Cardiac Toxicity after Radiotherapy for Breast Cancer: Myths and Facts

Radiotherapy is an important component in the multidisciplinary treatment of breast cancer. In recent years, the cardiac risks of radiation have been discussed several times. This problem has long been known and resolved from the radiotherapeutic point of view. The current data is briefly described here

Emerging Role of Hypofractionated Radiotherapy with Simultaneous Integrated Boost in Modern Radiotherapy of Breast Cancer

Hypofractionated radiotherapy for breast cancer is becoming increasingly important. The scientific background of this development as well as the introduction of the simultaneous integrated boost to the primary tumor region in this context are discussed here

The hunter and the hunted : A 3D analysis of predator-prey interactions between three-spined sticklebacks (Gasterosteus aculeatus) and larvae of different prey fishes

Predator-prey interactions play a key life history role, as animals cope with changing predation risk and opportunities to hunt prey. It has recently been shown that the hunting success of sticklebacks (Gasterosteus aculeatus) targeting fish larvae is dependent on both the size of the prey and the prior exposure of its species to stickleback predation. The purpose of the current study was to identify the behavioural predator-prey interactions explaining the success or failure of sticklebacks hunting larvae of three potential prey species [roach (Rutilus rutilus), perch (Perca fluviatilis) and whitefish (Coregonus wartmannii)] in a 3D environment. Trials were carried out for each prey species at four different size classes in a standardised laboratory setup and were recorded using a slow motion, stereo camera setup. 75 predator-prey interactions including both failed and successful hunts were subject to the analysis. 3D track analysis indicated that sticklebacks applied different strategies. Prey with less complex predator escape responses, i.e. whitefish larvae, were hunted using a direct but stealthy approach ending in a lunge, while the behaviourally more complex roach and perch larvae were hunted with a faster approach. A multivariate logistic regression identified that slow average speed and acceleration of the prey in the initial stages of the hunt increased the probability of stickleback success. Furthermore, predators adjusted their swimming direction more often when hunting larger whitefish compared to smaller whitefish. The results suggest that appropriate and adequately timed avoidance behaviours, which vary between prey species and ontogenetic stages, significantly increase the chances of outmanoeuvring and escaping stickleback predation. Small whitefish larvae can reach similar levels of swimming performance compared to older conspecifics, but display ineffective anti-predator behaviours, resulting in higher hunting success for sticklebacks. Thus, the development of appropriate anti-predator behaviours depending on size appears to be the crucial factor to escaping predation.publishe

Additional file 2: Figure S2. of The expression level of the transcription factor Aryl hydrocarbon receptor nuclear translocator (ARNT) determines cellular survival after radiation treatment

Clonogenic survival assays of irradiated renal cell carcinoma cells. a) 786-Owt vs. 786-Ovhl. b) RCC4wt vs. RCC4vhl. Representative result of n = 5–6 independent experiments. (PPTX 4610 kb

Reduction of overall treatment time in patients irradiated for more than three brain metastases

Patients with multiple brain metastases usually receive whole brain radiotherapy (WBRT). A dose of 30 Gy in 10 fractions (10 x 3 Gy) in 2 weeks is the standard treatment in many centers. Regarding the poor survival of these patients, a shorter RT regimen would be preferable if it provides a similar outcome as that with 10 x 3 Gy. This study compared 20 Gy in five fractions (5 x 4 Gy) within 5 days to 10 x 3 Gy. Data from 442 patients treated with WBRT for multiple brain metastases were retrospectively analyzed. Survival and local control within the brain of 232 patients treated with 5 x 4 Gy were compared with the survival and local control within the brain of 210 patients treated with 10 x 3 Gy. Seven additional potential prognostic factors were investigated: age, gender, Karnofsky performance score, tumor type, interval from tumor diagnosis to RT, extracranial metastases, and recursive partitioning analysis class. On univariate analysis, the WBRT program was not associated with survival (p = 0.29) or local control (p = 0.07). On multivariate analyses, improved survival was associated with a lower recursive partitioning analysis class (p or=70 (p = 0.015), and the absence of extracranial metastases (p = 0.005). Improved local control was associated with a lower recursive partitioning analysis class (p or=70 (p <0.001), and breast cancer (p = 0.043). Grade 3 acute toxicity rates were not significantly different between 5 x 4 Gy and 10 x 3 Gy. Shorter course WBRT with 5 x 4 Gy was associated with similar survival and local control as "standard" WBRT with 10 x 3 Gy in patients with more than three brain metastases. The 5 x 4-Gy regimen appears preferable for most of these patients, because it is less time consuming and more convenient for patients than the 10 x 3-Gy regime

Whole-brain radiotherapy with 20 Gy in 5 fractions for brain metastases in patients with cancer of unknown primary (CUP)

Whole brain radiotherapy (WBRT) is the most common treatment for brain metastases. Survival of patients with cancer of unknown primary (CUP) presenting with brain metastases is extremely poor. A radiation program with a short overall treatment time (short-course RT) would be preferable to longer programs if it provides similar outcomes. This study compares short-course RT with 20 Gy in 5 fractions (5 x 4 Gy) given over 5 days to longer programs in CUP patients. Data regarding 101 CUP patients who received either short course WBRT (n=34) with 5 x 4 Gy or long-course WBRT (n=67) with 10 x 3 Gy given over 2 weeks or 20 x 2 Gy given over 4 weeks for brain metastases were analyzed retrospectively. Six additional potential prognostic factors were investigated: age, gender, Karnofsky performance score (KPS), number of brain metastases, extracranial metastases, RPA-(Recursive Partitioning Analysis-)class. On univariate analysis, the radiation program was not associated with survival (p=0.88) nor intracerebral control (p=0.36). Improved survival was associated with KPS >or= 70 (p <0.001), absence of extracranial metastases (p <0.001), and RPA-class 1 (p <0.001). On multivariate analyses, KPS (risk ratio [RR]: 4.55; p <0.001), extracranial metastases (RR: 1.70; p=0.018), and RPA-class (RR: 2.86; p <0.001) maintained significance. On univariate analysis, KPS (p <0.001) and RPA-class (p <0.001) were significantly associated with intracerebral control. On multivariate analyses, KPS (RR: 2.72; p <0.001) and RPA-class (RR: 2.09; p <0.001) remained significant. Short-course WBRT with 5 x 4 Gy provided similar intracerebral control and survival as longer programs for the treatment of brain metastases in CUP patients. 5 x 4 Gy appears preferable because it is more convenient for patient