Sunday, July 22, 2018

Week 6


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.



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