Interventions for Radiation-Induced Fibrosis in Patients With Breast Cancer: Systematic Review and Meta-analyses

Nogueira, Regiane Mazzarioli Pereira; Vital, Flávia Maria Ribeiro; Bernabé, Daniel Galera; Carvalho, Marcos Brasilino de

doi:10.1016/j.adro.2022.100912

Cited by 7 publications

(7 citation statements)

References 31 publications

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“…Our second most downloaded article, from Chan et al, also focused on breast cancer and was a systematic review and meta-analysis of the literature on radiation-induced fibrosis after breast radiation. The authors suggested that “[a]lthough isolated studies show significant results favorable to the experimental groups, caution should be exercised in these findings because of the small number, small sample size, and high risk of bias presented by some of the included studies, which makes the recommendation for clinical practice still weak.” 2 …”

mentioning

confidence: 99%

ASTRO's Advances in Radiation Oncology’s Top 20 Downloads for 2022

Miller

Tsai

2023

Advances in Radiation Oncology

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confidence: 99%

ASTRO's Advances in Radiation Oncology’s Top 20 Downloads for 2022

Miller

Tsai

2023

Advances in Radiation Oncology

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“…A combined use of vitamin E and pentoxifylline, a methylxanthine derivative, has shown promising results [ 16 , 17 ]. A 2022 meta-analysis was unable to determine the effectiveness of pentoxifylline and vitamin E [ 18 ]. Autologous fat grafting has demonstrated promise in preclinical and clinical settings for post-radiation damage [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Metformin and adipose-derived stem cell combination therapy alleviates radiation-induced skin fibrosis in mice

Malekzadeh,

Surucu,

Chinnapaka

et al. 2024

Stem Cell Res Ther

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Background Radiation therapy often leads to late radiation-induced skin fibrosis (RISF), causing movement impairment and discomfort. We conducted a comprehensive study to assess the effectiveness of metformin and adipose-derived stem cells (ASCs), whether autologous or allogeneic, individually or in combination therapy, in mitigating RISF. Methods Using a female C57BL/6J mouse model subjected to hind limb irradiation as a representative RISF model, we evaluated metformin, ASCs, or their combination in two contexts: prophylactic (started on day 1 post-irradiation) and therapeutic (initiated on day 14 post-irradiation, coinciding with fibrosis symptoms). We measured limb movement, examined skin histology, and analyzed gene expression to assess treatment efficacy. Results Prophylactic metformin and ASCs, whether autologous or allogeneic, effectively prevented late fibrosis, with metformin showing promising results. However, combination therapy did not provide additional benefits when used prophylactically. Autologous ASCs, alone or with metformin, proved most effective against late-stage RISF. Prophylactic intervention outperformed late therapy for mitigating radiation skin damage. Co-culture studies revealed that ASCs and metformin downregulated inflammation and fibrotic gene expression in both mouse and human fibroblasts. Conclusions Our study suggests metformin's potential as a prophylactic measure to prevent RISF, and the combination of ASCs and metformin holds promise for late-stage RISF treatment. These findings have clinical implications for improving the quality of life for those affected by radiation-induced skin fibrosis.

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“…Surgeries, such as sentinel lymph node biopsy, lumpectomy, quadrantectomy, and modified radical mastectomy, with or without axillary lymph node dissection, can cause pain, postural impairments, neck mobility, upper limb anatomy, and upper body biomechanical functions. The main negative side effects are breast cancer-related lymphedema and shoulder mobility limitations, including scapula and scapulohumeral rhythm [1], which are negatively influenced by both chemotherapy [2] and radiation therapy [3].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, fibrosis is a common and disabling condition characterized by the abnormal formation of fibrous connective tissue leading to structural and functional changes affecting the skin, underlying fascia, muscles, organs, and bones. These result in decreased joint range of motion, mainly of the shoulder, pain, lymphatic and vascular dysfunction, as well as breast hardening, retraction, and fixation [3].…”

Section: Introductionmentioning

confidence: 99%

Flexibility and Strength Effects of Adapted Nordic Walking and Myofascial Exercises Practice in Breast Cancer Survivors and Analysis of Differences

Morano,

Lancia,

Di Marco

et al. 2024

Healthcare

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Breast cancer treatments can elicit negative kinesiological side effects concerning both the posture and functional status of breast cancer survivors. As our body is functionally organized in myofascial meridians, physical exercise practice should favor a whole-body approach rather than a local one. The aim of the study was to investigate and compare the effects of two whole-body disciplines, i.e., adapted Nordic Walking and myofascial exercise, on the flexibility and strength performances in BCS. One hundred and sixty breast cancer survivors were trained three times per week for 12 weeks through adapted Nordic Walking or myofascial exercise. Handgrip, sit and reach, back scratch, and single leg back bridge tests and body composition were assessed at the beginning and completion of the training period. Linear mixed models showed no significant changes in body composition, whereas flexibility (p < 0.001), strength (p < 0.001), and muscle quality index (p = 0.003) changed independently from the treatment. When data modification has been analyzed according to sub-sample membership, no significant differences have been observed. Age, radiation therapy, and chemotherapy seem to have independent effects on several investigated variables. Twelve weeks of adapted myofascial exercise and Nordic Walking led to significant changes in flexibility, strength, and muscle quality in breast cancer survivors, with no apparent superiority of one approach over the other.

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Interventions for Radiation-Induced Fibrosis in Patients With Breast Cancer: Systematic Review and Meta-analyses

Cited by 7 publications

References 31 publications

ASTRO's Advances in Radiation Oncology’s Top 20 Downloads for 2022

ASTRO's Advances in Radiation Oncology’s Top 20 Downloads for 2022

Metformin and adipose-derived stem cell combination therapy alleviates radiation-induced skin fibrosis in mice

Flexibility and Strength Effects of Adapted Nordic Walking and Myofascial Exercises Practice in Breast Cancer Survivors and Analysis of Differences

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