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Radiotherapy-induced reactivation of neurotrophic human herpes viruses: Overview and management
- Source :
- Journal of Clinical Virology. 98:18-27
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Purpose Infection by Human Herpes Viruses (HHV) types 1–3, are prevalent throughout the world. It is known that radiotherapy can reactivate HHVs, but it is unclear how and to what extent reactivations can interact with or affect radiotherapeutic efficacy, patient outcomes and mortality risk. Herein, we aim to summarize what is known about Herpes Simplex Virus (HSV)-1,2 and Varicella Zoster Virus (VZV) pathophysiology as it relates to tumor biology, radiotherapy, chemo-radiotherapy, diagnosis and management so as to optimize cancer treatment in the setting of active HHV infection. Our secondary aim is to emphasize the need for further research to elucidate the potential adverse effects of active HHV infection in irradiated tumor tissue and to design optimal management strategies to incorporate into cancer management guidelines. Materials and methods The literature regarding herpetic infection, herpetic reactivation, and recurrence occurring during radiotherapy and that regarding treatment guidelines for herpetic infections are reviewed. We aim to provide the oncologist with a reference for the infectious dangers of herpetic reactivation in patients under their care and well established methods for prevention, diagnosis, and treatment of such infections. Pain management is also considered. Conclusions In the radiotherapeutic setting, serologic assays for HSV-1 and HSV-2 are feasible and can alert the clinician to patients at risk for viral reactivation. RT-PCR is specific in identifying the exact viral culprit and is the preferred diagnostic method to measure interventional efficacy. It can also differentiate between herpetic infection and radionecrosis. The MicroTrak® HSV1/HSV2/VZV staining kit has high sensitivity and specificity in acute lesions, is also the most rapid means to confirm diagnosis. Herpetic reactivation and recurrences during radiotherapy can cause interruptions, cessations, or prolongations of the radiotherapeutic course, thus decreasing the biologically effective dose, to sub-therapeutic levels. Active HHV infection within the treatment volume results in increased tumor radio-resistance and potentially sub-therapeutic care if left untreated. Visceral reactivations may result in fatality and therefore, a high index of suspicion is important to identify these active infections. The fact that such infections may be mistaken for acute and/or late radiation effects, leading to less than optimal treatment decisions, makes knowledge of this problem even more relevant. To minimize the risk of these sequelae, prompt anti-viral therapy is recommended, lasting the course of radiotherapy.
- Subjects :
- 0301 basic medicine
Oncology
medicine.medical_specialty
Herpesvirus 2, Human
viruses
medicine.medical_treatment
Encephalopathy
Herpesvirus 1, Human
medicine.disease_cause
Culprit
Serology
03 medical and health sciences
0302 clinical medicine
Neoplasms
Virology
Internal medicine
medicine
Humans
Serologic Tests
Varicellovirus
Adverse effect
Radiotherapy
business.industry
Varicella zoster virus
Disease Management
Herpesviridae Infections
medicine.disease
Pathophysiology
Radiation therapy
030104 developmental biology
Infectious Diseases
Herpes simplex virus
Molecular Diagnostic Techniques
030220 oncology & carcinogenesis
Virus Activation
business
Subjects
Details
- ISSN :
- 13866532
- Volume :
- 98
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Virology
- Accession number :
- edsair.doi.dedup.....d41f317e52ff3fd91e346ac2deb498d3