Review
. 2020 Jul; 9(7):1651.
doi: 10.3390/cells9071651.

CSC Radioresistance: A Therapeutic Challenge to Improve Radiotherapy Effectiveness in Cancer

María Auxiliadora Olivares-Urbano 1 Carmen Griñán-Lisón 2 Juan Antonio Marchal 2 María Isabel Núñez 1 
Affiliations
  • PMID: 32660072
  •     259 References
  •     6 citations

Abstract

Radiotherapy (RT) is a modality of oncologic treatment that can be used to treat approximately 50% of all cancer patients either alone or in combination with other treatment modalities such as surgery, chemotherapy, immunotherapy, and therapeutic targeting. Despite the technological advances in RT, which allow a more precise delivery of radiation while progressively minimizing the impact on normal tissues, issues like radioresistance and tumor recurrence remain important challenges. Tumor heterogeneity is responsible for the variation in the radiation response of the different tumor subpopulations. A main factor related to radioresistance is the presence of cancer stem cells (CSC) inside tumors, which are responsible for metastases, relapses, RT failure, and a poor prognosis in cancer patients. The plasticity of CSCs, a process highly dependent on the epithelial-mesenchymal transition (EMT) and associated to cell dedifferentiation, complicates the identification and eradication of CSCs and it might be involved in disease relapse and progression after irradiation. The tumor microenvironment and the interactions of CSCs with their niches also play an important role in the response to RT. This review provides a deep insight into the characteristics and radioresistance mechanisms of CSCs and into the role of CSCs and tumor microenvironment in both the primary tumor and metastasis in response to radiation, and the radiobiological principles related to the CSC response to RT. Finally, we summarize the major advances and clinical trials on the development of CSC-based therapies combined with RT to overcome radioresistance. A better understanding of the potential therapeutic targets for CSC radiosensitization will provide safer and more efficient combination strategies, which in turn will improve the live expectancy and curability of cancer patients.

Keywords: CSC intratumoral radiosensitivity heterogeneity; CSC metabolism; CSC niche; accelerated repopulation; radiation resistance; signaling pathways; tumor microenvironment.

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Nature, 2017 Jul 25; 548(7668). PMID: 28738408    Free PMC article.
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Methods Cell Biol, 2004 Dec 18; 75. PMID: 15603433
Therapeutic Potential of the miRNA-ATM Axis in the Management of Tumor Radioresistance.
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Cancer Res, 2019 Nov 27; 80(2). PMID: 31767626
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Int J Cancer, 2009 May 12; 125(3). PMID: 19431142
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Cancer stem cells and radiotherapy.
Michael Baumann, Mechthild Krause, +2 authors, Daniel Zips.
Int J Radiat Biol, 2009 Apr 22; 85(5). PMID: 19382020
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Walter Tinganelli, Marco Durante, +6 authors, Emanuele Scifoni.
Sci Rep, 2015 Nov 26; 5. PMID: 26596243    Free PMC article.
The double edge sword of fibrosis in cancer.
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Sublethal irradiation promotes migration and invasiveness of glioma cells: implications for radiotherapy of human glioblastoma.
C Wild-Bode, M Weller, +2 authors, W Wick.
Cancer Res, 2001 Apr 06; 61(6). PMID: 11289157
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Radiotherapy induces responses of lung cancer to CTLA-4 blockade.
Silvia C Formenti, Nils-Petter Rudqvist, +15 authors, Sandra Demaria.
Nat Med, 2018 Nov 07; 24(12). PMID: 30397353    Free PMC article.
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Inhibition of PI3K/AKT Signaling Pathway Radiosensitizes Pancreatic Cancer Cells with ARID1A Deficiency in Vitro.
Lin Yang, Guanghai Yang, +5 authors, Guangyuan Hu.
J Cancer, 2018 Mar 28; 9(5). PMID: 29581767    Free PMC article.
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Charn-Jung Chang, Chuan-Chih Hsu, +8 authors, Hsin-I Ma.
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Nat Rev Cancer, 2020 Feb 26; 20(4). PMID: 32094544
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Cancer Biol Ther, 2012 Feb 18; 13(1). PMID: 22336584
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Antioxidant Mechanisms and ROS-Related MicroRNAs in Cancer Stem Cells.
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Cancer Biol Med, 2017 Jun 14; 14(2). PMID: 28607802    Free PMC article.
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Cancer Metastasis Rev, 2019 Apr 29; 38(1-2). PMID: 31030373
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Semin Cancer Biol, 2014 Jun 24; 31. PMID: 24956577
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N Engl J Med, 2018 Oct 04; 379(24). PMID: 30280658
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The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines.
Geoff Delaney, Susannah Jacob, Carolyn Featherstone, Michael Barton.
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Naoko Takebe, Lucio Miele, +5 authors, S Percy Ivy.
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The role of tumor stroma in cancer progression and prognosis: emphasis on carcinoma-associated fibroblasts and non-small cell lung cancer.
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J Thorac Oncol, 2010 Nov 26; 6(1). PMID: 21107292
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Cancer Stem Cells: Powerful Targets to Improve Current Anticancer Therapeutics.
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PLoS One, 2011 Sep 22; 6(9). PMID: 21935375    Free PMC article.
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Cancer stem cells: The potential of carbon ion beam radiation and new radiosensitizers (Review).
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Stem Cell Res Ther, 2015 Oct 17; 6. PMID: 26472041    Free PMC article.
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Highly Cited. Review.
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Trends Cancer, 2017 Jul 26; 2(11). PMID: 28741502
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Functionalized mesoporous silica nanoparticles for innovative boron-neutron capture therapy of resistant cancers.
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Highly Cited. Review.
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Cancer stem cells and radiotherapy: new insights into tumor radioresistance.
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Highly Cited. Review.
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Highly Cited. Review.
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Highly Cited. Review.
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Radiation-Activated PI3K/AKT Pathway Promotes the Induction of Cancer Stem-Like Cells via the Upregulation of SOX2 in Colorectal Cancer.
Ji-Hye Park, Young-Heon Kim, +8 authors, Min-Jung Kim.
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Cancer Stem Cells-Key Players in Tumor Relapse.
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Temozolomide Treatment Induces HMGB1 to Promote the Formation of Glioma Stem Cells via the TLR2/NEAT1/Wnt Pathway in Glioblastoma.
Xiang-Yu Gao, Jian Zang, +8 authors, Liang Liang.
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The CD44high Subpopulation of Multifraction Irradiation-Surviving NSCLC Cells Exhibits Partial EMT-Program Activation and DNA Damage Response Depending on Their p53 Status.
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