Abstract
During the last twenty years, mounting studies have supported the hypothesis that there is a genetic component that plays an important role in clinically observed variability in individual tissue/organ toxicity after radiotherapy. We propose the term “Personalized Radiogenomics” for the translational study of individual genetic variations that may associate with or contribute to the responses of tissues to radiation therapy used in the treatment of all types of cancer. The missions of personalized radiogenomic research are 1) to reveal the related genes, proteins, and biological pathways responsible for non-tumor or tumor tissue toxicity resulting from radiotherapy that could be targeted with radio-sensitizing and/or radio-protective agents, and 2) to identify specific genetic markers that can be used in risk prediction and evaluation models before and after clinical cancer surgery. For the members of the Terry Fox Cancer Research Lab in China Medical University and Hospital, the long-term goal is to develop SNP-based risk models that can be used to stratify patients to more precisely tailored radiotherapy protocols. Worldwide, the field has evolved over the last two decades in parallel with rapid advances in genetic and genomic technology, moving step by step from narrowly focused candidate gene studies to large-scale, collaborative genome-wide association studies. This article will summarize the candidate gene association studies published so far from the Terry Fox Cancer Research Lab as well as worldwide on the risk of radiation-related cancers and highlight some wholegenome association studies showing feasibility in fulfilling the dream of personalized radiogenomic cancer therapy.
Highlights
The current status of personalized radiotherapyThe ultimate goal of radiotherapy for cancer is to regain control of the growth of the cancer, and at the same time, minimize the possible adverse effects of the radiotherapy
During the last twenty years, mounting studies have supported the hypothesis that there is a genetic component that plays an important role in clinically observed variability in individual tissue/organ toxicity after radiotherapy
Even though amazing technological improvements have enabled a more precise focusing and killing of the tumor cells, there is still some normal tissue that is inevitably exposed to radiation and that becomes abnormal [1]. This radiation exposure leads to cytotoxicity, tissue toxicity or organ dysfunction and affects their quality of life. This is of particular importance for those patients diagnosed with early-stage localized cancer with a favorable prognosis who may live for a number of years after cancer therapy in the hospital
Summary
The ultimate goal of radiotherapy for cancer is to regain control of the growth of the cancer, and at the same time, minimize the possible adverse effects of the radiotherapy. While it may have been expected to reveal a significant association of those genes involved in DNA damage recognition and/or relevant DNA repair pathways, this study identified a SNP on a gene involved in normal cellular function This finding does not mean that those genes known to be involved in routine radiation responses do not play a role in the etiology of radiation-induced toxicities, but suggests that other tissue-specific pathways may be of some importance and play a role in the radiogenomics. This is evidence that a rough GWAS with less SNPs investigated or too small of a sample size may have lost lots of information and got too many false-positive findings, even with significant P-values. Further large-scale studies of mtDNA are in urgent need to provide definitive answers for radiogenomics
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