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Management of GBM: a problem of local recurrence. J Neurooncol 2017; 134:487-493. [PMID: 28378194 DOI: 10.1007/s11060-016-2347-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/23/2016] [Indexed: 01/22/2023]
Abstract
Forty years ago, adjuvant treatment of patients with GBM using fractionated radiotherapy following surgery was shown to substantially improve survival compared to surgery alone. However, even with the addition of temozolomide to radiotherapy, overall survival is quite limited and local failure remains a fundamental problem, despite multiple attempts to increase dose to the tumor target. This review presents the historical background and clinical rationale leading to the current standard of care consisting of 60 Gy total dose in 2 Gy fractions to the MRI-defined targets in younger, high performance status patients and more hypofractionated regimens in elderly and/or debilitated patients. Particle therapies offer the potential to increase local control while reducing dose and, potentially, long-term neurocognitive toxicity. However, improvements in systemic therapies for GBM will need to be implemented before the full benefits of improved local control can be realized.
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Hsieh M, Liu Y, Mostafaei F, Poulson JM, Nie LH. A feasibility study of a deuterium-deuterium neutron generator-based boron neutron capture therapy system for treatment of brain tumors. Med Phys 2017; 44:637-643. [PMID: 28205309 DOI: 10.1002/mp.12051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/01/2016] [Accepted: 12/03/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Boron neutron capture therapy (BNCT) is a binary treatment modality that uses high LET particles to achieve tumor cell killing. Deuterium-deuterium (DD) compact neutron generators have advantages over nuclear reactors and large accelerators as the BNCT neutron source, such as their compact size, low cost, and relatively easy installation. The purpose of this study is to design a beam shaping assembly (BSA) for a DD neutron generator and assess the potential of a DD-based BNCT system using Monte Carlo (MC) simulations. METHODS The MC model consisted of a head phantom, a DD neutron source, and a BSA. The head phantom had tally cylinders along the centerline for computing neutron and photon fluences and calculating the dose as a function of depth. The head phantom was placed at 4 cm from the BSA. The neutron source was modeled to resemble the source of our current DD neutron generator. A BSA was designed to moderate and shape the 2.45-MeV DD neutrons to the epithermal (0.5 eV to 10 keV) range. The BSA had multiple components, including moderator, reflector, collimator, and filter. Various materials and configurations were tested for each component. Each BSA layout was assessed in terms of the in-air and in-phantom parameters. The maximum brain dose was limited to 12.5 Gray-Equivalent (Gy-Eq) and the skin dose to 18 Gy-Eq. RESULTS The optimized BSA configuration included 30 cm of lead for reflector, 45 cm of LiF, and 10 cm of MgF2 for moderator, 10 cm of lead for collimator, and 0.1 mm of cadmium for thermal neutron filter. Epithermal flux at the beam aperture was 1.0 × 105 nepi /cm2 -s; thermal-to-epithermal neutron ratio was 0.05; fast neutron dose per epithermal was 5.5 × 10-13 Gy-cm2 /φepi , and photon dose per epithermal was 2.4 × 10-13 Gy-cm2 /φepi . The AD, AR, and the advantage depth dose rate were 12.1 cm, 3.7, and 3.2 × 10-3 cGy-Eq/min, respectively. The maximum skin dose was 0.56 Gy-Eq. The DD neutron yield that is needed to irradiate in reasonable time was 4.9 × 1013 n/s. CONCLUSIONS Results demonstrated that a DD-based BNCT system could be designed to produce neutron beams that have acceptable in-air and in-phantom characteristics. The parameter values were comparable to those of existing BNCT facilities. Continuing efforts are ongoing to improve the DD neutron yield.
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Affiliation(s)
- Mindy Hsieh
- School of Health Sciences, Purdue University, West Lafayette, IN, 47906, USA
| | - Yingzi Liu
- School of Health Sciences, Purdue University, West Lafayette, IN, 47906, USA
| | - Farshad Mostafaei
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Jean M Poulson
- College of Veterinary Medicine, Purdue University, West Lafayette, IN, 47906, USA
| | - Linda H Nie
- School of Health Sciences, Purdue University, West Lafayette, IN, 47906, USA
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Watanabe Y, Kurihara H, Itami J, Sasaki R, Arai Y, Sugimura K. Relationship between the uptake of 18F-borono-L-phenylalanine and L-[methyl- 11C] methionine in head and neck tumors and normal organs. Radiat Oncol 2017; 12:17. [PMID: 28088230 PMCID: PMC5237505 DOI: 10.1186/s13014-017-0763-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/04/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to determine the distribution of 4-borono-2-18F-fluoro-phenylalanine (18F-BPA) and L-[methyl-11C] methionine (11C-Met) in normal organs and tumors and to evaluate the usefulness of 11C-Met/PET in screening potential candidates for boron neutron capture therapy (BNCT). MATERIAL METHODS Seven patients who had at least one histologically confirmed head and neck tumor were included in this study. They underwent both whole-body 18F-BPA-PET/CT and 11C-Met-PET/CT within a span of 6 months. Uptake was evaluated using the maximum standardized uptake value (SUVmax). Regions of interest (ROIs) were placed within the tumors and target organs of brain, thyroid, submandibular gland, lung, liver, esophagus, stomach pancreas, spleen, muscle, and bone marrow. RESULTS The tumor SUVmax of FBPA and 11C-Met showed strong correlation (r 2 = 0.72, P = 0.015). Although 18F-BPA and 11C-Met showed markedly different uptake in some organs (submandibular gland, liver, heart, stomach pancreas, spleen, and bone marrow), the uptake of 11C-Met was consistently higher than that of 18F-BPA in these cases. CONCLUSION 11C-Met PET/CT might be used instead of 18F-BPA PET/CT to predict the accumulation of 10B in tumors and to select candidates for BNCT. However, it would not be suitable for evaluating accumulation in some normal organs. Therefore, the 18F-BPA-PET study remains a prerequisite for BNCT. This is the first report of the correlation between 18F-BPA and 11C-Met accumulation.
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Affiliation(s)
- Yoshiaki Watanabe
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hiroaki Kurihara
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kazuro Sugimura
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
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Wingelhofer B, Kreis K, Mairinger S, Muchitsch V, Stanek J, Wanek T, Langer O, Kuntner C. Preloading with L-BPA, L-tyrosine and L-DOPA enhances the uptake of [ 18F]FBPA in human and mouse tumour cell lines. Appl Radiat Isot 2016; 118:67-72. [PMID: 27619946 DOI: 10.1016/j.apradiso.2016.08.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 07/29/2016] [Accepted: 08/31/2016] [Indexed: 11/26/2022]
Abstract
Aim of this study was to investigate if cellular [18F]FBPA uptake can be increased upon preloading with amino acids. [18F]FBPA uptake was assessed in HuH-7, CaCo-2 and B16-F1 cells pretreated with different concentrations or incubation times of L-BPA, L-tyrosine or L-DOPA. Without preloading, highest uptake of [18F]FBPA was observed in B16-F1 cells, followed by CaCo-2 cells and HuH-7 cells. In all cell lines higher [18F]FBPA accumulation (up to 1.65-fold) was obtained with increasing L-BPA, L-DOPA and L-tyrosine concentrations.
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Affiliation(s)
| | - Katharina Kreis
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Severin Mairinger
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Viktoria Muchitsch
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Johann Stanek
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Thomas Wanek
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Oliver Langer
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Claudia Kuntner
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria.
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On the applicability of [ 18F]FBPA to predict L-BPA concentration after amino acid preloading in HuH-7 liver tumor model and the implication for liver boron neutron capture therapy. Nucl Med Biol 2016; 44:83-89. [PMID: 27837726 DOI: 10.1016/j.nucmedbio.2016.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION In recent years extra-corporal application of boron neutron capture therapy (BNCT) was evaluated for liver primary tumors or liver metastases. A prerequisite for such a high-risk procedure is proof of preferential delivery and high uptake of a 10B-pharmaceutical in liver malignancies. In this work we evaluated in a preclinical tumor model if [18F]FBPA tissue distribution measured with PET is able to predict the tissue distribution of [10B]L-BPA. METHODS Tumor bearing mice (hepatocellular carcinoma cell line, HuH-7) were either subject of a [18F]FBPA-PET scan with subsequent measurement of radioactivity content in extracted organs using a gamma counter or injected with [10B]L-BPA with tissue samples analyzed by prompt gamma activation analysis (PGAA) or quantitative neutron capture radiography (QNCR). The impact of L-tyrosine, L-DOPA and L-BPA preloading on the tissue distribution of [18F]FBPA and [10B]L-BPA was evaluated and the pharmacokinetics of [18F]FBPA investigated by compartment modeling. RESULTS We found a significant correlation between [18F]FBPA and [10B]L-BPA uptake in tumors and various organs as well as high accumulation levels in pancreas and kidneys as reported in previous studies. Tumor-to-liver ratios of [18F]FBPA ranged from 1.2 to 1.5. Preloading did not increase the uptake of [18F]FBPA or [10B]L-BPA in any organ and compartment modeling showed no statistically significant differences in [18F]FBPA tumor kinetics. CONCLUSIONS [18F]FBPA-PET predicts [10B]L-BPA concentration after amino acid preloading in HuH-7 hepatocellular carcinoma models. Preloading had no effect on tumor uptake of [18F]FBPA. ADVANCES IN KNOWLEDGE Despite differences in chemical structure and administered dose [18F]FBPA and [10B]L-BPA demonstrate an equivalent biodistribution in a preclinical tumor model. IMPLICATIONS FOR PATIENT CARE: [18F]FBPA-PET is suitable for treatment planning and dose calculations in BNCT applications for liver malignancies. However, alternative tracers with more favorable tumor-to-liver ratios should be investigated.
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MIYATAKE SI, KAWABATA S, HIRAMATSU R, KUROIWA T, SUZUKI M, KONDO N, ONO K. Boron Neutron Capture Therapy for Malignant Brain Tumors. Neurol Med Chir (Tokyo) 2016; 56:361-71. [PMID: 27250576 PMCID: PMC4945594 DOI: 10.2176/nmc.ra.2015-0297] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/27/2016] [Indexed: 01/17/2023] Open
Abstract
Boron neutron capture therapy (BNCT) is a biochemically targeted radiotherapy based on the nuclear capture and fission reactions that occur when non-radioactive boron-10, which is a constituent of natural elemental boron, is irradiated with low energy thermal neutrons to yield high linear energy transfer alpha particles and recoiling lithium-7 nuclei. Therefore, BNCT enables the application of a high dose of particle radiation selectively to tumor cells in which boron-10 compound has been accumulated. We applied BNCT using nuclear reactors for 167 cases of malignant brain tumors, including recurrent malignant gliomas, newly diagnosed malignant gliomas, and recurrent high-grade meningiomas from January 2002 to May 2014. Here, we review the principle and history of BNCT. In addition, we introduce fluoride-18-labeled boronophenylalanine positron emission tomography and the clinical results of BNCT for the above-mentioned malignant brain tumors. Finally, we discuss the recent development of accelerators producing epithermal neutron beams. This development could provide an alternative to the current use of specially modified nuclear reactors as a neutron source, and could allow BNCT to be performed in a hospital setting.
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Affiliation(s)
- Shin-Ichi MIYATAKE
- Cancer Center, Osaka Medical College, Takatsuki, Osaka
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka
| | - Shinji KAWABATA
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka
| | - Ryo HIRAMATSU
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka
| | | | - Minoru SUZUKI
- Particle Radiation Oncology Research Center, Kyoto University Research, Reactor Institute, Kumatori, Osaka
| | - Natsuko KONDO
- Particle Radiation Oncology Research Center, Kyoto University Research, Reactor Institute, Kumatori, Osaka
| | - Koji ONO
- Particle Radiation Oncology Research Center, Kyoto University Research, Reactor Institute, Kumatori, Osaka
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In vivo spatial correlation between (18)F-BPA and (18)F-FDG uptakes in head and neck cancer. Appl Radiat Isot 2016; 115:138-146. [PMID: 27372808 DOI: 10.1016/j.apradiso.2016.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE Borono-2-(18)F-fluoro-phenylalanine ((18)F-BPA) has been used to estimate the therapeutic effects of boron neutron capture therapy (BNCT), while (18)F-fluorodeoxyglucose ((18)F-FDG) is the most commonly used positron emission tomography (PET) radiopharmaceutical in a routine clinical use. The aim of the present study was to evaluate spatial correlation between (18)F-BPA and (18)F-FDG uptakes using a deformable image registration-based technique. MATERIAL AND METHODS Ten patients with head and neck cancer were recruited from January 2014 to December 2014. All patients underwent whole-body (18)F-BPA PET/computed tomography (CT) and (18)F-FDG PET/CT within a 2-week period. For each patient, (18)F-BPA PET/CT and (18)F-FDG PET/CT images were aligned based on a deformable image registration framework. The voxel-by-voxel spatial correlation of standardized uptake value (SUV) within the tumor was analyzed. RESULTS Our image processing framework achieved accurate and validated registration results for each PET/CT image. In 9/10 patients, the spatial distribution of SUVs between (18)F-BPA and (18)F-FDG showed a significant, positive correlation in the tumor volume. CONCLUSIONS Deformable image registration-based voxel-wise analysis demonstrated a spatial correlation between (18)F-BPA and (18)F-FDG uptakes in the head and neck cancer. A tumor sub-volume with a high (18)F-FDG uptake may predict high accumulation of (18)F-BPA.
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Moffitt GB, Stewart RD, Sandison GA, Goorley JT, Argento DC, Jevremovic T. MCNP6 model of the University of Washington clinical neutron therapy system (CNTS). Phys Med Biol 2016; 61:937-57. [PMID: 26738533 DOI: 10.1088/0031-9155/61/2/937] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A MCNP6 dosimetry model is presented for the Clinical Neutron Therapy System (CNTS) at the University of Washington. In the CNTS, fast neutrons are generated by a 50.5 MeV proton beam incident on a 10.5 mm thick Be target. The production, scattering and absorption of neutrons, photons, and other particles are explicitly tracked throughout the key components of the CNTS, including the target, primary collimator, flattening filter, monitor unit ionization chamber, and multi-leaf collimator. Simulations of the open field tissue maximum ratio (TMR), percentage depth dose profiles, and lateral dose profiles in a 40 cm × 40 cm × 40 cm water phantom are in good agreement with ionization chamber measurements. For a nominal 10 × 10 field, the measured and calculated TMR values for depths of 1.5 cm, 5 cm, 10 cm, and 20 cm (compared to the dose at 1.7 cm) are within 0.22%, 2.23%, 4.30%, and 6.27%, respectively. For the three field sizes studied, 2.8 cm × 2.8 cm, 10.4 cm × 10.3 cm, and 28.8 cm × 28.8 cm, a gamma test comparing the measured and simulated percent depth dose curves have pass rates of 96.4%, 100.0%, and 78.6% (depth from 1.5 to 15 cm), respectively, using a 3% or 3 mm agreement criterion. At a representative depth of 10 cm, simulated lateral dose profiles have in-field (⩾ 10% of central axis dose) pass rates of 89.7% (2.8 cm × 2.8 cm), 89.6% (10.4 cm × 10.3 cm), and 100.0% (28.8 cm × 28.8 cm) using a 3% and 3 mm criterion. The MCNP6 model of the CNTS meets the minimum requirements for use as a quality assurance tool for treatment planning and provides useful insights and information to aid in the advancement of fast neutron therapy.
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Affiliation(s)
- Gregory B Moffitt
- Nuclear Engineering Program, University of Utah, 50 South Central Drive, 1206 MEB, Salt Lake City, UT, USA
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Dewi N, Mi P, Yanagie H, Sakurai Y, Morishita Y, Yanagawa M, Nakagawa T, Shinohara A, Matsukawa T, Yokoyama K, Cabral H, Suzuki M, Sakurai Y, Tanaka H, Ono K, Nishiyama N, Kataoka K, Takahashi H. In vivo evaluation of neutron capture therapy effectivity using calcium phosphate-based nanoparticles as Gd-DTPA delivery agent. J Cancer Res Clin Oncol 2015; 142:767-75. [PMID: 26650198 DOI: 10.1007/s00432-015-2085-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/20/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE A more immediate impact for therapeutic approaches of current clinical research efforts is of major interest, which might be obtained by developing a noninvasive radiation dose-escalation strategy, and neutron capture therapy represents one such novel approach. Furthermore, some recent researches on neutron capture therapy have focused on using gadolinium as an alternative or complementary for currently used boron, taking into account several advantages that gadolinium offers. Therefore, in this study, we carried out feasibility evaluation for both single and multiple injections of gadolinium-based MRI contrast agent incorporated in calcium phosphate nanoparticles as neutron capture therapy agent. METHODS In vivo evaluation was performed on colon carcinoma Col-26 tumor-bearing mice irradiated at nuclear reactor facility of Kyoto University Research Reactor Institute with average neutron fluence of 1.8 × 10(12) n/cm(2). Antitumor effectivity was evaluated based on tumor growth suppression assessed until 27 days after neutron irradiation, followed by histopathological analysis on tumor slice. RESULTS The experimental results showed that the tumor growth of irradiated mice injected beforehand with Gd-DTPA-incorporating calcium phosphate-based nanoparticles was suppressed up to four times higher compared to the non-treated group, supported by the results of histopathological analysis. CONCLUSION The results of antitumor effectivity observed on tumor-bearing mice after neutron irradiation indicated possible effectivity of gadolinium-based neutron capture therapy treatment.
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Affiliation(s)
- Novriana Dewi
- Department of Nuclear Engineering and Management, Graduate School of Engineering, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Peng Mi
- Innovation Center of Nanomedicine, Kawasaki Institute of Industry Promotion, 66-20 Horikawa-cho, Saiwai-ku, Kawasaki, 212-0013, Japan.,Polymer Chemistry Division, Chemical Resources Laboratory, Tokyo Institute of Technology, R1-11, 4259 Nagatsuta, Midori-ku, Yokohama, 226-8503, Japan.,Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Hironobu Yanagie
- Department of Nuclear Engineering and Management, Graduate School of Engineering, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan. .,Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan. .,Department of Innovative Cancer Therapeutics: Alpha Particle and Immunotherapeutics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan.
| | - Yuriko Sakurai
- Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Yasuyuki Morishita
- Department of Human and Molecular Pathology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masashi Yanagawa
- Department of Applied Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Nishi 2 Sen-11 Inadacho, Obihiro, Hokkaido, 080-0834, Japan
| | - Takayuki Nakagawa
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Atsuko Shinohara
- Department of Humanities, Graduate School of Seisen University, 3-16-21 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8642, Japan
| | - Takehisa Matsukawa
- Department of Epidemiology and Environmental Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kazuhito Yokoyama
- Department of Epidemiology and Environmental Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Horacio Cabral
- Department of Bioengineering, Graduate School of Engineering, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Minoru Suzuki
- Research Reactor Institute, Kyoto University, Asahiro nishi, Kumatori-cho, Sennan-gun, Osaka, 590-0494, Japan
| | - Yoshinori Sakurai
- Research Reactor Institute, Kyoto University, Asahiro nishi, Kumatori-cho, Sennan-gun, Osaka, 590-0494, Japan
| | - Hiroki Tanaka
- Research Reactor Institute, Kyoto University, Asahiro nishi, Kumatori-cho, Sennan-gun, Osaka, 590-0494, Japan
| | - Koji Ono
- Research Reactor Institute, Kyoto University, Asahiro nishi, Kumatori-cho, Sennan-gun, Osaka, 590-0494, Japan
| | - Nobuhiro Nishiyama
- Innovation Center of Nanomedicine, Kawasaki Institute of Industry Promotion, 66-20 Horikawa-cho, Saiwai-ku, Kawasaki, 212-0013, Japan.,Polymer Chemistry Division, Chemical Resources Laboratory, Tokyo Institute of Technology, R1-11, 4259 Nagatsuta, Midori-ku, Yokohama, 226-8503, Japan
| | - Kazunori Kataoka
- Innovation Center of Nanomedicine, Kawasaki Institute of Industry Promotion, 66-20 Horikawa-cho, Saiwai-ku, Kawasaki, 212-0013, Japan.,Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan.,Department of Materials Engineering, Graduate School of Engineering, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Hiroyuki Takahashi
- Department of Nuclear Engineering and Management, Graduate School of Engineering, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan.,Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
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Luderer MJ, de la Puente P, Azab AK. Advancements in Tumor Targeting Strategies for Boron Neutron Capture Therapy. Pharm Res 2015; 32:2824-36. [DOI: 10.1007/s11095-015-1718-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/18/2015] [Indexed: 01/16/2023]
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61
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Wongthai P, Hagiwara K, Miyoshi Y, Wiriyasermkul P, Wei L, Ohgaki R, Kato I, Hamase K, Nagamori S, Kanai Y. Boronophenylalanine, a boron delivery agent for boron neutron capture therapy, is transported by ATB0,+, LAT1 and LAT2. Cancer Sci 2015; 106:279-86. [PMID: 25580517 PMCID: PMC4376436 DOI: 10.1111/cas.12602] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/30/2014] [Accepted: 01/05/2015] [Indexed: 01/30/2023] Open
Abstract
The efficacy of boron neutron capture therapy relies on the selective delivery of boron carriers to malignant cells. p-Boronophenylalanine (BPA), a boron delivery agent, has been proposed to be localized to cells through transporter-mediated mechanisms. In this study, we screened aromatic amino acid transporters to identify BPA transporters. Human aromatic amino acid transporters were functionally expressed in Xenopus oocytes and examined for BPA uptake and kinetic parameters. The roles of the transporters in BPA uptake were characterized in cancer cell lines. For the quantitative assessment of BPA uptake, HPLC was used throughout the study. Among aromatic amino acid transporters, ATB0,+, LAT1 and LAT2 were found to transport BPA with Km values of 137.4 ± 11.7, 20.3 ± 0.8 and 88.3 ± 5.6 μM, respectively. Uptake experiments in cancer cell lines revealed that the LAT1 protein amount was the major determinant of BPA uptake at 100 μM, whereas the contribution of ATB0,+ became significant at 1000 μM, accounting for 20–25% of the total BPA uptake in MCF-7 breast cancer cells. ATB0,+, LAT1 and LAT2 transport BPA at affinities comparable with their endogenous substrates, suggesting that they could mediate effective BPA uptake in vivo. The high and low affinities of LAT1 and ATB0,+, respectively, differentiate their roles in BPA uptake. ATB0,+, as well as LAT1, could contribute significantly to the tumor accumulation of BPA at clinical dose.
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Affiliation(s)
- Printip Wongthai
- Division of Bio-system Pharmacology, Department of Pharmacology, Graduate School of Medicine, Osaka University, Suita, Japan
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Tani H, Kurihara H, Hiroi K, Honda N, Yoshimoto M, Kono Y, Murakami R, Kumita S, Arai Y, Itami J. Correlation of (18)F-BPA and (18)F-FDG uptake in head and neck cancers. Radiother Oncol 2014; 113:193-7. [PMID: 25466367 DOI: 10.1016/j.radonc.2014.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 10/16/2014] [Accepted: 11/01/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to compare the accumulation of 4-borono-2-(18)F-fluoro-phenylalanine ((18)F-BPA) with that of (18)F-fluorodeoxyglucose ((18)F-FDG) in head and neck cancers, and to assess the usefulness of (18)F-FDG PET for screening candidates for boron neutron capture therapy (BNCT). MATERIAL AND METHODS Twenty patients with pathologically proven malignant tumors of the head and neck were recruited from March 2012 to January 2014. All patients underwent both whole-body (18)F-BPA PET/CT and (18)F-FDG PET/CT within 2weeks of each other. The uptakes of (18)F-BPA and (18)F-FDG at 1h after injection were evaluated using the maximum standardized uptake value (SUVmax). RESULTS The accumulation of (18)F-FDG was significantly correlated with that of (18)F-BPA. The SUVmax of (18)F-FDG ⩾5.0 is considered to be suggestive of high (18)F-BPA accumulation. CONCLUSIONS (18)F-FDG PET might be an effective screening method performed prior to (18)F-BPA for selecting patients with head and neck cancer for treatment with BNCT.
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Affiliation(s)
- Hitomi Tani
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan; Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Hiroaki Kurihara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
| | - Kenta Hiroi
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Natsuki Honda
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuyoshi Yoshimoto
- Division of Functional Imaging, National Cancer Center Hospital East, Chiba, Japan
| | - Yuzuru Kono
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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Therapeutic efficacy of boron neutron capture therapy mediated by boron-rich liposomes for oral cancer in the hamster cheek pouch model. Proc Natl Acad Sci U S A 2014; 111:16077-81. [PMID: 25349432 DOI: 10.1073/pnas.1410865111] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The application of boron neutron capture therapy (BNCT) mediated by liposomes containing (10)B-enriched polyhedral borane and carborane derivatives for the treatment of head and neck cancer in the hamster cheek pouch oral cancer model is presented. These liposomes are composed of an equimolar ratio of cholesterol and 1,2-distearoyl-sn-glycero-3-phosphocholine, incorporating K[nido-7-CH3(CH2)15-7,8-C2B9H11] (MAC) in the bilayer membrane while encapsulating the hydrophilic species Na3[ae-B20H17NH3] (TAC) in the aqueous core. Unilamellar liposomes with a mean diameter of 83 nm were administered i.v. in hamsters. After 48 h, the boron concentration in tumors was 67 ± 16 ppm whereas the precancerous tissue contained 11 ± 6 ppm, and the tumor/normal pouch tissue boron concentration ratio was 10:1. Neutron irradiation giving a 5-Gy dose to precancerous tissue (corresponding to 21 Gy in tumor) resulted in an overall tumor response (OR) of 70% after a 4-wk posttreatment period. In contrast, the beam-only protocol gave an OR rate of only 28%. Once-repeated BNCT treatment with readministration of liposomes at an interval of 4, 6, or 8 wk resulted in OR rates of 70-88%, of which the complete response ranged from 37% to 52%. Because of the good therapeutic outcome, it was possible to extend the follow-up of BNCT treatment groups to 16 wk after the first treatment. No radiotoxicity to normal tissue was observed. A salient advantage of these liposomes was that only mild mucositis was observed in dose-limiting precancerous tissue with a sustained tumor response of 70-88%.
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Blood–brain barrier (BBB) toxicity and permeability assessment after L-(4-10Boronophenyl)alanine, a conventional B-containing drug for boron neutron capture therapy, using an in vitro BBB model. Brain Res 2014; 1583:34-44. [DOI: 10.1016/j.brainres.2014.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 08/07/2014] [Indexed: 12/24/2022]
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Michiue H, Sakurai Y, Kondo N, Kitamatsu M, Bin F, Nakajima K, Hirota Y, Kawabata S, Nishiki TI, Ohmori I, Tomizawa K, Miyatake SI, Ono K, Matsui H. The acceleration of boron neutron capture therapy using multi-linked mercaptoundecahydrododecaborate (BSH) fused cell-penetrating peptide. Biomaterials 2014; 35:3396-405. [PMID: 24452095 DOI: 10.1016/j.biomaterials.2013.12.055] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/19/2013] [Indexed: 12/19/2022]
Abstract
New anti-cancer therapy with boron neutron capture therapy (BNCT) is based on the nuclear reaction of boron-10 with neutron irradiation. The median survival of BNCT patients with glioblastoma was almost twice as long as those receiving standard therapy in a Japanese BNCT clinical trial. In this clinical trial, two boron compounds, BPA (boronophenylalanine) and BSH (sodium borocaptate), were used for BNCT. BPA is taken up into cells through amino acid transporters that are expressed highly in almost all malignant cells, but BSH cannot pass through the cell membrane and remains outside the cell. We simulated the energy transfer against the nucleus at different locations of boron from outside the cell to the nuclear region with neutron irradiation and concluded that there was a marked difference between inside and outside the cell in boron localization. To overcome this disadvantage of BSH in BNCT, we used a cell-penetrating peptide system for transduction of BSH. CPP (cell-membrane penetrating peptide) is very common peptide domains that transduce many physiologically active substances into cells in vitro and in vivo. BSH-fused CPPs can penetrate the cell membrane and localize inside a cell. To increase the boron ratio in one BSH-peptide molecule, 8BSH fused to 11R with a dendritic lysine structure was synthesized and administrated to malignant glioma cells and a brain tumor mouse model. 8BSH-11R localized at the cell nucleus and showed a very high boron value in ICP results. With neutron irradiation, the 8BSH-11R administrated group showed a significant cancer killing effect compared to the 100 times higher concentration of BSH-administrated group. We concluded that BSH-fused CPPs were one of the most improved and potential boron compounds in the next-stage BNCT trial and 8BSH-11R may be applied in the clinical setting.
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Affiliation(s)
- Hiroyuki Michiue
- Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama City, Okayama 700-8558, Japan.
| | - Yoshinori Sakurai
- Particle Radiation Oncology Research Center, Research Reactor Institute, Kyoto University, Kumatori-cho, Osaka 590-0494, Japan
| | - Natsuko Kondo
- Particle Radiation Oncology Research Center, Research Reactor Institute, Kyoto University, Kumatori-cho, Osaka 590-0494, Japan
| | - Mizuki Kitamatsu
- Department of Applied Chemistry, Faculty of Science and Engineering, Kinki University, 3-4-1 Kowakae, Higashi-Osaka City, Osaka 577-8502, Japan
| | - Feng Bin
- Department of Biotechnology, Dalian Medical University, No. 9 West Section, Lvshun South, Dalian 116044, China
| | - Kiichiro Nakajima
- KNC Laboratories, Ltd., 1-1-1, Murotani, Nishi-ku, Kobe City, Hyogo 651-2241, Japan
| | - Yuki Hirota
- Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Tei-ichi Nishiki
- Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama City, Okayama 700-8558, Japan
| | - Iori Ohmori
- Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama City, Okayama 700-8558, Japan
| | - Kazuhito Tomizawa
- Department of Molecular Physiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjou, Kumamoto City, Kumamoto 860-8556, Japan
| | - Shin-ichi Miyatake
- Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Koji Ono
- Particle Radiation Oncology Research Center, Research Reactor Institute, Kyoto University, Kumatori-cho, Osaka 590-0494, Japan
| | - Hideki Matsui
- Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama City, Okayama 700-8558, Japan
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Kageji T, Nagahiro S, Mizobuchi Y, Matsuzaki K, Nakagawa Y, Kumada H. Boron neutron capture therapy (BNCT) for newly-diagnosed glioblastoma: Comparison of clinical results obtained with BNCT and conventional treatment. THE JOURNAL OF MEDICAL INVESTIGATION 2014; 61:254-63. [DOI: 10.2152/jmi.61.254] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Teruyoshi Kageji
- Department of Neurosurgery, School of Medicine, the University of Tokushima
| | - Shinji Nagahiro
- Department of Neurosurgery, School of Medicine, the University of Tokushima
| | | | | | - Yoshinobu Nakagawa
- Department of Neurosurgery, Shikoku Medical Center for Children and Adults
| | - Hiroaki Kumada
- Department of Radiation Oncology, Graduate School of Comprehensive Human Science, University of Tsukuba
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Nine-year interval recurrence after treatment of boron neutron capture therapy in a patient with glioblastoma: a case report. Appl Radiat Isot 2014; 88:28-31. [PMID: 24440540 DOI: 10.1016/j.apradiso.2013.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 12/23/2013] [Accepted: 12/24/2013] [Indexed: 11/20/2022]
Abstract
Boron neutron capture therapy (BNCT) has been reported to be effective in the patients with glioblastoma multiforme (GBM). Median survival time (MST) of GBM patients treated with BNCT is approximately two years. GBM patients surviving 2 or 3 years are considered long-term survivors. In general, most recurrences are local and dissemination is rare. We report an unusual patient with three recurrences; the first and the second recurrences were local, and the third recurrence was dissemination nine years after BNCT.
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68
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Sander A, Wosniok W, Gabel D. Case numbers for a randomized clinical trial of boron neutron capture therapy for Glioblastoma multiforme. Appl Radiat Isot 2013; 88:16-9. [PMID: 24373823 DOI: 10.1016/j.apradiso.2013.11.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 10/24/2013] [Accepted: 11/21/2013] [Indexed: 11/30/2022]
Abstract
Boron neutron capture therapy (BNCT) with Na2B12H11SH (BSH) or p-dihydroxyborylphenylalanine (BPA), and with a combination of both, was compared to radiotherapy with temozolomide, and the number of patients required to show statistically significant differences between the treatments was calculated. Whereas arms using BPA require excessive number of patients in each arm, a two-armed clinical trial with BSH and radiotherapy plus temozolomide is feasible.
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Affiliation(s)
- Anja Sander
- Kompetenzzentrum Klinische Studien KKS, Bremen, Germany; Cooperative Center Medicine, University of Bremen, Bremen, Germany
| | - Werner Wosniok
- Kompetenzzentrum Klinische Studien KKS, Bremen, Germany; Cooperative Center Medicine, University of Bremen, Bremen, Germany
| | - Detlef Gabel
- Department of Chemistry, University of Bremen, Bremen, Germany; Cooperative Center Medicine, University of Bremen, Bremen, Germany; School of Engineering and Science, Jacobs University Bremen, Campus Ring 1, D-28759 Bremen, Germany.
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Capoulat ME, Minsky DM, Kreiner AJ. Computational assessment of deep-seated tumor treatment capability of the 9Be(d,n)10B reaction for accelerator-based boron neutron capture therapy (AB-BNCT). Phys Med 2013; 30:133-46. [PMID: 23880544 DOI: 10.1016/j.ejmp.2013.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 06/10/2013] [Accepted: 07/02/2013] [Indexed: 11/19/2022] Open
Abstract
The 9Be(d,n)10B reaction was studied as an epithermal neutron source for brain tumor treatment through Boron Neutron Capture Therapy (BNCT). In BNCT, neutrons are classified according to their energies as thermal (<0.5 eV), epithermal (from 0.5 eV to 10 keV) or fast (>10 keV). For deep-seated tumors epithermal neutrons are needed. Since a fraction of the neutrons produced by this reaction are quite fast (up to 5-6 MeV, even for low-bombarding energies), an efficient beam shaping design is required. This task was carried out (1) by selecting the combinations of bombarding energy and target thickness that minimize the highest-energy neutron production; and (2) by the appropriate choice of the Beam Shaping Assembly (BSA) geometry, for each of the combinations found in (1). The BSA geometry was determined as the configuration that maximized the dose deliverable to the tumor in a 1 h treatment, within the constraints imposed by the healthy tissue dose adopted tolerance. Doses were calculated through the MCNP code. The highest dose deliverable to the tumor was found for an 8 μm target and a deuteron beam of 1.45 MeV. Tumor weighted doses ≥40 Gy can be delivered up to about 5 cm in depth, with a maximum value of 51 Gy at a depth of about 2 cm. This dose performance can be improved by relaxing the treatment time constraint and splitting the treatment into two 1-h sessions. These good treatment capabilities strengthen the prospects for a potential use of this reaction in BNCT.
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Affiliation(s)
- M E Capoulat
- Gerencia de Investigación y Aplicaciones, CNEA, Av. Gral. Paz 1499 (B1650KNA), San Martín, Buenos Aires, Argentina; Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín, M. de Irigoyen 3100 (1650), San Martín, Buenos Aires, Argentina; CONICET. Av. Rivadavia 1917 (C1033AAJ), Buenos Aires, Argentina.
| | - D M Minsky
- Gerencia de Investigación y Aplicaciones, CNEA, Av. Gral. Paz 1499 (B1650KNA), San Martín, Buenos Aires, Argentina; Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín, M. de Irigoyen 3100 (1650), San Martín, Buenos Aires, Argentina; CONICET. Av. Rivadavia 1917 (C1033AAJ), Buenos Aires, Argentina
| | - A J Kreiner
- Gerencia de Investigación y Aplicaciones, CNEA, Av. Gral. Paz 1499 (B1650KNA), San Martín, Buenos Aires, Argentina; Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín, M. de Irigoyen 3100 (1650), San Martín, Buenos Aires, Argentina; CONICET. Av. Rivadavia 1917 (C1033AAJ), Buenos Aires, Argentina
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70
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Quo vadis radiotherapy? Technological advances and the rising problems in cancer management. BIOMED RESEARCH INTERNATIONAL 2013; 2013:749203. [PMID: 23862155 PMCID: PMC3684032 DOI: 10.1155/2013/749203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/04/2013] [Indexed: 12/17/2022]
Abstract
Purpose. Despite the latest technological advances in radiotherapy, cancer control is still challenging for several tumour sites. The survival rates for the most deadly cancers, such as ovarian and pancreatic, have not changed over the last decades. The solution to the problem lies in the change of focus: from local treatment to systemic therapy. The aim of this paper is to present the current status as well as the gaps in radiotherapy and, at the same time, to look into potential solutions to improve cancer control and survival. Methods. The currently available advanced radiotherapy treatment techniques have been analysed and their cost-effectiveness discussed. The problem of systemic disease management was specifically targeted. Results. Clinical studies show limited benefit in cancer control from hadron therapy. However, targeted therapies together with molecular imaging could improve treatment outcome for several tumour sites while controlling the systemic disease. Conclusion. The advances in photon therapy continue to be competitive with the much more expensive hadron therapy. To justify the cost effectiveness of proton/heavy ion therapy, there is a need for phase III randomised clinical trials. Furthermore, the success of systemic disease management lies in the fusion between radiation oncology technology and microbiology.
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71
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Alkins RD, Brodersen PM, Sodhi RNS, Hynynen K. Enhancing drug delivery for boron neutron capture therapy of brain tumors with focused ultrasound. Neuro Oncol 2013; 15:1225-35. [PMID: 23640533 DOI: 10.1093/neuonc/not052] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Glioblastoma is a notoriously difficult tumor to treat because of its relative sanctuary in the brain and infiltrative behavior. Therapies need to penetrate the CNS but avoid collateral tissue injury. Boron neutron capture therapy (BNCT) is a treatment whereby a (10)B-containing drug preferentially accumulates in malignant cells and causes highly localized damage when exposed to epithermal neutron irradiation. Studies have suggested that (10)B-enriched L-4-boronophenylalanine-fructose (BPA-f) complex uptake can be improved by enhancing the permeability of the cerebrovasculature with osmotic agents. We investigated the use of MRI-guided focused ultrasound, in combination with injectable microbubbles, to noninvasively and focally augment the uptake of BPA-f. METHODS With the use of a 9L gliosarcoma tumor model in Fisher 344 rats, the blood-brain and blood-tumor barriers were disrupted with pulsed ultrasound using a 558 kHz transducer and Definity microbubbles, and BPA-f (250 mg/kg) was delivered intravenously over 2 h. (10)B concentrations were estimated with imaging mass spectrometry and inductively coupled plasma atomic emission spectroscopy. RESULTS The tumor to brain ratio of (10)B was 6.7 ± 0.5 with focused ultrasound and only 4.1 ± 0.4 in the control group (P < .01), corresponding to a mean tumor [(10)B] of 123 ± 25 ppm and 85 ± 29 ppm, respectively. (10)B uptake in infiltrating clusters treated with ultrasound was 0.86 ± 0.10 times the main tumor concentration, compared with only 0.29 ± 0.08 in controls. CONCLUSIONS Ultrasound increases the accumulation of (10)B in the main tumor and infiltrating cells. These findings, in combination with the expanding clinical use of focused ultrasound, may offer improvements in BNCT and the treatment of glioblastoma.
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Affiliation(s)
- Ryan D Alkins
- Department of Medical Biophysics, University of Toronto, Ontario, Canada.
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Smilowitz HM, Slatkin DN, Micca PL, Miura M. Microlocalization of lipophilic porphyrins: Non-toxic enhancers of boron neutron-capture therapy. Int J Radiat Biol 2013; 89:611-7. [DOI: 10.3109/09553002.2013.782446] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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73
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Boron neutron capture therapy demonstrated in mice bearing EMT6 tumors following selective delivery of boron by rationally designed liposomes. Proc Natl Acad Sci U S A 2013; 110:6512-7. [PMID: 23536304 DOI: 10.1073/pnas.1303437110] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The application of boron neutron capture therapy (BNCT) following liposomal delivery of a (10)B-enriched polyhedral borane and a carborane against mouse mammary adenocarcinoma solid tumors was investigated. Unilamellar liposomes with a mean diameter of 134 nm or less, composed of an equimolar mixture of cholesterol and 1,2-distearoyl-sn-glycero-3-phosphocholine and incorporating Na3[1-(2'-B10H9)-2-NH3B10H8] in the aqueous interior and K[nido-7-CH3(CH2)15-7,8-C2B9H11] in the bilayer, were injected into the tail veins of female BALB/c mice bearing right flank EMT6 tumors. Biodistribution studies indicated that two identical injections given 24 h apart resulted in tumor boron levels exceeding 67 µg/g tumor at 54 h--with tumor/blood boron ratios being greatest at 96 h (5.68:1; 43 µg boron/g tumor)--following the initial injection. For BNCT experiments, tumor-bearing mice were irradiated 54 h after the initial injection for 30 min with thermal neutrons, resulting in a total fluence of 1.6 × 10(12) neutrons per cm(2) (±7%). Significant suppression of tumor growth was observed in mice given BNCT vs. control mice (only 424% increase in tumor volume at 14 d post irradiation vs. 1551% in untreated controls). In a separate experiment in which mice were given a second injection/irradiation treatment 7 d after the first, the tumor growth was vastly diminished (186% tumor volume increase at 14 d). A similar response was obtained for mice irradiated for 60 min (169% increase at 14 d), suggesting that neutron fluence was the limiting factor controlling BNCT efficacy in this study.
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Short and long-term exposure of CNS cell lines to BPA-f a radiosensitizer for Boron Neutron Capture Therapy: safety dose evaluation by a battery of cytotoxicity tests. Neurotoxicology 2013; 35:84-90. [DOI: 10.1016/j.neuro.2012.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 12/21/2022]
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Halbert G, Elliott M, Ford S, Dick L, Schmidt E. Improved pharmaceutical stability of a boronphenylalanine mannitol formulation for boron neutron capture therapy. Eur J Pharm Sci 2013; 48:735-9. [PMID: 23354152 DOI: 10.1016/j.ejps.2013.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/21/2012] [Accepted: 01/03/2013] [Indexed: 11/18/2022]
Abstract
Boron neutron capture therapy (BNCT) is a radiotherapy based cancer treatment requiring the availability of a low energy thermal neutron beam and a boron containing drug. These requirements limit BNCT availability with the latter pharmaceutical issue related to the extremely short shelf-life and clinical acceptability of the current fructose based L-boronphenylalanine (BPA) formulation. Resolution of the formulation issues would remove this factor and therefore the stability of an alternative mannitol BPA formulation has been investigated. A mannitol BPA solution formulation was prepared and either lyophilised or stored as a solution at varying temperatures. After suitable periods the formulation was analysed by HPLC for BPA and degradation products. Lyophilised and solution mannitol BPA formulations exhibited a temperature and time dependent loss of BPA with concomitant increases in degradation products. Autoclaving the solution induced and accelerated degradation. A solution or lyophilised mannitol BPA formulation has a shelf-life of between 1 and 4 years respectively, a marked improvement over the current fructose formulation. Due to temperature dependent degradation the formulation cannot be terminally sterilised by autoclaving. The enhanced stability of the mannitol formulation removes the requirement for extemporaneous aseptic preparation of BPA just prior to treatment and eliminates one of the issues complicating the delivery of BNCT.
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Affiliation(s)
- Gavin Halbert
- Cancer Research UK Formulation Unit, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow G4 0RE, United Kingdom.
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Barth RF, Vicente MGH, Harling OK, Kiger WS, Riley KJ, Binns PJ, Wagner FM, Suzuki M, Aihara T, Kato I, Kawabata S. Current status of boron neutron capture therapy of high grade gliomas and recurrent head and neck cancer. Radiat Oncol 2012; 7:146. [PMID: 22929110 PMCID: PMC3583064 DOI: 10.1186/1748-717x-7-146] [Citation(s) in RCA: 291] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 07/23/2012] [Indexed: 11/25/2022] Open
Abstract
Boron neutron capture therapy (BNCT) is a biochemically targeted radiotherapy based on the nuclear capture and fission reactions that occur when non-radioactive boron-10, which is a constituent of natural elemental boron, is irradiated with low energy thermal neutrons to yield high linear energy transfer alpha particles and recoiling lithium-7 nuclei. Clinical interest in BNCT has focused primarily on the treatment of high grade gliomas, recurrent cancers of the head and neck region and either primary or metastatic melanoma. Neutron sources for BNCT currently have been limited to specially modified nuclear reactors, which are or until the recent Japanese natural disaster, were available in Japan, the United States, Finland and several other European countries, Argentina and Taiwan. Accelerators producing epithermal neutron beams also could be used for BNCT and these are being developed in several countries. It is anticipated that the first Japanese accelerator will be available for therapeutic use in 2013. The major hurdle for the design and synthesis of boron delivery agents has been the requirement for selective tumor targeting to achieve boron concentrations in the range of 20 μg/g. This would be sufficient to deliver therapeutic doses of radiation with minimal normal tissue toxicity. Two boron drugs have been used clinically, a dihydroxyboryl derivative of phenylalanine, referred to as boronophenylalanine or “BPA”, and sodium borocaptate or “BSH” (Na2B12H11SH). In this report we will provide an overview of other boron delivery agents that currently are under evaluation, neutron sources in use or under development for BNCT, clinical dosimetry, treatment planning, and finally a summary of previous and on-going clinical studies for high grade gliomas and recurrent tumors of the head and neck region. Promising results have been obtained with both groups of patients but these outcomes must be more rigorously evaluated in larger, possibly randomized clinical trials. Finally, we will summarize the critical issues that must be addressed if BNCT is to become a more widely established clinical modality for the treatment of those malignancies for which there currently are no good treatment options.
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Affiliation(s)
- Rolf F Barth
- Department of Pathology, The Ohio State University, 165 Hamilton Hall, 1645 Neil Avenue, Columbus, OH, 43210, USA.
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Boron Neutron Capture Therapy in the Treatment of Locally Recurred Head-and-Neck Cancer: Final Analysis of a Phase I/II Trial. Int J Radiat Oncol Biol Phys 2012; 82:e67-75. [DOI: 10.1016/j.ijrobp.2010.09.057] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 09/13/2010] [Accepted: 09/28/2010] [Indexed: 11/20/2022]
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Schmidt E, Dooley N, Ford SJ, Elliott M, Halbert GW. Physicochemical Investigation of the Influence of Saccharide-Based Parenteral Formulation Excipients on l-p-Boronphenylalanine Solubilisation for Boron Neutron Capture Therapy. J Pharm Sci 2012; 101:223-32. [DOI: 10.1002/jps.22761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 06/23/2011] [Accepted: 08/25/2011] [Indexed: 11/11/2022]
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Abstract
Relative to carbon, hydrogen, nitrogen and oxygen, very little is currently known about boron in therapeutics. In addition, there are very few boron-containing natural products identified to date to serve as leads for medicinal chemists. Perceived risks of using boron and lack of synthetic methods to handle boron-containing compounds have caused the medicinal chemistry community to shy away from using the atom. However, physical, chemical and biological properties of boron offer medicinal chemists a rare opportunity to explore and pioneer new areas of drug discovery. Boron therapeutics are emerging that show different modes of inhibition against a variety of biological targets. With one boron-containing therapeutic agent on the market and several more in various stages of clinical trials, the occurrence of this class of compound is likely to grow over the next decade and boron could become widely accepted as a useful element in future drug discovery.
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l-Boronophenylalanine-Mediated Boron Neutron Capture Therapy for Malignant Glioma Progressing After External Beam Radiation Therapy: A Phase I Study. Int J Radiat Oncol Biol Phys 2011; 80:369-76. [DOI: 10.1016/j.ijrobp.2010.02.031] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 02/09/2010] [Accepted: 02/09/2010] [Indexed: 11/30/2022]
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Barth RF, Yang W, Huo T, Riley KJ, Binns PJ, Grecula JC, Gupta N, Rousseau J, Elleaume H. Comparison of intracerebral delivery of carboplatin and photon irradiation with an optimized regimen for boron neutron capture therapy of the F98 rat glioma. Appl Radiat Isot 2011; 69:1813-6. [PMID: 21493080 DOI: 10.1016/j.apradiso.2011.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 02/23/2011] [Accepted: 03/14/2011] [Indexed: 11/24/2022]
Abstract
In this report we have summarized our studies to optimize the delivery of boronophenylalanine (BPA) and sodium borocaptate (BSH) for boron neutron capture therapy (BNCT) of F98 glioma bearing rats. These results have been compared to a chemoradiotherapeutic approach using the same tumor model. The best survival data from our BNCT studies were obtained using a combination of BPA and sodium borocaptate BSH administered via the internal carotid artery, in combination with blood-brain barrier disruption (BBB-D). This treatment resulted in a mean survival time (MST) of 140 d with a 25% cure rate. The other approach combined intracerebral administration of carboplatin by either convection enhanced delivery (CED) or Alzet pump infusion, followed by external beam photon irradiation. This resulted in MSTs of 83 d and 112 d, respectively, with a cure rate of 40% for the latter. However, a significant problem that must be solved for both BNCT and this new chemoradiotherapeutic approach is how to improve drug uptake and microdistribution within the tumor.
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Affiliation(s)
- Rolf F Barth
- Department of Pathology, The Ohio State University, Columbus, OH 43210, USA.
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82
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Niyazi M, Siefert A, Schwarz SB, Ganswindt U, Kreth FW, Tonn JC, Belka C. Therapeutic options for recurrent malignant glioma. Radiother Oncol 2010; 98:1-14. [PMID: 21159396 DOI: 10.1016/j.radonc.2010.11.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 10/08/2010] [Accepted: 11/07/2010] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE Despite the given advances in neuro-oncology most patients with high grade malignant glioma ultimately fail locally or locoregionally. In parallel with improvements of initial treatment options, several salvage strategies have been elucidated and already entered clinical practice. Aim of this article is to review the current status of salvage strategies in recurrent high grade glioma. MATERIAL AND METHODS Using the following MESH headings and combinations of these terms the pubmed database was searched: "Glioma", "Recurrence", "Neoplasm Recurrence, Local", "Radiosurgery", "Brachytherapy", "Neurosurgical Procedures" and "Drug Therapy". For citation crosscheck the ISI web of science database was used employing the same search terms. In parallel, the abstracts of ASCO 2008-2009 were analyzed accordingly. RESULTS Currently the following options for salvage entered clinical practice: re-resection, re-irradiation (stereotactic radiosurgery, (hypo-)fractionated (stereotactic) radiotherapy, interstitial brachytherapy) or single/poly-chemotherapy schedules including new dose-intensified or alternative treatment protocols employing targeted drugs. Re-operation is associated with high morbidity and mortality, however, is an option in a highly selected patient cohort. Since toxicity has been overestimated, re-irradiation is an increasingly used option with precise fractionated radiotherapy being the most optimal technique. On average, time to secondary progression is in the range of several months. Conventional chemotherapy regimens also improve time to secondary progression; however the efficacy is only modest and treatment-related toxicities like myelo-suppression occur very frequently. Molecular targeted agents/kinases are undergoing clinical testing; however no final recommendations can be made. CONCLUSIONS Currently, several re-treatment options with only modest efficacy exist. The relative value of each approach compared to other options is unknown as well as it remains open which sequence of modalities should be chosen.
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Affiliation(s)
- Maximilian Niyazi
- Department of Radiation Oncology, Ludwig-Maximilians-University Munich, München, Germany
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83
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Bondiau PY, Fauchon F, Jadaud E, Paquis P. [Radiotherapy in adult glioblastomas]. Neurochirurgie 2010; 56:486-90. [PMID: 20869090 DOI: 10.1016/j.neuchi.2010.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022]
Abstract
Radiation therapy is a treatment of malignant gliomas in adults. It improves survival rates, whether used alone, in addition to surgery, or in combination with chemotherapy. Three-dimensional imaging techniques, image fusion, and conformational radiotherapy are optimizing treatment plans for the treatment of these tumors and are sparing healthy tissue. After a review of the physical and biological bases of ionizing radiation, we present the techniques, results, side effects, and results of irradiation of glioblastomas.
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Affiliation(s)
- P-Y Bondiau
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06100 Nice, France.
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84
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Sköld K, Gorlia T, Pellettieri L, Giusti V, H-Stenstam B, Hopewell JW. Boron neutron capture therapy for newly diagnosed glioblastoma multiforme: an assessment of clinical potential. Br J Radiol 2010; 83:596-603. [PMID: 20603410 DOI: 10.1259/bjr/56953620] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study was to assess the potential of boron neutron capture therapy (BNCT), with a 6-h infusion of the boron carrier l-boronophenylalanine as a fructose preparation (BPA-f), as first-line radiotherapy for newly diagnosed glioblastoma multiforme (GBM). Patient survival data from a Phase II study using BNCT were compared with retrospective data from the two arms of a Phase III study using conventional radiotherapy (RT) in the reference arm and using RT plus concomitant and adjuvant medication with temozolomide (TMZ) in the experimental arm, and were also compared with small subgroups of these patients for whom the methylation status of the MGMT (O(6)-methylguanine-DNA methyltransferase) DNA repair gene was known. Differences in the baseline characteristics, salvage therapy after recurrence and levels of severe adverse events were also considered. The results indicate that BNCT offers a treatment that is at least as effective as conventional RT alone. For patients with an unmethylated MGMT DNA repair gene, a possible clinical advantage of BNCT over RT/TMZ was suggested. BNCT is a single-day treatment, which is of convenience to patients, with mild side effects, which would offer an initial 6 weeks of good-quality life during the time when patients would otherwise be undergoing daily treatments with RT and TMZ. It is suggested that the use of BNCT with a 6-h infusion of BPA-f should be explored in a stratified randomised Phase II trial in which patients with the unmethylated MGMT DNA repair gene are offered BNCT in the experimental arm and RT plus TMZ in the reference arm.
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Affiliation(s)
- K Sköld
- Hammercap Medical AB, Stockholm, Sweden
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85
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Sköld K, H-Stenstam B, Diaz AZ, Giusti V, Pellettieri L, Hopewell JW. Boron Neutron Capture Therapy for glioblastoma multiforme: advantage of prolonged infusion of BPA-f. Acta Neurol Scand 2010; 122:58-62. [PMID: 19951268 DOI: 10.1111/j.1600-0404.2009.01267.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess possible improved efficacy of Boron Neutron Capture Therapy (BNCT) for glioblastoma multiforme (GBM) using prolonged infusion and a correspondingly higher dose of l-boronophenylalanine, as the fructose complex (BPA-f). MATERIALS AND METHODS The benefit of prolonged infusion was analyzed by comparing the results from a Phase II study using 6 h infusion of BPA-f with those obtained from a Phase I/II study using 2 h of infusion. Median survival time (MST) from diagnosis, patient baseline characteristics, salvage treatment and severe adverse events were considered in the comparison. RESULTS MST increased significantly, from 12.8 (95% confidence interval or CI: 10.3-14.0) months with 2 h infusion to 17.7 (95% CI: 13.6-19.9) months with 6 h of infusion. The fraction of patients with WHO grade 3-4 adverse events was similar in the two studies at 13% and 14%, respectively. CONCLUSION Prolonged infusion was found to be beneficial for the efficacy of BNCT and it is suggested that 6 h infusion of BPA-f should be used in future trials of BNCT for GBM. BNCT, which is a single-day treatment with mild side effects, should be assessed in a controlled trial, as an alternative to 30 daily fractions of conventional fractionated photon therapy over a period of 6 weeks.
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86
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Aromando RF, Trivillin VA, Heber EM, Pozzi E, Schwint AE, Itoiz ME. Early effect of boron neutron capture therapy mediated by boronophenylalanine (BPA–BNCT) on mast cells in premalignant tissue and tumors of the hamster cheek pouch. Oral Oncol 2010; 46:355-9. [DOI: 10.1016/j.oraloncology.2010.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 02/11/2010] [Accepted: 02/12/2010] [Indexed: 10/19/2022]
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87
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Persson BRR, Koch CB, Grafström G, Ceberg C, Rosenschöld PM, Nittby H, Widegren B, Salford LG. Radiation Immunomodulatory Gene Tumor Therapy of Rats with Intracerebral Glioma Tumors. Radiat Res 2010; 173:433-40. [DOI: 10.1667/rr1733.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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88
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Kumar S, Freytag SO, Barton KN, Burmeister J, Joiner MC, Sedghi B, Movsas B, Binns PJ, Kim JH, Brown SL. A novel method of boron delivery using sodium iodide symporter for boron neutron capture therapy. JOURNAL OF RADIATION RESEARCH 2010; 51:621-626. [PMID: 20921830 PMCID: PMC3735134 DOI: 10.1269/jrr.10036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Boron Neutron Capture Therapy (BNCT) effectiveness depends on the preferential sequestration of boron in cancer cells relative to normal tissue cells. We present a novel strategy for sequestering boron using an adenovirus expressing the sodium iodide symporter (NIS). Human glioma grown subcutaneously in athymic mice and orthotopic rat brain tumors were transfected with NIS using a direct tumor injection of adenovirus. Boron bound as sodium tetrafluoroborate (NaBF(4)) was administered systemically several days after transfection. Tumors were excised hours later and assessed for boron concentration using inductively coupled plasma atomic emission spectroscopy. In the human glioma transfected with NIS, boron concentration was more than 10 fold higher with 100 mg/kg of NaBF(4), compared to tumor not transfected. In the orthotopic tumor model, the presence of NIS conferred almost 4 times the boron concentration in rat tumors transfected with human virus compared with contralateral normal brain not transfected. We conclude that adenovirus expressing NIS has the potential to be used as a novel boron delivery agent and should be explored for future clinical applications.
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Affiliation(s)
- Sanath Kumar
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA.
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89
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Garnica-Garza HM. Contrast-enhanced radiotherapy: feasibility and characteristics of the physical absorbed dose distribution for deep-seated tumors. Phys Med Biol 2009; 54:5411-25. [DOI: 10.1088/0031-9155/54/18/004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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90
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Characterization of a boron neutron capture therapy beam line at the University of Missouri Research Reactor. J Radioanal Nucl Chem 2009. [DOI: 10.1007/s10967-009-0169-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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91
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Jung SH, Yoon SM, Park SH, Choi IS, Kim JK, Choi EK, Ahn SD, Lee SW, Song SY, Kim JH. A treatment planning study on glioblastoma with different techniques using boron neutron capture therapy, 3-dimensional conformal radiotherapy, and intensity modulated radiotherapy. Appl Radiat Isot 2009; 67:1180-4. [PMID: 19321353 DOI: 10.1016/j.apradiso.2009.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To propose adequate indices predicting efficacy of boron neutron capture therapy (BNCT) for glioblastoma, a comparative treatment planning study between BNCT, 3-dimensional conformal radiotherapy (3D-CRT), and intensity-modulated radiotherapy (IMRT) was performed, and dose-volume histograms (DVHs) on planning target volume (PTV) and normal brain were calculated. Therapeutic benefit of BNCT was quantitatively evaluated using conformity indices, which have been previously suggested by radiation therapy oncology group (RTOG) and Saint-Anne, Lariboisière, Tenon (SALT). Although dose homogeneities from the BNCT plans were poor than the other modalities due to simple irradiation fields, lesion coverage factor, CVF, from the BNCT plans were comparable to those from the 3D-CRT and IMRT plans (median values, 0.991, 0.989, and 0.961, respectively). The geometrical factors, g, from the BNCT plans, which describes target volumes receiving doses under the prescribed doses and normal brain volume covered by the prescribed doses, were lowest compared to those for the other modalities (median values, 0.009, 0.115, and 0.043). For the BNCT plans, maximum dose escalation up to 2.080 times the prescribed dose was possible without exceeding normal brain tolerance dose. As the indices can evaluate the quantitative benefit of BNCT and maximum dose escalation for the individual patient, it is expected that the indices can effectively evaluate the treatment plan of BNCT.
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Affiliation(s)
- Sang Hoon Jung
- Department of Radiation Oncology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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92
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Riley KJ, Binns PJ, Harling OK, Albritton JR, Kiger WS, Rezaei A, Sköld K, Seppälä T, Savolainen S, Auterinen I, Marek M, Viererbl L, Nievaart VA, Moss RL. An international dosimetry exchange for BNCT part II: computational dosimetry normalizations. Med Phys 2009; 35:5419-25. [PMID: 19175101 DOI: 10.1118/1.3005480] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The meaningful sharing and combining of clinical results from different centers in the world performing boron neutron capture therapy (BNCT) requires improved precision in dose specification between programs. To this end absorbed dose normalizations were performed for the European clinical centers at the Joint Research Centre of the European Commission, Petten (The Netherlands), Nuclear Research Institute, Rez (Czech Republic), VTT, Espoo (Finland), and Studsvik, Nyköping (Sweden). Each European group prepared a treatment plan calculation that was bench-marked against Massachusetts Institute of Technology (MIT) dosimetry performed in a large, water-filled phantom to uniformly evaluate dose specifications with an estimated precision of +/-2%-3%. These normalizations were compared with those derived from an earlier exchange between Brookhaven National Laboratory (BNL) and MIT in the USA. Neglecting the uncertainties related to biological weighting factors, large variations between calculated and measured dose are apparent that depend upon the 10B uptake in tissue. Assuming a boron concentration of 15 microg g(-1) in normal tissue, differences in the evaluated maximum dose to brain for the same nominal specification of 10 Gy(w) at the different facilities range between 7.6 and 13.2 Gy(w) in the trials using boronophenylalanine (BPA) as the boron delivery compound and between 8.9 and 11.1 Gy(w) in the two boron sulfhydryl (BSH) studies. Most notably, the value for the same specified dose of 10 Gy(w) determined at the different participating centers using BPA is significantly higher than at BNL by 32% (MIT), 43% (VTT), 49% (JRC), and 74% (Studsvik). Conversion of dose specification is now possible between all active participants and should be incorporated into future multi-center patient analyses.
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Affiliation(s)
- K J Riley
- Nuclear Reactor Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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93
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Aromando RF, Heber EM, Trivillin VA, Nigg DW, Schwint AE, Itoiz ME. Insight into the mechanisms underlying tumor response to boron neutron capture therapy in the hamster cheek pouch oral cancer model. J Oral Pathol Med 2009; 38:448-54. [PMID: 19141057 DOI: 10.1111/j.1600-0714.2008.00720.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The therapeutic success of different boron neutron capture therapy (BNCT) protocols employing the hamster cheek pouch oral cancer model has been previously reported by our laboratory. The aim of this study was to explore potential mechanisms of BNCT-induced damage to tumor in terms of potential inhibition in DNA synthesis and induction of apoptosis in the tumors that underwent partial remission following application of the different BNCT protocols in this model. MATERIALS AND METHODS We evaluated DNA synthesis employing incorporation of 5-bromo-2'-deoxyuridine as an end-point. Apoptosis was evaluated by immunohistochemistry employing the deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling technique and Bax and Bcl-2 labeling. These studies were performed in tumors that underwent partial remission 1-30 days post-BNCT mediated by boronophenylalanine (BPA), GB-10 (Na(2)(10)B(10)H(10)) or (BPA + GB-10). RESULTS BNCT exerted a marked inhibitory effect on DNA synthesis in tumors for all the protocols under study. The inhibitory effect of BPA-BNCT occurred as soon as 1 day post-treatment (P < 0.001). Conversely, the effect of GB-10-BNCT became apparent 7-14 days after therapy (P < 0.001) and was sustained until killed at 30 days post-treatment (P < 0.001). (GB-10 + BPA)-BNCT exerted a rapid and persistent effect, conceivably because of the combined effect of BNCT mediated by both boron compounds. The apoptosis studies did not show differences between the pre-treatment group and any of the BNCT groups. CONCLUSIONS One of the mechanisms involved in BNCT-induced tumor control in our model would be an inhibitory effect on DNA synthesis. Apoptosis does not seem to have a significant role in BNCT-induced tumor control in our model.
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Affiliation(s)
- Romina F Aromando
- Department of Oral Pathology, Faculty of Dentistry, University of Buenos Aires, Buenos Aires, Argentina.
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94
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Kawabata S, Miyatake SI, Kuroiwa T, Yokoyama K, Doi A, Iida K, Miyata S, Nonoguchi N, Michiue H, Takahashi M, Inomata T, Imahori Y, Kirihata M, Sakurai Y, Maruhashi A, Kumada H, Ono K. Boron neutron capture therapy for newly diagnosed glioblastoma. JOURNAL OF RADIATION RESEARCH 2009; 50:51-60. [PMID: 18957828 DOI: 10.1269/jrr.08043] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We evaluate the clinical results of a form of tumor selective particle radiation known as boron neutron capture therapy (BNCT) for newly-diagnosed glioblastoma (NDGB) patients, especially in combination with X-ray treatment (XRT). Between 2002 and 2006, we treated 21 patients of NDGB with BNCT utilizing sodium borocaptate and boronophenylalanine simultaneously. The first 10 were treated with only BNCT (protocol 1), and the last 11 were treated with BNCT followed by XRT of 20 to 30 Gy (protocol 2) to reduce the possibility of local tumor recurrence. No chemotherapy was applied until tumor progression was observed. The patients treated with BNCT (protocol 1 plus 2) showed a significant survival prolongation compared with the institutional historical controls. BNCT also showed favorable results in correspondence with the RTOG- and EORTC-RPA subclasses. The median survival time (MST) was 15.6 months for protocols 1 and 2 together. For protocol 2, the MST was 23.5 months. The main causes of death were cerebrospinal fluid dissemination as well as local recurrence. Our modified BNCT protocol showed favorable results of patients with NDGB not only for those with good prognoses but also for those with poor prognoses.
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Affiliation(s)
- Shinji Kawabata
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan
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95
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Porcari P, Capuani S, D'Amore E, Lecce M, La Bella A, Fasano F, Campanella R, Migneco LM, Pastore FS, Maraviglia B. In vivo (19)F MRI and (19)F MRS of (19)F-labelled boronophenylalanine-fructose complex on a C6 rat glioma model to optimize boron neutron capture therapy (BNCT). Phys Med Biol 2008; 53:6979-89. [PMID: 19001698 DOI: 10.1088/0031-9155/53/23/021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Boron neutron capture therapy (BNCT) is a promising binary modality used to treat malignant brain gliomas. To optimize BNCT effectiveness a non-invasive method is needed to monitor the spatial distribution of BNCT carriers in order to estimate the optimal timing for neutron irradiation. In this study, in vivo spatial distribution mapping and pharmacokinetics evaluation of the (19)F-labelled boronophenylalanine (BPA) were performed using (19)F magnetic resonance imaging ((19)F MRI) and (19)F magnetic resonance spectroscopy ((19)F MRS). Characteristic uptake of (19)F-BPA in C6 glioma showed a maximum at 2.5 h after compound infusion as confirmed by both (19)F images and (19)F spectra acquired on blood samples collected at different times after infusion. This study shows the ability of (19)F MRI to selectively map the bio-distribution of (19)F-BPA in a C6 rat glioma model, as well as providing a useful method to perform pharmacokinetics of BNCT carriers.
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Affiliation(s)
- Paola Porcari
- CNR-INFM SOFT, Physics Department, University of Rome "Sapienza", Rome, Italy.
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96
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Survival benefit of Boron neutron capture therapy for recurrent malignant gliomas. J Neurooncol 2008; 91:199-206. [PMID: 18813875 DOI: 10.1007/s11060-008-9699-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 09/08/2008] [Indexed: 10/21/2022]
Abstract
We have applied boron neutron capture therapy (BNCT) to malignant brain tumors. Here we evaluated the survival benefit of BNCT for recurrent malignant glioma (MG). Since 2002, we have treated 22 cases of recurrent MG with BNCT. Survival time was analyzed with special reference to recursive partitioning analysis (RPA) classification, by Carson et al. (J Clin Oncol 25:2601-2606, 2007). Median survival times (MSTs) after BNCT for all patients and for glioblastoma as on-study histology at recurrence was 10.8 months (n = 22; 95% CI, 7.3-12.8 months) and 9.6 months (n = 19; 95% CI, 6.9-11.4 months), respectively. In our study, MST for the high-risk RPA classes was 9.1 months (n = 11; 95% CI, 4.4-11.0 months). By contrast, the original journal data showed that the MST of the same RPA classes was 4.4 months (n = 129; 95% CI, 3.6-5.4 months). BNCT showed a survival benefit for recurrent MG, especially in the high-risk group.
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97
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H-Stenstam B. Comments to article: Henriksson R et al., Boron neutron capture therapy (BNCT) for glioblastoma multiforme: A phase II study evaluating a prolonged high-dose of boronophenylalanine (BPA) Radiother Oncol (2008). Radiother Oncol 2008; 88:287-8; author reply 288. [DOI: 10.1016/j.radonc.2008.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 05/28/2008] [Accepted: 05/29/2008] [Indexed: 10/21/2022]
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