The effect of dose escalation on gastric toxicity when treating lower oesophageal tumours: a radiobiological investigation

Carrington, R.; Staffurth, John; Warren, S.; Partridge, Mike; Hurt, Chris; Spezi, Emiliano; Gwynne, S.; Hawkins, M.; Crosby, T.

doi:10.1186/s13014-015-0537-y

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…Radiation-induced digestive injury manifests as a dosevolume effect, meaning that the extent of the lesion highly depends on the radiation dose and radiated volume (23). This theory has been verified in many studies in different organs, including the esophagus (21,24), stomach (25,26), small bowel (26,27), rectum (28)(29)(30)(31), and anus. On the basis of the dosevolume effect, radiotherapy-induced injury can be assessed by radiation dose and/or volume calculations.…”

Section: B) Dose-volume Effectmentioning

confidence: 81%

Radiotherapy-Induced Digestive Injury: Diagnosis, Treatment and Mechanisms

et al. 2021

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Radiotherapy is one of the main therapeutic methods for treating cancer. The digestive system consists of the gastrointestinal tract and the accessory organs of digestion (the tongue, salivary glands, pancreas, liver and gallbladder). The digestive system is easily impaired during radiotherapy, especially in thoracic and abdominal radiotherapy. In this review, we introduce the physical classification, basic pathogenesis, clinical characteristics, predictive/diagnostic factors, and possible treatment targets of radiotherapy-induced digestive injury. Radiotherapy-induced digestive injury complies with the dose-volume effect and has a radiation-based organ correlation. Computed tomography (CT), MRI (magnetic resonance imaging), ultrasound (US) and endoscopy can help diagnose and evaluate the radiation-induced lesion level. The latest treatment approaches include improvement in radiotherapy (such as shielding, hydrogel spacers and dose distribution), stem cell transplantation and drug administration. Gut microbiota modulation may become a novel approach to relieving radiogenic gastrointestinal syndrome. Finally, we summarized the possible mechanisms involved in treatment, but they remain varied. Radionuclide-labeled targeting molecules (RLTMs) are promising for more precise radiotherapy. These advances contribute to our understanding of the assessment and treatment of radiation-induced digestive injury.

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Section: B) Dose-volume Effectmentioning

confidence: 81%

Radiotherapy-Induced Digestive Injury: Diagnosis, Treatment and Mechanisms

et al. 2021

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“…26 Therefore, it is necessary to explore novel mechanisms, biomarkers, and intervention targets to understand and identify strategies against radiation-induced gastric injury. 27 Comparing the transcriptome profiles in response to radiation, we identified 136 differentially expressed genes (27 mRNAs and 109 lncRNAs) between the control and irradiated gastric tissues including 29 upregulated and 107 downregulated RNAs. To our knowledge, this study is the first to show RNA profiles of gastric tissues in response to ionizing radiation.…”

Section: Discussionmentioning

confidence: 99%

mRNA and lncRNA Expression Profiling of Radiation-Induced Gastric Injury Reveals Potential Radiation-Responsive Transcription Factors

et al. 2019

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Radiation-induced gastric injury is a serious concern that may limit the duration and the delivered dose of radiation. However, the genome-wide molecular changes in stomach upon ionizing radiation have not been reported. In this study, mouse stomach was irradiated with 6 or 12 Gy X-ray irradiation and we found that radiation resulted in the atrophy of gastric mucosa and abnormal morphology of chief and parietal cells. Radiation-induced gastric injury was accompanied by an increase in the serum levels of pepsinogen A and pepsinogen C but not gastrin-17. The expression profiles of messenger RNA (mRNA) and long noncoding RNA (lncRNA) in normal and irradiated gastric tissues were measured by microarray analysis. Results revealed 17 upregulated and 10 downregulated mRNAs were consistent in 6 and 12 Gy irradiated gastric tissues, including D site-binding protein (Dbp) and fibrinogen-like protein 1 (Fgl1). Thirteen upregulated and 96 downregulated lncRNAs were commonly changed in 6 and 12 Gy irradiated gastric tissues. The dysregulated mRNAs were implicated in multiple pathways and showed coexpression with lncRNAs. To identify motifs for transcription factors and coactivators in the proximal promoter regions of the dysregulated RNAs, the bioinformatic tool Biopython was used. A variety of common motifs that are associated with transcription factors were identified, including ZNF263, LMX1B, and Dlx1. Our findings illustrate the molecular changes during radiation-induced gastric injury and the potential transcription factors driving this alteration.

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“…Further research is necessary to define effective and safe dosage regimens for CIR. Special attention has to be paid to the esophagus itself as an organ at risk as well as the stomach for distal tumors being prone to complications with increased radiation dose [38]. …”

Section: Discussionmentioning

confidence: 99%

Intrafractional dose variation and beam configuration in carbon ion radiotherapy for esophageal cancer

Haefner

Sterzing²,

Krug

et al. 2016

Radiat Oncol

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BackgroundIn carbon ion radiotherapy (CIR) for esophageal cancer, organ and target motion is a major challenge for treatment planning due to potential range deviations. This study intends to analyze the impact of intrafractional variations on dosimetric parameters and to identify favourable settings for robust treatment plans.MethodsWe contoured esophageal boost volumes in different organ localizations for four patients and calculated CIR-plans with 13 different beam geometries on a free-breathing CT. Forward calculation of these plans was performed on 4D-CT datasets representing seven different phases of the breathing cycle. Plan quality was assessed for each patient and beam configuration.ResultsTarget volume coverage was adequate for all settings in the baseline CIR-plans (V95 > 98% for two-beam geometries, > 94% for one-beam geometries), but reduced on 4D-CT plans (V95 range 50–95%). Sparing of the organs at risk (OAR) was adequate, but range deviations during the breathing cycle partly caused critical, maximum doses to spinal cord up to 3.5x higher than expected. There was at least one beam configuration for each patient with appropriate plan quality.ConclusionsDespite intrafractional motion, CIR for esophageal cancer is possible with robust treatment plans when an individually optimized beam setup is selected depending on tumor size and localization.

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The effect of dose escalation on gastric toxicity when treating lower oesophageal tumours: a radiobiological investigation

Cited by 4 publications

References 28 publications

Radiotherapy-Induced Digestive Injury: Diagnosis, Treatment and Mechanisms

Radiotherapy-Induced Digestive Injury: Diagnosis, Treatment and Mechanisms

mRNA and lncRNA Expression Profiling of Radiation-Induced Gastric Injury Reveals Potential Radiation-Responsive Transcription Factors

Intrafractional dose variation and beam configuration in carbon ion radiotherapy for esophageal cancer

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