which can pose a diagnostic challenge. The problem of artefact is also addressed as another factor which may alter the appearance of a specimen. It is hoped that the information provided in this brief review will help clinicians better evaluate what information may be relevant when submitting a specimen.
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Genetic susceptibility to bone and soft tissue sarcomas: a field synopsis and meta-analysis. Oncotarget 2018; 9:18607-18626. [PMID: 29719630 PMCID: PMC5915097 DOI: 10.18632/oncotarget.24719] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/07/2018] [Indexed: 12/18/2022] Open
Abstract
Background The genetic architecture of bone and soft tissue sarcomas susceptibility is yet to be elucidated. We aimed to comprehensively collect and meta-analyze the current knowledge on genetic susceptibility in these rare tumors. Methods We conducted a systematic review and meta-analysis of the evidence on the association between DNA variation and risk of developing sarcomas through searching PubMed, The Cochrane Library, Scopus and Web of Science databases. To evaluate result credibility, summary evidence was graded according to the Venice criteria and false positive report probability (FPRP) was calculated to further validate result noteworthiness. Integrative analysis of genetic and eQTL (expression quantitative trait locus) data was coupled with network and pathway analysis to explore the hypothesis that specific cell functions are involved in sarcoma predisposition. Results We retrieved 90 eligible studies comprising 47,796 subjects (cases: 14,358, 30%) and investigating 1,126 polymorphisms involving 320 distinct genes. Meta-analysis identified 55 single nucleotide polymorphisms (SNPs) significantly associated with disease risk with a high (N=9), moderate (N=38) and low (N=8) level of evidence, findings being classified as noteworthy basically only when the level of evidence was high. The estimated joint population attributable risk for three independent SNPs (rs11599754 of ZNF365/EGR2, rs231775 of CTLA4, and rs454006 of PRKCG) was 37.2%. We also identified 53 SNPs significantly associated with sarcoma risk based on single studies.Pathway analysis enabled us to propose that sarcoma predisposition might be linked especially to germline variation of genes whose products are involved in the function of the DNA repair machinery. Conclusions We built the first knowledgebase on the evidence linking DNA variation to sarcomas susceptibility, which can be used to generate mechanistic hypotheses and inform future studies in this field of oncology.
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O'Connor SM, Wobker SE, Cardona DM, Eward W, Esther RJ, Dodd LG. Iatrogenic lesions of soft tissue and bone. Semin Diagn Pathol 2017; 35:208-217. [PMID: 29110897 DOI: 10.1053/j.semdp.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S M O'Connor
- Department of Pathology and Laboratory Medicine, University of North Carolina Chapel Hill, United States
| | - S E Wobker
- Department of Pathology and Laboratory Medicine, University of North Carolina Chapel Hill, United States
| | - D M Cardona
- Department of Pathology, Duke University, Durham, NC, United States
| | - W Eward
- Division of Oncology, Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - R J Esther
- Department of Orthopaedic Surgery, University of North Carolina Chapel Hill, United States
| | - L G Dodd
- Department of Pathology and Laboratory Medicine, University of North Carolina Chapel Hill, United States.
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Kurashige T, Shimamura M, Nagayama Y. N-Acetyl-L-cysteine protects thyroid cells against DNA damage induced by external and internal irradiation. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2017; 56:405-412. [PMID: 28871381 DOI: 10.1007/s00411-017-0711-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
We evaluated the effect of the antioxidant N-acetyl-L-cysteine (NAC) on the levels of reactive oxygen species (ROS), DNA double strand breaks (DSB) and micronuclei (MN) induced by internal and external irradiation using a rat thyroid cell line PCCL3. In internal irradiation experiments, ROS and DSB levels increased immediately after 131I addition and then gradually declined, resulting in very high levels of MN at 24 and 48 h. NAC administration both pre- and also post-131I addition suppressed ROS, DSB and MN. In external irradiation experiments with a low dose (0.5 Gy), ROS and DSB increased shortly and could be prevented by NAC administration pre-, but not post-irradiation. In contrast, external irradiation with a high dose (5 Gy) increased ROS and DSB in a bimodal way: ROS and DSB levels increased immediately after irradiation, quickly returned to the basal levels and gradually rose again after >24 h. The second phase was in parallel with an increase in 4-hydroxy-2-nonenal. The number of MN induced by the second wave of ROS/DSB elevations was much higher than that by the first peak. In this situation, NAC administered pre- and post-irradiation comparably suppressed MN induced by a delayed ROS elevation. In conclusion, a prolonged ROS increase during internal irradiation and a delayed ROS increase after external irradiation with a high dose caused serious DNA damage, which were efficiently prevented by NAC. Thus, NAC administration even both after internal or external irradiation prevents ROS increase and eventual DNA damage.
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Affiliation(s)
- Tomomi Kurashige
- Department of Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Mika Shimamura
- Department of Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Yuji Nagayama
- Department of Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
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Bellés M, Gonzalo S, Serra N, Esplugas R, Arenas M, Domingo JL, Linares V. Environmental exposure to low-doses of ionizing radiation. Effects on early nephrotoxicity in mice. ENVIRONMENTAL RESEARCH 2017; 156:291-296. [PMID: 28371757 DOI: 10.1016/j.envres.2017.03.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 06/07/2023]
Abstract
Nuclear accidents of tremendous magnitude, such as those of Chernobyl (1986) and Fukushima (2011), mean that individuals living in the contaminated areas are potentially exposed to ionizing radiation (IR). However, the dose-response relationship for effects of low doses of radiation is not still established. The present study was aimed at investigating in mice the early effects of low-dose internal radiation exposure on the kidney. Adult male (C57BL/6J) mice were divided into three groups. Two groups received a single subcutaneous (s.c.) doses of cesium (137Cs) with activities of 4000 and 8000Bq/kg bw. A third group (control group) received a single s.c. injection of 0.9% saline. To evaluate acute and subacute effects, mice (one-half of each group) were euthanized at 72h and 10 days post-exposure to 137Cs, respectively. Urine samples were collected for biochemical analysis, including the measurement of F2-isoprostane (F2-IsoP) and kidney injury molecule-1 (KIM-1) levels. Moreover, the concentrations of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a sensitive marker of oxidative DNA damage, were measured in renal tissue. Urinary excretion of total protein significantly increased at 72h in mice exposed to Cs4000. Uric acid and lactate dehydrogenase (LDH) decreased significantly at both times post-exposure in animals exposed to Cs8000. After 72h and 10d of exposure to Cs4000, a significant increase in the γ-glutamil transferase (GGT) and N-acetyl-β-D-glucosaminidase (NAG) activities was observed. In turn, F2-IsoP levels increased -mainly in the Cs4000 group- at 72h post-exposure. Following irradiation (137Cs), the highest level of KIM-1 was corresponded to the Cs4000 group at 72h. Likewise, the main DNA damage was detected in mice exposed to Cs4000, mainly at 10d after irradiation. The alterations observed in several biomarkers suggest an immediate renal damage following exposure to low doses of IR (given as 137Cs). Further investigations are required to clarify the mechanisms involved in the internal IR-induced nephrotoxicity.
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Affiliation(s)
- Montserrat Bellés
- Physiology Unit, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain; Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain
| | - Sergio Gonzalo
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain
| | - Noemí Serra
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain
| | - Roser Esplugas
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain
| | - Meritxell Arenas
- Radiation Oncology Department, Sant Joan University Hospital, IISPV, Rovira i Virgili University, Reus, Spain
| | - José Luis Domingo
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain
| | - Victoria Linares
- Physiology Unit, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain; Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain.
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Reiter RJ, Rosales-Corral SA, Tan DX, Acuna-Castroviejo D, Qin L, Yang SF, Xu K. Melatonin, a Full Service Anti-Cancer Agent: Inhibition of Initiation, Progression and Metastasis. Int J Mol Sci 2017; 18:E843. [PMID: 28420185 PMCID: PMC5412427 DOI: 10.3390/ijms18040843] [Citation(s) in RCA: 326] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 12/21/2022] Open
Abstract
There is highly credible evidence that melatonin mitigates cancer at the initiation, progression and metastasis phases. In many cases, the molecular mechanisms underpinning these inhibitory actions have been proposed. What is rather perplexing, however, is the large number of processes by which melatonin reportedly restrains cancer development and growth. These diverse actions suggest that what is being observed are merely epiphenomena of an underlying more fundamental action of melatonin that remains to be disclosed. Some of the arresting actions of melatonin on cancer are clearly membrane receptor-mediated while others are membrane receptor-independent and involve direct intracellular actions of this ubiquitously-distributed molecule. While the emphasis of melatonin/cancer research has been on the role of the indoleamine in restraining breast cancer, this is changing quickly with many cancer types having been shown to be susceptible to inhibition by melatonin. There are several facets of this research which could have immediate applications at the clinical level. Many studies have shown that melatonin's co-administration improves the sensitivity of cancers to inhibition by conventional drugs. Even more important are the findings that melatonin renders cancers previously totally resistant to treatment sensitive to these same therapies. Melatonin also inhibits molecular processes associated with metastasis by limiting the entrance of cancer cells into the vascular system and preventing them from establishing secondary growths at distant sites. This is of particular importance since cancer metastasis often significantly contributes to death of the patient. Another area that deserves additional consideration is related to the capacity of melatonin in reducing the toxic consequences of anti-cancer drugs while increasing their efficacy. Although this information has been available for more than a decade, it has not been adequately exploited at the clinical level. Even if the only beneficial actions of melatonin in cancer patients are its ability to attenuate acute and long-term drug toxicity, melatonin should be used to improve the physical wellbeing of the patients. The experimental findings, however, suggest that the advantages of using melatonin as a co-treatment with conventional cancer therapies would far exceed improvements in the wellbeing of the patients.
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Affiliation(s)
- Russel J Reiter
- Department of Cell Systems and Anatomy, UT Health, San Antonio, TX 78229, USA.
| | - Sergio A Rosales-Corral
- Centro de Investigacion Biomedica de Occidente, Del Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico.
| | - Dun-Xian Tan
- Department of Cell Systems and Anatomy, UT Health, San Antonio, TX 78229, USA.
| | | | - Lilan Qin
- Department of Cell Systems and Anatomy, UT Health, San Antonio, TX 78229, USA.
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan, Medical University, Taichung 40201, Taiwan.
| | - Kexin Xu
- Department of Molecular Medicine, UT Health, San Antonio, TX 78229, USA.
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