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Juvkam IS, Zlygosteva O, Sitarz M, Sørensen BS, Aass HCD, Edin NJ, Galtung HK, Søland TM, Malinen E. Proton- compared to X-irradiation leads to more acinar atrophy and greater hyposalivation accompanied by a differential cytokine response. Sci Rep 2024; 14:22311. [PMID: 39333378 PMCID: PMC11437014 DOI: 10.1038/s41598-024-73110-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 09/13/2024] [Indexed: 09/29/2024] Open
Abstract
Proton therapy gives less dose to healthy tissue compared to conventional X-ray therapy, but systematic comparisons of normal tissue responses are lacking. The aim of this study was to investigate late tissue responses in the salivary glands following proton- or X-irradiation of the head and neck in mice. Moreover, we aimed at investigating molecular responses by monitoring the cytokine levels in serum and saliva. Female C57BL/6J mice underwent local fractionated irradiation with protons or X-rays to the maximally tolerated acute level. Saliva and serum were collected before and at different time points after irradiation to assess salivary gland function and cytokine expression. To study late responses in the major salivary glands, histological analyses were performed on tissues collected at day 105 after onset of irradiation. Saliva volume after proton and X-irradiation was significantly lower than for controls and remained reduced at all time points after irradiation. Protons caused reduced saliva production and fewer acinar cells in the submandibular glands compared to X-rays at day 105. X-rays induced a stronger inflammatory cytokine response in saliva compared to protons. This work supports previous preclinical findings and indicate that the relative biological effectiveness of protons in normal tissue might be higher than the commonly used value of 1.1.
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Affiliation(s)
- Inga Solgård Juvkam
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Department of Radiation Biology, Institute of Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Olga Zlygosteva
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Mateusz Sitarz
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Brita Singers Sørensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Christian D Aass
- The Blood Cell Research Group, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Nina Jeppesen Edin
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Hilde Kanli Galtung
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tine Merete Søland
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Eirik Malinen
- Department of Radiation Biology, Institute of Cancer Research, Oslo University Hospital, Oslo, Norway.
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
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2
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Paganetti H, Simone CB, Bosch WR, Haas-Kogan D, Kirsch DG, Li H, Liang X, Liu W, Mahajan A, Story MD, Taylor PA, Willers H, Xiao Y, Buchsbaum JC. NRG Oncology White Paper on the Relative Biological Effectiveness in Proton Therapy. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)02974-2. [PMID: 39059509 DOI: 10.1016/j.ijrobp.2024.07.2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/17/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024]
Abstract
This position paper, led by the NRG Oncology Particle Therapy Work Group, focuses on the concept of relative biologic effect (RBE) in clinical proton therapy (PT), with the goal of providing recommendations for the next-generation clinical trials with PT on the best practice of investigating and using RBE, which could deviate from the current standard proton RBE value of 1.1 relative to photons. In part 1, current clinical utilization and practice are reviewed, giving the context and history of RBE. Evidence for variation in RBE is presented along with the concept of linear energy transfer (LET). The intertwined nature of tumor radiobiology, normal tissue constraints, and treatment planning with LET and RBE considerations is then reviewed. Part 2 summarizes current and past clinical data and then suggests the next steps to explore and employ tools for improved dynamic models for RBE. In part 3, approaches and methods for the next generation of prospective clinical trials are explored, with the goal of optimizing RBE to be both more reflective of clinical reality and also deployable in trials to allow clinical validation and interpatient comparisons. These concepts provide the foundation for personalized biologic treatments reviewed in part 4. Finally, we conclude with a summary including short- and long-term scientific focus points for clinical PT. The practicalities and capacity to use RBE in treatment planning are reviewed and considered with more biological data in hand. The intermediate step of LET optimization is summarized and proposed as a potential bridge to the ultimate goal of case-specific RBE planning that can be achieved as a hypothesis-generating tool in near-term proton trials.
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Affiliation(s)
- Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Charles B Simone
- New York Proton Center, New York, New York; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Walter R Bosch
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston Children's Hospital, Boston, Massachusetts
| | - David G Kirsch
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Xiaoying Liang
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Michael D Story
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey C Buchsbaum
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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Lyngholm E, Stokkevåg CH, Lühr A, Tian L, Meric I, Tjelta J, Henjum H, Handeland AH, Ytre-Hauge KS. An updated variable RBE model for proton therapy. Phys Med Biol 2024; 69:125025. [PMID: 38527373 DOI: 10.1088/1361-6560/ad3796] [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: 10/17/2023] [Accepted: 03/25/2024] [Indexed: 03/27/2024]
Abstract
Objective.While a constant relative biological effectiveness (RBE) of 1.1 forms the basis for clinical proton therapy, variable RBE models are increasingly being used in plan evaluation. However, there is substantial variation across RBE models, and several newin vitrodatasets have not yet been included in the existing models. In this study, an updatedin vitroproton RBE database was collected and used to examine current RBE model assumptions, and to propose an up-to-date RBE model as a tool for evaluating RBE effects in clinical settings.Approach.A proton database (471 data points) was collected from the literature, almost twice the size of the previously largest model database. Each data point included linear-quadratic model parameters and linear energy transfer (LET). Statistical analyses were performed to test the validity of commonly applied assumptions of phenomenological RBE models, and new model functions were proposed forRBEmaxandRBEmin(RBE at the lower and upper dose limits). Previously published models were refitted to the database and compared to the new model in terms of model performance and RBE estimates.Main results.The statistical analysis indicated that the intercept of theRBEmaxfunction should be a free fitting parameter and RBE estimates were clearly higher for models with free intercept.RBEminincreased with increasing LET, while a dependency ofRBEminon the reference radiation fractionation sensitivity (α/βx) did not significantly improve model performance. Evaluating the models, the new model gave overall lowest RMSE and highest R2 score. RBE estimates in the distal part of a spread-out-Bragg-peak in water (α/βx= 2.1 Gy) were 1.24-1.51 for original models, 1.25-1.49 for refits and 1.42 for the new model.Significance.An updated RBE model based on the currently largest database among published phenomenological models was proposed. Overall, the new model showed better performance compared to refitted published RBE models.
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Affiliation(s)
- Erlend Lyngholm
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - Camilla Hanquist Stokkevåg
- Department of Physics and Technology, University of Bergen, Bergen, Norway
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Armin Lühr
- Department of Physics, TU Dortmund University, Dortmund, Germany
| | - Liheng Tian
- Department of Physics, TU Dortmund University, Dortmund, Germany
| | - Ilker Meric
- Department of Computer Science, Electrical Engineering and Mathematical Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Johannes Tjelta
- Department of Physics and Technology, University of Bergen, Bergen, Norway
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Helge Henjum
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - Andreas Havsgård Handeland
- Department of Physics and Technology, University of Bergen, Bergen, Norway
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
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4
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Denbeigh JM, Howard ME, Garcia DA, Debrot EK, Cole KC, Remmes NB, Beltran CJ. Characterizing Proton-Induced Biological Effects in a Mouse Spinal Cord Model: A Comparison of Bragg Peak and Entrance Beam Response in Single and Fractionated Exposures. Int J Radiat Oncol Biol Phys 2024; 119:924-935. [PMID: 38310485 DOI: 10.1016/j.ijrobp.2023.12.031] [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: 11/06/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Proton relative biological effectiveness (RBE) is a dynamic variable influenced by factors like linear energy transfer (LET), dose, tissue type, and biological endpoint. The standard fixed proton RBE of 1.1, currently used in clinical planning, may not accurately represent the true biological effects of proton therapy (PT) in all cases. This uncertainty can contribute to radiation-induced normal tissue toxicity in patients. In late-responding tissues such as the spinal cord, toxicity can cause devastating complications. This study investigated spinal cord tolerance in mice subjected to proton irradiation and characterized the influence of fractionation on proton- induced myelopathy at entrance (ENT) and Bragg peak (BP) positions. METHODS AND MATERIALS Cervical spinal cords of 8-week-old C57BL/6J female mice were irradiated with single- or multi-fractions (18x) using lateral opposed radiation fields at 1 of 2 positions along the Bragg curve: ENT (dose-mean LET = 1.2 keV/μm) and BP (LET = 6.9 keV/μm). Mice were monitored over 1 year for changes in weight, mobility, and general health, with radiation-induced myelopathy as the primary biological endpoint. Calculations of the RBE of the ENT and BP curve (RBEENT/BP) were performed. RESULTS Single-fraction RBEENT/BP for 50% effect probability (tolerance dose (TD50), grade II paresis, determined using log-logistic model fitting) was 1.10 ± 0.06 (95% CI) and for multifraction treatments it was 1.19 ± 0.05 (95% CI). Higher incidence and faster onset of paralysis were seen in mice treated at the BP compared with ENT. CONCLUSIONS The findings challenge the universally fixed RBE value in PT, indicating up to a 25% mouse spinal cord RBEENT/BP variation for multifraction treatments. These results highlight the importance of considering fractionation in determining RBE for PT. Robust characterization of proton-induced toxicity, aided by in vivo models, is paramount for refining clinical decision-making and mitigating potential patient side effects.
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Affiliation(s)
- Janet M Denbeigh
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
| | - Michelle E Howard
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
| | - Darwin A Garcia
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Emily K Debrot
- St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | - Kristin C Cole
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Chris J Beltran
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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5
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Reaz F, Traneus E, Bassler N. Tuning spatially fractionated radiotherapy dose profiles using the moiré effect. Sci Rep 2024; 14:8468. [PMID: 38605022 PMCID: PMC11009409 DOI: 10.1038/s41598-024-55104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/20/2024] [Indexed: 04/13/2024] Open
Abstract
Spatially Fractionated Radiotherapy (SFRT) has demonstrated promising potential in cancer treatment, combining the advantages of reduced post-radiation effects and enhanced local control rates. Within this paradigm, proton minibeam radiotherapy (pMBRT) was suggested as a new treatment modality, possibly producing superior normal tissue sparing to conventional proton therapy, leading to improvements in patient outcomes. However, an effective and convenient beam generation method for pMBRT, capable of implementing various optimum dose profiles, is essential for its real-world application. Our study investigates the potential of utilizing the moiré effect in a dual collimator system (DCS) to generate pMBRT dose profiles with the flexibility to modify the center-to-center distance (CTC) of the dose distribution in a technically simple way.We employ the Geant4 Monte Carlo simulations tool to demonstrate that the angle between the two collimators of a DCS can significantly impact the dose profile. Varying the DCS angle from 10∘ to 50∘ we could cover CTC ranging from 11.8 mm to 2.4 mm, respectively. Further investigations reveal the substantial influence of the multi-slit collimator's (MSC) physical parameters on the spatially fractionated dose profile, such as period (CTC), throughput, and spacing between MSCs. These findings highlight opportunities for precision dose profile adjustments tailored to specific clinical scenarios.The DCS capacity for rapid angle adjustments during the energy transition stages of a spot scanning system can facilitate dynamic alterations in the irradiation profile, enhancing dose contrast in normal tissues. Furthermore, its unique attribute of spatially fractionated doses in both lateral directions could potentially improve normal tissue sparing by minimizing irradiated volume. Beyond the realm of pMBRT, the dual MSC system exhibits remarkable versatility, showing compatibility with different types of beams (X-rays and electrons) and applicability across various SFRT modalities.Our study illuminates the dual MSC system's potential as an efficient and adaptable tool in the refinement of pMBRT techniques. By enabling meticulous control over irradiation profiles, this system may expedite advancements in clinical and experimental applications, thereby contributing to the evolution of SFRT strategies.
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Affiliation(s)
- Fardous Reaz
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
| | | | - Niels Bassler
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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6
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Kotecha R, La Rosa A, Mehta MP. How proton therapy fits into the management of adult intracranial tumors. Neuro Oncol 2024; 26:S26-S45. [PMID: 38437667 PMCID: PMC10911801 DOI: 10.1093/neuonc/noad183] [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] [Indexed: 03/06/2024] Open
Abstract
Intracranial tumors include a challenging array of primary and secondary parenchymal and extra-axial tumors which cause neurologic morbidity consequential to location, disease extent, and proximity to critical neurologic structures. Radiotherapy can be used in the definitive, adjuvant, or salvage setting either with curative or palliative intent. Proton therapy (PT) is a promising advance due to dosimetric advantages compared to conventional photon radiotherapy with regards to normal tissue sparing, as well as distinct physical properties, which yield radiobiologic benefits. In this review, the principles of efficacy and safety of PT for a variety of intracranial tumors are discussed, drawing upon case series, retrospective and prospective cohort studies, and randomized clinical trials. This manuscript explores the potential advantages of PT, including reduced acute and late treatment-related side effects and improved quality of life. The objective is to provide a comprehensive review of the current evidence and clinical outcomes of PT. Given the lack of consensus and directives for its utilization in patients with intracranial tumors, we aim to provide a guide for its judicious use in clinical practice.
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Affiliation(s)
- Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
- Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
- Department of Translational Medicine, Hebert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Alonso La Rosa
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
- Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
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7
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Selva A, Bianchi A, Cirrone GAP, Petringa G, Romano F, Schettino G, Conte V. Sensitivity of a mini-TEPC to radiation quality variations in clinical proton beams. Phys Med 2024; 118:103201. [PMID: 38199179 DOI: 10.1016/j.ejmp.2023.103201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/30/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE This work aims at studying the sensitivity of a miniaturized Tissue-Equivalent Proportional Counter to variations of beam quality in clinical radiation fields, to further investigate its performances as radiation quality monitor. METHODS Measurements were taken at the CATANA facility (INFN-LNS, Catania, Italy), in a monoenergetic and an energy-modulated proton beam with the same initial energy of 62 MeV. PMMA layers were placed in front of the detector to measure at different depths along the depth-dose profile. The frequency- and dose-mean lineal energy were compared to the track- and dose-averaged LET calculated by Monte Carlo simulations. A microdosimetric evaluation of the Relative Biological Effectiveness (RBE) was performed and compared with cell survival experiments. RESULTS Microdosimetric distributions measured at identical depths in the two beams show spectral differences reflecting their different radiation quality. Discrepancies are most evident at depths corresponding to the Spread-Out Bragg Peak, while spectra at the entrance and in the dose fall-off regions are similar. This can be explained by the different energy components that compose the pristine and spread-out peaks at each depth. The trend of microdosimetric mean values matches that of calculated LET averages along the entire penetration depth, and the microdosimetric estimation of RBE is consistent with radiobiological data not only at 2 Gy but also at lower dose levels, such as those absorbed by healthy tissues. CONCLUSIONS The mini-TEPC is sensitive to differences in radiation quality resulting from different modulations of the proton beam, confirming its potential for beam quality monitoring in proton therapy.
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Affiliation(s)
- A Selva
- INFN Laboratori Nazionali di Legnaro, Legnaro, Italy.
| | - A Bianchi
- INFN Laboratori Nazionali di Legnaro, Legnaro, Italy
| | | | - G Petringa
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - F Romano
- INFN Sezione di Catania, Catania, Italy
| | - G Schettino
- National Physical Laboratory, Medical Radiation Science, Teddington, UK
| | - V Conte
- INFN Laboratori Nazionali di Legnaro, Legnaro, Italy
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Juvkam IS, Zlygosteva O, Sitarz M, Thiede B, Sørensen BS, Malinen E, Edin NJ, Søland TM, Galtung HK. Proton Compared to X-Irradiation Induces Different Protein Profiles in Oral Cancer Cells and Their Derived Extracellular Vesicles. Int J Mol Sci 2023; 24:16983. [PMID: 38069306 PMCID: PMC10707519 DOI: 10.3390/ijms242316983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
Extracellular vesicles (EVs) are membrane-bound particles released from cells, and their cargo can alter the function of recipient cells. EVs from X-irradiated cells have been shown to play a likely role in non-targeted effects. However, EVs derived from proton irradiated cells have not yet been studied. We aimed to investigate the proteome of EVs and their cell of origin after proton or X-irradiation. The EVs were derived from a human oral squamous cell carcinoma (OSCC) cell line exposed to 0, 4, or 8 Gy from either protons or X-rays. The EVs and irradiated OSCC cells underwent liquid chromatography-mass spectrometry for protein identification. Interestingly, we found different protein profiles both in the EVs and in the OSCC cells after proton irradiation compared to X-irradiation. In the EVs, we found that protons cause a downregulation of proteins involved in cell growth and DNA damage response compared to X-rays. In the OSCC cells, proton and X-irradiation induced dissimilar cell death pathways and distinct DNA damage repair systems. These results are of potential importance for understanding how non-targeted effects in normal tissue can be limited and for future implementation of proton therapy in the clinic.
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Affiliation(s)
- Inga Solgård Juvkam
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, 0372 Oslo, Norway; (I.S.J.); (T.M.S.)
- Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, 0379 Oslo, Norway;
| | - Olga Zlygosteva
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Oslo, 0371 Oslo, Norway; (O.Z.); (N.J.E.)
| | - Mateusz Sitarz
- Danish Centre for Particle Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark; (M.S.); (B.S.S.)
| | - Bernd Thiede
- Department of Biosciences, Faculty of Mathematics and Natural Sciences, University of Oslo, 0371 Oslo, Norway;
| | - Brita Singers Sørensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark; (M.S.); (B.S.S.)
- Department of Experimental Clinical Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Eirik Malinen
- Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, 0379 Oslo, Norway;
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Oslo, 0371 Oslo, Norway; (O.Z.); (N.J.E.)
| | - Nina Jeppesen Edin
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Oslo, 0371 Oslo, Norway; (O.Z.); (N.J.E.)
| | - Tine Merete Søland
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, 0372 Oslo, Norway; (I.S.J.); (T.M.S.)
- Department of Pathology, Oslo University Hospital, 0372 Oslo, Norway
| | - Hilde Kanli Galtung
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, 0372 Oslo, Norway; (I.S.J.); (T.M.S.)
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9
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Kneepkens E, Wolfs C, Wanders RG, Traneus E, Eekers D, Verhaegen F. Shoot-through proton FLASH irradiation lowers linear energy transfer in organs at risk for neurological tumors and is robust against density variations. Phys Med Biol 2023; 68:215020. [PMID: 37820687 DOI: 10.1088/1361-6560/ad0280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023]
Abstract
Objective. The goal of the study was to test the hypothesis that shoot-through FLASH proton beams would lead to lower dose-averaged LET (LETD) values in critical organs, while providing at least equal normal tissue sparing as clinical proton therapy plans.Approach. For five neurological tumor patients, pencil beam scanning (PBS) shoot-through plans were made, using the maximum energy of 227 MeV and assuming a hypothetical FLASH protective factor (FPF) of 1.5. The effect of different FPF ranging from 1.2 to 1.8 on the clinical goals were also considered. LETDwas calculated for the clinical plan and the shoot-through plan, applying a 2 Gy total dose threshold (RayStation 8 A/9B and 9A-IonRPG). Robust evaluation was performed considering density uncertainty (±3% throughout entire volume).Main results.Clinical plans showed large LETDvariations compared to shoot-through plans and the maximum LETDin OAR is 1.2-8 times lower for the latter. Although less conformal, shoot-through plans met the same clinical goals as the clinical plans, for FLASH protection factors above 1.4. The FLASH shoot-through plans were more robust to density uncertainties with a maximum OAR D2%increase of 0.6 Gy versus 5.7 Gy in the clinical plans.Significance.Shoot-through proton FLASH beams avoid uncertainties in LETDdistributions and proton range, provide adequate target coverage, meet planning constraints and are robust to density variations.
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Affiliation(s)
- Esther Kneepkens
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Cecile Wolfs
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Roel-Germ Wanders
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Erik Traneus
- RaySearch Laboratories AB, SE-103 65, Stockholm, Sweden
| | - Danielle Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
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10
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Overgaard CB, Reaz F, Sitarz M, Poulsen P, Overgaard J, Bassler N, Grau C, Sørensen BS. An experimental setup for proton irradiation of a murine leg model for radiobiological studies. Acta Oncol 2023; 62:1566-1573. [PMID: 37603112 DOI: 10.1080/0284186x.2023.2246641] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND The purpose of this study was to introduce an experimental radiobiological setup used for in vivo irradiation of a mouse leg target in multiple positions along a proton beam path to investigate normal tissue- and tumor models with varying linear energy transfer (LET). We describe the dosimetric characterizations and an acute- and late-effect assay for normal tissue damage. METHODS The experimental setup consists of a water phantom that allows the right hind leg of three to five mice to be irradiated at the same time. Absolute dosimetry using a thimble (Semiflex) and a plane parallel (Advanced Markus) ionization chamber and Monte Carlo simulations using Geant4 and SHIELD-HIT12A were applied for dosimetric validation of positioning along the spread-out Bragg peak (SOBP) and at the distal edge and dose fall-off. The mice were irradiated in the center of the SOBP delivered by a pencil beam scanning system. The SOBP was 2.8 cm wide, centered at 6.9 cm depth, with planned physical single doses from 22 to 46 Gy. The biological endpoint was acute skin damage and radiation-induced late damage (RILD) assessed in the mouse leg. RESULTS The dose-response curves illustrate the percentage of mice exhibiting acute skin damage, and at a later point, RILD as a function of physical doses (Gy). Each dose-response curve represents a specific severity score of each assay, demonstrating a higher ED50 (50% responders) as the score increases. Moreover, the results reveal the reversible nature of acute skin damage as a function of time and the irreversible nature of RILD as time progresses. CONCLUSIONS We want to encourage researchers to report all experimental details of their radiobiological setups, including experimental protocols and model descriptions, to facilitate transparency and reproducibility. Based on this study, more experiments are being performed to explore all possibilities this radiobiological experimental setup permits.
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Affiliation(s)
- Cathrine Bang Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Fardous Reaz
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Mateusz Sitarz
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Per Poulsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Niels Bassler
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Cai Grau
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Brita Singers Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
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11
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Nielsen S, Sitarz MK, Sinha PM, Folefac CA, Høyer M, Sørensen BS, Horsman MR. Using immunotherapy to enhance the response of a C3H mammary carcinoma to proton radiation. Acta Oncol 2023; 62:1581-1586. [PMID: 37498559 DOI: 10.1080/0284186x.2023.2238550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The benefit of combining immunotherapy with photon irradiation has been shown pre-clinically and clinically. This current pre-clinical study was designed to investigate the anti-tumour action of combining immunotherapy with protons. MATERIALS AND METHODS Male CDF1 mice, with a C3H mammary carcinoma inoculated on the right rear foot, were locally irradiated with single radiation doses when tumours reached 200mm3. Radiation was delivered with an 83-107MeV pencil scanning proton beam in the centre of a 3 cm spread out Bragg peak. Following irradiation (day 0), mice were injected intraperitoneal with anti-CTLA-4, anti-PD-1, or anti-PD-L1 (10 mg/kg) twice weekly for two weeks. Endpoints were tumour growth time (TGT3; time to reach 3 times treatment volume) or local tumour control (percent of mice showing tumour control at 90 days). A Student's T-test (tumour growth) or Chi-squared test (tumour control) were used for statistical analysis; significance levels of p < 0.05. RESULTS Untreated tumours had a mean (± 1 S.E.) TGT3 of 4.6 days (± 0.4). None of the checkpoint inhibitors changed this TGT3. A linear increase in TGT3 was seen with increasing radiation doses (5-20 Gy), reaching 17.2 days (± 0.7) with 20 Gy. Anti-CTLA-4 had no effect on radiation doses up to 15 Gy, but significantly enhanced 20 Gy; the TGT3 being 23.0 days (± 1.3). Higher radiation doses (35-60 Gy) were investigated using a tumour control assay. Logit analysis of the dose response curve, resulted in a TCD50 value (radiation dose causing 50% tumour control; with 95% confidence intervals) of 48 Gy (44-53) for radiation only. This significantly decreased to 43 Gy (38-49) when mice were treated with anti-CTLA-4. Neither anti-PD-1 nor anti-PD-L1 significantly affected tumour control. CONCLUSION Checkpoint inhibitors enhanced the response of this C3H mammary carcinoma to proton irradiation. However, this enhancement depended on the checkpoint inhibitor and radiation dose.
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Affiliation(s)
- Steffen Nielsen
- Experimental Clinical Oncology-Dept. Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mateusz K Sitarz
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Priyanshu M Sinha
- Experimental Clinical Oncology-Dept. Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlemagne A Folefac
- Experimental Clinical Oncology-Dept. Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Brita S Sørensen
- Experimental Clinical Oncology-Dept. Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Michael R Horsman
- Experimental Clinical Oncology-Dept. Oncology, Aarhus University Hospital, Aarhus, Denmark
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12
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Reaz F, Sitarz MK, Traneus E, Bassler N. Parameters for proton minibeam radiotherapy using a clinical scanning beam system. Acta Oncol 2023; 62:1561-1565. [PMID: 37837215 DOI: 10.1080/0284186x.2023.2266125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Fardous Reaz
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Niels Bassler
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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13
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Zlygosteva O, Juvkam IS, Arous D, Sitarz M, Sørensen BS, Ankjærgaard C, Andersen CE, Galtung HK, Søland TM, Edin NJ, Malinen E. Acute normal tissue responses in a murine model following fractionated irradiation of the head and neck with protons or X-rays. Acta Oncol 2023; 62:1574-1580. [PMID: 37703217 DOI: 10.1080/0284186x.2023.2254481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND The purpose of this study was to investigate acute normal tissue responses in the head and neck region following proton- or X-irradiation of a murine model. MATERIALS AND METHODS Female C57BL/6J mice were irradiated with protons (25 or 60 MeV) or X-rays (100 kV). The radiation field covered the oral cavity and the major salivary glands. For protons, two different treatment plans were used, either with the Bragg Peak in the middle of the mouse (BP) or outside the mouse (transmission mode; TM). Delivered physical doses were 41, 45, and 65 Gy given in 6, 7, and 10 fractions for BP, TM, and X-rays, respectively. Alanine dosimetry was used to assess delivered doses. Oral mucositis and dermatitis were scored using CTC v.2.0-based tables. Saliva was collected at baseline, right after end of irradiation, and at day 35. RESULTS The measured dose distribution for protons (TM) and X-rays was very similar. Oral mucositis appeared earlier, had a higher score and was found in a higher percentage of mice after proton irradiation compared to X-irradiation. Dermatitis, on the other hand, had a similar appearance after protons and X-rays. Compared to controls, saliva production was lower right after termination of proton- and X-irradiation. The BP group demonstrated saliva recovery compared to the TM and X-ray group at day 35. CONCLUSION With lower delivered doses, proton irradiation resulted in similar skin reactions and increased oral mucositis compared to X-irradiation. This indicates that the relative biological effectiveness of protons for acute tissue responses in the mouse head and neck is greater than the clinical standard of 1.1. Thus, there is a need for further investigations of the biological effect of protons in normal tissues.
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Affiliation(s)
- Olga Zlygosteva
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Inga Solgård Juvkam
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Delmon Arous
- Department of Medical Physics, Cancer Clinic, Oslo University Hospital, Oslo, Norway
| | - Mateusz Sitarz
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Brita Singers Sørensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Claus E Andersen
- Department of Health Technology, Technical University of Denmark, Roskilde, Denmark
| | - Hilde Kanli Galtung
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tine Merete Søland
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Nina Jeppesen Edin
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Eirik Malinen
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Department of Medical Physics, Cancer Clinic, Oslo University Hospital, Oslo, Norway
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14
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Bianchi A, Selva A, Rossignoli M, Pasquato F, Missiaggia M, La Tessa C, Scifoni E, Tommasino F, Conte V. Microdosimetric analysis of the radiation quality of two different proton beams in the distal edge of the depth-dose profile. RADIATION PROTECTION DOSIMETRY 2023; 199:1979-1983. [PMID: 37819318 DOI: 10.1093/rpd/ncac236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 10/13/2023]
Abstract
Proton-therapy exploits the advantageous depth-dose profile of protons to induce the highest damage to tumoral cells in the last millimetres of their range in sharp Bragg Peak. To cover the whole tumoral volume, beams of different energies are combined to create the Spread Out Bragg Peak (SOBP). In passive modulated beams, the energy spread is created with modulators in which the highest energy beam is degraded through different thicknesses of calibrated plastic materials. The highest energy is chosen depending on the deepest point that needs to be treated. This study aims to investigate differences in the radiation quality in the distal edge of SOBP beams with different initial energy and modulation techniques based on microdosimetric measurements with mini Tissue-Equivalent Proportional Counters. The beams investigated are the 62 MeV proton SOBP of the clinical facility of CATANA and the 148 MeV proton SOBP of the research beam line of the proton-therapy centre of Trento.
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Affiliation(s)
- A Bianchi
- INFN-Laboratori Nazionali di Legnaro, 35020 Legnaro, Italy
| | - A Selva
- INFN-Laboratori Nazionali di Legnaro, 35020 Legnaro, Italy
| | - M Rossignoli
- INFN-Laboratori Nazionali di Legnaro, 35020 Legnaro, Italy
| | - F Pasquato
- INFN-Laboratori Nazionali di Legnaro, 35020 Legnaro, Italy
| | - M Missiaggia
- University of Trento, Dipartimento di Fisica, 38123 Povo Trento, Italy
- Trento Institute of Fundamental Physics and Applications, 38123 Povo Trento, Italy
| | - C La Tessa
- University of Trento, Dipartimento di Fisica, 38123 Povo Trento, Italy
- Trento Institute of Fundamental Physics and Applications, 38123 Povo Trento, Italy
| | - E Scifoni
- Trento Institute of Fundamental Physics and Applications, 38123 Povo Trento, Italy
| | - F Tommasino
- University of Trento, Dipartimento di Fisica, 38123 Povo Trento, Italy
- Trento Institute of Fundamental Physics and Applications, 38123 Povo Trento, Italy
| | - V Conte
- INFN-Laboratori Nazionali di Legnaro, 35020 Legnaro, Italy
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15
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Bianchi A, Agosteo S, Bortot D, Cirrone GAP, Colautti P, La Tessa C, Mazzucconi D, Missiaggia M, Petringa G, Rosenfeld AB, Selva A, Tran L, Verona C, Verona Rinati G, Conte V. Microdosimetry of a 62-MeV clinical proton beam with five detectors. RADIATION PROTECTION DOSIMETRY 2023; 199:1968-1972. [PMID: 37819306 DOI: 10.1093/rpd/ncac231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 10/13/2023]
Abstract
In proton therapy, most treatment planning systems (TPS) use a fixed relative biological effectiveness (RBE) of 1.1 all along the depth-dose profile. Innovative TPS are now investigated considering the variability of RBE with radiation quality. New TPS need an experimental verification in the quality assurance (QA) routine in clinics, but RBE data are usually obtained with radiobiological measurements that are time consuming and not suitable for daily QA. Microdosimetry is a useful tool based on physical measurements which can monitor the radiation quality. Several microdosimeters are available in different research institutions, which could potentially be used for the QA in TPS. In this study, the response functions of five detectors in the same 62-MeV proton Spread Out Bragg Peak is compared in terms of spectral distributions and their average values and microdosimetric RBE. Their different response function has been commented and must be considered in the clinical practice.
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Affiliation(s)
- A Bianchi
- INFN-Laboratori Nazionali di Legnaro, 35020 Legnaro, Italy
| | - S Agosteo
- Politecnico di Milano, Dipartimento di Energia, 20156 Milano, Italy
- INFN-Milano, 20133 Milano, Italy
| | - D Bortot
- Politecnico di Milano, Dipartimento di Energia, 20156 Milano, Italy
- INFN-Milano, 20133 Milano, Italy
| | - G A P Cirrone
- INFN-Laboratori Nazionali del Sud, 95125 Catania, Italy
| | - P Colautti
- INFN-Laboratori Nazionali di Legnaro, 35020 Legnaro, Italy
| | - C La Tessa
- University of Trento, Dipartimento di Fisica, 38123 Povo, Trento, Italy
- Trento Institute of Fundamental Physics and Applications, 38123 Povo, Trento, Italy
| | - D Mazzucconi
- Politecnico di Milano, Dipartimento di Energia, 20156 Milano, Italy
- INFN-Milano, 20133 Milano, Italy
| | - M Missiaggia
- University of Trento, Dipartimento di Fisica, 38123 Povo, Trento, Italy
- Trento Institute of Fundamental Physics and Applications, 38123 Povo, Trento, Italy
| | - G Petringa
- INFN-Laboratori Nazionali del Sud, 95125 Catania, Italy
- ELI Beamlines Center, Institute of Physics, Czech Academy of Sciences, 252 41 Dolní Břežany, Czech Republic
| | - A B Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, 2522 Wollongong, Australia
| | - A Selva
- INFN-Laboratori Nazionali di Legnaro, 35020 Legnaro, Italy
| | - L Tran
- Centre for Medical Radiation Physics, University of Wollongong, 2522 Wollongong, Australia
| | - C Verona
- INFN-Roma2, Dipartimento di Ingegneria Industriale, Università di Roma "Tor Vergata", 00133 Roma, Italy
| | - G Verona Rinati
- INFN-Roma2, Dipartimento di Ingegneria Industriale, Università di Roma "Tor Vergata", 00133 Roma, Italy
| | - V Conte
- INFN-Laboratori Nazionali di Legnaro, 35020 Legnaro, Italy
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16
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Sioen S, Vanhove O, Vanderstraeten B, De Wagter C, Engelbrecht M, Vandevoorde C, De Kock E, Van Goethem MJ, Vral A, Baeyens A. Impact of proton therapy on the DNA damage induction and repair in hematopoietic stem and progenitor cells. Sci Rep 2023; 13:16995. [PMID: 37813904 PMCID: PMC10562436 DOI: 10.1038/s41598-023-42362-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/08/2023] [Indexed: 10/11/2023] Open
Abstract
Proton therapy is of great interest to pediatric cancer patients because of its optimal depth dose distribution. In view of healthy tissue damage and the increased risk of secondary cancers, we investigated DNA damage induction and repair of radiosensitive hematopoietic stem and progenitor cells (HSPCs) exposed to therapeutic proton and photon irradiation due to their role in radiation-induced leukemia. Human CD34+ HSPCs were exposed to 6 MV X-rays, mid- and distal spread-out Bragg peak (SOBP) protons at doses ranging from 0.5 to 2 Gy. Persistent chromosomal damage was assessed with the micronucleus assay, while DNA damage induction and repair were analyzed with the γ-H2AX foci assay. No differences were found in induction and disappearance of γ-H2AX foci between 6 MV X-rays, mid- and distal SOBP protons at 1 Gy. A significantly higher number of micronuclei was found for distal SOBP protons compared to 6 MV X-rays and mid- SOBP protons at 0.5 and 1 Gy, while no significant differences in micronuclei were found at 2 Gy. In HSPCs, mid-SOBP protons are as damaging as conventional X-rays. Distal SOBP protons showed a higher number of micronuclei in HSPCs depending on the radiation dose, indicating possible changes of the in vivo biological response.
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Affiliation(s)
- Simon Sioen
- Radiobiology, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Oniecha Vanhove
- Radiobiology, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Barbara Vanderstraeten
- Medical Physics, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent, Belgium
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Carlos De Wagter
- Medical Physics, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent, Belgium
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Monique Engelbrecht
- Separated Sector Cyclotron Laboratory, Radiation Biophysics Division, iThemba LABS (NRF), Cape Town, 7131, South Africa
| | - Charlot Vandevoorde
- Separated Sector Cyclotron Laboratory, Radiation Biophysics Division, iThemba LABS (NRF), Cape Town, 7131, South Africa
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Evan De Kock
- Separated Sector Cyclotron Laboratory, Radiation Biophysics Division, iThemba LABS (NRF), Cape Town, 7131, South Africa
| | - Marc-Jan Van Goethem
- Department of Radiation Oncology and Particle Therapy Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne Vral
- Radiobiology, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Ans Baeyens
- Radiobiology, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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17
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Sebastián SM, Alejandro C, Ignacio E, Sophia G, Pía VM, Andrea R. Monte Carlo simulations of cell survival in proton SOBP. Phys Med Biol 2023; 68:195024. [PMID: 37673077 DOI: 10.1088/1361-6560/acf752] [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: 06/28/2023] [Accepted: 09/06/2023] [Indexed: 09/08/2023]
Abstract
Objective. The objective of this study is to develop a multi-scale modeling approach that accurately predicts radiation-induced DNA damage and survival fraction in specific cell lines.Approach. A Monte Carlo based simulation framework was employed to make the predictions. The FLUKA Monte Carlo code was utilized to estimate absorbed doses and fluence energy spectra, which were then used in the Monte Carlo Damage Simulation code to compute DNA damage yields in Chinese hamster V79 cell lines. The outputs were converted into cell survival fractions using a previously published theoretical model. To reduce the uncertainties of the predictions, new values for the parameters of the theoretical model were computed, expanding the database of experimental points considered in the previous estimation. Simulated results were validated against experimental data, confirming the applicability of the framework for proton beams up to 230 MeV. Additionally, the impact of secondary particles on cell survival was estimated.Main results. The simulated survival fraction versus depth in a glycerol phantom is reported for eighteen different configurations. Two proton spread out Bragg peaks at several doses were simulated and compared with experimental data. In all cases, the simulations follow the experimental trends, demonstrating the accuracy of the predictions up to 230 MeV.Significance. This study holds significant importance as it contributes to the advancement of models for predicting biological responses to radiation, ultimately contributing to more effective cancer treatment in proton therapy.
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Affiliation(s)
| | - Carabe Alejandro
- Hampton University Proton Therapy Institute, 40 Enterprise Pkwy Hampton, VA 2366, United States of America
| | - Espinoza Ignacio
- Instituto de Física, Pontificia Universidad Católica de Chile, 7820436 Santiago, Chile
| | - Galvez Sophia
- Instituto de Física, Pontificia Universidad Católica de Chile, 7820436 Santiago, Chile
| | - Valenzuela María Pía
- Instituto de Física, Pontificia Universidad Católica de Chile, 7820436 Santiago, Chile
| | - Russomando Andrea
- Instituto de Física, Pontificia Universidad Católica de Chile, 7820436 Santiago, Chile
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18
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Kong X, Wang Y, Huang J, Zhang W, Du C, Yin Y, Xue H, Gao H, Liu K, Wu T, Sun L. Microdosimetric assessment about proton spread-out Bragg peak at different depths based on the normal human mesh-type cell population model. Phys Med Biol 2023; 68:175010. [PMID: 37578025 DOI: 10.1088/1361-6560/acec2b] [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: 02/09/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Objective.In clinical proton therapy, the spread-out Bragg peak (SOBP) is commonly used to fit the target shape. Dose depositions at microscopic sites vary, even with a consistent absorbed dose (D) in SOBP. In the present study, monolayer mesh-type cell population models were developed for microdosimetric assessment at different SOBP depths.Approach.Normal human bronchial epithelial (BEAS-2B) and hepatocytes (L-O2) mesh-type cell models were constructed based on fluorescence tomography images of normal human cells. Particle transport simulation in cell populations was performed coupled with Monte Carlo software PHITS. The relationship between microdosimetry and macrodosimetry of SOBP at different depths was described by analyzing the microdosimetric indicators such as specific energyz,specific energy distributionfz,D,and relative standard deviationσz/z¯within cells. Additionally, the microdosimetric distributions characteristics and their contributing factors were also discussed.Main results.The microscopic dose distribution is strongly influenced by cellular size, shape, and material. The mean specific energyz¯of nucleus and cytoplasm in the cell population is greater than the overall absorbed dose of the cell population model (Dp), with a maximumz¯/Dpof 1.1. The cellular dose distribution is different between the BEAS-2B mesh-type model and its concentric ellipsoid geometry-type model, which difference inz¯is about 10.3% for the nucleus and about 7.5% for the cytoplasm with the SOBP depth of 15 cm. WhenD= 2 Gy, the maximumzof L-O2 nucleus reaches 2.8 Gy andσz/z¯is 5.1% at the mid-depth SOBP (16-18 cm); while the maximumzof the BEAS-2B nucleus reaches 2.2 Gy with only 2.7% ofσz/z¯.Significance.The significant variation of microdosimetric distributions of SOBP different depths indicates the necessity to use mesh-type cell population models, which have the potential to be compared with biological results and build the bio-physical model.
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Affiliation(s)
- Xianghui Kong
- State Key Laboratory of Radiation Medicine and Protection, Suzhou 215123, People's Republic of China
- School of Radiation Medicine and Protection, Soochow University, Suzhou 215123, People's Republic of China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, People's Republic of China
| | - Yidi Wang
- State Key Laboratory of Radiation Medicine and Protection, Suzhou 215123, People's Republic of China
- School of Radiation Medicine and Protection, Soochow University, Suzhou 215123, People's Republic of China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, People's Republic of China
| | - Jiachen Huang
- State Key Laboratory of Radiation Medicine and Protection, Suzhou 215123, People's Republic of China
- School of Radiation Medicine and Protection, Soochow University, Suzhou 215123, People's Republic of China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, People's Republic of China
| | - Wenyue Zhang
- State Key Laboratory of Radiation Medicine and Protection, Suzhou 215123, People's Republic of China
- School of Radiation Medicine and Protection, Soochow University, Suzhou 215123, People's Republic of China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, People's Republic of China
| | - Chuansheng Du
- State Key Laboratory of Radiation Medicine and Protection, Suzhou 215123, People's Republic of China
- School of Radiation Medicine and Protection, Soochow University, Suzhou 215123, People's Republic of China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, People's Republic of China
| | - Yuchen Yin
- State Key Laboratory of Radiation Medicine and Protection, Suzhou 215123, People's Republic of China
- School of Radiation Medicine and Protection, Soochow University, Suzhou 215123, People's Republic of China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, People's Republic of China
| | - Huiyuan Xue
- State Key Laboratory of Radiation Medicine and Protection, Suzhou 215123, People's Republic of China
- School of Radiation Medicine and Protection, Soochow University, Suzhou 215123, People's Republic of China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, People's Republic of China
| | - Han Gao
- State Key Laboratory of Radiation Medicine and Protection, Suzhou 215123, People's Republic of China
- School of Radiation Medicine and Protection, Soochow University, Suzhou 215123, People's Republic of China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, People's Republic of China
| | - Kun Liu
- State Key Laboratory of Radiation Medicine and Protection, Suzhou 215123, People's Republic of China
- School of Radiation Medicine and Protection, Soochow University, Suzhou 215123, People's Republic of China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, People's Republic of China
| | - Tao Wu
- State Key Laboratory of Radiation Medicine and Protection, Suzhou 215123, People's Republic of China
- School of Radiation Medicine and Protection, Soochow University, Suzhou 215123, People's Republic of China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, People's Republic of China
| | - Liang Sun
- State Key Laboratory of Radiation Medicine and Protection, Suzhou 215123, People's Republic of China
- School of Radiation Medicine and Protection, Soochow University, Suzhou 215123, People's Republic of China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, People's Republic of China
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19
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Giovannini D, De Angelis C, Astorino MD, Fratini E, Cisbani E, Bazzano G, Ampollini A, Piccinini M, Nichelatti E, Trinca E, Nenzi P, Mancuso M, Picardi L, Marino C, Ronsivalle C, Pazzaglia S. In Vivo Radiobiological Investigations with the TOP-IMPLART Proton Beam on a Medulloblastoma Mouse Model. Int J Mol Sci 2023; 24:ijms24098281. [PMID: 37175984 PMCID: PMC10179102 DOI: 10.3390/ijms24098281] [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: 03/28/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Protons are now increasingly used to treat pediatric medulloblastoma (MB) patients. We designed and characterized a setup to deliver proton beams for in vivo radiobiology experiments at a TOP-IMPLART facility, a prototype of a proton-therapy linear accelerator developed at the ENEA Frascati Research Center, with the goal of assessing the feasibility of TOP-IMPLART for small animal proton therapy research. Mice bearing Sonic-Hedgehog (Shh)-dependent MB in the flank were irradiated with protons to test whether irradiation could be restricted to a specific depth in the tumor tissue and to compare apoptosis induced by the same dose of protons or photons. In addition, the brains of neonatal mice at postnatal day 5 (P5), representing a very small target, were irradiated with 6 Gy of protons with two different collimated Spread-Out Bragg Peaks (SOBPs). Apoptosis was visualized by immunohistochemistry for the apoptotic marker caspase-3-activated, and quantified by Western blot. Our findings proved that protons could be delivered to the upper part while sparing the deepest part of MB. In addition, a comparison of the effectiveness of protons and photons revealed a very similar increase in the expression of cleaved caspase-3. Finally, by using a very small target, the brain of P5-neonatal mice, we demonstrated that the proton irradiation field reached the desired depth in brain tissue. Using the TOP-IMPLART accelerator we established setup and procedures for proton irradiation, suitable for translational preclinical studies. This is the first example of in vivo experiments performed with a "full-linac" proton-therapy accelerator.
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Affiliation(s)
- Daniela Giovannini
- ENEA SSPT-TECS-TEB, Casaccia Research Center, Division of Health Protection Technology (TECS), Agenzia Nazionale per le Nuove Tecnologie, l'Energia e lo Sviluppo Economico Sostenibile (ENEA), Via Anguillarese 301, 00123 Rome, Italy
| | - Cinzia De Angelis
- Istituto Superiore di Sanità (ISS), Viale Regina Elena 299, 00161 Rome, Italy
| | - Maria Denise Astorino
- ENEA FSN-TECFIS-APAM, Frascati Research Center, Via Enrico Fermi 45, 00044 Frascati, Italy
| | - Emiliano Fratini
- ENEA SSPT-TECS-TEB, Casaccia Research Center, Division of Health Protection Technology (TECS), Agenzia Nazionale per le Nuove Tecnologie, l'Energia e lo Sviluppo Economico Sostenibile (ENEA), Via Anguillarese 301, 00123 Rome, Italy
| | - Evaristo Cisbani
- Istituto Superiore di Sanità (ISS), Viale Regina Elena 299, 00161 Rome, Italy
| | - Giulia Bazzano
- ENEA FSN-TECFIS-APAM, Frascati Research Center, Via Enrico Fermi 45, 00044 Frascati, Italy
| | - Alessandro Ampollini
- ENEA FSN-TECFIS-APAM, Frascati Research Center, Via Enrico Fermi 45, 00044 Frascati, Italy
| | - Massimo Piccinini
- ENEA FSN-TECFIS-MNF, Frascati Research Center, Via Enrico Fermi 45, 00044 Frascati, Italy
| | - Enrico Nichelatti
- ENEA FSN-TECFIS-MNF, Casaccia Research Center, Via Anguillarese 301, 00123 Rome, Italy
| | - Emiliano Trinca
- ENEA FSN-TECFIS-APAM, Frascati Research Center, Via Enrico Fermi 45, 00044 Frascati, Italy
| | - Paolo Nenzi
- ENEA FSN-TECFIS-APAM, Frascati Research Center, Via Enrico Fermi 45, 00044 Frascati, Italy
| | - Mariateresa Mancuso
- ENEA SSPT-TECS-TEB, Casaccia Research Center, Division of Health Protection Technology (TECS), Agenzia Nazionale per le Nuove Tecnologie, l'Energia e lo Sviluppo Economico Sostenibile (ENEA), Via Anguillarese 301, 00123 Rome, Italy
| | - Luigi Picardi
- ENEA FSN-TECFIS-APAM, Frascati Research Center, Via Enrico Fermi 45, 00044 Frascati, Italy
| | - Carmela Marino
- ENEA SSPT-TECS-TEB, Casaccia Research Center, Division of Health Protection Technology (TECS), Agenzia Nazionale per le Nuove Tecnologie, l'Energia e lo Sviluppo Economico Sostenibile (ENEA), Via Anguillarese 301, 00123 Rome, Italy
| | - Concetta Ronsivalle
- ENEA FSN-TECFIS-APAM, Frascati Research Center, Via Enrico Fermi 45, 00044 Frascati, Italy
| | - Simonetta Pazzaglia
- ENEA SSPT-TECS-TEB, Casaccia Research Center, Division of Health Protection Technology (TECS), Agenzia Nazionale per le Nuove Tecnologie, l'Energia e lo Sviluppo Economico Sostenibile (ENEA), Via Anguillarese 301, 00123 Rome, Italy
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20
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Vaniqui A, Vaassen F, Di Perri D, Eekers D, Compter I, Rinaldi I, van Elmpt W, Unipan M. Linear Energy Transfer and Relative Biological Effectiveness Investigation of Various Structures for a Cohort of Proton Patients With Brain Tumors. Adv Radiat Oncol 2023; 8:101128. [PMID: 36632089 PMCID: PMC9827037 DOI: 10.1016/j.adro.2022.101128] [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: 09/21/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose The current knowledge on biological effects associated with proton therapy is limited. Therefore, we investigated the distributions of dose, dose-averaged linear energy transfer (LETd), and the product between dose and LETd (DLETd) for a patient cohort treated with proton therapy. Different treatment planning system features and visualization tools were explored. Methods and Materials For a cohort of 24 patients with brain tumors, the LETd, DLETd, and dose was calculated for a fixed relative biological effectiveness value and 2 variable models: plan-based and phenomenological. Dose threshold levels of 0, 5, and 20 Gy were imposed for LETd visualization. The relationship between physical dose and LETd and the frequency of LETd hotspots were investigated. Results The phenomenological relative biological effectiveness model presented consistently higher dose values. For lower dose thresholds, the LETd distribution was steered toward higher values related to low treatment doses. Differences up to 26.0% were found according to the threshold. Maximum LETd values were identified in the brain, periventricular space, and ventricles. An inverse relationship between LETd and dose was observed. Frequency information to the domain of dose and LETd allowed for the identification of clusters, which steer the mean LETd values, and the identification of higher, but sparse, LETd values. Conclusions Identifying, quantifying, and recording LET distributions in a standardized fashion is necessary, because concern exists over a link between toxicity and LET hotspots. Visualizing DLETd or dose × LETd during treatment planning could allow for clinicians to make informed decisions.
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Affiliation(s)
- Ana Vaniqui
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Femke Vaassen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dario Di Perri
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Daniëlle Eekers
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Inge Compter
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ilaria Rinaldi
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Mirko Unipan
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
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21
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Bianchi A, Selva A, Reniers B, Vanhavere F, Conte V. TOPAS simulations of the response of a mini-TEPC: benchmark with experimental data. Phys Med Biol 2023; 68. [PMID: 36595254 DOI: 10.1088/1361-6560/acabfe] [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: 06/10/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Objective. Microdosimetry offers a fast tool for radiation quality (RQ) verification to be implemented in treatment planning systems in proton therapy based on variable LET or RBE to move forward from the use of a fixed RBE of 1.1. It is known that the RBE of protons can increase up to 50% higher than that value in the last few millimetres of their range. Microdosimetry can be performed both experimentally and by means of Monte Carlo (MC) simulations. This paper has the aim of comparing the two approaches.Approach. Experimental measurements have been performed using a miniaturized Tissue equivalent proportional counter developed at the Legnaro National Laboratories of the Italian National Institute for Nuclear Physics with the aim of being used as RQ monitors for high intensity beams. MC simulations have been performed using the microdosimetric extension of TOPAS which provides optimized parameters and scorers for this application.Main results. Simulations were compared with experimental microdosimetric spectra in terms of shape of the spectra and their average values. Moreover, the latter have been investigated as possible estimators of LET obtained with the same MC code. The shape of the spectra is in general consistent with the experimental distributions and the average values of the distributions in both cases can predict the RQ increase with depth.Significance. This study aims at the comparison of microdosimetric spectra obtained from both experimental measurements and the microdosimetric extension of TOPAS in the same radiation field.
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Affiliation(s)
- Anna Bianchi
- INFN Laboratori Nazionali di Legnaro, viale dell'Università 2, I-35020 Legnaro, Italy
| | - Anna Selva
- INFN Laboratori Nazionali di Legnaro, viale dell'Università 2, I-35020 Legnaro, Italy
| | - Brigitte Reniers
- UHasselt, Faculty of Engineering Technology, Centre for Environmental Sciences, Nuclear Technology Center, Agoralaan 3590 Diepenbeek, Belgium
| | - Filip Vanhavere
- Belgian Nuclear Research Centre, SCK CEN, Boeretang 200, 2400 Mol, Belgium
| | - Valeria Conte
- INFN Laboratori Nazionali di Legnaro, viale dell'Università 2, I-35020 Legnaro, Italy
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22
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Chevli N, Grosshans DR, McAleer MF, Foster JH, Harrison D, McGovern SL, Paulino AC. Renal function in abdominal neuroblastoma patients undergoing proton radiotherapy. Pediatr Blood Cancer 2023; 70:e29981. [PMID: 36129239 DOI: 10.1002/pbc.29981] [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: 06/16/2022] [Revised: 08/05/2022] [Accepted: 08/18/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The purpose of this study is to analyze renal function outcomes in abdominal neuroblastoma patients undergoing proton therapy (PT). PROCEDURE From 2011 to 2019, two single-institution Institutional Review Board-approved protocols prospectively enrolled neuroblastoma patients for data collection. To assess renal function, serum creatinine (Cr), blood urea nitrogen (BUN), and creatinine clearance (CrCl) before proton therapy (pre-PT) were compared with the values at last follow-up. RESULTS A total of 30 children with abdominal neuroblastoma with median age 3.5 years (range, 0.9-9.1) at time of PT were included in this study. All patients underwent chemotherapy and resection of primary tumor prior to PT. Two patients required radical nephrectomy. Median follow-up after PT was 35 months. Mean dose to ipsilateral and contralateral kidney was 13.9 and 5.4 Gy, respectively. No patients developed hypertension or renal dysfunction during follow-up. There was no statistically significant change in serum BUN (p = .508), CrCl (p = .280), or eGFR (p = .246) between pre-PT and last follow-up. CONCLUSION At a median follow-up of almost 3 years, renal toxicity was uncommon after PT. Longer follow-up and larger patient cohort data are needed to further assess impact of PT on renal function in this population.
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Affiliation(s)
- Neil Chevli
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA
| | - David R Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer H Foster
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Douglas Harrison
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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23
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Salgado Maldonado S, Russomando A. CONVERSION OF DOSE DISTRIBUTION TO CELL SURVIVAL FRACTION THROUGH DNA DAMAGE: A MONTE CARLO STUDY. RADIATION PROTECTION DOSIMETRY 2022; 198:1462-1470. [PMID: 36138448 DOI: 10.1093/rpd/ncac191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/24/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Ionizing radiation plays an important role in cancer treatment. Radiation is able to damage the genetic material of cells, blocking their ability to divide and proliferate further. Since radiation affects both healthy and malignant tissues, for all radiation treatments, the design of an accurate treatment plan is fundamental. Usually, weight factors, such as the relative biological effectiveness, are applied to estimate the impact of the kind of radiation and the irradiated medium on the dose deposition. However, these factors can only provide a partial estimation of the real effect on tissues. In this work, a flexible system that is able to predict cell survival fractions according to the planned dose distribution is presented. Dose deposition and subsequent DNA damage were simulated with a multi-scale modeling approach by first applying the FLUKA Monte Carlo (MC) code to estimate the absorbed doses and fluence energy spectra and then using the MC Damage Simulation code to compute the DNA damage yields. Lastly, the results are converted into cell survival fraction using a theoretical model. The comparisons between the simulated survival fractions with experimental data are reported for a proton spread out Bragg peak at several doses. The presented approach helps to elucidate radiobiological responses along the Bragg curve and has the flexibility to be extended to a wide range of situations of clinical interest.
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Affiliation(s)
| | - Andrea Russomando
- Instituto de Fisica, Pontificia Universidad Catolica de Chile, 8970117 Santiago, Chile
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24
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Bianchi A, Selva A, Rossignoli M, Pasquato F, Missiaggia M, Scifoni E, La Tessa C, Tommasino F, Conte V. Microdosimetry with a mini-TEPC in the spread-out Bragg peak of 148 MeV protons. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Dubois LJ. Commentary on the article: Sørensen BS et al., Pencil beam scanning proton FLASH maintains tumor control while normal tissue damage is reduced in a mouse model. Radiother Oncol 2022; 175:191-192. [PMID: 35988775 DOI: 10.1016/j.radonc.2022.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ludwig J Dubois
- The M-Lab, Department of Precision Medicine, GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
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26
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Frame CM, Chen Y, Gagnon J, Yuan Y, Ma T, Dritschilo A, Pang D. Proton induced DNA double strand breaks at the Bragg peak: Evidence of enhanced LET effect. Front Oncol 2022; 12:930393. [PMID: 35992825 PMCID: PMC9388940 DOI: 10.3389/fonc.2022.930393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo investigate DNA double strand breaks (DSBs) induced by therapeutic proton beams in plateau and Bragg peak to demonstrate DSB induction due to the higher LET in the Bragg peak.Materials and MethodspUC19 plasmid DNA samples were irradiated to doses of 1000 and 3000 Gy on a Mevion S250i proton system with a monoenergetic, 110 MeV, proton beam at depths of 2 and 9.4 cm, corresponding to a position on the plateau and distal Bragg peak of the beam, respectively. The irradiated DNA samples were imaged by atomic force microscopy for visualization of individual DNA molecules, either broken or intact, and quantification of the DNA fragment length distributions for each of the irradiated samples. Percentage of the broken DNA and average number of DSBs per DNA molecule were obtained.ResultsCompared to irradiation effects in the plateau region, DNA irradiated at the Bragg peak sustained more breakage at the same dose, yielding more short DNA fragments and higher numbers of DSB per DNA molecule.ConclusionThe higher LET of proton beams at the Bragg peak results in more densely distributed DNA DSBs, which supports an underlying mechanism for the increased cell killing by protons at the Bragg peak.
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27
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Naumann M, Czempiel T, Lößner AJ, Pape K, Beyreuther E, Löck S, Drukewitz S, Hennig A, von Neubeck C, Klink B, Krause M, William D, Stange DE, Bütof R, Dietrich A. Combined Systemic Drug Treatment with Proton Therapy: Investigations on Patient-Derived Organoids. Cancers (Basel) 2022; 14:cancers14153781. [PMID: 35954444 PMCID: PMC9367296 DOI: 10.3390/cancers14153781] [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: 06/28/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023] Open
Abstract
To optimize neoadjuvant radiochemotherapy of pancreatic ductal adenocarcinoma (PDAC), the value of new irradiation modalities such as proton therapy needs to be investigated in relevant preclinical models. We studied individual treatment responses to RCT using patient-derived PDAC organoids (PDO). Four PDO lines were treated with gemcitabine, 5-fluorouracile (5FU), photon and proton irradiation and combined RCT. Therapy response was subsequently measured via viability assays. In addition, treatment-naive PDOs were characterized via whole exome sequencing and tumorigenicity was investigated in NMRI Foxn1nu/nu mice. We found a mutational pattern containing common mutations associated with PDAC within the PDOs. Although we could unravel potential complications of the viability assay for PDOs in radiobiology, distinct synergistic effects of gemcitabine and 5FU with proton irradiation were observed in two PDO lines that may lead to further mechanistical studies. We could demonstrate that PDOs are a powerful tool for translational proton radiation research.
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Affiliation(s)
- Max Naumann
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf, 01307 Dresden, Germany; (M.N.); (E.B.); (S.L.); (C.v.N.); (M.K.); (R.B.)
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Tabea Czempiel
- Core Unit for Molecular Tumor Diagnostics (CMTD), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany; (T.C.); (S.D.); (B.K.); (D.W.)
| | - Anna Jana Lößner
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (A.J.L.); (K.P.); (A.H.); (D.E.S.)
| | - Kristin Pape
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (A.J.L.); (K.P.); (A.H.); (D.E.S.)
| | - Elke Beyreuther
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf, 01307 Dresden, Germany; (M.N.); (E.B.); (S.L.); (C.v.N.); (M.K.); (R.B.)
- Institute of Radiation Physics, Helmholtz-Zentrum Dresden-Rossendorf, 01328 Dresden, Germany
| | - Steffen Löck
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf, 01307 Dresden, Germany; (M.N.); (E.B.); (S.L.); (C.v.N.); (M.K.); (R.B.)
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, German Cancer Research Center (DKFZ), 69192 Heidelberg, Germany
- Institute of Radiooncology—OncoRay, Helmholtz-Zentrum Dresden—Rossendorf, 01307 Dresden, Germany
| | - Stephan Drukewitz
- Core Unit for Molecular Tumor Diagnostics (CMTD), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany; (T.C.); (S.D.); (B.K.); (D.W.)
- Institute of Human Genetics, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Alexander Hennig
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (A.J.L.); (K.P.); (A.H.); (D.E.S.)
- National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
| | - Cläre von Neubeck
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf, 01307 Dresden, Germany; (M.N.); (E.B.); (S.L.); (C.v.N.); (M.K.); (R.B.)
- German Cancer Consortium (DKTK), Partner Site Dresden, German Cancer Research Center (DKFZ), 69192 Heidelberg, Germany
- Clinic for Particle Therapy, University Hospital Essen, Universität Duisburg Essen, 45147 Essen, Germany
| | - Barbara Klink
- Core Unit for Molecular Tumor Diagnostics (CMTD), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany; (T.C.); (S.D.); (B.K.); (D.W.)
- Department of Genetics, Laboratoire National de Santé, 3555 Dudelange, Luxembourg
- Institute for Clinical Genetics, University Hospital Carl Gustav Carus, Technische Universität Dresden, ERN-GENTURIS, Hereditary Cancer Syndrome Center Dresden, 01307 Dresden, Germany
| | - Mechthild Krause
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf, 01307 Dresden, Germany; (M.N.); (E.B.); (S.L.); (C.v.N.); (M.K.); (R.B.)
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, German Cancer Research Center (DKFZ), 69192 Heidelberg, Germany
- Institute of Radiooncology—OncoRay, Helmholtz-Zentrum Dresden—Rossendorf, 01307 Dresden, Germany
| | - Doreen William
- Core Unit for Molecular Tumor Diagnostics (CMTD), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany; (T.C.); (S.D.); (B.K.); (D.W.)
- Institute for Clinical Genetics, University Hospital Carl Gustav Carus, Technische Universität Dresden, ERN-GENTURIS, Hereditary Cancer Syndrome Center Dresden, 01307 Dresden, Germany
| | - Daniel E. Stange
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (A.J.L.); (K.P.); (A.H.); (D.E.S.)
- National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
| | - Rebecca Bütof
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf, 01307 Dresden, Germany; (M.N.); (E.B.); (S.L.); (C.v.N.); (M.K.); (R.B.)
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
- Institute of Radiooncology—OncoRay, Helmholtz-Zentrum Dresden—Rossendorf, 01307 Dresden, Germany
| | - Antje Dietrich
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf, 01307 Dresden, Germany; (M.N.); (E.B.); (S.L.); (C.v.N.); (M.K.); (R.B.)
- German Cancer Consortium (DKTK), Partner Site Dresden, German Cancer Research Center (DKFZ), 69192 Heidelberg, Germany
- Correspondence:
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28
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A case-control study of linear energy transfer and relative biological effectiveness related to symptomatic brainstem toxicity following pediatric proton therapy. Radiother Oncol 2022; 175:47-55. [PMID: 35917900 DOI: 10.1016/j.radonc.2022.07.022] [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: 04/07/2022] [Revised: 06/28/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE A fixed relative biological effectiveness (RBE) of 1.1 (RBE1.1) is used clinically in proton therapy even though the RBE varies with properties such as dose level and linear energy transfer (LET). We therefore investigated if symptomatic brainstem toxicity in pediatric brain tumor patients treated with proton therapy could be associated with a variable LET and RBE. MATERIALS AND METHODS 36 patients treated with passive scattering proton therapy were selected for a case-control study from a cohort of 954 pediatric brain tumor patients. Nine children with symptomatic brainstem toxicity were each matched to three controls based on age, diagnosis, adjuvant therapy, and brainstem RBE1.1 dose characteristics. Differences across cases and controls related to the dose-averaged LET (LETd) and variable RBE-weighted dose from two RBE models were analyzed in the high-dose region. RESULTS LETd metrics were marginally higher for cases vs. controls for the majority of dose levels and brainstem substructures. Considering areas with doses above 54 Gy(RBE1.1), we found a moderate trend of 13% higher median LETd in the brainstem for cases compared to controls (P = .08), while the difference in the median variable RBE-weighted dose for the same structure was only 2% (P = .6). CONCLUSION Trends towards higher LETd for cases compared to controls were noticeable across structures and LETd metrics for this patient cohort. While case-control differences were minor, an association with the observed symptomatic brainstem toxicity cannot be ruled out.
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Holtzman AL, Rutenberg MS, De Leo AN, Rao D, Patel J, Morris CG, Indelicato DJ, Mendenhall WM. The incidence of brainstem toxicity following high-dose conformal proton therapy for adult skull-base malignancies. Acta Oncol 2022; 61:1026-1031. [PMID: 35897132 DOI: 10.1080/0284186x.2022.2101900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Dose escalation for skull-based malignancies often presents risks to critical adjacent neural structures, including the brainstem. We report the incidence of brainstem toxicity following fractionated high-dose conformal proton therapy and associated dosimetric parameters. MATERIAL AND METHODS We performed a single-institution review of patients with skull-base chordoma or chondrosarcoma who were treated with proton therapy between February 2007 and January 2020 on a prospective outcomes-tracking protocol. The primary endpoint was grade ≥2 brainstem toxicity. No patients received concurrent chemotherapy, and brainstem toxicity was censored for analysis if it coincided with local disease progression. RESULTS We analyzed 163 patients who received a minimum of 45 GyRBE to 0.03 cm3 of the brainstem. Patients were treated to a median total dose of 73.8 (range 64.5-74.4) GyRBE at 1.8 GyRBE per fraction with 17 patients undergoing twice-daily treatment at 1.2 GyRBE per fraction. With a median follow-up of 4 years, the 5-year cumulative incidence of grade ≥2 brainstem injury was 1.3% (95% CI 0.25-4.3%). There was one grade 2, one grade 3, and no grade 4 or 5 events, with all patients recovering function with medical management. CONCLUSION In delivering curative-intent radiotherapy for skull-base chordoma and chondrosarcoma in adults, small volumes of the brainstem can safely receive at least 64 GyRBE with minimal risk of serious brainstem injury.
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Affiliation(s)
- Adam L Holtzman
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | | | - Alexandra N De Leo
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Dinesh Rao
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Jeet Patel
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
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Sato T, Matsuya Y, Hamada N. Microdosimetric modeling of relative biological effectiveness for skin reactions: Possible linkage between in vitro and in vivo data. Int J Radiat Oncol Biol Phys 2022; 114:153-162. [DOI: 10.1016/j.ijrobp.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/22/2022] [Accepted: 05/07/2022] [Indexed: 11/17/2022]
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Koh WYC, Tan HQ, Ng YY, Lin YH, Ang KW, Lew WS, Lee JCL, Park SY. Quantifying Systematic RBE-Weighted Dose Uncertainty Arising from Multiple Variable RBE Models in Organ at Risk. Adv Radiat Oncol 2022; 7:100844. [PMID: 35036633 PMCID: PMC8749202 DOI: 10.1016/j.adro.2021.100844] [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: 06/12/2021] [Revised: 09/27/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Relative biological effectiveness (RBE) uncertainties have been a concern for treatment planning in proton therapy, particularly for treatment sites that are near organs at risk (OARs). In such a clinical situation, the utilization of variable RBE models is preferred over constant RBE model of 1.1. The problem, however, lies in the exact choice of RBE model, especially when current RBE models are plagued with a host of uncertainties. This paper aims to determine the influence of RBE models on treatment planning, specifically to improve the understanding of the influence of the RBE models with regard to the passing and failing of treatment plans. This can be achieved by studying the RBE-weighted dose uncertainties across RBE models for OARs in cases where the target volume overlaps the OARs. Multi-field optimization (MFO) and single-field optimization (SFO) plans were compared in order to recommend which technique was more effective in eliminating the variations between RBE models. METHODS Fifteen brain tumor patients were selected based on their profile where their target volume overlaps with both the brain stem and the optic chiasm. In this study, 6 RBE models were analyzed to determine the RBE-weighted dose uncertainties. Both MFO and SFO planning techniques were adopted for the treatment planning of each patient. RBE-weighted dose uncertainties in the OARs are calculated assuming( α β ) x of 3 Gy and 8 Gy. Statistical analysis was used to ascertain the differences in RBE-weighted dose uncertainties between MFO and SFO planning. Additionally, further investigation of the linear energy transfer (LET) distribution was conducted to determine the relationship between LET distribution and RBE-weighted dose uncertainties. RESULTS The results showed no strong indication on which planning technique would be the best for achieving treatment planning constraints. MFO and SFO showed significant differences (P <.05) in the RBE-weighted dose uncertainties in the OAR. In both clinical target volume (CTV)-brain stem and CTV-chiasm overlap region, 10 of 15 patients showed a lower median RBE-weighted dose uncertainty in MFO planning compared with SFO planning. In the LET analysis, 8 patients (optic chiasm) and 13 patients (brain stem) showed a lower mean LET in MFO planning compared with SFO planning. It was also observed that lesser RBE-weighted dose uncertainties were present with MFO planning compared with SFO planning technique. CONCLUSIONS Calculations of the RBE-weighted dose uncertainties based on 6 RBE models and 2 different( α β ) x revealed that MFO planning is a better option as opposed to SFO planning for cases of overlapping brain tumor with OARs in eliminating RBE-weighted dose uncertainties. Incorporation of RBE models failed to dictate the passing or failing of a treatment plan. To eliminate RBE-weighted dose uncertainties in OARs, the MFO planning technique is recommended for brain tumor when CTV and OARs overlap.
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Affiliation(s)
- Wei Yang Calvin Koh
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Yan Yee Ng
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Yen Hwa Lin
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Khong Wei Ang
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Wen Siang Lew
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore
| | - James Cheow Lei Lee
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Sung Yong Park
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Oncology Academic Clinical Programme, Duke-NUS Medical School, National University of Singapore, Singapore
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A pilot study of a novel method to visualize three-dimensional dose distribution on skin surface images to evaluate radiation dermatitis. Sci Rep 2022; 12:2729. [PMID: 35177737 PMCID: PMC8854641 DOI: 10.1038/s41598-022-06713-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/27/2022] [Indexed: 11/09/2022] Open
Abstract
Predicting the radiation dose‒toxicity relationship is important for local tumor control and patients’ quality of life. We developed a first intuitive evaluation system that directly matches the three-dimensional (3D) dose distribution with the skin surface image of patients with radiation dermatitis (RD) to predict RD in patients undergoing radiotherapy. Using an RGB-D camera, 82 3D skin surface images (3DSSIs) were acquired from 19 patients who underwent radiotherapy. 3DSSI data acquired included 3D skin surface shape and optical imaging of the area where RD occurs. Surface registration between 3D skin dose (3DSD) and 3DSSI is performed using the iterative closest point algorithm, then reconstructed as a two-dimensional color image. The developed system successfully matched 3DSSI and 3DSD, and visualized the planned dose distribution onto the patient's RD image. The dose distribution pattern was consistent with the occurrence pattern of RD. This new approach facilitated the evaluation of the direct correlation between skin-dose distribution and RD and, therefore, provides a potential to predict the probability of RD and thereby decrease RD severity by enabling informed treatment decision making by physicians. However, the results need to be interpreted with caution due to the small sample size.
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Singers Sørensen B, Krzysztof Sitarz M, Ankjærgaard C, Johansen J, Andersen CE, Kanouta E, Overgaard C, Grau C, Poulsen P. In vivo validation and tissue sparing factor for acute damage of pencil beam scanning proton FLASH. Radiother Oncol 2021; 167:109-115. [PMID: 34953933 DOI: 10.1016/j.radonc.2021.12.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Preclinical studies indicate a normal tissue sparing effect using ultra-high dose rate (FLASH) radiation with comparable tumor response. Most data so far are based on electron beams with limited utility for human treatments. This study validates the effect of proton FLASH delivered with pencil beam scanning (PBS) in a mouse leg model of acute skin damage and quantifies the normal tissue sparing factor, the FLASH factor, through full dose response curves. MATERIALS AND METHODS The right hind limb of CDF1 mice was irradiated with a single fraction of proton PBS in the entrance plateau of either a 244MeV conventional dose rate field or a 250MeV FLASH field. In total, 301 mice were irradiated in four separate experiments, with 7-21 mice per dose point. The endpoints were the level of acute moist desquamation to the skin of the foot within 25 days post irradiation. RESULTS The field duration and field dose rate were 61-107s and 0.35-0.40 Gy/s for conventional dose rate and 0.35-0.73s and 65-92 Gy/s for FLASH. Full dose response curves for five levels of acute skin damage for both conventional and FLASH dose rate revealed a distinct normal tissue sparing effect with FLASH: across all scoring levels, a 44-58% higher dose was required to give the same biological response with FLASH as compared to the conventional dose rate. CONCLUSIONS The normal tissue sparing effect of PBS proton FLASH was validated. The FLASH factor was quantified through full dose response curves.
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Affiliation(s)
- Brita Singers Sørensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
| | | | | | - Jacob Johansen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Eleni Kanouta
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Cathrine Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Per Poulsen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Sørensen BS, Pawelke J, Bauer J, Burnet NG, Dasu A, Høyer M, Karger CP, Krause M, Schwarz M, Underwood TSA, Wagenaar D, Whitfield GA, Lühr A. Does the uncertainty in relative biological effectiveness affect patient treatment in proton therapy? Radiother Oncol 2021; 163:177-184. [PMID: 34480959 DOI: 10.1016/j.radonc.2021.08.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/09/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
Clinical treatment with protons uses the concept of relative biological effectiveness (RBE) to convert the absorbed dose into an RBE-weighted dose that equals the dose for radiotherapy with photons causing the same biological effect. Currently, in proton therapy a constant RBE of 1.1 is generically used. However, empirical data indicate that the RBE is not constant, but increases at the distal edge of the proton beam. This increase in RBE is of concern, as the clinical impact is still unresolved, and clinical studies demonstrating a clinical effect of an increased RBE are emerging. Within the European Particle Therapy Network (EPTN) work package 6 on radiobiology and RBE, a workshop was held in February 2020 in Manchester with one day of discussion dedicated to the impact of proton RBE in a clinical context. Current data on RBE effects, patient outcome and modelling from experimental as well as clinical studies were presented and discussed. Furthermore, representatives from European clinical proton therapy centres, who were involved in patient treatment, laid out their current clinical practice on how to consider the risk of a variable RBE in their centres. In line with the workshop, this work considers the actual impact of RBE issues on patient care in proton therapy by reviewing preclinical data on the relation between linear energy transfer (LET) and RBE, current clinical data sets on RBE effects in patients, and applied clinical strategies to manage RBE uncertainties. A better understanding of the variability in RBE would allow development of proton treatments which are safer and more effective.
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Affiliation(s)
- Brita S Sørensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Experimental Clinical Oncology - Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
| | - Jörg Pawelke
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Institute of Radiooncology-OncoRay, Dresden, Germany
| | - Julia Bauer
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | | | - Alexandru Dasu
- The Skandion Clinic, Uppsala, Sweden; Medical Radiation Sciences, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Morten Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Christian P Karger
- Dept. of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Mechthild Krause
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Institute of Radiooncology-OncoRay, Dresden, Germany; German Cancer Consortium Dresden and German Cancer Research Center Heidelberg, Germany; Dept. of Radiation Oncology, University Hospital and Faculty of Medicine C.G. Carus, Dresden, Germany; National Center for Tumor Diseases Dresden, German Cancer Research Center Heidelberg, University Hospital and Faculty of Medicine C.G. Carus Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Marco Schwarz
- Protontherapy Department -Trento Hospital, and TIFPA-INFN, Trento, Italy
| | - Tracy S A Underwood
- Division of Cancer Sciences, School of Medical Sciences, The University of Manchester, UK
| | - Dirk Wagenaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gillian A Whitfield
- The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, UK
| | - Armin Lühr
- Department of Physics, TU Dortmund University, Dortmund, Germany
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Suckert T, Nexhipi S, Dietrich A, Koch R, Kunz-Schughart LA, Bahn E, Beyreuther E. Models for Translational Proton Radiobiology-From Bench to Bedside and Back. Cancers (Basel) 2021; 13:4216. [PMID: 34439370 PMCID: PMC8395028 DOI: 10.3390/cancers13164216] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022] Open
Abstract
The number of proton therapy centers worldwide are increasing steadily, with more than two million cancer patients treated so far. Despite this development, pending questions on proton radiobiology still call for basic and translational preclinical research. Open issues are the on-going discussion on an energy-dependent varying proton RBE (relative biological effectiveness), a better characterization of normal tissue side effects and combination treatments with drugs originally developed for photon therapy. At the same time, novel possibilities arise, such as radioimmunotherapy, and new proton therapy schemata, such as FLASH irradiation and proton mini-beams. The study of those aspects demands for radiobiological models at different stages along the translational chain, allowing the investigation of mechanisms from the molecular level to whole organisms. Focusing on the challenges and specifics of proton research, this review summarizes the different available models, ranging from in vitro systems to animal studies of increasing complexity as well as complementing in silico approaches.
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Affiliation(s)
- Theresa Suckert
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01309 Dresden, Germany; (T.S.); (S.N.); (A.D.); (L.A.K.-S.)
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Sindi Nexhipi
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01309 Dresden, Germany; (T.S.); (S.N.); (A.D.); (L.A.K.-S.)
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, 01309 Dresden, Germany
| | - Antje Dietrich
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01309 Dresden, Germany; (T.S.); (S.N.); (A.D.); (L.A.K.-S.)
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Robin Koch
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (R.K.); (E.B.)
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Leoni A. Kunz-Schughart
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01309 Dresden, Germany; (T.S.); (S.N.); (A.D.); (L.A.K.-S.)
- National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
| | - Emanuel Bahn
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (R.K.); (E.B.)
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- German Cancer Research Center (DKFZ), Clinical Cooperation Unit Radiation Oncology, 69120 Heidelberg, Germany
| | - Elke Beyreuther
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01309 Dresden, Germany; (T.S.); (S.N.); (A.D.); (L.A.K.-S.)
- Helmholtz-Zentrum Dresden—Rossendorf, Institute of Radiation Physics, 01328 Dresden, Germany
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Tissue Architecture Influences the Biological Effectiveness of Boron Neutron Capture Therapy in In Vitro/In Silico Three-Dimensional Self-Assembly Cell Models of Pancreatic Cancers. Cancers (Basel) 2021; 13:cancers13164058. [PMID: 34439214 PMCID: PMC8394840 DOI: 10.3390/cancers13164058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Boron neutron capture therapy (BNCT) is becoming one of the most promising radiotherapies for aggressive cancers, but the detailed cellular mechanisms of BNCT remain largely underexplored. Solid tumors are composed of heterogeneous cell populations, which create a 3-dimensional complicated microenvironment for tumor progression. To recapture the influences of the microenvironment on BNCT efficacy, we applied a self-assembly 3D cell culture system with two different types of pancreatic cancer cells. In contrast to previous findings with γ-ray exposure, we found that the 3D architecture of pancreatic tumor can facilitate the susceptibility of cancer cells to BNCT, as compared to 2D tissue structure; a computer simulation model was established to further confirm this unexpected finding. These outcomes can contribute to better understanding of the radiobiology of BNCT, and the developed models may facilitate the recent development in personalized radiotherapy. Abstract Pancreatic cancer is a leading cause of cancer death, and boron neutron capture therapy (BNCT) is one of the promising radiotherapy techniques for patients with pancreatic cancer. In this study, we evaluated the biological effectiveness of BNCT at multicellular levels using in vitro and in silico models. To recapture the phenotypic characteristic of pancreatic tumors, we developed a cell self-assembly approach with human pancreatic cancer cells Panc-1 and BxPC-3 cocultured with MRC-5 fibroblasts. On substrate with physiological stiffness, tumor cells self-assembled into 3D spheroids, and the cocultured fibroblasts further facilitated the assembly process, which recapture the influence of tumor stroma. Interestingly, after 1.2 MW neutron irradiation, lower survival rates and higher apoptosis (increasing by 4-fold for Panc-1 and 1.5-fold for BxPC-3) were observed in 3D spheroids, instead of in 2D monolayers. The unexpected low tolerance of 3D spheroids to BNCT highlights the unique characteristics of BNCT over conventional radiotherapy. The uptake of boron-containing compound boronophenylalanine (BPA) and the alteration of E-cadherin can partially contribute to the observed susceptibility. In addition to biological effects, the probability of induced α-particle exposure correlated to the multicellular organization was speculated to affect the cellular responses to BNCT. A Monte Carlo (MC) simulation was also established to further interpret the observed survival. Intracellular boron distribution in the multicellular structure and related treatment resistance were reconstructed in silico. Simulation results demonstrated that the physical architecture is one of the essential factors for biological effectiveness in BNCT, which supports our in vitro findings. In summary, we developed in vitro and in silico self-assembly 3D models to evaluate the effectiveness of BNCT on pancreatic tumors. Considering the easy-access of this 3D cell-assembly platform, this study may not only contribute to the current understanding of BNCT but is also expected to be applied to evaluate the BNCT efficacy for individualized treatment plans in the future.
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Flatten V, Burg JM, Witt M, Derksen L, Fragoso Costa P, Wulff J, Bäumer C, Timmermann B, Weber U, Vorwerk H, Engenhart-Cabillic R, Zink K, Baumann KS. Estimating the modulating effect of lung tissue in particle therapy using a clinical CT voxel histogram analysis. Phys Med Biol 2021; 66. [PMID: 34298533 DOI: 10.1088/1361-6560/ac176e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/23/2021] [Indexed: 11/12/2022]
Abstract
To treat lung tumours with particle therapy, different additional tasks and challenges in treatment planning and application have to be addressed thoroughly. One of these tasks is the quantification and consideration of the Bragg peak degradation due to lung tissue: As lung is an heterogeneous tissue, the Bragg peak is broadened when particles traverse the microscopic alveoli. These are not fully resolved in clinical CT images and thus, the effect is not considered in the dose calculation. In this work, a correlation between the CT histograms of heterogeneous material and the impact on the Bragg peak curve is presented. Different inorganic materials were scanned with a conventional CT scanner and additionally, the Bragg peak degradation was measured in a proton beam and was then quantified. A model is proposed that allows an estimation of the modulation power by performing a histogram analysis on the CT scan. To validate the model for organic samples, a second measurement series was performed with frozen porcine lunge samples. This allows to investigate the possible limits of the proposed model in a set-up closer to clinical conditions. For lung substitutes, the agreement between model and measurement is within ±0.05 mm and for the organic lung samples, within ±0.15 mm. This work presents a novel, simple and efficient method to estimate if and how much a material or a distinct region (within the lung) is degrading the Bragg peak on the basis of a common clinical CT image. Up until now, only a direct in-beam measurement of the region or material of interest could answer this question.
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Affiliation(s)
- Veronika Flatten
- Department of Radiotherapy and Radiooncology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, GERMANY
| | - Jan Michael Burg
- , University of Applied Sciences, Institute of Medical Physics and Radiation Protection, Giessen, GERMANY
| | - Matthias Witt
- Department of Radiotherapy and Radiooncology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, GERMANY
| | - Larissa Derksen
- , University of Applied Sciences, Institute of Medical Physics and Radiation Protection, Giessen, GERMANY
| | | | - Jörg Wulff
- Medical Physics, Westdeutsches Protonentherapiezentrum Essen gGmbH, Essen, GERMANY
| | | | - Beate Timmermann
- Deparment of Particle Therapy, University Hospital Essen, Essen, GERMANY
| | - Uli Weber
- , GSI Helmholtzzentrum fur Schwerionenforschung GmbH, Darmstadt, Hessen, GERMANY
| | - Hilke Vorwerk
- Department of Radiotherapy and Radiooncology, University Medical Center Giessen-Marburg, Marburg, GERMANY
| | - Rita Engenhart-Cabillic
- University Medical Center Giessen-Marburg, Department of Radiotherapy and Radiooncology, Marburg, GERMANY
| | - Klemens Zink
- University Medical Center Giessen-Marburg, Department of Radiotherapy and Radiooncology, Marburg, GERMANY
| | - Kilian-Simon Baumann
- Department of Radiotherapy and Radiooncology, University Medical Center Giessen-Marburg, Marburg, GERMANY
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Balakin VE, Rozanova OM, Smirnova EN, Belyakova TA, Shemyakov AE, Strelnikova NS. Assessment of the Relative Biological Efficiency of Pencil Beam Scanning of Protons in Mice in Vivo. DOKL BIOCHEM BIOPHYS 2021; 499:215-219. [PMID: 34426914 DOI: 10.1134/s1607672921040037] [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: 03/17/2021] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022]
Abstract
The effect of proton pencil beam scanning in the dose range of 4.5-15 Gy on the radiosensitivity of mice under irradiation in two regions of the Bragg curve was studied according to the criteria of 30-day survival, dynamics of death, and average lifespan of mice. The relative biological effectiveness (RBE) value of protons relative to X-ray radiation before and at the Bragg peak determined by the LD50/30 index was 0.86 and 0.94, respectively, and by the criterion of 30-day survival at a dose of 6.5 Gy it was 0.83 and 0.84, respectively. With similar RBE values for protons in different regions of the Bragg curve, significant differences in the dynamics of the course of radiation sickness were revealed, which indicates different damage to critical systems and organs of animals and the induction of compensatory mechanisms involved in the formation of stress responses at the organismal level.
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Affiliation(s)
- V E Balakin
- Physical Technical Center, Lebedev Physical Institute, Russian Academy of Sciences, Protvino, Russia.
| | - O M Rozanova
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - E N Smirnova
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - T A Belyakova
- Physical Technical Center, Lebedev Physical Institute, Russian Academy of Sciences, Protvino, Russia
| | - A E Shemyakov
- Physical Technical Center, Lebedev Physical Institute, Russian Academy of Sciences, Protvino, Russia
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - N S Strelnikova
- Physical Technical Center, Lebedev Physical Institute, Russian Academy of Sciences, Protvino, Russia
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Welzel T, Bendinger AL, Glowa C, Babushkina I, Jugold M, Peschke P, Debus J, Karger CP, Saager M. Longitudinal MRI study after carbon ion and photon irradiation: shorter latency time for myelopathy is not associated with differential morphological changes. Radiat Oncol 2021; 16:63. [PMID: 33789720 PMCID: PMC8011205 DOI: 10.1186/s13014-021-01792-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/18/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Radiation-induced myelopathy is a severe and irreversible complication that occurs after a long symptom-free latency time if the spinal cord was exposed to a significant irradiation dose during tumor treatment. As carbon ions are increasingly investigated for tumor treatment in clinical trials, their effect on normal tissue needs further investigation to assure safety of patient treatments. Magnetic resonance imaging (MRI)-visible morphological alterations could serve as predictive markers for medicinal interventions to avoid severe side effects. Thus, MRI-visible morphological alterations in the rat spinal cord after high dose photon and carbon ion irradiation and their latency times were investigated. METHODS Rats whose spinal cords were irradiated with iso-effective high photon (n = 8) or carbon ion (n = 8) doses as well as sham-treated control animals (n = 6) underwent frequent MRI measurements until they developed radiation-induced myelopathy (paresis II). MR images were analyzed for morphological alterations and animals were regularly tested for neurological deficits. In addition, histological analysis was performed of animals suffering from paresis II compared to controls. RESULTS For both beam modalities, first morphological alterations occurred outside the spinal cord (bone marrow conversion, contrast agent accumulation in the musculature ventral and dorsal to the spinal cord) followed by morphological alterations inside the spinal cord (edema, syrinx, contrast agent accumulation) and eventually neurological alterations (paresis I and II). Latency times were significantly shorter after carbon ions as compared to photon irradiation. CONCLUSIONS Irradiation of the rat spinal cord with photon or carbon ion doses that lead to 100% myelopathy induced a comparable fixed sequence of MRI-visible morphological alterations and neurological distortions. However, at least in the animal model used in this study, the observed MRI-visible morphological alterations in the spinal cord are not suited as predictive markers to identify animals that will develop myelopathy as the time between MRI-visible alterations and the occurrence of myelopathy is too short to intervene with protective or mitigative drugs.
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Affiliation(s)
- Thomas Welzel
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Department of Radiation Oncology and Radiotherapy, University Hospital of Heidelberg, Heidelberg, Germany
| | - Alina L Bendinger
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany. .,Department of Medical Physics in Radiation Oncology (E040), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Christin Glowa
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Department of Radiation Oncology and Radiotherapy, University Hospital of Heidelberg, Heidelberg, Germany.,Department of Medical Physics in Radiation Oncology (E040), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Inna Babushkina
- Core Facility Small Animal Imaging Center, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Manfred Jugold
- Core Facility Small Animal Imaging Center, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Peschke
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Department of Medical Physics in Radiation Oncology (E040), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology and Radiotherapy, University Hospital of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Therapy, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian P Karger
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Department of Medical Physics in Radiation Oncology (E040), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Maria Saager
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Department of Medical Physics in Radiation Oncology (E040), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Bertolet A, Cortés-Giraldo M, Carabe-Fernandez A. Implementation of the microdosimetric kinetic model using analytical microdosimetry in a treatment planning system for proton therapy. Phys Med 2021; 81:69-76. [DOI: 10.1016/j.ejmp.2020.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/17/2020] [Accepted: 11/19/2020] [Indexed: 02/06/2023] Open
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Conte V, Agosteo S, Bianchi A, Bolst D, Bortot D, Catalano R, Cirrone GAP, Colautti P, Cuttone G, Guatelli S, James B, Mazzucconi D, Rosenfeld AB, Selva A, Tran L, Petringa G. Microdosimetry of a therapeutic proton beam with a mini-TEPC and a MicroPlus-Bridge detector for RBE assessment. Phys Med Biol 2020; 65:245018. [PMID: 33086208 DOI: 10.1088/1361-6560/abc368] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Proton beams are widely used worldwide to treat localized tumours, the lower entrance dose and no exit dose, thus sparing surrounding normal tissues, being the main advantage of this treatment modality compared to conventional photon techniques. Clinical proton beam therapy treatment planning is based on the use of a general relative biological effectiveness (RBE) of 1.1 along the whole beam penetration depth, without taking into account the documented increase in RBE at the end of the depth dose profile, in the Bragg peak and beyond. However, an inaccurate estimation of the RBE can cause both underdose or overdose, in particular it can cause the unfavourable situation of underdosing the tumour and overdosing the normal tissue just beyond the tumour, which limits the treatment success and increases the risk of complications. In view of a more precise dose delivery that takes into account the variation of RBE, experimental microdosimetry offers valuable tools for the quality assurance of LET or RBE-based treatment planning systems. The purpose of this work is to compare the response of two different microdosimetry systems: the mini-TEPC and the MicroPlus-Bridge detector. Microdosimetric spectra were measured across the 62 MeV spread out Bragg peak of CATANA with the mini-TEPC and with the Bridge microdosimeter. The frequency and dose distributions of lineal energy were compared and the different contributions to the spectra were analysed, discussing the effects of different site sizes and chord length distributions. The shape of the lineal energy distributions measured with the two detectors are markedly different, due to the different water-equivalent sizes of the sensitive volumes: 0.85 μm for the TEPC and 17.3 μm for the silicon detector. When the Loncol's biological weighting function is applied to calculate the microdosimetric assessment of the RBE, both detectors lead to results that are consistent with biological survival data for glioma U87 cells. Both the mini-TEPC and the MicroPlus-Bridge detector can be used to assess the RBE variation of a 62 MeV modulated proton beam along its penetration depth. The microdosimetric assessment of the RBE based on the Loncol's weighting function is in good agreement with radiobiological results when the 10% biological uncertainty is taken into account.
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Affiliation(s)
- V Conte
- INFN Laboratori Nazionali di Legnaro, viale dell'Università 2 35020 Legnaro, Italy
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Nielsen S, Bassler N, Grzanka L, Swakon J, Olko P, Horsman MR, Sørensen BS. Proton scanning and X-ray beam irradiation induce distinct regulation of inflammatory cytokines in a preclinical mouse model. Int J Radiat Biol 2020; 96:1238-1244. [PMID: 32780616 DOI: 10.1080/09553002.2020.1807644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Conventional X-ray radiotherapy induces a pro-inflammatory response mediated by altered expression of inflammation-regulating cytokines. Proton scanning and X-ray irradiation produce distinct changes to cytokine gene expression in vitro suggesting that proton beam therapy may induce an inflammatory response dissimilar to that of X-ray radiation. The purpose of the present study was to determine whether proton scanning beam radiation and conventional X-ray photon radiation would induce differential regulation of circulating cytokines in vivo. MATERIALS AND METHODS Female CDF1 mice were irradiated locally at the right hind leg using proton pencil beam scanning or X-ray photons. Blood samples were obtained from two separate mice groups. Samples from one group were drawn by retro-orbital puncture 16 months post irradiation, while samples from the other group were drawn 5 and 30 days post irradiation. Concentration of the cytokines IL-6, IL-1β, IL-10, IL-17A, IFN-γ, and TNFα was measured in plasma using bead-based immunoassays. RESULTS The cytokines IL-6, IL-1β, IL-10, IFN-γ, and TNFα were expressed at lower levels in plasma samples from proton-irradiated mice compared with X-ray-irradiated mice 16 months post irradiation. The same cytokines were downregulated in proton-irradiated mice 5 days post irradiation when compared to controls, while at day 30 expression had increased to the same level or higher. X-ray radiation did not markedly change expression levels at days 5 and 30. CONCLUSIONS The inflammatory response to proton and X-ray irradiation seem to be distinct as the principal pro-inflammatory cytokines are differentially regulated short- and long-term following irradiation. Both the development of normal tissue damage and efficacy of immunotherapy could be influenced by an altered inflammatory response to irradiation.
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Affiliation(s)
- Steffen Nielsen
- Experimental Clinical Oncology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Bassler
- Medical Radiation Physics, Department of Physics, Stockholm University, Stockholm, Sweden
| | - Leszek Grzanka
- Proton Radiotherapy Group, Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Jan Swakon
- Proton Radiotherapy Group, Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Pawel Olko
- Proton Radiotherapy Group, Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Michael R Horsman
- Experimental Clinical Oncology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Brita Singers Sørensen
- Experimental Clinical Oncology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Pisciotta P, Costantino A, Cammarata FP, Torrisi F, Calabrese G, Marchese V, Cirrone GAP, Petringa G, Forte GI, Minafra L, Bravatà V, Gulisano M, Scopelliti F, Tommasino F, Scifoni E, Cuttone G, Ippolito M, Parenti R, Russo G. Evaluation of proton beam radiation-induced skin injury in a murine model using a clinical SOBP. PLoS One 2020; 15:e0233258. [PMID: 32442228 PMCID: PMC7244158 DOI: 10.1371/journal.pone.0233258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 05/03/2020] [Indexed: 11/18/2022] Open
Abstract
The purpose of this paper is to characterize the skin deterministic damage due to the effect of proton beam irradiation in mice occurred during a long-term observational experiment. This study was initially defined to evaluate the insurgence of myelopathy irradiating spinal cords with the distal part of a Spread-out Bragg peak (SOBP). To the best of our knowledge, no study has been conducted highlighting high grades of skin injury at the dose used in this paper. Nevertheless these effects occurred. In this regard, the experimental evidence of significant insurgence of skin injury induced by protons using a SOBP configuration will be shown. Skin damages were classified into six scores (from 0 to 5) according to the severity of the injuries and correlated to ED50 (i.e. the radiation dose at which 50% of animals show a specific score) at 40 days post-irradiation (d.p.i.). The effects of radiation on the overall animal wellbeing have been also monitored and the severity of radiation-induced skin injuries was observed and quantified up to 40 d.p.i.
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Affiliation(s)
- Pietro Pisciotta
- Physics and Astronomy Department, University of Catania, Catania, Italy
- Institute of Molecular Bioimaging and Physiology (IBFM-CNR), Cefalù (PA), Italy
- National Laboratory of South, National Institute for Nuclear Physics (LNS-INFN), Catania, Italy
| | - Angelita Costantino
- Laboratory of Molecular and Cellular Physiology, Biomedical and Biotechnological Sciences Department, University of Catania, Catania, Italy
| | - Francesco Paolo Cammarata
- Institute of Molecular Bioimaging and Physiology (IBFM-CNR), Cefalù (PA), Italy
- National Laboratory of South, National Institute for Nuclear Physics (LNS-INFN), Catania, Italy
- * E-mail: (FPC); (RP)
| | - Filippo Torrisi
- National Laboratory of South, National Institute for Nuclear Physics (LNS-INFN), Catania, Italy
- Laboratory of Molecular and Cellular Physiology, Biomedical and Biotechnological Sciences Department, University of Catania, Catania, Italy
| | - Giovanna Calabrese
- Laboratory of Molecular and Cellular Physiology, Biomedical and Biotechnological Sciences Department, University of Catania, Catania, Italy
| | - Valentina Marchese
- Laboratory of Molecular and Cellular Physiology, Biomedical and Biotechnological Sciences Department, University of Catania, Catania, Italy
- Centre for Advanced Preclinical in vivo Research (CAPiR), University of Catania, Catania, Italy
| | | | - Giada Petringa
- National Laboratory of South, National Institute for Nuclear Physics (LNS-INFN), Catania, Italy
| | - Giusi Irma Forte
- Institute of Molecular Bioimaging and Physiology (IBFM-CNR), Cefalù (PA), Italy
| | - Luigi Minafra
- Institute of Molecular Bioimaging and Physiology (IBFM-CNR), Cefalù (PA), Italy
| | - Valentina Bravatà
- Institute of Molecular Bioimaging and Physiology (IBFM-CNR), Cefalù (PA), Italy
| | - Massimo Gulisano
- Laboratory of Synthetic and Systems Biology, Drug Science Department, University of Catania, Catania, Italy
- Molecular Preclinical and Translational Imaging Research Center (IMPRonTe), University of Catania, Catania, Italy
| | - Fabrizio Scopelliti
- Radiopharmacy Laboratory Nuclear Medicine Department, Cannizzaro Hospital, Catania, Italy
| | - Francesco Tommasino
- Department of Physics, University of Trento, Povo, Italy
- Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute for Nuclear Physics, INFN, Povo, Italy
| | - Emanuele Scifoni
- Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute for Nuclear Physics, INFN, Povo, Italy
| | - Giacomo Cuttone
- National Laboratory of South, National Institute for Nuclear Physics (LNS-INFN), Catania, Italy
| | - Massimo Ippolito
- Nuclear Medicine Department, Cannizzaro Hospital, Catania, Italy
| | - Rosalba Parenti
- Laboratory of Molecular and Cellular Physiology, Biomedical and Biotechnological Sciences Department, University of Catania, Catania, Italy
- Centre for Advanced Preclinical in vivo Research (CAPiR), University of Catania, Catania, Italy
- Molecular Preclinical and Translational Imaging Research Center (IMPRonTe), University of Catania, Catania, Italy
- * E-mail: (FPC); (RP)
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology (IBFM-CNR), Cefalù (PA), Italy
- National Laboratory of South, National Institute for Nuclear Physics (LNS-INFN), Catania, Italy
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Mara E, Clausen M, Khachonkham S, Deycmar S, Pessy C, Dörr W, Kuess P, Georg D, Gruber S. Investigating the impact of alpha/beta and LET d on relative biological effectiveness in scanned proton beams: An in vitro study based on human cell lines. Med Phys 2020; 47:3691-3702. [PMID: 32347564 PMCID: PMC7496287 DOI: 10.1002/mp.14212] [Citation(s) in RCA: 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: 08/19/2019] [Revised: 04/03/2020] [Accepted: 04/13/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE A relative biological effectiveness (RBE) of 1.1 is commonly used in clinical proton therapy, irrespective of tissue type and depth. This in vitro study was conducted to quantify the RBE of scanned protons as a function of the dose-averaged linear energy transfer (LETd ) and the sensitivity factor (α/ß)X . Additionally, three phenomenological models (McNamara, Rørvik, and Jones) and one mechanistic model (repair-misrepair-fixation, RMF) were applied to the experimentally derived data. METHODS Four human cell lines (FaDu, HaCat, Du145, SKMel) with differential (α/ß)X ratios were irradiated in a custom-designed irradiation setup with doses between 0 and 6 Gy at proximal, central, and distal positions of a 80 mm spread-out Bragg peak (SOBP) centered at 80 mm (setup A: proton energies 66.5-135.6 MeV) and 155 mm (setup B: proton energies 127.2-185.9 MeV) depth, respectively. LETd values at the respective cell positions were derived from Monte Carlo simulations performed with the treatment planning system (TPS, RayStation). Dosimetric measurements were conducted to verify dose homogeneity and dose delivery accuracy. RBE values were derived for doses that resulted in 90 % (RBE90 ) and 10 % (RBE10 ) of cell survival, and survival after a 0.5 Gy dose (RBE0.5Gy ), 2 Gy dose (RBE2Gy ), and 6 Gy dose (RBE6Gy ). RESULTS LETd values at sample positions were 1.9, 2.1, 2.5, 2.8, 4.1, and 4.5 keV/µm. For the cell lines with high (α/ß)X ratios (FaDu, HaCat), the LETd did not impact on the RBE. For low (α/ß)X cell lines (Du145, SKMel), LQ-derived survival curves indicated a clear correlation of LETd and RBE. RBE90 values up to 2.9 and RBE10 values between 1.4 and 1.8 were obtained. Model-derived RBE predictions slightly overestimated the RBE for the high (α/ß)X cell lines, although all models except the Jones model provided RBE values within the experimental uncertainty. For low (α/ß)X cell lines, no agreement was found between experiments and model predictions, that is, all models underestimated the measured RBE. CONCLUSIONS The sensitivity parameter (α/ß)X was observed to be a major influencing factor for the RBE of protons and its sensitivity toward LETd changes. RBE prediction models are applicable for high (α/ß)X cell lines but do not estimate RBE values with sufficient accuracy in low (α/ß)X cell lines.
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Affiliation(s)
- Elisabeth Mara
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.,University of Applied Science, Wiener Neustadt, Austria
| | - Monika Clausen
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Suphalak Khachonkham
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.,Division of Radiation Therapy, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Simon Deycmar
- Laboratory of Applied Radiobiology, Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Clara Pessy
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Dörr
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Peter Kuess
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.,EBG MedAustron GmbH, Wiener Neustadt, Austria
| | - Dietmar Georg
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.,EBG MedAustron GmbH, Wiener Neustadt, Austria
| | - Sylvia Gruber
- Department of Radiation Oncology/Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.,EBG MedAustron GmbH, Wiener Neustadt, Austria
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Suckert T, Müller J, Beyreuther E, Azadegan B, Brüggemann A, Bütof R, Dietrich A, Gotz M, Haase R, Schürer M, Tillner F, von Neubeck C, Krause M, Lühr A. High-precision image-guided proton irradiation of mouse brain sub-volumes. Radiother Oncol 2020; 146:205-212. [PMID: 32222488 DOI: 10.1016/j.radonc.2020.02.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 01/31/2020] [Accepted: 02/27/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Proton radiotherapy offers the potential to reduce normal tissue toxicity. However, clinical safety margins, range uncertainties, and varying relative biological effectiveness (RBE) may result in a critical dose in tumor-surrounding normal tissue. To assess potential adverse effects in preclinical studies, image-guided proton mouse brain irradiation and analysis of DNA damage repair was established. MATERIAL AND METHODS We designed and characterized a setup to shape proton beams with 7 mm range in water and 3 mm in diameter and commissioned a Monte Carlo model for in vivo dose simulation. Cone-beam computed tomography and orthogonal X-ray imaging were used to delineate the right hippocampus and position the mice. The brains of three C3H/HeNRj mice were irradiated with 8 Gy and excised 30 min later. Initial DNA double-strand breaks were visualized by staining brain sections for cell nuclei and γH2AX. Imaged sections were analyzed with an automated and validated processing pipeline to provide a quantitative, spatially resolved radiation damage indicator. RESULTS The analyzed DNA damage pattern clearly visualized the radiation effect in the mouse brains and could be mapped to the simulated dose distribution. The proton beam passed the right hippocampus and stopped in the central brain region for all evaluated mice. CONCLUSION We established image-guided proton irradiation of mouse brains. The clinically oriented workflow facilitates (back-) translational studies. Geometric accuracy, detailed Monte Carlo dose simulations, and cell-based assessment enable a biologically and spatially resolved analysis of radiation response and RBE.
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Affiliation(s)
- Theresa Suckert
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Germany
| | - Johannes Müller
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Germany
| | - Elke Beyreuther
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute for Radiation Physics, Germany
| | - Behnam Azadegan
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Anja Brüggemann
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Rebecca Bütof
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Germany
| | - Antje Dietrich
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Germany
| | - Malte Gotz
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Robert Haase
- Myers Lab, Max Planck Institute CBG, Dresden, Germany
| | - Michael Schürer
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Germany
| | - Falk Tillner
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Cläre von Neubeck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Germany; Department of Particle Therapy, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Mechthild Krause
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Germany
| | - Armin Lühr
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Germany; Department of Medical Physics, Faculty of Physics, TU Dort-mund University, Germany.
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Cross-modality applicability of rectal normal tissue complication probability models from photon- to proton-based radiotherapy. Radiother Oncol 2020; 142:253-260. [DOI: 10.1016/j.radonc.2019.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 11/21/2022]
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Ödén J, Toma‐Dasu I, Witt Nyström P, Traneus E, Dasu A. Spatial correlation of linear energy transfer and relative biological effectiveness with suspected treatment‐related toxicities following proton therapy for intracranial tumors. Med Phys 2019; 47:342-351. [DOI: 10.1002/mp.13911] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/07/2019] [Accepted: 11/04/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jakob Ödén
- Department of Physics Medical Radiation Physics Stockholm University Stockholm171 76Sweden
- RaySearch Laboratories AB Stockholm111 34Sweden
| | - Iuliana Toma‐Dasu
- Department of Physics Medical Radiation Physics Stockholm University Stockholm171 76Sweden
- Department of Oncology and Pathology Medical Radiation Physics Karolinska Institutet Stockholm17176Sweden
| | - Petra Witt Nyström
- The Skandion Clinic Uppsala752 37Sweden
- Danish Centre for Particle Therapy Aarhus8200Denmark
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Deycmar S, Faccin E, Kazimova T, Knobel PA, Telarovic I, Tschanz F, Waller V, Winkler R, Yong C, Zingariello D, Pruschy M. The relative biological effectiveness of proton irradiation in dependence of DNA damage repair. Br J Radiol 2019; 93:20190494. [PMID: 31687835 DOI: 10.1259/bjr.20190494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Clinical parameters and empirical evidence are the primary determinants for current treatment planning in radiation oncology. Personalized medicine in radiation oncology is only at the very beginning to take the genetic background of a tumor entity into consideration to define an individual treatment regimen, the total dose or the combination with a specific anticancer agent. Likewise, stratification of patients towards proton radiotherapy is linked to its physical advantageous energy deposition at the tumor site with minimal healthy tissue being co-irradiated distal to the target volume. Hence, the fact that photon and proton irradiation also induce different qualities of DNA damages, which require differential DNA damage repair mechanisms has been completely neglected so far. These subtle differences could be efficiently exploited in a personalized treatment approach and could be integrated into personalized treatment planning. A differential requirement of the two major DNA double-strand break repair pathways, homologous recombination and non-homologous end joining, was recently identified in response to proton and photon irradiation, respectively, and subsequently influence the mode of ionizing radiation-induced cell death and susceptibility of tumor cells with defects in DNA repair machineries to either quality of ionizing radiation.This review focuses on the differential DNA-damage responses and subsequent biological processes induced by photon and proton irradiation in dependence of the genetic background and discusses their impact on the unicellular level and in the tumor microenvironment and their implications for combined treatment modalities.
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Affiliation(s)
- Simon Deycmar
- Laboratory for Applied Radiobiology Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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de Leve S, Wirsdörfer F, Jendrossek V. The CD73/Ado System-A New Player in RT Induced Adverse Late Effects. Cancers (Basel) 2019; 11:cancers11101578. [PMID: 31623231 PMCID: PMC6827091 DOI: 10.3390/cancers11101578] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy (RT) is a central component of standard treatment for many cancer patients. RT alone or in multimodal treatment strategies has a documented contribution to enhanced local control and overall survival of cancer patients, and cancer cure. Clinical RT aims at maximizing tumor control, while minimizing the risk for RT-induced adverse late effects. However, acute and late toxicities of IR in normal tissues are still important biological barriers to successful RT: While curative RT may not be tolerable, sub-optimal tolerable RT doses will lead to fatal outcomes by local recurrence or metastatic disease, even when accepting adverse normal tissue effects that decrease the quality of life of irradiated cancer patients. Technical improvements in treatment planning and the increasing use of particle therapy have allowed for a more accurate delivery of IR to the tumor volume and have thereby helped to improve the safety profile of RT for many solid tumors. With these technical and physical strategies reaching their natural limits, current research for improving the therapeutic gain of RT focuses on innovative biological concepts that either selectively limit the adverse effects of RT in normal tissues without protecting the tumor or specifically increase the radiosensitivity of the tumor tissue without enhancing the risk of normal tissue complications. The biology-based optimization of RT requires the identification of biological factors that are linked to differential radiosensitivity of normal or tumor tissues, and are amenable to therapeutic targeting. Extracellular adenosine is an endogenous mediator critical to the maintenance of homeostasis in various tissues. Adenosine is either released from stressed or injured cells or generated from extracellular adenine nucleotides by the concerted action of the ectoenzymes ectoapyrase (CD39) and 5′ ectonucleotidase (NT5E, CD73) that catabolize ATP to adenosine. Recent work revealed a role of the immunoregulatory CD73/adenosine system in radiation-induced fibrotic disease in normal tissues suggesting a potential use as novel therapeutic target for normal tissue protection. The present review summarizes relevant findings on the pathologic roles of CD73 and adenosine in radiation-induced fibrosis in different organs (lung, skin, gut, and kidney) that have been obtained in preclinical models and proposes a refined model of radiation-induced normal tissue toxicity including the disease-promoting effects of radiation-induced activation of CD73/adenosine signaling in the irradiated tissue environment. However, expression and activity of the CD73/adenosine system in the tumor environment has also been linked to increased tumor growth and tumor immune escape, at least in preclinical models. Therefore, we will discuss the use of pharmacologic inhibition of CD73/adenosine-signaling as a promising strategy for improving the therapeutic gain of RT by targeting both, malignant tumor growth and adverse late effects of RT with a focus on fibrotic disease. The consideration of the therapeutic window is particularly important in view of the increasing use of RT in combination with various molecularly targeted agents and immunotherapy to enhance the tumor radiation response, as such combinations may result in increased or novel toxicities, as well as the increasing number of cancer survivors.
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Affiliation(s)
- Simone de Leve
- Institute of Cell Biology (Cancer Research), University Hospital Essen, 45122 Essen, Germany.
| | - Florian Wirsdörfer
- Institute of Cell Biology (Cancer Research), University Hospital Essen, 45122 Essen, Germany.
| | - Verena Jendrossek
- Institute of Cell Biology (Cancer Research), University Hospital Essen, 45122 Essen, Germany.
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Affiliation(s)
- Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Ludvig Paul Muren
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Cai Grau
- Department of Oncology and Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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