Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Semin Radiat Oncol. 2021 Oct;31(4):274-285. doi: 10.1016/j.semradonc.2021.02.009.
In multiple anatomic sites, patients with cancers associated with the Human Papillomavirus (HPV) experience better locoregional control and overall survival after radiotherapy and/or chemoradiotherapy than patients with HPV-negative cancers. These improved outcomes suggest that relatively unique biological features in HPV-positive cancers may increase sensitivity to DNA damaging agents as well as an impaired DNA damage response. This review will address potential biological mechanisms driving this increased sensitivity of HPV-positive cancer to radiation and/or chemotherapy. This review will discuss the clinical and preclinical observations that support the intrinsic radiosensitivity and/or chemosensitivity of HPV-positive cancers. Furthermore, this review will highlight the molecular mechanisms for increased radiation sensitivity using the classical "4 Rs" of radiobiology: repair, reassortment, repopulation, and reoxygenation. First, HPV-positive cancers have increased DNA damage due to increased oxidative stress and impaired DNA damage repair due to the altered activity TP53, p16, TIP60, and other repair proteins. Second, irradiated HPV-positive cancer cells display increased G2/M arrest leading to reassortment of cancer cells in more radiosensitive phases of the cell cycle. In addition, HPV-positive cancers have less radioresistant cancer stem cell subpopulations that may limit their repopulation during radiotherapy. Finally, HPV-positive cancers may also have less hypoxic tumor microenvironments that make these cancers more sensitive to radiation than HPV-negative cells. We will also discuss extrinsic immune and microenvironmental factors enriched in HPV-positive cancers that facilities responses to radiation. Therefore, these potential biological mechanisms may underpin the improved clinical outcomes often observed in these virally induced cancers.
在多个解剖部位,与人类乳头瘤病毒 (HPV) 相关的癌症患者在接受放疗和/或放化疗后,局部区域控制和总体生存率均优于 HPV 阴性癌症患者。这些改善的结果表明,HPV 阳性癌症中相对独特的生物学特征可能增加对 DNA 损伤剂的敏感性以及对 DNA 损伤反应的损伤。这篇综述将探讨导致 HPV 阳性癌症对辐射和/或化疗敏感性增加的潜在生物学机制。这篇综述将讨论支持 HPV 阳性癌症固有放射敏感性和/或化学敏感性的临床和临床前观察结果。此外,本综述将重点介绍使用放射生物学经典的“4 Rs”(修复、重排、再增殖和再氧合)来增加辐射敏感性的分子机制。首先,HPV 阳性癌症由于氧化应激增加和 TP53、p16、TIP60 和其他修复蛋白活性改变导致 DNA 损伤修复受损,导致 DNA 损伤增加。其次,受照射的 HPV 阳性癌细胞显示出增加的 G2/M 期阻滞,导致癌细胞在细胞周期中更敏感的放射敏感期重新排列。此外,HPV 阳性癌症中具有较少的放射抗性癌症干细胞亚群,这可能限制它们在放疗期间的再增殖。最后,HPV 阳性癌症也可能具有较少的缺氧肿瘤微环境,这使得这些癌症比 HPV 阴性细胞对辐射更敏感。我们还将讨论 HPV 阳性癌症中富含的外在免疫和微环境因素,这些因素促进了对辐射的反应。因此,这些潜在的生物学机制可能是 HPV 诱导的癌症中经常观察到的改善临床结果的基础。