This week I focused on diving into the effects of radiation
on the microenvironment of the tumor and surrounding healthy tissue. With
profound residual effects on the vasculature, stroma, immune cells, and cell
signaling of exposed tissue, it seemed logical that irradiation of bone for
treatment of metastases would affect true recurrence rates in patients.
Finding epidemiological studies of true metastatic
recurrence rates in post-radiotherapy patients is much harder than I
anticipated. Doctors in the department told me that it is almost impossible
except with records from your own institution – perhaps a project for another
student.
It is clear that radiotherapy has the potential to stiffen
the extracellular matrix, destroy or thicken blood vessels in a doasge
dependent manner, and recruit immune cells (both pro- and anti-cancerous) to
the treatment area. Additionally, radiotherapy can drive growth factor and
cytokine production in cells, as well as promote release of factors from the
ECM. Additionally, the associated inflammatory response has the potential to
affect risk of outgrowth or recurrence substantially. In bone, these effects all
appear to be muted, thus suggesting that the likelihood of bone metastatic
cancer recurrence is not changed in an appreciable way by successful
radiotherapy treatment.
Additionally, I watched a fat transfer operation for a
patient getting breast reconstruction after a lumpectomy. It was interesting
seeing all of the places where a surgeon’s expertise matters in terms of choice
of approach, how to handle the tissue, how quickly they move etc. I was also
surprised to learn about the extreme fragility of fat tissue. The surgeons extracted the fat
from the abdomen with a vacuum-assisted canula, then washed it several times in
Ringer’s lactate solution (sodium lactate solution), partially dried it on
pads, then scooped it into 6ml syringes to deliver through a specialized canula.
No comments:
Post a Comment