1
|
Eling L, Verry C, Balosso J, Flandin I, Kefs S, Bouchet A, Adam JF, Laissue JA, Serduc R. Neurologic Changes Induced by Whole-Brain Synchrotron Microbeam Irradiation: 10-Month Behavioral and Veterinary Follow-Up. Int J Radiat Oncol Biol Phys 2024; 120:178-188. [PMID: 38462014 DOI: 10.1016/j.ijrobp.2024.02.053] [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: 10/27/2023] [Revised: 02/19/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE Novel radiation therapy approaches have increased the therapeutic efficacy for malignant brain tumors over the past decades, but the balance between therapeutic gain and radiotoxicity remains a medical hardship. Synchrotron microbeam radiation therapy, an innovative technique, deposes extremely high (peak) doses in micron-wide, parallel microbeam paths, whereas the diffusing interbeam (valley) doses lie in the range of conventional radiation therapy doses. In this study, we evaluated normal tissue toxicity of whole-brain microbeam irradiation (MBI) versus that of a conventional hospital broad beam (hBB). METHODS AND MATERIALS Normal Fischer rats (n = 6-7/group) were irradiated with one of the two modalities, exposing the entire brain to MBI valley/peak doses of 0/0, 5/200, 10/400, 13/520, 17/680, or 25/1000 Gy or to hBB doses of 7, 10, 13, 17, or 25 Gy. Two additional groups of rats received an MBI valley dose of 10 Gy coupled with an hBB dose of 7 or 15 Gy (groups MBI17* and MBI25*). Behavioral parameters were evaluated for 10 months after irradiation combined with veterinary observations. RESULTS MBI peak doses of ≥680 Gy caused acute toxicity and death. Animals exposed to hBB or MBI dose-dependently gained less weight than controls; rats in the hBB25 and MBI25* groups died within 6 months after irradiation. Increasing doses of MBI caused hyperactivity but no other detectable behavioral alterations in our tests. Importantly, no health concerns were seen up to an MBI valley dose of 17 Gy. CONCLUSIONS While acute toxicity of microbeam exposures depends on very high peak doses, late toxicity mainly relates to delivery of high MBI valley doses. MBI seems to have a low impact on normal rat behavior, but further tests are warranted to fully explore this hypothesis. However, high peak and valley doses are well tolerated from a veterinary point of view. This normal tissue tolerance to whole-brain, high-dose MBI reveals a promising avenue for microbeam radiation therapy, that is, therapeutic applications of microbeams that are poised for translation to a clinical environment.
Collapse
Affiliation(s)
- Laura Eling
- Université Grenoble Alpes, Institut National de la Santé et de la Recherche Médicale UA7 Synchrotron Radiation for Biomedicine, Saint-Martin d'Hères, France.
| | - Camille Verry
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, La Tronche, France
| | - Jacques Balosso
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, La Tronche, France
| | - Isabelle Flandin
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, La Tronche, France
| | - Samy Kefs
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, La Tronche, France
| | - Audrey Bouchet
- INSERM U1296, Radiation: Defense, Health, Environment, Lyon, France
| | - Jean François Adam
- Université Grenoble Alpes, Institut National de la Santé et de la Recherche Médicale UA7 Synchrotron Radiation for Biomedicine, Saint-Martin d'Hères, France; Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, La Tronche, France
| | | | - Raphael Serduc
- Université Grenoble Alpes, Institut National de la Santé et de la Recherche Médicale UA7 Synchrotron Radiation for Biomedicine, Saint-Martin d'Hères, France; Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, La Tronche, France
| |
Collapse
|
2
|
Potez M, Rome C, Lemasson B, Heemeryck P, Laissue JA, Stupar V, Mathieu H, Collomb N, Barbier EL, Djonov V, Bouchet A. Microbeam Radiation Therapy Opens a Several Days' Vessel Permeability Window for Small Molecules in Brain Tumor Vessels. Int J Radiat Oncol Biol Phys 2024; 119:1506-1516. [PMID: 38373658 DOI: 10.1016/j.ijrobp.2024.02.007] [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: 09/04/2023] [Revised: 12/27/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Synchrotron microbeam radiation therapy (MRT), based on an inhomogeneous geometric and microscopic irradiation pattern of the tissues with high-dose and high-dose-rate x-rays, enhances the permeability of brain tumor vessels. This study attempted to determine the time and size range of the permeability window induced by MRT in the blood-brain (tumor) barrier. METHODS AND MATERIALS Rats-bearing 9L gliomas were exposed to MRT, either unidirectional (tumor dose, 406 Gy) or bidirectional (crossfired) (2 × 203 Gy). We measured vessel permeability to molecules of 3 sizes (Gd-DOTA, Dotarem, 0.56 kDa; gadolinium-labeled albumin, ∼74 kDa; and gadolinium-labeled IgG, 160 kDa) by daily in vivo magnetic resonance imaging, from 1 day before to 10 days after irradiation. RESULTS An equivalent tumor dose of bidirectional MRT delivered from 2 orthogonal directions increased tumor vessel permeability for the smallest molecule tested more effectively than unidirectional MRT. Bidirectional MRT also affected the permeability of normal contralateral vessels to a different extent than unidirectional MRT. Conversely, bidirectional MRT did not modify the permeability of normal or tumor vessels for both larger molecules (74 and 160 kDa). CONCLUSIONS High-dose bidirectional (cross-fired) MRT induced a significant increase in tumor vessel permeability for small molecules between the first and the seventh day after irradiation, whereas permeability of vessels in normal brain tissue remained stable. Such a permeability window could facilitate an efficient and safe delivery of intravenous small molecules (≤0.56 kDa) to tumoral tissues. A permeability window was not achieved by molecules larger than gado-grafted albumin (74 kDa). Vascular permeability for molecules between these 2 sizes has not been determined.
Collapse
Affiliation(s)
- Marine Potez
- Institute of Anatomy, Group Topographic and Clinical Anatomy, University of Bern, Bern, Switzerland
| | - Claire Rome
- University Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, La Tronche, France
| | - Benjamin Lemasson
- University Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, La Tronche, France
| | - Pierre Heemeryck
- Inserm U1296 "Radiation: Defense, Health, Environment," Lyon, France
| | | | - Vasile Stupar
- University Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, La Tronche, France; University Grenoble Alpes, Inserm, CNRS, CHU Grenoble Alpes, IRMaGe, Grenoble, France
| | - Hervé Mathieu
- University Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, La Tronche, France; University Grenoble Alpes, Inserm, CNRS, CHU Grenoble Alpes, IRMaGe, Grenoble, France
| | - Nora Collomb
- University Grenoble Alpes, Inserm, CNRS, CHU Grenoble Alpes, IRMaGe, Grenoble, France
| | - Emmanuel L Barbier
- University Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, La Tronche, France; University Grenoble Alpes, Inserm, CNRS, CHU Grenoble Alpes, IRMaGe, Grenoble, France.
| | - Valentin Djonov
- Institute of Anatomy, Group Topographic and Clinical Anatomy, University of Bern, Bern, Switzerland
| | - Audrey Bouchet
- Institute of Anatomy, Group Topographic and Clinical Anatomy, University of Bern, Bern, Switzerland; Inserm U1296 "Radiation: Defense, Health, Environment," Lyon, France.
| |
Collapse
|
3
|
Eling L, Kefs S, Keshmiri S, Balosso J, Calvet S, Chamel G, Drevon-Gaud R, Flandin I, Gaudin M, Giraud L, Laissue JA, Pellicioli P, Verry C, Adam JF, Serduc R. Neuro-Oncologic Veterinary Trial for the Clinical Transfer of Microbeam Radiation Therapy: Acute to Subacute Radiotolerance after Brain Tumor Irradiation in Pet Dogs. Cancers (Basel) 2024; 16:2701. [PMID: 39123429 PMCID: PMC11311398 DOI: 10.3390/cancers16152701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/08/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Synchrotron Microbeam Radiation Therapy (MRT) has repeatedly proven its superiority compared with conventional radiotherapy for glioma control in preclinical research. The clinical transfer phase of MRT has recently gained momentum; seven dogs with suspected glioma were treated under clinical conditions to determine the feasibility and safety of MRT. We administered a single fraction of 3D-conformal, image-guided MRT. Ultra-high-dose rate synchrotron X-ray microbeams (50 µm-wide, 400 µm-spaced) were delivered through five conformal irradiation ports. The PTV received ~25 Gy peak dose (within microbeams) per port, corresponding to a minimal cumulated valley dose (diffusing between microbeams) of 2.8 Gy. The dogs underwent clinical and MRI follow-up, and owner evaluations. One dog was lost to follow-up. Clinical exams of the remaining six dogs during the first 3 months did not indicate radiotoxicity induced by MRT. Quality of life improved from 7.3/10 [±0.7] to 8.9/10 [±0.3]. Tumor-induced seizure activity decreased significantly. A significant tumor volume reduction of 69% [±6%] was reached 3 months after MRT. Our study is the first neuro-oncologic veterinary trial of 3D-conformal Synchrotron MRT and reveals that MRT does not induce acute to subacute radiotoxicity in normal brain tissues. MRT improves quality of life and leads to remarkable tumor volume reduction despite low valley dose delivery. This trial is an essential step towards the forthcoming clinical application of MRT against deep-seated human brain tumors.
Collapse
Affiliation(s)
- Laura Eling
- Institut National de la Santé et de la Recherche Médicale UA7 Synchrotron Radiation for Biomedicine, Université Grenoble Alpes, 38400 Saint-Martin-d’Hères, France; (S.K.); (J.-F.A.); (R.S.)
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| | - Samy Kefs
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| | - Sarvenaz Keshmiri
- Institut National de la Santé et de la Recherche Médicale UA7 Synchrotron Radiation for Biomedicine, Université Grenoble Alpes, 38400 Saint-Martin-d’Hères, France; (S.K.); (J.-F.A.); (R.S.)
| | - Jacques Balosso
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| | - Susan Calvet
- Argos Clinique Vétérinaire Pierre du Terrail, 38530 Pontcharra, France;
| | - Gabriel Chamel
- Clinical Oncology Unit, Small Animal Internal Medicine Department, University of Lyon, VetAgro Sup Campus Vétérinaire, 69280 Marcy l’Etoile, France;
- Unité de Recherche Interaction Cellules Environnement, University of Lyon, VetAgro Sup Campus Vétérinaire, 69280 Marcy l’Etoile, France
| | | | - Isabelle Flandin
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| | - Maxime Gaudin
- OnlyVet, Centre Hospitalier Vétérinaire, 69800 Saint Priest, France; (M.G.); (L.G.)
| | - Lucile Giraud
- OnlyVet, Centre Hospitalier Vétérinaire, 69800 Saint Priest, France; (M.G.); (L.G.)
| | | | - Paolo Pellicioli
- European Synchrotron Radiation Facility, 38000 Grenoble, France;
| | - Camille Verry
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| | - Jean-François Adam
- Institut National de la Santé et de la Recherche Médicale UA7 Synchrotron Radiation for Biomedicine, Université Grenoble Alpes, 38400 Saint-Martin-d’Hères, France; (S.K.); (J.-F.A.); (R.S.)
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| | - Raphaël Serduc
- Institut National de la Santé et de la Recherche Médicale UA7 Synchrotron Radiation for Biomedicine, Université Grenoble Alpes, 38400 Saint-Martin-d’Hères, France; (S.K.); (J.-F.A.); (R.S.)
- Centre Hospitalier Universitaire Grenoble Alpes, Maquis du Grésivaudan, 38700 La Tronche, France; (S.K.); (J.B.); (I.F.); (C.V.)
| |
Collapse
|
4
|
Ahmed M, Bicher S, Combs SE, Lindner R, Raulefs S, Schmid TE, Spasova S, Stolz J, Wilkens JJ, Winter J, Bartzsch S. In Vivo Microbeam Radiation Therapy at a Conventional Small Animal Irradiator. Cancers (Basel) 2024; 16:581. [PMID: 38339332 PMCID: PMC11154279 DOI: 10.3390/cancers16030581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
Microbeam radiation therapy (MRT) is a still pre-clinical form of spatially fractionated radiotherapy, which uses an array of micrometer-wide, planar beams of X-ray radiation. The dose modulation in MRT has proven effective in the treatment of tumors while being well tolerated by normal tissue. Research on understanding the underlying biological mechanisms mostly requires large third-generation synchrotrons. In this study, we aimed to develop a preclinical treatment environment that would allow MRT independent of synchrotrons. We built a compact microbeam setup for pre-clinical experiments within a small animal irradiator and present in vivo MRT application, including treatment planning, dosimetry, and animal positioning. The brain of an immobilized mouse was treated with MRT, excised, and immunohistochemically stained against γH2AX for DNA double-strand breaks. We developed a comprehensive treatment planning system by adjusting an existing dose calculation algorithm to our setup and attaching it to the open-source software 3D-Slicer. Predicted doses in treatment planning agreed within 10% with film dosimetry readings. We demonstrated the feasibility of MRT exposures in vivo at a compact source and showed that the microbeam pattern is observable in histological sections of a mouse brain. The platform developed in this study will be used for pre-clinical research of MRT.
Collapse
Affiliation(s)
- Mabroor Ahmed
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
- Department of Physics, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany
| | - Sandra Bicher
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
| | - Stephanie Elisabeth Combs
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
| | - Rainer Lindner
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
| | - Susanne Raulefs
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
| | - Thomas E. Schmid
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
| | - Suzana Spasova
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
- Department of Physics, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany
| | - Jessica Stolz
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
| | - Jan Jakob Wilkens
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Department of Physics, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany
| | - Johanna Winter
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
- Department of Physics, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany
- Heinz Maier-Leibnitz Zentrum (MLZ), 85748 Garching, Germany
| | - Stefan Bartzsch
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
- Heinz Maier-Leibnitz Zentrum (MLZ), 85748 Garching, Germany
| |
Collapse
|
5
|
Zhang T, García-Calderón D, Molina-Hernández M, Leitão J, Hesser J, Seco J. A theoretical study of H 2 O 2 as the surrogate of dose in minibeam radiotherapy, with a diffusion model considering radical removal process. Med Phys 2023; 50:5262-5272. [PMID: 37345373 DOI: 10.1002/mp.16570] [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: 11/21/2022] [Revised: 05/16/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Minibeam radiation therapy (MBRT) is an innovative dose delivery method with the potential to spare normal tissue while achieving similar tumor control as conventional radiotherapy. However, it is difficult to use a single dose parameter, such as mean dose, to compare different patterns of MBRT due to the spatially fractionated radiation. Also, the mechanism leading to the biological effects is still unknown. PURPOSE This study aims to demonstrate that the hydrogen peroxide (H2 O2 ) distribution could serve as a surrogate of dose distribution when comparing different patterns of MBRT. METHODS A free diffusion model (FDM) for H2 O2 developed with Fick's second law was compared with a previously published model based on Monte Carlo & convolution method. Since cells form separate compartments that can eliminate H2 O2 radicals diffusing inside the cell, a term describing the elimination was introduced into the equation. The FDM and the diffusion model considering removal (DMCR) were compared by simulating various dose rate irradiation schemes and uniform irradiation. Finally, the DMCR was compared with previous microbeam and minibeam animal experiments. RESULTS Compared with a previous Monte Carlo & Convolution method, this analytical method provides more accurate results. Furthermore, the new model shows H2 O2 concentration distribution instead of the time to achieve a certain H2 O2 uniformity. The comparison between FDM and DMCR showed that H2 O2 distribution from FDM varied with dose rate irradiation, while DMCR had consistent results. For uniform irradiation, FDM resulted in a Gaussian distribution, while the H2 O2 distribution from DMCR was close to the dose distribution. The animal studies' evaluation showed a correlation between the H2 O2 concentration in the valley region and treatment outcomes. CONCLUSION DMCR is a more realistic model for H2 O2 simulation than the FDM. In addition, the H2 O2 distribution can be a good surrogate of dose distribution when the minibeam effect could be observed.
Collapse
Affiliation(s)
- Tengda Zhang
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel García-Calderón
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Miguel Molina-Hernández
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- Laboratory of Instrumentation and Experimental Particle Physics (LIP), Lisbon, Portugal
- Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Leitão
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- Laboratory of Instrumentation and Experimental Particle Physics (LIP), Lisbon, Portugal
- Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Jürgen Hesser
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Joao Seco
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
6
|
Serduc R, Bouchet A. MRT-boost as the last fraction may be the most efficient irradiation schedule for increased survival times in a rat glioma model. JOURNAL OF SYNCHROTRON RADIATION 2023; 30:591-595. [PMID: 37067258 PMCID: PMC10161883 DOI: 10.1107/s1600577523002606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 03/19/2023] [Indexed: 05/06/2023]
Abstract
Synchrotron microbeam radiation therapy (MRT) is based on the spatial fractionation of the incident synchrotron beam into arrays of parallel microbeams, typically a few tens of micrometres wide and depositing several hundred Gray. This high dose, high dose rate, spatially fractionated radiotherapy has a high therapeutic impact on tumors, especially in intracranial locations. MRT leads to better control of incurable high-grade glioma than from homogeneous radiotherapy. The schedule of MRT within a conventional irradiation protocol (three fractions of 11 Gy) of brain tumors was evaluated on the 9L glioma model in rats. MRT delivered as a first fraction increased the median survival time of the animals by four days compared with conventional radiotherapy, while the last MRT fraction improved the lifespan by 148% (+15.5 days compared with conventional radiotherapy, p < 0.0001). The most efficient radiation regimen was obtained when the MRT-boost was applied as the last fraction, following two conventional clinical exposures.
Collapse
Affiliation(s)
- Raphael Serduc
- Univ. Grenoble Alpes, INSERM UA7 STROBE, Rue de la Piscine, 38400 Saint-Martin d’Hères, France
- Centre Hospitalier Universitaire Grenoble-Alpes, Maquis du Grésivaudan, 38700 La Tronche, France
| | - Audrey Bouchet
- INSERM U1296, Radiation: Defense, Health, Environment, 28 Rue Laennec, 69008 Lyon, France
| |
Collapse
|
7
|
Tubin S, Vozenin M, Prezado Y, Durante M, Prise K, Lara P, Greco C, Massaccesi M, Guha C, Wu X, Mohiuddin M, Vestergaard A, Bassler N, Gupta S, Stock M, Timmerman R. Novel unconventional radiotherapy techniques: Current status and future perspectives - Report from the 2nd international radiation oncology online seminar. Clin Transl Radiat Oncol 2023; 40:100605. [PMID: 36910025 PMCID: PMC9996385 DOI: 10.1016/j.ctro.2023.100605] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023] Open
Abstract
•Improvement of therapeutic ratio by novel unconventional radiotherapy approaches.•Immunomodulation using high-dose spatially fractionated radiotherapy.•Boosting radiation anti-tumor effects by adding an immune-mediated cell killing.
Collapse
Affiliation(s)
- S. Tubin
- Medaustron Center for Ion Therapy, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
| | - M.C. Vozenin
- Radiation Oncology Laboratory, Radiation Oncology Service, Oncology Department, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Y. Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay 91400, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay 91400, France
| | - M. Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, Darmstadt 64291, Germany
- Technsiche Universität Darmstadt, Institute for Condensed Matter Physics, Darmstadt, Germany
| | - K.M. Prise
- Patrick G Johnston Centre for Cancer Research Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom
| | - P.C. Lara
- Canarian Comprehensive Cancer Center, San Roque University Hospital & Fernando Pessoa Canarias University, C/Dolores de la Rocha 9, Las Palmas GC 35001, Spain
| | - C. Greco
- Department of Radiation Oncology Champalimaud Foundation, Av. Brasilia, Lisbon 1400-038, Portugal
| | - M. Massaccesi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - C. Guha
- Montefiore Medical Center Radiation Oncology, 111 E 210th St, New York, NY, United States
| | - X. Wu
- Executive Medical Physics Associates, 19470 NE 22nd Road, Miami, FL 33179, United States
| | - M.M. Mohiuddin
- Northwestern Medicine Cancer Center Warrenville and Northwestern Medicine Proton Center, 4455 Weaver Pkwy, Warrenville, IL 60555, United States
| | - A. Vestergaard
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - N. Bassler
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - S. Gupta
- The Loop Immuno-Oncology Laboratory, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - M. Stock
- Medaustron Center for Ion Therapy, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
- Karl Landsteiner University of Health Sciences, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
| | - R. Timmerman
- Department of Radiation Oncology, University of Texas, Southwestern Medical Center, Inwood Road Dallas, TX 2280, United States
| |
Collapse
|
8
|
Jaekel F, Paino J, Engels E, Klein M, Barnes M, Häusermann D, Hall C, Zheng G, Wang H, Hildebrandt G, Lerch M, Schültke E. The Spinal Cord as Organ of Risk: Assessment for Acute and Subacute Neurological Adverse Effects after Microbeam Radiotherapy in a Rodent Model. Cancers (Basel) 2023; 15:cancers15092470. [PMID: 37173938 PMCID: PMC10177263 DOI: 10.3390/cancers15092470] [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: 03/07/2023] [Revised: 04/16/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Microbeam radiotherapy (MRT), a high dose rate radiotherapy technique using spatial dose fractionation at the micrometre range, has shown a high therapeutic efficacy in vivo in different tumour entities, including lung cancer. We have conducted a toxicity study for the spinal cord as organ of risk during irradiation of a target in the thoracic cavity. In young adult rats, the lower thoracic spinal cord was irradiated over a length of 2 cm with an array of quasi-parallel microbeams of 50 µm width, spaced at a centre-to-centre distance of 400 µm, with MRT peak doses up to 800 Gy. No acute or subacute adverse effects were observed within the first week after irradiation up to MRT peak doses of 400 Gy. No significant differences were seen between irradiated animals and non-irradiated controls in motor function and sensitivity, open field test and somatosensory evoked potentials (SSEP). After irradiation with MRT peak doses of 450-800 Gy, dose-dependent neurologic signs occurred. Provided that long-term studies do not reveal significant morbidity due to late toxicity, an MRT dose of 400 Gy can be considered safe for the spinal cord in the tested beam geometry and field size.
Collapse
Affiliation(s)
- Felix Jaekel
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany
| | - Jason Paino
- Centre of Medical Radiation Physics, University of Wollongong, Wollongong 2522, Australia
| | - Elette Engels
- Centre of Medical Radiation Physics, University of Wollongong, Wollongong 2522, Australia
| | - Mitzi Klein
- Australian Synchrotron, ANSTO, Clayton 3168, Australia
| | - Micah Barnes
- Australian Synchrotron, ANSTO, Clayton 3168, Australia
| | | | | | - Gang Zheng
- Monash Biomedical Imaging, Clayton 3168, Australia
| | - Hongxin Wang
- Monash Biomedical Imaging, Clayton 3168, Australia
| | - Guido Hildebrandt
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany
| | - Michael Lerch
- Centre of Medical Radiation Physics, University of Wollongong, Wollongong 2522, Australia
| | - Elisabeth Schültke
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany
| |
Collapse
|
9
|
Mentzel F, Paino J, Barnes M, Cameron M, Corde S, Engels E, Kröninger K, Lerch M, Nackenhorst O, Rosenfeld A, Tehei M, Tsoi AC, Vogel S, Weingarten J, Hagenbuchner M, Guatelli S. Accurate and Fast Deep Learning Dose Prediction for a Preclinical Microbeam Radiation Therapy Study Using Low-Statistics Monte Carlo Simulations. Cancers (Basel) 2023; 15:cancers15072137. [PMID: 37046798 PMCID: PMC10093595 DOI: 10.3390/cancers15072137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023] Open
Abstract
Microbeam radiation therapy (MRT) utilizes coplanar synchrotron radiation beamlets and is a proposed treatment approach for several tumor diagnoses that currently have poor clinical treatment outcomes, such as gliosarcomas. Monte Carlo (MC) simulations are one of the most used methods at the Imaging and Medical Beamline, Australian Synchrotron to calculate the dose in MRT preclinical studies. The steep dose gradients associated with the 50μm-wide coplanar beamlets present a significant challenge for precise MC simulation of the dose deposition of an MRT irradiation treatment field in a short time frame. The long computation times inhibit the ability to perform dose optimization in treatment planning or apply online image-adaptive radiotherapy techniques to MRT. Much research has been conducted on fast dose estimation methods for clinically available treatments. However, such methods, including GPU Monte Carlo implementations and machine learning (ML) models, are unavailable for novel and emerging cancer radiotherapy options such as MRT. In this work, the successful application of a fast and accurate ML dose prediction model for a preclinical MRT rodent study is presented for the first time. The ML model predicts the peak doses in the path of the microbeams and the valley doses between them, delivered to the tumor target in rat patients. A CT imaging dataset is used to generate digital phantoms for each patient. Augmented variations of the digital phantoms are used to simulate with Geant4 the energy depositions of an MRT beam inside the phantoms with 15% (high-noise) and 2% (low-noise) statistical uncertainty. The high-noise MC simulation data are used to train the ML model to predict the energy depositions in the digital phantoms. The low-noise MC simulations data are used to test the predictive power of the ML model. The predictions of the ML model show an agreement within 3% with low-noise MC simulations for at least 77.6% of all predicted voxels (at least 95.9% of voxels containing tumor) in the case of the valley dose prediction and for at least 93.9% of all predicted voxels (100.0% of voxels containing tumor) in the case of the peak dose prediction. The successful use of high-noise MC simulations for the training, which are much faster to produce, accelerates the production of the training data of the ML model and encourages transfer of the ML model to different treatment modalities for other future applications in novel radiation cancer therapies.
Collapse
Affiliation(s)
- Florian Mentzel
- Department of Physics, TU Dortmund University, D-44227 Dortmund, Germany
| | - Jason Paino
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Micah Barnes
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Imaging and Medical Beamline, Australian Synchrotron, ANSTO, Clayton, VIC 3168, Australia
- Peter MacCallum Cancer Center, Physical Sciences, Melbourne, VIC 3000, Australia
| | - Matthew Cameron
- Imaging and Medical Beamline, Australian Synchrotron, ANSTO, Clayton, VIC 3168, Australia
| | - Stéphanie Corde
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
- Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Elette Engels
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Imaging and Medical Beamline, Australian Synchrotron, ANSTO, Clayton, VIC 3168, Australia
- Peter MacCallum Cancer Center, Physical Sciences, Melbourne, VIC 3000, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Kevin Kröninger
- Department of Physics, TU Dortmund University, D-44227 Dortmund, Germany
| | - Michael Lerch
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Olaf Nackenhorst
- Department of Physics, TU Dortmund University, D-44227 Dortmund, Germany
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Moeava Tehei
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Ah Chung Tsoi
- School of Computing and Information Technology, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Sarah Vogel
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Jens Weingarten
- Department of Physics, TU Dortmund University, D-44227 Dortmund, Germany
| | - Markus Hagenbuchner
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
- School of Computing and Information Technology, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Susanna Guatelli
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
| |
Collapse
|
10
|
Matejcek C, Winter J, Aulenbacher K, Dimroth A, Natour G, Bartzsch S. A novel electron source for a compact x-ray tube for microbeam radiotherapy with very high dose rates. Phys Med 2023; 106:102532. [PMID: 36652809 DOI: 10.1016/j.ejmp.2023.102532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
Microbeam radiotherapy (MRT) is a novel concept in radiation oncology with arrays of alternating micrometer-wide high-dose peaks and low-dose valleys. Preclinical experiments have shown a lower normal tissue toxicity for MRT with similar tumor control rates compared to conventional radiotherapy. A promising candidate for the demanded compact radiation source is the line-focus x-ray tube. Here, we present the setup of a prototype for an electron accelerator being able to provide a suitable x-ray beam for the tube. Several beam dynamic calculations and simulations were performed concerning particle tracking, thermal and electrostatic properties of the electron source, resulting in a proper beamline, including the cathode, the pierce electrode (PE) and the focusing magnets. These parts are discussed separately. The simulations showed that a rectangular cathode with a small width of 0.4mm is mandatory. To quickly shut down the electron beam, an additional voltage of -600V must be applied to the PE. Moreover, the electric field inside the vacuum chamber stays below 10MVm-1 to minimize the risk of field emission. The thermal simulation validates a small displacement of 0.1mm of the heated cathode with respect to the PE, which must be considered during manufacturing of the cathode-PE assembly. The simulations lead to an adequate choice of cathode, electrodes and beamline to achieve the required focal spot of 0.05×20mm2 with a beam current of 0.3A and an electron energy of 300keV. With this setup first MRT experiments with high dose rates up to 10Gys-1 can be executed.
Collapse
Affiliation(s)
- Christoph Matejcek
- Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Johannes Gutenberg-Universität Mainz, Institut für Kernphysik, Mainz, Germany.
| | - Johanna Winter
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, Neuherberg, Germany; Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Technical University of Munich, Physics Department, Garching, Germany
| | - Kurt Aulenbacher
- Johannes Gutenberg-Universität Mainz, Institut für Kernphysik, Mainz, Germany; GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany; Helmholtz-Institut Mainz, Germany
| | - Anton Dimroth
- Forschungszentrum Jülich GmbH, Central Institute for Engineering, Electronics and Analytics (ZEA), Jülich, Germany; RWTH Aachen University, Faculty of Mechanical Engineering, Aachen, Germany
| | - Ghaleb Natour
- Forschungszentrum Jülich GmbH, Central Institute for Engineering, Electronics and Analytics (ZEA), Jülich, Germany; RWTH Aachen University, Faculty of Mechanical Engineering, Aachen, Germany
| | - Stefan Bartzsch
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, Neuherberg, Germany; Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany
| |
Collapse
|
11
|
Effects of Microbeam Irradiation on Rodent Esophageal Smooth Muscle Contraction. Cells 2022; 12:cells12010176. [PMID: 36611969 PMCID: PMC9818134 DOI: 10.3390/cells12010176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/14/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND High-dose-rate radiotherapy has shown promising results with respect to normal tissue preservation. We developed an ex vivo model to study the physiological effects of experimental radiotherapy in the rodent esophageal smooth muscle. METHODS We assessed the physiological parameters of the esophageal function in ex vivo preparations of the proximal, middle, and distal segments in the organ bath. High-dose-rate synchrotron irradiation was conducted using both the microbeam irradiation (MBI) technique with peak doses greater than 200 Gy and broadbeam irradiation (BBI) with doses ranging between 3.5-4 Gy. RESULTS Neither MBI nor BBI affected the function of the contractile apparatus. While peak latency and maximal force change were not affected in the BBI group, and no changes were seen in the proximal esophagus segments after MBI, a significant increase in peak latency and a decrease in maximal force change was observed in the middle and distal esophageal segments. CONCLUSION No severe changes in physiological parameters of esophageal contraction were determined after high-dose-rate radiotherapy in our model, but our results indicate a delayed esophageal function. From the clinical perspective, the observed increase in peak latency and decreased maximal force change may indicate delayed esophageal transit.
Collapse
|
12
|
Schültke E, Jaekel F, Bartzsch S, Bräuer-Krisch E, Requardt H, Laissue JA, Blattmann H, Hildebrandt G. Good Timing Matters: The Spatially Fractionated High Dose Rate Boost Should Come First. Cancers (Basel) 2022; 14:cancers14235964. [PMID: 36497446 PMCID: PMC9738329 DOI: 10.3390/cancers14235964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
Monoplanar microbeam irradiation (MBI) and pencilbeam irradiation (PBI) are two new concepts of high dose rate radiotherapy, combined with spatial dose fractionation at the micrometre range. In a small animal model, we have explored the concept of integrating MBI or PBI as a simultaneously integrated boost (SIB), either at the beginning or at the end of a conventional, low-dose rate schedule of 5x4 Gy broad beam (BB) whole brain radiotherapy (WBRT). MBI was administered as array of 50 µm wide, quasi-parallel microbeams. For PBI, the target was covered with an array of 50 µm × 50 µm pencilbeams. In both techniques, the centre-to-centre distance was 400 µm. To assure that the entire brain received a dose of at least 4 Gy in all irradiated animals, the peak doses were calculated based on the daily BB fraction to approximate the valley dose. The results of our study have shown that the sequence of the BB irradiation fractions and the microbeam SIB is important to limit the risk of acute adverse effects, including epileptic seizures and death. The microbeam SIB should be integrated early rather than late in the irradiation schedule.
Collapse
Affiliation(s)
- Elisabeth Schültke
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany
- Correspondence:
| | - Felix Jaekel
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany
| | - Stefan Bartzsch
- Department of Radiooncology, Technical University of Munich, 81675 Munich, Germany
- Institute for Radiation Medicine, Helmholtz Center Munich, 85764 Munich, Germany
| | - Elke Bräuer-Krisch
- Biomedical Beamline ID 17, European Synchrotron Radiation Facility (ESRF), 38043 Grenoble, France
| | - Herwig Requardt
- Biomedical Beamline ID 17, European Synchrotron Radiation Facility (ESRF), 38043 Grenoble, France
| | | | - Hans Blattmann
- Independent Researcher, 5417 Untersiggenthal, Switzerland
| | - Guido Hildebrandt
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany
| |
Collapse
|
13
|
The Microbeam Insert at the White Beam Beamline P61A at the Synchrotron PETRA III/DESY: A New Tool for High Dose Rate Irradiation Research. Cancers (Basel) 2022; 14:cancers14205137. [PMID: 36291920 PMCID: PMC9600877 DOI: 10.3390/cancers14205137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/04/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The excellent preservation of normal tissue function after high dose rate radiotherapy has been shown in pre-clinical studies. Normal tissue in the tumor environment is well preserved even after target doses of several hundred Gy while reliably destroying the tumor cells. These results have triggered the establishment of appropriate research structures at the synchrotron PETRA III on the DESY campus in Hamburg, Germany. Dose rates of hundreds of Gy/s can be achieved, compared to 6–20 Gy/min in clinical radiotherapy. We describe the design, development, key parameters, and first use of a mobile insert for high dose rate radiotherapy research, a new research instrument at P61A, the first polychromatic beamline of PETRA III. The data obtained at the end station P61A will support the international interdisciplinary effort to improve radiotherapy concepts for patients with malignant tumors that are considered radioresistant with the currently established clinical radiotherapy techniques. Abstract High dose rate radiotherapies such as FLASH and microbeam radiotherapy (MRT) both have developed to the stage of first veterinary studies within the last decade. With the development of a new research tool for high dose rate radiotherapy at the end station P61A of the synchrotron beamline P61 on the DESY campus in Hamburg, we increased the research capacity in this field to speed up the translation of the radiotherapy techniques which are still experimental, from bench to bedside. At P61, dose rates of several hundred Gy/s can be delivered. Compared to dedicated biomedical beamlines, the beam width available for MRT experiments is a very restrictive factor. We developed two model systems specifically to suit these specific technical parameters and tested them in a first set of experiments.
Collapse
|
14
|
Schneider T, Fernandez-Palomo C, Bertho A, Fazzari J, Iturri L, Martin OA, Trappetti V, Djonov V, Prezado Y. Combining FLASH and spatially fractionated radiation therapy: The best of both worlds. Radiother Oncol 2022; 175:169-177. [PMID: 35952978 DOI: 10.1016/j.radonc.2022.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/23/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022]
Abstract
FLASH radiotherapy (FLASH-RT) and spatially fractionated radiation therapy (SFRT) are two new therapeutical strategies that use non-standard dose delivery methods to reduce normal tissue toxicity and increase the therapeutic index. Although likely based on different mechanisms, both FLASH-RT and SFRT have shown to elicit radiobiological effects that significantly differ from those induced by conventional radiotherapy. With the therapeutic potential having been established separately for each technique, the combination of FLASH-RT and SFRT could therefore represent a winning alliance. In this review, we discuss the state of the art, advantages and current limitations, potential synergies, and where a combination of these two techniques could be implemented today or in the near future.
Collapse
Affiliation(s)
- Tim Schneider
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | | | - Annaïg Bertho
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Lorea Iturri
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Olga A Martin
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland; Division of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; University of Melbourne, Parkville, VIC 3010, Australia
| | - Verdiana Trappetti
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France.
| |
Collapse
|
15
|
Jaekel F, Bräuer-Krisch E, Bartzsch S, Laissue J, Blattmann H, Scholz M, Soloviova J, Hildebrandt G, Schültke E. Microbeam Irradiation as a Simultaneously Integrated Boost in a Conventional Whole-Brain Radiotherapy Protocol. Int J Mol Sci 2022; 23:ijms23158319. [PMID: 35955454 PMCID: PMC9368396 DOI: 10.3390/ijms23158319] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
Microbeam radiotherapy (MRT), an experimental high-dose rate concept with spatial fractionation at the micrometre range, has shown a high therapeutic potential as well as good preservation of normal tissue function in pre-clinical studies. We investigated the suitability of MRT as a simultaneously integrated boost (SIB) in conventional whole-brain irradiation (WBRT). A 174 Gy MRT SIB was administered with an array of quasi-parallel, 50 µm wide microbeams spaced at a centre-to-centre distance of 400 µm either on the first or last day of a 5 × 4 Gy radiotherapy schedule in healthy adult C57 BL/6J mice and in F98 glioma cell cultures. The animals were observed for signs of intracranial pressure and focal neurologic signs. Colony counts were conducted in F98 glioma cell cultures. No signs of acute adverse effects were observed in any of the irradiated animals within 3 days after the last irradiation fraction. The tumoricidal effect on F98 cell in vitro was higher when the MRT boost was delivered on the first day of the irradiation course, as opposed to the last day. Therefore, the MRT SIB should be integrated into a clinical radiotherapy schedule as early as possible.
Collapse
Affiliation(s)
- Felix Jaekel
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany; (F.J.); (M.S.); (J.S.); (G.H.)
| | - Elke Bräuer-Krisch
- Biomedical Beamline ID 17, European Synchrotron Radiation Facility (ESRF), 38043 Grenoble, France;
| | - Stefan Bartzsch
- Department of Radiooncology, Technical University of Munich, 81675 Munich, Germany;
- Institute for Radiation Medicine, Helmholtz Center Munich, 85764 Munich, Germany
| | - Jean Laissue
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland;
| | | | - Marten Scholz
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany; (F.J.); (M.S.); (J.S.); (G.H.)
| | - Julia Soloviova
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany; (F.J.); (M.S.); (J.S.); (G.H.)
- Department of Paediatric Surgery, Leipzig University Medical Centre, 04103 Leipzig, Germany
| | - Guido Hildebrandt
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany; (F.J.); (M.S.); (J.S.); (G.H.)
| | - Elisabeth Schültke
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany; (F.J.); (M.S.); (J.S.); (G.H.)
- Correspondence:
| |
Collapse
|
16
|
Schültke E, Lerch M, Kirschstein T, Lange F, Porath K, Fiedler S, Davis J, Paino J, Engels E, Barnes M, Klein M, Hall C, Häusermann D, Hildebrandt G. Modification of the Langendorff system of the isolated beating heart for experimental radiotherapy at a synchrotron: 4000 Gy in a heart beat. JOURNAL OF SYNCHROTRON RADIATION 2022; 29:1027-1032. [PMID: 35787570 PMCID: PMC9255585 DOI: 10.1107/s1600577522004489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/28/2022] [Indexed: 05/27/2023]
Abstract
Microbeam radiotherapy could help to cure malignant tumours which are currently still considered therapy-resistant. With an irradiation target in the thoracic cavity, the heart would be one of the most important organs at risk. To assess the acute adverse effects of microbeam irradiation in the heart, a powerful ex vivo tool was created by combining the Langendorff model of the isolated beating mammalian heart with X-Tream dosimetry. In a first pilot experiment conducted at the Biomedical and Imaging Beamline of the Australian Synchrotron, the system was tested at a microbeam peak dose approximately ten times higher than the anticipated future microbeam irradiation treatment doses. The entire heart was irradiated with a dose of 4000 Gy at a dose rate of >6000 Gy s-1, using an array of 50 µm-wide microbeams spaced at a centre-to-centre distance of 400 µm. Although temporary arrhythmias were seen, they reverted spontaneously to a stable rhythm and no cardiac arrest occurred. This amazing preservation of cardiac function is promising for future therapeutic approaches.
Collapse
Affiliation(s)
- Elisabeth Schültke
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059 Rostock, Germany
| | - Michael Lerch
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Timo Kirschstein
- Oscar Langendorff Institute of Physiology, University of Rostock Medical Center, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, Rostock, Germany
| | - Falko Lange
- Oscar Langendorff Institute of Physiology, University of Rostock Medical Center, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, Rostock, Germany
| | - Katrin Porath
- Oscar Langendorff Institute of Physiology, University of Rostock Medical Center, Rostock, Germany
| | - Stefan Fiedler
- European Molecular Biology Laboratory, Notkestrasse 85, 22607 Hamburg, Germany
| | - Jeremy Davis
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Jason Paino
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Elette Engels
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Micah Barnes
- Australian Synchrotron/ANSTO, Clayton, Australia
| | - Mitzi Klein
- Australian Synchrotron/ANSTO, Clayton, Australia
| | | | | | - Guido Hildebrandt
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059 Rostock, Germany
| |
Collapse
|
17
|
Kundapur V, Mayer M, Auer RN, Alexander A, Weibe S, Pushie MJ, Cranmer-Sargison G. Is Mini Beam Ready for Human Trials? Results of Randomized Study of Treating De-Novo Brain Tumors in Canines Using Linear Accelerator Generated Mini Beams. Radiat Res 2022; 198:162-171. [PMID: 35536992 DOI: 10.1667/rade-21-00093.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
The main challenge in treating malignant brain neoplasms lies in eradicating the tumor while minimizing treatment-related damage. Conventional radiation treatments are associated with considerable side effects. Synchrotron generated micro-beam radiation (SMBRT) has shown to preserve brain architecture while killing tumor cells, however physical characteristics and limited facility access restrict its use. We have created a new clinical device which produces mini beams on a linear accelerator, to provide a new type of treatment called mini-beam radiation therapy (MBRT). The objective of this study is to compare the treatment outcomes of linear accelerator based MBRT versus standard radiation treatment (SRT), to evaluate the tumor response and the treatment-related changes in the normal brain with respect to each treatment type. Pet dogs with de-novo brain tumors were accrued for treatment. Dogs were randomized between standard fractionated stereotactic (9 Gy in 3 fractions) radiation treatment vs. a single fraction of MBRT (26 Gy mean dose). Dogs were monitored after treatment for clinical assessment and imaging. When the dogs were euthanized, a veterinary pathologist assessed the radiation changes and tumor response. We accrued 16 dogs, 8 dogs in each treatment arm. In the MBRT arm, 71% dogs achieved complete pathological remission. The radiation-related changes were all confined to the target region. Structural damage was not observed in the beam path outside of the target region. In contrast, none of the dogs in control group achieved remission and the treatment related damage was more extensive. Therapeutic superiority was observed with MBRT, including both tumor control and the normal structural preservation. The MBRT findings are suggestive of an immune related mechanism which is absent in standard treatment. These findings together with the widespread availability of clinical linear accelerators make MBRT a promising research topic to explore further treatment and clinical trial opportunities.
Collapse
Affiliation(s)
- V Kundapur
- Radiation Oncology, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - M Mayer
- Veterinary Radiation Oncology, Department of Small Animal clinical Sciences, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - R N Auer
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - A Alexander
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - S Weibe
- Department of Clinical Imaging, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - M J Pushie
- Department of Surgery, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - G Cranmer-Sargison
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| |
Collapse
|
18
|
Lange F, Kirschstein T, Davis J, Paino J, Barnes M, Klein M, Porath K, Stöhlmacher P, Fiedler S, Frank M, Köhling R, Hildebrandt G, Hausermann D, Lerch M, Schültke E. Microbeam irradiation of the beating rodent heart: an ex vivo study of acute and subacute effects on cardiac function. Int J Radiat Oncol Biol Phys 2022; 114:143-152. [PMID: 35533907 DOI: 10.1016/j.ijrobp.2022.05.001] [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: 12/16/2021] [Revised: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Microbeam radiation therapy (MRT) has shown several advantages compared to conventional broad-beam radiotherapy in small animal models, including a better preservation of normal tissue function and improved drug delivery based on a rapidly increased vascular permeability in the target region. Normal tissue tolerance is the limiting factor in clinical radiotherapy. Knowledge of the normal tissue tolerance of organs at risk is therefore a prerequisite in evaluating any new radiotherapy approach. With an irradiation target in the thoracic cavity, the heart would be the most important organ at risk. METHODS AND MATERIALS We used the ex vivo beating rodent heart in the Langendorff perfusion system at the synchrotron in order to administer microbeam irradiation (MBI) with a peak dose of 40 or 400 Gy. By continuously recording the electrocardiogram, the left ventricular pressure, and the aortic pressure before, during and after MBI, we were able to assess acute and subacute effects of MBI on electrophysiological and mechanical cardiac function. In addition, we analyzed histological and ultrastructural sequelae caused by MBI. RESULTS There were no significant changes in heart rate, heart rate variability, systolic increase of left ventricular pressure or aortic pressure. Moreover, the changes of heart rate, left ventricular pressure and aortic pressure by adding 10-5 mol/l norepinephrine to the perfusate, were also not significant between MBI and sham experiments. However, the rate-pressure product as a surrogate marker for maximum workload after MBI was significantly lower compared to sham-irradiated controls. On the structural level, no severe membranous, sarcomeric, mitochondrial or nuclear changes caused by MBI were detected by desmin immunohistochemistry and electron microscopy. CONCLUSION With respect to acute and subacute toxicity, an MBI peak dose up to 400 Gy did not result in severe changes in cardiac electrophysiology or mechanics.
Collapse
Affiliation(s)
- Falko Lange
- Oscar Langendorff Institute of Physiology, Rostock University Medical Centre, Rostock, Germany; Centre for Transdisciplinary Neurosciences Rostock, University of Rostock, Rostock, Germany
| | - Timo Kirschstein
- Oscar Langendorff Institute of Physiology, Rostock University Medical Centre, Rostock, Germany; Centre for Transdisciplinary Neurosciences Rostock, University of Rostock, Rostock, Germany.
| | - Jeremy Davis
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Jason Paino
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Micah Barnes
- Australian Synchrotron-Australian Nuclear Science and Technology Organisation (ANSTO), Kulin Nation, Melbourne, Australia
| | - Mitzi Klein
- Australian Synchrotron-Australian Nuclear Science and Technology Organisation (ANSTO), Kulin Nation, Melbourne, Australia
| | - Katrin Porath
- Oscar Langendorff Institute of Physiology, Rostock University Medical Centre, Rostock, Germany
| | - Paula Stöhlmacher
- Oscar Langendorff Institute of Physiology, Rostock University Medical Centre, Rostock, Germany
| | - Stefan Fiedler
- European Molecular Biology Laboratory (EMBL), Hamburg Outstation/ Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - Marcus Frank
- Medical Biology and Electron Microscopy Centre, Rostock University Medical Center, Rostock, Germany; Department of Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Rüdiger Köhling
- Oscar Langendorff Institute of Physiology, Rostock University Medical Centre, Rostock, Germany; Centre for Transdisciplinary Neurosciences Rostock, University of Rostock, Rostock, Germany
| | - Guido Hildebrandt
- Department of Radiooncology, Rostock University Medical Centre, Rostock, Germany
| | - Daniel Hausermann
- Australian Synchrotron-Australian Nuclear Science and Technology Organisation (ANSTO), Kulin Nation, Melbourne, Australia
| | - Michael Lerch
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Elisabeth Schültke
- Department of Radiooncology, Rostock University Medical Centre, Rostock, Germany
| |
Collapse
|
19
|
Trappetti V, Fazzari J, Fernandez-Palomo C, Smyth L, Potez M, Shintani N, de Breuyn Dietler B, Martin OA, Djonov V. Targeted Accumulation of Macrophages Induced by Microbeam Irradiation in a Tissue-Dependent Manner. Biomedicines 2022; 10:735. [PMID: 35453485 PMCID: PMC9025837 DOI: 10.3390/biomedicines10040735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
Radiation therapy (RT) is a vital component of multimodal cancer treatment, and its immunomodulatory effects are a major focus of current therapeutic strategies. Macrophages are some of the first cells recruited to sites of radiation-induced injury where they can aid in tissue repair, propagate radiation-induced fibrogenesis and influence tumour dynamics. Microbeam radiation therapy (MRT) is a unique, spatially fractionated radiation modality that has demonstrated exceptional tumour control and reduction in normal tissue toxicity, including fibrosis. We conducted a morphological analysis of MRT-irradiated normal liver, lung and skin tissues as well as lung and melanoma tumours. MRT induced distinct patterns of DNA damage, reflecting the geometry of the microbeam array. Macrophages infiltrated these regions of peak dose deposition at variable timepoints post-irradiation depending on the tissue type. In normal liver and lung tissue, macrophages clearly demarcated the beam path by 48 h and 7 days post-irradiation, respectively. This was not reflected, however, in normal skin tissue, despite clear DNA damage marking the beam path. Persistent DNA damage was observed in MRT-irradiated lung carcinoma, with an accompanying geometry-specific influx of mixed M1/M2-like macrophage populations. These data indicate the unique potential of MRT as a tool to induce a remarkable accumulation of macrophages in an organ/tissue-specific manner. Further characterization of these macrophage populations is warranted to identify their organ-specific roles in normal tissue sparing and anti-tumour responses.
Collapse
Affiliation(s)
- Verdiana Trappetti
- Institute of Anatomy, University of Bern, Baltzerstarsse 2, 3012 Bern, Switzerland; (V.T.); (J.F.); (C.F.-P.); (M.P.); (N.S.); (B.d.B.D.); (O.A.M.)
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, Baltzerstarsse 2, 3012 Bern, Switzerland; (V.T.); (J.F.); (C.F.-P.); (M.P.); (N.S.); (B.d.B.D.); (O.A.M.)
| | - Cristian Fernandez-Palomo
- Institute of Anatomy, University of Bern, Baltzerstarsse 2, 3012 Bern, Switzerland; (V.T.); (J.F.); (C.F.-P.); (M.P.); (N.S.); (B.d.B.D.); (O.A.M.)
| | - Lloyd Smyth
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital, University of Melbourne, Melbourne, VIC 3052, Australia;
| | - Marine Potez
- Institute of Anatomy, University of Bern, Baltzerstarsse 2, 3012 Bern, Switzerland; (V.T.); (J.F.); (C.F.-P.); (M.P.); (N.S.); (B.d.B.D.); (O.A.M.)
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Nahoko Shintani
- Institute of Anatomy, University of Bern, Baltzerstarsse 2, 3012 Bern, Switzerland; (V.T.); (J.F.); (C.F.-P.); (M.P.); (N.S.); (B.d.B.D.); (O.A.M.)
| | - Bettina de Breuyn Dietler
- Institute of Anatomy, University of Bern, Baltzerstarsse 2, 3012 Bern, Switzerland; (V.T.); (J.F.); (C.F.-P.); (M.P.); (N.S.); (B.d.B.D.); (O.A.M.)
| | - Olga A. Martin
- Institute of Anatomy, University of Bern, Baltzerstarsse 2, 3012 Bern, Switzerland; (V.T.); (J.F.); (C.F.-P.); (M.P.); (N.S.); (B.d.B.D.); (O.A.M.)
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC 3000, Australia
- Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, Baltzerstarsse 2, 3012 Bern, Switzerland; (V.T.); (J.F.); (C.F.-P.); (M.P.); (N.S.); (B.d.B.D.); (O.A.M.)
| |
Collapse
|
20
|
Bouchet A, Le Clec'h C, Rogalev L, Le Duc G, Pelletier L. Meloxicam can Potentiate the Therapeutic Effects of Synchrotron Microbeam Radiation Therapy on High-Grade Glioma Bearing Rats. Radiat Res 2022; 197:655-661. [PMID: 35245385 DOI: 10.1667/rade-21-00107.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
The microbeam radiation therapy (MRT), a spatially micro-fractionated synchrotron radiotherapy, leads to better control of incurable high-grade glioma than that obtained upon homogeneous radiotherapy. We evaluated the effect of meloxicam, a non-steroidal anti-inflammatory drug (NSAID), to increase the MRT response. Survival of rats bearing intracranial 9L gliosarcoma treated with meloxicam and/or MRT (400 Gy, 50 μm-wide microbeams, 200 μm spacing) was monitored. Tumor growth was assessed on histological tissue sections and COX-2 transcriptomic expression was studied 1 to 25 days after radiotherapy. Meloxicam significantly extended the median survival of microbeam-irradiated rats (from +10.5 to +20 days). Dual treatment led to last survivors until D90 (D39 for the MRT group) and to tumor 9.5 times smaller than MRT alone. No significant modification of COX-2 expression was induced by MRT in normal and tumor tissues. The meloxicam reinforced the anti-tumor effect of MRT for glioma treatment. Although the mechanisms of interaction between meloxicam and MRT remain to be elucidated, the addition of this NSAID, easily implemented as a supplement to water for example, is a very favorable therapeutic regimen since it doubled the survival benefit compared to MRT alone.
Collapse
Affiliation(s)
- Audrey Bouchet
- INSERM U1296 "Radiation: Defense, Health Environment", Centre Léon-Bérard, 28 Rue Laennec, 69008 Lyon, France.,Biomedical Beamline, European Synchrotron Radiation Facility, BP220, F38043 Grenoble cedex
| | - Céline Le Clec'h
- Biomedical Beamline, European Synchrotron Radiation Facility, BP220, F38043 Grenoble cedex
| | - Léonid Rogalev
- Biomedical Beamline, European Synchrotron Radiation Facility, BP220, F38043 Grenoble cedex
| | - Géraldine Le Duc
- Biomedical Beamline, European Synchrotron Radiation Facility, BP220, F38043 Grenoble cedex
| | - Laurent Pelletier
- Grenoble University Hospital, BP217, F-38043 Grenoble cedex.,INSERM U836, Team Nanomedicine and brain, 6 Rue Fortuné Ferrini, F38706 La Tronche
| |
Collapse
|
21
|
Abstract
AbstractSpatially fractionated radiation therapy (SFRT) challenges some of the classical dogmas in conventional radiotherapy. The highly modulated spatial dose distributions in SFRT have been shown to lead, both in early clinical trials and in small animal experiments, to a significant increase in normal tissue dose tolerances. Tumour control effectiveness is maintained or even enhanced in some configurations as compared with conventional radiotherapy. SFRT seems to activate distinct radiobiological mechanisms, which have been postulated to involve bystander effects, microvascular alterations and/or immunomodulation. Currently, it is unclear which is the dosimetric parameter which correlates the most with both tumour control and normal tissue sparing in SFRT. Additional biological experiments aiming at parametrizing the relationship between the irradiation parameters (beam width, spacing, peak-to-valley dose ratio, peak and valley doses) and the radiobiology are needed. A sound knowledge of the interrelation between the physical parameters in SFRT and the biological response would expand its clinical use, with a higher level of homogenisation in the realisation of clinical trials. This manuscript reviews the state of the art of this promising therapeutic modality, the current radiobiological knowledge and elaborates on future perspectives.
Collapse
|
22
|
Laissue JA, Barré S, Bartzsch S, Blattmann H, Bouchet AM, Djonov VG, Haberthür D, Hlushchuk R, Kaser-Hotz B, Laissue PP, LeDuc G, Reding SO, Serduc R. Tolerance of Normal Rabbit Facial Bones and Teeth to Synchrotron X-Ray Microbeam Irradiation. Radiat Res 2021; 197:233-241. [PMID: 34755190 DOI: 10.1667/rade-21-00032.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/30/2021] [Indexed: 11/03/2022]
Abstract
Microbeam radiation therapy, an alternative radiosurgical treatment under preclinical investigation, aims to safely treat muzzle tumors in pet animals. This will require data on the largely unknown radiation toxicity of microbeam arrays for bones and teeth. To this end, the muzzle of six young adult New Zealand rabbits was irradiated by a lateral array of microplanar beamlets with peak entrance doses of 200, 330 or 500 Gy. The muzzles were examined 431 days postirradiation by computed microtomographic imaging (micro-CT) ex vivo, and extensive histopathology. The boundaries of the radiation field were identified histologically by microbeam tracks in cartilage and other tissues. There was no radionecrosis of facial bones in any rabbit. Conversely, normal incisor teeth exposed to peak entrance doses of 330 Gy or 500 Gy developed marked caries-like damage, whereas the incisors of the two rabbits exposed to 200 Gy remained unscathed. A single, unidirectional array of microbeams with a peak entrance dose ≤200 Gy (valley dose14 Gy) did not damage normal bone, teeth and soft tissues of the muzzle of normal rabbits longer than one year after irradiation. Because of that, Microbeam radiation therapy of muzzle tumors in pet animals is unlikely to cause sizeable damage to normal teeth, bone and soft tissues, if a single array as used here delivers a limited entrance dose of 200 Gy and a valley dose of ≤14 Gy.
Collapse
Affiliation(s)
- Jean Albert Laissue
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, CH -3012 Bern, Switzerland
| | - Sébastien Barré
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, CH -3012 Bern, Switzerland
| | - Stefan Bartzsch
- Department of Radiation Oncology, Klinikum rechts der Isar - TU Munich, Germany
| | - Hans Blattmann
- Niederwiesstrasse 13C, CH-5417 Untersiggenthal, Switzerland
| | - Audrey M Bouchet
- INSERM UA8, "Radiations : Défense, Santé, Environnement," 69008 Lyon, France
| | | | - David Haberthür
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, CH -3012 Bern, Switzerland
| | - Ruslan Hlushchuk
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, CH -3012 Bern, Switzerland
| | | | | | | | | | | |
Collapse
|
23
|
Romano M, Bravin A, Mittone A, Eckhardt A, Barbone GE, Sancey L, Dinkel J, Bartzsch S, Ricke J, Alunni-Fabbroni M, Hirner-Eppeneder H, Karpov D, Giannini C, Bunk O, Bouchet A, Ruf V, Giese A, Coan P. A Multi-Scale and Multi-Technique Approach for the Characterization of the Effects of Spatially Fractionated X-ray Radiation Therapies in a Preclinical Model. Cancers (Basel) 2021; 13:cancers13194953. [PMID: 34638437 PMCID: PMC8507698 DOI: 10.3390/cancers13194953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study is to use a multi-technique approach to detect the effects of spatially fractionated X-ray Microbeam (MRT) and Minibeam Radiation Therapy (MB) and to compare them to seamless Broad Beam (BB) irradiation. Healthy- and Glioblastoma (GBM)-bearing male Fischer rats were irradiated in-vivo on the right brain hemisphere with MRT, MB and BB delivering three different doses for each irradiation geometry. Brains were analyzed post mortem by multi-scale X-ray Phase Contrast Imaging-Computed Tomography (XPCI-CT), histology, immunohistochemistry, X-ray Fluorescence (XRF), Small- and Wide-Angle X-ray Scattering (SAXS/WAXS). XPCI-CT discriminates with high sensitivity the effects of MRT, MB and BB irradiations on both healthy and GBM-bearing brains producing a first-time 3D visualization and morphological analysis of the radio-induced lesions, MRT and MB induced tissue ablations, the presence of hyperdense deposits within specific areas of the brain and tumor evolution or regression with respect to the evaluation made few days post-irradiation with an in-vivo magnetic resonance imaging session. Histology, immunohistochemistry, SAXS/WAXS and XRF allowed identification and classification of these deposits as hydroxyapatite crystals with the coexistence of Ca, P and Fe mineralization, and the multi-technique approach enabled the realization, for the first time, of the map of the differential radiosensitivity of the different brain areas treated with MRT and MB. 3D XPCI-CT datasets enabled also the quantification of tumor volumes and Ca/Fe deposits and their full-organ visualization. The multi-scale and multi-technique approach enabled a detailed visualization and classification in 3D of the radio-induced effects on brain tissues bringing new essential information towards the clinical implementation of the MRT and MB radiation therapy techniques.
Collapse
Affiliation(s)
- Mariele Romano
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität, Am Coulombwall 1, München, 85748 Garching, Germany; (M.R.); (A.E.); (G.E.B.)
| | - Alberto Bravin
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38000 Grenoble, France; (A.B.); (A.M.); (D.K.)
- Department of Physics, Faculty of Physics, University of Milano-Bicocca, 20126 Milan, Italy
| | - Alberto Mittone
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38000 Grenoble, France; (A.B.); (A.M.); (D.K.)
- CELLS-ALBA Synchrotron, 08290 Cerdanyola del Valles, Spain
| | - Alicia Eckhardt
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität, Am Coulombwall 1, München, 85748 Garching, Germany; (M.R.); (A.E.); (G.E.B.)
| | - Giacomo E. Barbone
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität, Am Coulombwall 1, München, 85748 Garching, Germany; (M.R.); (A.E.); (G.E.B.)
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (J.D.); (J.R.); (M.A.-F.); (H.H.-E.)
| | - Lucie Sancey
- Centre de Recherche UGA/INSERM U1209/CNRS UMR5309, Institute for Advanced Biosciences, 38700 La Tronche, France;
| | - Julien Dinkel
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (J.D.); (J.R.); (M.A.-F.); (H.H.-E.)
| | - Stefan Bartzsch
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany;
- Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (J.D.); (J.R.); (M.A.-F.); (H.H.-E.)
| | - Marianna Alunni-Fabbroni
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (J.D.); (J.R.); (M.A.-F.); (H.H.-E.)
| | - Heidrun Hirner-Eppeneder
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (J.D.); (J.R.); (M.A.-F.); (H.H.-E.)
| | - Dmitry Karpov
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38000 Grenoble, France; (A.B.); (A.M.); (D.K.)
- Swiss Light Source, Paul Scherrer Institute, 5232 Villigen, Switzerland;
| | - Cinzia Giannini
- Institute of Crystallography, National Research Council, 70126 Bari, Italy;
| | - Oliver Bunk
- Swiss Light Source, Paul Scherrer Institute, 5232 Villigen, Switzerland;
| | - Audrey Bouchet
- Inserm U1296 Unit “Radiation: Defense, Health Environment”, 69008 Lyon, France;
| | - Viktoria Ruf
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (V.R.); (A.G.)
| | - Armin Giese
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (V.R.); (A.G.)
| | - Paola Coan
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität, Am Coulombwall 1, München, 85748 Garching, Germany; (M.R.); (A.E.); (G.E.B.)
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (J.D.); (J.R.); (M.A.-F.); (H.H.-E.)
- Correspondence:
| |
Collapse
|
24
|
Montay-Gruel P, Corde S, Laissue JA, Bazalova-Carter M. FLASH radiotherapy with photon beams. Med Phys 2021; 49:2055-2067. [PMID: 34519042 DOI: 10.1002/mp.15222] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/12/2021] [Accepted: 08/30/2021] [Indexed: 12/16/2022] Open
Abstract
Ultra-high-dose rate "FLASH" radiotherapy (FLASH-RT) has been shown to drastically reduce normal tissue toxicities while being as efficacious as conventional dose rate radiotherapy to treat tumors. A large number of preclinical studies describing this so-called FLASH effect have led to the clinical translation of FLASH-RT using ultra-high-dose rate electron and proton beams. Although the vast majority of radiation therapy treatments are delivered using X-rays, few preclinical data using ultra-high-dose rate X-ray irradiation have been published. This review focuses on different methods that can be used to generate ultra-high-dose rate X-rays and their beam characteristics along with their effect on the biological tissues and the perspectives for the development of FLASH-RT with X-rays.
Collapse
Affiliation(s)
- Pierre Montay-Gruel
- Department of Radiation Oncology, University of California, Irvine, California, USA.,Department of Radiotherapy, Iridium Network, Antwerp, Belgium
| | - Stéphanie Corde
- Department of Radiation Oncology, Prince of Wales Hospital, Randwick, NSW, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Jean A Laissue
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | |
Collapse
|
25
|
A Brief Overview of the Preclinical and Clinical Radiobiology of Microbeam Radiotherapy. Clin Oncol (R Coll Radiol) 2021; 33:705-712. [PMID: 34454806 DOI: 10.1016/j.clon.2021.08.011] [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: 06/07/2021] [Revised: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022]
Abstract
Microbeam radiotherapy (MRT) is the delivery of spatially fractionated beams that have the potential to offer significant improvements in the therapeutic ratio due to the delivery of micron-sized high dose and dose rate beams. They build on longstanding clinical experience of GRID radiotherapy and more recently lattice-based approaches. Here we briefly overview the preclinical evidence for MRT efficacy and highlight the challenges for bringing this to clinical utility. The biological mechanisms underpinning MRT efficacy are still unclear, but involve vascular, bystander, stem cell and potentially immune responses. There is probably significant overlap in the mechanisms underpinning MRT responses and FLASH radiotherapy that needs to be further defined.
Collapse
|
26
|
Laissue JA. Elke Bräuer-Krisch: dedication, creativity and generosity: May 17, 1961-September 10, 2018. Int J Radiat Biol 2021; 98:280-287. [PMID: 34129423 DOI: 10.1080/09553002.2021.1941385] [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] [Indexed: 10/21/2022]
Abstract
PURPOSE This extraordinary woman worked her professional way from a radiation protection engineer to become the successful principal investigator of a prestigious international European project for a new radiation therapy (ERC Synergy grant, HORIZON 2020). The evaluation of the submitted proposal was very positive. The panel proposed that it be funded. Elke tragically passed away a few days before this conclusion of the panel. The present account describes her gradual career development; it includes many episodes that Elke personally chronicled in her curriculum of 2017. METHODS An internet literature search was performed using Google Scholar and other sources to assist in the writing of this narrative review and account. CONCLUSIONS In parallel to the development of the new Biomedical Beamline ID17 at the European Synchrotron Radiation Facility in Grenoble in the late nineties, Elke focused her interest and her personal and professional priorities on MRT, particularly on its clinical goals. She outlined her main objectives in several documents: (1) develop a new paradigm of cancer care by broadening the foundation for MRT. (2) Filling the gaps in basic biological knowledge about the mechanisms of MRT effects on normal and neoplastic tissues. (3) Broaden the preclinical level of evidence for the low normal organ toxicity of MRT versus standard X-ray irradiations; preclinical experiments involved the application of MRT to animal tumor patients, to animals of larger size than laboratory rodents, using larger radiation field sizes, and irradiating in a real-time scenario comparable to the one planned for human patients. (4) To foster the specific purpose of radiosurgical MRT of tumor patients at the ESRF that required development of new, specific state of the art modalities and tools for treatment planning, dosimetry, dose calculation, patient positioning and, of particular importance, redundant levels of patient safety. Just as she was about to take responsibility as principal investigator for a prestigious international European project on a new radiation therapy, death called Elke in.
Collapse
Affiliation(s)
- Jean A Laissue
- Institute of Pathology, University of Bern, Bern, Switzerland
| |
Collapse
|
27
|
Schültke E, Bayat S, Bartzsch S, Bräuer-Krisch E, Djonov V, Fiedler S, Fernandez-Palomo C, Jaekel F, Pellicioli P, Trappetti V, Hildebrandt G. A Mouse Model for Microbeam Radiation Therapy of the Lung. Int J Radiat Oncol Biol Phys 2021; 110:521-525. [DOI: 10.1016/j.ijrobp.2020.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/28/2020] [Accepted: 12/20/2020] [Indexed: 01/15/2023]
|
28
|
Lamirault C, Brisebard E, Patriarca A, Juchaux M, Crepin D, Labiod D, Pouzoulet F, Sebrie C, Jourdain L, Le Dudal M, Hardy D, De Marzi L, Dendale R, Jouvion G, Prezado Y. Spatially Modulated Proton Minibeams Results in the Same Increase of Lifespan as a Uniform Target Dose Coverage in F98-Glioma-Bearing Rats. Radiat Res 2021; 194:715-723. [PMID: 32991712 DOI: 10.1667/rade-19-00013.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 08/14/2020] [Indexed: 11/03/2022]
Abstract
Proton minibeam radiation therapy (pMBRT) is a new approach in proton radiotherapy, by which a significant increase in the therapeutic index has already been demonstrated in RG2 glioma-bearing rats. In the current study we investigated the response of other types of glioma (F98) and performed a comparative evaluation of tumor control effectiveness by pMBRT (with different levels of dose heterogeneity) versus conventional proton therapy. The results of our study showed an equivalent increase in the lifespan for all evaluated groups (conventional proton irradiation and pMBRT) and no significant differences in the histopathological analysis of the tumors or remaining brain tissue. The reduced long-term toxicity observed with pMBRT in previous evaluations at the same dose suggests a possible use of pMBRT to treat glioma with less side effects while ensuring the same tumor control achieved with standard proton therapy.
Collapse
Affiliation(s)
- Charlotte Lamirault
- Laboratoire Imagerie et Modelisation pour la Neurobiologie et la Cancerologie, CNRS-Paris 7-Paris 11, Campus d'Orsay, France
| | - Elise Brisebard
- Department of Global Health, Experimental Neuropathology Unit, Institut Pasteur, 75015 Paris, France.,Laboratoire d'Histopathologie, VetAgro-Sup, Université de Lyon, Marcy l'Etoile, Lyon, France
| | - Annalisa Patriarca
- Radiation Oncology Department, Centre de Protonthérapie d'Orsay, University Paris Saclay, Orsay, France
| | - Marjorie Juchaux
- Laboratoire Imagerie et Modelisation pour la Neurobiologie et la Cancerologie, CNRS-Paris 7-Paris 11, Campus d'Orsay, France
| | - Delphine Crepin
- Laboratoire Imagerie et Modelisation pour la Neurobiologie et la Cancerologie, CNRS-Paris 7-Paris 11, Campus d'Orsay, France
| | - Dalila Labiod
- Experimental Radiotherapy Platform Institut Curie, University Paris Saclay, Orsay, France
| | - Frederic Pouzoulet
- Experimental Radiotherapy Platform Institut Curie, University Paris Saclay, Orsay, France
| | - Catherine Sebrie
- BioMaps, Université Paris-Saclay, CEA, CNRS, Inserm,Service Hospitalier Frédéric Joliot, 91401 Orsay, France
| | - Laurene Jourdain
- BioMaps, Université Paris-Saclay, CEA, CNRS, Inserm,Service Hospitalier Frédéric Joliot, 91401 Orsay, France
| | - Marine Le Dudal
- Department of Global Health, Experimental Neuropathology Unit, Institut Pasteur, 75015 Paris, France.,Histologie, Embryologie et Anatomie Pathologique, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France
| | - David Hardy
- Department of Global Health, Experimental Neuropathology Unit, Institut Pasteur, 75015 Paris, France
| | - Ludovic De Marzi
- Radiation Oncology Department, Centre de Protonthérapie d'Orsay, University Paris Saclay, Orsay, France.,Institut Curie, University Paris Saclay, PSL Research University, Inserm U 1021-CNRS UMR 3347, Orsay, France
| | - Remi Dendale
- Radiation Oncology Department, Centre de Protonthérapie d'Orsay, University Paris Saclay, Orsay, France
| | - Gregory Jouvion
- Department of Global Health, Experimental Neuropathology Unit, Institut Pasteur, 75015 Paris, France.,Sorbonne Université, INSERM, Pathophysiology of Pediatric Genetic Diseases, Assistance Publique - Hôpitaux de Paris, Hôpital Armand-Trousseau, UF Génétique Moléculaire, Paris, France
| | - Yolanda Prezado
- Institut Curie, University Paris Saclay, PSL Research University, Inserm U 1021-CNRS UMR 3347, Orsay, France
| |
Collapse
|
29
|
Schültke E, Fiedler S, Menk RH, Jaekel F, Dreossi D, Casarin K, Tromba G, Bartzsch S, Kriesen S, Hildebrandt G, Arfelli F. Perspectives for microbeam irradiation at the SYRMEP beamline. JOURNAL OF SYNCHROTRON RADIATION 2021; 28:410-418. [PMID: 33650552 PMCID: PMC7941286 DOI: 10.1107/s1600577521000400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/12/2021] [Indexed: 05/10/2023]
Abstract
It has been shown previously both in vitro and in vivo that microbeam irradiation (MBI) can control malignant tumour cells more effectively than the clinically established concepts of broad beam irradiation. With the aim to extend the international capacity for microbeam research, the first MBI experiment at the biomedical beamline SYRMEP of the Italian synchrotron facility ELETTRA has been conducted. Using a multislit collimator produced by the company TECOMET, arrays of quasi-parallel microbeams were successfully generated with a beam width of 50 µm and a centre-to-centre distance of 400 µm. Murine melanoma cell cultures were irradiated with a target dose of approximately 65 Gy at a mean photon energy of ∼30 keV with a dose rate of 70 Gy s-1 and a peak-to-valley dose of ∼123. This work demonstrated a melanoma cell reduction of approximately 80% after MBI. It is suggested that, while a high energy is essential to achieve high dose rates in order to deposit high treatment doses in a short time in a deep-seated target, for in vitro studies and for the treatment of superficial tumours a spectrum in the lower energy range might be equally suitable or even advantageous.
Collapse
Affiliation(s)
- Elisabeth Schültke
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059 Rostock, Germany
| | - Stefan Fiedler
- European Molecular Biology Laboratory, Notkestrasse 85, 22607 Hamburg, Germany
| | - Ralf Hendrik Menk
- Elettra-Sincrotrone Trieste, Strada Statale 14, Trieste 34149, Italy
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Trieste Section, Istituto Nazionale Fisica Nucleare (INFN), Trieste, Italy
| | - Felix Jaekel
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059 Rostock, Germany
| | - Diego Dreossi
- Elettra-Sincrotrone Trieste, Strada Statale 14, Trieste 34149, Italy
| | - Katia Casarin
- Elettra-Sincrotrone Trieste, Strada Statale 14, Trieste 34149, Italy
| | - Giuliana Tromba
- Elettra-Sincrotrone Trieste, Strada Statale 14, Trieste 34149, Italy
| | - Stefan Bartzsch
- Department of Radiooncology, Technical University Munich, Munich, Germany
- Institute for Innovative Radiotherapy, Helmholtz-Zentrum Munich (HMGU), Munich, Germany
| | - Stephan Kriesen
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059 Rostock, Germany
| | - Guido Hildebrandt
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059 Rostock, Germany
| | - Fulvia Arfelli
- Trieste Section, Istituto Nazionale Fisica Nucleare (INFN), Trieste, Italy
- Department of Physics, University of Trieste, Trieste, Italy
| |
Collapse
|
30
|
Unexpected Benefits of Multiport Synchrotron Microbeam Radiation Therapy for Brain Tumors. Cancers (Basel) 2021; 13:cancers13050936. [PMID: 33668110 PMCID: PMC7956531 DOI: 10.3390/cancers13050936] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary We unveiled the potential of an innovative irradiation technique that ablates brain cancer while sparing normal tissues. Spatially fractionating the incident beam into arrays of micrometer-wide beamlets of X-rays (MRT for Microbeam Radiation Therapy) has led to significantly increased survival and tumor control in preclinical studies. Multiport MRT versus conventional irradiations, for the same background continuous dose, resulted in unexpectedly high equivalent biological effects in rats that have not been achieved with any other radiotherapeutic method. These hallmarks of multiport MRT, i.e., minimal impact on normal tissues and exceptional tumor control, may promote this method towards clinical applications, possibly increasing survival and improving long-term outcomes in neuro-oncology patients. Abstract Delivery of high-radiation doses to brain tumors via multiple arrays of synchrotron X-ray microbeams permits huge therapeutic advantages. Brain tumor (9LGS)-bearing and normal rats were irradiated using a conventional, homogeneous Broad Beam (BB), or Microbeam Radiation Therapy (MRT), then studied by behavioral tests, MRI, and histopathology. A valley dose of 10 Gy deposited between microbeams, delivered by a single port, improved tumor control and median survival time of tumor-bearing rats better than a BB isodose. An increased number of ports and an accumulated valley dose maintained at 10 Gy delayed tumor growth and improved survival. Histopathologically, cell death, vascular damage, and inflammatory response increased in tumors. At identical valley isodose, each additional MRT port extended survival, resulting in an exponential correlation between port numbers and animal lifespan (r2 = 0.9928). A 10 Gy valley dose, in MRT mode, delivered through 5 ports, achieved the same survival as a 25 Gy BB irradiation because of tumor dose hot spots created by intersecting microbeams. Conversely, normal tissue damage remained minimal in all the single converging extratumoral arrays. Multiport MRT reached exceptional ~2.5-fold biological equivalent tumor doses. The unique normal tissue sparing and therapeutic index are eminent prerequisites for clinical translation.
Collapse
|
31
|
Treibel F, Nguyen M, Ahmed M, Dombrowsky A, Wilkens JJ, Combs SE, Schmid TE, Bartzsch S. Establishment of Microbeam Radiation Therapy at a Small-Animal Irradiator. Int J Radiat Oncol Biol Phys 2021; 109:626-636. [PMID: 33038461 DOI: 10.1016/j.ijrobp.2020.09.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/03/2020] [Accepted: 09/21/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Microbeam radiation therapy is a preclinical concept in radiation oncology. It spares normal tissue more effectively than conventional radiation therapy at equal tumor control. The radiation field consists of peak regions with doses of several hundred gray, whereas doses between the peaks (valleys) are below the tissue tolerance level. Widths and distances of the beams are in the submillimeter range for microbeam radiation therapy. A similar alternative concept with beam widths and distances in the millimeter range is presented by minibeam radiation therapy. Although both methods were developed at large synchrotron facilities, compact alternative sources have been proposed recently. METHODS AND MATERIALS A small-animal irradiator was fitted with a special 3-layered collimator that is used for preclinical research and produces microbeams of flexible width of up to 100 μm. Film dosimetry provided measurements of the dose distributions and was compared with Monte Carlo dose predictions. Moreover, the micronucleus assay in Chinese hamster CHO-K1 cells was used as a biological dosimeter. The focal spot size and beam emission angle of the x-ray tube were modified to optimize peak dose rate, peak-to-valley dose ratio (PVDR), beam shape, and field homogeneity. An equivalent collimator with slit widths of up to 500 μm produced minibeams and allowed for comparison of microbeam and minibeam field characteristics. RESULTS The setup achieved peak entrance dose rates of 8 Gy/min and PVDRs >30 for microbeams. Agreement between Monte Carlo simulations and film dosimetry is generally better for larger beam widths; qualitative measurements validated Monte Carlo predicted results. A smaller focal spot enhances PVDRs and reduces beam penumbras but substantially reduces the dose rate. A reduction of the beam emission angle improves the PVDR, beam penumbras, and dose rate without impairing field homogeneity. Minibeams showed similar field characteristics compared with microbeams at the same ratio of beam width and distance but had better agreement with simulations. CONCLUSION The developed setup is already in use for in vitro experiments and soon for in vivo irradiations. Deviations between Monte Carlo simulations and film dosimetry are attributed to scattering at the collimator surface and manufacturing inaccuracies and are a matter of ongoing research.
Collapse
Affiliation(s)
- Franziska Treibel
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany; Physics Department, Technical University of Munich, Garching, Germany
| | - Mai Nguyen
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany
| | - Mabroor Ahmed
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany; Physics Department, Technical University of Munich, Garching, Germany
| | - Annique Dombrowsky
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany
| | - Jan J Wilkens
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Physics Department, Technical University of Munich, Garching, Germany
| | - Stephanie E Combs
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany
| | - Thomas E Schmid
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany
| | - Stefan Bartzsch
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany.
| |
Collapse
|
32
|
Clinical microbeam radiation therapy with a compact source: specifications of the line-focus X-ray tube. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 14:74-81. [PMID: 33458318 PMCID: PMC7807643 DOI: 10.1016/j.phro.2020.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 02/02/2023]
Abstract
Line-focus X-ray tubes are suitable for clinical microbeam radiation therapy (MRT). A modular high-voltage supply safely enables high electron beam powers. An electron accelerator was designed to generate an eccentric focal spot. We simulated a peak-to-valley dose ratio above 20 for single-field MRT. Microbeam arc therapy spares healthy brain tissue compared to single-field MRT.
Background and purpose Microbeam radiotherapy (MRT) is a preclinical concept in radiation oncology with arrays of alternating micrometer-wide high-dose peaks and low-dose valleys. Experiments demonstrated a superior normal tissue sparing at similar tumor control rates with MRT compared to conventional radiotherapy. Possible clinical applications are currently limited to large third-generation synchrotrons. Here, we investigated the line-focus X-ray tube as an alternative microbeam source. Materials and methods We developed a concept for a high-voltage supply and an electron source. In Monte Carlo simulations, we assessed the influence of X-ray spectrum, focal spot size, electron incidence angle, and photon emission angle on the microbeam dose distribution. We further assessed the dose distribution of microbeam arc therapy and suggested to interpret this complex dose distribution by equivalent uniform dose. Results An adapted modular multi-level converter can supply high-voltage powers in the megawatt range for a few seconds. The electron source with a thermionic cathode and a quadrupole can generate an eccentric, high-power electron beam of several 100 keV energy. Highest dose rates and peak-to-valley dose ratios (PVDRs) were achieved for an electron beam impinging perpendicular onto the target surface and a focal spot smaller than the microbeam cross-section. The line-focus X-ray tube simulations demonstrated PVDRs above 20. Conclusion The line-focus X-ray tube is a suitable compact source for clinical MRT. We demonstrated its technical feasibility based on state-of-the-art high-voltage and electron-beam technology. Microbeam arc therapy is an effective concept to increase the target-to-entrance dose ratio of orthovoltage microbeams.
Collapse
|
33
|
Complete Remission of Mouse Melanoma after Temporally Fractionated Microbeam Radiotherapy. Cancers (Basel) 2020; 12:cancers12092656. [PMID: 32957691 PMCID: PMC7563854 DOI: 10.3390/cancers12092656] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Synchrotron Microbeam Radiotherapy (MRT) significantly improves local tumour control with minimal normal tissue toxicity. MRT delivers orthovoltage X-rays at an ultra-high "FLASH" dose rate in spatially fractionated beams, typically only few tens of micrometres wide. One of the biggest challenges in translating MRT to the clinic is its use of high peak doses, of around 300-600 Gy, which can currently only be delivered by synchrotron facilities. Therefore, in an effort to improve the translation of MRT to the clinic, this work studied whether the temporal fractionation of traditional MRT into several sessions with lower, more clinically feasible, peak doses could still maintain local tumour control. METHODS Two groups of twelve C57Bl/6J female mice harbouring B16-F10 melanomas in their ears were treated with microbeams of 50 µm in width spaced by 200 µm from their centres. The treatment modality was either (i) a single MRT session of 401.23 Gy peak dose (7.40 Gy valley dose, i.e., dose between beams), or (ii) three MRT sessions of 133.41 Gy peak dose (2.46 Gy valley dose) delivered over 3 days in different anatomical planes, which intersected at 45 degrees. The mean dose rate was 12,750 Gy/s, with exposure times between 34.2 and 11.4 ms, respectively. RESULTS Temporally fractionated MRT ablated 50% of B16-F10 mouse melanomas, preventing organ metastases and local tumour recurrence for 18 months. In the rest of the animals, the median survival increased by 2.5-fold in comparison to the single MRT session and by 4.1-fold with respect to untreated mice. CONCLUSIONS Temporally fractionating MRT with lower peak doses not only maintained tumour control, but also increased the efficacy of this technique. These results demonstrate that the solution to making MRT more clinically feasible is to irradiate with several fractions of intersecting arrays with lower peak doses. This provides alternatives to synchrotron sources where future microbeam radiotherapy could be delivered with less intense radiation sources.
Collapse
|
34
|
Griffin RJ, Ahmed MM, Amendola B, Belyakov O, Bentzen SM, Butterworth KT, Chang S, Coleman CN, Djonov V, Formenti SC, Glatstein E, Guha C, Kalnicki S, Le QT, Loo BW, Mahadevan A, Massaccesi M, Maxim PG, Mohiuddin M, Mohiuddin M, Mayr NA, Obcemea C, Petersson K, Regine W, Roach M, Romanelli P, Simone CB, Snider JW, Spitz DR, Vikram B, Vozenin MC, Abdel-Wahab M, Welsh J, Wu X, Limoli CL. Understanding High-Dose, Ultra-High Dose Rate, and Spatially Fractionated Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 107:766-778. [PMID: 32298811 DOI: 10.1016/j.ijrobp.2020.03.028] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/12/2022]
Abstract
The National Cancer Institute's Radiation Research Program, in collaboration with the Radiosurgery Society, hosted a workshop called Understanding High-Dose, Ultra-High Dose Rate and Spatially Fractionated Radiotherapy on August 20 and 21, 2018 to bring together experts in experimental and clinical experience in these and related fields. Critically, the overall aims were to understand the biological underpinning of these emerging techniques and the technical/physical parameters that must be further defined to drive clinical practice through innovative biologically based clinical trials.
Collapse
Affiliation(s)
- Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mansoor M Ahmed
- Division of Cancer Treatment and Diagnosis, Rockville, Maryland
| | | | - Oleg Belyakov
- International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Søren M Bentzen
- Division of Biostatistics and Bioinformatics, University of Maryland, Baltimore, Maryland
| | - Karl T Butterworth
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, United Kingdom
| | - Sha Chang
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Valentin Djonov
- Bern Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Sylvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Eli Glatstein
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chandan Guha
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Health Systems, Danville, Pennsylvania
| | - Mariangela Massaccesi
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Peter G Maxim
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Nina A Mayr
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington
| | | | - Kristoffer Petersson
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - William Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mack Roach
- Department of Radiation Oncology & Urology, University of California, San Francisco, San Francisco, California
| | | | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - James W Snider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Douglas R Spitz
- Free Radical & Radiation Biology Program, University of Iowa, Iowa City, Iowa
| | | | - Marie-Catherine Vozenin
- Laboratory of Radiation Oncology/DO/Radio-Oncology/CHUV, Lausanne University Hospital, Switzerland
| | - May Abdel-Wahab
- International Atomic Energy Agency Headquarters, Vienna International Centre, Vienna, Austria
| | - James Welsh
- Edward Hines VA Medical Center and Loyola University Stritch School of Medicine, Chicago, Illinois
| | - Xiaodong Wu
- Executive Medical Physics Associates, Miami, Florida; Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Charles L Limoli
- Department of Radiation Oncology, University of California-Irvine, Irvine, California.
| |
Collapse
|
35
|
Hombrink G, Wilkens JJ, Combs SE, Bartzsch S. Simulation and measurement of microbeam dose distribution in lung tissue. Phys Med 2020; 75:77-82. [PMID: 32559648 DOI: 10.1016/j.ejmp.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/01/2020] [Indexed: 11/26/2022] Open
Abstract
Microbeam radiation therapy (MRT), a so far preclinical method in radiation oncology, modulates treatment doses on a micrometre scale. MRT uses treatment fields with a few ten micrometre wide high dose regions (peaks) separated by a few hundred micrometre wide low dose regions (valleys) and was shown to spare tissue much more effectively than conventional radiation therapy at similar tumour control rates. While preclinical research focused primarily on tumours of the central nervous system, recently also lung tumours have been suggested as a potential target for MRT. This study investigates the effect of the lung microstructure, comprising air cavities of a few hundred micrometre diameter, on the microbeam dose distribution in lung. In Monte Carlo simulations different models of heterogeneous lung tissue are compared with pure water and homogeneous air-water mixtures. Experimentally, microbeam dose distributions in porous foam material with cavity sizes similar to the size of lung alveoli were measured with film dosimetry at the European Synchrotron Radiation Facility (ESRF) in Grenoble, France. Simulations and experiments show that the microstructure of the lung has a huge impact on the local doses in the microbeam fields. Locally, material inhomogeneities may change the dose by a factor of 1.7, and also average peak and valley doses substantially differ from those in homogeneous material. Our results imply that accurate dose prediction for MRT in lung requires adequate models of the lung microstructure. Even if only average peak and valley doses are of interest, the assumption of a simple homogeneous air-water mixture is not sufficient. Since anatomic information on a micrometre scale are unavailable for clinical treatment planning, alternative methods and models have to be developed.
Collapse
Affiliation(s)
- Gerrit Hombrink
- University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Physics Department, Technical University of Munich, Garching, Germany; Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
| | - Jan J Wilkens
- University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Physics Department, Technical University of Munich, Garching, Germany
| | - Stephanie E Combs
- University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
| | - Stefan Bartzsch
- University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
| |
Collapse
|
36
|
Dombrowsky AC, Burger K, Porth AK, Stein M, Dierolf M, Günther B, Achterhold K, Gleich B, Feuchtinger A, Bartzsch S, Beyreuther E, Combs SE, Pfeiffer F, Wilkens JJ, Schmid TE. A proof of principle experiment for microbeam radiation therapy at the Munich compact light source. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2020; 59:111-120. [PMID: 31655869 DOI: 10.1007/s00411-019-00816-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
Microbeam radiation therapy (MRT), a preclinical form of spatially fractionated radiotherapy, uses an array of microbeams of hard synchrotron X-ray radiation. Recently, compact synchrotron X-ray sources got more attention as they provide essential prerequisites for the translation of MRT into clinics while overcoming the limited access to synchrotron facilities. At the Munich compact light source (MuCLS), one of these novel compact X-ray facilities, a proof of principle experiment was conducted applying MRT to a xenograft tumor mouse model. First, subcutaneous tumors derived from the established squamous carcinoma cell line FaDu were irradiated at a conventional X-ray tube using broadbeam geometry to determine a suitable dose range for the tumor growth delay. For irradiations at the MuCLS, FaDu tumors were irradiated with broadbeam and microbeam irradiation at integral doses of either 3 Gy or 5 Gy and tumor growth delay was measured. Microbeams had a width of 50 µm and a center-to-center distance of 350 µm with peak doses of either 21 Gy or 35 Gy. A dose rate of up to 5 Gy/min was delivered to the tumor. Both doses and modalities delayed the tumor growth compared to a sham-irradiated tumor. The irradiated area and microbeam pattern were verified by staining of the DNA double-strand break marker γH2AX. This study demonstrates for the first time that MRT can be successfully performed in vivo at compact inverse Compton sources.
Collapse
Affiliation(s)
- Annique C Dombrowsky
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Karin Burger
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Ann-Kristin Porth
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Marlon Stein
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Martin Dierolf
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Benedikt Günther
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Bernhard Gleich
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Annette Feuchtinger
- Research Unit Analytical Pathology, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
| | - Stefan Bartzsch
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Elke Beyreuther
- Helmholtz-Zentrum Dresden-Rossendorf, 01328, Dresden, Germany
- OncoRay, National Center for Radiation Research in Oncology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01328, Dresden, Germany
| | - Stephanie E Combs
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
- German Consortium for Translational Cancer Research, Deutsches Konsortium für Translationale Krebsforschung (dktk), Technical University Munich, 81675, Munich, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiobiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
| | - Thomas E Schmid
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany.
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany.
| |
Collapse
|
37
|
Fernandez-Palomo C, Fazzari J, Trappetti V, Smyth L, Janka H, Laissue J, Djonov V. Animal Models in Microbeam Radiation Therapy: A Scoping Review. Cancers (Basel) 2020; 12:cancers12030527. [PMID: 32106397 PMCID: PMC7139755 DOI: 10.3390/cancers12030527] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Microbeam Radiation Therapy (MRT) is an innovative approach in radiation oncology where a collimator subdivides the homogeneous radiation field into an array of co-planar, high-dose beams which are tens of micrometres wide and separated by a few hundred micrometres. OBJECTIVE This scoping review was conducted to map the available evidence and provide a comprehensive overview of the similarities, differences, and outcomes of all experiments that have employed animal models in MRT. METHODS We considered articles that employed animal models for the purpose of studying the effects of MRT. We searched in seven databases for published and unpublished literature. Two independent reviewers screened citations for inclusion. Data extraction was done by three reviewers. RESULTS After screening 5688 citations and 159 full-text papers, 95 articles were included, of which 72 were experimental articles. Here we present the animal models and pre-clinical radiation parameters employed in the existing MRT literature according to their use in cancer treatment, non-neoplastic diseases, or normal tissue studies. CONCLUSIONS The study of MRT is concentrated in brain-related diseases performed mostly in rat models. An appropriate comparison between MRT and conventional radiotherapy (instead of synchrotron broad beam) is needed. Recommendations are provided for future studies involving MRT.
Collapse
Affiliation(s)
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
| | - Verdiana Trappetti
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
| | - Lloyd Smyth
- Department of Obstetrics & Gynaecology, University of Melbourne, 3057 Parkville, Australia;
| | - Heidrun Janka
- Medical Library, University Library Bern, University of Bern, 3012 Bern, Switzerland;
| | - Jean Laissue
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
- Correspondence: ; Tel.: +41-31-631-8432
| |
Collapse
|
38
|
Potez M, Bouchet A, Flaender M, Rome C, Collomb N, Grotzer M, Krisch M, Djonov V, Balosso J, Brun E, Laissue JA, Serduc R. Synchrotron X-Ray Boost Delivered by Microbeam Radiation Therapy After Conventional X-Ray Therapy Fractionated in Time Improves F98 Glioma Control. Int J Radiat Oncol Biol Phys 2020; 107:360-369. [PMID: 32088292 DOI: 10.1016/j.ijrobp.2020.02.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Synchrotron microbeam radiation therapy (MRT) is based on the spatial fractionation of the incident, highly collimated synchrotron beam into arrays of parallel microbeams depositing several hundred grays. It appears relevant to combine MRT with a conventional treatment course, preparing a treatment scheme for future patients in clinical trials. The efficiency of MRT delivered after several broad-beam (BB) fractions to palliate F98 brain tumors in rats in comparison with BB fractions alone was evaluated in this study. METHODS AND MATERIALS Rats bearing 106 F98 cells implanted in the caudate nucleus were irradiated by 5 fractions in BB mode (3 × 6 Gy + 2 × 8 Gy BB) or by 2 boost fractions in MRT mode to a total of 5 fractions (3 × 6 Gy BB + MRT 2 × 8 Gy valley dose; peak dose 181 Gy [50/200 μm]). Tumor growth was evaluated in vivo by magnetic resonance imaging follow-up at T-1, T7, T12, T15, T20, and T25 days after radiation therapy and by histology and flow cytometry. RESULTS MRT-boosted tumors displayed lower cell density and cell proliferation compared with BB-irradiated tumors. The MRT boost completely stopped tumor growth during ∼4 weeks and led to a significant increase in median survival time, whereas tumors treated with BB alone recurred within a few days after the last radiation fraction. CONCLUSIONS The first evidence is presented that MRT, delivered as a boost of conventionally fractionated irradiation by orthovoltage broad x-ray beams, is feasible and more efficient than conventional radiation therapy alone.
Collapse
Affiliation(s)
- Marine Potez
- Inserm UA7, Rayonnement synchrotron pour la recherche médicale (STROBE), Université Grenoble Alpes, Grenoble, France
| | - Audrey Bouchet
- Inserm UA7, Rayonnement synchrotron pour la recherche médicale (STROBE), Université Grenoble Alpes, Grenoble, France; Institute of Anatomy, Group Tomographic and Clinical Anatomy, University of Bern, Bern, Switzerland.
| | - Mélanie Flaender
- Inserm UA7, Rayonnement synchrotron pour la recherche médicale (STROBE), Université Grenoble Alpes, Grenoble, France
| | - Claire Rome
- Team Functional NeuroImaging and Brain Perfusion, Inserm, France; Grenoble Institut des Neurosciences, Université Grenoble Alpes, La Tronche, France
| | - Nora Collomb
- Team Functional NeuroImaging and Brain Perfusion, Inserm, France; Grenoble Institut des Neurosciences, Université Grenoble Alpes, La Tronche, France
| | - Michael Grotzer
- Department of Oncology, University Children's Hospital of Zurich, Switzerland
| | - Michael Krisch
- European Synchrotron Radiation Facility, Grenoble, France
| | - Valentin Djonov
- Institute of Anatomy, Group Tomographic and Clinical Anatomy, University of Bern, Bern, Switzerland
| | - Jacques Balosso
- Inserm UA7, Rayonnement synchrotron pour la recherche médicale (STROBE), Université Grenoble Alpes, Grenoble, France
| | - Emmanuel Brun
- Inserm UA7, Rayonnement synchrotron pour la recherche médicale (STROBE), Université Grenoble Alpes, Grenoble, France
| | | | - Raphaël Serduc
- Inserm UA7, Rayonnement synchrotron pour la recherche médicale (STROBE), Université Grenoble Alpes, Grenoble, France
| |
Collapse
|
39
|
Mazal A, Prezado Y, Ares C, de Marzi L, Patriarca A, Miralbell R, Favaudon V. FLASH and minibeams in radiation therapy: the effect of microstructures on time and space and their potential application to protontherapy. Br J Radiol 2020; 93:20190807. [PMID: 32003574 PMCID: PMC7066940 DOI: 10.1259/bjr.20190807] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
After years of lethargy, studies on two non-conventional microstructures in time and space of the beams used in radiation therapy are enjoying a huge revival. The first effect called “FLASH” is based on very high dose-rate irradiation (pulse amplitude ≥106 Gy/s), short beam-on times (≤100 ms) and large single doses (≥10 Gy) as experimental parameters established so far to give biological and potential clinical effects. The second effect relies on the use of arrays of minibeams (e.g., 0.5–1 mm, spaced 1–3.5 mm). Both approaches have been shown to protect healthy tissues as an endpoint that must be clearly specified and could be combined with each other (e.g., minibeams under FLASH conditions). FLASH depends on the presence of oxygen and could proceed from the chemistry of peroxyradicals and a reduced incidence on DNA and membrane damage. Minibeams action could be based on abscopal effects, cell signalling and/or migration of cells between “valleys and hills” present in the non-uniform irradiation field as well as faster repair of vascular damage. Both effects are expected to maintain intact the tumour control probability and might even preserve antitumoural immunological reactions. FLASH in vivo experiments involving Zebrafish, mice, pig and cats have been done with electron beams, while minibeams are an intermediate approach between X-GRID and synchrotron X-ray microbeams radiation. Both have an excellent rationale to converge and be applied with proton beams, combining focusing properties and high dose rates in the beam path of pencil beams, and the inherent advantage of a controlled limited range. A first treatment with electron FLASH (cutaneous lymphoma) has recently been achieved, but clinical trials have neither been presented for FLASH with protons, nor under the minibeam conditions. Better understanding of physical, chemical and biological mechanisms of both effects is essential to optimize the technical developments and devise clinical trials.
Collapse
Affiliation(s)
| | - Yolanda Prezado
- IMNC, University Paris-Sud and Paris-Saclay, CNRS/IN2P3, Orsay, France
| | - Carme Ares
- Centro de Protonterapia Quironsalud, Madrid, Spain
| | - Ludovic de Marzi
- Institut Curie, Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay 91898, France.,Institut Curie, Inserm U 1021-CNRS UMR 3347, Paris-Saclay and PSL Research Universities, Orsay, France
| | - Annalisa Patriarca
- Institut Curie, Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay 91898, France
| | | | - Vincent Favaudon
- Institut Curie, Inserm U 1021-CNRS UMR 3347, Paris-Saclay and PSL Research Universities, Orsay, France
| |
Collapse
|
40
|
Bartzsch S, Corde S, Crosbie JC, Day L, Donzelli M, Krisch M, Lerch M, Pellicioli P, Smyth LML, Tehei M. Technical advances in x-ray microbeam radiation therapy. Phys Med Biol 2020; 65:02TR01. [PMID: 31694009 DOI: 10.1088/1361-6560/ab5507] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In the last 25 years microbeam radiation therapy (MRT) has emerged as a promising alternative to conventional radiation therapy at large, third generation synchrotrons. In MRT, a multi-slit collimator modulates a kilovoltage x-ray beam on a micrometer scale, creating peak dose areas with unconventionally high doses of several hundred Grays separated by low dose valley regions, where the dose remains well below the tissue tolerance level. Pre-clinical evidence demonstrates that such beam geometries lead to substantially reduced damage to normal tissue at equal tumour control rates and hence drastically increase the therapeutic window. Although the mechanisms behind MRT are still to be elucidated, previous studies indicate that immune response, tumour microenvironment, and the microvasculature may play a crucial role. Beyond tumour therapy, MRT has also been suggested as a microsurgical tool in neurological disorders and as a primer for drug delivery. The physical properties of MRT demand innovative medical physics and engineering solutions for safe treatment delivery. This article reviews technical developments in MRT and discusses existing solutions for dosimetric validation, reliable treatment planning and safety. Instrumentation at synchrotron facilities, including beam production, collimators and patient positioning systems, is also discussed. Specific solutions reviewed in this article include: dosimetry techniques that can cope with high spatial resolution, low photon energies and extremely high dose rates of up to 15 000 Gy s-1, dose calculation algorithms-apart from pure Monte Carlo Simulations-to overcome the challenge of small voxel sizes and a wide dynamic dose-range, and the use of dose-enhancing nanoparticles to combat the limited penetrability of a kilovoltage energy spectrum. Finally, concepts for alternative compact microbeam sources are presented, such as inverse Compton scattering set-ups and carbon nanotube x-ray tubes, that may facilitate the transfer of MRT into a hospital-based clinical environment. Intensive research in recent years has resulted in practical solutions to most of the technical challenges in MRT. Treatment planning, dosimetry and patient safety systems at synchrotrons have matured to a point that first veterinary and clinical studies in MRT are within reach. Should these studies confirm the promising results of pre-clinical studies, the authors are confident that MRT will become an effective new radiotherapy option for certain patients.
Collapse
Affiliation(s)
- Stefan Bartzsch
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany. Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Dipuglia A, Cameron M, Davis JA, Cornelius IM, Stevenson AW, Rosenfeld AB, Petasecca M, Corde S, Guatelli S, Lerch MLF. Validation of a Monte Carlo simulation for Microbeam Radiation Therapy on the Imaging and Medical Beamline at the Australian Synchrotron. Sci Rep 2019; 9:17696. [PMID: 31776395 PMCID: PMC6881291 DOI: 10.1038/s41598-019-53991-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 11/05/2019] [Indexed: 01/05/2023] Open
Abstract
Microbeam Radiation Therapy (MRT) is an emerging cancer treatment modality characterised by the use of high-intensity synchrotron-generated x-rays, spatially fractionated by a multi-slit collimator (MSC), to ablate target tumours. The implementation of an accurate treatment planning system, coupled with simulation tools that allow for independent verification of calculated dose distributions are required to ensure optimal treatment outcomes via reliable dose delivery. In this article we present data from the first Geant4 Monte Carlo radiation transport model of the Imaging and Medical Beamline at the Australian Synchrotron. We have developed the model for use as an independent verification tool for experiments in one of three MRT delivery rooms and therefore compare simulation results with equivalent experimental data. The normalised x-ray spectra produced by the Geant4 model and a previously validated analytical model, SPEC, showed very good agreement using wiggler magnetic field strengths of 2 and 3 T. However, the validity of absolute photon flux at the plane of the Phase Space File (PSF) for a fixed number of simulated electrons was unable to be established. This work shows a possible limitation of the G4SynchrotronRadiation process to model synchrotron radiation when using a variable magnetic field. To account for this limitation, experimentally derived normalisation factors for each wiggler field strength determined under reference conditions were implemented. Experimentally measured broadbeam and microbeam dose distributions within a Gammex RMI457 Solid Water® phantom were compared to simulated distributions generated by the Geant4 model. Simulated and measured broadbeam dose distributions agreed within 3% for all investigated configurations and measured depths. Agreement between the simulated and measured microbeam dose distributions agreed within 5% for all investigated configurations and measured depths.
Collapse
Affiliation(s)
- Andrew Dipuglia
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Matthew Cameron
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Jeremy A Davis
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Iwan M Cornelius
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Andrew W Stevenson
- CSIRO, Clayton, 3168, Australia
- Imaging and Medical Beamline, ANSTO/Australian Synchrotron, Melbourne, 3168, Australia
| | - Anatoly B Rosenfeld
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Marco Petasecca
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Stéphanie Corde
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
- Department of Radiation Oncology, Prince of Wales Hospital, Randwick, 2031, Australia
| | - Susanna Guatelli
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Michael L F Lerch
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia.
| |
Collapse
|
42
|
Potez M, Fernandez-Palomo C, Bouchet A, Trappetti V, Donzelli M, Krisch M, Laissue J, Volarevic V, Djonov V. Synchrotron Microbeam Radiation Therapy as a New Approach for the Treatment of Radioresistant Melanoma: Potential Underlying Mechanisms. Int J Radiat Oncol Biol Phys 2019; 105:1126-1136. [PMID: 31461675 DOI: 10.1016/j.ijrobp.2019.08.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/04/2019] [Accepted: 08/18/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE Synchrotron microbeam radiation therapy (MRT) is a method that spatially distributes the x-ray beam into several microbeams of very high dose (peak dose), regularly separated by low-dose intervals (valley dose). MRT selectively spares normal tissues, relative to conventional (uniform broad beam [BB]) radiation therapy. METHODS AND MATERIALS To evaluate the effect of MRT on radioresistant melanoma, B16-F10 murine melanomas were implanted into mice ears. Tumors were either treated with MRT (407.6 Gy peak; 6.2 Gy valley dose) or uniform BB irradiation (6.2 Gy). RESULTS MRT induced significantly longer tumor regrowth delay than did BB irradiation. A significant 24% reduction in blood vessel perfusion was observed 5 days after MRT, and the cell proliferation index was significantly lower in melanomas treated by MRT compared with BB. MRT provoked a greater induction of senescence in melanoma cells. Bio-Plex analyses revealed enhanced concentration of monocyte-attracting chemokines in the MRT group: MCP-1 at D5, MIP-1α, MIP-1β, IL12p40, and RANTES at D9. This was associated with leukocytic infiltration at D9 after MRT, attributed mainly to CD8 T cells, natural killer cells, and macrophages. CONCLUSIONS In light of its potential to disrupt blood vessels that promote infiltration of the tumor by immune cells and its induction of senescence, MRT could be a new therapeutic approach for radioresistant melanoma.
Collapse
Affiliation(s)
- Marine Potez
- Institute of Anatomy, University of Bern, Bern, Switzerland
| | | | - Audrey Bouchet
- Institute of Anatomy, University of Bern, Bern, Switzerland; Synchrotron Radiation for Biomedicine, INSERM UA7, 71 rue des Martyrs, 38000 Grenoble, France
| | | | - Mattia Donzelli
- Biomedical Beamline ID17, European Synchrotron Radiation Facility, Grenoble, France; Joint Department of Physics, The Institute of Cancer Research and the Royal Marsden Hospital, London, United Kingdom
| | - Michael Krisch
- Biomedical Beamline ID17, European Synchrotron Radiation Facility, Grenoble, France
| | - Jean Laissue
- Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Vladislav Volarevic
- Department of Microbiology and Immunology, Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, Bern, Switzerland.
| |
Collapse
|
43
|
Eling L, Bouchet A, Nemoz C, Djonov V, Balosso J, Laissue J, Bräuer-Krisch E, Adam JF, Serduc R. Ultra high dose rate Synchrotron Microbeam Radiation Therapy. Preclinical evidence in view of a clinical transfer. Radiother Oncol 2019; 139:56-61. [PMID: 31307824 DOI: 10.1016/j.radonc.2019.06.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022]
Abstract
This paper reviews the current state of the art of an emerging form of radiosurgery dedicated to brain tumour treatment and which operates at very high dose rate (kGy·s-1). Microbeam Radiation Therapy uses synchrotron-generated X-rays which triggered normal tissue sparing partially mediated by FLASH effect.
Collapse
Affiliation(s)
- Laura Eling
- Inserm UA7, Synchrotron Radiation for Biomedical Research (STROBE), Université Grenoble Alpes - ID17, Installation Européenne du Rayonnement Synchrotron (ESRF) CS 40220, Grenoble Cedex 9, France
| | - Audrey Bouchet
- Inserm UA7, Synchrotron Radiation for Biomedical Research (STROBE), Université Grenoble Alpes - ID17, Installation Européenne du Rayonnement Synchrotron (ESRF) CS 40220, Grenoble Cedex 9, France
| | | | | | | | | | | | - Jean Francois Adam
- Inserm UA7, Synchrotron Radiation for Biomedical Research (STROBE), Université Grenoble Alpes - ID17, Installation Européenne du Rayonnement Synchrotron (ESRF) CS 40220, Grenoble Cedex 9, France
| | - Raphael Serduc
- Inserm UA7, Synchrotron Radiation for Biomedical Research (STROBE), Université Grenoble Alpes - ID17, Installation Européenne du Rayonnement Synchrotron (ESRF) CS 40220, Grenoble Cedex 9, France.
| |
Collapse
|
44
|
Donzelli M, Oelfke U, Bräuer-Krisch E. Introducing the concept of spiral microbeam radiation therapy (spiralMRT). Phys Med Biol 2019; 64:065005. [PMID: 30650386 DOI: 10.1088/1361-6560/aaff23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
MOTIVATION With interlaced microbeam radiation therapy (MRT) a first kilovoltage radiotherapy (RT) concept combining spatially fractionated entrance beams and homogeneous dose distribution at the target exists. However, this technique suffers from its high sensitivity to positioning errors of the target relative to the radiation source. With spiral microbeam radiation therapy (spiralMRT), this publication introduces a new irradiation geometry, offering similar spatial fractionation properties as interlaced MRT, while being less vulnerable to target positioning uncertainties. METHODS The dose distributions achievable with spiralMRT in a simplified human head geometry were calculated with Monte Carlo simulations based on Geant4 and the dependence of the result on the microbeam pitch, total field size, and photon energy were analysed. A comparison with interlaced MRT and conventional megavoltage tomotherapy was carried out. RESULTS SpiralMRT can deliver homogeneous dose distributions, while using spatially fractionated entrance beams. The valley dose of spiralMRT entrance beams is by up to 40% lower than the corresponding tomotherapy dose, thus indicating a better normal tissue sparing. The optimum photon energy is found to be around [Formula: see text]. CONCLUSIONS SpiralMRT is a promising approach to delivering homogeneous dose distributions with spatially fractionated entrance beams, possibly decreasing normal tissue side effects in hypofractionated RT.
Collapse
Affiliation(s)
- Mattia Donzelli
- European Synchrotron Radiation Facility, Biomedical beamline ID17, Grenoble, France. Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom. Author to whom any correspondence should be addressed
| | | | | |
Collapse
|
45
|
Meyer J, Eley J, Schmid TE, Combs SE, Dendale R, Prezado Y. Spatially fractionated proton minibeams. Br J Radiol 2019; 92:20180466. [PMID: 30359081 PMCID: PMC6541186 DOI: 10.1259/bjr.20180466] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 12/26/2022] Open
Abstract
Extraordinary normal tissue response to highly spatially fractionated X-ray beams has been explored for over 25 years. More recently, alternative radiation sources have been developed and utilized with the aim to evoke comparable effects. These include protons, which lend themselves well for this endeavour due to their physical depth dose characteristics as well as corresponding variable biological effectiveness. This paper addresses the motivation for using protons to generate spatially fractionated beams and reviews the technological implementations and experimental results to date. This includes simulation and feasibility studies, collimation and beam characteristics, dosimetry and biological considerations as well as the results of in vivo and in vitro studies. Experimental results are emerging indicating an extraordinary normal tissue sparing effect analogous to what has been observed for synchrotron generated X-ray microbeams. The potential for translational research and feasibility of spatially modulated proton beams in clinical settings is discussed.
Collapse
Affiliation(s)
- Juergen Meyer
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - John Eley
- Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, MD, USA
| | | | | | - Remi Dendale
- Institut Curie, Centre de Protonthérapie d’Orsay, Orsay, France
| | - Yolanda Prezado
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique, Universités Paris 11 and Paris 7, Campus d'Orsay, Orsay, France
| |
Collapse
|
46
|
Synchrotron microbeam radiotherapy evokes a different early tumor immunomodulatory response to conventional radiotherapy in EMT6.5 mammary tumors. Radiother Oncol 2019; 133:93-99. [PMID: 30935588 DOI: 10.1016/j.radonc.2019.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/05/2018] [Accepted: 01/07/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Synchrotron microbeam radiation therapy (MRT) is a new, evolving form of radiotherapy that has potential for clinical application. Several studies have shown in preclinical models that synchrotron MRT achieves equivalent tumor control to conventional radiotherapy (CRT) but with significantly reduced normal tissue damage. METHODS To explore differences between these two modalities, we assessed the immune cell infiltrate into EMT6.5 mammary tumors after CRT and MRT. RESULTS CRT induced marked increases in tumor-associated macrophages and neutrophils while there were no increases in these populations following MRT. In contrast, there were higher numbers of T cells in the MRT treated tumors. There were also increased levels of CCL2 by immunohistochemistry in tumors subjected to CRT, but not to MRT. Conversely, we found that MRT induced higher levels of pro-inflammatory genes in tumors than CRT. CONCLUSION Our data are the first to demonstrate substantial differences in macrophage, neutrophil and T cell numbers in tumors following MRT versus CRT, providing support for the concept that MRT evokes a different immunomodulatory response in tumors compared to CRT.
Collapse
|
47
|
Montay-Gruel P, Bouchet A, Jaccard M, Patin D, Serduc R, Aim W, Petersson K, Petit B, Bailat C, Bourhis J, Bräuer-Krisch E, Vozenin MC. X-rays can trigger the FLASH effect: Ultra-high dose-rate synchrotron light source prevents normal brain injury after whole brain irradiation in mice. Radiother Oncol 2018; 129:582-588. [DOI: 10.1016/j.radonc.2018.08.016] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/06/2018] [Accepted: 08/23/2018] [Indexed: 11/16/2022]
|
48
|
Esplen NM, Chergui L, Johnstone CD, Bazalova-Carter M. Monte Carlo optimization of a microbeam collimator design for use on the small animal radiation research platform (SARRP). ACTA ACUST UNITED AC 2018; 63:175004. [DOI: 10.1088/1361-6560/aad7e2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
49
|
Schültke E, Bräuer-Krisch E, Blattmann H, Requardt H, Laissue JA, Hildebrandt G. Survival of rats bearing advanced intracerebral F 98 tumors after glutathione depletion and microbeam radiation therapy: conclusions from a pilot project. Radiat Oncol 2018; 13:89. [PMID: 29747666 PMCID: PMC5946497 DOI: 10.1186/s13014-018-1038-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/30/2018] [Indexed: 12/24/2022] Open
Abstract
Background Resistance to radiotherapy is frequently encountered in patients with glioblastoma multiforme. It is caused at least partially by the high glutathione content in the tumour tissue. Therefore, the administration of the glutathione synthesis inhibitor Buthionine-SR-Sulfoximine (BSO) should increase survival time. Methods BSO was tested in combination with an experimental synchrotron-based treatment, microbeam radiation therapy (MRT), characterized by spatially and periodically alternating microscopic dose distribution. One hundred thousand F98 glioma cells were injected into the right cerebral hemisphere of adult male Fischer rats to generate an orthotopic small animal model of a highly malignant brain tumour in a very advanced stage. Therapy was scheduled for day 13 after tumour cell implantation. At this time, 12.5% of the animals had already died from their disease. The surviving 24 tumour-bearing animals were randomly distributed in three experimental groups: subjected to MRT alone (Group A), to MRT plus BSO (Group B) and tumour-bearing untreated controls (Group C). Thus, half of the irradiated animals received an injection of 100 μM BSO into the tumour two hours before radiotherapy. Additional tumour-free animals, mirroring the treatment of the tumour-bearing animals, were included in the experiment. MRT was administered in bi-directional mode with arrays of quasi-parallel beams crossing at the tumour location. The width of the microbeams was ≈28 μm with a center-to-center distance of ≈400 μm, a peak dose of 350 Gy, and a valley dose of 9 Gy in the normal tissue and 18 Gy at the tumour location; thus, the peak to valley dose ratio (PVDR) was 31. Results After tumour-cell implantation, otherwise untreated rats had a mean survival time of 15 days. Twenty days after implantation, 62.5% of the animals receiving MRT alone (group A) and 75% of the rats given MRT + BSO (group B) were still alive. Thirty days after implantation, survival was 12.5% in Group A and 62.5% in Group B. There were no survivors on or beyond day 35 in Group A, but 25% were still alive in Group B. Thus, rats which underwent MRT with adjuvant BSO injection experienced the largest survival gain. Conclusions In this pilot project using an orthotopic small animal model of advanced malignant brain tumour, the injection of the glutathione inhibitor BSO with MRT significantly increased mean survival time.
Collapse
Affiliation(s)
- E Schültke
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059, Rostock, Germany.
| | - E Bräuer-Krisch
- European Synchrotron Radiation Facility (ESRF), Grenoble, France
| | | | - H Requardt
- European Synchrotron Radiation Facility (ESRF), Grenoble, France
| | - J A Laissue
- Institute of Anatomy, University of Bern, Bern, Switzerland
| | - G Hildebrandt
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059, Rostock, Germany
| |
Collapse
|
50
|
Barbone GE, Bravin A, Romanelli P, Mittone A, Bucci D, Gaaβ T, Le Duc G, Auweter S, Reiser MF, Kraiger MJ, Hrabě de Angelis M, Battaglia G, Coan P. Micro-imaging of Brain Cancer Radiation Therapy Using Phase-contrast Computed Tomography. Int J Radiat Oncol Biol Phys 2018; 101:965-984. [PMID: 29976510 DOI: 10.1016/j.ijrobp.2018.03.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Experimental neuroimaging provides a wide range of methods for the visualization of brain anatomic morphology down to subcellular detail. Still, each technique-specific detection mechanism presents compromises among the achievable field-of-view size, spatial resolution, and nervous tissue sensitivity, leading to partial sample coverage, unresolved morphologic structures, or sparse labeling of neuronal populations and often also to obligatory sample dissection or other sample invasive manipulations. X-ray phase-contrast imaging computed tomography (PCI-CT) is an experimental imaging method that simultaneously provides micrometric spatial resolution, high soft-tissue sensitivity, and ex vivo full organ rodent brain coverage without any need for sample dissection, staining or labeling, or contrast agent injection. In the present study, we explored the benefits and limitations of PCI-CT use for in vitro imaging of normal and cancerous brain neuromorphology after in vivo treatment with synchrotron-generated x-ray microbeam radiation therapy (MRT), a spatially fractionated experimental high-dose radiosurgery. The goals were visualization of the MRT effects on nervous tissue and a qualitative comparison of the results to the histologic and high-field magnetic resonance imaging findings. METHODS AND MATERIALS MRT was administered in vivo to the brain of both healthy and cancer-bearing rats. At 45 days after treatment, the brain was dissected out and imaged ex vivo using propagation-based PCI-CT. RESULTS PCI-CT visualizes the brain anatomy and microvasculature in 3 dimensions and distinguishes cancerous tissue morphology, necrosis, and intratumor accumulation of iron and calcium deposits. Moreover, PCI-CT detects the effects of MRT throughout the treatment target areas (eg, the formation of micrometer-thick radiation-induced tissue ablation). The observed neurostructures were confirmed by histologic and immunohistochemistry examination and related to the micro-magnetic resonance imaging data. CONCLUSIONS PCI-CT enabled a unique 3D neuroimaging approach for ex vivo studies on small animal models in that it concurrently delivers high-resolution insight of local brain tissue morphology in both normal and cancerous micro-milieu, localizes radiosurgical damage, and highlights the deep microvasculature. This method could assist experimental small animal neurology studies in the postmortem evaluation of neuropathology or treatment effects.
Collapse
Affiliation(s)
- Giacomo E Barbone
- Department of Physics, Ludwig Maximilians University, Garching, Germany
| | - Alberto Bravin
- European Synchrotron Radiation Facility, Grenoble, France
| | | | | | - Domenico Bucci
- Department of Molecular Pathology, Neuropharmacology Section, I.R.C.C.S. Neuromed, Pozzilli, Italy
| | - Thomas Gaaβ
- Department of Clinical Radiology, Ludwig Maximilians University, Munich, Germany
| | | | - Sigrid Auweter
- Department of Clinical Radiology, Ludwig Maximilians University, Munich, Germany
| | - Maximilian F Reiser
- Department of Clinical Radiology, Ludwig Maximilians University, Munich, Germany
| | - Markus J Kraiger
- Institute of Experimental Genetics and German Mouse Clinic, German Research Center for Environmental Health, Neuherberg, Germany
| | - Martin Hrabě de Angelis
- Institute of Experimental Genetics and German Mouse Clinic, German Research Center for Environmental Health, Neuherberg, Germany; Department of Experimental Genetics, School of Life Science Weihenstephan, Technical University of Munich, Freising, Germany; German Center for Diabetes Research, Neuherberg, Germany
| | - Giuseppe Battaglia
- Department of Molecular Pathology, Neuropharmacology Section, I.R.C.C.S. Neuromed, Pozzilli, Italy
| | - Paola Coan
- Department of Physics, Ludwig Maximilians University, Garching, Germany; Department of Clinical Radiology, Ludwig Maximilians University, Munich, Germany.
| |
Collapse
|