Targeted dose enhancement in radiotherapy for breast cancer using gold nanoparticles, part 1: A radiobiological model study

Approaches for reducing chemo/radiation-induced cardiotoxicity by nanoparticles

Nanoparticles are fascinating and encouraging carriers for cancer treatment due to their extraordinary properties and potential applications in targeted drug delivery, treatment, and diagnosis. Experimental studies including in vitro and in vivo examinations show that nanoparticles can cause a revolution in different aspects of cancer therapy. Normal tissue toxicity and early and late consequences are the major limitations of cancer therapy by radiotherapy and chemotherapy. However, the delivery of drugs into tumors or reducing the accumulation of drugs in normal tissues can permit a more satisfactory response of malignancies to therapy with more inferior side effects. Cardiac toxicity is one of the major problems for chemotherapy and radiotherapy. Therefore, several experimental studies have been performed to minimize the degenerative impacts of cancer treatment on the heart and also enhance the influences of radiotherapy and chemotherapy agents in cancers. This review article emphasizes the benefits of nanoparticle-based drug delivery techniques, including minimizing the exposure of the heart to anticancer drugs, enhancing the accumulation of drugs in cancers, and expanding the effectiveness of radiotherapy. The article also discusses the challenges and problems accompanied with nanoparticle-based drug delivery techniques such as toxicity, which need to be addressed through further research. Moreover, the article emphasizes the importance of developing safe and effective nanoparticle-based therapies that can be translated into clinical practice.

Application of unlaminated EBT3 film dosimeter for quantification of dose enhancement using silver nanoparticle-embedded alginate film

Purpose.The paper describes the application of unlaminated Gafchromic EBT3 film dosimeter for quantification of dose enhancement using locally synthesized silver nanoparticle-embedded alginate film (AgNPs-Alg film) for nanoparticles-aided radiotherapy.Materials and Methods.AgNPs-Alg film was synthesized and characterized using standard techniques. The unlaminated Gafchromic EBT3 film was specially customized for dosimetric measurement. The dose enhancements due to AgNPs-Alg film was experimentally determined for ISO wide spectrum x-rays series (average energy ranging from 57-137 keV) and 6 and 10 MV x-rays using laminated and unlaminated Gafchromic EBT3 film. The radiation dose of 1 Gy was delivered to a combination of AgNPs-Alg films and EBT3 film.Results.Ultraviolet-Visible spectroscopy of silver nanoparticles shows a surface plasmon resonance peak at 400 nm. The average particle size of 13 ± 2 nm was measured using Atomic Force Microscopy. For unlaminated film, the dose enhancements of 29%, 23%, 14% and 2% was observed for ISO wide spectrum x-rays having average energy of 57, 79, 104 and 137 keV, respectively. The dose enhancement was negligible for 6 and 10 MV x-rays. In the case of laminated film, no significant dose enhancement was measured for all the x-ray energies.Conclusion.The unlaminated Gafchromic EBT3 film can be a suitable choice for the measurement of dose enhancement. Further, silver nanoparticles can be used during nanoparticle-aided radiotherapy when irradiated at low x-ray energy.

Nanoparticle radiosensitization: from extended local effect modeling to a survival modification framework of compound Poisson additive killing and its carbon dots validation

Objective. To construct an analytical model instead of local effect modeling for the prediction of the biological effectiveness of nanoparticle radiosensitization. Approach. An extended local effects model is first proposed with a more comprehensive description of the nanoparticles mediated local killing enhancements, but meanwhile puts forward challenging issues that remain difficult and need to be further studied. As a novel method instead of local effect modeling, a survival modification framework of compound Poisson additive killing is proposed, as the consequence of an independent additive killing by the assumed equivalent uniform doses of individual nanoparticles per cell under the LQ model. A compound Poisson killing (CPK) model based on the framework is thus derived, giving a general expression of nanoparticle mediated LQ parameter modification. For practical use, a simplified form of the model is also derived, as a concentration dependent correction only to the α parameter, with the relative correction (α″/α) dominated by the mean number, and affected by the agglomeration of nanoparticles per cell. For different agglomeration state, a monodispersion model of the dispersity factor η = 1, and an agglomeration model of 2/3 < η < 1, are provided for practical prediction of (α″/α) value respectively. Main results. Initial validation by the radiosensitization of HepG2 cells by carbon dots showed a high accuracy of the CPK model. In a safe range of concentration (0.003–0.03 μg μl−1) of the carbon dots, the prediction errors of the monodispersion and agglomeration models were both within 2%, relative to the clonogenic survival data of the sensitized HepG2 cells. Significance. The compound Poisson killing model provides a novel approach for analytical prediction of the biological effectiveness of nanoparticle radiosensitization, instead of local effect modeling.

Advances in modelling gold nanoparticle radiosensitization using new Geant4-DNA physics models

Gold nanoparticles have demonstrated significant radiosensitization of cancer treatment with x-ray radiotherapy. To understand the mechanisms at the basis of nanoparticle radiosensitization, Monte Carlo simulations are used to investigate the dose enhancement, given a certain nanoparticle concentration and distribution in the biological medium. Earlier studies have ordinarily used condensed history physics models to predict nanoscale dose enhancement with nanoparticles. This study uses Geant4-DNA complemented with novel track structure physics models to accurately describe electron interactions in gold and to calculate the dose surrounding gold nanoparticle structures at nanoscale level. The computed dose in silico due to a clinical kilovoltage beam and the presence of gold nanoparticles was related to in vitro brain cancer cell survival using the local effect model. The comparison of the simulation results with radiobiological experimental measurements shows that Geant4-DNA and local effect model can be used to predict cell survival in silico in the case of x-ray kilovoltage beams.

Mechanisms of nanoparticle radiosensitization

Metal-based nanoparticles applied to potentiating the effects of radiotherapy have drawn significant attention from the research community and are now available clinically. By improving our mechanistic understanding, nanoparticles are likely to evolve to provide very significant improvements in radiotherapy outcomes with only incremental increase in cost. This review critically assesses the inconsistent observations surrounding physical, physicochemical, chemical and biological mechanisms of radiosensitization. In doing so, a number of needs are identified for continuing research and are highlighted. The large degree of variability from one nanoparticle to another emphasizes that it is a mistake to generalize nanoparticle radiosensitizer mechanisms. Nanoparticle formulations should be considered in an analogous way as pharmacological agents and as a broad class of therapeutic agents, needing to be considered with a high degree of individuality with respect to their interactions and ultimate impact on radiobiological response. In the same way that no universal anti-cancer drug exists, it is unlikely that a single nanoparticle formulation will lead to the best therapeutic outcomes for all cancers. The high degree of complexity and variability in mechanistic action provides notable opportunities for nanoparticle formulations to be optimized for specific indications. This article is categorized under: Therapeutic Approaches and Drug Discovery > Emerging Technologies Nanotechnology Approaches to Biology > Nanoscale Systems in Biology.

Biological dose-enhancement analysis with Monte Carlo simulation for Lipiodol for photon beams

Background

Previously, the physical dose-enhancement factor (D_physEF) enhancement was introduced. However, the dose enhancement considering the biological effectiveness was not shown.

Purpose

The aim of the current study was to evaluate the biological dose-enhancement factor (D_bioEF) by the dose rate and to compare the D_physEF and the D_bioEF in Lipiodol for liver Stereotactic Body Radiation Therapy (SBRT).

Materials and methods

Flattening-filter-free (FFF) 6-MV (6MVX) and 10MVX beams were delivered by TrueBeam. A virtual inhomogeneity phantom and a liver SBRT patient-treatment plan were used. The D_physEF and lineal energy distribution ( y ) distribution was calculated from Monte Carlo simulations. Using a microdosimetric-kinetic (MK) model that is estimated based on the linear-quadratic formula for Lipiodol using human liver hepatocellular cells (HepG2), the biological dose and biological dose enhancement factor (D_bioEF) were calculated. The dose rate in the simulation was changed from 0.1 to 24 Gy/min.

Results

The D_bioEF (DR:2Gy/min) and D_physEF with 10MVX FFF beam were 23.2% and 19.1% at maximum and 12.8% and 11.1% on average in the Lipiodol. In the comparison of the D_bioEF between 0.1-24 Gy/min, the D_bioEF was 21.2% and 11.1% with 0.1 Gy/min for 6MVX and 10 MVX, respectively. The D_bioEF was larger than DEF for the 6MVX and 10MVX FFF beams. In clinical cases with the 10MVX FFF beam, the D_bioEF and D_physEF in the Lipiodol region can increase the in-tumor dose by approximately 11% and 10%, respectively, without increasing the dose to normal tissue.

Conclusions

The lower-energy and higher-dose-rate beams were contributed to the biological dose. The Lipiodol caused the enhancement of the physical dose and biological effectiveness.

Advances in knowledge

The biological dose enhancement (D_bioEF) should be considered in the high-density material such as the Lipiodol.

Systematic quantification of nanoscopic dose enhancement of gold nanoparticles in ion beams

High-Z material nanoparticles are being studied as localized dose enhancers in radiotherapeutic applications. Here, the nano-scale physical dose enhancement of proton, carbon and oxygen ion beam radiation by gold nanoparticles was studied by means of Monte Carlo track structure simulation with the TRAX code. We present 2D distributions and radial profiles of the additional dose and the dose enhancement factor for two geometries which consider an isolated and a water-embedded nanoparticle, respectively. Different nanoparticle sizes (radius of 1.2-22 nm) were found to yield qualitatively different absolute and relative dose enhancement distributions and different maximum dose enhancement factors (up to 20). Whereas the smallest nanoparticles produced the highest local dose enhancement factor close to the metal, larger ones led to lower, more diffuse dose enhancement factors that contributed more at larger distances. Differential absorption effects inside the metal were found to be responsible for those characteristics. For the energy range 15-204 MeVu^-1, also a mild trend with ion E/A, regardless of the ion species, was found for embedded nanoparticles. In analogy to the width of the ion track itself, slower ions increased the enhancement at the nanoparticle surface. In contrast, no dependence on linear energy transfer was encountered. For slower ions (3-10 MeVu^-1), the enhancement effect began to break down over all distances. Finally, the significance of any indirect physical effect was excluded, giving important hints especially in view of the low probabilities (at realistic concentrations and fluences) of direct ion-NP-hits. The very localized nature of the physical dose enhancement found suggests a strong action upon targets closeby, but no relevant effect at cellular distances. When pondering different possible damage enhancement mechanisms of gold nanoparticles in the context of published in vitro and in vivo experimental results, biological pathways are likely to play the key role.

AN ALGORITHM TO DETERMINE THE NANODOSIMETRIC IMPACT OF GOLD NANOPARTICLES ON CELL MODELS

High-Z nanomaterials, e.g. gold nanoparticles (GNPs), are being investigated worldwide for potential application in radiation imaging and therapy. Photon irradiation of cells containing GNP was shown to produce enhanced DNA damage which is believed to be related to the increased secondary electron (SE) yield and ionization density. In this work, an algorithm was developed for simulating the physical radiation damage inside the nucleus of a spherical cell model for the case of uniformly distributed GNPs within the cytoplasm. Previously calculated energy spectra of SE emerging from a single NP irradiated with different photon sources are used as input to obtain the SE energy spectrum at the surface of the cell nucleus. In a second step, the SE transport inside the cell nucleus is simulated with a track structure Monte Carlo code to obtain the spatial distribution of ionizations. The preliminary results presented here show that the developed algorithm allows for a fast calculation of the SE spectra at the cell nucleus surface, thus enabling a more realistic assessment of the ionization density inside the cell nucleus than that obtained by the simulation of a single GNP. Furthermore, the algorithm can be easily adapted to investigate both the effect of GNP clustering and the impact of GNP-GNP interactions on SE spectra.

Enhancing radiotherapy effect in breast cancer with nanoparticles: A review

Amongst all efforts for improving oncological management outcomes, nanoparticles enhanced radiation for breast cancer patient's treatment is a novel approach that has grown interest for research in the last decade. Multiple preclinical data has been published, from all around the globe; however, clinical evidence is still insufficient for implementing the method in routine practice and in disease specific management. Gold nanoparticles (AuNP), which may be among the most studed materials, account for the majority of available data; however, some new materials have also been used in preclinical settings. Without any safety data available at the moment to support an active use, dosimetric in vitro and in vivo information seems to be consistent with a very promising and hopeful panorama for clinical applications. This review evaluates existing dosimetric data in breast cancer tissue, and a probable future impact in treatment choices and patient outcomes, as further investigation is required in a clinical setting.

Towards photon radiotherapy treatment planning with high Z nanoparticle radiosensitisation agents: the Relative Biological Effective Dose (RBED) framework

A novel treatment planning framework, the Relative Biological Effective Dose (RBED), for high Z nanoparticle (NP)-enhanced photon radiotherapy is developed and tested in silico for the medical exemplar of neoadjuvant (preoperative) breast cancer MV photon radiotherapy. Two different treatment scenarios, conventional and high Z NP enhanced, were explored with a custom Geant4 application that was developed to emulate the administration of a single 2 Gy fraction as part of a 50 Gy radiotherapy treatment plan. It was illustrated that there was less than a 1% difference in the dose deposition throughout the standard and high Z NP-doped adult female phantom. Application of the RBED framework found that the extent of possible biological response with high Z NP doping was great than expected via the dose deposition alone. It is anticipated that this framework will assist the scientific community in future high Z NP-enhanced in-silico, pre-clinical and clinical trials.

Gold Nanoparticles in Radiotherapy and Recent Progress in Nanobrachytherapy

Over the last few decades, gold nanoparticles (GNPs) have emerged as "radiosensitizers" in oncology. Radiosensitizers are additives that can enhance the effects of radiation on biological tissues treated with radiotherapy. The interaction of photons with GNPs leads to the emission of low-energy and short-range secondary electrons, which in turn increase the dose deposited in tissues. In this context, GNPs are the subject of intensive theoretical and experimental studies aiming at optimizing the parameters leading to greater dose enhancement and highest therapeutic effect. This review describes the main mechanisms occurring between photons and GNPs that lead to dose enhancement. The outcome of theoretical simulations of the interactions between GNPs and photons is presented. Finally, the findings of the most recent in vivo studies about interactions between GNPs and photon sources (e.g., external beams, brachytherapy sources, and molecules labeled with radioisotopes) are described. The advantages and challenges inherent to each of these approaches are discussed. Future directions, providing new guidelines for the successful translation of GNPs into clinical applications, are also highlighted.

Dual-Energy CT Imaging of Tumor Liposome Delivery After Gold Nanoparticle-Augmented Radiation Therapy

Gold nanoparticles (AuNPs) are emerging as promising agents for both cancer therapy and computed tomography (CT) imaging. AuNPs absorb x-rays and subsequently release low-energy, short-range photoelectrons during external beam radiation therapy (RT), increasing the local radiation dose. When AuNPs are near tumor vasculature, the additional radiation dose can lead to increased vascular permeability. This work focuses on understanding how tumor vascular permeability is influenced by AuNP-augmented RT, and how this effect can be used to improve the delivery of nanoparticle chemotherapeutics.

Methods: Dual-energy CT was used to quantify the accumulation of both liposomal iodine and AuNPs in tumors following AuNP-augmented RT in a mouse model of primary soft tissue sarcoma. Mice were injected with non-targeted AuNPs, RGD-functionalized AuNPs (vascular targeting), or no AuNPs, after which they were treated with varying doses of RT. The mice were injected with either liposomal iodine (for the imaging study) or liposomal doxorubicin (for the treatment study) 24 hours after RT. Increased tumor liposome accumulation was assessed by dual-energy CT (iodine) or by tracking tumor treatment response (doxorubicin).

Results: A significant increase in vascular permeability was observed for all groups after 20 Gy RT, for the targeted and non-targeted AuNP groups after 10 Gy RT, and for the vascular-targeted AuNP group after 5 Gy RT. Combining targeted AuNPs with 5 Gy RT and liposomal doxorubicin led to a significant tumor growth delay (tumor doubling time ~ 8 days) compared to AuNP-augmented RT or chemotherapy alone (tumor doubling time ~3-4 days).

Conclusions: The addition of vascular-targeted AuNPs significantly improved the treatment effect of liposomal doxorubicin after RT, consistent with the increased liposome accumulation observed in tumors in the imaging study. Using this approach with a liposomal drug delivery system can increase specific tumor delivery of chemotherapeutics, which has the potential to significantly improve tumor response and reduce the side effects of both RT and chemotherapy.

Targeted dose enhancement in radiotherapy for breast cancer using gold nanoparticles, part 2: A treatment planning study

PURPOSE

In recent years, there has been growing interest in the use of gold nanoparticles (GNPs) combined with radiotherapy to improve tumor control. However, the complex interplay between GNP uptake and dose distribution in realistic clinical treatment are still somewhat unknown.

METHODS

The effects of different concentrations of 2 nm diameter GNP, ranging from 0 to 5×105 nanoparticles per tumoral cell, were theoretically investigated. A parametrization of the GNP distribution outside the target was carried out using a Gaussian standard deviation σ, from a zero value, relative to a selective concentration of GNPs inside the tumor volume alone, to 50mm, when GNPs are spatially distributed also in the healthy tissues surrounding the tumor. Treatment simulations of five patients with breast cancer were performed with 6 and 15 MV photons assuming a partial breast irradiation. A closed analytical reformulation of the Local Effect Model coupled with the estimation of local dose deposited around a GNP was validated using an in vitro study for MDA-MB-231 tumoral cells. The expected treatment outcome was quantified in terms of tumor control probability (TCP) and normal tissue complication probability (NTCP) as a function of the spatially varying gold uptake.

RESULTS

Breast cancer treatment planning simulations show improved treatment outcomes when GNPs are selectively concentrated in the tumor volume (i.e., σ = 0 mm). In particular, the TCP increases up to 18% for 5×105 nanoparticles per cell in the tumor region depending on the treatment schedules, whereas an improvement of the therapeutic index is observed only for concentrations of about 105 GNPs per tumoral cell and limited spatial distribution in the normal tissue.

CONCLUSIONS

The model provides a useful framework to estimate the nanoparticle-driven radiosensitivity in breast cancer treatment irradiation, accounting for the complex interplay between dose and GNP uptake distributions.