Abstract
A detailed understanding of the interactions and the best dose-fractionation scheme of radiation to maximize antitumor immunity have not been fully established. In this study, the effect on the host immune system of a single dose of 20 Gy through intraoperative radiation therapy (IORT) on the surgical bed in low-risk breast cancer patients undergoing conserving breast cancer has been assessed. Peripheral blood samples from 13 patients were collected preoperatively and at 48 h and 3 and 10 weeks after the administration of radiation. We performed a flow cytometry analysis for lymphocyte subpopulations, natural killer cells (NK), regulatory T cells (Treg) and myeloid-derived suppressor cells (MDSCs). We observed that the subpopulation of NK CD56+high CD16+ increased significantly at 3 weeks after IORT (0.30–0.42%, P < 0.001), while no changes were found in immunosuppressive profile, CD4+CD25+Foxp3+Helios+ Treg cells, granulocytic MDSCs (G-MDSCs) and monocytic MDSCs (Mo-MDSCs). A single dose of IORT may be an effective approach to improve antitumor immunity based on the increase in NK cells and the non-stimulation of immunosuppressive cells involved in immune escape. These findings support future combinations of IORT with immunotherapy, if they are confirmed in a large cohort of breast cancer patients.
Highlights
Breast cancer is the most common malignancy and the second highest cause of death in women worldwide [1]
Results presented in this study indicate that treatment with intraoperative radiation therapy (IORT) in low-risk breast cancer patients undergoing conserving breast surgery can affect the balance of immune cells in the peripheral blood
We noted that radiation therapy increased the presence of peripheral natural killer cells (NK) cells while no changes were detected in the immunosuppressive profile, characterized by Treg cells and myeloid-derived suppressor cells (MDSCs)
Summary
Breast cancer is the most common malignancy and the second highest cause of death in women worldwide [1]. The current treatment for early-stage breast cancer is breast conservation surgery followed by radiation therapy. Changes in peripheral immune cells after intraoperative radiation therapy in low-risk breast cancer 111. The results indicate that treatment with intraoperative radiation therapy (IORT) yields similar results in terms of survival and toxicity as whole-breast radiation therapy, with the benefit of reduced treatment time. In this context, IORT has been established as a good option for patients’ treatment in early-stage breast cancer undergoing conserving surgery, or in combination with external beam radiation therapy (EBRT) in patients with risk factors [4, 6]
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