Personalized Medicine for Radiation Therapy

سال انتشار: 1395
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 384

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شناسه ملی سند علمی:

IPMCMED01_003

تاریخ نمایه سازی: 23 آذر 1397

چکیده مقاله:

Radiation therapy (RT) plays an essential role in treatment of most cancers. For example, examination of Surveillance, Epidemiology and End Results data revealed an estimated 29% of patients with cancer received RT during their initial treatment course. However, it can have significant side effects both during and after treatment and also newer techniques such as IMRT, could be so expensive. Thus, there is a significant need for tools to predict the utility of RT in individual patients and personalized medicine for RT could be a potential effective way to predict what patients would receive the best gain and less toxicity from radiation therapy.Gene expression and cellular radiosensitivity in a database of 48 human cancer cell lines representing a wide array of primary sites, including breast, colon, leukemia, melanoma, non-small-cell lung, ovarian, renal and prostate cancer to identify 500 genes associated with radiosensitivity, have been investigated. From these 500 genes, a ten-gene network were proposed to play a central role in determining radiophenotype. A modele of cellular radiosensitivity as a linear function of gene expression for the ten genes have been studied. The Radiosensitivity index (RSI) is modeled on the cellular survival after RT in the cell lines, therefore a low RSI indicates a higher response to RT (i.e., radiosensitive).The radiosensitivity index, or any other assay that can predict response to radiotherapy, will have a transformative impact on the practice of radiation oncology and can predict radiation sensitivity which is associated with improved outcomes for patients treated with radiotherapy. This is seen for a number of different end points (response rate, locoregional control, distant metastasis-free survival and relapse-free survival) and different tumor types.As a matter of fact, RSI may impact clinical decisions in radiation oncology in multiple ways – for example, in patients who are in the low RSI spectrum (radiosensitive) RT is predicted to be effective. Depending on the disease site it may be reasonable for these patients to undergo radiotherapy rather than surgery. In contrast, patients in the high end of the RSI spectrum (radioresistant) may be better off treated without radiotherapy. A clinical example would be in rectal or esophageal cancer where radioresistant patients may proceed directly to surgery without preoperative RT. Finally, there might be patients that will fall in the intermediate range for RSI and these are the patients where RT dose modifications or concurrent chemotherapy might significantly impact their clinical outcome. Future clinical trials may seek to modulate the dose of radiotherapy based on radiosensitivity; a lower dose of radiotherapy should result in less risk of short- and long-term side effects.

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نویسندگان

Ehsan Karbasi

Radiation Oncologist, Azad University of Medical Sciences