Enhancing Chemo/Radiosensitivity in Hepato-Pancreatic Biliary Cancers

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Background

Hepato-Pancreatic Biliary Cancers (HPBCs) are leading causes of cancer mortality and the incidence of this disease is expected to continue to rise. However, the overall survival rate of patients with HPBCs have only slightly improved in recent years. The only current curative approach for HPBCs is surgery, but only 15–20% of the patients are candidates for resection with curative-intent at the time of diagnosis as there are very specific criteria that need to be met for this approach to be considered, namely that the cancer is small, the individual’s liver is healthy, and that the cancer is localized in the liver and hasn’t spread to the blood vessels. Chemotherapy and Radiation therapy are now becoming more widely used in the treatment of HPBCs, but are still limited in their functionality and commonly only used in an attempt to reduce the size of cancers so that surgical intervention can be considered.

Chemotherapy is the use of drugs to destroy cancer cells and works by keeping the cancer cells from growing, dividing, and making more cells, and also acts by reducing the blood flow to the cancer cells, starving them of both oxygen and nutrients and hence preventing cell reproduction and subsequent growth. In liver cancers, chemotherapy is delivered directly into the blood vessels which are feeding the tumor, this is known as trans arterial chemoembolization (TACE), and is usually only considered where surgery is not an option, and as mentioned previously depends on other specific patient criteria being met.

Radiation Therapy induces cancer cell death through use of high energy particles or waves which can include x-rays, gamma rays, electron beams or protons, to either directly cause DNA damage or create free radicals within tumor cells which can in turn damage the host DNA and prevent further cancer cell production. While other methods of cancer treatment, including chemotherapy, are often administered systemically and can incur side effects in tissues besides the target cancer cells, radiation therapy is a very localized treatment to the specific cancer cells, which minimizes damage to healthy cells in the liver and in other organs in the body, which should in turn minimize unpleasant external side effects which is more common in chemotherapy through systemic use of cytotoxic drugs. More novel methods of radiation therapy are now being incorporated in hepatic cancers, such as stereotactic body radiotherapy (SBRT), and thermal ablative procedure such as radiofrequency ablation (RFA) and microwave ablation (MWA), but these procedures again rely upon specific patient criteria being met.

The survival benefit gained from adding both Chemotherapy and Radiation Therapy in patients with HPBCs remains controversial. Moreover, combined treatments have brought survival benefits but the potential mechanisms are still unknown. Researchers should focus on developing novel drugs to enhance the chemo/radiosensitivity in Hepato-Pancreatic Biliary Cancers and explore the potential mechanism related with combined treatments.

Scope of the Research Topic: translational research on enhancing the chemo/radiosensitivity in Hepato-Pancreatic Biliary Cancers and improving the survival of these patients.

The topics include but are not limited to:
- Novel drugs related with chemo/radiosensitivity
- Combined treatments for patients with HPBCs
- The potential mechanism for chemo/radio resistance in HPBCs
- Novel procedures incorporating radiation therapy proving effective in HPBCs
- Broadening the uses of chemotherapies and radiation therapies in HPBCs

Important Note: Manuscripts consisting solely of bioinformatics, computational analysis, or predictions of public databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) will not be accepted in any of the sections of Frontiers in Oncology.

Keywords: chemotherapy; radiotherapy; combined treatments; survival benefit; Hepato Pancreatic Biliary Cancers.

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