Quantitative investigation of physical factors contributing to gold nanoparticle-mediated proton dose enhancement

Radiosensitization with metallic nanoparticles under MeV proton beams: local dose enhancement

In addition to specific dosimetric properties of protons, their higher biological effectiveness makes them superior to X-rays and gamma radiation, in radiation therapy. In recent years, enrichment of tumours with metallic nanoparticles as radiosensitizer agents has generated high interest, with several studies attempting to confirm the efficacy of nanoparticles in proton therapy. In the present study Geant4 Monte Carlo (MC) code was used to quantify the increased nanoscopic dose deposition of 50 nm metallic nanoparticles including gold, bismuth, iridium, and gadolinium in water upon exposure to 5, 25, and 50 MeV protons. Dose enhancement factors, radial dose distributions in nano-scale, as well as secondary electron and photon energy spectra were calculated for the studied nanoparticles and proton beams. The obtained results demonstrated that in the presence of metallic nanoparticles an increase in proton energy leads to a decrease in secondary electron and photon production yield. Additionally, an increase in the radial dose enhancement factor from 1.4 to 16 was calculated for the studied nanoparticles when the proton energy was increased from 5 to 50 MeV. It is concluded that the dosimetric advantages of proton beams could be improved significantly in the presence of metallic nanoparticles.

An Optimized Method for Evaluating the Potential Gd-Nanoparticle Dose Enhancement Produced by Electronic Brachytherapy

This work reports an optimized method to experimentally quantify the Gd-nanoparticle dose enhancement generated by electronic brachytherapy. The dose enhancement was evaluated considering energy beams of 50 kVp and 70 kVp, determining the Gd-nanoparticle concentration ranges that would optimize the process for each energy. The evaluation was performed using delaminated radiochromic films and a Poly(methyl methacrylate) (PMMA) phantom covered on one side by a thin 2.5 μm Mylar filter acting as an interface between the region with Gd suspension and the radiosensitive film substrate. The results for the 70 kVp beam quality showed dose increments of 6±6%, 22±7%, and 9±7% at different concentrations of 10, 20, and 30 mg/mL, respectively, verifying the competitive mechanisms of enhancement and attenuation. For the 50 kVp beam quality, no increase in dose was recorded for the concentrations studied, indicating that the major contribution to enhancement is from the K-edge interaction. In order to separate the contributions of attenuation and enhancement to the total dose, measurements were replicated with a 12 μm Mylar filter, obtaining a dose enhancement attributable to the K-edge of 29±7% and 34±7% at 20 and 30 mg/mL, respectively, evidencing a significant additional dose proportional to the Gd concentration.

Prospects of nanoparticle-based radioenhancement for radiotherapy

Radiotherapy is a key pillar of solid cancer treatment. Despite a high level of conformal dose deposition, radiotherapy is limited due to co-irradiation of organs at risk and subsequent normal tissue toxicities. Nanotechnology offers an attractive opportunity for increasing the efficacy and safety of cancer radiotherapy. Leveraging the freedom of design and the growing synthetic capabilities of the nanomaterial-community, a variety of engineered nanomaterials have been designed and investigated as radiosensitizers or radioenhancers. While research so far has been primarily focused on gold nanoparticles and other high atomic number materials to increase the absorption cross section of tumor tissue, recent studies are challenging the traditional concept of high-Z nanoparticle radioenhancers and highlight the importance of catalytic activity. This review provides a concise overview on the knowledge of nanoparticle radioenhancement mechanisms and their quantification. It critically discusses potential radioenhancer candidate materials and general design criteria for different radiation therapy modalities, and concludes with research priorities in order to advance the development of nanomaterials, to enhance the efficacy of radiotherapy and to increase at the same time the therapeutic window.

Surface Chemistry and Specific Surface Area Rule the Efficiency of Gold Nanoparticle Sensitizers in Proton Therapy

Gold nanoparticles (AuNPs) are currently the most studied radiosensitizers in proton therapy (PT) applicable for the treatment of solid tumors, where they amplify production of reactive oxygen species (ROS). However, it is underexplored how this amplification is correlated with the AuNPs' surface chemistry. To clarify this issue, we fabricated ligand-free AuNPs of different mean diameters by laser ablation in liquids (LAL) and laser fragmentation in liquids (LFL) and irradiated them with clinically relevant proton fields by using water phantoms. ROS generation was monitored by the fluorescent dye 7-OH-coumarin. Our findings reveal an enhancement of ROS production driven by I) increased total particle surface area, II) utilization of ligand-free AuNPs avoiding sodium citrate as a radical quencher ligands, and III) a higher density of structural defects generated by LFL synthesis, indicated by surface charge density. Based on these findings it may be concluded that the surface chemistry is a major and underexplored contributor to ROS generation and sensitizing effects of AuNPs in PT. We further highlight the applicability of AuNPs in vitro in human medulloblastoma cells.

The radiosensitizing effect of platinum nanoparticles in proton irradiations is not caused by an enhanced proton energy deposition at the macroscopic scale

Objective. Due to the radiosensitizing effect of biocompatible noble metal nanoparticles (NPs), their administration is considered to potentially increase tumor control in radiotherapy. The underlying physical, chemical and biological mechanisms of the NPs’ radiosensitivity especially when interacting with proton radiation is not conclusive. In the following work, the energy deposition of protons in matter containing platinum nanoparticles (PtNPs) is experimentally investigated. Approach. Surfactant-free monomodal PtNPs with a mean diameter of (40 ± 10) nm and a concentration of 300 μg ml−1, demonstrably leading to a substantial production of reactive oxygen species (ROS), were homogeneously dispersed into cubic gelatin samples serving as tissue-like phantoms. Gelatin samples without PtNPs were used as control. The samples’ dimensions and contrast of the PtNPs were verified in a clinical computed tomography scanner. Fields from a clinical proton machine were used for depth dose and stopping power measurements downstream of both samples types. These experiments were performed with a variety of detectors at a pencil beam scanning beam line as well as a passive beam line with proton energies from about 56–200 MeV. Main results. The samples’ water equivalent ratios in terms of proton stopping as well as the mean proton energy deposition downstream of the samples with ROS-producing PtNPs compared to the samples without PtNPs showed no differences within the experimental uncertainties of about 2%. Significance. This study serves as experimental proof that the radiosensitizing effect of biocompatible PtNPs is not due to a macroscopically increased proton energy deposition, but is more likely caused by a catalytic effect of the PtNPs. Thus, these experiments provide a contribution to the highly discussed radiobiological question of the proton therapy efficiency with noble metal NPs and facilitate initial evidence that the dose calculation in treatment planning is straightforward and not affected by the presence of sensitizing PtNPs.

Gafchromic™ EBT3 Film Measurements of Dose Enhancement Effects by Metallic Nanoparticles for 192Ir Brachytherapy, Proton, Photon and Electron Radiotherapy

Interest in combining metallic nanoparticles, such as iron (SPIONs), gold (AuNPs) and bismuth oxide (BiONPs), with radiotherapy has increased due to the promising therapeutic advantages. While the underlying physical mechanisms of NP-enhanced radiotherapy have been extensively explored, only a few research works were motivated to quantify its contribution in an experimental dosimetry setting. This work aims to explore the feasibility of radiochromic films to measure the physical dose enhancement (DE) caused by the release of secondary electrons and photons during NP–radiotherapy interactions. A 10 mM each of SPIONs, AuNPs or BiONPs was loaded into zipper bags packed with GAFCHROMIC™ EBT3 films. The samples were exposed to a single radiation dose of 4.0 Gy with clinically relevant beams. Scanning was conducted using a flatbed scanner in red-component analysis for optimum sensitivity. Experimental dose enhancement factors (DEFExperimental) were then calculated using the ratio of absorbed doses (with/without NPs) converted from the films’ calibration curves. DEFExperimental for all NPs showed no significant physical DE beyond the uncertainty limits (p > 0.05). These results suggest that SPIONs, AuNPs and BiONPs might potentially enhance the dose in these clinical beams. However, changes in NPs concentration, as well as dosimeter sensitivity, are important to produce observable impact.

Enhancement of Proton Therapy Efficiency by Noble Metal Nanoparticles Is Driven by the Number and Chemical Activity of Surface Atoms

Proton-based radiotherapy is a modern technique for the treatment of solid tumors with significantly reduced side effects to adjacent tissues. Biocompatible nanoparticles (NPs) with high atomic numbers are known to serve as sensitizers and to enhance treatment efficacy, which is commonly believed to be attributed to the generation of reactive oxygen species (ROS). However, little systematic knowledge is available on how either physical effects due to secondary electron generation or the particle surface chemistry affect ROS production. Thereto, ligand-free colloidal platinum (Pt) and gold (Au) NPs with well-controlled particle size distributions and defined total surface area are proton-irradiated. A fluorescence-based assay is developed to monitor the formation of ROS using terephthalic acid as a cross-effect-free dye. The findings indicate that proton irradiation (PI)-induced ROS formation sensitized by noble metal NPs is driven by the total available particle surface area rather than particle size or mass. Furthermore, a distinctive material effect with Pt being more active than Au is observed which clearly indicates that the chemical reactivity of the NP surface is a main contributor to ROS generation upon PI. These results pave the way towards an in-depth understanding of the NP-induced sensitizing effects upon PI and hence a well-controlled enhanced therapy.

Experimental determination of Gd dose enhancement and Gd dose sparing by 192Ir brachytherapy source with Gafchromic EBT3 dosimeter

This work evaluates experimentally the dose enhancement factor (DEF) and dose sparing factor (DSF) due to radiation self-shielding, produced by Gd infused in tumor phantom irradiated with brachytherapy HDR ¹⁹²Ir source by Gafchromic EBT3 dosimeter. The phantom was made of a set of solid water slabs (30 × 30 × 1.0) cm³ and three acrylic slabs of (30 × 30 × 0.5) cm³ machined to contain in the central axis acrylics vials of (1 × 1 × 5) cm³. The first and second acrylic vials were filled with an identical Gd solution of 0, 10 and 20 mg/ml, simulating Gd-doped and undoped tumor, and the third vial was filled in all the measurement only with water, representing an organ at risk. Additional solid water slabs were used to complete a phantom of (30 × 30 × 16) cm³. In the phantom center an acrylic slab was machined to introduce the 2.5 mm flexible guide tube of GammaMed plus iX equipment and positioning the ¹⁹²Ir source in the phantom central part. EBT3 fragments of (0.9 × 4) cm² were placed on the inner edge of the second and third vials to measure dose enhancement and dose sparing simultaneously. Phantom CT images were acquired for planning and to prescribe a dose of 6.0 Gy at 2.0 cm of the source, achieving an isodose curve of 44.5% at 3.0 cm (positions of the EBT3 films). Additionally, Monte Carlo simulation of the identical experimental setup was implemented to compare measurement values. The results showed the feasibility of measuring a DEF of 1.15 ± 0.05 in 20 mg/ml of Gd concentration consistent with the Monte Carlo DEF of 1.112 ± 0.005 for the same concentration. DEF value for concentration of 10 mg/ml would not be detected (1.00 ± 0.04) by an expected under measurement of the EBT3 films associated with the non-detection of photoelectrons and Auger electrons of very low energy that cannot reach the radiosensitive substrate.

Advancements in the use of Auger electrons in science and medicine during the period 2015-2019

Auger electrons can be highly radiotoxic when they are used to irradiate specific molecular sites. This has spurred basic science investigations of their radiobiological effects and clinical investigations of their potential for therapy. Focused symposia on the biophysical aspects of Auger processes have been held quadrennially. This 9th International Symposium on Physical, Molecular, Cellular, and Medical Aspects of Auger Processes at Oxford University brought together scientists from many different fields to review past findings, discuss the latest studies, and plot the future work to be done. This review article examines the research in this field that was published during the years 2015-2019 which corresponds to the period since the last meeting in Japan. In addition, this article points to future work yet to be done. There have been a plethora of advancements in our understanding of Auger processes. These advancements range from basic atomic and molecular physics to new ways to implement Auger electron emitters in radiopharmaceutical therapy. The highly localized doses of radiation that are deposited within a 10 nm of the decay site make them precision tools for discovery across the physical, chemical, biological, and medical sciences.

Gold Nanoparticles as a Potent Radiosensitizer: A Transdisciplinary Approach from Physics to Patient

Over the last decade, a growing interest in the improvement of radiation therapies has led to the development of gold-based nanomaterials as radiosensitizer. Although the radiosensitization effect was initially attributed to a dose enhancement mechanism, an increasing number of studies challenge this mechanistic hypothesis and evidence the importance of chemical and biological contributions. Despite extensive experimental validation, the debate regarding the mechanism(s) of gold nanoparticle radiosensitization is limiting its clinical translation. This article reviews the current state of knowledge by addressing how gold nanoparticles exert their radiosensitizing effects from a transdisciplinary perspective. We also discuss the current and future challenges to go towards a successful clinical translation of this promising therapeutic approach.

Mechanisms of nanoparticle radiosensitization

Metal-based nanoparticles applied to potentiating the effects of radiotherapy have drawn significant attention from the research community and are now available clinically. By improving our mechanistic understanding, nanoparticles are likely to evolve to provide very significant improvements in radiotherapy outcomes with only incremental increase in cost. This review critically assesses the inconsistent observations surrounding physical, physicochemical, chemical and biological mechanisms of radiosensitization. In doing so, a number of needs are identified for continuing research and are highlighted. The large degree of variability from one nanoparticle to another emphasizes that it is a mistake to generalize nanoparticle radiosensitizer mechanisms. Nanoparticle formulations should be considered in an analogous way as pharmacological agents and as a broad class of therapeutic agents, needing to be considered with a high degree of individuality with respect to their interactions and ultimate impact on radiobiological response. In the same way that no universal anti-cancer drug exists, it is unlikely that a single nanoparticle formulation will lead to the best therapeutic outcomes for all cancers. The high degree of complexity and variability in mechanistic action provides notable opportunities for nanoparticle formulations to be optimized for specific indications. This article is categorized under: Therapeutic Approaches and Drug Discovery > Emerging Technologies Nanotechnology Approaches to Biology > Nanoscale Systems in Biology.

Modelling Spatial Scales of Dose Deposition and Radiolysis Products from Gold Nanoparticle Sensitisation of Proton Therapy in A Cell: From Intracellular Structures to Adjacent Cells

Gold nanoparticle (GNP) enhanced proton therapy is a promising treatment concept offering increased therapeutic effect. It has been demonstrated in experiments which provided indications that reactive species play a major role. Simulations of the radiolysis yield from GNPs within a cell model were performed using the Geant4 toolkit. The effect of GNP cluster size, distribution and number, cell and nuclear membrane absorption and intercellular yields were evaluated. It was found that clusters distributed near the nucleus increased the nucleus yield by 91% while reducing the cytoplasm yield by 7% relative to a disperse distribution. Smaller cluster sizes increased the yield, 200 nm clusters had nucleus and cytoplasm yields 117% and 35% greater than 500 nm clusters. Nuclear membrane absorption reduced the cytoplasm and nucleus yields by 8% and 35% respectively to a permeable membrane. Intercellular enhancement was negligible. Smaller GNP clusters delivered near sub-cellular targets maximise radiosensitisation. Nuclear membrane absorption reduces the nucleus yield, but can damage the membrane providing another potential pathway for biological effect. The minimal effect on adjacent cells demonstrates that GNPs provide a targeted enhancement for proton therapy, only effecting cells with GNPs internalised. The provided quantitative data will aid further experiments and clinical trials.

The effects of a transverse magnetic field on the dose enhancement of nanoparticles in a proton beam: a Monte Carlo simulation

High-Z nanoparticles (NP) as radio-sensitization agents provide the feasibility of dose localization within the tumor in radiotherapy. Dose enhancement of NPs in the presence of a magnetic field (MF) could be challenged when magnetic resonance imaging (MRI) systems are used as an image-guided system. The MF can influence dose enhancement of NPs at their interfaces and surrounding medium and affect their dose deposition behavior. In the TOPAS Monte Carlo code, gold nanoparticle (GNP) and superparamagnetic iron oxide nanoparticle (SPION) were irradiated using 70 and 150 MeV proton beams, in presence of transverse MF strengths with 0, 1, 3, and 7 T. The changes in the liberated secondary electrons from NPs and their dose enhancement ratio (DER), magnetic dose enhancement ratio (MDER), and angular dose distribution in 10 nm shell thicknesses up to 500 nanometers from their centers were measured. The central plane of NPs was considered as a scorer. Its thickness was 2 nm and divided into 6-degree sectors with 10 nm radial length. The dose deposition in this voxelated scorer was calculated. The values of the deposited doses around NPs decrease rapidly while the DERs resulted from the secondary electrons are increased. MDERs are changed within [Formula: see text] and [Formula: see text] for 20 and 50 nm radius NPs, respectively. The variation in the angular dose distribution around a singular NP was not considerable when different MF strengths were applied. The dose values in the voxelated central plane show very similar results for the same NPs types in the different MF strengths. The typically used MF in the MRI systems would not considerably affect the energy deposition behavior of the secondary electrons produced in the interaction of proton beam with NPs, at least in the near vicinity of NPs. The DERs of NPs in a water medium resulted from emerged secondary electrons, experience a low degree of perturbation in the presence of an MF. The results of this study show that the NPs as dose enhancement agents can also be used in an MF without pronounced modification in their efficacy.

Gold Nanoparticle Enhanced Proton Therapy: Monte Carlo Modeling of Reactive Species' Distributions Around a Gold Nanoparticle and the Effects of Nanoparticle Proximity and Clustering

Gold nanoparticles (GNPs) are promising radiosensitizers with the potential to enhance radiotherapy. Experiments have shown GNP enhancement of proton therapy and indicated that chemical damage by reactive species plays a major role. Simulations of the distribution and yield of reactive species from 10 ps to 1 µs produced by a single GNP, two GNPs in proximity and a GNP cluster irradiated with a proton beam were performed using the Geant4 Monte Carlo toolkit. It was found that the reactive species distribution at 1 µs extended a few hundred nm from a GNP and that the largest enhancement occurred over 50 nm from the nanoparticle. Additionally, the yield for two GNPs in proximity and a GNP cluster was reduced by up to 17% and 60% respectively from increased absorption. The extended range of action from the diffusion of the reactive species may enable simulations to model GNP enhanced proton therapy. The high levels of absorption for a large GNP cluster suggest that smaller clusters and diffuse GNP distributions maximize the total radiolysis yield within a cell. However, this must be balanced against the high local yields near a cluster particularly if the cluster is located adjacent to a biological target.

Experimental determination of the gadolinium dose enhancement in phantom irradiated with low energy X-ray sources by a spectrophotometer -Gafchromic-EBT3 dosimetry system

This work reports the experimental determination of dose enhancement produced in phantoms containing target volumes doped with Gadolinium and irradiated with low-energy X-ray beams. EBT3 Gafchromic films were immersed into 5 ml target volumes to simulate tumor filling with 100% ultra-pure water (blank sample) and ultra-pure water infused with Gd solution (Omniscan®) in different concentration (9-24 mg/ml). The dose enhancement due to excitation of Gd K-edge (50.2 keV) was evaluated in terms of the increment in optical density, obtained by a Spectrophotometer-Gafchromic-EBT3 dosimetry system calibrated in terms of the dose-response for 1-8 Gy range. The dose enhancement was evaluated in two condition: a beam quality with spectrum above the absorption edge in a medium with and without Gd; and two beam qualities (above and below the absorption edge) in a medium with a fixed Gd concentration (18 mg/ml). The obtained results confirmed increments in relative dose enhancement according to Gd concentrations up to 18 mg/ml, with a dose enhancement of 1.1 Gy and an average percentage enhancement of 28.4%. For higher values of concentration, the attenuation interaction of the primary beam is more relevant instead of dose enhancement process. On the other hand, the dose enhancement obtained to comparison the spectra above and below the absorption edge, shown results up to 3.3 Gy of enhancement and average percentage enhancement of 88%.

Antibody-functionalized gold nanoparticles as tumor-targeting radiosensitizers for proton therapy

AIM

This study aimed at developing antibody-functionalized gold nanoparticles (AuNPs) to selectively target cancer cells and probing their potential radiosensitizing effects under proton irradiation.

MATERIALS & METHODS

AuNPs were conjugated with cetuximab (Ctxb-AuNPs). Ctxb-AuNP uptake was evaluated by transmission electron microscopy and atomic absorption spectroscopy. Radioenhancing effect was assessed using conventional clonogenic assay.

RESULTS & CONCLUSION

Ctxb-AuNPs specifically bound to and accumulated in EGFR-overexpressing A431 cells, compared with EGFR-negative MDA-MB-453 cells. Ctxb-AuNPs enhanced the effect of proton irradiation in A431 cells but not in MDA-MB-453 cells. These data indicate, for the first time, that combining enhanced uptake by specific targeting and radioenhancing effect, using conjugated AuNPs, is a promising strategy to increase cell killing by protontherapy.

Feasibility of dose enhancement assessment: Preliminary results by means of Gd-infused polymer gel dosimeter and Monte Carlo study

This work reports the experimental development of an integral Gd-infused dosimeter suitable for Gd dose enhancement assessment along with Monte Carlo simulations applied to determine the dose enhancement by radioactive and X-ray sources of interest in conventional and electronic brachytherapy. In this context, capability to elaborate a stable and reliable Gd-infused dosimeter was the first goal aimed at direct and accurate measurements of dose enhancement due to Gd presence. Dose-response was characterized for standard and Gd-infused PAGAT polymer gel dosimeters by means of optical transmission/absorbance. The developed Gd-infused PAGAT dosimeters demonstrated to be stable presenting similar dose-response as standard PAGAT within a linear trend up to 13 Gy along with good post-irradiation readout stability verified at 24 and 48 h. Additionally, dose enhancement was evaluated for Gd-infused PAGAT dosimeters by means of Monte Carlo (PENELOPE) simulations considering scenarios for isotopic and X-ray generator sources. The obtained results demonstrated the feasibility of obtaining a maximum enhancement around of (14 ± 1)% for ¹⁹²Ir source and an average enhancement of (70 ± 13)% for ²⁴¹Am. However, dose enhancement up to (267 ± 18)% may be achieved if suitable filtering is added to the ²⁴¹Am source. On the other hand, optimized X-ray spectra may attain dose enhancements up to (253 ± 22) %, which constitutes a promising future alternative for replacing radioactive sources by implementing electronic brachytherapy achieving high dose levels.

Nanoparticle radio-enhancement: principles, progress and application to cancer treatment

Enhancement of radiation effects by high-atomic number nanoparticles (NPs) has been increasingly studied for its potential to improve radiotherapeutic efficacy. The underlying principle of NP radio-enhancement is the potential to release copious electrons into a nanoscale volume, thereby amplifying radiation-induced biological damage. While the vast majority of studies to date have focused on gold nanoparticles with photon radiation, an increasing number of experimental, theoretical and simulation studies have explored opportunities offered by other NPs (e.g. gadolinium, platinum, iron oxide, hafnium) and other therapeutic radiation sources such as ion beams. It is thus of interest to the research community to consolidate findings from the different studies and summarise progress to date, as well as to identify strategies that offer promising opportunities for clinical translation. This is the purpose of this Topical Review.

Modelling direct DNA damage for gold nanoparticle enhanced proton therapy

Gold nanoparticles have been proven as potential radiosensitizer when combined with protons. Initially the radiosensitization effect was attributed to the physical interactions of radiation with the gold and the production of secondary electrons that induce DNA damage. However, emerging data challenge this hypothesis, supporting the existence of alternative or supplementary radiosensitization mechanisms. In this work we incorporate a realistic cell model with detailed DNA geometry and a realistic gold nanoparticle biodistribution based on experimental data. The DNA single and double strand breaks, and damage complexity are counted under various scenarios of different gold nanoparticle size, biodistribution and concentration, and proton energy. The locality of the effect, i.e. the existence of higher damage at a location close to the gold distribution, is also addressed by investigating the DNA damage at a chromosomal territory. In all the cases we do not observe any significant increase in the single/double strand break yield or damage complexity in the presence of gold nanoparticles under proton irradiation; nor there is a locality to the effect. Our results show for the first time that the physical interactions of protons with the gold nanoparticles should not be considered directly responsible for the observed radiosensitization effect. The model used only accounts for DNA damage from direct interactions, whilst considering the indirect effect, and it is possible the radiosensitization effect to be due to other physical effects, although we consider that possibility unlikely. Our conclusion suggests that other mechanisms might have greater contribution to the radiosensitization effect and further investigation should be conducted.

Particle therapy and nanomedicine: state of art and research perspectives

Cancer radiation therapy with charged particle beams, called particle therapy, is a new therapeutic treatment presenting major advantages when compared to conventional radiotherapy. Because ions have specific ballistic properties and a higher biological effectiveness, they are superior to x-rays. Numerous medical centres are starting in the world using mostly protons but also carbon ions as medical beams. Several investigations are attempting to reduce the cost/benefit ratio and enlarge the range of therapeutic indications. A major limitation of particle therapy is the presence of low but significant damage induced in healthy tissues located at the entrance of the ion track prior to reaching the tumour. It is thus a major challenge to improve the targeting of the tumours, concentrating radiation effects in the malignance. A novel strategy, based on the addition of nanoparticles targeting the tumour, was suggested over a decade ago to improve the performance of conventional photon therapy. Recently, similar developments have emerged for particle therapy and the amount of research is now exploding. In this paper, we review the experimental results, as well as theoretical and simulation studies that shed light in the promising outcomes of this strategy and in the underpinning mechanisms. Several experiments provide consistent evidence of significant enhancement of ion radiation effects in the presence of nanoparticles. In view of implementing this strategy for cancer treatment, simulation studies have begun to establish the rationale and the specificity of this effect. In addition, these studies will help to outline a list of possible mechanisms and to predict the impact of ion beams and nanoparticle characteristics. Many questions remain unsolved, but the findings of these first studies are encouraging and open new challenges. After summarizing the main results in the field, we propose a roadmap to pursue future research with the aim to strengthen the potential interplay between particle therapy and nanomedicine.

Metallic nanoparticles irradiated by low-energy protons for radiation therapy: Are there significant physical effects to enhance the dose delivery?

PURPOSE

To identify which physical properties of nanoparticles are correlated with the survival fraction of cells exposed in vitro to low-energy protons in combination with nanoparticles.

METHODS

The Geant4 simulation toolkit (version 10.3) was used to model nanoparticles of different sizes (5-50 nm) and materials (Ti, Zr, Hf, Ta, Au, Pt), with or without an organic capping ensuring biocompatibility and to irradiate them with 1.3 or 4 MeV protons and 5.3 MeV alpha particles. The spectra of secondary electrons inside and at the nanoparticle surface were computed, as well as electron yields, Auger and organic capping contribution, trapping in metal bulk and linear energy transfer profiles as a function of distance from the nanoparticle center. In a next step, an in silico cell model was designed and loaded with gold nanoparticles, according to experimental uptake values. Dose to the cell was evaluated macroscopically and microscopically in 100 × 100 × 100 nm³ voxels for different radiation qualities.

RESULTS

The cell geometry showed that radiation enhancement is negligible for the gold concentration used and for any radiation quality. However, when the single nanoparticle geometry is considered, we observed a local LET in its vicinity considerably higher than for the water equivalent case (up to 5 keV/μm at the titanium nanoparticle surface compared to 2.5 keV/μm in the water case). The yield of secondary electrons per primary interaction with 1.3 MeV protons was found to be most favorable for titanium (1.54), platinum (1.44), and gold (1.32), although results for higher Z metals are probably underestimated due to the incomplete simulation of de-excitation cascade in outer shells. It was also found that the organic capping contributed mostly to the production of low-energy electrons, adding a spike of dose near the nanoparticle surface. Indeed, the yield for the coated gold nanoparticle increased to 1.53 when exposed to 1.3 MeV protons. Although most electrons are retained inside larger nanoparticles (50 nm), it was shown that their yield is comparable to smaller sizes and that the linear energy transfer profile is better. From a combination of ballistic and nanoparticle size factors, it was concluded that 10-nm gold nanoparticles were better inducers of additional cell killing than 5-nm gold nanoparticles, matching our previous in vitro study.

CONCLUSIONS

Although effects from a physical standpoint are limited, the high linear energy transfer profile at the nanoparticle surface generates detrimental events in the cell, in particular ROS-induced damage and local heating.

Evaluation of the microscopic dose enhancement for nanoparticle-enhanced Auger therapy

The aim of this study is to investigate the dosimetric characteristics of nanoparticle-enhanced Auger therapy. Monte Carlo (MC) simulations were performed to assess electron energy spectra and dose enhancement distributions around a nanoparticle. In the simulations, two types of nanoparticle structures were considered: nanoshell and nanosphere, both of which were assumed to be made of one of five elements (Fe, Ag, Gd, Au, and Pt) in various sizes (2-100 nm). Auger-electron emitting radionuclides (I-125, In-111, and Tc-99m) were simulated within a nanoshell or on the surface of a nanosphere. For the most promising combination of Au and I-125, the maximum dose enhancement was up to 1.3 and 3.6 for the nanoshell and the nanosphere, respectively. The dose enhancement regions were restricted within 20-100 nm and 0-30 nm distances from the surface of Au nanoshell and nanosphere, respectively. The dose enhancement distributions varied with sizes of nanoparticles, nano-elements, and radionuclides and thus should be carefully taken into account for biological modeling. If the nanoparticles are accumulated in close proximity to the biological target, this new type of treatment can deliver an enhanced microscopic dose to the target (e.g. DNA). Therefore, we conclude that Auger therapy combined with nanoparticles could have the potential to provide a better therapeutic effect than conventional Auger therapy alone.

Development of bimetallic (Zn@Au) nanoparticles as potential PET-imageable radiosensitizers

PURPOSE

Gold nanoparticles (GNPs) are being investigated actively for various applications in cancer diagnosis and therapy. As an effort to improve the imaging of GNPs in vivo, the authors developed bimetallic hybrid Zn@Au NPs with zinc cores and gold shells, aiming to render them in vivo visibility through positron emission tomography (PET) after the proton activation of the zinc core as well as capability to induce radiosensitization through the secondary electrons produced from the gold shell when irradiated by various radiation sources.

METHODS

Nearly spherical zinc NPs (∼5-nm diameter) were synthesized and then coated with a ∼4.25-nm gold layer to make Zn@Au NPs (∼13.5-nm total diameter). 28.6 mg of these Zn@Au NPs was deposited (∼100 μm thick) on a thin cellulose target and placed in an aluminum target holder and subsequently irradiated with 14.15-MeV protons from a GE PETtrace cyclotron with 5-μA current for 5 min. After irradiation, the cellulose matrix with the NPs was placed in a dose calibrator to assess the induced radioactivity. The same procedure was repeated with 8-MeV protons. Gamma ray spectroscopy using an high-purity germanium detector was conducted on a very small fraction (<1 mg) of the irradiated NPs for each proton energy. In addition to experimental measurements, Monte Carlo simulations were also performed with radioactive Zn@Au NPs and solid GNPs of the same size irradiated with 160-MeV protons and 250-kVp x-rays.

RESULTS

The authors measured 168 μCi of activity 32 min after the end of bombardment for the 14.15-MeV proton energy sample using the (66)Ga setting on a dose calibrator; activity decreased to 2 μCi over a 24-h period. For the 8-MeV proton energy sample, PET imaging was additionally performed for 5 min after a 12-h delay. A 12-h gamma ray spectrum showed strong peaks at 511 keV (2.05 × 10(6) counts) with several other peaks of smaller magnitude for each proton energy sample. PET imaging showed strong PET signals from mostly decaying (66)Ga. The Monte Carlo results showed that radioactive Zn@Au NPs and solid GNPs provided similar characteristics in terms of their secondary electron spectra when irradiated.

CONCLUSIONS

The Zn@Au NPs developed in this investigation have the potential to be used as PET-imageable radiosensitizers for radiotherapy applications as well as PET tracers for molecular imaging applications.