Potential risks associated with the use of ionizing radiation for imaging and treatment of colorectal cancer in Lynch syndrome patients.
Mingzhu SunJayne MoquetMichele EllenderSimon BoufflerChristophe BadieRachel Baldwin-ClelandKevin MonahanAndrew LatchfordDavid LloydSusan ClarkNicola A AnyameneElizabeth AinsburyDavid BurlingPublished in: Familial cancer (2022)
The aim of this review is to investigate the literature pertaining to the potential risks of low-dose ionizing radiation to Lynch syndrome patients by use of computed tomography (CT), either diagnostic CT colonography (CTC), standard staging CT or CT surveillance. Furthermore, this review explores the potential risks of using radiotherapy for treatment of rectal cancer in these patients. No data or longitudinal observational studies of the impact of radiation exposure on humans with Lynch syndrome were identified. Limited experimental studies utilizing cell lines and primary cells exposed to both low and high radiation doses have been carried out to help determine radio-sensitivity associated with DNA mismatch repair gene deficiency, the defining feature of Lynch syndrome. On balance, these studies suggest that mismatch repair deficient cells may be relatively radio-resistant (particularly for low dose rate exposures) with higher mutation rates, albeit no firm conclusions can be drawn. Mouse model studies, though, showed an increased risk of developing colorectal tumors in mismatch repair deficient mice exposed to radiation doses around 2 Gy. With appropriate ethical approval, further studies investigating radiation risks associated with CT imaging and radiotherapy relevant doses using cells/tissues derived from confirmed Lynch patients or genetically modified animal models are urgently required for future clinical guidance.
Keyphrases
- computed tomography
- end stage renal disease
- ejection fraction
- newly diagnosed
- chronic kidney disease
- rectal cancer
- magnetic resonance imaging
- induced apoptosis
- peritoneal dialysis
- dual energy
- image quality
- squamous cell carcinoma
- contrast enhanced
- positron emission tomography
- high resolution
- gene expression
- patient reported outcomes
- machine learning
- cross sectional
- public health
- radiation therapy
- risk assessment
- dna methylation
- magnetic resonance
- deep learning
- locally advanced
- signaling pathway
- transcription factor
- circulating tumor
- big data
- photodynamic therapy