Sunday, February 25, 2024

Does Radiation Treatment Affect Your Immune System

What Is Radiation Recall

Radiation, How Does It Affect My Immune System

Radiation recall is a rash that looks like a severe sunburn. It is rare but it can happen when certain types of chemotherapy are given during or soon after external-beam radiation therapy.

The rash appears on the part of the body that received radiation therapy. Symptoms may include redness, tenderness, swelling, wet sores, and peeling skin.

Typically, these effects start within days or weeks of starting radiation therapy. But they can also appear months or years later. Doctors treat radiation recall with medications called corticosteroids. Rarely, it may be necessary to wait until the skin heals to continue with chemotherapy.

In Built Immune Protection

This is also called innate immunity. These mechanisms are always ready and prepared to defend the body from infection. They can act immediately . This in built protection comes from:

  • a barrier formed by the skin around the body
  • the inner linings of the gut and lungs, which produce mucus and trap invading bacteria
  • hairs that move the mucus and trapped bacteria out of the lungs
  • stomach acid, which kills bacteria
  • helpful bacteria growing in the bowel, which prevent other bacteria from taking over
  • urine flow, which flushes bacteria out of the bladder and urethra
  • white blood cells called neutrophils, which can find and kill bacteria

Different things can overcome and damage these natural protection mechanisms. For example:

  • something may break the skin barrier, such as having a drip in your arm or a wound from surgery
  • a catheter into your bladder can become a route for bacteria to get inside the bladder and cause infection
  • anti acid medicines for heartburn may neutralise the stomach acid that kills bacteria

Certain cancer treatments can also overcome these protection mechanisms. Chemotherapy can temporarily reduce the number of neutrophils in the body, making it harder for you to fight infections. Radiotherapy to the lung can damage the hairs and mucus producing cells that help to remove bacteria.

Vitamin D Metabolism And Epidemiology

Vitamin D is produced from 7-dehydrocholesterol in the human skin after exposure to ultraviolet radiation in sunlight, therefore, it can be influenced by season, latitude, skin pigmentation, and cultural habits. In addition, dietary habits and supplementation can also affect vitamin D levels . A two-step catalysis mediated by cytochrome P450 is the crucial process in the production of the steroid hormone calcitriol . The less active form of vitamin D, 25D3, is generated after the first hydroxylation by vitamin D 25-hydroxylase in the liver . 25D3 is found to be the major circulating form of vitamin D in the blood, however, general agreement on the threshold levels has not been defined. Recently, 25D levels of 75-150 nmol/L have been proposed to be the optimal range for vitamin D . The association between 25D level and cancer risk has been described in several solid cancers , and higher 25D circulating level contributes to better prognosis in colorectal cancer . Subsequently, the kidneys utilize the circulating 25D3 as a substrate and convert it into 1,25-dihydroxy-vitamin D3, which is hydroxylated by CYP27B1 .

Also Check: Chances Of Getting Colon Cancer

Spreading The News: The Role Of Mhc

The anti-tumor immune response against neoantigens that are expressed by solid tumors is predominantly attributed to MHC-I-restricted CD8 cytotoxic T cells, but MHC-II-restricted CD4 T cells are also important drivers of anti-tumor immunity . With some exceptions, MHC-II molecules are not expressed by solid tumors, but are selectively expressed by antigen-presenting cells , including DCs, B cells, and macrophages. Therefore, CD4 T cells do not directly target cancer cells but promote the cross-priming of CD8 T cells to tumor antigens by CD40 ligand-mediated DC activation .

As described above, CD4 T-cell responses that are specific for neoantigens exert their helper function at the level of the DC and enhance the activation of anti-tumor CD8 T cells . The abundance of an antigen is critical to achieving an efficient presentation via the endosomal pathway of APCs , so it can be predicted that the radiation-induced mutanome may boost neoantigen presentation by MHC-II, enhancing the activation of CD4 T-helper responses. Moreover, radiation and chemotherapy have been shown to markedly enhance antigen transfer from cancer cells to myeloid cells that are present in the tumor stroma , thus spreading the news about the antigenic composition of the cancer cells, with potential consequences for T-cell priming and T-cell-mediated restructuring of the tumor microenvironment.

The Type Of Cancer Treatment You Have

Radiation And Immunotherapy

Chemotherapy

Chemotherapy reduces the number of white blood cells produced by the bone marrow. This can have a big effect on the immune system. It reduces your body’s defences against infection during and after treatment. Chemotherapy treatment is usually the most common reason for reduced immunity.

You are particularly at risk of getting an infection 7 to 14 days after having chemotherapy, when the level of white blood cells is at its lowest. This time is called the nadir. It can vary slightly depending on the drugs used.

The number of white blood cells will increase steadily and usually returns to normal before your next cycle of chemotherapy.

You will have your blood checked before you have more chemotherapy, to make sure the white cells are at a normal level. Your chemotherapy nurse will give you more information.

Surgery

Surgery can make you more at risk of infection. This is because it makes a break in the skin or in the mucous membranes, which both help protect the body from infection.

If the operation involves removing the spleen, infection is much more likely. The spleen is an important part of the immune system. It contains white blood cells that fight infection and gets rid of old red blood cells. Having your spleen removed means that your immunity is permanently affected. Your doctor will advise you to take low-dose antibiotics for the rest of your life, to protect your from infection.

Radiotherapy

Also Check: Difference In Chemo And Radiation

Association Of Radiotherapy With Immunotherapies

Many immunotherapies were tested in combination with radiotherapy in preclinical studies and are now under investigation in the clinical setting 52. Among them, several immunological manipulation treatments have been used, including immune checkpoint blockade, adaptive T cell transfer, cytokine therapy, dendritic cell and peptide vaccines, and monoclonal antibodies.

The induction of anti-tumor immunity seems to be regulated step by step by positive and negative signals. Immunotherapies that have been currently approved and those in development act at one or multiple steps of this process. Radiotherapy seems to potentially accentuate each step, including the uptake of tumor antigens by dendritic cells and their activation, as well as migration of the activated effector T cells back to the tumor. Therefore, radiotherapy enhances and complements the action of many different immunotherapy agents, and its synergistic use is the goal of many exploratory studies 52,5759.

Targeting Cancer Cells With Advanced Radiation Therapy

Advances in stereotactic radiation therapy and technology are helping the Radiation Oncology team at UT Southwestern’s Harold C. Simmons Cancer Center deliver more effective and less invasive treatments to patients. Nina Sanford, M.D., provides a behind-the-scenes look at the life-changing options.

In general, dietary supplements are not regulated by the U.S. Food and Drug Administration. They are not tested for effectiveness or safety in the same way as medications or prescribed treatments. So, we can’t fully predict how supplements and vitamins will interact with or reduce the effectiveness of prescribed treatments, including radiation therapy.

A recently published study showed that women with breast cancer who took supplements in addition to treatment had higher risk of their cancer coming back. I also published a study in 2019 showing that nearly a third of patients with cancer who were using complementary and alternative therapies such as dietary supplements did not discuss it with their doctors.

No matter how beneficial a supplement might seem, its important to let your provider know about it, so we can best advise you on weighing potential risks and benefits.

4. Will radiation change the way I look?

Most patients dont need to worry about long-term dermatological issues after radiation treatment, but we generally advise them to use good sun protection and to keep their skin moisturized to minimize risk.

5. Can I continue to work and exercise during treatment?

Read Also: Is Chemo Or Radiation Worse

Common Prostate Cancer Treatments Suppress Immune Response May Promote Relapse

Date:
UT Southwestern Medical Center
Summary:
Prostate cancer patients and their doctors may want to think twice about the best timing for chemotherapy or radiation therapy in conjunction with a common nonsurgical treatment, based on international research findings.

Prostate cancer patients and their doctors may want to think twice about the best timing for chemotherapy or radiation therapy in conjunction with a common nonsurgical treatment, based on international research findings led by UT Southwestern Medical Center investigators.

Researchers using mouse models found that many medical androgen deprivation therapies — the most commonly used nonsurgical treatments for prostate cancer — may suppress patients’ adaptive immune responses, preventing immunotherapies from working if both treatments are used but not sequenced properly. ADTs are anti-hormone therapies that decrease the body’s levels of androgens, the type of hormone that is required for prostate cancer to survive and grow.

The study findings were published this week in Science Translational Medicine.

“Medical ADTs have been used for a half century to treat prostate cancer, and promising clinical results for cancer immunotherapy have led to attempts to combine it and other standard-of-care therapies with immunotherapy to treat the disease,” said senior author and principal investigator Dr. Yang-Xin Fu, Professor of Pathology and Immunology.

Relapse of prostate tumors, however, has been a major problem.

About The Guest Speakers

The immune system vs. cancer | Jedd Wolchok | TEDxTimesSquare

Ronald D. Ennis, MD is a radiation oncologist at the Cancer Institute of New Jersey. He has expertise in prostate cancer, genitourinary malignancies and gynecologic malignancies. He has extensive experience with high dose-rate and low dose-rate brachytherapy, stereotactic body radiosurgery , intensity modulated radiotherapy, three-dimensional conformal radiotherapy, image-guided radiotherapy, hormone therapy, surveillance and survivorship. Dr. Ennis strongly believes in a compassionate patient-centered approach, finding the optimal care for each patient taking into account his/her individual needs, preferences and medical conditions.

Louis Potters, MD is chairman of the Department of Radiation Medicine at Northwell Health and professor at the Zucker School of Medicine at Hofstra/Northwell. He is also immediate past Chair of the Northwell Health Physician Partners Board of Governors and executive Committee. Dr. Potters is a practicing radiation oncologist and an internationally recognized expert in the management and treatment of prostate cancer. Board-certified in internal medicine and radiation oncology, Dr. Potters oversees one of the largest radiation oncology departments with a faculty and staff devoted to excellent patient care, research and the education of tomorrows oncologists.

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Radiation Therapy Side Effects

Radiation not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Damage to healthy cells can cause side effects.

Many people who get radiation therapy have fatigue. Fatigue is feeling exhausted and worn out. It can happen all at once or come on slowly. People feel fatigue in different ways and you may feel more or less fatigue than someone else who is getting the same amount of radiation therapy to the same part of the body. See Fatigue and Cancer Treatment to learn more.

Other radiation therapy side effects you may have depend on the part of the body that is treated. To see which side effects you might expect, find the part of your body being treated in the following chart. Many of the side effects in the list link to more information in the Side Effects section. Discuss this chart with your doctor or nurse. Ask them about the side effects that you might expect.

What Are The Common Side Effects Of Radiation Therapy

Radiation therapy is called a local treatment. This means that it only affects the specific area of the body that is targeted. For example, radiation therapy to the scalp may cause hair loss. But people who have radiation therapy to other parts of their body do not usually lose the hair on their head.

Common physical side effects of radiation therapy include:

Skin changes. Some people who receive radiation therapy experience dryness, itching, blistering, or peeling on the skin in the area being treated. Skin changes from radiation therapy usually go away a few weeks after treatment ends. If skin damage becomes a serious problem, your doctor may change your treatment plan. Lotion may help with skin changes, but be sure to check with your health care team about which cream they recommend and when to apply it. It is also best to protect affected skin from the sun. Learn more about skin-related treatment side effects.

Fatigue. Fatigue is a term used to describe feeling physical, emotional, and mental exhaustion even if you are getting enough rest and sleep. Many patients experience fatigue. Your level of fatigue may increase if you are receiving more than 1 type of treatment, such as radiation therapy combined with chemotherapy. Learn how to cope with fatigue.

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What Foods Should I Avoid During Radiation

Foods to avoid or reduce during radiation therapy include excess processed sodium , refined sugars, unsaturated fats, and an excess of alcohol. Some salt, ideally unrefined, is needed in all diets. Your doctor or dietitian can recommend how much salt you should consume based on your medical history.

In addition to foods to avoid that are listed above, spicy foods can cause gastrointestinal problems during radiation therapy. While nausea and diarrhea are symptoms of radiation therapy, spicy foods can lead to cramping, and diarrhea.

One of the potential side effects of radiation therapy includes intestinal problems, such as bloating, says Lara. Patients should watch out for foods and dietary habits that may cause bloating such as cruciferous vegetables, carbonated beverages, and drinking from straws.

If you are receiving radiation therapy for head and neck cancer, refrain from consuming foods that may get stuck when swallowing or those that are high in acid which can be irritating.

Clinical Implications / On

The Connection Between Radiation Therapy &  Cancer

The potential benefits of the combination of radiotherapy with drugs that cause immune system activation was already described in the 1970s 87. However, only in the past 10 years has this type of treatment started to be developed. Currently, there is still a lack of information about the ideal combination of ionizing radiation with immunotherapy, and there are no recommended off-protocol approaches already established for routine patient management.

The main objective of the current ongoing trials is to evaluate the abscopal effect of the combination of ionizing radiation with immunotherapy, mainly in patients with advanced disease.

Different vaccines and immune checkpoint inhibitors are combined with radiotherapy that is delivered to the primary tumor or metastatic sites in oligometastatic disease. Among these, vaccinia prostate-specific antigen , Toll-like receptor -7 agonist, cytokine FLT3L ligand , anti-programmed cell death-1 , anti-programmed cell death ligand-1 , and anti-cytotoxic T-lymphocyte associated protein 4 antibodies, IL-2, recombined human granulocyte-macrophage colony stimulating factor , and tyrosine kinase inhibitors have been identified and tested 44,8892.

The trials involve distinct tumor sites, in different stages of the disease, most frequently in the metastatic setting. All are phase 1 or 2, and radiotherapy is preferentially delivered with SBRT.

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How Can I Boost My Immune System After Radiation

Those treatments, including chemotherapy and radiation, are known to lower your immune response.These five science-backed tips can help keep your immune system as strong as possible during cancer treatment.Sleep Well. Aim for 7 hours of sleep a night. Eat Smart. Get Moving. Manage Stress. Stay Away From Illness.

Cancer Treatments Can Increase Infection Risk

Certain cancer treatments can interfere with the way the immune system works. The damage can be short- or long-term. For example, if a person with cancer has their spleen removed due to cancer, this causes long-term damage because the spleen is part of the immune system. On the other hand, radiation therapy, immunotherapy, and chemotherapy, either alone or in combination can lead to short-term immune system damage because they affect immune system blood cells for a fairly short period of time. A bone marrow or stem cell transplant uses very high-dose treatments to kill cancer cells that also damage immune system cells for weeks to months.

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Emerging Radiation Advancements At Ut Southwestern

At UT Southwesterns Radiation Oncology Clinics, weve pioneered hypofractionated radiation therapy which delivers high doses of radiation in fewer treatments to more targeted areas. This is also called Stereotactic Ablative Radiation Therapy .

Robert Timmerman, M.D., spearheaded the use of SAbR with SBRT for early stage lung cancer at UT Southwestern. Now were working to apply the treatment to nearly every location in the body where cancer can grow, including previously difficult-to-reach areas such as the head and neck or gastrointestinal tract.

SAbR or SBRT offer two major benefits for patients:

  • Convenience: Instead of coming to appointments every day for six or seven weeks, patients come three to five times total, which is more convenient and cost-effective.
  • Smaller treatment zones: Advanced targeting technology allows us to deliver higher doses to smaller areas with the goal of improving treatment effectiveness and reducing damage to healthy tissue.

Related reading: Radiation Reimagined

Additionally, were pioneering strategies to combine radiation therapy with immunotherapy, which is geared toward revving up the patients own immune system to fight the cancer, and further improve clinical responses.

To learn more about radiation oncology at UT Southwestern, call or request an appointment online.

Why Does Radiation Therapy Cause Side Effects

Cancer Revealed: How the Immune System Sees and Destroys Tumors, with Jeffrey Weber

In this type of treatment, high doses of radiation therapy are used to destroy cancer cells. Side effects come from damage to healthy cells and tissues near the treatment area.

There have been major research advances in radiation therapy over recent years that have made it more precise. This has reduced this treatment’s side effects compared to radiation therapy techniques used in the past.

Some people experience few or no side effects from radiation therapy. Other people experience more severe side effects. Reactions to radiation therapy often start during the second or third week of treatment. Or, they may last for several weeks after the final treatment. Some side effects may be long term. Talk with your treatment team about what you can expect.

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