1
|
Rana S, Manthala Padannayil N, Tran L, Rosenfeld AB, Saeed H, Kasper M. Quantifying the Dosimetric Impact of Proton Range Uncertainties on RBE-Weighted Dose Distributions in Intensity-Modulated Proton Therapy for Bilateral Head and Neck Cancer. Curr Oncol 2024; 31:3690-3697. [PMID: 39057144 PMCID: PMC11275331 DOI: 10.3390/curroncol31070272] [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: 05/05/2024] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND In current clinical practice, intensity-modulated proton therapy (IMPT) head and neck cancer (HNC) plans are generated using a constant relative biological effectiveness (cRBE) of 1.1. The primary goal of this study was to explore the dosimetric impact of proton range uncertainties on RBE-weighted dose (RWD) distributions using a variable RBE (vRBE) model in the context of bilateral HNC IMPT plans. METHODS The current study included the computed tomography (CT) datasets of ten bilateral HNC patients who had undergone photon therapy. Each patient's plan was generated using three IMPT beams to deliver doses to the CTV_High and CTV_Low for doses of 70 Gy(RBE) and 54 Gy(RBE), respectively, in 35 fractions through a simultaneous integrated boost (SIB) technique. Each nominal plan calculated with a cRBE of 1.1 was subjected to the range uncertainties of ±3%. The McNamara vRBE model was used for RWD calculations. For each patient, the differences in dosimetric metrices between the RWD and nominal dose distributions were compared. RESULTS The constrictor muscles, oral cavity, parotids, larynx, thyroid, and esophagus showed average differences in mean dose (Dmean) values up to 6.91 Gy(RBE), indicating the impact of proton range uncertainties on RWD distributions. Similarly, the brachial plexus, brain, brainstem, spinal cord, and mandible showed varying degrees of the average differences in maximum dose (Dmax) values (2.78-10.75 Gy(RBE)). The Dmean and Dmax to the CTV from RWD distributions were within ±2% of the dosimetric results in nominal plans. CONCLUSION The consistent trend of higher mean and maximum doses to the OARs with the McNamara vRBE model compared to cRBE model highlighted the need for consideration of proton range uncertainties while evaluating OAR doses in bilateral HNC IMPT plans.
Collapse
Affiliation(s)
- Suresh Rana
- Department of Radiation Oncology, Lynn Cancer Institute, Boca Raton Regional Hospital, Baptist Health South Florida, Boca Raton, FL 33486, USA
- Department of Radiation Oncology, Florida International University, Miami, FL 33199, USA
| | - Noufal Manthala Padannayil
- Department of Radiation Oncology, Lynn Cancer Institute, Boca Raton Regional Hospital, Baptist Health South Florida, Boca Raton, FL 33486, USA
| | - Linh Tran
- Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, NSW 2522, Australia
| | - Anatoly B. Rosenfeld
- Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, NSW 2522, Australia
| | - Hina Saeed
- Department of Radiation Oncology, Lynn Cancer Institute, Boca Raton Regional Hospital, Baptist Health South Florida, Boca Raton, FL 33486, USA
- Department of Radiation Oncology, Florida International University, Miami, FL 33199, USA
| | - Michael Kasper
- Department of Radiation Oncology, Lynn Cancer Institute, Boca Raton Regional Hospital, Baptist Health South Florida, Boca Raton, FL 33486, USA
| |
Collapse
|
2
|
Mossahebi S, Molitoris JK, Poirier Y, Jatczak J, Zhang B, Mohindra P, Ferris M, Regine WF, Yi B. Clinical Implementation and Dosimetric Evaluation of a Robust Proton Lattice Planning Strategy Using Primary and Robust Complementary Beams. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00742-9. [PMID: 38936634 DOI: 10.1016/j.ijrobp.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 05/17/2024] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Pencil-beam scanning proton therapy has been considered a potential modality for the 3D form of spatially fractionated radiation therapy called lattice therapy. However, few practical solutions have been introduced in the clinic. Existing limitations include degradation in plan quality and robustness when using single-field versus multifield lattice plans, respectively. We propose a practical and robust proton lattice (RPL) planning method using multifield and evaluate its dosimetric characteristics compared to clinically acceptable photon lattice plans. METHODS AND MATERIALS Seven cases previously treated with photon lattice therapy were used to evaluate a novel RPL planning technique using 2-orthogonal beams: a primary beam (PB) and a robust complementary beam (RCB) that deliver 67% and 33%, respectively, of the prescribed dose to vertices inside the gross target volume (GTV). Only RCB is robustly optimized for setup and range uncertainties. The number and volume of vertices, peak-to-valley dose ratios (PVDRs), and volume of low dose to GTV of proton and photon plans were compared. The RPL technique was then used in the treatment of 2 patients and their dosimetric parameters were reported. RESULTS The RPL strategy was able to achieve the clinical planning goals. Compared to previously treated photon plans, the average number of vertices increased by 30%, the average vertex volume by 49% (18.2 ± 25.9 cc vs 12.2 ± 14.5 cc, P = .21), and higher PVDR (10.5 ± 4.8 vs 2.5 ± 0.9, P < .005) was achieved. In addition, RPL plans show more conformal dose with less low dose to GTV (V30%, 60.9% ± 7.2% vs 81.6% ± 13.9% and V10%, 88.3% ± 4.5% vs 98.6% ± 3.6% [P < .01]). The RPL plan for 2 treated patients showed PVDRs of 4.61 and 14.85 with vertices-to-GTV ratios of 1.52% and 1.30%, respectively. CONCLUSIONS A novel RPL planning strategy using a pair of orthogonal beams was developed and successfully translated to the clinic. The proposed method can generate better quality plans, a higher number of vertices, and higher PVDRs than currently used photon lattice plans.
Collapse
Affiliation(s)
- Sina Mossahebi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland; Maryland Proton Treatment Center, Baltimore, Maryland.
| | - Jason K Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland; Maryland Proton Treatment Center, Baltimore, Maryland
| | - Yannick Poirier
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jenna Jatczak
- Maryland Proton Treatment Center, Baltimore, Maryland
| | - Baoshe Zhang
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland; Maryland Proton Treatment Center, Baltimore, Maryland
| | - Pranshu Mohindra
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Matthew Ferris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland; Maryland Proton Treatment Center, Baltimore, Maryland
| | - William F Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland; Maryland Proton Treatment Center, Baltimore, Maryland
| | - ByongYong Yi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland; Maryland Proton Treatment Center, Baltimore, Maryland
| |
Collapse
|
3
|
Zhou S, Ding X, Zhang Y, Liu Y, Wang X, Guo Y, Zhang J, Liu X, Gong G, Su Y, Wang L, Zhao M, Hu M. Evaluation of specific RBE in different cells of hippocampus under high-dose proton irradiation in rats. Sci Rep 2024; 14:8193. [PMID: 38589544 PMCID: PMC11001863 DOI: 10.1038/s41598-024-58831-z] [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: 01/23/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024] Open
Abstract
The study aimed to determine the specific relative biological effectiveness (RBE) of various cells in the hippocampus following proton irradiation. Sixty Sprague-Dawley rats were randomly allocated to 5 groups receiving 20 or 30 Gy of proton or photon irradiation. Pathomorphological neuronal damage in the hippocampus was assessed using Hematoxylin-eosin (HE) staining. The expression level of NeuN, Nestin, Caspase-3, Olig2, CD68 and CD45 were determined by immunohistochemistry (IHC). The RBE range established by comparing the effects of proton and photon irradiation at equivalent biological outcomes. Proton20Gy induced more severe damage to neurons than photon20Gy, but showed no difference compared to photon30Gy. The RBE of neuron was determined to be 1.65. Similarly, both proton20Gy and proton30Gy resulted in more inhibition of oligodendrocytes and activation of microglia in the hippocampal regions than photon20Gy and photon30Gy. However, the expression of Olig2 was higher and CD68 was lower in the proton20Gy group than in the photon30Gy group. The RBE of oligodendrocyte and microglia was estimated to be between 1.1 to 1.65. For neural stem cells (NSCs) and immune cells, there were no significant difference in the expression of Nestin and CD45 between proton and photon irradiation (both 20 and 30 Gy). Therefore, the RBE for NSCs and immune cell was determined to be 1.1. These findings highlight the varying RBE values of different cells in the hippocampus in vivo. Moreover, the actual RBE of the hippocampus may be higher than 1.1, suggesting that using as RBE value of 1.1 in clinical practice may underestimate the toxicities induced by proton radiation.
Collapse
Affiliation(s)
- Shengying Zhou
- School of Clinical Medicine, Shandong Second Medical University, Weifang, 261053, Shandong, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, NO.440 Ji Yan Road, Jinan, 250117, Shandong, China
| | - Xingchen Ding
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, NO.440 Ji Yan Road, Jinan, 250117, Shandong, China
| | - Yiyuan Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, NO.440 Ji Yan Road, Jinan, 250117, Shandong, China
| | - Yuanyuan Liu
- Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Xiaowen Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, NO.440 Ji Yan Road, Jinan, 250117, Shandong, China
- Shandong University cancer center, Jinan, 250100, Shandong, China
| | - Yujiao Guo
- Affiliated Hospital of Jining Medical College, Jining, 272067, Shandong, China
| | | | - Xiao Liu
- 960 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Jinan, 250031, Shandong, China
| | - Guanzhong Gong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, NO.440 Ji Yan Road, Jinan, 250117, Shandong, China
| | - Ya Su
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, NO.440 Ji Yan Road, Jinan, 250117, Shandong, China
| | - Lizhen Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, NO.440 Ji Yan Road, Jinan, 250117, Shandong, China
| | - Miaoqing Zhao
- Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.
| | - Man Hu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, NO.440 Ji Yan Road, Jinan, 250117, Shandong, China.
| |
Collapse
|
4
|
Vieceli M, Park J, Hsi WC, Saki M, Mendenhall NP, Johnson P, Artz M. Potential Therapeutic Improvements in Prostate Cancer Treatment Using Pencil Beam Scanning Proton Therapy with LET d Optimization and Disease-Specific RBE Models. Cancers (Basel) 2024; 16:780. [PMID: 38398171 PMCID: PMC10886728 DOI: 10.3390/cancers16040780] [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: 01/03/2024] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE To demonstrate the feasibility of improving prostate cancer patient outcomes with PBS proton LETd optimization. METHODS SFO, IPT-SIB, and LET-optimized plans were created for 12 patients, and generalized-tissue and disease-specific LET-dependent RBE models were applied. The mean LETd in several structures was determined and used to calculate mean RBEs. LETd- and dose-volume histograms (LVHs/DVHs) are shown. TODRs were defined based on clinical dose goals and compared between plans. The impact of robust perturbations on LETd, TODRs, and DVH spread was evaluated. RESULTS LETd optimization achieved statistically significant increased target volume LETd of ~4 keV/µm compared to SFO and IPT-SIB LETd of ~2 keV/µm while mitigating OAR LETd increases. A disease-specific RBE model predicted target volume RBEs > 1.5 for LET-optimized plans, up to 18% higher than for SFO plans. LET-optimized target LVHs/DVHs showed a large increase not present in OARs. All RBE models showed a statistically significant increase in TODRs from SFO to IPT-SIB to LET-optimized plans. RBE = 1.1 does not accurately represent TODRs when using LETd optimization. Robust evaluations demonstrated a trade-off between increased mean target LETd and decreased DVH spread. CONCLUSION The demonstration of improved TODRs provided via LETd optimization shows potential for improved patient outcomes.
Collapse
Affiliation(s)
- Michael Vieceli
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Medical Physics Graduate Program, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Jiyeon Park
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Wen Chien Hsi
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Mo Saki
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Nancy P Mendenhall
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Perry Johnson
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Mark Artz
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| |
Collapse
|
5
|
Sakae T, Takada K, Kamizawa S, Terunuma T, Ando K. Formulation of Time-Dependent Cell Survival with Saturable Repairability of Radiation Damage. Radiat Res 2023; 200:139-150. [PMID: 37303133 DOI: 10.1667/rade-21-00066.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/10/2023] [Indexed: 06/13/2023]
Abstract
This study aims to provide a model that compounds historically proposed ideas regarding cell survival irradiated with X rays or particles. The parameters used in this model have simple meanings and are closely related to cell death-related phenomena. The model is adaptable to a wide range of doses and dose rates and thus can consistently explain previously published cell survival data. The formulas of the model were derived by using five basic ideas: 1. "Poisson's law"; 2. "DNA affected damage"; 3. "repair"; 4. "clustered affected damage"; and 5. "saturation of reparability". The concept of affected damage is close to but not the same as the effect caused by the double-strand break (DSB). The parameters used in the formula are related to seven phenomena: 1. "linear coefficient of radiation dose"; 2. "probability of making affected damage"; 3. "cell-specific repairability", 4. "irreparable damage by adjacent affected damage"; 5. "recovery of temporally changed repairability"; 6. "recovery of simple damage which will make the affected damage"; 7. "cell division". By using the second parameter, this model includes cases where a single hit results in repairable-lethal and double-hit results in repairable-lethal. The fitting performance of the model for the experimental data was evaluated based on the Akaike information criterion, and practical results were obtained for the published experiments irradiated with a wide range of doses (up to several 10 Gy) and dose rates (0.17 Gy/h to 55.8 Gy/h). The direct association of parameters with cell death-related phenomena has made it possible to systematically fit survival data of different cell types and different radiation types by using crossover parameters.
Collapse
Affiliation(s)
- Takeji Sakae
- Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
- University of Tsukuba Hospital, Proton Medical Research Center, 2-1-1, Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kenta Takada
- Graduate School of Radiology, Gunma Prefectural College of Health Sciences, 323-1 Kamiokimachi, Maebashi, Gunma 371-0052, Japan
| | - Satoshi Kamizawa
- University of Tsukuba Hospital, Proton Medical Research Center, 2-1-1, Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Toshiyuki Terunuma
- Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
- University of Tsukuba Hospital, Proton Medical Research Center, 2-1-1, Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Koichi Ando
- Gunma University Heavy Ion Medical Center, 3-39, Showamachi, Maebashi, Gunma 371-0034, Japan
| |
Collapse
|
6
|
Lo CY, Tsai SW, Niu H, Chen FH, Hwang HC, Chao TC, Hsiao IT, Liaw JW. Gold-Nanoparticles-Enhanced Production of Reactive Oxygen Species in Cells at Spread-Out Bragg Peak under Proton Beam Radiation. ACS OMEGA 2023; 8:17922-17931. [PMID: 37251180 PMCID: PMC10210040 DOI: 10.1021/acsomega.3c01025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023]
Abstract
This study investigates the radiobiological effects of gold nanoparticles (GNPs) as radiosensitizers for proton beam therapy (PBT). Specifically, we explore the enhanced production of reactive oxygen species (ROS) in GNP-loaded tumor cells irradiated by a 230 MeV proton beam in a spread-out Bragg peak (SOBP) zone obtained by a passive scattering system. Our findings indicate that the radiosensitization enhancement factor is 1.24 at 30% cell survival fraction, 8 days after 6 Gy proton beam irradiation. Since protons deposit the majority of their energy at the SOBP region and interact with GNPs to induce more ejected electrons from the high-Z GNPs, these ejected electrons then react with water molecules to produce excessive ROS that can damage cellular organelles. Laser scanning confocal microscopy reveals the excessive ROS induced inside the GNP-loaded cells immediately after proton irradiation. Furthermore, the damage to cytoskeletons and mitochondrial dysfunction in GNP-loaded cells caused by the induced ROS becomes significantly severe, 48 h after proton irradiation. Our biological evidence suggests that the cytotoxicity of GNP-enhanced ROS production has the potential to increase the tumoricidal efficacy of PBT.
Collapse
Affiliation(s)
- Chang-Yun Lo
- Department
of Mechanical Engineering, Chang Gung University, Taoyuan 333, Taiwan
| | - Shiao-Wen Tsai
- Department
of Biomedical Engineering, Chang Gung University, Taoyuan 333, Taiwan
- Department
of Periodontics, Chang Gung Memorial Hospital, Taipei 105, Taiwan
| | - Huan Niu
- Accelerator
Laboratory, Nuclear Science and Technology Development Center, National Tsing Hua University, Hsinchu 300, Taiwan
| | - Fang-Hsin Chen
- Institute
of Nuclear Engineering and Science, National
Tsing Hua University, Hsinchu 300, Taiwan
- Department
of Radiation Oncology, Chang Gung Memorial
Hospital, Taoyuan 333, Taiwan
- Department
of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsiao-Chien Hwang
- Proton
and Radiation Therapy Center, Linkou Chang
Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Tsi-Chian Chao
- Department
of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan 333, Taiwan
| | - Ing-Tsung Hsiao
- Department
of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan 333, Taiwan
| | - Jiunn-Woei Liaw
- Department
of Mechanical Engineering, Chang Gung University, Taoyuan 333, Taiwan
- Proton
and Radiation Therapy Center, Linkou Chang
Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department
of Mechanical Engineering, Ming Chi University
of Technology, New Taipei City 243, Taiwan
| |
Collapse
|
7
|
Chaudhary P, Gwynne DC, Odlozilik B, McMurray A, Milluzzo G, Maiorino C, Doria D, Ahmed H, Romagnani L, Alejo A, Padda H, Green J, Carroll D, Booth N, McKenna P, Kar S, Petringa G, Catalano R, Cammarata FP, Cirrone GAP, McMahon SJ, Prise KM, Borghesi M. Development of a portable hypoxia chamber for ultra-high dose rate laser-driven proton radiobiology applications. Radiat Oncol 2022; 17:77. [PMID: 35428301 PMCID: PMC9013042 DOI: 10.1186/s13014-022-02024-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/03/2022] [Indexed: 11/22/2022] Open
Abstract
Background There is currently significant interest in assessing the role of oxygen in the radiobiological effects at ultra-high dose rates. Oxygen modulation is postulated to play a role in the enhanced sparing effect observed in FLASH radiotherapy, where particles are delivered at 40–1000 Gy/s. Furthermore, the development of laser-driven accelerators now enables radiobiology experiments in extreme regimes where dose rates can exceed 109 Gy/s, and predicted oxygen depletion effects on cellular response can be tested. Access to appropriate experimental enviroments, allowing measurements under controlled oxygenation conditions, is a key requirement for these studies. We report on the development and application of a bespoke portable hypoxia chamber specifically designed for experiments employing laser-driven sources, but also suitable for comparator studies under FLASH and conventional irradiation conditions. Materials and methods We used oxygen concentration measurements to test the induction of hypoxia and the maintenance capacity of the chambers. Cellular hypoxia induction was verified using hypoxia inducible factor-1α immunostaining. Calibrated radiochromic films and GEANT-4 simulations verified the dosimetry variations inside and outside the chambers. We irradiated hypoxic human skin fibroblasts (AG01522B) cells with laser-driven protons, conventional protons and reference 225 kVp X-rays to quantify DNA DSB damage and repair under hypoxia. We further measured the oxygen enhancement ratio for cell survival after X-ray exposure in normal fibroblast and radioresistant patient- derived GBM stem cells. Results Oxygen measurements showed that our chambers maintained a radiobiological hypoxic environment for at least 45 min and pathological hypoxia for up to 24 h after disconnecting the chambers from the gas supply. We observed a significant reduction in the 53BP1 foci induced by laser-driven protons, conventional protons and X-rays in the hypoxic cells compared to normoxic cells at 30 min post-irradiation. Under hypoxic irradiations, the Laser-driven protons induced significant residual DNA DSB damage in hypoxic AG01522B cells compared to the conventional dose rate protons suggesting an important impact of these extremely high dose-rate exposures. We obtained an oxygen enhancement ratio (OER) of 2.1 ± 0.1 and 2.5 ± 0.1 respectively for the AG01522B and patient-derived GBM stem cells for X-ray irradiation using our hypoxia chambers. Conclusion We demonstrated the design and application of portable hypoxia chambers for studying cellular radiobiological endpoints after exposure to laser-driven protons at ultra-high dose, conventional protons and X-rays. Suitable levels of reduced oxygen concentration could be maintained in the absence of external gassing to quantify hypoxic effects. The data obtained provided indication of an enhanced residual DNA DSB damage under hypoxic conditions at ultra-high dose rate compared to the conventional protons or X-rays. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02024-3.
Collapse
|
8
|
Deycmar S, Mara E, Kerschbaum-Gruber S, Waller V, Georg D, Pruschy M. Ganetespib selectively sensitizes cancer cells for proximal and distal spread-out Bragg peak proton irradiation. Radiat Oncol 2022; 17:72. [PMID: 35410422 PMCID: PMC8996402 DOI: 10.1186/s13014-022-02036-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/20/2022] [Indexed: 02/03/2023] Open
Abstract
Objective Hypersensitivity towards proton versus photon irradiation was demonstrated in homologous recombination repair (HRR)-deficient cell lines. Hence, combined treatment concepts targeting HRR provide a rational for potential pharmaceutical exploitation. The HSP90 inhibitor ganetespib (STA-9090) downregulates a multitude of HRR-associated proteins and sensitizes for certain chemotherapeutics. Thus, the radiosensitizing effect of HSP90-inhibiting ganetespib was investigated for reference photon irradiation and proton irradiation at a proximal and distal position in a spread-out Bragg peak (SOBP). Methods A549 and FaDu cells were treated with low-dose (2 nM resp. 1 nM) ganetespib and irradiated with 200 kV photons. Proton irradiation was performed at a proximal and a distal position within a SOBP, with corresponding dose-averaged linear-energy transfer (LETD) values of 2.1 and 4.5 keV/µm, respectively. Cellular survival data was fitted to the linear-quadratic model to calculate relative biological effectiveness (RBE) and the dose-modifying factor (DMF). Additionally, A549 cells were treated with increasing doses of ganetespib and investigated by flow cytometry, immunoblotting, and immunofluorescence microscopy to investigate cell cycle distribution, Rad51 protein levels, and γH2AX foci, respectively. Results Low-dosed ganetespib significantly sensitized both cancer cell lines exclusively for proton irradiation at both investigated LETD, resulting in increased RBE values of 10–40%. In comparison to photon irradiation, the fraction of cells in S/G2/M phase was elevated in response to proton irradiation with 10 nM ganetespib consistently reducing this population. No changes in cell cycle distribution were detected in unirradiated cells by ganetespib alone. Protein levels of Rad51 are downregulated in irradiated A549 cells by 10 nM and also 2 nM ganetespib within 24 h. Immunofluorescence staining demonstrated similar induction and removal of γH2AX foci, irrespective of irradiation type or ganetespib administration. Conclusion Our findings illustrate a proton-specific sensitizing effect of low-dosed ganetespib in both employed cell lines and at both investigated SOBP positions. We provide additional experimental data on cellular response and a rational for future combinatorial approaches with proton radiotherapy. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02036-z.
Collapse
|
9
|
Garbacz M, Gajewski J, Durante M, Kisielewicz K, Krah N, Kopeć R, Olko P, Patera V, Rinaldi I, Rydygier M, Schiavi A, Scifoni E, Skóra T, Skrzypek A, Tommasino F, Rucinski A. Quantification of biological range uncertainties in patients treated at the Krakow proton therapy centre. Radiat Oncol 2022; 17:50. [PMID: 35264184 PMCID: PMC8905899 DOI: 10.1186/s13014-022-02022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/28/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Variable relative biological effectiveness (vRBE) in proton therapy might significantly modify the prediction of RBE-weighted dose delivered to a patient during proton therapy. In this study we will present a method to quantify the biological range extension of the proton beam, which results from the application of vRBE approach in RBE-weighted dose calculation. METHODS AND MATERIALS The treatment plans of 95 patients (brain and skull base patients) were used for RBE-weighted dose calculation with constant and the McNamara RBE model. For this purpose the Monte Carlo tool FRED was used. The RBE-weighted dose distributions were analysed using indices from dose-volume histograms. We used the volumes receiving at least 95% of the prescribed dose (V95) to estimate the biological range extension resulting from vRBE approach. RESULTS The vRBE model shows higher median value of relative deposited dose and D95 in the planning target volume by around 1% for brain patients and 4% for skull base patients. The maximum doses in organs at risk calculated with vRBE was up to 14 Gy above dose limit. The mean biological range extension was greater than 0.4 cm. DISCUSSION Our method of estimation of biological range extension is insensitive for dose inhomogeneities and can be easily used for different proton plans with intensity-modulated proton therapy (IMPT) optimization. Using volumes instead of dose profiles, which is the common method, is more universal. However it was tested only for IMPT plans on fields arranged around the tumor area. CONCLUSIONS Adopting a vRBE model results in an increase in dose and an extension of the beam range, which is especially disadvantageous in cancers close to organs at risk. Our results support the need to re-optimization of proton treatment plans when considering vRBE.
Collapse
Affiliation(s)
- Magdalena Garbacz
- Institute of Nuclear Physics Polish Academy of Sciences, 31342, Kraków, Poland.
| | - Jan Gajewski
- Institute of Nuclear Physics Polish Academy of Sciences, 31342, Kraków, Poland
| | - Marco Durante
- GSI Helmholtzzentrum fur Schwerionenforschung, 64291, Darmstadt, Germany
- The Technical University of Darmstadt, 64289, Darmstadt, Germany
| | - Kamil Kisielewicz
- National Oncology Institute, National Research Institute, Krakow Branch, 31115, Kraków, Poland
| | - Nils Krah
- University of Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Centre Léon Bérard, France
- University of Lyon, Université Claude Bernard Lyon 1, CNRS/IN2P3, IP2I Lyon, UMR 5822, Villeurbanne, France
| | - Renata Kopeć
- Institute of Nuclear Physics Polish Academy of Sciences, 31342, Kraków, Poland
| | - Paweł Olko
- Institute of Nuclear Physics Polish Academy of Sciences, 31342, Kraków, Poland
| | - Vincenzo Patera
- INFN - Section of Rome, 00185, Rome, Italy
- Department of Basic and Applied Sciences for Engineering, Sapienza University of Rome, 00161, Rome, Italy
| | | | - Marzena Rydygier
- Institute of Nuclear Physics Polish Academy of Sciences, 31342, Kraków, Poland
| | | | - Emanuele Scifoni
- Trento Institute for Fundamental Physics and Applications, TIFPA-INFN, 38123, Povo, Trento, Italy
| | - Tomasz Skóra
- National Oncology Institute, National Research Institute, Krakow Branch, 31115, Kraków, Poland
| | | | - Francesco Tommasino
- Trento Institute for Fundamental Physics and Applications, TIFPA-INFN, 38123, Povo, Trento, Italy
- Department of Physics, University of Trento, 38123, Povo, Trento, Italy
| | - Antoni Rucinski
- Institute of Nuclear Physics Polish Academy of Sciences, 31342, Kraków, Poland
| |
Collapse
|
10
|
Paganetti H. Mechanisms and Review of Clinical Evidence of Variations in Relative Biological Effectiveness in Proton Therapy. Int J Radiat Oncol Biol Phys 2022; 112:222-236. [PMID: 34407443 PMCID: PMC8688199 DOI: 10.1016/j.ijrobp.2021.08.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/14/2021] [Accepted: 08/10/2021] [Indexed: 01/03/2023]
Abstract
Proton therapy is increasingly being used as a radiation therapy modality. There is uncertainty about the biological effectiveness of protons relative to photon therapies as it depends on several physical and biological parameters. Radiation oncology currently applies a constant and generic value for the relative biological effectiveness (RBE) of 1.1, which was chosen conservatively to ensure tumor coverage. The use of a constant value has been challenged particularly when considering normal tissue constraints. Potential variations in RBE have been assessed in several published reviews but have mostly focused on data from clonogenic cell survival experiments with unclear relevance for clinical proton therapy. The goal of this review is to put in vitro findings in relation to clinical observations. Relevant in vivo pathways determining RBE for tumors and normal tissues are outlined, including not only damage to tumor cells and parenchyma but also vascular damage and immune response. Furthermore, the current clinical evidence of varying RBE is reviewed. The assessment can serve as guidance for treatment planning, personalized dose prescriptions, and outcome analysis.
Collapse
Affiliation(s)
- Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| |
Collapse
|
11
|
Smith EAK, Winterhalter C, Underwood TSA, Aitkenhead AH, Richardson JC, Merchant MJ, Kirkby NF, Kirby KJ, Mackay RI. A Monte Carlo study of different LET definitions and calculation parameters for proton beam therapy. Biomed Phys Eng Express 2021; 8. [PMID: 34874308 DOI: 10.1088/2057-1976/ac3f50] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/02/2021] [Indexed: 12/19/2022]
Abstract
The strongin vitroevidence that proton Relative Biological Effectiveness (RBE) varies with Linear Energy Transfer (LET) has led to an interest in applying LET within treatment planning. However, there is a lack of consensus on LET definition, Monte Carlo (MC) parameters or clinical methodology. This work aims to investigate how common variations of LET definition may affect potential clinical applications. MC simulations (GATE/GEANT4) were used to calculate absorbed dose and different types of LET for a simple Spread Out Bragg Peak (SOBP) and for four clinical PBT plans covering a range of tumour sites. Variations in the following LET calculation methods were considered: (i) averaging (dose-averaged LET (LETd) & track-averaged LET); (ii) scoring (LETdto water, to medium and to mass density); (iii) particle inclusion (LETdto all protons, to primary protons and to particles); (iv) MC settings (hit type and Maximum Step Size (MSS)). LET distributions were compared using: qualitative comparison, LET Volume Histograms (LVHs), single value criteria (maximum and mean values) and optimised LET-weighted dose models. Substantial differences were found between LET values in averaging, scoring and particle type. These differences depended on the methodology, but for one patient a difference of ∼100% was observed between the maximum LETdfor all particles and maximum LETdfor all protons within the brainstem in the high isodose region (4 keVμm-1and 8 keVμm-1respectively). An RBE model using LETdincluding heavier ions was found to predict substantially different LET-weighted dose compared to those using other LET definitions. In conclusion, the selection of LET definition may affect the results of clinical metrics considered in treatment planning and the results of an RBE model. The authors' advocate for the scoring of dose-averaged LET to water for primary and secondary protons using a random hit type and automated MSS.
Collapse
Affiliation(s)
- Edward A K Smith
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Carla Winterhalter
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Tracy S A Underwood
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Adam H Aitkenhead
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jenny C Richardson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Michael J Merchant
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Norman F Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Karen J Kirby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ranald I Mackay
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
12
|
Rucinski A, Biernacka A, Schulte R. Applications of nanodosimetry in particle therapy planning and beyond. Phys Med Biol 2021; 66. [PMID: 34731854 DOI: 10.1088/1361-6560/ac35f1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/03/2021] [Indexed: 12/28/2022]
Abstract
This topical review summarizes underlying concepts of nanodosimetry. It describes the development and current status of nanodosimetric detector technology. It also gives an overview of Monte Carlo track structure simulations that can provide nanodosimetric parameters for treatment planning of proton and ion therapy. Classical and modern radiobiological assays that can be used to demonstrate the relationship between the frequency and complexity of DNA lesion clusters and nanodosimetric parameters are reviewed. At the end of the review, existing approaches of treatment planning based on relative biological effectiveness (RBE) models or dose-averaged linear energy transfer are contrasted with an RBE-independent approach based on nandosimetric parameters. Beyond treatment planning, nanodosimetry is also expected to have applications and give new insights into radiation protection dosimetry.
Collapse
Affiliation(s)
| | - Anna Biernacka
- University of Gdansk, Intercollegiate Faculty of Biotechnology of University of Gdańsk and Medical University of Gdansk, 80-307 Gdansk, Poland
| | | |
Collapse
|
13
|
Suckert T, Nexhipi S, Dietrich A, Koch R, Kunz-Schughart LA, Bahn E, Beyreuther E. Models for Translational Proton Radiobiology-From Bench to Bedside and Back. Cancers (Basel) 2021; 13:4216. [PMID: 34439370 PMCID: PMC8395028 DOI: 10.3390/cancers13164216] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022] Open
Abstract
The number of proton therapy centers worldwide are increasing steadily, with more than two million cancer patients treated so far. Despite this development, pending questions on proton radiobiology still call for basic and translational preclinical research. Open issues are the on-going discussion on an energy-dependent varying proton RBE (relative biological effectiveness), a better characterization of normal tissue side effects and combination treatments with drugs originally developed for photon therapy. At the same time, novel possibilities arise, such as radioimmunotherapy, and new proton therapy schemata, such as FLASH irradiation and proton mini-beams. The study of those aspects demands for radiobiological models at different stages along the translational chain, allowing the investigation of mechanisms from the molecular level to whole organisms. Focusing on the challenges and specifics of proton research, this review summarizes the different available models, ranging from in vitro systems to animal studies of increasing complexity as well as complementing in silico approaches.
Collapse
Affiliation(s)
- Theresa Suckert
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01309 Dresden, Germany; (T.S.); (S.N.); (A.D.); (L.A.K.-S.)
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Sindi Nexhipi
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01309 Dresden, Germany; (T.S.); (S.N.); (A.D.); (L.A.K.-S.)
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, 01309 Dresden, Germany
| | - Antje Dietrich
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01309 Dresden, Germany; (T.S.); (S.N.); (A.D.); (L.A.K.-S.)
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Robin Koch
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (R.K.); (E.B.)
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Leoni A. Kunz-Schughart
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01309 Dresden, Germany; (T.S.); (S.N.); (A.D.); (L.A.K.-S.)
- National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
| | - Emanuel Bahn
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (R.K.); (E.B.)
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- German Cancer Research Center (DKFZ), Clinical Cooperation Unit Radiation Oncology, 69120 Heidelberg, Germany
| | - Elke Beyreuther
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01309 Dresden, Germany; (T.S.); (S.N.); (A.D.); (L.A.K.-S.)
- Helmholtz-Zentrum Dresden—Rossendorf, Institute of Radiation Physics, 01328 Dresden, Germany
| |
Collapse
|
14
|
James B, Tran LT, Bolst D, Prokopovich DA, Lerch M, Petasecca M, Guatelli S, Povoli M, Kok A, Petringa G, Cirrone GAP, Jackson M, Rosenfeld AB. In-field and out-of-field microdosimetric characterisation of a 62 MeV proton beam at CATANA. Med Phys 2021; 48:4532-4541. [PMID: 33908049 DOI: 10.1002/mp.14905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/15/2021] [Accepted: 04/04/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE A 5 and 10 μm thin silicon on insulator (SOI) 3D mushroom microdosimeter was used to characterize both the in-field and out-of-field of a 62 MeV proton beam. METHODS The SOI mushroom microdosimeter consisted of an array of cylindrical sensitive volumes (SVs), developed by the Centre for Medical Radiation Physics, University of Wollongong, was irradiated with 62 MeV protons at the CATANA (Centro di AdroTerapia Applicazioni Nucleari Avanzate) facility in Catania, Italy, a facility dedicated to the radiation treatment of ocular melanomas. Dose mean lineal energy, ( y D ¯ ), values were obtained at various depths in PMMA along a pristine and spread out Bragg peak (SOBP). The measured microdosimetric spectra at each position were then used as inputs into the modified Microdosimetric Kinetic Model (MKM) to derive the RBE for absorbed dose in a middle of the SOBP 2Gy (RBED ). Microdosimetric spectra were obtained with both the 5 and 10 μm 3D SOI microdosimeters, with a focus on the distal part of the BP. The in-field and out-of-field measurement configurations along the Bragg curve were modeled in Geant4 for comparison with experimental results. Lateral out-of-field measurements were performed to study secondary particles' contribution to normal tissue's dose, up to 12 mm from the edge of the beam field, and quality factor and dose equivalent results were obtained. RESULTS Comparison between experimental and simulation results showed good agreement between one another for both the pristine and SOBP beams in terms of y D ¯ and RBED. Though a small discrepancy between experiment and simulation was seen at the entrance of the Bragg curve, where experimental results were slightly lower than Geant4. The dose equivalent value measured 12 mm from the edge of the target volume was 1.27 ± 0.15 mSv/Gy with a Q ¯ value of 2.52 ± 0.30, both of which agree within uncertainty with Geant4 simulation. CONCLUSIONS These results demonstrate that SOI microdosimeters are an effective tool to predict RBED in-field as well as dose equivalent monitoring out-of-field to provide insight to probability of second cancer generation.
Collapse
Affiliation(s)
- Benjamin James
- Centre of Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Linh T Tran
- Centre of Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - David Bolst
- Centre of Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Dale A Prokopovich
- NSTLI Nuclear Stewardship, Australian Nuclear Science and Technology Organization, Lucas Heights, NSW, Australia
| | - Michael Lerch
- Centre of Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Marco Petasecca
- Centre of Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Susanna Guatelli
- Centre of Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | | | | | | | | | - Michael Jackson
- Centre of Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Anatoly B Rosenfeld
- Centre of Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| |
Collapse
|
15
|
Proton Radiotherapy to Preserve Fertility and Endocrine Function: A Translational Investigation. Int J Radiat Oncol Biol Phys 2021; 109:84-94. [PMID: 32758642 DOI: 10.1016/j.ijrobp.2020.07.2320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Photon radiation therapy (x-ray radiation therapy [XRT] and gamma-ray radiation therapy [GRT]) of tumors close to ovaries causes reproductive and endocrine sequelae due to ovarian primordial follicle depletion. Given its finite range, proton radiation therapy (PRT) can preserve ovarian function when ovaries are positioned distal to the spread-out Bragg peak (SOBP) in tumors of the abdominopelvic region. This study compared anti-Müllerian hormone (AMH) levels (a biomarker of ovarian function) and primordial follicle survival after in vivo mouse pelvic GRT versus PRT. METHODS AND MATERIALS One hundred twenty-four female prepubertal mice received sham, GRT, or PRT with ovaries positioned at various depth with respect to the proton SOBP, with single doses of 1.8 or 0.2 Gy. AMH was measured at baseline, 1, 3, and 8 weeks after treatment, and the total number of surviving primordial follicles was counted. Multivariable linear mixed-effects modeling was used to assess the relationship between radiation therapy modality and dose on AMH and primordial follicle survival. RESULTS For ovaries beyond the SOBP, ovarian function (P = .5) and ovarian primordial follicle (OPF; P = 1.0) were spared relative to sham controls. For ovaries in the SOBP plateau, ovarian function and primordial follicle reserve 8 weeks after treatment were reduced for all groups: 1.8 Gy GRT (βAMH = -4.9 ng/mL; βOPF = -728.2/animal), 1.8 Gy (relative biological effectiveness [RBE] = 1.1) PRT (βAMH = -5.1 ng/mL; βOPF = -728.2/animal), 0.2 Gy GRT (βAMH = -2.5 ng/mL; βOPF = -595.1/animal), and 0.2 Gy (RBE = 1.1) PRT (βAMH = -3.0 ng/mL; βOPF = -555.4/animal) relative to sham controls (all differences P < .001). CONCLUSIONS This study uses an animal model to demonstrate the safety of proton therapy in sparing fertility. Ovaries positioned beyond the SOBP during PRT maintain ovarian reserve, suggesting that a proton beam has no energy and exit dose beyond SOBP. This study proposes that proton therapy is much safer than photon radiation therapy to protect ovarian follicles with the same dose, and it supports further testing of proton therapy for abdominopelvic tumors in young women.
Collapse
|
16
|
Conte V, Agosteo S, Bianchi A, Bolst D, Bortot D, Catalano R, Cirrone GAP, Colautti P, Cuttone G, Guatelli S, James B, Mazzucconi D, Rosenfeld AB, Selva A, Tran L, Petringa G. Microdosimetry of a therapeutic proton beam with a mini-TEPC and a MicroPlus-Bridge detector for RBE assessment. Phys Med Biol 2020; 65:245018. [PMID: 33086208 DOI: 10.1088/1361-6560/abc368] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Proton beams are widely used worldwide to treat localized tumours, the lower entrance dose and no exit dose, thus sparing surrounding normal tissues, being the main advantage of this treatment modality compared to conventional photon techniques. Clinical proton beam therapy treatment planning is based on the use of a general relative biological effectiveness (RBE) of 1.1 along the whole beam penetration depth, without taking into account the documented increase in RBE at the end of the depth dose profile, in the Bragg peak and beyond. However, an inaccurate estimation of the RBE can cause both underdose or overdose, in particular it can cause the unfavourable situation of underdosing the tumour and overdosing the normal tissue just beyond the tumour, which limits the treatment success and increases the risk of complications. In view of a more precise dose delivery that takes into account the variation of RBE, experimental microdosimetry offers valuable tools for the quality assurance of LET or RBE-based treatment planning systems. The purpose of this work is to compare the response of two different microdosimetry systems: the mini-TEPC and the MicroPlus-Bridge detector. Microdosimetric spectra were measured across the 62 MeV spread out Bragg peak of CATANA with the mini-TEPC and with the Bridge microdosimeter. The frequency and dose distributions of lineal energy were compared and the different contributions to the spectra were analysed, discussing the effects of different site sizes and chord length distributions. The shape of the lineal energy distributions measured with the two detectors are markedly different, due to the different water-equivalent sizes of the sensitive volumes: 0.85 μm for the TEPC and 17.3 μm for the silicon detector. When the Loncol's biological weighting function is applied to calculate the microdosimetric assessment of the RBE, both detectors lead to results that are consistent with biological survival data for glioma U87 cells. Both the mini-TEPC and the MicroPlus-Bridge detector can be used to assess the RBE variation of a 62 MeV modulated proton beam along its penetration depth. The microdosimetric assessment of the RBE based on the Loncol's weighting function is in good agreement with radiobiological results when the 10% biological uncertainty is taken into account.
Collapse
Affiliation(s)
- V Conte
- INFN Laboratori Nazionali di Legnaro, viale dell'Università 2 35020 Legnaro, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Howard ME, Denbeigh JM, Debrot EK, Remmes NB, Herman MG, Beltran CJ. A High-Precision Method for In Vitro Proton Irradiation. Int J Part Ther 2020; 7:62-69. [PMID: 33274258 PMCID: PMC7707323 DOI: 10.14338/ijpt-20-00007.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/02/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose Although proton therapy has become a well-established radiation modality, continued efforts are needed to improve our understanding of the molecular and cellular mechanisms occurring during treatment. Such studies are challenging, requiring many resources. The purpose of this study was to create a phantom that would allow multiple in vitro experiments to be irradiated simultaneously with a spot-scanning proton beam. Materials and Methods The setup included a modified patient-couch top coupled with a high-precision robotic arm for positioning. An acrylic phantom was created to hold 4 6-well cell-culture plates at 2 different positions along the Bragg curve in a reproducible manner. The proton treatment plan consisted of 1 large field encompassing all 4 plates with a monoenergetic 76.8-MeV posterior beam. For robust delivery, a mini pyramid filter was used to broaden the Bragg peak (BP) in the depth direction. Both a Markus ionization chamber and EBT3 radiochromic film measurements were used to verify absolute dose. Results A treatment plan for the simultaneous irradiation of 2 plates irradiated with high linear energy transfer protons (BP, 7 keV/μm) and 2 plates irradiated with low linear energy transfer protons (entrance, 2.2 keV/μm) was created. Dose uncertainty was larger across the setup for cell plates positioned at the BP because of beam divergence and, subsequently, variable proton-path lengths. Markus chamber measurements resulted in uncertainty values of ±1.8% from the mean dose. Negligible differences were seen in the entrance region (<0.3%). Conclusion The proposed proton irradiation setup allows 4 plates to be simultaneously irradiated with 2 different portions (entrance and BP) of a 76.8-MeV beam. Dosimetric uncertainties across the setup are within ±1.8% of the mean dose.
Collapse
Affiliation(s)
| | - Janet M Denbeigh
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Michael G Herman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
18
|
Kirkby KJ, Kirkby NF, Burnet NG, Owen H, Mackay RI, Crellin A, Green S. Heavy charged particle beam therapy and related new radiotherapy technologies: The clinical potential, physics and technical developments required to deliver benefit for patients with cancer. Br J Radiol 2020; 93:20200247. [PMID: 33021102 PMCID: PMC7715999 DOI: 10.1259/bjr.20200247] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 11/05/2022] Open
Abstract
In the UK, one in two people will develop cancer during their lifetimes and radiotherapy (RT) plays a key role in effective treatment. High energy proton beam therapy commenced in the UK National Health Service in 2018. Heavier charged particles have potential advantages over protons by delivering more dose in the Bragg peak, with a sharper penumbra, lower oxygen dependence and increased biological effectiveness. However, they also require more costly equipment including larger gantries to deliver the treatment. There are significant uncertainties in the modelling of relative biological effectiveness and the effects of the fragmentation tail which can deliver dose beyond the Bragg peak. These effects need to be carefully considered especially in relation to long-term outcomes.In 2019, a group of clinicians, clinical scientists, engineers, physical and life scientists from academia and industry, together with funding agency stakeholders, met to consider how the UK should address new technologies for RT, especially the use of heavier charged particles such as helium and carbon and new modes of delivery such as FLASH and spatially fractionated radiotherapy (SFRT).There was unanimous agreement that the UK should develop a facility for heavier charged particle therapy, perhaps constituting a new National Ion Research Centre to enable research using protons and heavier charged particles. Discussion followed on the scale and features, including which ions should be included, from protons through helium, boron, and lithium to carbon, and even oxygen. The consensus view was that any facility intended to treat patients must be located in a hospital setting while providing dedicated research space for physics, preclinical biology and clinical research with beam lines designed for both in vitro and in vivo research. The facility should to be able to investigate and deliver both ultra-high dose rate FLASH RT and SFRT (GRID, minibeams etc.). Discussion included a number of accelerator design options and whether gantries were required. Other potential collaborations might be exploited, including with space agencies, electronics and global communications industries and the nuclear industry.In preparation for clinical delivery, there may be opportunities to send patients overseas (for 12C or 4He ion therapy) using the model of the National Health Service (NHS) Proton Overseas Programme and to look at potential national clinical trials which include heavier ions, FLASH or SFRT. This could be accomplished under the auspices of NCRI CTRad (National Cancer Research Institute, Clinical and Translational Radiotherapy Research Working Group).The initiative should be a community approach, involving all interested parties with a vision that combines discovery science, a translational research capability and a clinical treatment facility. Barriers to the project and ways to overcome them were discussed. Finally, a set of different scenarios of features with different costs and timelines was constructed, with consideration given to the funding environment (prer-Covid-19) and need for cross-funder collaboration.
Collapse
Affiliation(s)
| | | | | | - Hywel Owen
- University of Manchester/Cockcroft Institute, Manchester, United Kingdom
| | | | | | - Stuart Green
- Department of Medical Physics, University Hospital Birmingham, Birmingham, Edgbaston, UK
| |
Collapse
|
19
|
|
20
|
Mara E, Clausen M, Khachonkham S, Deycmar S, Pessy C, Dörr W, Kuess P, Georg D, Gruber S. Investigating the impact of alpha/beta and LET d on relative biological effectiveness in scanned proton beams: An in vitro study based on human cell lines. Med Phys 2020; 47:3691-3702. [PMID: 32347564 PMCID: PMC7496287 DOI: 10.1002/mp.14212] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 04/03/2020] [Accepted: 04/13/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE A relative biological effectiveness (RBE) of 1.1 is commonly used in clinical proton therapy, irrespective of tissue type and depth. This in vitro study was conducted to quantify the RBE of scanned protons as a function of the dose-averaged linear energy transfer (LETd ) and the sensitivity factor (α/ß)X . Additionally, three phenomenological models (McNamara, Rørvik, and Jones) and one mechanistic model (repair-misrepair-fixation, RMF) were applied to the experimentally derived data. METHODS Four human cell lines (FaDu, HaCat, Du145, SKMel) with differential (α/ß)X ratios were irradiated in a custom-designed irradiation setup with doses between 0 and 6 Gy at proximal, central, and distal positions of a 80 mm spread-out Bragg peak (SOBP) centered at 80 mm (setup A: proton energies 66.5-135.6 MeV) and 155 mm (setup B: proton energies 127.2-185.9 MeV) depth, respectively. LETd values at the respective cell positions were derived from Monte Carlo simulations performed with the treatment planning system (TPS, RayStation). Dosimetric measurements were conducted to verify dose homogeneity and dose delivery accuracy. RBE values were derived for doses that resulted in 90 % (RBE90 ) and 10 % (RBE10 ) of cell survival, and survival after a 0.5 Gy dose (RBE0.5Gy ), 2 Gy dose (RBE2Gy ), and 6 Gy dose (RBE6Gy ). RESULTS LETd values at sample positions were 1.9, 2.1, 2.5, 2.8, 4.1, and 4.5 keV/µm. For the cell lines with high (α/ß)X ratios (FaDu, HaCat), the LETd did not impact on the RBE. For low (α/ß)X cell lines (Du145, SKMel), LQ-derived survival curves indicated a clear correlation of LETd and RBE. RBE90 values up to 2.9 and RBE10 values between 1.4 and 1.8 were obtained. Model-derived RBE predictions slightly overestimated the RBE for the high (α/ß)X cell lines, although all models except the Jones model provided RBE values within the experimental uncertainty. For low (α/ß)X cell lines, no agreement was found between experiments and model predictions, that is, all models underestimated the measured RBE. CONCLUSIONS The sensitivity parameter (α/ß)X was observed to be a major influencing factor for the RBE of protons and its sensitivity toward LETd changes. RBE prediction models are applicable for high (α/ß)X cell lines but do not estimate RBE values with sufficient accuracy in low (α/ß)X cell lines.
Collapse
Affiliation(s)
- Elisabeth Mara
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.,University of Applied Science, Wiener Neustadt, Austria
| | - Monika Clausen
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Suphalak Khachonkham
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.,Division of Radiation Therapy, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Simon Deycmar
- Laboratory of Applied Radiobiology, Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Clara Pessy
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Dörr
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Peter Kuess
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.,EBG MedAustron GmbH, Wiener Neustadt, Austria
| | - Dietmar Georg
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.,EBG MedAustron GmbH, Wiener Neustadt, Austria
| | - Sylvia Gruber
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.,EBG MedAustron GmbH, Wiener Neustadt, Austria
| |
Collapse
|
21
|
Cao H, Xiao Z, Zhang Y, Kwong T, Danish SF, Weiner J, Wang X, Yue N, Dai Z, Kuang Y, Bai Y, Nie K. Dosimetric comparisons of different hypofractionated stereotactic radiotherapy techniques in treating intracranial tumors > 3 cm in longest diameter. J Neurosurg 2020; 132:1024-1032. [PMID: 30901747 DOI: 10.3171/2018.12.jns181578] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to compare the dosimetric quality of hypofractionated stereotactic radiosurgery in treating sizeable brain tumors across the following treatment platforms: GammaKnife (GK) Icon, CyberKnife (CK) G4, volumetric modulated arc therapy (VMAT) on the Varian TrueBeam STx, double scattering proton therapy (DSPT) on the Mevion S250, and intensity modulated proton therapy (IMPT) on the Varian ProBeam. METHODS In this retrospective study, stereotactic radiotherapy treatment plans were generated for 10 patients with sizeable brain tumors (> 3 cm in longest diameter) who had been treated with VMAT. Six treatment plans, 20-30 Gy in 5 fractions, were generated for each patient using the same constraints for each of the following radiosurgical methods: 1) GK, 2) CK, 3) coplanar arc VMAT (VMAT-C), 4) noncoplanar arc VMAT (VMAT-NC), 5) DSPT, and 6) IMPT. The coverage; conformity index; gradient index (GI); homogeneity index; mean and maximum point dose of organs at risk; total dose volume (V) in Gy to the normal brain for 2 Gy (V2), 5 Gy (V5), and 12 Gy (V12); and integral dose were compared across all platforms. RESULTS Among the 6 techniques, GK consistently produced a sharper dose falloff despite a greater central target dose. GK gave the lowest GI, with a mean of 2.7 ± 0.1, followed by CK (2.9 ± 0.1), VMAT-NC (3.1 ± 0.3), and VMAT-C (3.5 ± 0.3). The highest mean GIs for the proton beam treatments were 3.8 ± 0.4 for DSPT and 3.9 ± 0.4 for IMPT. The GK consistently targeted the lowest normal brain volume, delivering 5 to 12 Gy when treating relatively smaller- to intermediate-sized lesions (less than 15-20 cm3). Yet, the differences across the 6 modalities relative to GK decreased with the increase of target volume. In particular, the proton treatments delivered the lowest V5 to the normal brain when the target size was over 15-20 cm3 and also produced the lowest integral dose to the normal brain regardless of the target size. CONCLUSIONS This study provides an insightful understanding of dosimetric quality from both photon and proton treatment across the most advanced stereotactic radiotherapy platforms.
Collapse
Affiliation(s)
- Hongbin Cao
- 1Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyan Xiao
- 2Proton Therapy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Yin Zhang
- 3Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Tiffany Kwong
- 4Department of Radiological Science, University of California Irvine, Irvine, California
| | - Shabbar F Danish
- 5Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Joseph Weiner
- 3Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Xiao Wang
- 3Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ning Yue
- 3Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Zhitao Dai
- 6Department of Radiation Oncology, Shanghai Hospital, The Second Military Medical University, Shanghai, China; and
| | - Yu Kuang
- 7Department of Medical Physics, University of Nevada, Las Vegas, Nevada
| | - Yongrui Bai
- 1Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ke Nie
- 3Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| |
Collapse
|
22
|
Beltran C, Schultz HL, Anand A, Merrell K. Radiation biology considerations of proton therapy for gastrointestinal cancers. J Gastrointest Oncol 2020; 11:225-230. [PMID: 32175125 DOI: 10.21037/jgo.2019.06.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Clinical enthusiasm for proton therapy (PT) is high, with an exponential increase in the number of centers offering treatment. Attraction for this charged particle therapy modality stems from the favorable proton dose distribution, with low radiation dose absorption on entry and maximum radiation deposition at the Bragg peak. The current clinical convention is to use a fixed relative biological effectiveness (RBE) value of 1.1 in order to correct the physical dose relative to photon therapy (i.e., proton radiation is 10% more biologically effective then photon radiation). In recent years, concerns about the potential side effects of PT have emerged. Various studies and review articles have sought to better quantify the RBE of PT and shine some light on the complexity of this problem. Reduction in biologic hot spots of non-target tissue is paramount in proton radiation therapy (RT) planning as the primary benefit of proton RT is a reduction in organ at risk (OAR) irradiation. New and emerging clinical data is in support of variable proton biological effectiveness and demonstrate late toxicity, presumably associated with high biological dose, to OAR. Overall, PT has promise to treat many cancer sites with similar efficacy as conventional RT but with fewer acute and late toxicities. However, further knowledge of biologic effective dose and its impact on both cancer and adjacent OAR is paramount for effective and safe treatment of patients with PT.
Collapse
Affiliation(s)
- Chris Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Aman Anand
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Kenneth Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
23
|
Burnet NG, Mackay RI, Smith E, Chadwick AL, Whitfield GA, Thomson DJ, Lowe M, Kirkby NF, Crellin AM, Kirkby KJ. Proton beam therapy: perspectives on the National Health Service England clinical service and research programme. Br J Radiol 2020; 93:20190873. [PMID: 31860337 PMCID: PMC7066938 DOI: 10.1259/bjr.20190873] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/05/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022] Open
Abstract
The UK has an important role in the evaluation of proton beam therapy (PBT) and takes its place on the world stage with the opening of the first National Health Service (NHS) PBT centre in Manchester in 2018, and the second in London coming in 2020. Systematic evaluation of the role of PBT is a key objective. By September 2019, 108 patients had started treatment, 60 paediatric, 19 teenagers and young adults and 29 adults. Obtaining robust outcome data is vital, if we are to understand the strengths and weaknesses of current treatment approaches. This is important in demonstrating when PBT will provide an advantage and when it will not, and in quantifying the magnitude of benefit.The UK also has an important part to play in translational PBT research, and building a research capability has always been the vision. We are perfectly placed to perform translational pre-clinical biological and physical experiments in the dedicated research room in Manchester. The nature of DNA damage from proton irradiation is considerably different from X-rays and this needs to be more fully explored. A better understanding is needed of the relative biological effectiveness (RBE) of protons, especially at the end of the Bragg peak, and of the effects on tumour and normal tissue of PBT combined with conventional chemotherapy, targeted drugs and immunomodulatory agents. These experiments can be enhanced by deterministic mathematical models of the molecular and cellular processes of DNA damage response. The fashion of ultra-high dose rate FLASH irradiation also needs to be explored.
Collapse
Affiliation(s)
| | | | - Ed Smith
- The Christie NHS Foundation Trust, Manchester, and University of Manchester, M20 4BX, UK
| | - Amy L Chadwick
- Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, and The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | - Gillian A Whitfield
- The Christie NHS Foundation Trust, Manchester, and University of Manchester, M20 4BX, UK
| | - David J Thomson
- The Christie NHS Foundation Trust, Manchester, and University of Manchester, M20 4BX, UK
| | | | - Norman F Kirkby
- Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, and The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | | | - Karen J Kirkby
- Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, and The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| |
Collapse
|
24
|
Kobayashi D, Isobe T, Takada K, Mori Y, Takei H, Kumada H, Kamizawa S, Tomita T, Sato E, Yokota H, Sakae T. Establishment of a New Three-Dimensional Dose Evaluation Method Considering Variable Relative Biological Effectiveness and Dose Fractionation in Proton Therapy Combined with High-Dose-Rate Brachytherapy. J Med Phys 2020; 44:270-275. [PMID: 31908386 PMCID: PMC6936203 DOI: 10.4103/jmp.jmp_117_18] [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: 11/20/2018] [Revised: 09/18/2019] [Accepted: 11/01/2019] [Indexed: 11/07/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the influence of variable relative biological effectiveness (RBE) of proton beam and dose fractionation has on dose distribution and to establish a new three-dimensional dose evaluation method for proton therapy combined with high-dose-rate (HDR) brachytherapy. Materials and Methods: To evaluate the influence of variable RBE and dose fractionation on dose distribution in proton beam therapy, the depth-dose distribution of proton therapy was compared with clinical dose, RBE-weighted dose, and equivalent dose in 2 Gy fractions using a linear-quadratic-linear model (EQD2LQL). The clinical dose was calculated by multiplying the physical dose by RBE of 1.1. The RBE-weighted dose is a biological dose that takes into account RBE variation calculated by microdosimetric kinetic model implemented in Monte Carlo code. The EQD2LQL is a biological dose that makes the RBE-weighted dose equivalent to 2 Gy using a linear-quadratic-linear (LQL) model. Finally, we evaluated the three-dimensional dose by taking into account RBE variation and LQL model for proton therapy combined with HDR brachytherapy. Results: The RBE-weighted dose increased at the distal of the spread-out Bragg peak (SOBP). With the difference in the dose fractionation taken into account, the EQD2LQL at the distal of the SOBP increased more than the RBE-weighted dose. In proton therapy combined with HDR brachytherapy, a divergence of 103% or more was observed between the conventional dose estimation method and the dose estimation method we propose. Conclusions: Our dose evaluation method can evaluate the EQD2LQL considering RBE changes in the dose distribution.
Collapse
Affiliation(s)
- Daisuke Kobayashi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Department of Radiology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tomonori Isobe
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Proton Medical Research Center, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kenta Takada
- Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Gunma, Japan
| | - Yutaro Mori
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Proton Medical Research Center, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hideyuki Takei
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Proton Medical Research Center, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hiroaki Kumada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Proton Medical Research Center, University of Tsukuba Hospital, Ibaraki, Japan
| | - Satoshi Kamizawa
- Proton Medical Research Center, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tetsuya Tomita
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Department of Radiology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Eisuke Sato
- Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Hiroshi Yokota
- Department of Radiology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Takeji Sakae
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Proton Medical Research Center, University of Tsukuba Hospital, Ibaraki, Japan
| |
Collapse
|
25
|
Rabus H, Ngcezu SA, Braunroth T, Nettelbeck H. “Broadscale” nanodosimetry: Nanodosimetric track structure quantities increase at distal edge of spread-out proton Bragg peaks. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
26
|
Smith EAK, Henthorn NT, Warmenhoven JW, Ingram SP, Aitkenhead AH, Richardson JC, Sitch P, Chadwick AL, Underwood TSA, Merchant MJ, Burnet NG, Kirkby NF, Kirkby KJ, Mackay RI. In Silico Models of DNA Damage and Repair in Proton Treatment Planning: A Proof of Concept. Sci Rep 2019; 9:19870. [PMID: 31882690 PMCID: PMC6934522 DOI: 10.1038/s41598-019-56258-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 11/29/2019] [Indexed: 01/29/2023] Open
Abstract
There is strong in vitro cell survival evidence that the relative biological effectiveness (RBE) of protons is variable, with dependence on factors such as linear energy transfer (LET) and dose. This is coupled with the growing in vivo evidence, from post-treatment image change analysis, of a variable RBE. Despite this, a constant RBE of 1.1 is still applied as a standard in proton therapy. However, there is a building clinical interest in incorporating a variable RBE. Recently, correlations summarising Monte Carlo-based mechanistic models of DNA damage and repair with absorbed dose and LET have been published as the Manchester mechanistic (MM) model. These correlations offer an alternative path to variable RBE compared to the more standard phenomenological models. In this proof of concept work, these correlations have been extended to acquire RBE-weighted dose distributions and calculated, along with other RBE models, on a treatment plan. The phenomenological and mechanistic models for RBE have been shown to produce comparable results with some differences in magnitude and relative distribution. The mechanistic model found a large RBE for misrepair, which phenomenological models are unable to do. The potential of the MM model to predict multiple endpoints presents a clear advantage over phenomenological models.
Collapse
Affiliation(s)
- Edward A K Smith
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK. .,Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK.
| | - N T Henthorn
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - J W Warmenhoven
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - S P Ingram
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - A H Aitkenhead
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - J C Richardson
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - P Sitch
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - A L Chadwick
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - T S A Underwood
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M J Merchant
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - N G Burnet
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - N F Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - K J Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - R I Mackay
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| |
Collapse
|
27
|
Sørensen BS. Commentary: RBE in proton therapy - where is the experimental in vivo data? Acta Oncol 2019; 58:1337-1339. [PMID: 31578911 DOI: 10.1080/0284186x.2019.1669819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Brita Singers Sørensen
- Department of Experimental Clinical Oncology and Danish Center for Particle Therapy, DCPT, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
28
|
Ulmer W. Aspects of linear energy transfer (LET) and relative biological effectiveness (RBE) in radiation therapy with positively charged particles and the role of electron capture. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2019.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
29
|
Friedrich T. Proton RBE dependence on dose in the setting of hypofractionation. Br J Radiol 2019; 93:20190291. [PMID: 31437004 DOI: 10.1259/bjr.20190291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hypofractionated radiotherapy is attractive concerning patient burden and therapy costs, but many aspects play a role when it comes to assess its safety. While exploited for conventional photon therapy and carbon ion therapy, hypofractionation with protons is only rarely applied. One reason for this is uncertainty in the described dose, mainly due to the relative biological effectiveness (RBE), which is small for protons, but not negligible. RBE is generally dose-dependent, and for higher doses as used in hypofractionation, a thorough RBE evaluation is needed. This review article focuses on the RBE variability in protons and associated issues or implications for hypofractionation.
Collapse
Affiliation(s)
- Thomas Friedrich
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| |
Collapse
|
30
|
Hojo H, Dohmae T, Hotta K, Kageyama SI, Baba H, Kohno R, Motegi A, Tsuchihara K, Akimoto T. Effect of 5-fluorouracil on cellular response to proton beam in esophageal cancer cell lines according to the position of spread-out Bragg peak. Acta Oncol 2019; 58:475-482. [PMID: 30632869 DOI: 10.1080/0284186x.2018.1555373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION To investigate enhancement by 5-fluorouracil (5-FU) of the sensitivity of cancer cells to proton beam irradiation and clarify the differences in the responses of the 5-FU-treated cells to proton beam irradiation according to the position of the cells on the spread-out Bragg peak (SOBP). METHODS OE21 human esophageal squamous cells were irradiated with a 235-MeV proton beam at four different positions on the SOBP. The effects of the irradiation plus 5-FU treatment on the cell survival were assessed by clonogenic assays and determination of the sensitizer enhancement ratio (SER). In addition, DNA double-strand breaks were estimated by measuring phospho-histone H2AX (γH2AX) foci formation in the cells at 0.5 and 24 h after irradiation. RESULTS The relative biological effectiveness (RBE) of proton beam irradiation against vehicle-control cells tended to increase with an increase in the depth of the cells on the SOBP. On the other hand, the degree of enhancement of the cellular sensitivity to proton beam irradiation by 5-FU was similar across all the positions on the SOBP. Furthermore, a marked increase in the number of residual γH2AX foci at 24 h post-irradiation was observed in the cells at the distal end of the SOBP. CONCLUSIONS Our data indicated that the degree of enhancement by 5-FU of the sensitivity of OE21 cells to 235-MeV proton beam irradiation did not differ significantly depending on the position of the cells on the SOBP. Furthermore, the degree of increase in the number of γH2AX foci at 24 h after proton beam irradiation with or without 5-FU exposure did not differ significantly according to the position on the SOBP. The effect of 5-FU in enhancing the effect of proton beam irradiation on cancer cells may be constant for all positions on the SOBP.
Collapse
Affiliation(s)
- Hidehiro Hojo
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takeshi Dohmae
- High Energy Accelerator Research Organization, Tsukuba, Japan
| | - Kenji Hotta
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Shun-Ichiro Kageyama
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hiromi Baba
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Ryosuke Kohno
- Department of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Atsushi Motegi
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Katsuya Tsuchihara
- Division of Translational Research, EPOC, National Cancer Center, Kashiwa, Chiba, Japan
| | - Tetsuo Akimoto
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| |
Collapse
|
31
|
Oeck S, Szymonowicz K, Wiel G, Krysztofiak A, Lambert J, Koska B, Iliakis G, Timmermann B, Jendrossek V. Relating Linear Energy Transfer to the Formation and Resolution of DNA Repair Foci After Irradiation with Equal Doses of X-ray Photons, Plateau, or Bragg-Peak Protons. Int J Mol Sci 2018; 19:ijms19123779. [PMID: 30486506 PMCID: PMC6320817 DOI: 10.3390/ijms19123779] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/24/2018] [Accepted: 11/26/2018] [Indexed: 12/27/2022] Open
Abstract
Proton beam therapy is increasingly applied for the treatment of human cancer, as it promises to reduce normal tissue damage. However, little is known about the relationship between linear energy transfer (LET), the type of DNA damage, and cellular repair mechanisms, particularly for cells irradiated with protons. We irradiated cultured cells delivering equal doses of X-ray photons, Bragg-peak protons, or plateau protons and used this set-up to quantitate initial DNA damage (mainly DNA double strand breaks (DSBs)), and to analyze kinetics of repair by detecting γH2A.X or 53BP1 using immunofluorescence. The results obtained validate the reliability of our set-up in delivering equal radiation doses under all conditions employed. Although the initial numbers of γH2A.X and 53BP1 foci scored were similar under the different irradiation conditions, it was notable that the maximum foci level was reached at 60 min after irradiation with Bragg-peak protons, as compared to 30 min for plateau protons and photons. Interestingly, Bragg-peak protons induced larger and irregularly shaped γH2A.X and 53BP1 foci. Additionally, the resolution of these foci was delayed. These results suggest that Bragg-peak protons induce DNA damage of increased complexity which is difficult to process by the cellular repair apparatus.
Collapse
Affiliation(s)
- Sebastian Oeck
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, Medical School, Virchowstrasse 173, 45122 Essen, Germany.
- Department of Therapeutic Radiology, Yale University School of Medicine, 15 York Street, New Haven, CT 06520, USA.
| | - Klaudia Szymonowicz
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, Medical School, Virchowstrasse 173, 45122 Essen, Germany.
| | - Gesa Wiel
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, Medical School, Virchowstrasse 173, 45122 Essen, Germany.
| | - Adam Krysztofiak
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, Medical School, Virchowstrasse 173, 45122 Essen, Germany.
| | - Jamil Lambert
- West German Proton Therapy Centre Essen, University Hospital Essen, Am Muehlenbach 1, 45147 Essen, Germany.
| | - Benjamin Koska
- West German Proton Therapy Centre Essen, University Hospital Essen, Am Muehlenbach 1, 45147 Essen, Germany.
| | - George Iliakis
- Institute of Medical Radiation Biology; University of Duisburg-Essen; Medical School; Hufelandstr. 55, 45122 Essen, Germany.
| | - Beate Timmermann
- West German Proton Therapy Centre Essen, University Hospital Essen, Am Muehlenbach 1, 45147 Essen, Germany.
| | - Verena Jendrossek
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, Medical School, Virchowstrasse 173, 45122 Essen, Germany.
| |
Collapse
|
32
|
Schuemann J, Bassler N, Inaniwa T. Computational models and tools. Med Phys 2018; 45:e1073-e1085. [PMID: 30421814 DOI: 10.1002/mp.12521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/21/2017] [Accepted: 08/01/2017] [Indexed: 12/12/2022] Open
Abstract
In this chapter, we describe two different methods, analytical (pencil beam) algorithms and Monte Carlo simulations, used to obtain the intended dose distributions in patients and evaluate their strengths and shortcomings. We discuss the difference between the prescribed physical dose and the biologically effective dose, the relative biological effectiveness (RBE) between ions and photons and the dependence of RBE on the linear energy transfer (LET). Lastly, we show how LET- or RBE-based optimization can be used to improve treatment plans and explore how the availability of multimodality ion beam facilities can be used to design a tumor-specific optimal treatment.
Collapse
Affiliation(s)
- Jan Schuemann
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Niels Bassler
- Medical Radiation Physics, Dept. of Physics, Stockholm University, Sweden
| | - Taku Inaniwa
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences, QST, Chiba, Japan
| |
Collapse
|
33
|
McMahon SJ, Paganetti H, Prise KM. LET-weighted doses effectively reduce biological variability in proton radiotherapy planning. ACTA ACUST UNITED AC 2018; 63:225009. [DOI: 10.1088/1361-6560/aae8a5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
34
|
Radisavljevic Z. Muon disrupts AKT hydrogen bond network in cancer. J Cell Physiol 2018; 234:7994-7998. [DOI: 10.1002/jcp.27554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/12/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Ziv Radisavljevic
- Department of Surgery Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts
| |
Collapse
|
35
|
Rawojć K, Miszczyk J, Możdżeń A, Swakoń J, Sowa-Staszczak A. Evaluation of the premature chromosome condensation scoring protocol after proton and X-ray irradiation of human peripheral blood lymphocytes at high doses range. Int J Radiat Biol 2018; 94:996-1005. [PMID: 30295106 DOI: 10.1080/09553002.2018.1490038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF THE STUDY One of the main difficulties in radiation dose assessment is cells inability to reach mitosis after exposure to acute radiation. Premature chromosome condensation (PCC) has become an important method used in biological dosimetry in case of exposure to high doses. Various ways to induce PCC including mitotic cells fusion, chemical stimulation with calyculin A or okadaic acid give wide spectrum of application. The main goal of this study was to evaluate the utility of drug-induced PCC scoring procedure by testing 2 experimental modes where 150 and 75 G2/M-PCC phase cells were analyzed after exposure to high dose proton and X-ray radiation. Another aim is to determine the differences in cellular response induced by proton and photon radiation using a HPBL in vitro model as a further extension of our previous studies involving doses up to 4.0 Gy. MATERIALS AND METHODS Total body exposure was simulated by irradiating whole blood collected from a healthy donor. Whole blood samples were exposed to two radiation types: 60 MeV protons and 250 kVp X-rays in the dose range of 5.0-20.0 Gy, the dose rate for protons was 0.075 and 0.15 Gy/s for X-rays. Post 48 h of human peripheral blood lymphocytes (HPBL) culture, calyculin A was added. After Giemsa staining, chromosome spreads were photographed and manually analyzed by scorers in the G2/M-PCC phase. In order to check the consistency of obtained results all scorers followed identical scoring criteria. Additionally, PCC index kinetics was evaluated for first 500 cells scored. CONCLUSIONS Here we provide a different method of results analysis. Presented dose-response curves were obtained by calculating the value of counted excess chromosome fragments. The results indicated that obtained dose estimates as adequate in the high dose range till 18.0 Gy for both studied radiation types, giving an opportunity to further improve PCC assay procedure and shorten the analysis time i.e. in case of partial-body exposure. Moreover, the study presents preliminary results of HPBL cellular response after proton irradiation at high doses range showing differences of PCC index kinetics for different cell classes and cell distribution.
Collapse
Affiliation(s)
- K Rawojć
- a Department of Endocrinology , Nuclear Medicine Unit, The University Hospital , Kraków , Poland
| | - J Miszczyk
- b Department of Experimental Physics of Complex Systems , Institute of Nuclear Physics Polish Academy of Sciences , Kraków , Poland
| | - A Możdżeń
- b Department of Experimental Physics of Complex Systems , Institute of Nuclear Physics Polish Academy of Sciences , Kraków , Poland
| | - J Swakoń
- c Proton Radiotherapy Group, Institute of Nuclear Physics Polish Academy of Sciences , Kraków , Poland
| | - A Sowa-Staszczak
- a Department of Endocrinology , Nuclear Medicine Unit, The University Hospital , Kraków , Poland.,d Chair and Department of Endocrinology , Jagiellonian University, Medical College , Kraków , Poland
| |
Collapse
|
36
|
Lühr A, von Neubeck C, Pawelke J, Seidlitz A, Peitzsch C, Bentzen SM, Bortfeld T, Debus J, Deutsch E, Langendijk JA, Loeffler JS, Mohan R, Scholz M, Sørensen BS, Weber DC, Baumann M, Krause M. "Radiobiology of Proton Therapy": Results of an international expert workshop. Radiother Oncol 2018; 128:56-67. [PMID: 29861141 DOI: 10.1016/j.radonc.2018.05.018] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 12/25/2022]
Abstract
The physical properties of proton beams offer the potential to reduce toxicity in tumor-adjacent normal tissues. Toward this end, the number of proton radiotherapy facilities has steeply increased over the last 10-15 years to currently around 70 operational centers worldwide. However, taking full advantage of the opportunities offered by proton radiation for clinical radiotherapy requires a better understanding of the radiobiological effects of protons alone or combined with drugs or immunotherapy on normal tissues and tumors. This report summarizes the main results of the international expert workshop "Radiobiology of Proton Therapy" that was held in November 2016 in Dresden. It addresses the major topics (1) relative biological effectiveness (RBE) in proton beam therapy, (2) interaction of proton radiobiology with radiation physics in current treatment planning, (3) biological effects in proton therapy combined with systemic treatments, and (4) testing biological effects of protons in clinical trials. Finally, important research avenues for improvement of proton radiotherapy based on radiobiological knowledge are identified. The clinical distribution of radiobiological effectiveness of protons alone or in combination with systemic chemo- or immunotherapies as well as patient stratification based on biomarker expressions are key to reach the full potential of proton beam therapy. Dedicated preclinical experiments, innovative clinical trial designs, and large high-quality data repositories will be most important to achieve this goal.
Collapse
Affiliation(s)
- Armin Lühr
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Cläre von Neubeck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jörg Pawelke
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany
| | - Annekatrin Seidlitz
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Claudia Peitzsch
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Germany
| | - Søren M Bentzen
- Division of Biostatistics and Bioinformatics, Department of Epidemiology and Public Health and the Maryland Proton Therapy Center, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Thomas Bortfeld
- Physics Division, Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Jürgen Debus
- German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University Heidelberg German Consortium for Translational Oncology (DKTK), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Eric Deutsch
- Department of Radiation Oncology Gustave Roussy Cancer Campus, INSERM, 1030 Villejuif, France; Université Paris-Sud, Faculté de Medecine du Kremlin Bicetre Paris Sud, Le Kremlin-Bicêtre, France
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jay S Loeffler
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, USA
| | - Radhe Mohan
- Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, USA
| | - Michael Scholz
- GSI Helmholtz Center for Heavy Ion Research, Department of Biophysics, Darmstadt, Germany
| | - Brita S Sørensen
- Dept. Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Michael Baumann
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Mechthild Krause
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Germany
| | | |
Collapse
|
37
|
Carante MP, Aimè C, Cajiao JJT, Ballarini F. BIANCA, a biophysical model of cell survival and chromosome damage by protons, C-ions and He-ions at energies and doses used in hadrontherapy. Phys Med Biol 2018; 63:075007. [PMID: 29508768 DOI: 10.1088/1361-6560/aab45f] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An upgraded version of the BIANCA II biophysical model, which describes more realistically interphase chromosome organization and the link between chromosome aberrations and cell death, was applied to V79 and AG01522 cells exposed to protons, C-ions and He-ions over a wide LET interval (0.6-502 keV µm-1), as well as proton-irradiated U87 cells. The model assumes that (i) ionizing radiation induces DNA 'cluster lesions' (CLs), where by definition each CL produces two independent chromosome fragments; (ii) fragment (distance-dependent) mis-rejoining, or un-rejoining, produces chromosome aberrations; (iii) some aberrations lead to cell death. The CL yield, which mainly depends on radiation quality but is also modulated by the target cell, is an adjustable parameter. The fragment un-rejoining probability, f, is the second, and last, parameter. The value of f, which is assumed to depend on the cell type but not on radiation quality, was taken from previous studies, and only the CL yield was adjusted in the present work. Good agreement between simulations and experimental data was obtained, suggesting that BIANCA II is suitable for calculating the biological effectiveness of hadrontherapy beams. For both V79 and AG01522 cells, the mean number of CLs per micrometer was found to increase with LET in a linear-quadratic fashion before the over-killing region, where a less rapid increase, with a tendency to saturation, was observed. Although the over-killing region deserves further investigation, the possibility of fitting the CL yields is an important feature for hadrontherapy, because it allows performing predictions also at LET values where experimental data are not available. Finally, an approach was proposed to predict the ion-response of the cell line(s) of interest from the ion-response of a reference cell line and the photon response of both. A pilot study on proton-irradiated AG01522 and U87 cells, taking V79 cells as a reference, showed encouraging results.
Collapse
Affiliation(s)
- Mario Pietro Carante
- Physics Department, University of Pavia, via Bassi 6, I-27100 Pavia, Italy. INFN-Sezione di Pavia, via Bassi 6, I-27100 Pavia, Italy
| | | | | | | |
Collapse
|
38
|
Howard ME, Beltran C, Anderson S, Tseung WC, Sarkaria JN, Herman MG. Investigating Dependencies of Relative Biological Effectiveness for Proton Therapy in Cancer Cells. Int J Part Ther 2018; 4:12-22. [PMID: 30159358 DOI: 10.14338/ijpt-17-00031.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Relative biological effectiveness (RBE) accounts for the differences in biological effect from different radiation types. The RBE for proton therapy remains uncertain, as it has been shown to vary from the clinically used value of 1.1. In this work we investigated the RBE of protons and correlated the biological differences with the underlying physical quantities. Materials and Methods Three cell lines were irradiated (CHO, Chinese hamster ovary; A549, human lung adenocarcinoma; and T98, human glioma) and assessed for cell survival by using clonogenic assay. Cells were irradiated with 71- and 160-MeV protons at depths along the Bragg curve and 6-MV photons to various doses. The dose-averaged lineal energy ( y‒D ) was measured under similar conditions as the cells by using a microdosimeter. Dose-averaged linear energy transfer (LETd) was also calculated by using Monte Carlo (MC) simulations. Survival data were fit by using the linear quadratic model. The RBE values were calculated by comparing the physical dose (D6MV/Dp) that results in 50% (RBE0.5) and 10% (RBE0.1) cell survival, and survival after 2 Gy (RBE2Gy). Results Proton RBE values ranged from 0.89 to 2.40. The RBE for all 3 cell lines increased with decreasing proton energy and was higher at 50% survival than at 10% survival. Additionally, both A549 and T98 cells generally had higher RBE values relative to the CHO cells, indicating a greater biological response to protons. An increase in RBE corresponded with an increase in y‒D and LETd. Conclusion Proton RBE was found to depend on mean proton energy, survival end point, and cell type. Changes in both y‒D and LETd were also found to impact proton RBE values, but consideration of the energy spectrum may provide additional information. The RBE values in this study vary greatly, indicating the clinical value of 1.1 may not be suitable in all cases.
Collapse
Affiliation(s)
| | - Chris Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sarah Anderson
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Wan Chan Tseung
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Jann N Sarkaria
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Michael G Herman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
39
|
Jones B, McMahon SJ, Prise KM. The Radiobiology of Proton Therapy: Challenges and Opportunities Around Relative Biological Effectiveness. Clin Oncol (R Coll Radiol) 2018; 30:285-292. [PMID: 29454504 DOI: 10.1016/j.clon.2018.01.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/16/2018] [Indexed: 01/31/2023]
Abstract
With the current UK expansion of proton therapy there is a great opportunity for clinical oncologists to develop a translational interest in the associated scientific base and clinical results. In particular, the underpinning controversy regarding the conversion of photon dose to proton dose by the relative biological effectiveness (RBE) must be understood, including its important implications. At the present time, the proton prescribed dose includes an RBE of 1.1 regardless of tissue, tumour and dose fractionation. A body of data has emerged against this pragmatic approach, including a critique of the existing evidence base, due to choice of dose, use of only acute-reacting in vivo assays, analysis methods and the reference radiations used to determine the RBE. Modelling systems, based on the best available scientific evidence, and which include the clinically useful biological effective dose (BED) concept, have also been developed to estimate proton RBEs for different dose and linear energy transfer (LET) values. The latter reflect ionisation density, which progressively increases along each proton track. Late-reacting tissues, such as the brain, where α/β = 2 Gy, show a higher RBE than 1.1 at a low dose per fraction (1.2-1.8 Gy) at LET values used to cover conventional target volumes and can be much higher. RBE changes with tissue depth seem to vary depending on the method of beam delivery used. To reduce unexpected toxicity, which does occasionally follow proton therapy, a more rational approach to RBE allocation, using a variable RBE that depends on dose per fraction and the tissue and tumour radiobiological characteristics such as α/β, is proposed.
Collapse
Affiliation(s)
- B Jones
- Oxford Institute for Radiation Oncology, University of Oxford, Old Road Campus Research Building, Oxford, UK.
| | - S J McMahon
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
| | - K M Prise
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
| |
Collapse
|
40
|
In Silico Non-Homologous End Joining Following Ion Induced DNA Double Strand Breaks Predicts That Repair Fidelity Depends on Break Density. Sci Rep 2018; 8:2654. [PMID: 29422642 PMCID: PMC5805743 DOI: 10.1038/s41598-018-21111-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/25/2018] [Indexed: 12/19/2022] Open
Abstract
This work uses Monte Carlo simulations to investigate the dependence of residual and misrepaired double strand breaks (DSBs) at 24 hours on the initial damage pattern created during ion therapy. We present results from a nanometric DNA damage simulation coupled to a mechanistic model of Non-Homologous End Joining, capable of predicting the position, complexity, and repair of DSBs. The initial damage pattern is scored by calculating the average number of DSBs within 70 nm from every DSB. We show that this local DSB density, referred to as the cluster density, can linearly predict misrepair regardless of ion species. The models predict that the fraction of residual DSBs is constant, with 7.3% of DSBs left unrepaired following 24 hours of repair. Through simulation over a range of doses and linear energy transfer (LET) we derive simple correlations capable of predicting residual and misrepaired DSBs. These equations are applicable to ion therapy treatment planning where both dose and LET are scored. This is demonstrated by applying the correlations to an example of a clinical proton spread out Bragg peak. Here we see a considerable biological effect past the distal edge, dominated by residual DSBs.
Collapse
|
41
|
Ilicic K, Combs SE, Schmid TE. New insights in the relative radiobiological effectiveness of proton irradiation. Radiat Oncol 2018; 13:6. [PMID: 29338744 PMCID: PMC5771069 DOI: 10.1186/s13014-018-0954-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/05/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Proton radiotherapy is a form of charged particle therapy that is preferentially applied for the treatment of tumors positioned near to critical structures due to their physical characteristics, showing an inverted depth-dose profile. The sparing of normal tissue has additional advantages in the treatment of pediatric patients, in whom the risk of secondary cancers and late morbidity is significantly higher. Up to date, a fixed relative biological effectiveness (RBE) of 1.1 is commonly implemented in treatment planning systems with protons in order to correct the physical dose. This value of 1.1 comes from averaging the results of numerous in vitro experiments, mostly conducted in the middle of the spread-out Bragg peak, where RBE is relatively constant. However, the use of a constant RBE value disregards the experimental evidence which clearly demonstrates complex RBE dependency on dose, cell- or tissue type, linear energy transfer and biological endpoints. In recent years, several in vitro studies indicate variations in RBE of protons which translate to an uncertainty in the biological effective dose delivery to the patient. Particularly for regions surrounding the Bragg peak, the more localized pattern of energy deposition leads to more complex DNA lesions. These RBE variations of protons bring the validity of using a constant RBE into question. MAIN BODY This review analyzes how RBE depends on the dose, different biological endpoints and physical properties. Further, this review gives an overview of the new insights based on findings made during the last years investigating the variation of RBE with depth in the spread out Bragg peak and the underlying differences in radiation response on the molecular and cellular levels between proton and photon irradiation. Research groups such as the Klinische Forschergruppe Schwerionentherapie funded by the German Research Foundation (DFG, KFO 214) have included work on this topic and the present manuscript highlights parts of the preclinical work and summarizes the research activities in this context. SHORT CONCLUSION In summary, there is an urgent need for more coordinated in vitro and in vivo experiments that concentrate on a realistic dose range of in clinically relevant tissues like lung or spinal cord.
Collapse
Affiliation(s)
- K Ilicic
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, 81675, München, Germany.,Institute of Innovative Radiotherapy, Helmholtz Zentrum München, Neuherberg, Germany
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, 81675, München, Germany.,Institute of Innovative Radiotherapy, Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - T E Schmid
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, 81675, München, Germany. .,Institute of Innovative Radiotherapy, Helmholtz Zentrum München, Neuherberg, Germany.
| |
Collapse
|
42
|
Howard ME, Beltran C, Anderson S, Tseung WC, Sarkaria JN, Herman MG. Investigating Dependencies of Relative Biological Effectiveness for Proton Therapy in Cancer Cells. Int J Part Ther 2018. [PMID: 30159358 DOI: 10.14338/ijpt-17-0031.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
PURPOSE Relative biological effectiveness (RBE) accounts for the differences in biological effect from different radiation types. The RBE for proton therapy remains uncertain, as it has been shown to vary from the clinically used value of 1.1. In this work we investigated the RBE of protons and correlated the biological differences with the underlying physical quantities. MATERIALS AND METHODS Three cell lines were irradiated (CHO, Chinese hamster ovary; A549, human lung adenocarcinoma; and T98, human glioma) and assessed for cell survival by using clonogenic assay. Cells were irradiated with 71- and 160-MeV protons at depths along the Bragg curve and 6-MV photons to various doses. The dose-averaged lineal energy ( y‒D ) was measured under similar conditions as the cells by using a microdosimeter. Dose-averaged linear energy transfer (LETd) was also calculated by using Monte Carlo (MC) simulations. Survival data were fit by using the linear quadratic model. The RBE values were calculated by comparing the physical dose (D6MV/Dp) that results in 50% (RBE0.5) and 10% (RBE0.1) cell survival, and survival after 2 Gy (RBE2Gy). RESULTS Proton RBE values ranged from 0.89 to 2.40. The RBE for all 3 cell lines increased with decreasing proton energy and was higher at 50% survival than at 10% survival. Additionally, both A549 and T98 cells generally had higher RBE values relative to the CHO cells, indicating a greater biological response to protons. An increase in RBE corresponded with an increase in y‒D and LETd. CONCLUSION Proton RBE was found to depend on mean proton energy, survival end point, and cell type. Changes in both y‒D and LETd were also found to impact proton RBE values, but consideration of the energy spectrum may provide additional information. The RBE values in this study vary greatly, indicating the clinical value of 1.1 may not be suitable in all cases.
Collapse
Affiliation(s)
| | - Chris Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sarah Anderson
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Wan Chan Tseung
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Jann N Sarkaria
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Michael G Herman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
43
|
Spyratou E, Makropoulou M, Efstathopoulos EP, Georgakilas AG, Sihver L. Recent Advances in Cancer Therapy Based on Dual Mode Gold Nanoparticles. Cancers (Basel) 2017; 9:cancers9120173. [PMID: 29257070 PMCID: PMC5742821 DOI: 10.3390/cancers9120173] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/09/2017] [Accepted: 12/15/2017] [Indexed: 11/21/2022] Open
Abstract
Many tumor-targeted strategies have been used worldwide to limit the side effects and improve the effectiveness of therapies, such as chemotherapy, radiotherapy (RT), etc. Biophotonic therapy modalities comprise very promising alternative techniques for cancer treatment with minimal invasiveness and side-effects. These modalities use light e.g., laser irradiation in an extracorporeal or intravenous mode to activate photosensitizer agents with selectivity in the target tissue. Photothermal therapy (PTT) is a minimally invasive technique for cancer treatment which uses laser-activated photoabsorbers to convert photon energy into heat sufficient to induce cells destruction via apoptosis, necroptosis and/or necrosis. During the last decade, PTT has attracted an increased interest since the therapy can be combined with customized functionalized nanoparticles (NPs). Recent advances in nanotechnology have given rise to generation of various types of NPs, like gold NPs (AuNPs), designed to act both as radiosensitizers and photothermal sensitizing agents due to their unique optical and electrical properties i.e., functioning in dual mode. Functionalized AuNPS can be employed in combination with non-ionizing and ionizing radiation to significantly improve the efficacy of cancer treatment while at the same time sparing normal tissues. Here, we first provide an overview of the use of NPs for cancer therapy. Then we review many recent advances on the use of gold NPs in PTT, RT and PTT/RT based on different types of AuNPs, irradiation conditions and protocols. We refer to the interaction mechanisms of AuNPs with cancer cells via the effects of non-ionizing and ionizing radiations and we provide recent existing experimental data as a baseline for the design of optimized protocols in PTT, RT and PTT/RT combined treatment.
Collapse
Affiliation(s)
- Ellas Spyratou
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece.
| | - Mersini Makropoulou
- Department of Physics, School of Applied Mathematical and Physical Sciences, National Technical University of Athens, 15780 Athens, Greece.
| | - Efstathios P Efstathopoulos
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece.
| | - Alexandros G Georgakilas
- Department of Physics, School of Applied Mathematical and Physical Sciences, National Technical University of Athens, 15780 Athens, Greece.
| | - Lembit Sihver
- Atominstitut, Technische Universität Wien, Stadionallee 2, 1020 Vienna, Austria.
| |
Collapse
|
44
|
Abstract
PURPOSE To better estimate relative biological effectiveness (RBE) in therapeutic proton beams by using a modeled approach, in order to improve their clinical safety and effectiveness. INTRODUCTION Concerns exist about the 1.1 RBE used in proton therapy, since it may lead to unintentional over- and under-dosage in patients and so lead to unexpected clinical outcomes. Late reacting normal tissues (with low α/β values), might be overdosed if RBE >1.1; very radiosensitive tumors (with high α/β), might be under-dosed if RBE <1.1. Some physicists recommend ignoring RBE in favor of a LET × dose product to predict effects. MATERIAL AND METHODS Extensive linear-quadratic based modeling is scaled between a standard hospital megavoltage photon reference radiation (low LET of 0.22 keV μm-1) α and β values and their values at higher LETs, representative of the middle and end of the SOBPs. A previously published energy-efficiency model provide RBE estimates for different α/β (2-27 Gy). The concept of using a LET × dose product is assessed by comparing it with surviving fraction and the equivalent dose in 2 Gy fractions (EQD-2). RESULTS Low α/β value biosystems have the widest RBE ranges with dose per fraction changes and increasing LET, often above 1.1 even within the SOBP LET range, with lower values at higher dose per fraction. Highly radiosensitive tumors (α/β 10-27 Gy) have the lowest RBEs, often below 1.1, and are not fraction-sensitive. RBE's generally increase with LET, so curtailment of LET in normal tissues is important. The LET × dose product is insufficiently discriminating when compared with surviving fraction and biological effective dose (BED) or EQD-2. CONCLUSIONS An overall research framework is suggested. Proton therapy advantages will only be fully realized if reasonably correct RBE values are used.
Collapse
Affiliation(s)
- B. Jones
- Gray Laboratory, CRUK/MRC Oxford Oncology Institute, The University of Oxford, Oxford, UK
| |
Collapse
|
45
|
Abstract
Denser ionisation clustering and complex DNA damage in proton Bragg peaks far exceeds that seen with conventional X-rays. This results in more efficient cell sterilisation, quantified by the relative biological effectiveness (RBE). Currently, a 1.1 RBE is used to determine the clinical proton doses by dividing the usual X-rays dose by this amount. This number, derived from short-term experiments, has been criticised as being irrelevant to late normal tissue (NT) effects following radiotherapy and included many control irradiations using lower voltage X-rays (with elevated RBE values) than those used in the clinic. In principle, an increased RBE could be used for each organ at risk, by using extensions of the clinically successful linear quadratic model. Protons undoubtedly reduce or eliminate NT radiation dose in tissues distantly located from a tumour, but the necessity to include NT margins around a tumour can result in a higher volume of NT than tumour being irradiated. Deleterious side-effects can follow if the NT RBE exceeds 1.1, including in tissue very close to these margins and which are only partially spared. Use of a constant 1.1 RBE can ‘overdose’ NT, which may require a greater dose reduction such as 1.2 in the brain; some tumours may be ‘under-dosed’ (since they might require a lesser or no reduction in dose). More sophisticated proton experiments show that RBE values of 1.1–1.5 and higher occur in some situations. There are now mathematical models of varying degrees of complexity that can estimate the RBE from the dose, LET and the low-LET radiosensitivities. True multidisciplinary cooperation is required to implement such new ideas in proton therapy in order to improve safety and effectiveness.
Collapse
Affiliation(s)
- Bleddyn Jones
- Gray Laboratory, CRUK/MRC Oxford Oncology Institute, The University of Oxford, ORCRB - Roosevelt Drive, Oxford OX3 7DQ, UK
| |
Collapse
|
46
|
Recovery from sublethal damage and potentially lethal damage : Proton beam irradiation vs. X‑ray irradiation. Strahlenther Onkol 2017; 194:343-351. [PMID: 29038831 DOI: 10.1007/s00066-017-1223-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/26/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE In order to clarify the biological response of tumor cells to proton beam irradiation, sublethal damage recovery (SLDR) and potentially lethal damage recovery (PLDR) induced after proton beam irradiation at the center of a 10 cm spread-out Bragg peak (SOBP) were compared with those seen after X‑ray irradiation. METHODS Cell survival was determined by a colony assay using EMT6 and human salivary gland tumor (HSG) cells. First, two doses of 4 Gy/GyE (Gray equivalents, GyE) were given at an interfraction interval of 0-6 h. Second, five fractions of 1.6 Gy/GyE were administered at interfraction intervals of 0-5 min. Third, a delayed-plating assay involving cells in plateau-phase cultures was conducted. The cells were plated in plastic dishes immediately or 2-24 h after being irradiated with 8 Gy/GyE of X‑rays or proton beams. Furthermore, we investigated the degree of protection from the effects of X‑rays or proton beams afforded by the radical scavenger dimethyl sulfoxide to estimate the contribution of the indirect effect of radiation. RESULTS In both the first and second experiments, SLDR was more suppressed after proton beam irradiation than after X‑ray irradiation. In the third experiment, there was no difference in PLDR between the proton beam and X‑ray irradiation conditions. The degree of protection tended to be higher after X‑ray irradiation than after proton beam irradiation. CONCLUSION Compared with that seen after X‑ray irradiation, SLDR might take place to a lesser extent after proton beam irradiation at the center of a 10 cm SOBP, while the extent of PLDR does not differ significantly between these two conditions.
Collapse
|
47
|
Tran LT, Chartier L, Bolst D, Pogossov A, Guatelli S, Petasecca M, Lerch MLF, Prokopovich DA, Reinhard MI, Clasie B, Depauw N, Kooy H, Flanz JB, McNamara A, Paganetti H, Beltran C, Furutani K, Perevertaylo VL, Jackson M, Rosenfeld AB. Characterization of proton pencil beam scanning and passive beam using a high spatial resolution solid‐state microdosimeter. Med Phys 2017; 44:6085-6095. [DOI: 10.1002/mp.12563] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/31/2017] [Accepted: 08/25/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Linh T. Tran
- Centre for Medical Radiation Physics University of Wollongong Wollongong Australia
| | - Lachlan Chartier
- Centre for Medical Radiation Physics University of Wollongong Wollongong Australia
| | - David Bolst
- Centre for Medical Radiation Physics University of Wollongong Wollongong Australia
| | - Alex Pogossov
- Centre for Medical Radiation Physics University of Wollongong Wollongong Australia
| | - Susanna Guatelli
- Centre for Medical Radiation Physics University of Wollongong Wollongong Australia
| | - Marco Petasecca
- Centre for Medical Radiation Physics University of Wollongong Wollongong Australia
| | - Michael L. F. Lerch
- Centre for Medical Radiation Physics University of Wollongong Wollongong Australia
| | - Dale A. Prokopovich
- Australian Nuclear Science and Technology Organisation Lucas Heights Australia
| | - Mark I. Reinhard
- Australian Nuclear Science and Technology Organisation Lucas Heights Australia
| | - Benjamin Clasie
- Department of Radiation Oncology Massachusetts General Hospital & Harvard Medical School Boston MA USA
| | - Nicolas Depauw
- Department of Radiation Oncology Massachusetts General Hospital & Harvard Medical School Boston MA USA
| | - Hanne Kooy
- Department of Radiation Oncology Massachusetts General Hospital & Harvard Medical School Boston MA USA
| | - Jacob B. Flanz
- Department of Radiation Oncology Massachusetts General Hospital & Harvard Medical School Boston MA USA
| | - Aimee McNamara
- Department of Radiation Oncology Massachusetts General Hospital & Harvard Medical School Boston MA USA
| | - Harald Paganetti
- Department of Radiation Oncology Massachusetts General Hospital & Harvard Medical School Boston MA USA
| | | | | | | | - Michael Jackson
- Radiation Oncology Department Prince of Wales Hospital Randwick NSW 2031 Australia
| | - Anatoly B. Rosenfeld
- Centre for Medical Radiation Physics University of Wollongong Wollongong Australia
| |
Collapse
|
48
|
McDonald F, Hanna GG. Do protons have a role in the treatment of locally advanced NSCLC with radiotherapy? Lung Cancer 2017; 110:71-73. [PMID: 28624125 DOI: 10.1016/j.lungcan.2017.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Fiona McDonald
- The Royal Marsden NHS Foundation Trust Associate Honorary Faculty, UK; Centre for Cancer Research and Cell Biology, Queens University, UK.
| | - Gerard G Hanna
- The Royal Marsden NHS Foundation Trust Associate Honorary Faculty, UK; Centre for Cancer Research and Cell Biology, Queens University, UK
| |
Collapse
|
49
|
Radisavljevic Z. AKT as Locus of Hydrogen Bond Network in Cancer. J Cell Biochem 2017; 119:130-133. [DOI: 10.1002/jcb.26193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Ziv Radisavljevic
- Department of SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts 02115
| |
Collapse
|
50
|
Leeman JE, Romesser PB, Zhou Y, McBride S, Riaz N, Sherman E, Cohen MA, Cahlon O, Lee N. Proton therapy for head and neck cancer: expanding the therapeutic window. Lancet Oncol 2017; 18:e254-e265. [DOI: 10.1016/s1470-2045(17)30179-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 12/25/2022]
|