Radiation for lung nodules - what do I need to know

Please feel free to read, share your thoughts, your stories and connect with others!
dianne052506
Posts: 1651
Joined: Sun Nov 02, 2008 11:57 pm
Location: North Carolina

Radiation for lung nodules - what do I need to know

Postby dianne052506 » Wed Feb 19, 2014 5:41 pm

Backstory: The Dec 27th CT showed that at least 2 of my lung nodules are now "golf-ball-sized." I've had 2 more treatments of the study drug since then, but my cough and ribcage pain kept getting worse. Finally, this weekend, a 104 degree fever, and the resulting dehydration as I sweated it off, sent me to the hospital. A CT report from there reads
Interval development dense consolidation involving the lingual, mainly the inferior segment. This is consistent with postobstructive atelectasis or pneumonia. Additionally, there is now a small left pleural effusion.

My feeble interpretation is that the nodule in the lingula (tongue-shaped projection of the left lung) was blocking air to that part of the lung, causing collapse of that part of the lung, as well as fluid buildup in the layers of membrane lining the lung. The fever and pneumonia and fever were complications.

After massive amounts of antibiotics and IV fluids, I am home, but the research doc wants radiation on some of the bigger nodules and the appointment is tomorrow.
I don't even know what questions to ask, and the sleep deprivation from the time in the hospital is making it hard for me to think. I would appreciate any comments, thoughts, or advice that anyone has to share.
Best wishes to all,
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again

KWT
Posts: 3214
Joined: Thu Jul 11, 2013 7:22 pm

Re: Radiation for lung nodules - what do I need to know

Postby KWT » Wed Feb 19, 2014 5:45 pm

I hope they can zap those things. Why did they wait for them to get so big before addressing this?

User avatar
vilca11
Posts: 730
Joined: Fri Feb 14, 2014 11:19 am
Location: Moscow, Russia; Baltimore, USA 1992; Vilcabamba, Ecuador 2012

Re: Radiation for lung nodules - what do I need to know

Postby vilca11 » Wed Feb 19, 2014 6:42 pm

Dear Dianne,

You've been thru terrible events from 2006 and you passed them by now. So, first of all, please calm down, do not panic and do not fear, you will be thru that one too. We are all in the same boat here, so I perfectly understand what you are feeling right now, my dear. But it will pass too and you WILL come out of this crisis - I am very sure, since your physical body shows great will to live and great resilience.

Secondly, the questions to ask.
1) What do they want to accomplish with the radiation? I understand that they will be doing a general radiation to the lungs, not the focused one, since Stereotactic Radiation (SBRT) requires time for planning and from your email it seems that no much time passed after you was out of the hospital. Therefore:
2) Are you a candidate for the SBRT to REALLY affect these two big nodules? May be not right away, but after this radiation. If yes, how many grays and how many sessions? If your hospital does not have much experience with SBRT, consider going to MDA or Sloan or Hopkins - you need someone good with lots of experience.
3) Can you do SBRT AFTER the radiation you are scheduled for?

Again, do not panic right now, everything will be ok. Big hug, Vilca :)
11/2005 CC stage 1, F,50yo@dx
Mod dif adenocar, MSS, APC, TP53, CEAs1.6-4.8
1/12 1met liver@Vena Cava, RFA, 3oxi,11 5FU
8/13 2 mets same place,SBRT
4/14 2 Xeliri+Avastin
5/14 Nano Knife liver same 2 mets
6/14 2 Xeliri, ADAPT
4/15 PET, 2 same mets,Cryo Liver
5/15 MJ Oil, Herbs, Suppl, ADAPT
10/15 PET, same area, doubled in size, high SUV
10/15 RH, HAI, visceral involv., no LN
2/16 red FF, 50% red dose FUDR, CEA trends up
3/16 CT, PET, MRI L.Lobe all in small tumors
4/16 No acceptable options, going home

dianne052506
Posts: 1651
Joined: Sun Nov 02, 2008 11:57 pm
Location: North Carolina

Re: Radiation for lung nodules - what do I need to know

Postby dianne052506 » Wed Feb 19, 2014 6:49 pm

kennyt,
I really don't know why they waited. I've been on a clinical trial since August 2012. Each time the nodules grew, it was just under the guidelines to where they would have kicked me out of the study. My regular onc has been saying for a couple of months that there was enough progression that I should stop the study, but he has no options for me, so I kept at it. Somehow, the subject of radiation never came up.
What I didn't mention is that these two are the biggest of approx. 20 nodules. I guess early on, the thinking was that radiation wasn't an answer because they couldn't get all the nodules with it.
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again

dianne052506
Posts: 1651
Joined: Sun Nov 02, 2008 11:57 pm
Location: North Carolina

Re: Radiation for lung nodules - what do I need to know

Postby dianne052506 » Wed Feb 19, 2014 7:03 pm

Vilca,
Thank you for your kind response and your intelligent questions.
I just assumed it was SBRT since the doctor's office mentioned marking my body. (This was from a phone call late today). I didn't even know it was possible to do radiation to the whole lung.
vilca11 wrote:how many grays and how many sessions
I have no idea, so will put those questions on the list.
The research doctor is the one who is pushing for everything to be done right away. This is the first time since the clinical trial started that I have felt like a test subject instead of a patient.
I've been living with these lung mets since at least October 2007, maybe even since my original dx. I met with thoracic surgeons at MDA and MSKCC in 2009, and nobody seemed willing to do anything since there were so many nodules and they were so small. Now there seems to be a rush and I am not prepared.
Trying to stay strong.
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again

User avatar
Maia
Posts: 2443
Joined: Fri Aug 24, 2012 8:00 am

Re: Radiation for lung nodules - what do I need to know

Postby Maia » Wed Feb 19, 2014 7:28 pm

Dianne, radiation to some lung nodule may be not a bad thing, in itself -and if it's SBRT, better, since it's more focused.
My friend had rad to a problematic lung nodule past October and really had not issues from that -she's facing other challenges, but not radiation related.
Of course, there is the possibility of some rad damage. But you can do some little things to *try* and prevent that (of course, I learnt about them *after* she got the procedure. Duh. But I'll share later what I've read).

On the other hand... when you have radiation, you have the *possibility* of experimenting a good posterior effect called abscopal effect (see Abscopal Effect - When Radiation Also Destroys Non Targeted Tumors. In two words, it's that: the radiation, nobody is sure why, has *systemic* effects, outside the field of the target. It's more usual when people is undergoing some kind of immunological therapy (like you can see in that article I linked). The tumour works like a vaccination in situ. Since you have been since more than a year ago on MPDL3280A, who knows! You may be the lucky one, and the other little buggers can be gone too :)
It's a very, very interesting effect.
There is a researcher, specialist in breast cancer, who is very into studying this --Dr Silvia Formenti. I've uploaded months ago this vid, looks like this is the right time to share it here (the comments in the vid are mine). Pukalania, if you're reading this, there you have the GMCSF shots Dr Lin proposed your hubby):

http://www.youtube.com/watch?v=8FNkdNCGzVA

I'll try and be back (dishes time! LOL) but... hang in there, Dianne!!!!!
love you
xooxxo

dianne052506
Posts: 1651
Joined: Sun Nov 02, 2008 11:57 pm
Location: North Carolina

Re: Radiation for lung nodules - what do I need to know

Postby dianne052506 » Wed Feb 19, 2014 7:47 pm

Maia,
Your post reminded me of two things:
Months ago, one of the trial coordinators at the clinic mentioned that there was a possibility that Avastin "jump-started" the effects of the MPDL3280A so that there was some efficacy even for patients who were negative for the protein. She also mentioned the possibility that patients who had radiation also got this added effect.
When you used the word "vaccination," I find the most interesting thing about this study is that the nodules that were present at the beginning have grown over the 18 months, but each CT report notes that there are no new nodules. Without the immunotherapy, wouldn't you expect something new to be popping up somewhere while these original nodules were growing? That's why I haven't minded staying with the study. With my (very) limited knowledge, that seems like a vaccination effect.
I'm sorry about the dishes. My husband feels very sorry for me right now, so he is doing the dishes.
Thank you so much for sharing all your knowledge. Is your beautiful daughter as smart as you?
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again

NWgirl
Posts: 6659
Joined: Sat Feb 02, 2008 3:24 am
Facebook Username: Belle Piazza
Location: Battle Ground, Washington

Re: Radiation for lung nodules - what do I need to know

Postby NWgirl » Wed Feb 19, 2014 7:59 pm

I had radiation to a lung met last October that has been growing and was beginning to cause me discomfort. I was told the only radiation they would do was palliative efforts. I don't necessarily agree with the logic to wait till they start to hurt to zap them, but I got 3 opinions and they were all the same. I got 3 very small tattoos. 15 treatments. About 2 weeks in I started having minor problems swallowing. I had to remember to take small bites and chew well. This went away completely about 2 weeks after finishing treatment. The skin on my back got a little itchy but it wasn't bad. I have had weird pain since finishing treatment that seems to be getting better very slowly. I have a minor cough that doesn't seem to want to go away. My next scan is next week so I'll have a better idea of what's going on in there.

Compared to other treatments and procedures this one wasn't too bad. The pain at its worst just meant I needed an ibuprofen and 1 oxycodone to sleep at night and I avoided sleeping on my left side.
Belle - "Don't Retreat - Reload"DX 10/07 Stage III Rectal
Surgery 11/07; 27 of 38 nodes
Perm Colostomy 8/11
12/10 recurrence lungs & LN's
VATS Jan 2011
Radiation Oct 2013
Chemo for Life
2012 Colondar Model

User avatar
Maia
Posts: 2443
Joined: Fri Aug 24, 2012 8:00 am

Re: Radiation for lung nodules - what do I need to know

Postby Maia » Wed Feb 19, 2014 9:03 pm

dianne052506 wrote:Without the immunotherapy, wouldn't you expect something new to be popping up somewhere while these original nodules were growing?

Just my opinion, but yes -well, more than an opinion... we all know what happens when you have unresectable (not SBRT, RFA, surgery) lung mets and you don't do some kind of chemo during months... right? That's something similar to what happened to Marc (lohidoc) since July 2012. Some people can think 'hey, fancy thing the immunotherapy, but you still have progression'. Well, it's not a cure (yet) but certainly it's an effective treatment, equal or better than chemo.
My girl is smart in other senses -she has some developmental delays, 7 y.o. and struggling to write her name and some few words, reading less than what she writes and counting and starting with some notion of addition. She had a severe hypoglycemia from 3 to 10 days old, so these may be the sequels. Still had some motor problems but we worked a lot on them, during her first years, so now she skates and she's the queen of the monkey bars since she's 2, so she's almost 'there' now, about motor issues. But she's very outgoing and happy, and she's quite confident, so she's doing well and will be better, I'm positive : )

The two *possible* (only possible, ok... doesn't mean it'll happen to you) complications from radiation to the lung are radiation pneumonitis and pulmonary fibrosis. Can't really find the articles right now. They are trying many things, more unaccesible to us mortal, without a willing doctor to prescribe them, but one thing that I remember is that they tried a liposomal curcumin with great success. However, there are proof that also dietary curcumin works (in mice, but well...): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873679/ It's in my favorite category ('it's unlikely that it hurts, it may help') so... there you go.
The other thing that I've found interesting that sensitizes tumors to radiation and protects good cells is... oh you guess: Celebrex (celecoxib). When my friend had IMRT (targeted radiation) to the site where they removed the brain met (January 2013), both her oncologist and her radiation oncologist agreed it was a good idea for her to continue (she was using it) celecoxib during her IMRT sessions, because there is certain evidence about celecoxib being a good radiosensitizer for the cancer cells. They are for different cancers. I'm copying again here what I posted back then:


*********************************

Cancer Biother Radiopharm. 2012 Dec 26. [Epub ahead of print]
Different Cell Cycle Modulation by Celecoxib at Different Concentrations.
Kim YM, Pyo H.
Source

Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea.

Abstract

Different cyclooxygenase (COX)-2 inhibitors were known to cause different cell cycle changes. We investigated whether this different effect on cell cycle change was due to concentration-dependent effect. We investigated the effects of celecoxib, a COX-2 selective inhibitor, on cell cycle regulation in irradiated cancer cells that express high or low levels of COX-2. Four stably COX-2 knocked-down or overexpressed cell lines were treated with various concentrations of celecoxib with or without radiation. Celecoxib differentially modulated the cell cycle according to the concentrations applied. G(1) arrest was induced at lower concentrations, whereas G(2)/M arrest was induced at higher concentrations in each cell line tested. Radiation-induced G(2)/M arrest was enhanced at lower concentrations but reduced at higher concentrations. The cutoff values to divide lower and higher concentrations were cell-type specific. Celecoxib treatment activated Cdc25C and inhibited p21 expression in both unirradiated and irradiated cells, regardless of COX-2 expression. Apoptosis was induced in irradiated cells 48 hours after treatment with celecoxib dependent of COX-2. These results imply that celecoxib deactivates the G(2) checkpoint via both Cdc25C- and p21-dependent pathways in irradiated cells, which subsequently die by secondary apoptosis. Cell cycle modulating effects in irradiated cells resulting from treatment with celecoxib may have clinical importance with regard to the potential application of celecoxib in cancer patients undergoing radiotherapy.

http://www.ncbi.nlm.nih.gov/pubmed/23268707


*********************
[This is for glioblastoma but CD133(+) are desirable targets for CRC too]

J Neurosurg. 2011 Mar;114(3):651-62. doi: 10.3171/2009.11.JNS091396. Epub 2010 Nov 5.
Celecoxib and radioresistant glioblastoma-derived CD133+ cells: improvement in radiotherapeutic effects. Laboratory investigation.
Ma HI, Chiou SH, Hueng DY, Tai LK, Huang PI, Kao CL, Chen YW, Sytwu HK.
Source
Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. uf004693@mail2000.com.tw
Abstract
OBJECT:
Glioblastoma, the most common primary brain tumor, has a poor prognosis, even with aggressive resection and chemoradiotherapy. Recent studies indicate that CD133(+) cells play a key role in radioresistance and recurrence of glioblastoma. Cyclooxygenase-2 (COX-2), which converts arachidonic acid to prostaglandins, is over-expressed in a variety of tumors, including CD133(+) glioblastomas. The COX-2-derived prostaglandins promote neovascularization during tumor development, and conventional radiotherapy increases the proportion of CD133(+) cells rather than eradicating them. The aim of the present study was to investigate the role of celecoxib, a selective COX-2 inhibitor, in enhancing the therapeutic effects of radiation on CD133(+) glioblastomas.
METHODS:
Cells positive for CD133 were isolated from glioblastoma specimens and characterized by flow cytometry, then treated with celecoxib and/or ionizing radiation (IR). Clonogenic assay, cell irradiation, cell cycle analysis, Western blot, and xenotransplantation were used to assess the effects of celecoxib alone, IR alone, and IR with celecoxib on CD133(+) and CD133(-) glioblastoma cells. Three separate xenotransplantation experiments were carried out using 310 severe combined immunodeficient (SCID) mice: 1) an initial tumorigenicity evaluation in which 3 different quantities of untreated CD133(-) cells or untreated or pretreated CD133(+) cells (5 treatment conditions) from 7 different tumors were injected into the striatum of 2 mice (210 mice total); 2) a tumor growth study (50 mice); and 3) a survival study (50 mice). For these last 2 studies the same 5 categories of cells were used as in the tumorigenicity (untreated CD133(-) cells, untreated or pretreated CD133(+) cells, with pretreatment consisting of celecoxib alone, IR alone, or IR and celecoxib), but only 1 cell source (Case 2) and quantity (5 × 10(4) cells) were used. Results: High levels of COX-2 protein were detected in the CD133(+) but not the CD133(-) glioblastoma cells. The authors further demonstrated that 30 μM celecoxib was able to effectively enhance the IR effect in inhibiting colony formation and increasing IR-mediated apoptosis in celecoxib-treated CD133(+) glioblastoma cells. Furthermore, reduction in radioresistance was correlated with the induction of G2/M arrest, which was partially mediated through the increase in the level of phosphorylated-cdc2. In vivo xenotransplant analysis further confirmed that CD133(+)-associated tumorigenicity was significantly suppressed by celecoxib treatment. Importantly, pretreatment of CD133(+) glioblastoma cells with a combination of celecoxib and IR before injection into the striatum of SCID mice resulted in a statistically significant reduction in tumor growth and a statistically significant increase in the mean survival rate of the mice.
CONCLUSIONS:
Celecoxib combined with radiation plays a critical role in the suppression of growth of CD133(+) glioblastoma stemlike cells. Celecoxib is therefore a radiosensitizing drug for clinical application in glioblastoma.

http://www.ncbi.nlm.nih.gov/pubmed/21054139

*******************************
Childs Nerv Syst. 2010 Nov;26(11):1605-12. doi: 10.1007/s00381-010-1190-2. Epub 2010 Jun 5.
Celecoxib enhances radiosensitivity in medulloblastoma-derived CD133-positive cells.
Chen KH, Hsu CC, Song WS, Huang CS, Tsai CC, Kuo CD, Hsu HS, Tsai TH, Tsai CY, Woung LC, Chiou SH, Lu KH, Chen YW.
Source
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Abstract
OBJECTS:
Cyclooxygenase-2 (COX-2), the enzyme that converts arachidonic acid to prostaglandins, is overexpressed in a variety of tumors, including medulloblastoma (MB). CD133, a transmembrane glycoprotein, has been suggested as a marker for cancer stem cells in brain tumors. The aim of the present study was to investigate the role of celecoxib, a selective COX-2 inhibitor, in enhancing the effects of ionizing radiotherapy (IR) on medulloblastoma-derived CD133-positive cells (MB-CD133(+)).
MATERIALS AND METHODS:
MB-CD133(+) were isolated from two medulloblastoma cell lines (Daoy and UW228). Then, they were treated with celecoxib in different concentrations, and cell viability was assessed. The assays of cell survival, soft agar, radiosensitivity, colony formation, and apoptotic activity in MB-CD133(+) treated with celecoxib alone, radiation alone, or celecoxib combined with radiation were further evaluated.
RESULTS:
MB-CD133(+) showed the self-renew ability to form sphere bodies in vitro and regenerate tumors in vivo. The levels of COX-2 mRNA and protein in MB-CD133(+) were significantly higher than those in MB-CD133(-). The treatment of 30 μM celecoxib could effectively inhibit the abilities of cell proliferation and colony formation and increase IR-induced apoptosis in treated MB-CD133(+). Furthermore, in vivo study demonstrated that celecoxib significantly enhanced radiosensitivity in MB-CD133(+)-transplanted grafts. Notably, xenotransplantation analysis demonstrated that the treatment of celecoxib could further suppress the expressions of angiogenic and stemness-related genes in treated MB-CD133(+) grafts of SCID mice.
CONCLUSIONS:
Celecoxib presents the potential of radiosensitizing effect in MB-derived cancer stem cells. Therefore, it should be warranted in future trials to enhance the radiotherapeutic effects in MB patients.

http://www.ncbi.nlm.nih.gov/pubmed/20526717

**************************************
Cancer Res. 2005 Oct 15;65(20):9501-9.
Radiosensitivity enhancement by celecoxib, a cyclooxygenase (COX)-2 selective inhibitor, via COX-2-dependent cell cycle regulation on human cancer cells expressing differential COX-2 levels.
Shin YK, Park JS, Kim HS, Jun HJ, Kim GE, Suh CO, Yun YS, Pyo H.
Source
Yonsei Institute for Cancer Research, Brain Korea 21 Project for Medical Science, College of Medicine, Yonsei University, South Korea .

Abstract
To characterize the radiation-enhancing effects on human cancer cells and underlying mechanisms of celecoxib, a cyclooxygenase (COX)-2 selective inhibitor, and to ascertain whether its effects are COX-2 dependent. Clonogenic cytotoxicity assays and radiation survival assays after treatment with celecoxib +/- radiation were done on four human cancer cell lines that expressed differential COX-2 levels. Stably COX-2 knocked down or overexpressed cell lines were developed, and clonogenic assays, apoptosis assays, or cell cycle change measurements were conducted after treatment with celecoxib +/- radiation. Prostaglandin E(2) (PGE2) was applied to medium after treatment with celecoxib +/- radiation to determine whether the radiation-enhancing effect associated with celecoxib results from reduced generation of prostaglandin. Celecoxib's radiation-enhancing effect was observed in COX-2-expressing A549 and NCI-H460 cells but was not observed in the COX-2 nonexpressing MCF-7 and HCT-116 cells. Celecoxib's radiation-enhancing effects in A549 cells were shown to disappear after the administration of COX-2 knocked down. In contrast, the HCT-116 cells were radiosensitized by celecoxib after being transfected with COX-2 expression vector. The addition of PGE2 after treatment with celecoxib +/- radiation had no significant effects on celecoxib's radiation-enhancing effects in A549 and COX-2 transfected HCT-116 cells. Radiation-induced G2-M arrest was enhanced and sustained in the COX-2-overexpressing cells compared with that seen in COX-2 low-expressing cells. Celecoxib or NS-398 effected no changes or attenuated radiation-induced G(2)-M arrest in the COX-2-overexpressing cells but further enhanced the radiation-induced G(2)-M arrest in the COX-2 low-expressing cells. Celecoxib's radiation-enhancing effects seem to occur in a COX-2 expression-dependent manner in the cancer cells. This effect does not seem to be the result of reduced PGE2 generation. Celecoxib may exert an inhibitory effect on enhanced radiation-induced G2-M arrest in the COX-2-overexpressing cells, which may allow the arrested cells to enter mitosis and die after radiation, but may also further enhance radiation-induced G2-M arrest in the COX-2 low-expressing cells, by virtue of another mechanism.

http://www.ncbi.nlm.nih.gov/pubmed/16230415

*****************************
Oncology (Williston Park). 2003 May;17(5 Suppl 5):15-24.
Improvement of radiotherapy or chemoradiotherapy by targeting COX-2 enzyme.
Milas L, Mason KA, Crane CH, Liao Z, Masferrer J.
Source

Department of Experimental Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA. lmilas@mdanderson.org
Abstract

Radiation therapy has traditionally been the treatment of choice for locally or regionally advanced cancer, but its therapeutic efficacy is often hindered by limited tolerance of normal tissues and by tumor radioresistance. To improve therapeutic outcome, radiotherapy is frequently combined with chemotherapeutic drugs that are themselves cytotoxic and may sensitize cells to radiation. Solid evidence exists that administering standard chemotherapeutic agents during the course of radiotherapy (concurrent chemoradiotherapy) increases both local tumor control and patient survival in a number of cancer sites. These therapeutic improvements, however, have been achieved at the expense of considerable normal tissue toxicity. To improve chemoradiotherapy further, there have been extensive explorations of the potential of newer chemotherapeutic agents, including irinotecan (CPT-11, Camptosar) and other topoisomerase inhibitors. Preclinical studies have shown that these agents are potent radiosensitizers, providing a strong biologic rationale for using these drugs in combination with radiotherapy. These studies also generated information critical for designing effective treatment schedules in clinical settings. The therapeutic efficacy of topoisomerase inhibitor-radiation combinations is currently being tested clinically. Recent advances in molecular biology have discovered many cellular molecules, including the cyclooxygenase-2 (COX-2) enzyme, that promote tumor cell survival and are responsible for tumor resistance to cytotoxic agents, and hence may serve as potential targets for augmentation of radio (or chemo) response. COX-2 is often overexpressed in premalignant lesions and cancer, and is involved in carcinogenesis, tumor growth, and metastatic spread. Preclinical studies provided solid evidence that inhibition of this enzyme with selective COX-2 inhibitors prevents carcinogenesis, slows the growth of established tumors, and enhances tumor response to radiation without appreciably affecting normal tissue radioresponse. The mechanisms of enhancement of tumor radioresponse involve direct actions on tumor cells and indirect actions, primarily on tumor vasculature. COX-2 inhibitors also improve tumor response to chemotherapeutic agents, including irinotecan. Additional therapeutic benefit was observed for celecoxib (Celebrex), a selective COX-2 inhibitor, consisting of a strong reduction in irinotecan-induced diarrhea. Thus, selective targeting of COX-2 may potentially improve radiotherapy, chemotherapy, or chemoradiotherapy--a therapeutic strategy that is currently being tested in clinical trials.

****************************
J Natl Cancer Inst. 2003 Oct 1;95(19):1440-52.
Enhancing radiotherapy with cyclooxygenase-2 enzyme inhibitors: a rational advance?
Choy H, Milas L.
Source

Vanderbilt-Ingram Cancer Center, Nashville, TN, USA. hak.choy@utsouthwestern.edu
Abstract

Results of preclinical studies suggesting that the efficacy of molecular therapies is enhanced when they are combined with radiation have generated a surge of clinical trials combining these modalities. We reviewed the literature to identify the rationale and experimental foundation supporting the use of cyclooxygenase-2 (COX-2) inhibitors with standard radiotherapy regimens in current clinical trials. Radiation affects the ability of cells to divide and proliferate and induces the expression of genes involved in signaling pathways that promote cell survival or trigger cell death. Future advances in radiotherapy will hinge on understanding mechanisms by which radiation-induced transcription of genes governs cell death and survival, the selective control of this process, and the optimal approaches to combining this knowledge with existing therapeutic modalities. COX-2 is expressed in all stages of cancer, and in several cancers its overexpression is associated with poor prognosis. Evidence from clinical and preclinical studies indicates that COX-2-derived prostaglandins participate in carcinogenesis, inflammation, immune response suppression, apoptosis inhibition, angiogenesis, and tumor cell invasion and metastasis. Clinical trial results have demonstrated that selective inhibition of COX-2 can alter the development and the progression of cancer. In animal models, selective inhibition of COX-2 activity is associated with the enhanced radiation sensitivity of tumors without appreciably increasing the effects of radiation on normal tissue, and preclinical evidence suggests that the principal mechanism of radiation potentiation through selective COX-2 inhibition is the direct increase in cellular radiation sensitivity and the direct inhibition of tumor neovascularization. Results of current early-phase studies of non-small-cell lung, esophageal, cervical, and brain cancers will determine whether therapies that combine COX-2 inhibitors and radiation will enter randomized clinical trials.

http://www.ncbi.nlm.nih.gov/pubmed/14519750

*******************
Cancer Invest. 2012 Dec 17. [Epub ahead of print]
Celecoxib Downregulates CD133 Expression Through Inhibition of the Wnt Signaling Pathway in Colon Cancer Cells.
Deng Y, Su Q, Mo J, Fu X, Zhang Y, Lin EH.
Source
1Department of Medical Oncology, Gastrointestinal Hospital, Sun Yatsen University.

Abstract
CD133-positive cancer stem cells in colon cancer are resistant to conventional chemotherapy. The aim of the present study was to investigate the effect of celecoxib, a COX-2 inhibitor, on CD133 expression in HT29 and DLD1 cells. HT29 and DLD1 cells were treated with celecoxib using different concentrations and duration. CD133 expression was detected by flow cytometry, Western blotting, immunofluorescence, and quantitative real-time PCR. Wnt signaling pathway activity was measured by luciferase assay and gene expression changes were monitored using microarray analysis. HT29 cells showed significantly decreasing levels of CD133 expression with increasing concentrations of or duration of exposure to celecoxib. CD133 mRNA relative expression in HT29 and DLD1 cells also decreased with drug exposure. Furthermore, Wnt activation in HT29 and DLD1 cells decreased with celecoxib treatment. Gene expression microarray showed stemness genes, including Lgr5, Oct4, Prominin-1, Prominin-2, CXCR4, E2F8, CDK-2, were downregulated and differentiation genes, including CEACAM5, GDF, ADFP, ICAM1, were upregulated. Our results show that CD133 expression was downregulated by celecoxib through inhibition of the Wnt signaling pathway, which may be lead to cell differentiation.

(The article, here: http://informahealthcare.com/doi/abs/10 ... 012.754458 This article is not about celecoxib as radiosensitizer but gives you some context about why it maybe making the cells less resistant.
It would mean that the celecoxib would be helping to restore the paths for the cells to make the right signals so the angry (colon cancer) stem cells will differentiate and die instead of lying dormant and repopulating the tumor)

dianne052506
Posts: 1651
Joined: Sun Nov 02, 2008 11:57 pm
Location: North Carolina

Re: Radiation for lung nodules - what do I need to know

Postby dianne052506 » Wed Feb 19, 2014 9:23 pm

Maia,
Again, thank you so much for all the ideas. You are an angel to go to so much trouble. I'm sure your daughter takes after you in spreading kindness all around.
I feel so much better about tomorrow's meeting. I see the radiation doc tomorrow, my regular oncologist on Friday, and then back to Dr. P. at the research clinic on Monday. I want an agreement from everyone want we are trying to do here.
My wish is for everyone to have a peaceful sleep tonight, free of pain and worries.
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: No registered users and 36 guests