A Novel Radiotherapeutic Approach to Treat Bulky Metastases Even From Cutaneous Squamous Cell Carcinoma: Its Rationale and a Look at the Reliability of the Linear-Quadratic Model to Explain Its Radiobiological Effects
IntroductionMetastatic cutaneous squamous cell carcinoma (cSCC) is a very rare condition. The lack of definition of an oligometastatic subgroup means that there is no consensus for its treatment, unlike the mucosal head and neck counterpart. Like the latter, the cutaneous form is able to develop bul...
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Frontiers Media S.A.
2022-02-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.809279/full |
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| author | Gianluca Ferini Paolo Castorina Paolo Castorina Paolo Castorina Vito Valenti Salvatore Ivan Illari Ilias Sachpazidis Ilias Sachpazidis Luigi Castorina Maurizio Marrale Maurizio Marrale Stefano Pergolizzi |
| author_facet | Gianluca Ferini Paolo Castorina Paolo Castorina Paolo Castorina Vito Valenti Salvatore Ivan Illari Ilias Sachpazidis Ilias Sachpazidis Luigi Castorina Maurizio Marrale Maurizio Marrale Stefano Pergolizzi |
| author_sort | Gianluca Ferini |
| collection | DOAJ |
| description | IntroductionMetastatic cutaneous squamous cell carcinoma (cSCC) is a very rare condition. The lack of definition of an oligometastatic subgroup means that there is no consensus for its treatment, unlike the mucosal head and neck counterpart. Like the latter, the cutaneous form is able to develop bulky tumor masses. When this happens, the classic care approach is just for palliative intent due to a likely unfavorable benefit–risk balance typical of aggressive treatments. Here we proposed a novel radiotherapy (RT) technique to treat bulky metastases from cSCC in the context of an overall limited tumor burden and tried to explain its clinical outcome by the currently available mathematical radiobiological and ad hoc developed models.MethodsWe treated a case of facial cSCC with three metastases: two of them by classic stereotactic RT and the other by lattice RT supported by metabolic imaging (18F-FDG PET) due to its excessively large dimensions. For the latter lesion, we compared four treatment plans with different RT techniques in order to define the best approach in terms of normal tissue complication probability (NTCP) and tumor control probability (TCP). Moreover, we developed an ad hoc mathematical radiobiological model that could fit better with the characteristics of heterogeneity of this bulky metastasis for which, indeed, a segmentation of normoxic, hypoxic, and necrotic subvolumes might have been assumed.ResultsWe observed a clinical complete response in all three disease sites; the bulky metastasis actually regressed more rapidly than the other two treated by stereotactic RT. For the large lesion, NTCP predictions were good for all four different plans but even significantly better for the lattice RT plan. Neither the classic TCP nor the ad hoc developed radiobiological models could be totally adequate to explain the reported outcome. This finding might support a key role of the host immune system.ConclusionsPET-guided lattice RT might be safe and effective for the treatment of bulky lesions from cSCC. There might be some need for complex mathematical radiobiological models that are able to take into account any immune system’s role in order to explain the possible mechanisms of the tumor response to radiation and the relevant key points to enhance it. |
| first_indexed | 2024-12-24T00:23:53Z |
| format | Article |
| id | doaj.art-5c239048149f4722808de8b6fa7396e5 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-24T00:23:53Z |
| publishDate | 2022-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-5c239048149f4722808de8b6fa7396e52022-12-21T17:24:31ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-02-011210.3389/fonc.2022.809279809279A Novel Radiotherapeutic Approach to Treat Bulky Metastases Even From Cutaneous Squamous Cell Carcinoma: Its Rationale and a Look at the Reliability of the Linear-Quadratic Model to Explain Its Radiobiological EffectsGianluca Ferini0Paolo Castorina1Paolo Castorina2Paolo Castorina3Vito Valenti4Salvatore Ivan Illari5Ilias Sachpazidis6Ilias Sachpazidis7Luigi Castorina8Maurizio Marrale9Maurizio Marrale10Stefano Pergolizzi11Department of Radiation Oncology, REM Radioterapia srl, Viagrande, ItalyIstituto Oncologico del Mediterraneo, Viagrande, ItalyFaculty of Mathematics and Physics, Charles University, Prague, CzechiaIstituto Nazionale Fisica Nucleare, Catania, ItalyDepartment of Radiation Oncology, REM Radioterapia srl, Viagrande, ItalyDepartment of Radiation Oncology, Fondazione IOM, Viagrande, ItalyDepartment of Radiation Oncology, Division of Medical Physics, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Research & Development, Medical Innovation and Technology P. C., Mesolongi, GreeceDepartment of Radiation Oncology, REM Radioterapia srl, Viagrande, ItalyDepartment of Physics and Chemistry, “Emilio Segrè” ATeN Center, University of Palermo, Palermo, ItalyIstituto Nazionale di Fisica Nucleare (INFN), Sezione di Catania, Catania, Italy0Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, Messina, ItalyIntroductionMetastatic cutaneous squamous cell carcinoma (cSCC) is a very rare condition. The lack of definition of an oligometastatic subgroup means that there is no consensus for its treatment, unlike the mucosal head and neck counterpart. Like the latter, the cutaneous form is able to develop bulky tumor masses. When this happens, the classic care approach is just for palliative intent due to a likely unfavorable benefit–risk balance typical of aggressive treatments. Here we proposed a novel radiotherapy (RT) technique to treat bulky metastases from cSCC in the context of an overall limited tumor burden and tried to explain its clinical outcome by the currently available mathematical radiobiological and ad hoc developed models.MethodsWe treated a case of facial cSCC with three metastases: two of them by classic stereotactic RT and the other by lattice RT supported by metabolic imaging (18F-FDG PET) due to its excessively large dimensions. For the latter lesion, we compared four treatment plans with different RT techniques in order to define the best approach in terms of normal tissue complication probability (NTCP) and tumor control probability (TCP). Moreover, we developed an ad hoc mathematical radiobiological model that could fit better with the characteristics of heterogeneity of this bulky metastasis for which, indeed, a segmentation of normoxic, hypoxic, and necrotic subvolumes might have been assumed.ResultsWe observed a clinical complete response in all three disease sites; the bulky metastasis actually regressed more rapidly than the other two treated by stereotactic RT. For the large lesion, NTCP predictions were good for all four different plans but even significantly better for the lattice RT plan. Neither the classic TCP nor the ad hoc developed radiobiological models could be totally adequate to explain the reported outcome. This finding might support a key role of the host immune system.ConclusionsPET-guided lattice RT might be safe and effective for the treatment of bulky lesions from cSCC. There might be some need for complex mathematical radiobiological models that are able to take into account any immune system’s role in order to explain the possible mechanisms of the tumor response to radiation and the relevant key points to enhance it.https://www.frontiersin.org/articles/10.3389/fonc.2022.809279/fulllattice radiotherapytumor control probability (TCP)normal tissue complication probability (NTCP)spatially fractionated radiation therapyimmunotherapymetabolic tumor volume |
| spellingShingle | Gianluca Ferini Paolo Castorina Paolo Castorina Paolo Castorina Vito Valenti Salvatore Ivan Illari Ilias Sachpazidis Ilias Sachpazidis Luigi Castorina Maurizio Marrale Maurizio Marrale Stefano Pergolizzi A Novel Radiotherapeutic Approach to Treat Bulky Metastases Even From Cutaneous Squamous Cell Carcinoma: Its Rationale and a Look at the Reliability of the Linear-Quadratic Model to Explain Its Radiobiological Effects Frontiers in Oncology lattice radiotherapy tumor control probability (TCP) normal tissue complication probability (NTCP) spatially fractionated radiation therapy immunotherapy metabolic tumor volume |
| title | A Novel Radiotherapeutic Approach to Treat Bulky Metastases Even From Cutaneous Squamous Cell Carcinoma: Its Rationale and a Look at the Reliability of the Linear-Quadratic Model to Explain Its Radiobiological Effects |
| title_full | A Novel Radiotherapeutic Approach to Treat Bulky Metastases Even From Cutaneous Squamous Cell Carcinoma: Its Rationale and a Look at the Reliability of the Linear-Quadratic Model to Explain Its Radiobiological Effects |
| title_fullStr | A Novel Radiotherapeutic Approach to Treat Bulky Metastases Even From Cutaneous Squamous Cell Carcinoma: Its Rationale and a Look at the Reliability of the Linear-Quadratic Model to Explain Its Radiobiological Effects |
| title_full_unstemmed | A Novel Radiotherapeutic Approach to Treat Bulky Metastases Even From Cutaneous Squamous Cell Carcinoma: Its Rationale and a Look at the Reliability of the Linear-Quadratic Model to Explain Its Radiobiological Effects |
| title_short | A Novel Radiotherapeutic Approach to Treat Bulky Metastases Even From Cutaneous Squamous Cell Carcinoma: Its Rationale and a Look at the Reliability of the Linear-Quadratic Model to Explain Its Radiobiological Effects |
| title_sort | novel radiotherapeutic approach to treat bulky metastases even from cutaneous squamous cell carcinoma its rationale and a look at the reliability of the linear quadratic model to explain its radiobiological effects |
| topic | lattice radiotherapy tumor control probability (TCP) normal tissue complication probability (NTCP) spatially fractionated radiation therapy immunotherapy metabolic tumor volume |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.809279/full |
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