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The genetics combined to the chemotherapy:cell survival after single-dose irradiation Poster No.: C-1147 Congress: ECR 2016 Type: Scientific Exhibit Authors: A. Mazza , M. Ignatti , G. Spagnoletti , F. Sabatino , G. Bove ; 1 1 2 1 1 1 2 Foggia/IT, Bari, IT/IT Keywords: Radiotherapy techniques, Experimental investigations, Experimental, Oncology DOI: 10.1594/ecr2016/C-1147 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. 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Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myESR.org Page 1 of 16 Aims and objectives From January 2014 to October 2014 at the Units of Radiation Oncology of the 'University Hospital "Riuniti Hospitals" in Foggia, was conducted on a weekly basis an experimental work on the effects of radiation on human tumor cells of colon and breast, radiated and studied in vitro with clonogenicity test. The purpose was to identify and optimize a technical and individual protocol for the study of cell survival after irradiation with mono-fraction dose, combined with the use of a chemotherapeutic drug. Methods and materials The cells used are represented by various tumor cell lines and colon cancer (HT-29, HCT-116 and Colo-320) and breast (MCF7) stored in liquid nitrogen and plated in culture in suitable soils for each cell line. They have been used plates of plexiglass with dimensions of 12x8 cm, each with 6 wells. According to maximum opening field (40x40 cm), it was calculated that could be radiated up to 6 plates simultaneously [Figure 1]. From the information TC, were established the spatial coordinates to define the set-up, the volumes to be irradiated and through TPS (treatment planning system) has been identified the isocenter and field geometry [Figures 2]. In addition, the SSD (source to skin distance) was set to 100 cm, the rotation of the gantry 180 ° and has highlighted the need for the interposition of a thickness (bolus) of plexiglass [Figure 3]. Irradiation: the irradiation was carried out with 6 MX-rays pro V duced by a linear accelerator Elekta at different doses : 4, 8 , 16, 24 Gy [Figure 4]. Test clonogenicity: completed the irradiation , the plates have been brought in a incubator where they were kept in culture for 10 days , during which time the medium was changed every other day. This allowed the surviving cells to organize into colonies Subsequently, they were subjected to washing, fixing and staining with crystal violet. The test of clonogenicity is based on the ability to produce colonies of more than 50 cells in a suitable growth environment with subsequent counting of those surviving. In practice it expresses the reproductive capacity of tumor cells and normal cells following radiation , important and decisive for the outcome of therapy. Page 2 of 16 Images for this section: Page 3 of 16 Fig. 1: Stored cells in the culture medium and divided into the wells. © U.O.C. di Radioterapia, U.O.C. di Radioterapia, Ospedali Riuniti di Foggia - Foggia/IT Fig. 2: Shaping the dose. © U.O.C. di Radioterapia, U.O.C. di Radioterapia, Ospedali Riuniti di Foggia - Foggia/IT Page 4 of 16 Fig. 3: Placing the bolus plexiglass. © U.O.C. di Radioterapia, U.O.C. di Radioterapia, Ospedali Riuniti di Foggia - Foggia/IT Fig. 4: Irradiation with linear accelerator Elekta:gantry is rotated 180° and the SSD 100 cm. © U.O.C. di Radioterapia, U.O.C. di Radioterapia, Ospedali Riuniti di Foggia - Foggia/IT Page 5 of 16 Results The irradiation of the plates have been numerous and realized investigating different dosages, a different number of cells, different cell lines and use or less of chemotherapy. This latter aspect of the work allows to count the cell colonies formed after combined treatment of radiotherapy and chemotherapy: in general, the two treatments can exercise its effect, independently of one another, the chemotherapy may increase the response of radiation therapy or even inhibit it. Therefore, this association is not always a therapeutic gain. In the first experiments have been distributed 600 cells for well, but it was immediately apparent that in this way, in the control sample, cell growth appeared so massive as to not be able to count the different colonies. Therefore, in the subsequent experiments we were distributed 200-300 cells for well. Moreover, the irradiation at 24 Gy has proved totally effective in inhibit cell growth: the counting of the colonies was regardless of cell type, equal to 0 (zero). In subsequent experiments it was, therefore, avoided the irradiation at 24 Gy. Irradiation of cells of the colon: Radiobiology show us that each tissue has a different radiosensitivity and each cell line has a different degree of growth and a different way of responding to the damage caused by radiation (intrinsic radiosensitivity ) and the differences are caused by genetic constitution of each tumor . The reasons of this different radiosensitivity in field of the same histological type to be found positioned in genetic of each celto the radiation induced damage :specifically , the cell line Colo - 320 proved to be the most radiosensitive and HT - 29 the most radioresistant. Page 6 of 16 Fig. 5 References: U.O.C. di Radioterapia, U.O.C. di Radioterapia, Ospedali Riuniti di Foggia - Foggia/IT Irradiation of cells of the colon with addition of chemotherapeutic: In these experiments, the cells of the colon was added the 5- fluorouracil chemotherapy at different concentrations ( 5 mM , 15 mM , 25 mM ). From the graphs 2 , 3 and 4 and in Tables 4 , 5 and 6 , we can calculate the growth of colonies of cells HT -29 , HCT - 116 and Colo320 with the addition of chemotherapy. Page 7 of 16 Fig. 6 References: U.O.C. di Radioterapia, U.O.C. di Radioterapia, Ospedali Riuniti di Foggia - Foggia/IT Page 8 of 16 Fig. 7 References: U.O.C. di Radioterapia, U.O.C. di Radioterapia, Ospedali Riuniti di Foggia - Foggia/IT Page 9 of 16 Fig. 8 References: U.O.C. di Radioterapia, U.O.C. di Radioterapia, Ospedali Riuniti di Foggia - Foggia/IT Irradiation of cells of the breast: between cells MCF7 and MCF7 SCR SH - TRAP [ Chart 5 and Table 5 ), of breast cancer, there were significant differences of radiosensitivity. Page 10 of 16 Fig. 9 References: U.O.C. di Radioterapia, U.O.C. di Radioterapia, Ospedali Riuniti di Foggia - Foggia/IT Conclusion The protocol used is effective: during the trial were changed cell lines, the dosages used and the number of cells well distribuited, but have never been necessary amendments to the technical protocol. Comparing the graphs and data of different cell lines, the cells of a breast tumor compared to cells HT-29 and HCT-116 are more radiosensitive: 4 Gy colonies form are less in number than formed with the same dose for colon tumors , while to 8 Gy there is no growth of the colony. Between the two breast cancer cell lines analyzed ( SCRMCF7 and MCF7SH - TRAP ) were most radiosensitive cells MCF7SCR, although the differences are not significant [ Table 6 ] . Page 11 of 16 Fig. 10 References: U.O.C. di Radioterapia, U.O.C. di Radioterapia, Ospedali Riuniti di Foggia - Foggia/IT The differences, however, are significant also between different cell lines of the same tumor. Among the cells of the colon, for example, the HT-29 and HCT-116 continue to form colonies even after irradiation by 8 Gy, while the Colo-320 after 8 Gy do not give any colony. For all three cell types, 16 and 24 Gy there is no growth of colonies. Therefore, the cells more radiosensitive are the Colo-320 and the more radioresistant are the HT- 2 29 forming many colonies more than in all other cell types. To the cells of the colon it was added the 5-fluorouracil chemotherapy at different concentrations. The presence of the drug significantly reduces the growth of the colonies and with a high concentration of 5-fluorouracil (25mM) in all samples, including the control, there is no growth of colonies for only effect of chemotherapy. It highlights the radiosensitivity of the cell line Colo-320 that, with the irradiation with 8 Gy and the addition of the drug, even at a concentration of 5 mM, does not allow the growth of any colony. The cells HT-29, without the addition of 5-fluorouracil are more radioresistant than the cells HCT-116; with the addition of chemotherapy at a low concentration, however, the cells HCT-116 continue to form colonies in the control sample and after the irradiation at 4 Gy, differently from how they behave the other cell lines for which the addition of the drug, even without radiation therapy, does not allow the growth of the colonies. So, if you consider only the effect of the drug, the HCT-116, proved to be the most resistant to chemotherapy 5-fluorouracil. The drug, when administered together with radiotherapy, has always improved the effect, even at low doses. All cell lines, finally, even without the addition of chemotherapy, behave the same way with the irradiation at 8 Gy with the absence of colonies. Page 12 of 16 Definitely, not all types of cancer can be effectively treated with radiotherapy for the inherent radiosensitivity , for the patient's medical history , for the conformation , histology and staging of the disease . For colon and breast cancer, has been possible to make objective assessments after in vitro testing, considering the different radiosensitivity of tumor cells in the arrangement genetic basis the response of each cell line reagent differently to radiation induced damage and the combination of the use in the treatment of chemotherapy drug . Personal information A. Mazza, Dipartimento di Radioterapia UOC, "Ospedali Riuniti" di Foggia, Foggia, Italia. ([email protected]) M. Ignatti, Dipartimento di Radiologia UOC, "San Paolo" di Bari, Bari, Italia. ([email protected]) G. Spagnoletti, Dipartimento di Radioterapia UOC, "Ospedali Riuniti" di Foggia, Foggia Italia. ([email protected]) F. Sabatino, libero professionista, Foggia Italia. (francescasabatino @ @ tiscali.it hptmail.it) G. Bove, Direttore UOC di Radioterapia, Ospedali Riuniti "di Foggia, Foggia Italia. ([email protected]) Images for this section: Page 13 of 16 Fig. 11: A. Mazza © U.O.C. di Radioterapia, U.O.C. di Radioterapia, Ospedali Riuniti di Foggia - Foggia/IT Page 14 of 16 Fig. 12: M. Ignatti © U.O.C. di Radioterapia, U.O.C. di Radioterapia, Ospedali Riuniti di Foggia - Foggia/IT Page 15 of 16 References Steel G.G. Basic Clinical Radiobiology. EDWARD ARNOLD, London 2002. Sandri M., D'arienzo S., Coniglio A. Radioprotezione di base. CISU, Roma 2008. Laitano R.F.; Fondamenti di dosimetria delle radiazioni ionizzanti. ENEA, Roma 2011. Shrieve C.D. Basic principles of radiobiology, radiotherapy, and radiosurgery. Neurosurgery Clinics of North America; Num.1 (Vol. 17). Conway J., Robinson M.H. CT Virtual Simulation. The British Journal of Radiology 1997; Num. 3 (Vol.59): pagg 311-318. Sherouse G.W., Bourland J.D. Virtual Simulation in the clinical setting: some practical considerations. Journal of Applied Clinical Medical Physics 2014; Num. 47 (Vol.7): pagg. 1193-1200. Brock W. In vitro radiosensitivity of tumor cells and local tumor control by radiotherapy. Treatment of Cancer 1992; Num.2 (Vol.22): pagg.241-246. Nicolaas A.P. Clonogenic assay of cells in vitro. Nature Protocols 2006; Num.1: pagg. 2315-2319. Burnet N.G. Describing patients' normal tissue reactions: concerning the possibility of individualising radiotherapy dose prescriptions based on potential predictive assay on normal tissue radiosensitivity. International Journal of Cancer 1998; Num.79 (Vol.6) Page 16 of 16