Cancer cells that survive fractionated irradiation can be radioresistant and cause tumor recurrence.
Wen-Feng Li, Li Zhang, Hai-Ying Li, Si-Si Zheng, Liang Zhao 2014, 'WISP-1 Contributes to Fractionated Irradiation-Induced Radioresistance in EsophagealCarcinoma Cell Lines and Mice', PLoS ONE10.1371/journal.pone.0094751. Retrieved from PLOS CC BY 4.0 (https://creativecommons.org/licenses/by-sa/4.0/legalcode)
Radioresistant cells exhibited enhanced migration and invasion, with evidence of epithelial-to-mesenchymal-transition.
Mark Gray, Arran K. Turnbull, Carol Ward, James Meehan, Carlos Martínez-Pérez, MariaBonello, Lisa Y. Pang, Simon P. Langdon, Ian H. Kunkler, Alan Murray, David Argyle 2019, 'Development and characterisation of acquired radioresistant breast cancer cell lines',Radiation Oncologyhttp://link.springer.com/article/10.1186/s13014-019-1268-2. Retrieved from DOAJ CC BY 4.0 (https://creativecommons.org/licenses/by-sa/4.0/legalcode)
Results showed that immune cells differed in their radiosensitivity, with monocytes being the most radioresistant.
Sylvia E. Falcke, Paul F. Rühle, Lisa Deloch, Rainer Fietkau, Benjamin Frey, UdoS. Gaipl 2018, 'Clinically Relevant Radiation Exposure Differentially Impacts Forms of Cell Deathin Human Cells of the Innate and Adaptive Immune System', International Journal of Molecular Scienceshttps://www.mdpi.com/1422-0067/19/11/3574. Retrieved from DOAJ CC BY 4.0 (https://creativecommons.org/licenses/by-sa/4.0/legalcode)
Various approaches to treat hypoxic and radioresistant cancers, including pancreatic cancer, have shownlimited success.
Sung-Won Shin, Wooju Jung, Changhoon Choi, Shin-Yeong Kim, Arang Son, Hakyoung Kim,Nohyun Lee, Hee Chul Park 2018, 'Fucoidan-Manganese Dioxide Nanoparticles Potentiate Radiation Therapy by Co-TargetingTumor Hypoxia and Angiogenesis', Marine Drugshttps://www.mdpi.com/1660-3397/16/12/510. Retrieved from DOAJ CC BY 4.0 (https://creativecommons.org/licenses/by-sa/4.0/legalcode)
More recently, heavy charged particles have been used to treat radioresistant andhigh-risk cancers.
Christopher B. Sylvester, Christopher B. Sylvester, Jun-ichi Abe, Zarana S. Patel,K. Jane Grande-Allen 2018, 'Radiation-Induced Cardiovascular Disease: Mechanisms and Importance of Linear EnergyTransfer', Frontiers in Cardiovascular Medicinehttp://journal.frontiersin.org/article/10.3389/fcvm.2018.00005/full. Retrieved from DOAJ CC BY 4.0 (https://creativecommons.org/licenses/by-sa/4.0/legalcode)
However, radioresistant cancer cells can eventually cause tumor relapse and even fatal metastasis.
Yuan-Hu Yao, Yan Cui, Xiang-Nan Qiu, Long-Zhen Zhang, Wei Zhang, Hao Li, Jin-MingYu 2016, 'Attenuated LKB1-SIK1 signaling promotes epithelial-mesenchymal transition and radioresistanceof non–small cell lung cancer cells', Chinese Journal of Cancerhttp://link.springer.com/article/10.1186/s40880-016-0113-3. Retrieved from DOAJ CC BY 4.0 (https://creativecommons.org/licenses/by-sa/4.0/legalcode)
Several clinical and research-based studies have shown that radiation treatment cannot target all cancer cells, leaving behind radioresistant cells.
Garima Sinha, Alejandra Ferrer, Yahaira Naaldijk, Caitlyn A Moore, Qunfeng Wu, HenningUlrich, Pranela Rameshwar 2018, 'Breast cancer stem cells, epigenetics, and radiation', Journal of Radiation and Cancer Researchhttp://www.journalrcr.org/article.asp?issn=2588-9273;year=2018;volume=9;issue=4;spage=155;epage=164;aulast=Sinha. Retrieved from DOAJ CC BY 4.0 (https://creativecommons.org/licenses/by-sa/4.0/legalcode)
Radioresistant characteristics were detected by clone formation assay, ultrastructural observations, cell doubling time, cell cycle distribution, and apoptosis assay.
Yang Zhen-Zhou, Li Zeng-Peng, Xiang De-Bing, Li Meng-Xia, Xie Jia-Yin, Lei Xin, ZhongZhao-Yang, Yang Xue-Qin, Qing Yi, Wang Ge, Wang Dong 2010, 'Microarray analysis of DNA damage repair gene expression profiles in cervical cancercells radioresistant to 252Cf neutron and X-rays', BMC Cancerhttp://www.biomedcentral.com/1471-2407/10/71. Retrieved from DOAJ CC BY 4.0 (https://creativecommons.org/licenses/by-sa/4.0/legalcode)
Derivative cells were compared with parental cells to identify putative biomarkers associated with the radioresistant phenotype.
Laura Smith, Omar Qutob, Mark B. Watson, Andrew W. Beavis, Donna Potts, Kevin J. Welham,Veerabhadram Garimella, Michael J. Lind, Philip J. Drew, Lynn Cawkwell 2009, 'Proteomic Identification of Putative Biomarkers of Radiotherapy Resistance: A PossibleRole for the 26S Proteasome?', Neoplasia: An International Journal for Oncology Researchhttp://www.sciencedirect.com/science/article/pii/S1476558609800778. Retrieved from DOAJ CC BY 4.0 (https://creativecommons.org/licenses/by-sa/4.0/legalcode)
Among others, radioresistant tumor clones as well as geographical miss can explain these high local failure rates.
Lore Helene Braun, Stefan Welz, Marén Viehrig, Frank Heinzelmann, Daniel Zips, CihanGani 2018, 'Resolution of atelectasis during radiochemotherapy of lung cancer with serious implicationsfor further treatment. A case report', Clinical and Translational Radiation Oncologyhttp://www.sciencedirect.com/science/article/pii/S2405630817300940. Retrieved from DOAJ CC BY 4.0 (https://creativecommons.org/licenses/by-sa/4.0/legalcode)