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Bortolussi S, Postuma I, Protti N, Provenzano L, Ferrari C, Cansolino L, Dionigi P, Galasso O, Gasparini G, Altieri S, Miyatake SI, González SJ. Understanding the potentiality of accelerator based-boron neutron capture therapy for osteosarcoma: dosimetry assessment based on the reported clinical experience. Radiat Oncol 2017; 12:130. [PMID: 28806981 PMCID: PMC5557419 DOI: 10.1186/s13014-017-0860-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 07/27/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Osteosarcoma is the most frequent primary malignant bone tumour, and its incidence is higher in children and adolescents, for whom it represents more than 10% of solid cancers. Despite the introduction of adjuvant and neo-adjuvant chemotherapy that markedly increased the success rate in the treatment, aggressive surgery is still needed and a considerable percentage of patients do not survive due to recurrences or early metastases. Boron Neutron Capture Therapy (BNCT), an experimental radiotherapy, was investigated as a treatment that could allow a less aggressive surgery by killing infiltrated tumour cells in the surrounding healthy tissues. BNCT requires an intense neutron beam to ensure irradiation times of the order of 1 h. In Italy, a Radio Frequency Quadrupole (RFQ) proton accelerator has been designed and constructed for BNCT, and a suitable neutron spectrum was tailored by means of Monte Carlo calculations. This paper explores the feasibility of BNCT to treat osteosarcoma using this neutron source based on accelerator. METHODS The therapeutic efficacy of BNCT was analysed evaluating the dose distribution obtained in a clinical case of femur osteosarcoma. Mixed field dosimetry was assessed with two different formalisms whose parameters were specifically derived from radiobiological experiments involving in vitro UMR-106 osteosarcoma cell survival assays and boron concentration assessments in an animal model of osteosarcoma. A clinical case of skull osteosarcoma treated with BNCT in Japan was re-evaluated from the point of view of dose calculation and used as a reference for comparison. RESULTS The results in the case of femur osteosarcoma show that the RFQ beam would ensure a suitable tumour dose painting in a total irradiation time of less than an hour. Comparing the dosimetry between the analysed case and the treated patient in Japan it turns out that doses obtained in the femur tumour are at least as good as the ones delivered in the skull osteosarcoma. The same is concluded when the comparison is carried out taking into account osteosarcoma irradiations with photon radiation therapy. CONCLUSIONS The possibility to apply BNCT to osteosarcoma would allow a multimodal treatment consisting in neo-adjuvant chemotherapy, high-LET selective radiation treatment and a more conservative surgery.
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Affiliation(s)
- Silva Bortolussi
- Department of Physics, University of Pavia, via A. Bassi 6, 27100 Pavia, Italy
- National Institute of Nuclear Physics (INFN), Unit of Pavia, via Bassi 6, 27100 Pavia, Italy
| | - Ian Postuma
- National Institute of Nuclear Physics (INFN), Unit of Pavia, via Bassi 6, 27100 Pavia, Italy
| | - Nicoletta Protti
- National Institute of Nuclear Physics (INFN), Unit of Pavia, via Bassi 6, 27100 Pavia, Italy
| | - Lucas Provenzano
- National Atomic Energy Commission (CNEA), Av. General Paz, 1499 Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Av. Godoy Cruz, 2290 Buenos Aires, Argentina
| | - Cinzia Ferrari
- National Institute of Nuclear Physics (INFN), Unit of Pavia, via Bassi 6, 27100 Pavia, Italy
- Department of Clinic-Surgical Sciences, Experimental Surgery Laboratory, University of Pavia, via Ferrata 9, 27100 Pavia, Italy
| | - Laura Cansolino
- Department of Clinic-Surgical Sciences, Experimental Surgery Laboratory, University of Pavia, via Ferrata 9, 27100 Pavia, Italy
- Polyclinic S. Matteo Foundation, Viale Golgi 19, 27100 Pavia, Italy
| | - Paolo Dionigi
- Department of Clinic-Surgical Sciences, Experimental Surgery Laboratory, University of Pavia, via Ferrata 9, 27100 Pavia, Italy
- Polyclinic S. Matteo Foundation, Viale Golgi 19, 27100 Pavia, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Ortopaedic Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Ortopaedic Surgery, University of Catanzaro, Catanzaro, Italy
| | - Saverio Altieri
- Department of Physics, University of Pavia, via A. Bassi 6, 27100 Pavia, Italy
- National Institute of Nuclear Physics (INFN), Unit of Pavia, via Bassi 6, 27100 Pavia, Italy
| | | | - Sara J. González
- National Atomic Energy Commission (CNEA), Av. General Paz, 1499 Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Av. Godoy Cruz, 2290 Buenos Aires, Argentina
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Evans JD, Gomez DR, Amini A, Rebueno N, Allen PK, Martel MK, Rineer JM, Ang KK, McAvoy S, Cox JD, Komaki R, Welsh JW. Aortic dose constraints when reirradiating thoracic tumors. Radiother Oncol 2013; 106:327-32. [PMID: 23453540 DOI: 10.1016/j.radonc.2013.02.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/30/2013] [Accepted: 02/09/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Improved radiation delivery and planning has allowed, in some instances, for the retreatment of thoracic tumors. We investigated the dose limits of the aorta wherein grade 5 aortic toxicity was observed after reirradiation of lung tumors. MATERIAL AND METHODS In a retrospective analysis, 35 patients were identified, between 1993 and 2008, who received two rounds of external beam irradiation that included the aorta in the radiation fields of both the initial and retreatment plans. We determined the maximum cumulative dose to 1 cm(3) of the aorta (the composite dose) for each patient, normalized these doses to 1.8 Gy/fraction, and corrected them for long-term tissue recovery between treatments (NIDR). RESULTS The median time interval between treatments was 30 months (range, 1-185 months). The median follow-up of patients alive at analysis was 42 months (range, 14-70 months). Two of the 35 patients (6%) were identified as having grade 5 aortic toxicities. There was a 25% rate of grade 5 aortic toxicity for patients receiving composite doses ≥120.0 Gy (vs. 0% for patients receiving <120.0 Gy) (P=0.047). CONCLUSIONS Grade 5 aortic toxicities were observed with composite doses ≥120.0 Gy (NIDR ≥90.0 Gy) to 1cm(3) of the aorta.
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Affiliation(s)
- Jaden D Evans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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Trombetta MG, Colonias A, Makishi D, Keenan R, Werts ED, Landreneau R, Parda DS. Tolerance of the aorta using intraoperative iodine-125 interstitial brachytherapy in cancer of the lung. Brachytherapy 2008; 7:50-4. [DOI: 10.1016/j.brachy.2007.11.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 10/07/2007] [Accepted: 11/08/2007] [Indexed: 12/25/2022]
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Leter EM, Schuurbiers JCH, Nowak PJCM, Levendag PC, Wentzel JJ, Pattynama PMT, de Feyter PJ, Serruys PW, Slager CJ. A biplane angiographic study on cardiac motion of coronary artery stents: options to minimize the target volume for high-precision external beam radiotherapy of coronary artery in-stent restenosis. Int J Radiat Oncol Biol Phys 2004; 58:278-83. [PMID: 14697449 DOI: 10.1016/j.ijrobp.2003.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE High-precision external beam radiotherapy (EBRT) has been suggested as a potential alternative to endovascular brachytherapy for the treatment of coronary artery in-stent restenosis. The purpose of our study was to investigate and compare different options to define a smallest feasible target volume. METHODS AND MATERIALS The cardiac motion of 17 coronary artery stents in 17 patients was studied by use of biplane conventional angiography, recorded during breath-hold. Each stent was reconstructed in three dimensions by use of biplane sets of frames covering an entire cardiac cycle. The volume traversed by the stent during the entire or part of the cardiac cycle was determined. Four options to define the stent-traversed volume (STV) as a target for high-precision EBRT were investigated. RESULTS The mean STV during the entire cardiac cycle was 3.5 cm3; the STV represented less than 1% of the heart volume in all patients. The STV during the diastolic and systolic phase resulted in a mean reduction of 26.6% and 29.1%, respectively, compared with the STV during the entire cardiac cycle. The smallest STV, measured during a 160-ms interval within the cardiac cycle, resulted in a mean maximal reduction of 75.9% compared with the STV during the entire cardiac cycle. CONCLUSIONS The STV during the entire cardiac cycle represents a small potential target volume for high-precision EBRT. A significant reduction of this target volume is possible in case of definition during a selected interval within the cardiac cycle.
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Affiliation(s)
- Edward M Leter
- Department of Radiotherapy, Erasmus MC, Rotterdam, The Netherlands.
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Kalef-Ezra J, Michalis LK, Malamou-Mitsi V, Tsekeris P, Katsouras C, Boziari A, Toumpoulis I, Bozios G, Charchanti A, Sideris DA. External beam irradiation in angioplasted arteries of hypercholesterolemic rabbits. The dose and time effect. CARDIOVASCULAR RADIATION MEDICINE 2002; 3:20-5. [PMID: 12479912 DOI: 10.1016/s1522-1865(02)00143-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the dose and time effect of external beam irradiation on the morphometry of both angioplasted and nonangioplasted arteries in a hypercholesterolemic rabbit model. METHODS AND MATERIALS Eight groups of rabbit femoral arteries were studied: arteries (a) with no intervention, (b) irradiated with a 12-Gy 6 MV X-ray dose, (c) with a 18-Gy, (d) treated with balloon angioplasty, (e) dosed with 12-Gy half an hour post-angioplasty, (f) dosed with 18-Gy half an hour post-angioplasty, (g) dosed with 12-Gy 48 h post angioplasty, (g) dosed with 18-Gy 48 h post angioplasty. RESULTS External irradiation at either 12 or 18 Gy was not found to change vessel morphometry in noninjured arteries. The 12-Gy dose given soon after angioplasty further increased percentage stenosis (63% on the average), despite the preservation of the lumen cross-sectional area. Positive remodeling was not observed in arteries given 18-Gy half an hour post angioplasty to counterbalance the increased neointimal formation. Therefore, this treatment resulted in a drastic reduction in lumen area and in enhancement of percentage stenosis (84% on the average). On the contrary, the delayed irradiation of the angioplasted arteries at either 12 or 18 Gy was not found to influence any of the studied morphometric parameters 5 weeks after angioplasty. CONCLUSIONS Uniform external beam irradiation up to 18 Gy was well tolerated by intact femoral arteries. Prompt 12- or 18-Gy irradiations accentuated percentage stenosis. However the lumen cross-sectional area was preserved only at the lower dose point. Delayed irradiation at any dose did not influence the restenosis process.
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Affiliation(s)
- J Kalef-Ezra
- Department of Medical Physics, Medical School, University of Ioannina, 451-10, Ioannina, Greece.
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Illig KA, Williams JP, Lyden SP, Hernady E, Soni A, Davies MG, Schell M, Okunieff P, Rubin P, Green RM. External beam irradiation for inhibition of intimal hyperplasia following prosthetic bypass: preliminary results. Ann Vasc Surg 2001; 15:533-8. [PMID: 11665436 DOI: 10.1007/s10016-001-0004-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To determine whether external beam irradiation delivered immediately after graft implantation can inhibit anastomotic intimal hyperplasia (IH) 1 month following polytetrafluoroethylene (PTFE) bypass in a sheep carotid artery model, 23 sheep underwent bilateral bypass of the ligated common carotid artery with 8-mm PTFE immediately followed by a single dose of irradiation (15, 21, or 30 Gy) to one side. The 15 animals with bilaterally patent grafts were euthanized at 1 month and graft-arterial anastomoses harvested. Using computer-aided image analysis, IH areas and thicknesses were measured. Graft patency in this model was 83% at 1 month and did not differ according to treatment administered. In the control animals, IH was greatest at mid-anastomosis, but minimal within the native vessel. All three radiation doses markedly inhibited mid-anastomotic IH area and thickness. At the proximal anastomosis, 30 Gy reduced the IH area 20-fold, from 2.06 to 0.14 mm2 (p < 0.0001 by ANOVA), and IH thickness 70-fold, from 29.0 to 0.4 micron (p < 0.0002); similar effects were seen at the distal anastomosis. No adverse effects of radiation treatment were observed. External beam irradiation in doses of 15 to 30 Gy delivered in a single fraction immediately after operation markedly inhibits development of intimal hyperplasia 1 month following end-to-side anastomosis with PTFE in sheep.
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Affiliation(s)
- K A Illig
- Division of Vascular Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 652, Rochester, NY 14642, USA.
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Illig KA, Soni A, Williams J, Shortell CK, Green RM. Clinical review: irradiation for lower extremity arterial occlusive disease. CARDIOVASCULAR RADIATION MEDICINE 1999; 1:288-96. [PMID: 11272374 DOI: 10.1016/s1522-1865(99)00017-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Lower extremity atherosclerosis, a disease of aging, is both widespread and increasing in prevalence-it is estimated that almost 100,000 patients per year in the United States require operative bypass for lower extremity ischemia. It is an axiom of vascular surgery that essentially every bypass graft will eventually fail. Many if not most such failures are due to the process of intimal hyperplasia at one or both anastomoses. The search for a "cure" for intimal hyperplasia has been long, but thus far unrewarding. Recent advances in therapeutic irradiation, however, offer a potential solution to this problem. This review is designed to acquaint the radiation oncologist with the basic concepts behind lower extremity atherosclerosis and its treatment, and to introduce briefly the special problems inherent in considering irradiation of an end-to-side anastomosis.
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Affiliation(s)
- K A Illig
- Division of Vascular Surgery, University of Rochester Medical Center, New York 14642, USA.
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