Exploiting sensitization windows of opportunity in hyper and hypofractionated radiation therapy

Anish Prasanna, Mansoor M. Ahmed, Mohammed Mohiuddin, C. Norman Coleman

Research output: Contribution to journalReview articlepeer-review

Abstract

In contrast to the conventional radiotherapy/chemoradiotherapy paradigms used in the treatment of majority of cancer types, this review will describe two areas of radiobiology, hyperfractionated and hypofractionated radiation therapy, for cancer treatment focusing on application of novel concepts underlying these treatment modalities. The initial part of the review discusses the phenomenon of hyper-radiation sensitivity (HRS) at lower doses (0.1 to 0.6 Gy), describing the underlying mechanisms and how this could enhance the effects of chemotherapy, particularly, in hyperfractionated settings. The second part examines the radiobiological/physiological mechanisms underlying the effects of high-dose hypofractionated radiation therapy that can be exploited for tumor cure. These include abscopal/bystander effects, activation of immune system, endothelial cell death and effect of hypoxia with re-oxygenation. These biological properties along with targeted dose delivery and distribution to reduce normal tissue toxicity may make high-dose hypofractionation more effective than conventional radiation therapy for treatment of advanced cancers. The novel radiation physics based methods that take into consideration the tumor volume to be irradiated and normal tissue avoidance/tolerance can further improve treatment outcome and post-treatment quality of life. In conclusion, there is enough evidence to further explore novel avenues to exploit biological mechanisms from hyper-fractionation by enhancing the efficacy of chemotherapy and hypo-fractionated radiation therapy that could enhance tumor control and use imaging and technological advances to reduce toxicity.

Original languageEnglish (US)
Pages (from-to)287-302
Number of pages16
JournalJournal of Thoracic Disease
Volume6
Issue number4
DOIs
StatePublished - 2014

Keywords

  • Chemopotentiation
  • Hyper-radiation sensitivity (HRS)
  • Hyperfractionation
  • Induced radiation resistance (IRR)
  • Lattice
  • Low doses fractionated radiation therapy (LDFRT)
  • Spatially fractionated GRID radiotherapy (SFGRT)
  • Stereotactic ablative radiosurgery (SARS)
  • Stereotactic ablative radiotherapy (SABR)
  • Stereotactic body radiation therapy (SBRT)
  • Stereotactic radiosurgery (SRS)

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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