Interaction between Immunotherapy and Radiotherapy

In recent years, treatment methods on immune checkpoints have emerged as promising novel therapeutic modalities against cancer as a result of studies focusing on elucidation of immune micro-environment. Immunotherapy has now become an established treatment in some cancers. [1-2] This has led the need for investigation of biomarkers which allow determining effectiveness of immunotherapies and patient groups which will most benefit from these therapies. In previous studies, it was suggested that programmed death receptor-1 (PD-1) and programmed death ligand-1 (PD-L1) expressions could be predictive biomarkers in cancers. PD-1 is a transmembrane protein present in macrophages, myeloid dendritic cells, B cells, epithelial cells and vascular endothelial cells, which limits and inhibits immunological activation in activated T cells. Blocking PD-1/PD-L1 interaction promises hope in the cancer treatment.  In clinical studies, it was shown that targeted PD-1/PD-L1 therapy alone or in combination with other modalities is beneficial in advanced cancers with aggressive behavior. It was shown that overexpression of PD-1 present in tumoral micro-environment is associated to poor prognosis in gastric cancer, breast cancer, ovarian cancer, kidney, pancreas and lung cancers and in melanoma. [1-5

Effects of Se, Zn and Cu levels on chemoradiotherapy related toxicity in patients with locally advanced lung cancer

315-321Lung cancer, with 12% of overall new cancer cases globally, has considerable mortality rate. Chemotherapy and radiotherapy are the most common treatment modalities apart from surgery. Both, chemo- and radio- therapies, are known to have side affects. Trace elements are reported to influence the radiotherapy related adverse effects in the body. In this context, here, we investigated whether there is a difference in serum Se, Zn and Cu levels in patients receiving chemoradiotherapy (CRT) due to lung cancer when compared to healthy individuals and to evaluate effects of serum trace element levels measured before and after therapy on CRT related toxicity. This prospective study included 50 patients received CRT due to lung cancer and 50 healthy individuals. Serum selenium (Se), zinc (Zn), and copper (Cu) levels were measured before and after radiotherapy in patients with cancer, while a single measurement was performed in controls. When serum trace element levels were compared between patients with lung cancer and healthy controls, a significant difference was found in Zn level. A significant difference was detected between serum Cu and Se levels measured before and after CRT in patients with lung cancer (P <0.001 and P =0.019). In the assessment of acute toxicity during, a significant difference was detected when Cu and Zn levels measured before and after treatment were compared. Our study indicates significant decreases in plasma Zn and Cu levels after radiotherapy, suggesting paying attention to nutritional status regarding these micronutrients and other antioxidant agents. Thus, Zn and Cu supplementation may reduce adverse effects in patients receiving CRT

Metachronous Bilateral Adenoid Cystic Carcinoma of the Lacrimal Gland

Background: To report an aggressive and treatment-resistant adenoid cystic carcinoma (ACC) of the lacrimal gland (LG).Case report: A 29-year-old woman with diagnosis of LG-ACC had operations 7 times, radiotherapy 3 times and systemic chemotherapy 2 times. Although she generally responded therapies, the duration of remissions was short lived and the tumor progressed locally and did hematogen metastases.Conclusion: LG-ACC presents a therapeutic challenge despite its slow growth rate and lower likelihood of lymph-node metastasis. Postoperative radiotherapy with wide margins should be utilized —even after a complete resection— because of persistent recurrences, perineural invasion and hematogenous spread.

Adrenal insufficiency in Bilateral Adrenal Metastasis implemented SBRT

Today, there is a considerable increase in localizing adrenal bulks with the bringing radiologic diagnosis methods having high technology into use and improvement in diagnostic tests. Adrenal glands are vital tissues for the organism due to the hormones they secrete. Death is a natural result in the absence of adrenal cortex. Adrenal bulks can be seen with different clinical, laboratory and radiological data. These bulks are often benign and rarely malign. They can be functional or non-functional. Major treatment methods used fort he treatment of adrenal gland primary tumors or metastases are surgery, arterial embolisation, chemical ablation, radiofrequency ablation and radiotherapy [1-4]. Adrenal glands are one of the metastatic fields. In wide autopsy series, adrenal metastasis has been determined between the rates of 13-17% [5]. While unilateral metastasis is common, bilateral metastasis&rsquo; rate of incidence is between 4-20%. It has been stated that lung (35%), gastric (14%), esophageal (12%) and hepatobiliary (10%) primary carcinomas adrenal metastasis are prevalent most frequently [2]. Curative treatments are tested on patients having cancer with oligo metastasis limited with adrenal gland and primary source is under control because of the expectation of long-term survival, and the surgery is the first choice. These bulks can be treated with open and laparoscopic surrenalectomy in a curative way. It was reported in studies that overall survival was longer in resection of clinically isolated adrenal metastases when compared with nonsurgical therapy (including RFA, external beam radiotherapy, arterial embolization, radioembolization, chemical ablation, and cryoablation) [1,2,5,7]. Lo et al., found one-year survival as 73% and two-year survival as 40% in their study conducted on 52 patients having curative resection for solitary adrenal metastasis [3]. Tanvetyanon et al., demonstrated 5-year survival rates of 25% following resection of isolated synchronous adrenal metastases and reported 26% after resection of metachronous adrenal metastases in their study conducted on NSCLC patients developing solitary adrenal metastasis [4]. Conducted studies revealed that the rate of complication was 9-20% in patients having adrenalectomy for solitary adrenal metastasis [2-4,7]. In recent years, the use of radiotherapy, which is a treatment modality as effective as surgical resection, has become prevalent for the management of oligometastases. Today, three different modalities have been tested in the radiotherapy treatment of adrenal gland metastases. In the first one, total 50 Gy treatment dose with 3D-CRT as daily 2 Gy fraction dose is given [8]. The second one is IMRT implementations for adrenal gland metastases but it isn&rsquo;t thought as suitable according to Practice Guidelines for Neuroendocrine Tumors published by NCCN in 2010. The third radiotherapy modality is stereotactic body radiotherapy (SBRT). SBRT implementations have started to be preferred today since they are completed in a few fractions in addition to that they show close results to surgery for primary tumors and metastases. Holy et al., implemented SBRT to patients having 13 solitary adrenal metastases with NSCLC at 5 fractions and between 20 and 40 Gy total doses. They found disease-free survival as median 12 months, overall survival as median 23 months and local control rate as 77% [9]. In SBRT implementations for different cancer types determined 30 adrenal metastases, Chawla et al., reported the rates of one-year survival, local control and distant metastasis as 44%, 55% and 13% respectively [10]. In Casamassima et al.,&rsquo;s study on this issue, the rate of two-year local control was found as 90% [11]. Second degree toxicity was seen in none of the above mentioned studies according to the RTOG toxicity classification. Wardak et al., reported that the patient having lung cancer that they implemented SBRT for bilateral adrenal metastases developed adrenal insufficiency depending on SBRT [6]. Ippolito et al., Reported that adrenal insuffiency may be due to both the tumor and the local treatment [12]. Incidence of symptomatic adrenal insufficiency were reported 4% [2,13]. Casamassima et al and Onishi et al studies, two grade 2 adrenal insuffiencies were reported [11,14]. Consequently, when all these data were evaluated, it is seen that SBRT use has gradually become prevalent for patients not suitable for surgery because of comorbid disease, for patients having oligometastatic cancer that are not suitable for surgery since it has vital risk to resect or that refuse surgery. However, it hasn&rsquo;t been clear yet that local control will be provided with how many total doses and which fraction schema. There is no agreement on the examination of the adrenal hormone axes because of the short length of life. Besides, it should be kept in mind that adrenal insufficiency can develop in patients implemented SBRT because of bilateral adrenal metastasis developing as synchronous or metachronous. The hormone levels of these patients need to be followed. More researches should be done to lighten this matter. &nbsp

Place of beta-radiation in the etiology and treatment of cataract

Among eye diseases, cataract is the most commonly encountered lens disease and the leading cause of reduced vision. Cataract caused by radiation develops due to neck &amp; head, central nervous system tumors, eye localized tumors and total body irradiation. Today, the only treatment of cataract is surgery. Beta radiation is seen to have an important place both in the etiology and treatment of cataract. Beta-radiation creates cataract in the lens as an adverse effect. However, beta radiation implementation is used for delay or prevention of cataract in glaucoma surgery. Effects of beta-radiation on the etiology and treatment should be supported by further prospective clinical studies

Which is the best? Palliative Radiation Therapy to Spleen or Splenectomy

Spleen is one of the most important organ of the reticuloendothelial system and coordinates the immune response. Splenectomy is performed for hypersplenism, and staging of hematological malignancy. In conservatively followed patients, radiation therapy can be used to reduce hypersplenism symptoms. Splenectomy or palliative radiotherapy to spleen may probably cause an immune suppressive condition. This may probably local and systemic complications