Immunologic Consequences of Sequencing Cancer Radiotherapy and Surgery.
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Authors
López Alfonso, Juan CarlosPoleszczuk, Jan
Walker, Rachel
Kim, Sungjune
Pilon-Thomas, Shari
Conejo-Garcia, Jose J
Soliman, Hatem
Czerniecki, Brian
Harrison, Louis B
Enderling, Heiko
Issue Date
2019-01-01
Metadata
Show full item recordAbstract
PURPOSE Early-stage cancers are routinely treated with surgery followed by radiotherapy (SR). Radiotherapy before surgery (RS) has been widely ignored for some cancers. We evaluate overall survival (OS) and diseasefree survival (DFS) with SR and RS for different cancer types and simulate the plausibility of RS- and SR-induced antitumor immunity contributing to outcomes. MATERIALS AND METHODS We analyzed a SEER data set of early-stage cancers treated with SR or RS. OS and DFS were calculated for cancers with sufficient numbers for statistical power (cancers of lung and bronchus, esophagus, rectum, cervix uteri, corpus uteri, and breast). We simulated the immunologic consequences of SR, RS, and radiotherapy alone in a mathematical model of tumor-immune interactions. RESULTS RS improved OS for cancers with low 20-year survival rates (lung: hazard ratio [HR], 0.88; P = .046) and improved DFS for cancers with higher survival (breast: HR = 0.64; P , .001). For rectal cancer, with intermediate 20-year survival, RS improved both OS (HR = 0.89; P = .006) and DFS (HR = 0.86; P = .04). Model simulations suggested that RS could increase OS by eliminating cancer for a broader range of model parameters and radiotherapy-induced antitumor immunity compared with SR for selected parameter combinations. This could create an immune memory that may explain increased DFS after RS for certain cancers. CONCLUSION Study results suggest plausibility that radiation to the bulk of the tumor could induce a more robust immune response and better harness the synergy of radiotherapy and antitumor immunity than postsurgical radiation to the tumor bed. This exploratory study provides motivation for prospective evaluation of immune activation of RS versus SR in controlled clinical studiesCitation
JCO Clin Cancer Inform. 2019 Apr;3:1-16. doi: 10.1200/CCI.18.00075.Affiliation
BRICS, Braunschweiger Zentrum für Systembiologie, Rebenring 56,38106 Braunschweig, Germany.Publisher
American Society of Clinical OncologyJournal
JCO Clinical Cancer InformaticsPubMed ID
30964698Type
ArticleLanguage
enISSN
2473-4276ae974a485f413a2113503eed53cd6c53
10.1200/CCI.18.00075
Scopus Count
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- Creative Commons
Except where otherwise noted, this item's license is described as Attribution-NonCommercial-ShareAlike 4.0 International
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