Radiosurgery for Recurrent Brain Metastases after Whole-Brain Radiotherapy : Factors Affecting Radiation-Induced Neurological Dysfunction

Gwak, Ho-Shin; Yoo, Hyun Jung; Youn, Sang-Min; Lee, Dong Han; Kim, Mi Sook; Rhee, Chang Hun

doi:10.3340/jkns.2009.45.5.275

Cited by 16 publications

(7 citation statements)

References 26 publications

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“…The severity of the nutritional problems related to radiation treatment, which include weight loss, depends on the location and amount of treatment, tissue thickness, nutritional status, tissue sensitivity, and psychological status of the patient. Radiation treatment causes stomatitis, mucositis, esophagitis, gastroenteritis, loss of taste, nausea, vomiting, diarrhea, constipation, bleeding, and proctitis, which lead to difficulties eating and in digestion [ 18 , 19 ]. Malnutrition caused by radiation weakens immunity, which, in turn, increases the rate of infection, reduces the reaction to treatment, weakens the whole body, reduces quality of life, and ultimately leads to death [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of quercetin on impaired immune function in mice exposed to irradiation

2012

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Radiation used in cancer treatment may cause side effects such as inflammation. Quercetin is a polyphenol that reduces inflammation. This study evaluated the recovery efficacy of quercetin on impaired immune function in irradiation-induced inflammatory mice. Quercetin administered at two concentrations of 10 and 40 mg/kg body weight was initiated 2 weeks before irradiation and was continued 30 days after irradiation. The animals exposed/not exposed to radiation were sacrificed on radiation days 10 and 30. Splenocyte proliferation, which was diminished after irradiation, was enhanced significantly by quercetin supplementation after 30 days of irradiation. Cytokine secretion increased in the radiation group compared to that in the non-radiation control group. After 30 days of radiation, interleukin (IL)-1β and IL-6 secretion decreased significantly in the radiation-quercetin groups. When quercetin was administered for 44 days, it showed a possible protective effect against irradiation-induced inflammation in mice. Quercetin could be beneficial in the recovery of irradiation-induced increases in cytokine secretion.

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Section: Introductionmentioning

confidence: 99%

Effect of quercetin on impaired immune function in mice exposed to irradiation

2012

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“…The limitations associated with treatment strategies include drug-resistant characteristics of the tumors, inability of chemotoxic agents to traverse the blood-brain barrier in effective amounts, radiation toxicity to normal brain tissue, and potential risk of significant neurologic damage associated with tumor resection in elegant brain regions. Administration of higher dosages of chemotherapeutic agents is generally not an option, because they are often accompanied by stronger adverse side effects (1); the same is true of increasing radiation toxicity (2). One effective way to increase efficacy of therapeutic agents is to increase the sensitivity of cancer cells to these agents.…”

Section: Introductionmentioning

confidence: 99%

Heavy Chain Ferritin siRNA Delivered by Cationic Liposomes Increases Sensitivity of Cancer Cells to Chemotherapeutic Agents

et al. 2011

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Approximately half of all gliomas are resistant to chemotherapy, and new therapeutic strategies are urgently needed to treat this cancer. We hypothesized that disrupting iron homeostasis in glioma cells could block tumor growth, based on an acute requirement for high levels of iron to meet energy requirements associated with their rapid growth. Ferritin is best known as an intracellular iron storage protein, but it also localizes to tumor cell nuclei where it seems to protect DNA from oxidative damage and to promote transcription. In this study, we hypothesize that silencing the H-ferritin (heavy chain ferritin) gene could increase tumor sensitivity to chemotoxins. To test this hypothesis, H-ferritin siRNA was delivered to several human cancer cell lines by using cationic liposomes (C-liposome). H-ferritin siRNA decreased protein expression by 80% within 48 hours, and this decrease was associated with more than 50% decrease in the LD 50 for DNA-alkylating agent carmustine (BCNU), which is commonly used to treat glioma in clinic. In a subcutaneous mouse model of human glioma, intratumoral injections of liposomes containing H-ferritin siRNA reduced the effective dose of BCNU needed for tumor suppression by more than 50%. A plasmid supercoil relaxation assay showed that H-ferritin specifically and directly protected DNA from BCNU treatment. H-ferritin siRNA additionally seemed to increase apoptosis in glioma cells in vitro upon H-ferritin knockdown. Overall, our results illustrate how silencing H-ferritin can effectively sensitize tumors to chemotherapy and also show the ability of C-liposomes to serve as a novel in vivo delivery tool for siRNAs. Cancer Res; 71(6); 2240-9. Ó2011 AACR.

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“…Many RN risk factors have been identified, including tumor volume, prescribed dose, fraction size, and interval between re-irradiation. However, the threshold for safe re-irradiation in terms of cumulative dose or treatment volume has been suggested, but is yet to be confirmed [ 14 27 28 29 ]. A prospective controlled study as well as increased RN awareness in the neuro-oncology field is required for further evaluation.…”

Section: Discussionmentioning

confidence: 99%

Clinical Experience of Bevacizumab for Radiation Necrosis in Patients with Brain Metastasis

Park

Gwak

Lee

et al. 2020

Brain Tumor Res Treat

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Background As the application of radiotherapy to brain metastasis (BM) increases, the incidence of radiation necrosis (RN) as a late toxicity of radiotherapy also increases. However, no specific treatment for RN is indicated except long-term steroids. Here, we summarize the clinical results of bevacizumab (BEV) for RN. Methods Ten patients with RN who were treated with BEV monotherapy (7 mg/kg) were retrospectively reviewed. RN diagnosis was made using MRI with or without perfusion MRI. Radiological response was based on Response Assessment in Neuro-Oncology criteria for BM. The initial response was observed after 2 cycles every 2 weeks, and maintenance observed after 3 cycles every 3–6 weeks of increasing length intervals. Results The initial response of gadolinium (Gd) enhancement diameter maintained stable disease (SD) in 9 patients, and 1 patient showed partial response (PR). The initial fluid-attenuated inversion recovery (FLAIR) response showed PR in 4 patients and SD in 6 patients. The best radiological response was observed in 9 patients. Gd enhancement response was 6 PR and 3 SD between 15–43 weeks. Reduction of FLAIR showed PR in 5 patients and SD in 4 patients. Clinical improvement was observed in all but 1 patient. Five patients were maintained on protocol with durable response up to 23 cycles. However, 2 patients stopped treatment due to primary cancer progression, 1 patient received surgical removal from tumor recurrence, and 1 patient changed to systemic chemotherapy for new BM. Grade 3 intractable hypertension occurred in 1 patient who had already received antihypertensive medication. Conclusion BEV treatment for RN from BM radiotherapy resulted in favorable radiological (60%) and clinical responses (90%). Side effects were expectable and controllable. We anticipate prospective clinical trials to verify the effect of BEV monotherapy for RN.

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Radiosurgery for Recurrent Brain Metastases after Whole-Brain Radiotherapy : Factors Affecting Radiation-Induced Neurological Dysfunction

Abstract: Salvage CyberKnife radiosurgery is effective for recurrent brain metastases in previously irradiated patients, but careful evaluation is advised in patients with large tumors and high cumulative radiation doses to avoid toxicity.

Cited by 16 publications

References 26 publications

Effect of quercetin on impaired immune function in mice exposed to irradiation

Effect of quercetin on impaired immune function in mice exposed to irradiation

Heavy Chain Ferritin siRNA Delivered by Cationic Liposomes Increases Sensitivity of Cancer Cells to Chemotherapeutic Agents

Clinical Experience of Bevacizumab for Radiation Necrosis in Patients with Brain Metastasis

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