Use genetic data to predict the best time of day to give radiotherapy to breast cancer patients, say researchers

University of Leicester | November 2018 | Use genetic data to predict the best time of day to give radiotherapy to breast cancer patients, say Researchers

Scientists from the University of Leicester followed two independent cohorts of patients with breast cancer being treated with radiotherapy (P equal to 879); where the researchers found that patients with variations of two genes were more likely to experience side effects if they received radiotherapy in the morning. 

The researchers explain that this is due to their circadian rhythms, with radiotherapy treatment in the morning causing worse acute toxicity for these patients.  They suggest that in future treatment it may be possible to reduce toxicity associated with breast cancer radiotherapy by identifying gene variants that affect circadian rhythm and tailoring treatment for appropriate morning or afternoon radiotherapy.

Professor Paul Symonds, a consultant oncologist at Leicester’s Hospitals and professor of clinical oncology at the University of Leicester said: “Our study found that some patients with a particular genetic profile are more at risk of side effects if given radiotherapy in the morning. This happens because the skin of these particular patients divides earlier in the day than others and dividing cells are more easily damaged by X-rays. This could allow an easy way to personalise treatment just by recommending what time of day a patient should be treated.”

The study was part-funded by the Breast Cancer Now charity and supported by funding from the European Union Seventh Framework Programme for research, technological development and demonstration (Source: University of Leicester).

Read the full article from the University of Leicester

Read and download the article Genetic Variants Predict Optimal Timing of Radiotherapy to Reduce Side-effects in Breast Cancer Patients from Clinical Oncology

Johnson, K., Chang-Claude, J., Critchley, A. M., Kyriacou, C., Lavers, S., Rattay, T., … & Talbot, C. J. (2018). Genetic variants predict optimal timing of radiotherapy to reduce side-effects in breast cancer patients. Clinical Oncology. https://doi.org/10.1016/j.clon.2018.10.001

Abstract

Aims

Radiotherapy is an important treatment for many types of cancer, but a minority of patients suffer long-term side-effects of treatment. Multiple lines of evidence suggest a role for circadian rhythm in the development of radiotherapy late side-effects.

Materials and methods

We carried out a study to examine the effect of radiotherapy timing in two breast cancer patient cohorts. The retrospective LeND cohort comprised 535 patients scored for late effects using the Late Effects of Normal Tissue-Subjective Objective Management Analytical (LENT-SOMA) scale. Acute effects were assessed prospectively in 343 patients from the REQUITE study using the CTCAE v4 scales. Genotyping was carried out for candidate circadian rhythm variants.


Results

In the LeND cohort, patients who had radiotherapy in the morning had a significantly increased incidence of late toxicity in univariate (P equal to 0.03) and multivariate analysis (P equal to 0.01). Acute effects in the REQUITE group were also significantly increased in univariate analysis after morning treatment (P equal to 0.03) but not on multivariate analysis.

Conclusion

Our results suggest that it may be possible to reduce toxicity associated with breast cancer radiotherapy by identifying gene variants that affect circadian rhythm and scheduling for appropriate morning or afternoon radiotherapy.

In the news:

The Telegraph Radiotherapy should be given at different times of day to reduce side effects, Leicester Uni study suggests

Evidence-based Peer Review for Radiation Therapy

Updated Review of the Literature with a Focus on Tumour Subsite and Treatment Modality | Clinical Oncology

Technological advances in radiation therapy permit steep dose gradients from the target to spare normal tissue, but increase the risk of geographic miss. Suboptimal target delineation adversely affects clinical outcomes. Prospective peer review is a method for quality assurance of oncologists’ radiotherapy plans. Published surveys suggest it is widely implemented. However, it may not be feasible to review every case before commencement of radiation therapy in all departments. The rate of plan changes following peer review of cases without a specific subsite or modality is typically around 10%. Stereotactic body radiation therapy, head and neck, gynaecological, gastrointestinal, haematological and lung cases are associated with higher rates of change of around 25%. These cases could thus be prioritised for peer review. Other factors may limit peer review efficacy including organisational culture, time constraints and the physical environment in which sessions are held. Recommendations for peer review endorsed by the American Society for Radiation Oncology were made available in 2013, but a number of relevant studies have been published since. Here we review and update the literature, and provide an updated suggestion for the implementation of peer review to serve as an adjunct to published guidelines. This may help practitioners evaluate their current processes and maximise the utility and effectiveness of peer review sessions.

Full reference: Huo, M. et al. (2017) Evidence-based Peer Review for Radiation Therapy – Updated Review of the Literature with a Focus on Tumour Subsite and Treatment Modality. Clinical Oncology. DOI: 10.1016/j.clon.2017.04.038

Movies could replace anaesthetic for child radiotherapy

Children with cancer could be spared dozens of doses of general anaesthesia by projecting a video directly on to the inside of a radiotherapy machine during treatment | OnMedica

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The new research was presented this week at the ESTRO 36 conference (European Society for Radiotherapy & Oncology), taking place in Vienna, Austria.

Catia Aguas, a radiation therapist and dosimetrist at the Cliniques Universitaires Saint Luc, Brussels, Belgium, told the conference that using video instead of general anaesthesia is less traumatic for children and their families, as well as making each treatment quicker and more cost effective.

The study included 12 children aged between one and a half and six years old who were treated with radiotherapy using a Tomotherapy® treatment unit at the university hospital. Six were treated before a video projector was installed in 2014 and six were treated after.

Before the video was available, general anaesthesia was needed for 83% of children’s treatments. Once the projector was installed, anaesthesia was only needed in 33% of treatments.

Read the full commentary here

Individualised mindfulness-based stress reduction for head and neck cancer patients undergoing radiotherapy

Pollard, A. et al. (2017) European Journal of Cancer Care. 26(2)

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Image source: mindfulness – Flickr // CC BY 2.0

People with head and neck cancer (HNC) experience elevated symptom toxicity and co-morbidity as a result of treatment, which is associated with poorer psychosocial and quality-of-life (QoL) outcomes.

This Phase I study examined whether an individualised mindfulness-based stress reduction (IMBSR) programme could be successfully used with HNC patients undergoing curative treatment.

After controlling for pre-intervention mindfulness, there was an association between higher post-intervention mindfulness and lower psychological distress and higher total, social and emotional QoL. This study offers important preliminary evidence than an IMBSR intervention can be administered to HNC patients during active cancer treatment. A randomised controlled trial is warranted to confirm these findings.

Read the full abstract here

Reducing Patient Waiting Times for Radiation Therapy and Improving the Treatment Planning Process:

Babshov, V. et al. Clinical Oncology. Published online: 19 February 2017

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Highlights

  • Modelling of an entire radiotherapy planning process at a cancer treatment facility.
  • Bottleneck analysis and resource level impact quantification to reduce waiting times.
  • Additional dosimetrist improved the mean waiting time by 6.5%.
  • Removing one physicist dramatically worsened the waiting time.
  • Applicability and transportability of the model to other facilities.

Read the full abstract here

Preoperative conventional chemoradiotherapy versus short-course radiotherapy with delayed surgery for rectal cancer

Latkauskas, T. et al. BMC Cancer. Published: 1 December 2016

https://wellcomeimages.org/indexplus/result.html?_IXMAXHITS_=1&_IXACTION_=query&_IXFIRST_=1&_IXSR_=Mo87xcXUtuT&_IXSS_=_IXMAXHITS_%3d250%26_IXFPFX_%3dtemplates%252ft%26_IXFIRST_%3d1%26c%3d%2522historical%2bimages%2522%2bOR%2b%2522contemporary%2bimages%2522%2bOR%2b%2522corporate%2bimages%2522%2bOR%2b%2522contemporary%2bclinical%2bimages%2522%26%252asform%3dwellcome%252dimages%26%2524%253dsi%3dtext%26_IXACTION_%3dquery%26i_pre%3d%26IXTO%3d%26t%3d%26_IXINITSR_%3dy%26i_num%3d%26%2524%253dsort%3dsort%2bsortexpr%2bimage_sort%26w%3d%26%2524%253ds%3drectal%2bcancer%26IXFROM%3d%26_IXSUBMIT_%3dSubmit%26_IXshc%3dy%26%2524%2b%2528%2528with%2bwi_sfgu%2bis%2bY%2529%2band%2bnot%2b%2528%2522contemporary%2bclinical%2bimages%2522%2bindex%2bwi_collection%2bor%2b%2522corporate%2bimages%2522%2bindex%2bwi_collection%2529%2529%2band%2bnot%2bwith%2bsys_deleted%3d%252e%26_IXrescount%3d5&_IXSPFX_=templates%2ft&_IXFPFX_=templates%2ft
Image source: Richard Kirsch and Raw’n’ Wild – Wellcome Images // CC BY-NC-ND 4.0

Background: There still is no evidence which neoadjuvant therapy regimen for stage II–III rectal cancer is superior. The aim of this study was to compare results achieved after long-course chemoradiotherapy (CRT) with short-term radiotherapy (RT) followed by delayed surgery.

 

Conclusion: Three-years disease-free survival was better in CRT group comparing with RT group with no difference in overall survival.

Read the full article here

Patterns of Referral to Radiation Oncology among Patients with Bladder Cancer

Quirt, J. S. et al. Clinical Oncology. Published online: 6 November 2016

https://wellcomeimages.org/indexplus/result.html?_IXMAXHITS_=1&_IXACTION_=query&_IXFIRST_=5&_IXSR_=5mQj60183wi&_IXSS_=_IXMAXHITS_%3d15%26_IXFPFX_%3dtemplates%252ft%26_IXFIRST_%3d1%26c%3d%2522historical%2bimages%2522%2bOR%2b%2522contemporary%2bimages%2522%2bOR%2b%2522corporate%2bimages%2522%2bOR%2b%2522contemporary%2bclinical%2bimages%2522%26%252asform%3dwellcome%252dimages%26%2524%253dsi%3dtext%26_IXACTION_%3dquery%26i_pre%3d%26IXTO%3d%26t%3d%26_IXINITSR_%3dy%26i_num%3d%26%2524%253dsort%3dsort%2bsortexpr%2bimage_sort%26w%3d%26%2524%253ds%3dbladder%2bcancer%26IXFROM%3d%26_IXSUBMIT_%3dSubmit%26_IXshc%3dy%26%2524%2b%2528%2528with%2bwi_sfgu%2bis%2bY%2529%2band%2bnot%2b%2528%2522contemporary%2bclinical%2bimages%2522%2bindex%2bwi_collection%2bor%2b%2522corporate%2bimages%2522%2bindex%2bwi_collection%2529%2529%2band%2bnot%2bwith%2bsys_deleted%3d%252e%26_IXrescount%3d8&_IXSPFX_=templates%2ft&_IXFPFX_=templates%2ft
Image source: Wellcome Images // CC BY-NC-ND 4.0

Image shows photomicrograph of adenocarcinoma of the bladder

Highlights:

  • Guidelines support either cystectomy or radiotherapy for invasive bladder cancer.
  • This population-based study describes referral patterns to radiation oncology.
  • One third of patients with bladder cancer were referred to radiation oncology.
  • Only 10% of patients were seen by radiation oncology postoperatively.
  • Closer collaboration between radiation oncology and urology is warranted.

Read the abstract here