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Shen H, Wang H, Mo J, Zhang J, Xu C, Sun F, Ou X, Zhu X, Du L, Ju H, Ye R, Shi G, Kwok RT, Lam JW, Sun J, Zhang T, Ning S, Tang BZ. Unrestricted molecular motions enable mild photothermy for recurrence-resistant FLASH antitumor radiotherapy. Bioact Mater 2024; 37:299-312. [PMID: 38694765 PMCID: PMC11061705 DOI: 10.1016/j.bioactmat.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/05/2024] [Accepted: 03/15/2024] [Indexed: 05/04/2024] Open
Abstract
Ultrahigh dose-rate (FLASH) radiotherapy is an emerging technology with excellent therapeutic effects and low biological toxicity. However, tumor recurrence largely impede the effectiveness of FLASH therapy. Overcoming tumor recurrence is crucial for practical FLASH applications. Here, we prepared an agarose-based thermosensitive hydrogel containing a mild photothermal agent (TPE-BBT) and a glutaminase inhibitor (CB-839). Within nanoparticles, TPE-BBT exhibits aggregation-induced emission peaked at 900 nm, while the unrestricted molecular motions endow TPE-BBT with a mild photothermy generation ability. The balanced photothermal effect and photoluminescence are ideal for phototheranostics. Upon 660-nm laser irradiation, the temperature-rising effect softens and hydrolyzes the hydrogel to release TPE-BBT and CB-839 into the tumor site for concurrent mild photothermal therapy and chemotherapy, jointly inhibiting homologous recombination repair of DNA. The enhanced FLASH radiotherapy efficiently kills the tumor tissue without recurrence and obvious systematic toxicity. This work deciphers the unrestricted molecular motions in bright organic fluorophores as a source of photothermy, and provides novel recurrence-resistant radiotherapy without adverse side effects.
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Affiliation(s)
- Hanchen Shen
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science, and State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
| | - Hongbin Wang
- The Second Ward of Breast Surgery, Cancer Hospital Affiliated to Harbin Medical University, Heilongjiang, 150081, China
| | - Jianlan Mo
- Department of Anesthesiology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jianyu Zhang
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science, and State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
| | - Changhuo Xu
- MOE Frontiers Science Center for Precision Oncology, Faculty of Health Sciences, University of Macau, Macao, China
| | - Feiyi Sun
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science, and State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
| | - Xinwen Ou
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science, and State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
| | - Xinyan Zhu
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science, and State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
| | - Lidong Du
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science, and State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
- MOE Frontiers Science Center for Precision Oncology, Faculty of Health Sciences, University of Macau, Macao, China
| | - Huaqiang Ju
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science, and State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
| | - Ruquan Ye
- Department of Chemistry, State Key Laboratory of Marine Pollution, City University of Hong Kong, Hong Kong, China
| | - Guangfu Shi
- Department of Breast Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ryan T.K. Kwok
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science, and State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
| | - Jacky W.Y. Lam
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science, and State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
| | - Jianwei Sun
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science, and State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
| | - Tianfu Zhang
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China
| | - Shipeng Ning
- Department of Breast Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ben Zhong Tang
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science, and State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
- School of Science and Engineering, Shenzhen Institute of Aggregate Science and Technology, The Chinese University of Hong Kong, Shenzhen (CUHK-Shenzhen), Guangdong, 518172, China
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Garibaldi C, Beddar S, Bizzocchi N, Tobias Böhlen T, Iliaskou C, Moeckli R, Psoroulas S, Subiel A, Taylor PA, Van den Heuvel F, Vanreusel V, Verellen D. Minimum and optimal requirements for a safe clinical implementation of ultra-high dose rate radiotherapy: A focus on patient's safety and radiation protection. Radiother Oncol 2024; 196:110291. [PMID: 38648991 DOI: 10.1016/j.radonc.2024.110291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/28/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Cristina Garibaldi
- IEO, Unit of Radiation Research, European Institute of Oncology IRCCS, 20141 Milan, Italy.
| | - Sam Beddar
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicola Bizzocchi
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - Till Tobias Böhlen
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Charoula Iliaskou
- Division of Medical Physics, Department of Radiation Oncology, University Medical Center Freiburg, 79106, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Raphaël Moeckli
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Serena Psoroulas
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - Anna Subiel
- National Physical Laboratory, Medical Radiation Science, Teddington, UK
| | - Paige A Taylor
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frank Van den Heuvel
- Zuidwest Radiotherapeutisch Institute, Vlissingen, the Netherlands; Dept of Oncology, University of Oxford, Oxford, UK
| | - Verdi Vanreusel
- Iridium Netwerk, Antwerp University (Centre for Oncological Research, CORE), Antwerpen, Belgium; SCK CEN (Research in Dosimetric Applications), Mol, Belgium
| | - Dirk Verellen
- Iridium Netwerk, Antwerp University (Centre for Oncological Research, CORE), Antwerpen, Belgium
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Yagi M, Shimizu S, Hamatani N, Miyoshi T, Nomura T, Toyoda T, Nakatani M, Tsubouchi T, Shimizu M, Kuwana Y, Umezawa M, Takashina M, Nishio T, Koizumi M, Ogawa K, Kanai T. Development and characterization of a dedicated dose monitor for ultrahigh-dose-rate scanned carbon-ion beams. Sci Rep 2024; 14:11574. [PMID: 38773165 PMCID: PMC11109334 DOI: 10.1038/s41598-024-62148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
The current monochromatic beam mode (i.e., uHDR irradiation mode) of the scanned carbon-ion beam lacks a dedicated dose monitor, making the beam control challenging. We developed and characterized a dedicated dose monitor for uHDR-scanned carbon-ion beams. Furthermore, a simple measurable dose rate (dose rate per spot (DRspot)) was suggested by using the developed dose monitor and experimentally validating quantities relevant to the uHDR scanned carbon-ion beam. A large plane-parallel ionization chamber (IC) with a smaller electrode spacing was used to reduce uHDR recombination effects, and a dedicated operational amplifier was manufactured for the uHDR-scanned carbon-ion beam. The dose linearity of the IC was within ± 1% in the range of 1.8-12.3 Gy. The spatial inhomogeneity of the dose response of the IC was ± 0.38% inside the ± 40-mm detector area, and a systematic deviation of approximately 2% was measured at the edge of the detector. uHDR irradiation with beam scanning was tested and verified for different doses at the corresponding dose rates (in terms of both the average dose rate and DRspot). We confirmed that the dose monitor can highlight the characteristics (i.e., dose, dose rate, and dose profile) of uHDR-scanned carbon-ion beams at several dose levels in the monochromatic beam mode.
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Affiliation(s)
- Masashi Yagi
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Shinichi Shimizu
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Noriaki Hamatani
- Department of Medical Physics, Osaka Heavy Ion Therapy Center, Osaka, Japan
| | - Takuto Miyoshi
- Hitachi, Ltd. Research & Development Group, Ibaraki, Japan
- Healthcare Business Groupe, Hitachi High-Tech Corporation, Chiba, Japan
| | - Takuya Nomura
- Healthcare Business Division, Hitachi, Ltd, Chiba, Japan
- Healthcare Business Groupe, Hitachi High-Tech Corporation, Chiba, Japan
| | - Takashi Toyoda
- Healthcare Business Division, Hitachi, Ltd, Chiba, Japan
- Healthcare Business Groupe, Hitachi High-Tech Corporation, Chiba, Japan
| | - Mahoro Nakatani
- Medical Physics Laboratory, Division of Health Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshiro Tsubouchi
- Department of Medical Physics, Osaka Heavy Ion Therapy Center, Osaka, Japan
| | - Masaki Shimizu
- Healthcare Business Division, Hitachi, Ltd, Chiba, Japan
- Healthcare Business Groupe, Hitachi High-Tech Corporation, Chiba, Japan
| | - Yoshiaki Kuwana
- Healthcare Business Division, Hitachi, Ltd, Chiba, Japan
- Healthcare Business Groupe, Hitachi High-Tech Corporation, Chiba, Japan
| | - Masumi Umezawa
- Healthcare Business Division, Hitachi, Ltd, Chiba, Japan
- Healthcare Business Groupe, Hitachi High-Tech Corporation, Chiba, Japan
| | - Masaaki Takashina
- Department of Medical Physics, Osaka Heavy Ion Therapy Center, Osaka, Japan
| | - Teiji Nishio
- Medical Physics Laboratory, Division of Health Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka, Japan
- Department of Radiation Oncology, Nozaki Tokushukai Hospital, Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tatsuaki Kanai
- Department of Medical Physics, Osaka Heavy Ion Therapy Center, Osaka, Japan
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Thwaites DI, Prokopovich DA, Garrett RF, Haworth A, Rosenfeld A, Ahern V. The rationale for a carbon ion radiation therapy facility in Australia. J Med Radiat Sci 2024; 71 Suppl 2:59-76. [PMID: 38061984 PMCID: PMC11011608 DOI: 10.1002/jmrs.744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/17/2023] [Indexed: 04/13/2024] Open
Abstract
Australia has taken a collaborative nationally networked approach to achieve particle therapy capability. This supports the under-construction proton therapy facility in Adelaide, other potential proton centres and an under-evaluation proposal for a hybrid carbon ion and proton centre in western Sydney. A wide-ranging overview is presented of the rationale for carbon ion radiation therapy, applying observations to the case for an Australian facility and to the clinical and research potential from such a national centre.
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Affiliation(s)
- David I. Thwaites
- Institute of Medical Physics, School of PhysicsUniversity of SydneySydneyNew South WalesAustralia
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
- Radiotherapy Research Group, Institute of Medical ResearchSt James's Hospital and University of LeedsLeedsUK
| | | | - Richard F. Garrett
- Australian Nuclear Science and Technology OrganisationLucas HeightsNew South WalesAustralia
| | - Annette Haworth
- Institute of Medical Physics, School of PhysicsUniversity of SydneySydneyNew South WalesAustralia
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, School of PhysicsUniversity of WollongongSydneyNew South WalesAustralia
| | - Verity Ahern
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
- Westmead Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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Rank L, Dogan O, Kopp B, Mein S, Verona-Rinati G, Kranzer R, Marinelli M, Mairani A, Tessonnier T. Development and benchmarking of a dose rate engine for raster-scanned FLASH helium ions. Med Phys 2024; 51:2251-2262. [PMID: 37847027 PMCID: PMC10939952 DOI: 10.1002/mp.16793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Radiotherapy with charged particles at high dose and ultra-high dose rate (uHDR) is a promising technique to further increase the therapeutic index of patient treatments. Dose rate is a key quantity to predict the so-called FLASH effect at uHDR settings. However, recent works introduced varying calculation models to report dose rate, which is susceptible to the delivery method, scanning path (in active beam delivery) and beam intensity. PURPOSE This work introduces an analytical dose rate calculation engine for raster scanned charged particle beams that is able to predict dose rate from the irradiation plan and recorded beam intensity. The importance of standardized dose rate calculation methods is explored here. METHODS Dose is obtained with an analytical pencil beam algorithm, using pre-calculated databases for integrated depth dose distributions and lateral penumbra. Dose rate is then calculated by combining dose information with the respective particle fluence (i.e., time information) using three dose-rate-calculation models (mean, instantaneous, and threshold-based). Dose rate predictions for all three models are compared to uHDR helium ion beam (145.7 MeV/u, range in water of approximatively 14.6 cm) measurements performed at the Heidelberg Ion Beam Therapy Center (HIT) with a diamond-detector prototype. Three scanning patterns (scanned or snake-like) and four field sizes are used to investigate the dose rate differences. RESULTS Dose rate measurements were in good agreement with in-silico generated distributions using the here introduced engine. Relative differences in dose rate were below 10% for varying depths in water, from 2.3 to 14.8 cm, as well as laterally in a near Bragg peak area. In the entrance channel of the helium ion beam, dose rates were predicted within 7% on average for varying irradiated field sizes and scanning patterns. Large differences in absolute dose rate values were observed for varying calculation methods. For raster-scanned irradiations, the deviation between mean and threshold-based dose rate at the investigated point was found to increase with the field size up to 63% for a 10 mm × 10 mm field, while no significant differences were observed for snake-like scanning paths. CONCLUSIONS This work introduces the first dose rate calculation engine benchmarked to instantaneous dose rate, enabling dose rate predictions for physical and biophysical experiments. Dose rate is greatly affected by varying particle fluence, scanning path, and calculation method, highlighting the need for a consensus among the FLASH community on how to calculate and report dose rate in the future. The here introduced engine could help provide the necessary details for the analysis of the sparing effect and uHDR conditions.
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Affiliation(s)
- Luisa Rank
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Karlsruhe Institute of Technology (KIT), Faculty of Physics, Karlsruhe, Germany
| | - Ozan Dogan
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg University, Faculty of Physics and Astronomy, Heidelberg, Germany
| | - Benedikt Kopp
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stewart Mein
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University Hospital (UKHD), Heidelberg Faculty of Medicine (MFHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Rafael Kranzer
- PTW-Freiburg, Freiburg, Germany
- University Clinic for Medical Radiation Physics, Medical Campus Pius Hospital, Carl von Ossietzky University Oldenburg, Germany
| | - Marco Marinelli
- Industrial Engineering Department, University of Rome “Tor Vergata”, Rome, Italy
| | - Andrea Mairani
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University Hospital (UKHD), Heidelberg Faculty of Medicine (MFHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Physics, National Centre of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University Hospital (UKHD), Heidelberg Faculty of Medicine (MFHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Shiraishi Y, Matsuya Y, Fukunaga H. Possible mechanisms and simulation modeling of FLASH radiotherapy. Radiol Phys Technol 2024; 17:11-23. [PMID: 38184508 DOI: 10.1007/s12194-023-00770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024]
Abstract
FLASH radiotherapy (FLASH-RT) has great potential to improve patient outcomes. It delivers radiation doses at an ultra-high dose rate (UHDR: ≥ 40 Gy/s) in a single instant or a few pulses. Much higher irradiation doses can be administered to tumors with FLASH-RT than with conventional dose rate (0.01-0.40 Gy/s) radiotherapy. UHDR irradiation can suppress toxicity in normal tissues while sustaining antitumor efficiency, which is referred to as the FLASH effect. However, the mechanisms underlying the effects of the FLASH remain unclear. To clarify these mechanisms, the development of simulation models that can contribute to treatment planning for FLASH-RT is still underway. Previous studies indicated that transient oxygen depletion or augmented reactions between secondary reactive species produced by irradiation may be involved in this process. To discuss the possible mechanisms of the FLASH effect and its clinical potential, we summarized the physicochemical, chemical, and biological perspectives as well as the development of simulation modeling for FLASH-RT.
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Affiliation(s)
- Yuta Shiraishi
- Graduate School of Health Sciences, Hokkaido University, N12 W5 Kita-Ku, Sapporo, Hokkaido, 060-0812, Japan
- Faculty of Health Sciences, Japan Healthcare University, 3-11-1-50 Tsukisamu-Higashi, Toyohira-Ku, Sapporo, Hokkaido, 062-0053, Japan
| | - Yusuke Matsuya
- Faculty of Health Sciences, Hokkaido University, N12 W5 Kita-Ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Hisanori Fukunaga
- Faculty of Health Sciences, Hokkaido University, N12 W5 Kita-Ku, Sapporo, Hokkaido, 060-0812, Japan.
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Pfuhl T, Weber U, Horst F, Durante M, Schuy C. Ground-based passive generation of Solar Particle Event spectra: Planning and manufacturing of a 3D-printed modulator. Z Med Phys 2024; 34:153-165. [PMID: 37940400 DOI: 10.1016/j.zemedi.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
The generation of space radiation on Earth is essential to study and predict the effects of radiation on space travelers, electronics, or materials during future long-term space missions. Next to the heavy ions of the galactic cosmic rays, solar particle events play a major role concerning the radiation risk in space, which consist of intermediate-energy protons with broad spectra and energies up to a few hundred MeV. This work describes an approach for the ground-based generation of solar particle events. As a proof of principle, a passive beam modulator with a specific funnel-shaped periodic structure was designed and is used to convert a monoenergetic proton beam into a spectral proton energy distribution, mimicking a solar particle event from August 1972, which is known as one of the strongest recorded SPE events. The required proton beam of 220 MeV can be generated at many existing particle accelerators at research or particle therapy facilities. The planning, manufacturing and testing of the modulator is described step by step. Its correct manufacturing and the characteristics of the solar particle event simulator are tested experimentally and by means of Monte Carlo simulations. Future modulators will follow the same concept with minor adjustments such as a larger lateral extension. As of now, the presented beam modulator is available to the research community to conduct experiments at GSI for exposure under solar particle event conditions. In addition, researchers can use and apply the described concept to design and print their individualized modulator to reproduce any desired solar particle event spectrum or request the presented modulator geometry from the authors.
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Affiliation(s)
- Tabea Pfuhl
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - Uli Weber
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.
| | - Felix Horst
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany; OncoRay - Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany(1)
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany; Technische Universität Darmstadt, Institut für Physik Kondensierter Materie, Darmstadt, Germany
| | - Christoph Schuy
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
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8
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Tessonnier T, Verona-Rinati G, Rank L, Kranzer R, Mairani A, Marinelli M. Diamond detectors for dose and instantaneous dose-rate measurements for ultra-high dose-rate scanned helium ion beams. Med Phys 2024; 51:1450-1459. [PMID: 37742343 PMCID: PMC10922163 DOI: 10.1002/mp.16757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/13/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND The possible emergence of the FLASH effect-the sparing of normal tissue while maintaining tumor control-after irradiations at dose-rates exceeding several tens of Gy per second, has recently spurred a surge of studies attempting to characterize and rationalize the phenomenon. Investigating and reporting the dose and instantaneous dose-rate of ultra-high dose-rate (UHDR) particle radiotherapy beams is crucial for understanding and assessing the FLASH effect, towards pre-clinical application and quality assurance programs. PURPOSE The purpose of the present work is to investigate a novel diamond-based detector system for dose and instantaneous dose-rate measurements in UHDR particle beams. METHODS Two types of diamond detectors, a microDiamond (PTW 60019) and a diamond detector prototype specifically designed for operation in UHDR beams (flashDiamond), and two different readout electronic chains, were investigated for absorbed dose and instantaneous dose-rate measurements. The detectors were irradiated with a helium beam of 145.7 MeV/u under conventional and UHDR delivery. Dose-rate delivery records by the monitoring ionization chamber and diamond detectors were studied for single spot irradiations. Dose linearity at 5 cm depth and in-depth dose response from 2 to 16 cm were investigated for both measurement chains and both detectors in a water tank. Measurements with cylindrical and plane-parallel ionization chambers as well as Monte-Carlo simulations were performed for comparisons. RESULTS Diamond detectors allowed for recording the temporal structure of the beam, in good agreement with the one obtained by the monitoring ionization chamber. A better time resolution of the order of few μs was observed as compared to the approximately 50 μs of the monitoring ionization chamber. Both diamonds detectors show an excellent linearity response in both delivery modalities. Dose values derived by integrating the measured instantaneous dose-rates are in very good agreement with the ones obtained by the standard electrometer readings. Bragg peak curves confirmed the consistency of the charge measurements by the two systems. CONCLUSIONS The proposed novel dosimetric system allows for a detailed investigation of the temporal evolution of UHDR beams. As a result, reliable and accurate determinations of dose and instantaneous dose-rate are possible, both required for a comprehensive characterization of UHDR beams and relevant for FLASH effect assessment in clinical treatments.
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Affiliation(s)
- Thomas Tessonnier
- Heidelberg Ion Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Luisa Rank
- Heidelberg Ion Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Faculty of Physics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Rafael Kranzer
- PTW-Freiburg, Freiburg, Germany
- University Clinic for Medical Radiation Physics, Medical Campus Pius Hospital, Carl von Ossietzky University, Oldenburg, Germany
| | - Andrea Mairani
- Heidelberg Ion Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Physics department, National Centre of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Marco Marinelli
- Industrial Engineering Department, University of Rome Tor Vergata, Rome, Italy
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Cordoni FG. A spatial measure-valued model for radiation-induced DNA damage kinetics and repair under protracted irradiation condition. J Math Biol 2024; 88:21. [PMID: 38285219 PMCID: PMC10824812 DOI: 10.1007/s00285-024-02046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/01/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024]
Abstract
In the present work, we develop a general spatial stochastic model to describe the formation and repair of radiation-induced DNA damage. The model is described mathematically as a measure-valued particle-based stochastic system and extends in several directions the model developed in Cordoni et al. (Phys Rev E 103:012412, 2021; Int J Radiat Biol 1-16, 2022a; Radiat Res 197:218-232, 2022b). In this new spatial formulation, radiation-induced DNA damage in the cell nucleus can undergo different pathways to either repair or lead to cell inactivation. The main novelty of the work is to rigorously define a spatial model that considers the pairwise interaction of lesions and continuous protracted irradiation. The former is relevant from a biological point of view as clustered lesions are less likely to be repaired, leading to cell inactivation. The latter instead describes the effects of a continuous radiation field on biological tissue. We prove the existence and uniqueness of a solution to the above stochastic systems, characterizing its probabilistic properties. We further couple the model describing the biological system to a set of reaction-diffusion equations with random discontinuity that model the chemical environment. At last, we study the large system limit of the process. The developed model can be applied to different contexts, with radiotherapy and space radioprotection being the most relevant. Further, the biochemical system derived can play a crucial role in understanding an extremely promising novel radiotherapy treatment modality, named in the community FLASH radiotherapy, whose mechanism is today largely unknown.
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10
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Lang X, Hu Z, Zhao Z, Zhou K, Xu Z, Li M, Mao R, Luo F, Huang C, Kang X, Li J, Liu X, Zhou L, Xiao G. Preliminary study of low-pressure ionization chamber for online dose monitoring in FLASH carbon ion radiotherapy. Phys Med Biol 2024; 69:025008. [PMID: 38064745 DOI: 10.1088/1361-6560/ad13d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
The FLASH effect of carbon ion therapy has recently attracted significant attention from the scientific community. However, the radiobiological mechanism of the effect and the exact therapeutic conditions are still under investigation. Therefore, the dosimetry accuracy is critical for testing hypotheses about the effect and quantifying FLASH Radiotherapy. In this paper, the FLASH ionization chamber at low-pressure was designed, and its dose rate dependence was verified with the Faraday cup. In addition, the dose response was tested under the air pressure of the ionization chamber of 10 mbar, 80 mbar and 845 mbar, respectively. The results showed that when the pressure was 10 mbar, the dose linearity was verified and calibrated at the dose rate of ∼50 Gy s-1, and the residuals were less than 2%. In conclusion, the FLASH ionization chamber is a promising instrument for online dose monitoring.
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Affiliation(s)
- Xinle Lang
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
- University of Chinese Academy of Sciences, School of Nuclear Science and Technology, Beijing 100049, People's Republic of China
| | - Zhengguo Hu
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
- University of Chinese Academy of Sciences, School of Nuclear Science and Technology, Beijing 100049, People's Republic of China
| | - Zulong Zhao
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
| | - Kai Zhou
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
| | - Zhiguo Xu
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
| | - Min Li
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
| | - Ruishi Mao
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
- University of Chinese Academy of Sciences, School of Nuclear Science and Technology, Beijing 100049, People's Republic of China
| | - Faming Luo
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
- University of Chinese Academy of Sciences, School of Nuclear Science and Technology, Beijing 100049, People's Republic of China
| | - Chuan Huang
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
- School of Nuclear Science and Technology, Lanzhou University, Lanzhou 730000, Gansu, People's Republic of China
| | - Xincai Kang
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
| | - Juan Li
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
| | - Xiaotao Liu
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
| | - Libin Zhou
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
| | - Guoqing Xiao
- Chinese Academy of Sciences, Institute of Modern Physics, Lanzhou 730000, Gansu, People's Republic of China
- University of Chinese Academy of Sciences, School of Nuclear Science and Technology, Beijing 100049, People's Republic of China
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11
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Knäusl B, Belotti G, Bertholet J, Daartz J, Flampouri S, Hoogeman M, Knopf AC, Lin H, Moerman A, Paganelli C, Rucinski A, Schulte R, Shimizu S, Stützer K, Zhang X, Zhang Y, Czerska K. A review of the clinical introduction of 4D particle therapy research concepts. Phys Imaging Radiat Oncol 2024; 29:100535. [PMID: 38298885 PMCID: PMC10828898 DOI: 10.1016/j.phro.2024.100535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024] Open
Abstract
Background and purpose Many 4D particle therapy research concepts have been recently translated into clinics, however, remaining substantial differences depend on the indication and institute-related aspects. This work aims to summarise current state-of-the-art 4D particle therapy technology and outline a roadmap for future research and developments. Material and methods This review focused on the clinical implementation of 4D approaches for imaging, treatment planning, delivery and evaluation based on the 2021 and 2022 4D Treatment Workshops for Particle Therapy as well as a review of the most recent surveys, guidelines and scientific papers dedicated to this topic. Results Available technological capabilities for motion surveillance and compensation determined the course of each 4D particle treatment. 4D motion management, delivery techniques and strategies including imaging were diverse and depended on many factors. These included aspects of motion amplitude, tumour location, as well as accelerator technology driving the necessity of centre-specific dosimetric validation. Novel methodologies for X-ray based image processing and MRI for real-time tumour tracking and motion management were shown to have a large potential for online and offline adaptation schemes compensating for potential anatomical changes over the treatment course. The latest research developments were dominated by particle imaging, artificial intelligence methods and FLASH adding another level of complexity but also opportunities in the context of 4D treatments. Conclusion This review showed that the rapid technological advances in radiation oncology together with the available intrafractional motion management and adaptive strategies paved the way towards clinical implementation.
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Affiliation(s)
- Barbara Knäusl
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Gabriele Belotti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Juliane Daartz
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Mischa Hoogeman
- Department of Medical Physics & Informatics, HollandPTC, Delft, The Netherlands
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Antje C Knopf
- Institut für Medizintechnik und Medizininformatik Hochschule für Life Sciences FHNW, Muttenz, Switzerland
| | - Haibo Lin
- New York Proton Center, New York, NY, USA
| | - Astrid Moerman
- Department of Medical Physics & Informatics, HollandPTC, Delft, The Netherlands
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Antoni Rucinski
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland
| | - Reinhard Schulte
- Division of Biomedical Engineering Sciences, School of Medicine, Loma Linda University
| | - Shing Shimizu
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kristin Stützer
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden – Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
| | - Xiaodong Zhang
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
| | - Katarzyna Czerska
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
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12
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Helm A, Fournier C. High-LET charged particles: radiobiology and application for new approaches in radiotherapy. Strahlenther Onkol 2023; 199:1225-1241. [PMID: 37872399 PMCID: PMC10674019 DOI: 10.1007/s00066-023-02158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023]
Abstract
The number of patients treated with charged-particle radiotherapy as well as the number of treatment centers is increasing worldwide, particularly regarding protons. However, high-linear energy transfer (LET) particles, mainly carbon ions, are of special interest for application in radiotherapy, as their special physical features result in high precision and hence lower toxicity, and at the same time in increased efficiency in cell inactivation in the target region, i.e., the tumor. The radiobiology of high-LET particles differs with respect to DNA damage repair, cytogenetic damage, and cell death type, and their increased LET can tackle cells' resistance to hypoxia. Recent developments and perspectives, e.g., the return of high-LET particle therapy to the US with a center planned at Mayo clinics, the application of carbon ion radiotherapy using cost-reducing cyclotrons and the application of helium is foreseen to increase the interest in this type of radiotherapy. However, further preclinical research is needed to better understand the differential radiobiological mechanisms as opposed to photon radiotherapy, which will help to guide future clinical studies for optimal exploitation of high-LET particle therapy, in particular related to new concepts and innovative approaches. Herein, we summarize the basics and recent progress in high-LET particle radiobiology with a focus on carbon ions and discuss the implications of current knowledge for charged-particle radiotherapy. We emphasize the potential of high-LET particles with respect to immunogenicity and especially their combination with immunotherapy.
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Affiliation(s)
- Alexander Helm
- Biophysics Department, GSI Helmholtz Center for Heavy Ion Research, Darmstadt, Germany
| | - Claudia Fournier
- Biophysics Department, GSI Helmholtz Center for Heavy Ion Research, Darmstadt, Germany.
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13
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Purushothaman S, Kostyleva D, Dendooven P, Haettner E, Geissel H, Schuy C, Weber U, Boscolo D, Dickel T, Graeff C, Hornung C, Kazantseva E, Kuzminchuk-Feuerstein N, Mukha I, Pietri S, Roesch H, Tanaka YK, Zhao J, Durante M, Parodi K, Scheidenberger C. Quasi-real-time range monitoring by in-beam PET: a case for 15O. Sci Rep 2023; 13:18788. [PMID: 37914762 PMCID: PMC10620432 DOI: 10.1038/s41598-023-45122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023] Open
Abstract
A fast and reliable range monitoring method is required to take full advantage of the high linear energy transfer provided by therapeutic ion beams like carbon and oxygen while minimizing damage to healthy tissue due to range uncertainties. Quasi-real-time range monitoring using in-beam positron emission tomography (PET) with therapeutic beams of positron-emitters of carbon and oxygen is a promising approach. The number of implanted ions and the time required for an unambiguous range verification are decisive factors for choosing a candidate isotope. An experimental study was performed at the FRS fragment-separator of GSI Helmholtzzentrum für Schwerionenforschung GmbH, Germany, to investigate the evolution of positron annihilation activity profiles during the implantation of [Formula: see text]O and [Formula: see text]O ion beams in a PMMA phantom. The positron activity profile was imaged by a dual-panel version of a Siemens Biograph mCT PET scanner. Results from a similar experiment using ion beams of carbon positron-emitters [Formula: see text]C and [Formula: see text]C performed at the same experimental setup were used for comparison. Owing to their shorter half-lives, the number of implanted ions required for a precise positron annihilation activity peak determination is lower for [Formula: see text]C compared to [Formula: see text]C and likewise for [Formula: see text]O compared to [Formula: see text]O, but their lower production cross-sections make it difficult to produce them at therapeutically relevant intensities. With a similar production cross-section and a 10 times shorter half-life than [Formula: see text]C, [Formula: see text]O provides a faster conclusive positron annihilation activity peak position determination for a lower number of implanted ions compared to [Formula: see text]C. A figure of merit formulation was developed for the quantitative comparison of therapy-relevant positron-emitting beams in the context of quasi-real-time beam monitoring. In conclusion, this study demonstrates that among the positron emitters of carbon and oxygen, [Formula: see text]O is the most feasible candidate for quasi-real-time range monitoring by in-beam PET that can be produced at therapeutically relevant intensities. Additionally, this study demonstrated that the in-flight production and separation method can produce beams of therapeutic quality, in terms of purity, energy, and energy spread.
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Affiliation(s)
- S Purushothaman
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.
| | - D Kostyleva
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - P Dendooven
- Department of Radiation Oncology, Particle Therapy Research Center (PARTREC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E Haettner
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - H Geissel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, Gießen, Germany
| | - C Schuy
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - U Weber
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - D Boscolo
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - T Dickel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, Gießen, Germany
| | - C Graeff
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- Department of Electrical Engineering and Information Technology, Technische Universität Darmstadt, Darmstadt, Germany
| | - C Hornung
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - E Kazantseva
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | | | - I Mukha
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - S Pietri
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - H Roesch
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- Institute for Nuclear Physics, Technische Universität Darmstadt, Darmstadt, Germany
| | - Y K Tanaka
- RIKEN Cluster for Pioneering Research, RIKEN, Wako, Japan
| | - J Zhao
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- School of Physics, Beihang University, Beijing, China
| | - M Durante
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.
- Department of Condensed Matter Physics, Technische Universität Darmstadt, Darmstadt, Germany.
| | - K Parodi
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians Universität München, Munich, Germany
| | - C Scheidenberger
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, Gießen, Germany
- Helmholtz Forschungsakademie Hessen für FAIR (HFHF), Campus Gießen, Gießen, Germany
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14
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Böhlen TT, Germond JF, Traneus E, Vallet V, Desorgher L, Ozsahin EM, Bochud F, Bourhis J, Moeckli R. 3D-conformal very-high energy electron therapy as candidate modality for FLASH-RT: A treatment planning study for glioblastoma and lung cancer. Med Phys 2023; 50:5745-5756. [PMID: 37427669 DOI: 10.1002/mp.16586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/27/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Pre-clinical ultra-high dose rate (UHDR) electron irradiations on time scales of 100 ms have demonstrated a remarkable sparing of brain and lung tissues while retaining tumor efficacy when compared to conventional dose rate irradiations. While clinically-used gantries and intensity modulation techniques are too slow to match such time scales, novel very-high energy electron (VHEE, 50-250 MeV) radiotherapy (RT) devices using 3D-conformed broad VHEE beams are designed to deliver UHDR treatments that fulfill these timing requirements. PURPOSE To assess the dosimetric plan quality obtained using VHEE-based 3D-conformal RT (3D-CRT) for treatments of glioblastoma and lung cancer patients and compare the resulting treatment plans to those delivered by standard-of-care intensity modulated photon RT (IMRT) techniques. METHODS Seven glioblastoma patients and seven lung cancer patients were planned with VHEE-based 3D-CRT using 3 to 16 coplanar beams with equidistant angular spacing and energies of 100 and 200 MeV using a forward planning approach. Dose distributions, dose-volume histograms, coverage (V95% ) and homogeneity (HI98% ) for the planning target volume (PTV), as well as near-maximum doses (D2% ) and mean doses (Dmean ) for organs-at-risk (OAR) were evaluated and compared to clinical IMRT plans. RESULTS Mean differences of V95% and HI98% of all VHEE plans were within 2% or better of the IMRT reference plans. Glioblastoma plan dose metrics obtained with VHEE configurations of 200 MeV and 3-16 beams were either not significantly different or were significantly improved compared to the clinical IMRT reference plans. All OAR plan dose metrics evaluated for VHEE plans created using 5 beams of 100 MeV were either not significantly different or within 3% on average, except for Dmean for the body, Dmean for the brain, D2% for the brain stem, and D2% for the chiasm, which were significantly increased by 1, 2, 6, and 8 Gy, respectively (however below clinical constraints). Similarly, the dose metrics for lung cancer patients were also either not significantly different or were significantly improved compared to the reference plans for VHEE configurations with 200 MeV and 5 to 16 beams with the exception of D2% and Dmean to the spinal canal (however below clinical constraints). For the lung cancer cases, the VHEE configurations using 100 MeV or only 3 beams resulted in significantly worse dose metrics for some OAR. Differences in dose metrics were, however, strongly patient-specific and similar for some patient cases. CONCLUSIONS VHEE-based 3D-CRT may deliver conformal treatments to simple, mostly convex target shapes in the brain and the thorax with a limited number of critical adjacent OAR using a limited number of beams (as low as 3 to 7). Using such treatment techniques, a dosimetric plan quality comparable to that of standard-of-care IMRT can be achieved. Hence, from a treatment planning perspective, 3D-conformal UHDR VHEE treatments delivered on time scales of 100 ms represent a promising candidate technique for the clinical transfer of the FLASH effect.
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Affiliation(s)
- Till Tobias Böhlen
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jean-François Germond
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | | | - Veronique Vallet
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Laurent Desorgher
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Esat Mahmut Ozsahin
- Department of Radiation Oncology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - François Bochud
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jean Bourhis
- Department of Radiation Oncology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Raphaël Moeckli
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
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15
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Zou W, Zhang R, Schüler E, Taylor PA, Mascia AE, Diffenderfer ES, Zhao T, Ayan AS, Sharma M, Yu SJ, Lu W, Bosch WR, Tsien C, Surucu M, Pollard-Larkin JM, Schuemann J, Moros EG, Bazalova-Carter M, Gladstone DJ, Li H, Simone CB, Petersson K, Kry SF, Maity A, Loo BW, Dong L, Maxim PG, Xiao Y, Buchsbaum JC. Framework for Quality Assurance of Ultrahigh Dose Rate Clinical Trials Investigating FLASH Effects and Current Technology Gaps. Int J Radiat Oncol Biol Phys 2023; 116:1202-1217. [PMID: 37121362 PMCID: PMC10526970 DOI: 10.1016/j.ijrobp.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/28/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
FLASH radiation therapy (FLASH-RT), delivered with ultrahigh dose rate (UHDR), may allow patients to be treated with less normal tissue toxicity for a given tumor dose compared with currently used conventional dose rate. Clinical trials are being carried out and are needed to test whether this improved therapeutic ratio can be achieved clinically. During the clinical trials, quality assurance and credentialing of equipment and participating sites, particularly pertaining to UHDR-specific aspects, will be crucial for the validity of the outcomes of such trials. This report represents an initial framework proposed by the NRG Oncology Center for Innovation in Radiation Oncology FLASH working group on quality assurance of potential UHDR clinical trials and reviews current technology gaps to overcome. An important but separate consideration is the appropriate design of trials to most effectively answer clinical and scientific questions about FLASH. This paper begins with an overview of UHDR RT delivery methods. UHDR beam delivery parameters are then covered, with a focus on electron and proton modalities. The definition and control of safe UHDR beam delivery and current and needed dosimetry technologies are reviewed and discussed. System and site credentialing for large, multi-institution trials are reviewed. Quality assurance is then discussed, and new requirements are presented for treatment system standard analysis, patient positioning, and treatment planning. The tables and figures in this paper are meant to serve as reference points as we move toward FLASH-RT clinical trial performance. Some major questions regarding FLASH-RT are discussed, and next steps in this field are proposed. FLASH-RT has potential but is associated with significant risks and complexities. We need to redefine optimization to focus not only on the dose but also on the dose rate in a manner that is robust and understandable and that can be prescribed, validated, and confirmed in real time. Robust patient safety systems and access to treatment data will be critical as FLASH-RT moves into the clinical trials.
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Affiliation(s)
- Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Rongxiao Zhang
- Department of Radiation Oncology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Emil Schüler
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paige A Taylor
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Eric S Diffenderfer
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Tianyu Zhao
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Ahmet S Ayan
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Manju Sharma
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Shu-Jung Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Weiguo Lu
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Walter R Bosch
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Christina Tsien
- Department of Radiation Oncology, McGill University Health Center, Montreal, QC, Canada
| | - Murat Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Julianne M Pollard-Larkin
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jan Schuemann
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Eduardo G Moros
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - David J Gladstone
- Department of Radiation Oncology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Heng Li
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
| | - Kristoffer Petersson
- Department of Radiation Oncology, MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Stephen F Kry
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amit Maity
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter G Maxim
- Department of Radiation Oncology, University of California Irvine, Irvine, CA, USA
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
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16
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Graeff C, Volz L, Durante M. Emerging technologies for cancer therapy using accelerated particles. PROGRESS IN PARTICLE AND NUCLEAR PHYSICS 2023; 131:104046. [PMID: 37207092 PMCID: PMC7614547 DOI: 10.1016/j.ppnp.2023.104046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Cancer therapy with accelerated charged particles is one of the most valuable biomedical applications of nuclear physics. The technology has vastly evolved in the past 50 years, the number of clinical centers is exponentially growing, and recent clinical results support the physics and radiobiology rationale that particles should be less toxic and more effective than conventional X-rays for many cancer patients. Charged particles are also the most mature technology for clinical translation of ultra-high dose rate (FLASH) radiotherapy. However, the fraction of patients treated with accelerated particles is still very small and the therapy is only applied to a few solid cancer indications. The growth of particle therapy strongly depends on technological innovations aiming to make the therapy cheaper, more conformal and faster. The most promising solutions to reach these goals are superconductive magnets to build compact accelerators; gantryless beam delivery; online image-guidance and adaptive therapy with the support of machine learning algorithms; and high-intensity accelerators coupled to online imaging. Large international collaborations are needed to hasten the clinical translation of the research results.
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Affiliation(s)
- Christian Graeff
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Planckstraße 1, 64291 Darmstadt, Germany
- Technische Universität Darmstadt, Darmstadt, Germany
| | - Lennart Volz
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Planckstraße 1, 64291 Darmstadt, Germany
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Planckstraße 1, 64291 Darmstadt, Germany
- Technische Universität Darmstadt, Darmstadt, Germany
- Dipartimento di Fisica “Ettore Pancini”, University Federico II, Naples, Italy
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17
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Camazzola G, Boscolo D, Scifoni E, Dorn A, Durante M, Krämer M, Abram V, Fuss MC. TRAX-CHEMxt: Towards the Homogeneous Chemical Stage of Radiation Damage. Int J Mol Sci 2023; 24:ijms24119398. [PMID: 37298351 DOI: 10.3390/ijms24119398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
The indirect effect of radiation plays an important role in radio-induced biological damages. Monte Carlo codes have been widely used in recent years to study the chemical evolution of particle tracks. However, due to the large computational efforts required, their applicability is typically limited to simulations in pure water targets and to temporal scales up to the µs. In this work, a new extension of TRAX-CHEM is presented, namely TRAX-CHEMxt, able to predict the chemical yields at longer times, with the capability of exploring the homogeneous biochemical stage. Based on the species coordinates produced around one track, the set of reaction-diffusion equations is solved numerically with a computationally light approach based on concentration distributions. In the overlapping time scale (500 ns-1 µs), a very good agreement to standard TRAX-CHEM is found, with deviations below 6% for different beam qualities and oxygenations. Moreover, an improvement in the computational speed by more than three orders of magnitude is achieved. The results of this work are also compared with those from another Monte Carlo-based algorithm and a fully homogeneous code (Kinetiscope). TRAX-CHEMxt will allow for studying the variation in chemical endpoints at longer timescales with the introduction, as the next step, of biomolecules, for more realistic assessments of biological response under different radiation and environmental conditions.
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Affiliation(s)
- Gianmarco Camazzola
- Biophysics Department, GSI Helmholtz Centre for Heavy Ion Research GmbH, 64291 Darmstadt, Germany
- Quantum Dynamics and Control Division, Max Planck Institute for Nuclear Physics, 69117 Heidelberg, Germany
- Department of Physics and Astronomy, Heidelberg University, 69120 Heidelberg, Germany
| | - Daria Boscolo
- Biophysics Department, GSI Helmholtz Centre for Heavy Ion Research GmbH, 64291 Darmstadt, Germany
| | - Emanuele Scifoni
- Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute for Nuclear Physics (INFN), 38123 Povo, Italy
| | - Alexander Dorn
- Quantum Dynamics and Control Division, Max Planck Institute for Nuclear Physics, 69117 Heidelberg, Germany
| | - Marco Durante
- Biophysics Department, GSI Helmholtz Centre for Heavy Ion Research GmbH, 64291 Darmstadt, Germany
- Institute for Condensed Matter Physics, Technical University of Darmstadt, 64289 Darmstadt, Germany
| | - Michael Krämer
- Biophysics Department, GSI Helmholtz Centre for Heavy Ion Research GmbH, 64291 Darmstadt, Germany
| | - Valentino Abram
- Department of Mathematics, University of Trento, 38123 Povo, Italy
| | - Martina C Fuss
- Biophysics Department, GSI Helmholtz Centre for Heavy Ion Research GmbH, 64291 Darmstadt, Germany
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18
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Song H, Kim Y, Sung W. Modeling of the FLASH effect for ion beam radiation therapy. Phys Med 2023; 108:102553. [PMID: 37021608 DOI: 10.1016/j.ejmp.2023.102553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/08/2023] [Accepted: 02/18/2023] [Indexed: 03/11/2023] Open
Abstract
PURPOSE Normal tissue sparing has been shown in preclinical studies under the ultra-fast dose rate condition, so-called FLASH radiotherapy. The preclinical and clinical FLASH studies are being conducted with various radiation modalities such as photons, protons, and heavy ions. The aim of this study is to propose a model to predict the dependency of the FLASH effect on linear energy transfer (LET) by quantifying the oxygen depletion. METHODS We develop an analytical model to examine the FLASH sparing effect by incorporating time-varying oxygen depletion equation and oxygen enhancement ratios according to LET. The variations in oxygen enhancement ratio (OER) are quantified over time with different dose rate (Gy/s) and LET (keV/μm). The FLASH sparing effect (FSE) is defined as the ratio of DFLASH/Dconv where Dconv is the reference absorbed dose delivered at the conventional dose rate, and DFLASH is the absorbed dose delivered at a high dose rate that causes the same amount of biological damage. RESULTS Our model suggests that the FLASH effect is significant only when the oxygen amount is at an intermediate level (10 ∼ 100 mmHg). The FSE is increased as LET decreases, suggesting that LET less than 100 keV/μm is required to induce FLASH sparing effects in normal tissue. CONCLUSIONS Oxygen depletion and recovery provide a quantitative model to understand the FLASH effect. These results highlight the FLASH sparing effects in normal tissue under the conditions with the intermediate oxygen level and low-LET region.
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19
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Missaglia A, Bourkadi-Idrissi A, Casamichiela F, Mazzucconi D, Carminati M, Agosteo S, Fiorini C. Prompt-gamma fall-off estimation with C-ion irradiation at clinical energies, using a knife-edge slit camera: A Monte Carlo study. Phys Med 2023; 107:102554. [PMID: 36907030 DOI: 10.1016/j.ejmp.2023.102554] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 02/09/2023] [Accepted: 02/18/2023] [Indexed: 03/12/2023] Open
Abstract
PURPOSE In-vivo range verification has been a hot topic in particle therapy since two decades. Many efforts have been done for proton therapy, while fewer studies were conducted considering a beam of carbon ions. In the present work, a simulation study was performed to show whether it is possible to measure the prompt-gamma fall-off inside the high neutron background typical of carbon-ion irradiation, using a knife-edge slit camera. In addition to this, we wanted to estimate the uncertainty in retrieving the particle range in the case of a pencil beam of C-ions at clinically relevant energy of 150 MeVu. METHODS For these purposes, the Monte Carlo code FLUKA was adopted for simulations and three different analytical methods were implemented to get the accuracy in the range retrieval of the simulated set-up. RESULTS The analysis of simulation data has brought to the promising and desired precision of about 4 mm in the determination of the dose profile fall-off in case of a spill irradiation, for which all the three cited methods were coherent in their predictions. CONCLUSIONS The Prompt Gamma Imaging technique should be further studied as a tool to reduce range uncertainties affecting carbon ion radiation therapy.
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Affiliation(s)
- Andrea Missaglia
- Dipartimento di Elettronica, Informazione e Bioingegneria - Politecnico di Milano, Via Ponzio, 34/5, 20133, Milan, Italy.
| | - Aicha Bourkadi-Idrissi
- Dipartimento di Elettronica, Informazione e Bioingegneria - Politecnico di Milano, Via Ponzio, 34/5, 20133, Milan, Italy; INFN - sezione di Milano, Via Giovanni Celoria, 16, 20133, Milan, Italy.
| | - Francesco Casamichiela
- Dipartimento di Energia - Politecnico di Milano, Via Lambruschini, 4, 20156, Milan, Italy.
| | - Davide Mazzucconi
- INFN - sezione di Milano, Via Giovanni Celoria, 16, 20133, Milan, Italy; Dipartimento di Energia - Politecnico di Milano, Via Lambruschini, 4, 20156, Milan, Italy.
| | - Marco Carminati
- Dipartimento di Elettronica, Informazione e Bioingegneria - Politecnico di Milano, Via Ponzio, 34/5, 20133, Milan, Italy; INFN - sezione di Milano, Via Giovanni Celoria, 16, 20133, Milan, Italy.
| | - Stefano Agosteo
- INFN - sezione di Milano, Via Giovanni Celoria, 16, 20133, Milan, Italy; Dipartimento di Energia - Politecnico di Milano, Via Lambruschini, 4, 20156, Milan, Italy.
| | - Carlo Fiorini
- Dipartimento di Elettronica, Informazione e Bioingegneria - Politecnico di Milano, Via Ponzio, 34/5, 20133, Milan, Italy; INFN - sezione di Milano, Via Giovanni Celoria, 16, 20133, Milan, Italy.
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20
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Togno M, Nesteruk KP, Schäfer R, Psoroulas S, Meer D, Grossmann M, Christensen JB, Yukihara EG, Lomax AJ, Weber DC, Safai S. Ultra-high dose rate dosimetry for pre-clinical experiments with mm-small proton fields. Phys Med 2022; 104:101-111. [PMID: 36395638 DOI: 10.1016/j.ejmp.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To characterize an experimental setup for ultra-high dose rate (UHDR) proton irradiations, and to address the challenges of dosimetry in millimetre-small pencil proton beams. METHODS At the PSI Gantry 1, high-energy transmission pencil beams can be delivered to biological samples and detectors up to a maximum local dose rate of ∼9000 Gy/s. In the presented setup, a Faraday cup is used to measure the delivered number of protons up to ultra-high dose rates. The response of transmission ion-chambers, as well as of different field detectors, was characterized over a wide range of dose rates using the Faraday cup as reference. RESULTS The reproducibility of the delivered proton charge was better than 1 % in the proposed experimental setup. EBT3 films, Al2O3:C optically stimulated luminescence detectors and a PTW microDiamond were used to validate the predicted dose. Transmission ionization chambers showed significant volume ion-recombination (>30 % in the tested conditions) which can be parametrized as a function of the maximum proton current density. Over the considered range, EBT3 films, inorganic scintillator-based screens and the PTW microDiamond were demonstrated to be dose rate independent within ±3 %, ±1.8 % and ±1 %, respectively. CONCLUSIONS Faraday cups are versatile dosimetry instruments that can be used for dose estimation, field detector characterization and on-line dose verification for pre-clinical experiments in UHDR proton pencil beams. Among the tested detectors, the commercial PTW microDiamond was found to be a suitable option to measure real time the dosimetric properties of narrow pencil proton beams for dose rates up to 2.2 kGy/s.
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Affiliation(s)
- M Togno
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland.
| | - K P Nesteruk
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - R Schäfer
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - S Psoroulas
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - D Meer
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - M Grossmann
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - J B Christensen
- Department of Radiation Safety and Security, Paul Scherrer Institut, Villigen, Switzerland
| | - E G Yukihara
- Department of Radiation Safety and Security, Paul Scherrer Institut, Villigen, Switzerland
| | - A J Lomax
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland; Department of Physics, ETH Zurich, Zurich, Switzerland
| | - D C Weber
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - S Safai
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
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21
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Lv Y, Lv Y, Wang Z, Lan T, Feng X, Chen H, Zhu J, Ma X, Du J, Hou G, Liao W, Yuan K, Wu H. FLASH radiotherapy: A promising new method for radiotherapy. Oncol Lett 2022; 24:419. [PMID: 36284652 PMCID: PMC9580247 DOI: 10.3892/ol.2022.13539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022] Open
Abstract
Among the treatments for malignant tumors, radiotherapy is of great significance both as a main treatment and as an adjuvant treatment. Radiation therapy damages cancer cells with ionizing radiation, leading to their death. However, radiation-induced toxicity limits the dose delivered to the tumor, thereby constraining the control effect of radiotherapy on tumor growth. In addition, the delayed toxicity caused by radiotherapy significantly harms the physical and mental health of patients. FLASH-RT, an emerging class of radiotherapy, causes a phenomenon known as the 'FLASH effect', which delivers radiotherapy at an ultra-high dose rate with lower toxicity to normal tissue than conventional radiotherapy to achieve local tumor control. Although its mechanism remains to be fully elucidated, this modality constitutes a potential new approach to treating malignant tumors. In the present review, the current research progress of FLASH-RT and its various particular effects are described, including the status of research on FLASH-RT and its influencing factors. The hypothetic mechanism of action of FLASH-RT is also summarized, providing insight into future tumor treatments.
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Affiliation(s)
- Yinghao Lv
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Yue Lv
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Zhen Wang
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
- Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Tian Lan
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Xuping Feng
- Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Hao Chen
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Jiang Zhu
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Xiao Ma
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Jinpeng Du
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Guimin Hou
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Wenwei Liao
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Kefei Yuan
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
- Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Hong Wu
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
- Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
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22
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Vozenin MC, Bourhis J, Durante M. Towards clinical translation of FLASH radiotherapy. Nat Rev Clin Oncol 2022; 19:791-803. [DOI: 10.1038/s41571-022-00697-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/09/2022]
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23
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Hageman E, Che PP, Dahele M, Slotman BJ, Sminia P. Radiobiological Aspects of FLASH Radiotherapy. Biomolecules 2022; 12:biom12101376. [PMID: 36291585 PMCID: PMC9599153 DOI: 10.3390/biom12101376] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Radiotherapy (RT) is one of the primary treatment modalities for cancer patients. The clinical use of RT requires a balance to be struck between tumor effect and the risk of toxicity. Sparing normal tissue is the cornerstone of reducing toxicity. Advances in physical targeting and dose-shaping technology have helped to achieve this. FLASH RT is a promising, novel treatment technique that seeks to exploit a potential normal tissue-sparing effect of ultra-high dose rate irradiation. A significant body of in vitro and in vivo data has highlighted a decrease in acute and late radiation toxicities, while preserving the radiation effect in tumor cells. The underlying biological mechanisms of FLASH RT, however, remain unclear. Three main mechanisms have been hypothesized to account for this differential FLASH RT effect between the tumor and healthy tissue: the oxygen depletion, the DNA damage, and the immune-mediated hypothesis. These hypotheses and molecular mechanisms have been evaluated both in vitro and in vivo. Furthermore, the effect of ultra-high dose rate radiation with extremely short delivery times on the dynamic tumor microenvironment involving circulating blood cells and immune cells in humans is essentially unknown. Therefore, while there is great interest in FLASH RT as a means of targeting tumors with the promise of an increased therapeutic ratio, evidence of a generalized FLASH effect in humans and data to show that FLASH in humans is safe and at least effective against tumors as standard photon RT is currently lacking. FLASH RT needs further preclinical investigation and well-designed in-human studies before it can be introduced into clinical practice.
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Affiliation(s)
- Eline Hageman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Radiation Oncology, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, 1081 HV Amsterdam, The Netherlands
| | - Pei-Pei Che
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Radiation Oncology, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, 1081 HV Amsterdam, The Netherlands
| | - Max Dahele
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Radiation Oncology, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ben J. Slotman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Radiation Oncology, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Peter Sminia
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Radiation Oncology, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, 1081 HV Amsterdam, The Netherlands
- Correspondence:
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24
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Rahman M, Trigilio A, Franciosini G, Moeckli R, Zhang R, Böhlen TT. FLASH radiotherapy treatment planning and models for electron beams. Radiother Oncol 2022; 175:210-221. [PMID: 35964763 DOI: 10.1016/j.radonc.2022.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 12/18/2022]
Abstract
The FLASH effect designates normal tissue sparing at ultra-high dose rate (UHDR, >40 Gy/s) compared to conventional dose rate (∼0.1 Gy/s) irradiation while maintaining tumour control and has the potential to improve the therapeutic ratio of radiotherapy (RT). UHDR high-energy electron (HEE, 4-20 MeV) beams are currently a mainstay for investigating the clinical potential of FLASH RT for superficial tumours. In the future very-high energy electron (VHEE, 50-250 MeV) UHDR beams may be used to treat deep-seated tumours. UHDR HEE treatment planning focused at its initial stage on accurate dosimetric modelling of converted and dedicated UHDR electron RT devices for the clinical transfer of FLASH RT. VHEE treatment planning demonstrated promising dosimetric performance compared to clinical photon RT techniques in silico and was used to evaluate and optimise the design of novel VHEE RT devices. Multiple metrics and models have been proposed for a quantitative description of the FLASH effect in treatment planning, but an improved experimental characterization and understanding of the FLASH effect is needed to allow for an accurate and validated modelling of the effect in treatment planning. The importance of treatment planning for electron FLASH RT will augment as the field moves forward to treat more complex clinical indications and target sites. In this review, TPS developments in HEE and VHEE are presented considering beam models, characteristics, and future FLASH applications.
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Affiliation(s)
- Mahbubur Rahman
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Antonio Trigilio
- Physics Department, "La Sapienza" University of Rome, Rome, Italy; INFN National Institute of Nuclear Physics, Rome Section, Rome, Italy
| | - Gaia Franciosini
- Physics Department, "La Sapienza" University of Rome, Rome, Italy; INFN National Institute of Nuclear Physics, Rome Section, Rome, Italy
| | - Raphaël Moeckli
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
| | - Rongxiao Zhang
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA; Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Till Tobias Böhlen
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
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25
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Schneider T, Fernandez-Palomo C, Bertho A, Fazzari J, Iturri L, Martin OA, Trappetti V, Djonov V, Prezado Y. Combining FLASH and spatially fractionated radiation therapy: The best of both worlds. Radiother Oncol 2022; 175:169-177. [PMID: 35952978 DOI: 10.1016/j.radonc.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/23/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022]
Abstract
FLASH radiotherapy (FLASH-RT) and spatially fractionated radiation therapy (SFRT) are two new therapeutical strategies that use non-standard dose delivery methods to reduce normal tissue toxicity and increase the therapeutic index. Although likely based on different mechanisms, both FLASH-RT and SFRT have shown to elicit radiobiological effects that significantly differ from those induced by conventional radiotherapy. With the therapeutic potential having been established separately for each technique, the combination of FLASH-RT and SFRT could therefore represent a winning alliance. In this review, we discuss the state of the art, advantages and current limitations, potential synergies, and where a combination of these two techniques could be implemented today or in the near future.
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Affiliation(s)
- Tim Schneider
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | | | - Annaïg Bertho
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Lorea Iturri
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Olga A Martin
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland; Division of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; University of Melbourne, Parkville, VIC 3010, Australia
| | - Verdiana Trappetti
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France.
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Zhang Z, Liu X, Chen D, Yu J. Radiotherapy combined with immunotherapy: the dawn of cancer treatment. Signal Transduct Target Ther 2022; 7:258. [PMID: 35906199 PMCID: PMC9338328 DOI: 10.1038/s41392-022-01102-y] [Citation(s) in RCA: 143] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/19/2022] [Accepted: 06/30/2022] [Indexed: 11/09/2022] Open
Abstract
Radiotherapy (RT) is delivered for purposes of local control, but can also exert systemic effect on remote and non-irradiated tumor deposits, which is called abscopal effect. The view of RT as a simple local treatment has dramatically changed in recent years, and it is now widely accepted that RT can provoke a systemic immune response which gives a strong rationale for the combination of RT and immunotherapy (iRT). Nevertheless, several points remain to be addressed such as the interaction of RT and immune system, the identification of the best schedules for combination with immunotherapy (IO), the expansion of abscopal effect and the mechanism to amplify iRT. To answer these crucial questions, we roundly summarize underlying rationale showing the whole immune landscape in RT and clinical trials to attempt to identify the best schedules of iRT. In consideration of the rarity of abscopal effect, we propose that the occurrence of abscopal effect induced by radiation can be promoted to 100% in view of molecular and genetic level. Furthermore, the “radscopal effect” which refers to using low-dose radiation to reprogram the tumor microenvironment may amplify the occurrence of abscopal effect and overcome the resistance of iRT. Taken together, RT could be regarded as a trigger of systemic antitumor immune response, and with the help of IO can be used as a radical and systemic treatment and be added into current standard regimen of patients with metastatic cancer.
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Affiliation(s)
- Zengfu Zhang
- Department of Radiation Oncology, Shandong University Cancer Center, Yantai Road, No. 2999, Jinan, Shandong, China
| | - Xu Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jiyan Road, No. 440, Jinan, Shandong, China
| | - Dawei Chen
- Department of Radiation Oncology, Shandong University Cancer Center, Yantai Road, No. 2999, Jinan, Shandong, China.
| | - Jinming Yu
- Department of Radiation Oncology, Shandong University Cancer Center, Yantai Road, No. 2999, Jinan, Shandong, China.
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Pompos A, Foote RL, Koong AC, Le QT, Mohan R, Paganetti H, Choy H. National Effort to Re-Establish Heavy Ion Cancer Therapy in the United States. Front Oncol 2022; 12:880712. [PMID: 35774126 PMCID: PMC9238353 DOI: 10.3389/fonc.2022.880712] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
In this review, we attempt to make a case for the establishment of a limited number of heavy ion cancer research and treatment facilities in the United States. Based on the basic physics and biology research, conducted largely in Japan and Germany, and early phase clinical trials involving a relatively small number of patients, we believe that heavy ions have a considerably greater potential to enhance the therapeutic ratio for many cancer types compared to conventional X-ray and proton radiotherapy. Moreover, with ongoing technological developments and with research in physical, biological, immunological, and clinical aspects, it is quite plausible that cost effectiveness of radiotherapy with heavier ions can be substantially improved.
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Affiliation(s)
- Arnold Pompos
- Department of Radiation Oncology, University of Texas (UT) Southwestern Medical Center, Dallas, TX, United States
| | - Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Robert L. Foote,
| | - Albert C. Koong
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States
| | - Radhe Mohan
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Harald Paganetti
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States
| | - Hak Choy
- Department of Radiation Oncology, University of Texas (UT) Southwestern Medical Center, Dallas, TX, United States
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Tinganelli W, Weber U, Puspitasari A, Simoniello P, Abdollahi A, Oppermann J, Schuy C, Horst F, Helm A, Fournier C, Durante M. FLASH with carbon ions: tumor control, normal tissue sparing, and distal metastasis in a mouse osteosarcoma model. Radiother Oncol 2022; 175:185-190. [DOI: 10.1016/j.radonc.2022.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 12/30/2022]
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Zhang Z, Zhao W, Butkus M, Wu X. Conformal Dose Modulator for Proton Beam Therapy Part 1: A Simulation Study. Front Oncol 2022; 12:840469. [PMID: 35480117 PMCID: PMC9035853 DOI: 10.3389/fonc.2022.840469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/15/2022] [Indexed: 11/14/2022] Open
Abstract
Purpose Conformal dose deliveries in proton therapy utilize either a passive scattering system with a modulator or a pencil beam scanning (PBS) system. Efforts have been made to achieve conformal dose delivery by scanning a single energy layer of pencil beams through a 3D conformal modulator (3DCM), which combines a spread-out Bragg peak (SOBP) modulator consisting of a micro-pyramid array and a range compensator. The current published approach of designing such 3DCM relies on forward calculation methods to determine the geometry of the modulator. This study presents an alternative designing algorithm that inversely generates the geometry of a 3DCM paired with a corresponding fluence map, customized to patient-specific clinical indications. Methods Critical spacing governing the size and separation between neighboring micro-pyramids was first determined, under which the dose homogeneity at desired depths could be achieved. We designed an adaptive ring optimization method using a modified gradient descent algorithm to inversely calculate the geometry of the 3DCM. This method includes several stages that progressively optimize both target coverage and dose conformity. The output contains the geometry of the 3DCM and its corresponding proton fluence map. Monte Carlo (MC) simulation was used to validate the results. Results The critical size and spacing of Lucite pyramids was determined to be 0.5 cm for a 184-MeV pristine proton beam. Using MATLAB (R2020a), the inverse designing algorithm generated an optimized 3DCM geometry and a fluence distribution achieving 100% target coverage with the 90% isodose surface and a corresponding conformity index of 1.057 on a spherical target. The resulting geometry was pruned to accommodate the MC simulation software and a currently accessible 3D printing service. The pruned geometry gave 95% target coverage by 90% isodose surface with a conformity index of 1.09 by ray-tracing dose computation. The MC simulation validated the 3DCM with 95% target coverage by 87% isodose surface and a conformity index of 1.12. Conclusion We have demonstrated the feasibility of using a novel inverse optimization algorithm to generate 3DCM geometry and its corresponding proton beam fluence/intensity map, which could deliver highly conformal dose distribution with pencil beam scanning system using a single energy layer.
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Affiliation(s)
- Zhexuan Zhang
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, United States
| | - Weizhao Zhao
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, United States
- *Correspondence: Xiaodong Wu, ; Weizhao Zhao,
| | - Michael Butkus
- Department of Radiation Oncology, University of Miami, Miami, FL, United States
| | - Xiaodong Wu
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, United States
- Department of Research and Development, Shanghai Proton and Heavy Ion Center, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Executive Medical Physics Associates, Miami, FL, United States
- *Correspondence: Xiaodong Wu, ; Weizhao Zhao,
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Taylor PA, Moran JM, Jaffray DA, Buchsbaum JC. A roadmap to clinical trials for FLASH. Med Phys 2022; 49:4099-4108. [PMID: 35366339 PMCID: PMC9321729 DOI: 10.1002/mp.15623] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/17/2022] [Accepted: 03/17/2022] [Indexed: 11/29/2022] Open
Abstract
While FLASH radiation therapy is inspiring enthusiasm to transform the field, it is neither new nor well understood with respect to the radiobiological mechanisms. As FLASH clinical trials are designed, it will be important to ensure we can deliver dose consistently and safely to every patient. Much like hyperthermia and proton therapy, FLASH is a promising new technology that will be complex to implement in the clinic and similarly will require customized credentialing for multi‐institutional clinical trials. There is no doubt that FLASH seems promising, but many technologies that we take for granted in conventional radiation oncology, such as rigorous dosimetry, 3D treatment planning, volumetric image guidance, or motion management, may play a major role in defining how to use, or whether to use, FLASH radiotherapy. Given the extended time frame for patients to experience late effects, we recommend moving deliberately but cautiously forward toward clinical trials. In this paper, we review the state of quality assurance and safety systems in FLASH, identify critical pre‐clinical data points that need to be defined, and suggest how lessons learned from previous technological advancements will help us close the gaps and build a successful path to evidence‐driven FLASH implementation.
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Affiliation(s)
- Paige A Taylor
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jean M Moran
- Memorial Sloan Kettering Cancer, New York, New York
| | - David A Jaffray
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Simeonov Y, Weber U, Schuy C, Engenhart-Cabillic R, Penchev P, Flatten V, Zink K. Development, Monte Carlo simulations and experimental evaluation of a 3D range-modulator for a complex target in scanned proton therapy. Biomed Phys Eng Express 2022; 8. [PMID: 35226887 DOI: 10.1088/2057-1976/ac5937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/28/2022] [Indexed: 01/02/2023]
Abstract
The purpose of this work was to develop and manufacture a 3D range-modulator (3D RM) for a complex target contour for scanned proton therapy. The 3D RM is considered to be a viable technique for the very fast dose application in patient-specific tumors with only one fixed energy. The RM was developed based on a tumor from a patient CT and manufactured with high-quality 3D printing techniques with both polymer resin and aluminum. Monte Carlo simulations were utilized to investigate its modulating properties and the resulting dose distribution. Additionally, the simulation results were validated with measurements at the Marburg Ion-Beam Therapy Centre. For this purpose, a previously developed water phantom was used to conduct fast, automated high-resolution dose measurements. The results show a very good agreement between simulations and measurements and indicate that highly homogeneous dose distributions are possible. The delivered dose is conformed to the distal as well as to the proximal edge of the target. The 3D range-modulator concept combines a high degree of dose homogeneity and conformity, comparable to standard IMPT with very short irradiation times, promising clinically applicable dose distributions for lung and/or FLASH treatment, comparable and competitive to those from conventional irradiation techniques.
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Affiliation(s)
- Yuri Simeonov
- University of Applied Sciences, Institute of Medical Physics and Radiation Protection (IMPS), Giessen, Germany.,Philipps-University, Marburg, Germany
| | - Uli Weber
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Biophysics division, Darmstadt, Germany
| | - Christoph Schuy
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Biophysics division, Darmstadt, Germany
| | - Rita Engenhart-Cabillic
- University Medical Center Giessen-Marburg, Department of Radiotherapy and Radiooncology, Marburg, Germany.,Marburg Ion Beam Therapy Center (MIT), Marburg, Germany
| | - Petar Penchev
- University of Applied Sciences, Institute of Medical Physics and Radiation Protection (IMPS), Giessen, Germany.,Philipps-University, Marburg, Germany
| | - Veronika Flatten
- University of Applied Sciences, Institute of Medical Physics and Radiation Protection (IMPS), Giessen, Germany.,Philipps-University, Marburg, Germany.,University Medical Center Giessen-Marburg, Department of Radiotherapy and Radiooncology, Marburg, Germany.,Marburg Ion Beam Therapy Center (MIT), Marburg, Germany
| | - Klemens Zink
- University of Applied Sciences, Institute of Medical Physics and Radiation Protection (IMPS), Giessen, Germany.,University Medical Center Giessen-Marburg, Department of Radiotherapy and Radiooncology, Marburg, Germany.,Marburg Ion Beam Therapy Center (MIT), Marburg, Germany
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32
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Liew H, Mein S, Tessonnier T, Abdollahi A, Debus J, Dokic I, Mairani A. The Impact of Sub-Millisecond Damage Fixation Kinetics on the In Vitro Sparing Effect at Ultra-High Dose Rate in UNIVERSE. Int J Mol Sci 2022; 23:ijms23062954. [PMID: 35328377 PMCID: PMC8954991 DOI: 10.3390/ijms23062954] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
The impact of the exact temporal pulse structure on the potential cell and tissue sparing of ultra-high dose-rate irradiation applied in FLASH studies has gained increasing attention. A previous version of our biophysical mechanistic model (UNIVERSE: UNIfied and VERSatile bio response Engine), based on the oxygen depletion hypothesis, has been extended in this work by considering oxygen-dependent damage fixation dynamics on the sub-milliseconds scale and introducing an explicit implementation of the temporal pulse structure. The model successfully reproduces in vitro experimental data on the fast kinetics of the oxygen effect in irradiated mammalian cells. The implemented changes result in a reduction in the assumed amount of oxygen depletion. Furthermore, its increase towards conventional dose-rates is parameterized based on experimental data from the literature. A recalculation of previous benchmarks shows that the model retains its predictive power, while the assumed amount of depleted oxygen approaches measured values. The updated UNIVERSE could be used to investigate the impact of different combinations of pulse structure parameters (e.g., dose per pulse, pulse frequency, number of pulses, etc.), thereby aiding the optimization of potential clinical application and the development of suitable accelerators.
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Affiliation(s)
- Hans Liew
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.L.); (J.D.)
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.M.); (A.A.); (I.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
- Faculty of Physics and Astronomy, Heidelberg University, 69120 Heidelberg, Germany
| | - Stewart Mein
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.M.); (A.A.); (I.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
| | - Amir Abdollahi
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.M.); (A.A.); (I.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
| | - Jürgen Debus
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.L.); (J.D.)
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.M.); (A.A.); (I.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
- Faculty of Physics and Astronomy, Heidelberg University, 69120 Heidelberg, Germany
| | - Ivana Dokic
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.M.); (A.A.); (I.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
| | - Andrea Mairani
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.M.); (A.A.); (I.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
- Correspondence: ; Tel.: +49-0-6221-56-37535
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Schwarz M, Traneus E, Safai S, Kolano A, van de Water S. Treatment planning for Flash radiotherapy: general aspects and applications to proton beams. Med Phys 2022; 49:2861-2874. [PMID: 35213040 DOI: 10.1002/mp.15579] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/22/2021] [Accepted: 02/14/2022] [Indexed: 11/08/2022] Open
Abstract
The increased radioresistence of healthy tissues when irradiated at very high dose rates (known as the Flash effect) is a radiobiological mechanism that is currently investigated in order to increase the therapeutic ratio of radiotherapy treatments. To maximize the benefits of the clinical application of Flash, a patient-specific balance between different properties of the dose distribution should be found, i.e. Flash needs to be one of the variables considered in treatment planning. We investigated the Flash potential of three proton therapy planning and beam delivery techniques, each on a different anatomical region. Based on a set of beam delivery parameters, on hypotheses on the dose and dose rate thresholds needed for the Flash effect to occur, and on two definitions of Flash dose rate, we generated exemplary illustrations of the capabilities of current proton therapy equipment to generate Flash dose distributions. All techniques investigated could both produce dose distributions comparable with a conventional proton plan and reach the Flash regime, to an extent that was strongly dependent on the dose per fraction and the Flash dose threshold. The beam current, Flash dose rate threshold and dose rate definition typically had a more moderate effect on the amount of Flash dose in normal tissue. A systematic estimation of the impact of Flash on different patient anatomies and treatment protocols is possible only if Flash-specific treatment planning features become readily available. Planning evaluation tools such as a voxel-based dose delivery time structure, and the inclusion in the optimization cost function of parameters directly associated with Flash (e.g. beam current, spot delivery sequence and scanning speed), are needed to generate treatment plans that are taking full advantage of the potential benefits of the Flash effect. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marco Schwarz
- Proton therapy Department, Trento Hospital and TIFPA-INFN, Trento, Italy
| | - Erik Traneus
- RaySearch Laboratories AB, Stockholm SE-103 65, Sweden
| | - Sairos Safai
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Anna Kolano
- Advanced Oncotherapy plc, London, England - Application of Detectors and Accelerators to Medicine(ADAM), Geneva, Switzerland
| | - Steven van de Water
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Yap J, De Franco A, Sheehy S. Future Developments in Charged Particle Therapy: Improving Beam Delivery for Efficiency and Efficacy. Front Oncol 2021; 11:780025. [PMID: 34956897 PMCID: PMC8697351 DOI: 10.3389/fonc.2021.780025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/16/2021] [Indexed: 01/09/2023] Open
Abstract
The physical and clinical benefits of charged particle therapy (CPT) are well recognized. However, the availability of CPT and complete exploitation of dosimetric advantages are still limited by high facility costs and technological challenges. There are extensive ongoing efforts to improve upon these, which will lead to greater accessibility, superior delivery, and therefore better treatment outcomes. Yet, the issue of cost remains a primary hurdle as utility of CPT is largely driven by the affordability, complexity and performance of current technology. Modern delivery techniques are necessary but limited by extended treatment times. Several of these aspects can be addressed by developments in the beam delivery system (BDS) which determines the overall shaping and timing capabilities enabling high quality treatments. The energy layer switching time (ELST) is a limiting constraint of the BDS and a determinant of the beam delivery time (BDT), along with the accelerator and other factors. This review evaluates the delivery process in detail, presenting the limitations and developments for the BDS and related accelerator technology, toward decreasing the BDT. As extended BDT impacts motion and has dosimetric implications for treatment, we discuss avenues to minimize the ELST and overview the clinical benefits and feasibility of a large energy acceptance BDS. These developments support the possibility of advanced modalities and faster delivery for a greater range of treatment indications which could also further reduce costs. Further work to realize methodologies such as volumetric rescanning, FLASH, arc, multi-ion and online image guided therapies are discussed. In this review we examine how increased treatment efficiency and efficacy could be achieved with improvements in beam delivery and how this could lead to faster and higher quality treatments for the future of CPT.
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Affiliation(s)
- Jacinta Yap
- School of Physics, University of Melbourne, Melbourne, VIC, Australia
| | - Andrea De Franco
- IFMIF Accelerator Development Group, Rokkasho Fusion Institute, National Institutes for Quantum Science and Technology, Aomori, Japan
| | - Suzie Sheehy
- School of Physics, University of Melbourne, Melbourne, VIC, Australia
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35
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Durante M, Debus J, Loeffler JS. Physics and biomedical challenges of cancer therapy with accelerated heavy ions. NATURE REVIEWS. PHYSICS 2021; 3:777-790. [PMID: 34870097 PMCID: PMC7612063 DOI: 10.1038/s42254-021-00368-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Radiotherapy should have low toxicity in the entrance channel (normal tissue) and be very effective in cell killing in the target region (tumour). In this regard, ions heavier than protons have both physical and radiobiological advantages over conventional X-rays. Carbon ions represent an excellent combination of physical and biological advantages. There are a dozen carbon-ion clinical centres in Europe and Asia, and more under construction or at the planning stage, including the first in the USA. Clinical results from Japan and Germany are promising, but a heated debate on the cost-effectiveness is ongoing in the clinical community, owing to the larger footprint and greater expense of heavy ion facilities compared with proton therapy centres. We review here the physical basis and the clinical data with carbon ions and the use of different ions, such as helium and oxygen. Research towards smaller and cheaper machines with more effective beam delivery is necessary to make particle therapy affordable. The potential of heavy ions has not been fully exploited in clinics and, rather than there being a single 'silver bullet', different particles and their combination can provide a breakthrough in radiotherapy treatments in specific cases.
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Affiliation(s)
- Marco Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Institute of Condensed Matter Physics, Technische Universität Darmstadt, Darmstadt, Germany
| | - Jürgen Debus
- Department of Radiation Oncology and Heidelberg Ion Beam Therapy Center, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jay S. Loeffler
- Departments of Radiation Oncology and Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Ultra-High Dose Rate (FLASH) Carbon Ion Irradiation: Dosimetry and First Cell Experiments. Int J Radiat Oncol Biol Phys 2021; 112:1012-1022. [PMID: 34813912 DOI: 10.1016/j.ijrobp.2021.11.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE To establish a beam monitoring and dosimetry system to enable the FLASH dose rate carbon ion irradiation and investigate, at different oxygen concentrations, the in vitro biological response in comparison to the conventional dose rate. METHODS AND MATERIALS CHO-K1 cell response to irradiation at different dose rates and at different levels of oxygenation was studied using clonogenic assay. The Heidelberg Ion-Beam Therapy Center (HIT) synchrotron, after technical improvements, was adjusted to extract ≥5 × 108 12C ions within approximately 150 milliseconds. The beam monitors were filled with helium. RESULTS The FLASH irradiation with beam scanning yields a dose of 7.5 Gy (homogeneity of ±5%) for a 280 MeV/u beam in a volume of at least 8 mm in diameter and a corresponding dose rate of 70 Gy/s (±20%). The dose repetition accuracy is better than 2%, the systematic uncertainty is better than 2%. Clonogenic assay demonstrates a significant FLASH sparing effect which is strongly oxygenation-dependent and mostly pronounced at 0.5% O2 but absent at 0% and 21% O2. CONCLUSION The FLASH dose rates >40 Gy/s were achieved with carbon beams. Cell survival analysis revealed FLASH dose rate sparing in hypoxia (0.5%-4% O2).
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