The impact of TNF-alpha induction on therapeutic efficacy following high dose spatially fractionated (GRID) radiation. 
A variety of cytokines especially TNF-alpha and TGF-beta are known to be released in response to high dose radiation of tumors.  However, these are not normally measurable in systemic circulation unless high levels of these cytokines are produced by tumor cells.  This study was undertaken to see if circulating levels of these cytokines could be measured in the serum of patients treated with high dose spatially fractionated (GRID) radiation and to correlate the finding of these cytokines with clinical response to treatment.  Thirty-four patients (31 patients had single treatment site and 3 patients had 2 treatment sites) treated with spatially fractionated (GRID) radiation were entered in this study.  Serum samples were collected before treatment and at 24, 48 and 72 hours after GRID radiation.  Sandwich enzyme linked immunosorbent assay (ELISA) was performed to estimate the levels of TNF-alpha and activated TGF-beta1 proteins.  Seven of 37 patients studied had no TNF-alpha protein before treatment but showed induction of TNF-alpha after GRID radiation.  Three patients showed faint basal level of TNF-alpha protein before treatment and these levels were induced after treatment.  Three patients showed a basal level of TNF-alpha protein before treatment and these levels decreased after treatment.  In 21 cases no TNF-alpha protein was detected before or after treatment at the time points measured.  In the case of TGF-beta1 protein, 2 patients showed no TGF-beta1 protein before GRID radiation and an induction of TGF-beta1 protein was observed after treatment.  Seven patients showed basal level of TGF-beta1 protein prior to treatment and these levels were induced after treatment.  Seventeen patients showed a basal level of TGF-beta1 protein before treatment and these levels decreased after treatment.  In 8 cases no TGF-beta1 protein was detected before or after treatment.  Complete clinical response (CR) to GRID therapy was seen in 12/37 (32%) treatment sites and partial response (PR) in 18/37 (49%) treatment sites.  A strong correlation was observed between clinical CR rate and TNF-alpha induction.  The rate of CR was 6/10 (60%) in patients where TNF-alpha was induced as compared to 6/27 (23%) treatment sites in patients where TNF-alpha induction was not seen (p = 0.029).  No significant correlation with CR rate and TGF-beta1 induction (44% vs. 28%, p = 0.36) was observed.  High dose spatially fractionated (GRID) radiation results in significant induction of TNF-alpha that can be measured in serum of some patients 24 72 hours after radiation.  Complete tumor response strongly correlated with the induction of TNF-alpha levels in the serum.