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One method of treatment used in cancer therapy is radiotherapy which can injure the oral, pharynx or larynx mucosa and predisposes tissue to the development of fungal infections. The aim of the study paper was the mycological examinations of swabs from the oral cavity and pharynx of patients obtained prior to, in week 3, on the last day of and 3 weeks after radiotherapy, as well as isolation of fungi and identification of the selected parameter of strains pathogenecity, i.e. hydrolytic enzyme release. Forty-three patients with oral cavity, pharynx or larynx carcinoma were examined at four points during a course of radiotherapy: before treatment, in week 3 of treatment, on the last day of treatment and 3 weeks afterwards. The mycological examination was conducted based on a procedure introduced in the Department of Biology and Medical Parasitology, Medical University of Lodz. The activity of the hydrolytic enzymes was evaluated with a bioMerieux API ZYM test kit. More than 2/3 of the patients (68.2%) were found to have a fungal infection in the first examination, 4/5 (80%) in the second, about 3/5 (57.1%) in the third and all (100%) in the last examination. The release of enzymes varied, and on different stages show different inactive enzymes: at the start, α-chymotrypsin and α-mannosidase; at 3 weeks, β-glucuronidase and α-mannosidase; at the end, α-chymotrypsin; at 3 weeks after the end, trypsin, α-chymotrypsin, α-galaktosidase and α-fucosidase. The most frequent species isolated from the patients treated by radiotherapy is Candida albicans and C. glabrata. The latter is characterized by resistance to the majority of antimycotic medications. The isolated strains are characterized by the highest activity of leucine arylamidase, acid phosphatase and naphthol – AS-BI-phosphohydrolase. Considering the enzymes produced, most of the strains can be included to biotypes D₃, C₆ and A.
Human prostate cancer cells were evaluated for growth after photodynamic therapy, radiotherapy, and combined treatment. Indocyanine green was tested as a photosensitizer and radiosensitizer. Two human cell lines were used: PC-3 derived from prostate carcinoma, and EPN derived from normal prostate tissue. The light source used for the photoactivation experiments was a diode laser peaked at 805 nm. The light dose incident on cells was 108 J/cm2. Ionizing radiation was produced by a linear accelerator, and the dose was 2, 4 and 6 Gy. Cytotoxicity was evaluated by measuring the colony forming ability of cells. Our results show that indocyanine green induces cell death by photoactivation, but it does not act as a radiosensitizer if used with ionizing radiation. The combined treatment of photodynamic therapy and radiotherapy produces an additive effect which does not depend on the sequence of the two treatments. Combined treatments could be more useful since they allow the reduction of the ionizing radiation
Radiotherapy and chemotherapeutic agents that damage DNA are the current major non-surgical means of treating cancer. However, many patients develop resistances to chemotherapy drugs in their later lives. The PI3K and Ras signaling pathways are deregulated in most cancers, so molecularly targeting PI3K-Akt or Ras-MAPK signaling sensitizes many cancer types to radiotherapy and chemotherapy, but the underlying molecular mechanisms have yet to be determined. During the multi-step processes of tumorigenesis, cancer cells gain the capability to disrupt the cell cycle checkpoint and increase the activity of CDK4/6 by disrupting the PI3K, Ras, p53, and Rb signaling circuits. Recent advances have demonstrated that PI3K-Akt-mTOR signaling controls FANCD2 and ribonucleotide reductase (RNR). FANCD2 plays an important role in the resistance of cells to DNA damage agents and the activation of DNA damage checkpoints, while RNR is critical for the completion of DNA replication and repair in response to DNA damage and replication stress. Regulation of FANCD2 and RNR suggests that cancer cells depend on PI3K-Akt-mTOR signaling for survival in response to DNA damage, indicating that the PI3K-AktmTOR pathway promotes resistance to chemotherapy and radiotherapy by enhancing DNA damage repair.
Radio- and chemotherapy for malignant neoplasms, especially in head and neck region, is associated with a greater risk of fungal infections due to secondary alterations in the mucous membranes. The study had three aims: 1. to determine the signs and symptoms which occur among patients undergoing radiotherapy; 2. to determine the fungi prevalence in the mouth and throat of patients before, during and after radiotherapy; 3. to examine the sensitivity of strains to antimycotic drugs. The study comprised 44 patients (11 female, 33 male) with head and neck cancers, examined at the following stages: before radiotherapy (44 patients – batch 1), 3rd week of therapy (30 of the 44 patients – batch 2), last day of therapy (28 of batch 2 – batch 3) and the 6th week after completion of radiotherapy (10 of batch 3 – batch 4). Clinical examination was performed and mycological status was estimated from an oral rinse on a selected medium. The fungal strains were isolated and sensitivity to antifungal drugs was determined. The most common symptoms were pain, dysphagia, and dysgeusia. Physical examination revealed signs of mucositis mainly among patients from batches 2 and 3. The presence of fungi in the mouth and throat was noted in over 2/3 (66.2%) of the patients from batch 1, and in 4/5 (80%) of batch 2. The fungi were detected in over half (57.1%) of patients from batch 3 and also in patients from batch 4. In all cases, fungi of various Candida species were identified: 6 species in batch 1, 8 in batch 2, 6 in batch 3 and 5 in batch 4. The most frequently detected species was C. albicans, constituting 40–60%; the other species detected are known to be resistant to antimycotic drugs. The isolated strains were the most sensitive to nystatin and miconazole, and the least to ketoconazole and fluconazole. Conclusions: 1. Patients undergoing radiotherapy complain of pain, dysphagia, and dysgeusia; in most cases mucositis is diagnosed. 2. The high prevalence of fungi in the mouth and throat of patients treated by radiotherapy reinforces the need to perform mycological examinations in this group of patients to detect fungi, identify their species and determine of their sensitivity to drugs in order to prevent complications. 3. The species most frequently isolated from the patients are C. albicans and C. glabrata. The latter is characterized by resistance to the majority of antimycotic medications. 4. Most of the isolated strains are sensitive to nystatin and miconazole (applied locally) and to itraconazole (absorbed from the gastrointestinal tract).
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It is reasonable to suppose that airway mucosa can be damaged by irradiation applied to chest and neck regions. The inflammatory process is a consequence of an injury. Airway inflammation is one mechanism responsible for cough induction. So, one can suppose that radiotherapy (RT) focused on the patients' chest or neck may injure airway mucosa, which might change sensitivity of the nerve-endings mediating the cough reflex. The purpose of this study was to examine cough reflex sensitivity (CRS) in patients who underwent RT in the chest and neck regions. CRS test using capsaicin was performed in patients with breast cancer (Group A, n=19), and with lung or neck cancer in (Group B, n=14) who underwent RT. Capsaicin aerosol in doubled concentrations (0.49-1000 µM) was inhaled by a single breath. CRS was defined as the lowest capsaicin concentration that evoked 2 or more coughs (C2). Radiation doses ranged from 40 to 70 Gy. Capsaicin cough challenge was performed before and then in the 2nd and 5th week of RT. We observed a significantly reduced value of C2, i.e., increased cough reflex sensitivity, in Group B in the 2nd week of RT (P= 0.04). We conclude that CRS in the lung or neck cancer patients undergoing RT is significantly enhanced, which could result from injury to the nerve endings in airway mucosa.
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