Archives April 2021

Organ-sparing treatments effective for bladder cancer; Brachytherapy cost-effective treatment for prostate cancer

Traditionally, treatment for muscle-invasive bladder cancer is chemotherapy followed by the removal of the patient’s entire bladder, known as a radical cystectomy. However, Beaumont researchers have data suggesting that treatment consisting of limited surgery followed by combination chemotherapy and radiation is just as effective, while allowing patients to keep their bladder and maintain function.

“This is a big deal. No one wants their bladder removed,” said Craig Stevens, M.D., Ph.D., chairman, Radiation Oncology, Beaumont Health.

The surgical approach affects a patient’s quality of life and daily activities. Radical cystectomy is also associated with 67 percent of patients experiencing complications and up to a 2 percent death rate within 90 days of surgery.

“Our resident, Dr. David Lin, recently analyzed the National Cancer Database and, through his research, found equivalent outcomes using bladder-preserving approaches as opposed to radical surgery for muscle invasive bladder cancer,” said Daniel Krauss, M.D., Beaumont Hospital, Royal Oak radiation oncologist and one of the study authors. “This was true after controlling for factors such as patient age, baseline health/performance status, and presenting clinical disease stage.”

Bladder cancer is the sixth most common cancer in the United States – responsible for nearly 17,000 deaths in 2017. Nearly a quarter of those with bladder cancer have cancer in the muscle wall of their bladder, also referred to as muscle-invasive bladder cancer. This deadly form of cancer has a high risk of spreading.

Explained Dr. Lin, “Our analysis contributes further support to the use of organ preservation through a combination chemotherapy/radiotherapy as a viable option in the management of muscle-invasive bladder cancer.”

Dr. Krauss said, “This was not a clinical trial, but rather the research team analyzed a large database of patients. In the case of bladder cancer, we have good data to support organ-sparing therapy. There is no reason for doctors not to try this therapy first, and it’s been shown previously that if it doesn’t work, the bladder can be removed at that point without a significant increase in the surgical complication rate.”

Other members of the Beaumont bladder cancer research team included: Hong Ye, Ph.D., Kenneth Kernen, M.D., and Jason Hafron, M.D. The team’s research was recently published in Cancer Medicine.

Brachytherapy a cost-effective treatment for prostate cancer

Health care costs currently account for nearly 18 percent of the nation’s gross domestic product. It’s estimated that the national costs of prostate cancer care in the United States will rise to $15-20 billion in 2020. Providing cost-effective, quality care is a local, regional and national priority.

Another research team at Beaumont looked at the cost effectiveness of treating intermediate to high-risk prostate cancer with a combination of brachytherapy and external beam radiation therapy, versus just external beam radiation.

According to the American Cancer Society, nearly 161,000 American men were diagnosed with prostate cancer in 2017. After skin cancer, prostate cancer is the most common cancer diagnosed nationally among men.

The researchers calculated the estimated expected lifetime Medicare cost of brachytherapy was $68,696 compared to $114,944 for external beam radiation alone. The brachytherapy boost significantly lowered expected lifetime treatment costs because it decreased the incidence of metastatic prostate cancer, cutting the use of expensive targeted therapies. Brachytherapy patients were additionally shown to have an increase in quality adjusted life years, a measure taking into account both survival time as well as disease and treatment related impacts on quality of life, of 10.8 years vs. 9.3 years for patients receiving external beam radiation alone.

Brachytherapy is a form of radiation therapy that involves placing a radioactive source within the patient’s body at the site of the cancer. The radioactive source used to destroy the cancer is delivered by devices called implants. Brachytherapy may be performed in combination with external beam radiation therapy to help destroy the main mass of tumor cells for certain types of cancer.

“We found that brachytherapy is a medically- and cost-effective treatment compared to external beam radiation therapy alone,” said Daniel Krauss, M.D., Beaumont Hospital, Royal Oak radiation oncologist and one of the study authors. “Therefore our team concluded, brachytherapy boost should be offered as an option to all eligible patients with intermediate to high-risk prostate cancer.”

Other members of the Beaumont prostate cancer research team included: Charles Vu, M.D., Kevin Blas, M.D., Tom Lanni, and Gary Gustafson, M.D. The team’s research was recently published in Brachytherapy.

UC San Diego Researchers Identify How Skin Ages, Loses Fat and Immunity

Dermal fibroblasts are specialized cells deep in the skin that generate connective tissue and help the skin recover from injury. Some fibroblasts have the ability to convert into fat cells that reside under the dermis, giving the skin a plump, youthful look and producing a peptide that plays a critical role in fighting infections.

In a study published in Immunity today, University of California San Diego School of Medicine researchers and colleagues show how fibroblasts develop into fat cells and identify the pathway that causes this process to cease as people age.

“We have discovered how the skin loses the ability to form fat during aging,” said Richard Gallo, MD, PhD, Distinguished Professor and chair of the Department of Dermatology at UC San Diego School of Medicine and senior author on study. “Loss of the ability of fibroblasts to convert into fat affects how the skin fights infections and will influence how the skin looks during aging.”

Don’t reach for the donuts. Gaining weight isn’t the path to converting dermal fibroblasts into fat cells since obesity also interferes with the ability to fight infections. Instead, a protein that controls many cellular functions, called transforming growth factor beta (TGF-β), stops dermal fibroblasts from converting into fat cells and prevents the cells from producing the antimicrobial peptide cathelicidin, which helps protect against bacterial infections, reported researchers.

“Babies have a lot of this type of fat under the skin, making their skin inherently good at fighting some types of infections. Aged dermal fibroblasts lose this ability and the capacity to form fat under the skin,” said Gallo. “Skin with a layer of fat under it looks more youthful. When we age, the appearance of the skin has a lot to do with the loss of fat.”

In mouse models, researchers used chemical blockers to inhibit the TGF-β pathway, causing the skin to revert back to a younger function and allowing dermal fibroblasts to convert into fat cells. Turning off the pathway in mice by genetic techniques had the same result.

Understanding the biological process that leads to an age-dependent loss of these specialized fat cells could be used to help the skin fight infections like Staphylococcus aureus (S. aureus) — a pathogenic bacteria that is the leading cause of infections of the skin and heart and a major factor in worsening diseases, like eczema. When S. aureus becomes antibiotic resistant it is known as methicillin-resistant Staphylococcus aureus or MRSA, which is a leading cause of death resulting from infection in the United States.

The long term goals and benefits of this research are to understand the infant immune system, said Gallo. The results may also help understand what goes wrong in other diseases like obesity, diabetes and autoimmune diseases.