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International Journal of Radiation... May 2021As part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy investigating normal tissue complication probability (NTCP)... (Review)
Review
PURPOSE
As part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy investigating normal tissue complication probability (NTCP) after hypofractionated radiation therapy, data from published reports (PubMed indexed 1995-2018) were pooled to identify dosimetric and clinical predictors of radiation-induced brain toxicity after single-fraction stereotactic radiosurgery (SRS) or fractionated stereotactic radiosurgery (fSRS).
METHODS AND MATERIALS
Eligible studies provided NTCPs for the endpoints of radionecrosis, edema, or symptoms after cranial SRS/fSRS and quantitative dose-volume metrics. Studies of patients with only glioma, meningioma, vestibular schwannoma, or brainstem targets were excluded. The data summary and analyses focused on arteriovenous malformations (AVM) and brain metastases.
RESULTS
Data from 51 reports are summarized. There was wide variability in reported rates of radionecrosis. Available data for SRS/fSRS for brain metastases were more amenable to NTCP modeling than AVM data. In the setting of brain metastases, SRS/fSRS-associated radionecrosis can be difficult to differentiate from tumor progression. For single-fraction SRS to brain metastases, tissue volumes (including target volumes) receiving 12 Gy (V12) of 5 cm, 10 cm, or >15 cm were associated with risks of symptomatic radionecrosis of approximately 10%, 15%, and 20%, respectively. SRS for AVM was associated with modestly lower rates of symptomatic radionecrosis for equivalent V12. For brain metastases, brain plus target volume V20 (3-fractions) or V24 (5-fractions) <20 cm was associated with <10% risk of any necrosis or edema, and <4% risk of radionecrosis requiring resection.
CONCLUSIONS
The risk of radionecrosis after SRS and fSRS can be modeled as a function of dose and volume treated. The use of fSRS appears to reduce risks of radionecrosis for larger treatment volumes relative to SRS. More standardized dosimetric and toxicity reporting is needed to facilitate future pooled analyses that can refine predictive models of brain toxicity risks.
Topics: Antineoplastic Agents; Brain; Brain Edema; Brain Neoplasms; Brain Stem; Disease Progression; Humans; Immune Checkpoint Inhibitors; Intracranial Arteriovenous Malformations; Models, Biological; Models, Theoretical; Necrosis; Organs at Risk; Probability; Radiation Dose Hypofractionation; Radiation Injuries; Radiation Tolerance; Radiosurgery; Radiotherapy Dosage; Re-Irradiation
PubMed: 32921513
DOI: 10.1016/j.ijrobp.2020.08.013 -
Cancer Radiotherapie : Journal de La... Jul 2021Purpose of this review of medical literature is to present the immediate side effects of radiation therapy for head and neck cancer and their treatment. The likelihood... (Review)
Review
Purpose of this review of medical literature is to present the immediate side effects of radiation therapy for head and neck cancer and their treatment. The likelihood and severity of these immediate side effects depends on a number of factors, including the total dose of radiation delivered, over what time it was delivered and what parts of the head and neck received radiation. Early side effects include: inflammation of the oropharyngeal mucosa (mucositis), painful swallowing (odynophagia), difficulty swallowing (dysphagia), hoarseness, lack of saliva (xerostomia), orofacial pain, laryngeal radionecrosis, dermatitis, hair loss, nausea, vomiting, inadequate nutrition and hydration, and weight loss. These complications can interfere with, and delay treatment. Most of these side effects generally dissipate over time. In conclusion, radiation treatment for the head and neck cancer causes significant early side effects. Many of these side effects present difficult challenges to the patients. Their recognition and treatment can significantly improve the patients' health, long-term survival and quality of life. The review provides information that can assist head and cancer survivors deal with radiation side effects.
Topics: Alopecia; Brain; Deglutition Disorders; Dehydration; Dysgeusia; Facial Pain; Fatigue; Head and Neck Neoplasms; Humans; Laryngeal Cartilages; Mouth Mucosa; Mucositis; Nausea; Necrosis; Periodontal Diseases; Radiodermatitis; Radiotherapy; Vomiting; Weight Loss; Xerostomia
PubMed: 33685809
DOI: 10.1016/j.canrad.2021.02.001 -
International Journal of Radiation... Jan 2024Radiation necrosis (RN) secondary to stereotactic radiosurgery is a significant cause of morbidity. The optimal management of corticosteroid-refractory brain RN remains... (Review)
Review
A Systematic Review Informing the Management of Symptomatic Brain Radiation Necrosis After Stereotactic Radiosurgery and International Stereotactic Radiosurgery Society Recommendations.
Radiation necrosis (RN) secondary to stereotactic radiosurgery is a significant cause of morbidity. The optimal management of corticosteroid-refractory brain RN remains unclear. Our objective was to summarize the literature specific to efficacy and toxicity of treatment paradigms for patients with symptomatic corticosteroid-refractory RN and to provide consensus guidelines for grading and management of RN on behalf of the International Stereotactic Radiosurgery Society. A systematic review of articles pertaining to treatment of RN with bevacizumab, laser interstitial thermal therapy (LITT), surgical resection, or hyperbaric oxygen therapy was performed. The primary composite outcome was clinical and/or radiologic stability/improvement (ie, proportion of patients achieving improvement or stability with the given intervention). Proportions of patients achieving the primary outcome were pooled using random weighted-effects analysis but not directly compared between interventions. Twenty-one articles were included, of which only 2 were prospective studies. Thirteen reports were relevant for bevacizumab, 5 for LITT, 5 for surgical resection and 1 for hyperbaric oxygen therapy. Weighted effects analysis revealed that bevacizumab had a pooled symptom improvement/stability rate of 86% (95% CI 77%-92%), pooled T2 imaging improvement/stability rate of 93% (95% CI 87%-98%), and pooled T1 postcontrast improvement/stability rate of 94% (95% CI 87%-98%). Subgroup analysis showed a statistically significant improvement favoring treatment with low-dose (below median, ≤7.5 mg/kg every 3 weeks) versus high-dose bevacizumab with regards to symptom improvement/stability rate (P = .02) but not for radiologic T1 or T2 changes. The pooled T1 postcontrast improvement/stability rate for LITT was 88% (95% CI 82%-93%), and pooled symptom improvement/stability rate for surgery was 89% (95% CI 81%-96%). Toxicity was inconsistently reported but was generally low for all treatment paradigms. Corticosteroid-refractory RN that does not require urgent surgical intervention, with sufficient noninvasive diagnostic testing that favors RN, can be treated medically with bevacizumab in carefully selected patients as a strong recommendation. The role of LITT is evolving as a less invasive image guided surgical modality; however, the overall evidence for each modality is of low quality. Prospective head-to-head comparisons are needed to evaluate the relative efficacy and toxicity profile among treatment approaches.
Topics: Humans; Radiosurgery; Bevacizumab; Prospective Studies; Brain Neoplasms; Brain; Radiation Injuries; Necrosis; Adrenal Cortex Hormones; Retrospective Studies
PubMed: 37482137
DOI: 10.1016/j.ijrobp.2023.07.015 -
Nature Biomedical Engineering Apr 2020Environmental factors are the largest contributors to cardiovascular disease. Here we show that cardiac organoids that incorporate an oxygen-diffusion gradient and that...
Environmental factors are the largest contributors to cardiovascular disease. Here we show that cardiac organoids that incorporate an oxygen-diffusion gradient and that are stimulated with the neurotransmitter noradrenaline model the structure of the human heart after myocardial infarction (by mimicking the infarcted, border and remote zones), and recapitulate hallmarks of myocardial infarction (in particular, pathological metabolic shifts, fibrosis and calcium handling) at the transcriptomic, structural and functional levels. We also show that the organoids can model hypoxia-enhanced doxorubicin cardiotoxicity. Human organoids that model diseases with non-genetic pathological factors could help with drug screening and development.
Topics: Cardiotoxicity; Drug Development; Drug Evaluation, Preclinical; Heart; Humans; Models, Cardiovascular; Myocardial Infarction; Organoids; Oxygen
PubMed: 32284552
DOI: 10.1038/s41551-020-0539-4 -
Journal of Cosmetic Dermatology Mar 2021Blue light is emitted visible light between the wavelengths of 400 to 500 nm. The main source of blue light is sunlight, but digital screens, light-emitting diodes... (Review)
Review
BACKGROUND
Blue light is emitted visible light between the wavelengths of 400 to 500 nm. The main source of blue light is sunlight, but digital screens, light-emitting diodes (LEDs), and fluorescent lighting serve as additional sources. Concerns about the negative effects of blue light on the skin have rapidly increased over the past 15 years, and consequently, the urge to learn more about this topic is increasing as well.
AIMS
Part I of this article provides up-to-date information on the definition of blue light and the negative and positive effects of blue light on the skin.
METHODS
An Internet search was completed using the Google scholar database for relevant literature.
RESULTS
Blue light can be both harmful and beneficial to the skin, depending on intensity and wavelength. Short-term safety information is more readily available from clinical studies; however, the biological effects of repeated and/or longer-term exposure are not fully understood yet.
CONCLUSIONS
Low-energy and low exposure times to high-energy blue light can help prevent skin diseases, while studies have revealed that longer exposure to high-energy blue light can increase the amount of DNA damage, cell and tissue death, and injury, eye damage, skin barrier damage, and photoaging.
Topics: DNA Damage; Humans; Light; Lighting; Necrosis; Sunlight
PubMed: 33247615
DOI: 10.1111/jocd.13837 -
Morphologie : Bulletin de L'Association... Jun 2021Medication related osteonecrosis of the jaws (MRONJ) and osteoradionecrosis of the jaws (ORNJ) are two different diseases of quite similar appearance. MRONJ is mainly... (Review)
Review
Medication related osteonecrosis of the jaws (MRONJ) and osteoradionecrosis of the jaws (ORNJ) are two different diseases of quite similar appearance. MRONJ is mainly due to antiresorptive or antiangiogenic drug therapy and ORNJ to radiotherapy. The present work aimed at presenting and comparing the current knowledge on MRONJ and ORNJ. They both present as an exposure of necrotic bone and differ in some clinical or radiological characteristics, clinical course and mostly in treatment. They share similar risk factors. A tooth extraction is more frequently found as a triggering factor in MRONJ. The frequency of a maxillary localisation seems higher for MRONJ. On computed tomographic images, a periosteal reaction seems characteristic of MRONJ. More frequent pathological fractures seem to occur in ORNJ. It is mandatory, for ORNJ diagnosis, to exclude a residual or recurrent tumour using histological examination. Both MRONJ and ORNJ are challenging to treat and cannot be managed similarly. For both, it would still be worth to optimise awareness within the medical community, patients' oral hygiene and dental cares to improve their prevention and make their incidences decrease. Conservative therapy is more frequently achieved for MRONJ than ORNJ and surgical resection is more often performed for ORNJ. For both diseases, the last treatment possible in refractory cases is a surgical extensive resection with free flap reconstruction. A MRONJ classification is widely used today, whereas no consensus exists to date for ORNJ classification. We propose a classification that could play this role.
Topics: Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Humans; Jaw; Osteoradionecrosis; Risk Factors; Tooth Extraction
PubMed: 33281055
DOI: 10.1016/j.morpho.2020.11.008 -
JAMA Oncology Dec 2023
Topics: Humans; Immunoconjugates; Brain Neoplasms; Radiosurgery; Necrosis; Retrospective Studies; Brain
PubMed: 37883079
DOI: 10.1001/jamaoncol.2023.4492 -
Cell Calcium Jul 2023Multiple forms of regulated cell death (RCD) have been characterized, each of which originates from the activation of a dedicated molecular machinery. RCD can occur in... (Review)
Review
Multiple forms of regulated cell death (RCD) have been characterized, each of which originates from the activation of a dedicated molecular machinery. RCD can occur in purely physiological settings or upon failing cellular adaptation to stress. Caions have been shown to physically interact with - and hence regulate - various components of the RCD machinery. Moreover, intracellular Ca accumulation can promote organellar dysfunction to degree that can be overtly cytotoxic or sensitize cells to RCD elicited by other stressors. Here, we provide an overview of the main links between Caand different forms of RCD, including apoptosis, mitochondrial permeability transition (MPT)-driven necrosis, necroptosis, ferroptosis, lysosome-dependent cell death, and parthanatos.
Topics: Humans; Apoptosis; Cell Death; Lysosomes; Necrosis; Signal Transduction
PubMed: 37210868
DOI: 10.1016/j.ceca.2023.102759 -
Mini Reviews in Medicinal Chemistry 2021Major approach in controlling as well as eradicating the cancerous growth is through radiotherapy, but this treatment leads to toxicity in the normal cells, leading to... (Review)
Review
BACKGROUND
Major approach in controlling as well as eradicating the cancerous growth is through radiotherapy, but this treatment leads to toxicity in the normal cells, leading to secondary malignancies, teratogenesis, and necrosis. More than 15,000 malignancies occur due to exposure to harmful radiations during computed tomography scans. Natural products are non-toxic; there have been reports that herbal products, when given along with radiation, have shown increased tumor control property. The discussed agents in this review have potential antioxidant, immunomodulatory, free radical scavenging, metal chelating, and anti-inflammatory properties.
OBJECTIVE
To reduce the chances of toxicity, reduction in radiation dose or reducing the frequency of the therapy is made which usually leads to a therapeutically poor outcome. The most feasible method is to protect the normal cells by administration of radioprotective agents either before or after the exposure. These agents have been tested on animals and human cell models for evaluating their safety window and toxicity profile at the cellular level. The study aims to compile the effective natural radioprotective agents available, which can be further exploited by using certain QSAR studies to increase their potency.
METHOD
Structured literature search from EMBASE, PubMed, Bentham Science, Scopus, and ScienceDirect was carried out and appropriate peer-reviewed review articles, as well as certain research articles, were included and compiled in this review paper.
CONCLUSION
As various studies have indicated the harmful effects of ionizing radiations on normal cells, to reduce these effects, radioprotective agents are used before or after exposure to radiations. Compounds derived from natural sources are proved to have few side effects and they possess radioprotective property due to the presence of alkaloids, resins, volatile oils, tannins in their molecular structure. Various plants having such radioprotective constitutes have been identified for their radioprotective action and compiled in the present study.
Topics: Animals; Antioxidants; Neoplasms; Radiation, Ionizing; Radiation-Protective Agents
PubMed: 33494677
DOI: 10.2174/1389557521666210120112814 -
Oxidative Medicine and Cellular... 2021Radiation-induced brain necrosis (RBN) is a serious complication of intracranial as well as skull base tumors after radiotherapy. In the past, due to the lack of... (Review)
Review
Radiation-induced brain necrosis (RBN) is a serious complication of intracranial as well as skull base tumors after radiotherapy. In the past, due to the lack of effective treatment, radiation brain necrosis was considered to be progressive and irreversible. With better understanding in histopathology and neuroimaging, the occurrence and development of RBN have been gradually clarified, and new treatment methods are constantly emerging. In recent years, some scholars have tried to treat RBN with bevacizumab, nerve growth factor, and gangliosides and have achieved similar results. Some cases of brain necrosis can be repairable and reversible. We aimed to summarize the incidence, pathogenesis, and treatment of RBN.
Topics: Brain Neoplasms; Humans; Necrosis; Radiation Injuries
PubMed: 34976300
DOI: 10.1155/2021/4793517