In silico optimisation of cancer treatment schedules

The central goal of this investigation is to describe the dynamic reaction of a multicellular tumour spheroid to treatment with radiotherapy. A focus will be on the triggered dynamic cell cycle reaction in the spheroid and how it can be employed within fractionated radiation schedules. An agent-based model for cancer cells is employed which features inherent cell cycle progression and reactions to environmental conditions. Cells are represented spatially by a weighted, dynamic and kinetic Voronoi/Delaunay model which also provides for the identification of cells in contact within the multicellular aggregate. Force-based interaction between cells will lead to rearrangement in response to proliferation and can induce cell quiescence via a mechanism of pressure-induced contact inhibition. The evolution of glucose and oxygen concentration inside the tumour spheroid is tracked in a diffusion solver in correspondence to in vitro or in vivo boundary conditions and a corresponding local nutrient uptake by single cells. Radiation effects are implemented based on the measured single cell survival in the linear-quadratic model. The survival probability will be affected by the radiosensitivity of the current cycle phase and the local oxygen concentration. Quiescent cells will reduce the effective dose they receive as a consequence of their increased radioresistance. The radiation model includes a fast response to fatal DNA damage through cell apoptosis and a slow response via cell loss due to misrepair during the radiation-induced G2-block. A simplified model for drug delivery in chemotherapy is implemented. The model can describe the growth dynamics of spheroids in accordance to experimental data, including total number of cells, histological structure and cell cycle distribution. Investigations of possible mechanisms for growth saturation reveal a critical dependence of tumour growth on the shedding rate of cells from the surface. In response to a dose of irradiation, a synchronisation of the cell cycle progression within the tumour is observed. This will lead to cyclic changes in the overall radiation sensitivity of the tumour which are quantified using an enhancement measure in comparison to the expected radiosensitivity of he tumour. A transient strong peak in radiosensitivity enhancement is observed after administration of irradiation. Mechanisms which influence the peak timing and development are systematically investigated, revealing quiescence and reactivation of cells to be a central mechanism for the enhancement. Direct redistribution of cells due to different survival in cell cycle phases, re-activation of quiescent cells in response to radiation-induced cell death and blocking of DNA damaged cells at the G2/M checkpoint are identified as the main mechanisms which contribute to a synchronisation and determine the radiosensitivity increase. A typical time scale for the development of radiosensitivity and the relaxation of tumours to a steady-state after irradiation is identified, which is related to the typical total cell cycle time. A range of clinical radiotherapy schedules is tested for their performance within the simulation and a systematic comparison with alternative delivery schedules is performed, in order to identify schedules which can most effectively employ the described transient enhancement effects. In response to high-dose schedules, a dissolution of the tumour spheroid into smaller aggregates can be observed which is a result of the loss of integrity in the spheroid that is associated with high cell death via apoptosis. Fractionated irradiation of spheroids with constant dose per time unit but different inter-fraction times clearly reveals optimal time-intervals for radiation, which are directly related to the enhancement response of the tumour. In order to test the use of triggered enhancement effects in tumours, combinations of trigger- and effector doses are examined for their performance in specific treatment regimens. Furthermore, the automatic identification and triggering in response to high enhancement periods in the tumour is analysed. While triggered schedules and automatic schedules both yield a higher treatment efficiency in comparison to conventional schedules, treatment optimisation is a revealed to be a global problem, which cannot be sufficiently solved using local optimisation only. The spatio-temporal dynamics of hypoxia in the tumour are studied in response to irradiation. Microscopic, diffusion-induced reoxygenation dynamics are demonstrated to be on a typical time-scale which is in the order of fractionation intervals. Neoadjuvant chemotherapy with hydroxyurea can yield a drastic improvement of radiosensitivity via cell cycle synchronisation and specific toxicity against radioresistant S-phase cells. The model makes clear predictions of radiation schedules which are especially effective as a result of triggered cell cycle-based radiosensitivity enhancement. Division of radiation into trigger and effector doses is highly effective and especially suited to be combined with adjuvant chemotherapy in order to limit regrowth of cells