Radiotherapy For Gastric Cancer Research Articles

The relationship between splenic dose and radiation-induced lymphopenia.

Lymphocytes, which are highly sensitive to radiation, play a crucial role in the body's defense against tumors. Radiation-induced lymphopenia has been associated with poorer outcomes in different cancer types. Despite being the largest secondary lymphoid organ, the spleen has not been officially designated as an organ at risk. This study hypothesizes a connection between spleen irradiation and lymphopenia and seeks to establish evidence-based dosage limits for the spleen. We retrospectively analyzed data from 96 patients with locally advanced gastric cancer who received postoperative chemoradiotherapy (CRT) between May 2010 and May 2017. Complete blood counts were collected before, during and after CRT. We established a model for predicting the minimum absolute lymphocyte count (Min ALC) and to investigate potential associations between spleen dosimetric variables and Min ALC. The median follow-up was 60months. The 5-year overall survival (OS) and disease-free survival (DFS) were 65.2% and 56.8%, respectively. The median values of pre-treatment ALC, Min ALC and post-treatment ALC were 1.40 × 109, 0.23 × 109 and 0.28 × 109/L, respectively. Regression analysis confirmed that the primary tumor location, number of fractions and spleen V5 were significant predictors of Min ALC during radiation therapy. Changes in ALC (ΔALC) were identified as an independent predictor of both OS and DFS. Spleen V5 is an independent predictor for Min ALC, and the maximum dose of the spleen is associated with an increased risk of severe lymphopenia. Therefore, these doses should be restricted in clinical practice. Additionally, ΔALC can serve as a prognostic indicator for adjuvant radiotherapy in gastric cancer.

Dosimetric comparison of 3D-Conformal and IMRT techniques used in radiotherapy of gastric cancer: A retrospective study

This study aimed to compare three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) planning techniques commonly used in gastric cancer radiotherapy with dose volume histograms. Computed tomography (CT) images of 20 gastric cancer patients were retrospectively analyzed. 3D-CRT, 5F- IMRT and 7F- IMRT treatment plans were created for each patient. The 3 plans were compared on dose volume histogram (DVH). 3D-CRT, 5F-IMRT and 7F-IMRT plans achieved a prescribed dose of 45 Gy for 95% of PTV volume. D95 values were 45.06±0.47 Gy for 3DCRT, 46.39±0.38 Gy for 5F-IMRT and 45.20±0.11 Gy for 7F-IMRT. In 3D-CRT, 5F-IMRT and 7F-IMRT techniques, the 13 Gy receiving volumes of the right kidney were found to be 35.08+9.59, 36.25+7.97 and 37.03+9.03 respectively. Moreover, the volume of the right kidney receiving a 20 Gy and 30 Gy dose received less dose with 5F-IMRT than with 7F-IMRT. Since each patient's critical organs are at different distances from the target and each technique has its own advantages in terms of critical organs, we suggest that the useful technique should be decided by clinical consensus.

Paeoniflorin Induces ER Stress-Mediated Apoptotic Cell Death by Generating Nox4-Derived ROS under Radiation in Gastric Cancer.

Gastric cancer is one of the most prevalent cancer types worldwide, and its resistance to cancer therapies, such as chemotherapy and radiotherapy, has made treating it a major challenge. Paeoniflorin (PF) is one potential pharmacological treatment derived from paeony root. However, in cancer, the molecular mechanisms and biological functions of PF are still unclear. In the present study, we found that PF exerts anti-tumor effects in vivo and in vitro and induces apoptotic cell death through ER stress, calcium (Ca2+), and reactive oxygen species (ROS) release in gastric cancer cells. However, ROS inhibition by DPI and NAC blocks cell death and the PERK signaling pathway via the reduction of Nox4. Moreover, PF triggers a synergistic inhibitory effect of the epithelial-mesenchymal transition (EMT) process under radiation exposure in radiation-resistant gastric cancer cells. These findings indicate that PF-induced Ca2+ and ROS release overcomes radioresistance via ER stress and induces cell death under radiation in gastric cancer cells. Therefore, PF, in combination with radiation, may be a powerful strategy for gastric cancer therapy.

Radiotherapy in gastric cancer: does it still play a significant role?

Ilaria Angelicone, Flavia de Giacomo, Alfredo Priore, Margherita Rotondi, Giuseppe Facondo, Mattia Falchetto Osti

Effect of Ward Noise Reduction Technology Combined with Music Therapy on Negative Emotions in Inpatients Undergoing Gastric Cancer Radiotherapy: A Retrospective Study.

Gastric cancer is a common malignant tumour in clinics. Noise affects the condition of patients with gastric cancer to a certain extent. This study aims to explore an effective noise control measure. This study retrospectively analysed the clinical data of 108 patients with gastric cancer who received radiotherapy in the oncology department of JiaoZhou Central Hospital from March 2021 to March 2022, and excluded eight patients who did not meet the inclusion criteria. The remaining patients were divided into a control group (CG, music therapy, n = 48) and a study group (SG, ward noise reduction technology + music therapy, n = 52) in accordance with different management modes. The key causes of noise in the ward that each patient thought were collected by questionnaire, and the ward noise, psychological state, and sleep changes in the two groups were observed under different management modes. The noise was mainly from patients and their family members, call bell, monitors, treatment carts, medical staff and surrounding environment. After the management, SG had lower noise decibel values in daytime and nighttime and significantly lower scores of anxiety and depression than CG (P < 0.01). The sleep quality scores of the two groups after the management were lower than those before management (P < 0.001) and the sleep quality score of SG was significantly lower than that of CG (P < 0.01). Ward noise reduction technology combined with music therapy is an effective method to effectively reduce the ward noise and improve the clinical condition of patients.

Neoadjuvant chemoradiotherapy induced lymphopenia in gastric cancer and associations with spleen dosimetry and survival outcomes

BackgroundFew studies concentrate on spleen dosimetry of radiotherapy for gastric cancer (GC). Although there is no consensus on the spleen dose-volume threshold for lymphopenia, several studies indicated that the higher the spleen dose, the higher the risk of lymphopenia. This study aimed to identify the appropriate spleen dosimetric parameters for predicting grade 4 + lymphopenia in patients with locally advanced GC. Material and methodsA total of 295 patients treated with nCRT and nChT from June 2013 to December 2021 at two major centers were included, of whom 220 were assigned to the training cohort and 75 to the external validation cohort. ResultsGrade 4 + lymphopenia was more common in the nCRT than in the nChT group (49.5% vs. 0, P < 0.001 in the training cohort; 25.0% vs. 0, P = 0.001 in the external validation cohort). Age ≥ 60 years (P = 0.006), lower pretreatment absolute lymphocyte count (P = 0.001), higher spleen volume (SPV) (P = 0.001), and higher V20 (P = 0.003) were significant risk factors of grade 4 + lymphopenia for patients treated with nCRT. Patients with grade 4 + lymphopenia had significantly worse PFS (P = 0.043) and showed a negative correlation trend with OS (P = 0.07). Limiting V20 to < 84.5% could decrease the incidence of grade 4 + lymphopenia by 35.7%. The predictive effectiveness of the multivariable model in the training and external validation cohorts was 0.880 and 0.737, respectively. ConclusionGrade 4 + lymphopenia during nCRT was more common than nChT, and was associated with a worse PFS in GC patients. Constraining the spleen V20 to < 84.5% may indirectly improve outcomes through lymphocyte preservation.

Dosimetric benefit of a library of plans versus single-plan strategy for pre-operative gastric cancer radiotherapy

Background and purposeThe stomach experiences large volume and shape changes during pre-operative gastric radiotherapy. This study evaluates the dosimetric benefit for organs-at-risk (OARs) of a library of plans (LoP) compared to the traditional single-plan (SP) strategy. Materials and methodsTwelve patients who received SP CBCT-guided pre-operative gastric radiotherapy (45 Gy; 25 fractions) were included. Clinical target volume (CTV) consisted of CTVstomach (i.e., stomach + 10 mm uniform margin minus OARs) and CTVLN (i.e., regional lymph node stations). For LoP, five stomach volumes (approximately equidistant with fixed volumes) were created using a previously developed stomach deformation model (volume = 150–750 mL). Appropriate planning target volume (PTV) margins were calculated for CTVstomach (SP and LoP, separately) and CTVLN. Treatment plans were automatically generated/optimized and the best-fitting library plan was manually selected for each daily CBCT. OARs (i.e., liver, kidneys, heart, spleen, spinal canal) doses were accumulated and dose-volume histogram (DVH) parameters were evaluated. ResultsThe non-isotropic PTVstomach margins were significantly (p < 0.05) smaller for LoP than SP (median = 13.1 vs 19.8 mm). For each patient, the average PTV was smaller using a LoP (difference range 134–1151 mL). For all OARs except the kidneys, DVH parameters were significantly reduced using a LoP. Differences in mean dose (Dmean) for liver, heart and spleen ranged between −1.8 to 5.7 Gy. For LoP, a benefit of heart Dmean > 4 Gy and spleen Dmean > 2 Gy was found in 4 and 5 patients, respectively. ConclusionA LoP strategy for pre-operative gastric cancer reduced average PTV and reduced OAR dose compared to a SP strategy, thereby potentially reducing risks for radiation-induced toxicities.

Investigations into the impact of non-coding RNA on the sensitivity of gastric cancer to radiotherapy.

Non-coding RNAs (ncRNAs) are a newly discovered functional RNA different from messenger RNA, which can participate in regulating the occurrence and development of tumors. More and more research results show that ncRNAs can participate in the regulation of gastric cancer (GC) radiotherapy response, and its mechanism may be related to its effect on DNA damage repair, gastric cancer cell stemness, cell apoptosis, activation of epidermal growth factor receptor signaling pathway, etc. This article summarizes the relevant mechanisms of ncRNAs regulating the response to radiotherapy in gastric cancer, which will be directly important for the introduction of ncRNAs particularly microRNAs (miRNAs), long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs) into clinical medicine as biomarkers and therapeutic targets.

Secondary cancer risk estimations following the gastric cancer radiotherapy

Secondary cancer risk estimations following the gastric cancer radiotherapy

Role of Adjuvant Radiotherapy in Gastric Cancer

Although continuous improvement in the treatment outcome of localized gastric cancer has been achieved through early screening, diagnosis, and treatment and the active application of surgery and adjuvant chemotherapy, the necessity of adjuvant radiotherapy (RT) remains controversial. In this review, based on the results of two recently published randomized phase III studies (Adjuvant Chemoradiation Therapy In Stomach Cancer 2 and ChemoRadiotherapy after Induction chemoTherapy of Cancer in the Stomach) and a meta-analysis of six randomized trials including these two studies, the role of adjuvant RT in gastric cancer was evaluated and discussed, especially in patients who underwent curative gastrectomy with D2 lymphadenectomy. This article also reported the possible indications for adjuvant RT in the current clinical situation and in future research to enable patient-specific treatments according to the risk of recurrence.

253P Hemostatic radiotherapy for gastric cancer: MRI as an alternative to endoscopy for post-treatment evaluation

Pretreatment diagnosis by diffusion-weighted magnetic resonance imaging (DW-MRI) is useful to determine the effect of chemotherapy for gastric cancer. Here, we investigated the relationship among DW-MRI, endoscopy, and tumor markers.

Temporal Profiles of Symptom Scores after Palliative Radiotherapy for Bleeding Gastric Cancer with the Adjustment for the Palliative Prognostic Index: An Exploratory Analysis of a Multicenter Prospective Observational Study (JROSG 17-3)

<h3>Purpose/Objective(s)</h3> Although palliative radiotherapy for gastric cancer may improve some symptoms, it may also have negative impact due to its toxicity. We investigated whether symptoms improved after radiotherapy with adjustment for the Palliative Prognostic Index (PPI) considering that patients with limited survival tend to experience deterioration of symptoms. <h3>Materials/Methods</h3> This study was an exploratory analysis of a multicenter prospective observational trial (Japanese Radiation Oncology Study Group [JROSG] 17-3). We assessed six symptom scores (nausea, lack of appetite, fatigue, shortness of breath, pain at the irradiated area, and distress) based on the M. D. Anderson Symptom Inventory at registration and 2, 4, and 8 weeks thereafter. PPI prediction model contains five independent indicators: palliative performance scale, intake, edema, dyspnea at rest, and delirium. A higher PPI score means worse survival. We tested whether symptoms linearly improved after adjusting for the baseline PPI. Shared parameter models were used to account for potential bias in missing data. <h3>Results</h3> The present study analyzed all 55 patients enrolled in JROSG 17-3. The median age was 73 years (range, 50–93 years). The average PPI was 2.9 (95% confidence interval: 2.2–3.6). The median 20 Gy (range, 8–45 Gy) total radiation dose was delivered in a median of 5 fractions. At registration, 27 (49%), 36 (65%), 44 (80%), 38 (69%), 29 (53%) and 44 patients (80%) had nausea, lack of appetite, fatigue, shortness of breath, pain, and distress, respectively. All six symptoms were evaluable for 48 (87%), 36 (65%), and 28 (51%) patients at 2, 4, and 8 weeks, respectively. With time from registration as the only explanatory variable in the model, a significant linear decrease was observed in shortness of breath, pain, and distress (slopes, −0.26, −0.22, and −0.19, respectively). Given that the interaction terms (i.e., PPI × time) were not significantly associated with symptom scores in any of the six symptoms, only PPI was included as the main effect in the final multivariable models. After adjusting for the PPI, shortness of breath, pain, and distress significantly improved (slope, −0.25, −0.19, and −0.17; p < 0.001, 0.002, and 0.047, respectively). Higher PPI scores were associated with higher symptom scores in all six symptoms. <h3>Conclusion</h3> Shortness of breath, pain, and distress significantly improved after radiotherapy. Moreover, a higher PPI was significantly associated with higher symptom scores at all time points, including baseline. In contrast, PPI did not seem to influence the improvement of these symptoms. Regardless of the expected survival, patients receiving radiotherapy for gastric cancer can expect improvement in shortness of breath, pain, and distress over 8 weeks.

Temporal Profiles of Symptom Scores After Palliative Radiotherapy for Bleeding Gastric Cancer With Adjustment for the Palliative Prognostic Index: An Exploratory Analysis of a Multicentre Prospective Observational Study (JROSG 17–3)

AimsAlthough palliative radiotherapy for gastric cancer may improve some symptoms, it may also have a negative impact due to its toxicity. We investigated whether symptoms improved after radiotherapy with adjustment for the Palliative Prognostic Index (PPI) considering that patients with limited survival tend to experience deterioration of symptoms. Materials and methodsThis study was an exploratory analysis of the Japanese Radiation Oncology Study Group study (JROSG 17-3). We assessed six symptom scores (nausea, anorexia, fatigue, shortness of breath, pain at the irradiated area and distress) at registration and 2, 4 and 8 weeks thereafter. We tested whether symptoms linearly improved after adjusting for the baseline PPI. Shared parameter models were used to adjust for potential bias in missing data. ResultsThe present study analysed all 55 patients enrolled in JROSG 17-3. With time from registration as the only explanatory variable in the model, a significant linear decrease was observed in shortness of breath, pain and distress (slopes, −0.26, −0.22 and −0.19, respectively). Given that the interaction terms (i.e. PPI × time) were not significantly associated with symptom scores in any of the six symptoms, only PPI was included as the main effect in the final multivariable models. After adjusting for the PPI, shortness of breath, pain and distress significantly improved (slope, −0.25, −0.19 and −0.17; P < 0.001, 0.002 and 0.047, respectively). An improvement in fatigue and distress was observed only in patients treated with a biologically effective dose ≤14.4 Gy. ConclusionShortness of breath, pain and distress improved after radiotherapy. Moreover, a higher PPI was significantly associated with higher symptom scores at all time points, including baseline. In contrast, PPI did not seem to influence the improvement of these symptoms. Regardless of the expected survival, patients receiving radiotherapy for gastric cancer can expect an improvement in shortness of breath, pain and distress over 8 weeks. Multiple-fraction radiotherapy might hamper the improvement in fatigue and distress by its toxicity or treatment burden.

Hemostatic Radiotherapy for Gastric Cancer: MRI as an Alternative to Endoscopy for Post-Treatment Evaluation.

Pretreatment diagnosis by diffusion-weighted magnetic resonance imaging (DW-MRI) is useful to determine the effect of chemotherapy for gastric cancer. Here, we investigated the relationship among DW-MRI, endoscopy, and tumor markers. Eight patients underwent hemostatic radiotherapy (RT) for gastric cancer in this prospective study from 2019 to 2021. The patients completed MRI, endoscopy, and blood tests before RT; MRI, endoscopy, and blood tests 1month after RT; and MRI and blood tests 3months after RT. Correlations between changes in apparent diffusion coefficient (ADC) derived from DW-MRI and the tumor marker carcinoembryonic antigen (CEA) were investigated. Univariate analysis of overall survival showed that sex and chemotherapy treatment were statistically significant factors. The CEA values before and 1month after RT decreased significantly. There was no statistical difference between the CEA value 1 and 3months after RT. The ADC value before and 1month after RT increased significantly but not between 1 and 3months after RT. Comparing the ratio of ADC before RT to 1 (or 3) month(s) after RT with that of CEA before RT to 1 (or 3) month(s) after RT, we found an inverse relationship between the two ratios. Therefore, changes in ADC and CEA are correlated. Additionally, 3months after RT, the decrease in ADC appeared earlier than the decrease in CEA. ADC may indicate a biological change earlier than CEA, and the ratios of ADC and CEA may be important factors. These aspects warrant further confirmation in a larger sample population.

Knockdown of Circ_0003506 Impedes Radioresistance, Cell Growth, Migration and Invasion in Gastric Cancer.

Radioresistance is a major obstacle for clinical treatment of gastric cancer (GC). has_circ_0003506 (circ_0003506) was reported as an oncogenic factor in GC, but its effect on radioresistant GC is unclear. This study aimed to explore the role of circ_0003506 in radioresistance and regulatory mechanism. The expression detection was performed by real-time polymerase chain reaction. Cell survival was analyzed by colony formation assay. Cell proliferation was measured by Cell Counting Kit-8 assay and colony formation assay. Cell migration and invasion were examined using transwell assay. Cell apoptosis was assessed by flow cytometry. The target binding was confirmed via dual-luciferase reporter assay. The protein level was determined through western blot. Animal assay was performed for the functional exploration of circ_0003506 on radiosensitivity in vivo. Circ_0003506 was upregulated in radioresistant GC cells. Downregulation of circ_0003506 inhibited radioresistance to repress proliferation, migration and invasion but increase apoptosis in radioresistant GC cells. Circ_0003506 was a sponge of miR-1256. The effects of si-circ_0003506 on radioresistant GC cells were reverted by miR-1256 inhibitor. MiR-1256 suppressed tumor progression in radioresistant GC cells by downregulating bone morphogenetic protein type 2 receptor. Circ_0003506 regulated the level of bone morphogenetic protein type 2 receptor by targeting miR-1256. Downregulating circ_0003506 increased radiosensitivity of GC in vivo via regulating miR-1256 and bone morphogenetic protein type 2 receptor. Knockdown of circ_0003506 suppressed radioresistance in GC through the regulation of miR-1256/bone morphogenetic protein type 2 receptor axis. Circ_0003506 might be a therapeutic target in radiotherapy of GC.

PO-1893 could we consider the Pancreas as an organ at risk during gastric cancer radiotherapy?

PO-1893 could we consider the Pancreas as an organ at risk during gastric cancer radiotherapy?

Clinical value of propranolol combined with oxaliplatin and tigio in concurrent chemoradiotherapy for locally advanced gastric cancer

Objectives:To investigate the clinical value of propranolol combined with oxaliplatin and tigio in concurrent chemoradiotherapy for locally advanced gastric cancer.Methods:A total of 74 patients with locally advanced gastric cancer admitted to the First Affiliated Hospital of Hainan Medical University from August 2018 to June 2020 were selected as the subject and divided into two groups by random number table method: Group-A and Group-B, with 37 cases in each group. Patients in Group-A were treated with oxaliplatin injection and oral administration of tigio combined with concurrent radiotherapy, while patients in Group-B were given propranolol on the basis of treatment in Group-A. The clinical efficacy and incidence of adverse reactions in the two groups were observed.Results:The response rate (RR) of Group-B was higher than that of Group-A, but with no statistically significant difference (P>0.05). No statistical difference was observed in the incidence of gastrointestinal reaction, bone marrow suppression, oral mucositis, and the incidence of grade III-IV adverse reactions in the two groups (P>0.05). There were no serious adverse reactions related to propranolol in Group-B, and the levels of tumor markers CEA, CA50, CA125, and CA242 in Group-B were lower than those in Group-A.Conclusion:Propranolol combined with oxaliplatin and tigio boasts satisfactory sensitization safety in radiotherapy for gastric cancer, but its sensitization effect needs to be further investigated in a multi-center study involving large sample size.

Verification of the Utility of Palliative Radiotherapy for Hemostasis of Gastric Cancer Bleeding: a Case Control Study.

Bleeding from unresectable gastric cancer is a localized condition that adversely affects quality of life. Radiotherapy can be used to treat gastric cancer bleeding when surgery, endoscopic treatment, and intravascular embolization are ineffective. This study evaluated the utility of radiotherapy for unresectable hemorrhagic gastric cancer. We retrospectively analyzed data from 33 patients with gastric cancer bleeding who underwent palliative radiotherapy in our hospital between April 2013 and May 2020. In this study, successful hemostasis was defined as >1month after starting radiotherapy with the patient alive and showing no need for blood transfusion, no drop in hemoglobin, and no evidence of melena or hematemesis. Patients comprised 26 men (79%) and 7 women (21%), with a median age of 71years (range, 41-78years). Hemostasis was achieved in 24 patients (73%). Thirty-two patients (94%) have been discharged home or transferred to the hospice. Patients with successful hemostasis from radiotherapy showed significantly longer overall survival than patients with unsuccessful hemostasis (p=0.0026). No toxicities of grade 2 or more were encountered. This retrospective study found that palliative radiotherapy for gastric cancer bleeding was useful and safe and can improve remaining quality of life in patients with poor prognosis.

Dosimetric effects related to collimator angle optimization in intensity‐modulated radiotherapy planning for gastric cancer

AbstractObjectiveTo investigate the dosimetric impact of different collimator angle optimization methods in intensity‐modulated radiotherapy of gastric cancer.MethodsA total of 10 gastric cases were retrospectively selected in this study. Three sets of plans were generated with different collimator angle optimization: setting the collimator angle to 0° (CL0), applying Eclipse automatic collimator angle optimization (CLA), and setting the collimator angle corresponding to the minimum X‐jaw gap (CLX). Different dosimetric metrics were applied in comparison of the target volume and normal tissues. Delivery efficiency was accessed in terms of control points, split fields, monitor units, and treatment time. All plans were verified using the 2‐D array MatriXX, and the γ‐index analysis was carried out by using different criteria.ResultsThere was no significant difference in dosimetric comparison of planning target volume and organs at risk. Compared with CL0, Both CLA and CLX can significantly reduce control points, split fields, and monitor units, except that CLA increased treatment time. For dose verification, the γ passing rate showed a tendency of CLx &gt; CLA &gt; CL0.ConclusionFor intensity‐modulated radiotherapy for gastric cancer, CLA and CLX can obtain comparable dosimetry distribution in respect to CL0. However, CLX can significantly increase the dose delivery efficiency and verification passing rates. It was suggested that CLx was beneficial in intensity‐modulated radiotherapy for gastric cancer.

Evaluation of Hemostatic Radiotherapy for Gastric Cancer

Evaluation of Hemostatic Radiotherapy for Gastric Cancer