Exercise Modulation of Tumour Perfusion and Hypoxia to Improve Radiotherapy Response

[pjoshea13]

New paper below [1].

".. recent studies reveal that exercise may also directly influence tumour physiology that could beneficially affect the response to radiotherapy."

"Preclinical research has shown that exercise can reduce intratumoral hypoxia-a major limiting factor in radiotherapy-by improving tumour perfusion and vascularisation. In addition, preliminary evidence suggests that exercise training can improve radiotherapy treatment outcomes by increasing natural killer cell infiltration in a murine PCa model."

"Exercise is a potentially promising adjunct therapy for men with PCa undergoing radiotherapy that may increase its effectiveness. However, exercise-induced tumour radiosensitisation remains to be confirmed in preclinical and clinical trials, as does the optimal exercise prescription to elicit such effects."

Yes, the response to hypoxia is the major reason for treatment resistance. Cancer does not "hate" oxygen, as many people seem to believe. The response to hypoxia has little to do with actual treatment. It is a survival response to inadequate oxygen, with angiogenesis as a major aim.

The hypoxia response can be forestalled or maybe reversed if more oxygen can be delivered. I use a nitroglycerine patch for that purpose.

I discussed the idea of frequent hyperbaric oxygen sessions with my alt-doc a year or so ago. He said that I could pick up a reconditioned chamber for not a lot of money. There is no data on benefit in PCa, of course. Some might be thinking that I have finally lost the plot, but here is what the Mayo says [2]:

"Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room or tube. Hyperbaric oxygen therapy is a well-established treatment for decompression sickness, a hazard of scuba diving. Other conditions treated with hyperbaric oxygen therapy include serious infections, bubbles of air in your blood vessels, and wounds that won't heal as a result of diabetes or radiation injury.

"In a hyperbaric oxygen therapy chamber, the air pressure is increased to three times higher than normal air pressure. Under these conditions, your lungs can gather more oxygen than would be possible breathing pure oxygen at normal air pressure.

"Your blood carries this oxygen throughout your body. This helps fight bacteria and stimulate the release of substances called growth factors and stem cells, which promote healing."

& inhibits hypoxia &, specifically: hypoxia inducible factor 1alpha [HIF-1alpha, HIF-1α or HIF-1A].

Or one could exercise, I suppose.

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/326...

Review Prostate Cancer Prostatic Dis

. 2020 Jul 6. doi: 10.1038/s41391-020-0245-z. Online ahead of print.

Exercise Modulation of Tumour Perfusion and Hypoxia to Improve Radiotherapy Response in Prostate Cancer

Oliver Schumacher 1 2 , Daniel A Galvão 3 4 , Dennis R Taaffe 3 4 5 , Raphael Chee 3 4 6 , Nigel Spry 3 4 6 , Robert U Newton 3 4 5

Affiliations expand

PMID: 32632128 DOI: 10.1038/s41391-020-0245-z

Abstract

Background: An increasing number of studies indicate that exercise plays an important role in the overall care of prostate cancer (PCa) patients before, during and after treatment. Historically, research has focused on exercise as a modulator of physical function, psychosocial well-being as well as a countermeasure to cancer- and treatment-related adverse effects. However, recent studies reveal that exercise may also directly influence tumour physiology that could beneficially affect the response to radiotherapy.

Methods: In this narrative review, we provide an overview of tumour vascular characteristics that limit the effect of radiation and establish a rationale for exercise as adjunct therapy during PCa radiotherapy. Further, we summarise the existing literature on exercise as a modulator of tumour perfusion and hypoxia and outline potential future research directions.

Results: Preclinical research has shown that exercise can reduce intratumoral hypoxia-a major limiting factor in radiotherapy-by improving tumour perfusion and vascularisation. In addition, preliminary evidence suggests that exercise training can improve radiotherapy treatment outcomes by increasing natural killer cell infiltration in a murine PCa model.

Conclusions: Exercise is a potentially promising adjunct therapy for men with PCa undergoing radiotherapy that may increase its effectiveness. However, exercise-induced tumour radiosensitisation remains to be confirmed in preclinical and clinical trials, as does the optimal exercise prescription to elicit such effects.

[2] mayoclinic.org/tests-proced...

[treedown]

Sounds good to me, hope it's true. I rode my bike to 41 of 44 radiation appointments and upto 21 miles afterward a total of 742 miles during the 8 weeks. I felt fine, had no need of anti-nausea pills even when getting abdominal radiation and lost weight. I am still getting faster and riding longer on bicycle than pre diagnosis. 51 miles yesterday average miles per hour 15.6. Also hit my best speed on a 30 mile circuit recently average mph 17.6. I plan on exercising regularly and pushing harder as long as my body keeps responding how it has, God willing.

[fmenninger in reply to treedown]

Hi tree down:

I start 36 IGIMRT rad treatments next Monday and was planning to do aerobic workout.(roller blading) just before getting zapped. Is it better to do aerobic before and/or after radiation treatments to get most effective response? I would think just before to really oxygenate cells and to prevent anaerobic conditions. Thoughts.

[treedown in reply to fmenninger]

I wish I could give you some insight. Maybe Patrick who started the thread has some idea. I did before and after. I can't say doing that was the reason I had no side effects during radiation but I am glad I did it. I plan on keeping it up as long as possible, my goal is 4000 miles for the year and I just hit 2300. Last year I was just under 3500. I spent a lot of time on my bike getting my head around what was happening after being diagnosed in July.

[pjoshea13 in reply to treedown]

16 years ago, Life Extension had a protocol. It was simply a nausiating amount of L-arginine immediately prior to each session. I had a big jar of the powder & I took it in water. After a few sessions I bought the largest size empty caps & filled them with the powder. I think I had to swallow 20 of them. The worse part of each day.

There were no post-session instructions. Perhaps than answers the question?

-Patrick

[GreenStreet]

I exercised immediately before and after SRT by joining a gym near the hospital. I think it helped me get through radiation but I also did it to enhance radiation effect but unfortunately I think they were aiming in the wrong place. Lol

[fmenninger]

Hi Patrick:

I plan to have 36 IGIMRT rad treatments and was planning to do pre aerobic workout just before getting zapped. My aerobic exercise entails a high intensity workout on roller blades. I see reports state to do before during and after....not sure if you can do aerobic during treatment as u can’t move. What’s your advice? Thanks.

[treedown in reply to fmenninger]

You definently can't doing during treatment , didn't see that myself but that would have been a typo.

[pjoshea13 in reply to treedown]

I would consider the sort of indecent thoughts that get the heart racing. -Patrick

[MateoBeach]

Or you could just exercise your mice more.

But you just keep thinking Butch, that’s what you’re good at. - Sundown

[j-o-h-n in reply to MateoBeach]

Mice admit no rat-ional and a trap to exercise more.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 07/10/2020 1:04 PM DST

[henukit]

Thanks a lot, Patrick! It reinforced my desire to start hyperbaric oxygen as a supplemental therapy. I requested from my MO. I do exercise as able in my condition and see the positive results

[nycrunner]

Hi Patrick

As part of my marathon training over the years I would do high altitude hypoxia training to increase my oxygen uptake.

3 years ago I was diagnosed with Type 4 and GS 9.

Still running around 8km / day.

Currently on Bicalutamide and Zoladex combo.

I am wondering if adding hypoxia training would be beneficial?

I think it will increase my RBC but what effect if any will that have on the cancer?

Thanks

Dave

[pjoshea13 in reply to nycrunner]

Hi Dave,

Unfortunately, if you further stress-out a tumor that is struggling with low access to oxygen, you might permanently trigger HIF-1alpha in those cells. HIF (hypoxia-induced factor) is responsible for many treatment failures.

This reminds me. I need to put on a nitroglycerine patch. It generates nitric oxide which dilates blood vessels & increases oxygen availability.

pubmed.ncbi.nlm.nih.gov/194...

My doc prescribes it based on the above paper.

It might be useful to runners too.

Best, -Patrick

[nycrunner in reply to pjoshea13]

Hi Patrick

Many thanks for the info.

Much appreciated

Regards

Dave