Abstract

For multimodality therapies such as the combination of hyperthermia and radiation, quantification of biological effects is key for dose prescription and response prediction. Tumour spheroids have a microenvironment that more closely resembles that of tumours in vivo and may thus be a superior in vitro cancer model than monolayer cultures. Here, the response of tumour spheroids formed from two established human cancer cell lines (HCT116 and CAL27) to single and combination treatments of radiation (0–20 Gy), and hyperthermia at 47 °C (0–780 CEM43) has been evaluated. Response was analysed in terms of spheroid growth, cell viability and the distribution of live/dead cells. Time-lapse imaging was used to evaluate mechanisms of cell death and cell detachment. It was found that sensitivity to heat in spheroids was significantly less than that seen in monolayer cultures. Spheroids showed different patterns of shrinkage and regrowth when exposed to heat or radiation: heated spheroids shed dead cells within four days of heating and displayed faster growth post-exposure than samples that received radiation or no treatment. Irradiated spheroids maintained a dense structure and exhibited a longer growth delay than spheroids receiving hyperthermia or combination treatment at (thermal) doses that yielded equivalent levels of clonogenic cell survival. We suggest that, unlike radiation, which kills dividing cells, hyperthermia-induced cell death affects cells independent of their proliferation status. This induces microenvironmental changes that promote spheroid growth. In conclusion, 3D tumour spheroid growth studies reveal differences in response to heat and/or radiation that were not apparent in 2D clonogenic assays but that may significantly influence treatment efficacy.

Highlights

  • For multimodality therapies such as the combination of hyperthermia and radiation, quantification of biological effects is key for dose prescription and response prediction

  • Our work demonstrated that calculations based on clonogenic survival alone could overestimate HT treatment efficacy (Fig. 6B,C), if effects are assessed relative to RT as previously suggested[30,31,48,49]

  • Tumour spheroids provide an in vitro model that more closely mimics the physiological environment of tumours in vivo than do monolayer cultures

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Summary

Introduction

For multimodality therapies such as the combination of hyperthermia and radiation, quantification of biological effects is key for dose prescription and response prediction. Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, has been suggested[13,14,15,16,17,18] potentially due to enhanced repair capability if cells are grown and treated in 3D It remains to be shown how this effect translates into spheroid growth response where cells remain in the spheroid microenvironment after treatment rather than being disaggregated and plated at (non-physiological) clonal densities. Given the non-physiological cell microenvironment present when isolated cells are grown as monolayers, and an inability to account for differences in the dynamic cell death mechanisms induced[32,33,34], the applicability of biologically weighted (thermal) dose prescription based on this assay alone is questionable. Analysis of 3D tumour spheroids can be used to test the applicability of BEQD calculations and provide a more accurate quantification of the effects of RT, HT and combinations thereof, to improve patient dose prescription

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