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Glowa C, Bendinger AL, Euler-Lange R, Peschke P, Brons S, Debus J, Karger CP. Irradiation with Carbon Ions Effectively Counteracts Hypoxia-related Radioresistance in a Rat Prostate Carcinoma. Int J Radiat Oncol Biol Phys 2024; 120:875-883. [PMID: 38750905 DOI: 10.1016/j.ijrobp.2024.05.004] [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: 01/08/2024] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE Hypoxia in tumors is associated with increased malignancy and resistance to conventional photon radiation therapy. This study investigated the potential of particle therapy to counteract radioresistance in syngeneic rat prostate carcinoma. METHODS AND MATERIALS Subcutaneously transplanted R3327-HI tumors were irradiated with photons or carbon ions under acute hypoxic conditions, induced by clamping the tumor-supplying artery 10 min before and during irradiation. Dose-response curves were determined for the endpoint "local tumor control within 300 days" and compared with previously published data acquired under oxic conditions. Doses at 50% tumor control probability (TCD50) were used to quantify hypoxia-induced radioresistance relative to that under oxic conditions and also to quantify the increased effectiveness of carbon ions under oxic and hypoxic conditions relative to photons. RESULTS Compared with those under oxic conditions, TCD50 values under hypoxic conditions increased by a factor of 1.53 ± 0.08 for photons and by a factor of 1.28 ± 0.06 for carbon ions (oxygen enhancement ratio). Compared with those for photons, TCD50 values for carbon ions decreased by a factor of 2.08 ± 0.13 under oxic conditions and by a factor of 2.49 ± 0.08 under hypoxic conditions (relative biological effectiveness). While the slope of the photon dose-response curves increased when changing from oxic to hypoxic conditions, the slopes were steeper and remained unchanged for carbon ions. CONCLUSIONS The reduced oxygen enhancement ratio of carbon ions indicated that the required dose increase in hypoxic tumors was 17% lower for carbon ions than for photons. Additionally, carbon ions reduced the effect of intertumor heterogeneity on the radiation response. Therefore, carbon ions may confer a significant advantage for the treatment of hypoxic tumors that are highly resistant to conventional photon radiation therapy.
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Affiliation(s)
- Christin Glowa
- Department of Radiation Oncology and Radiotherapy, University Hospital Heidelberg, Heidelberg, Germany; Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Alina L Bendinger
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany; University of Heidelberg, Faculty of Biosciences, Heidelberg, Germany
| | - Rosemarie Euler-Lange
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany; Department of Radiooncology/Radiobiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Peschke
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Stephan Brons
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany; Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology and Radiotherapy, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany; Clinical Cooperation Unit Radiation Therapy, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian P Karger
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.
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Hammad M, Salma R, Balosso J, Rezvani M, Haghdoost S. Role of Oxidative Stress Signaling, Nrf2, on Survival and Stemness of Human Adipose-Derived Stem Cells Exposed to X-rays, Protons and Carbon Ions. Antioxidants (Basel) 2024; 13:1035. [PMID: 39334694 PMCID: PMC11429097 DOI: 10.3390/antiox13091035] [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: 06/25/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/30/2024] Open
Abstract
Some cancers have a poor prognosis and often lead to local recurrence because they are resistant to available treatments, e.g., glioblastoma. Attempts have been made to increase the sensitivity of resistant tumors by targeting pathways involved in the resistance and combining it, for example, with radiotherapy (RT). We have previously reported that treating glioblastoma stem cells with an Nrf2 inhibitor increases their radiosensitivity. Unfortunately, the application of drugs can also affect normal cells. In the present study, we aim to investigate the role of the Nrf2 pathway in the survival and differentiation of normal human adipose-derived stem cells (ADSCs) exposed to radiation. We treated ADSCs with an Nrf2 inhibitor and then exposed them to X-rays, protons or carbon ions. All three radiation qualities are used to treat cancer. The survival and differentiation abilities of the surviving ADSCs were studied. We found that the enhancing effect of Nrf2 inhibition on cell survival levels was radiation-quality-dependent (X-rays > proton > carbon ions). Furthermore, our results indicate that Nrf2 inhibition reduces stem cell differentiation by 35% and 28% for adipogenesis and osteogenesis, respectively, using all applied radiation qualities. Interestingly, the results show that the cells that survive proton and carbon ion irradiations have an increased ability, compared with X-rays, to differentiate into osteogenesis and adipogenesis lineages. Therefore, we can conclude that the use of carbon ions or protons can affect the stemness of irradiated ADSCs at lower levels than X-rays and is thus more beneficial for long-time cancer survivors, such as pediatric patients.
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Affiliation(s)
- Mira Hammad
- Centre de Recherche sur les Ions, les Matériaux et la Photonique (CIMAP) UMR 6252, University of Caen Normandy, Cedex 04, F-14050 Caen, France
| | - Rima Salma
- Centre de Recherche sur les Ions, les Matériaux et la Photonique (CIMAP) UMR 6252, University of Caen Normandy, Cedex 04, F-14050 Caen, France
| | - Jacques Balosso
- Department of Radiation Oncology, Centre François Baclesse, F-14000 Caen, France
- Advanced Resource Center for HADrontherapy in Europe (ARCHADE), F-14000 Caen, France
| | - Mohi Rezvani
- Swiss Bioscience GmbH, Wagistrasse 27a, CH-8952 Schlieren, Switzerland
| | - Siamak Haghdoost
- Centre de Recherche sur les Ions, les Matériaux et la Photonique (CIMAP) UMR 6252, University of Caen Normandy, Cedex 04, F-14050 Caen, France
- Advanced Resource Center for HADrontherapy in Europe (ARCHADE), F-14000 Caen, France
- Le Laboratoire "Aliments, Bioprocédés, Toxicologie et Environnement (ABTE) UR 4651, ToxEMAC Team, University of Caen Normandy, Cedex 04, F-14050 Caen, France
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, SE-10691 Stockholm, Sweden
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Stengl C, Muñoz ID, Arbes E, Rauth E, Christensen JB, Vedelago J, Runz A, Jäkel O, Seco J. Dosimetric study for breathing-induced motion effects in an abdominal pancreas phantom for carbon ion mini-beam radiotherapy. Med Phys 2024; 51:5618-5631. [PMID: 38631000 DOI: 10.1002/mp.17077] [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: 11/30/2023] [Revised: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Particle mini-beam therapy exhibits promise in sparing healthy tissue through spatial fractionation, particularly notable for heavy ions, further enhancing the already favorable differential biological effectiveness at both target and entrance regions. However, breathing-induced organ motion affects particle mini-beam irradiation schemes since the organ displacements exceed the mini-beam structure dimensions, decreasing the advantages of spatial fractionation. PURPOSE In this study, the impact of breathing-induced organ motion on the dose distribution was examined at the target and organs at risk(OARs) during carbon ion mini-beam irradiation for pancreatic cancer. METHODS As a first step, the carbon ion mini-beam pattern was characterized with Monte Carlo simulations. To analyze the impact of breathing-induced organ motion on the dose distribution of a virtual pancreas tumor as target and related OARs, the anthropomorphic Pancreas Phantom for Ion beam Therapy (PPIeT) was irradiated with carbon ions. A mini-beam collimator was used to deliver a spatially fractionated dose distribution. During irradiation, varying breathing motion amplitudes were induced, ranging from 5 to 15 mm. Post-irradiation, the 2D dose pattern was analyzed, focusing on the full width at half maximum (FWHM), center-to-center distance (ctc), and the peak-to-valley dose ratio (PVDR). RESULTS The mini-beam pattern was visible within OARs, while in the virtual pancreas tumor a more homogeneous dose distribution was achieved. Applied motion affected the mini-beam pattern within the kidney, one of the OARs, reducing the PVDR from 3.78 ± $\pm$ 0.12 to 1.478 ± $\pm$ 0.070 for the 15 mm motion amplitude. In the immobile OARs including the spine and the skin at the back, the PVDR did not change within 3.4% comparing reference and motion conditions. CONCLUSIONS This study provides an initial understanding of how breathing-induced organ motion affects spatial fractionation during carbon ion irradiation, using an anthropomorphic phantom. A decrease in the PVDR was observed in the right kidney when breathing-induced motion was applied, potentially increasing the risk of damage to OARs. Therefore, further studies are needed to explore the clinical viability of mini-beam radiotherapy with carbon ions when irradiating abdominal regions.
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Affiliation(s)
- Christina Stengl
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Iván D Muñoz
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Department for Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Eric Arbes
- Department for Physics and Astronomy, Heidelberg University, Heidelberg, Germany
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Evelyn Rauth
- Department for Physics and Astronomy, Heidelberg University, Heidelberg, Germany
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jeppe B Christensen
- Department of Radiation Safety and Security, Paul Scherrer Institute (PSI), Villigen, Switzerland
| | - José Vedelago
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
| | - Armin Runz
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Oliver Jäkel
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Heidelberg Ion Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
| | - Joao Seco
- Department for Physics and Astronomy, Heidelberg University, Heidelberg, Germany
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Marignol L, McMahon SJ. Research Trends in the Study of the Relative Biological Effectiveness: A Bibliometric Study. Radiat Res 2024; 202:177-184. [PMID: 38918000 DOI: 10.1667/rade-24-00023.1.s1] [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: 01/19/2024] [Accepted: 04/23/2024] [Indexed: 06/27/2024]
Abstract
The relative biological effectiveness is a mathematical quantity first defined in the 1950s. This has resulted in more than 4,000 scientific papers published to date. Yet defining the correct value of the RBE to use in clinical practice remains a challenge. A scientific analysis in the radiation research literature can provide an understanding of how this mathematical quantity has evolved. The purpose of this study is to investigate documents published since 1950 using bibliometric indicators and network visualization. This analysis seeks to provide an assessment of global research activities, key themes, and RBE research within the radiation-related field. It strives to highlight top-performing authors, organizations, and nations that have made major contributions to this research domain, as well as their interactions. The Scopus Collection was searched for articles and reviews pertaining to RBE in radiation research from 1950 through 2023. Scopus and Bibiometrix analytic tools were used to investigate the most productive countries, researchers, collaboration networks, journals, along with the citation analysis of references and keywords. A total of 4,632 documents were retrieved produced by authors originating from 71 countries. Publication trends could be separated in 20-year groupings beginning with slow accrual from 1950 to 1970, an early rise from 1970-1990, followed by a sharp increase in the years 1990s-2010s that matches the development of charged particle therapy in clinics worldwide and opened discussion on the true value of the RBE in proton beam therapy. Since the 2010s, a steady 200 papers, on average, have been published per year. The United States produced the most publications overall (N = 1,378) and Radiation Research was the most likely journal to have published articles related to the RBE (606 publications during this period). J. Debus was the most prolific author (112 contributions, with 2,900 citations). The RBE has captured the research interest of over 7,000 authors in the past decade alone. This study supports that notion that the growth of the body of evidence surrounding the RBE, which started 75 years ago, is far from reaching its end. Applications to medicine have continuously dominated the field, with physics competing with Biochemistry, Genetics and Molecular Biology for second place over the decades. Future research can be predicted to continue.
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Affiliation(s)
- L Marignol
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - S J McMahon
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
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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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Félix-Bautista R, Hamad Y, Yáñez-González T, Ochoa-Parra P, Granja C, Martišíková M, Mairani A, Gehrke T. Towards precise LET measurements based on energy deposition of therapeutic ions in Timepix3 detectors. Phys Med Biol 2024; 69:125030. [PMID: 38815613 DOI: 10.1088/1361-6560/ad5267] [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: 11/24/2023] [Accepted: 05/30/2024] [Indexed: 06/01/2024]
Abstract
Objective.There is an increasing interest in calculating and measuring linear energy transfer (LET) spectra in particle therapy in order to assess their impact in biological terms. As such, the accuracy of the particle fluence energy spectra becomes paramount. This study focuses on quantifying energy depositions of distinct proton, helium, carbon, and oxygen ion beams using a silicon pixel detector developed at CERN to determine LET spectra in silicon.Approach.While detection systems have been investigated in this pursuit, the scarcity of detectors capable of providing per-ion data with high spatial and temporal resolution remains an issue. This gap is where silicon pixel detector technology steps in, enabling online tracking of single-ion energy deposition. The used detector consisted of a 300µm thick silicon sensor operated in partial depletion.Main results.During post-processing, artifacts in the acquired signals were identified and methods for their corrections were developed. Subsequently, a correlation between measured and Monte Carlo-based simulated energy deposition distributions was performed, relying on a two-step recalibration approach based on linear and saturating exponential models. Despite the observed saturation effects, deviations were confined below 7% across the entire investigated range of track-averaged LET values in silicon from 0.77 keVµm-1to 93.16 keVµm-1.Significance.Simulated and measured mean energy depositions were found to be aligned within 7%, after applying artifact corrections. This extends the range of accessible LET spectra in silicon to clinically relevant values and validates the accuracy and reliability of the measurements. These findings pave the way towards LET-based dosimetry through an approach to translate these measurements to LET spectra in water. This will be addressed in a future study, extending functionality of treatment planning systems into clinical routine, with the potential of providing ion-beam therapy of utmost precision to cancer patients.
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Affiliation(s)
- Renato Félix-Bautista
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Research in Radiation Oncology (NCRO), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Yasmin Hamad
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Research in Radiation Oncology (NCRO), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Faculty of Physics and Astronomy, Heidelberg University, Im Neuenheimer Feld 226, 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 450, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Tomás Yáñez-González
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Currently at Faculty of Mechanical Engineering, Leibniz University of Hannover
| | - Pamela Ochoa-Parra
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Research in Radiation Oncology (NCRO), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Faculty of Physics and Astronomy, Heidelberg University, Im Neuenheimer Feld 226, 69120 Heidelberg, Germany
| | - Carlos Granja
- ADVACAM, Department of Research and Development, U Pergamenky 12, 17000 Prague, Czech Republic
| | - Mária Martišíková
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Research in Radiation Oncology (NCRO), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Andrea Mairani
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Research in Radiation Oncology (NCRO), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 450, 69120 Heidelberg, Germany
| | - Tim Gehrke
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Research in Radiation Oncology (NCRO), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 450, 69120 Heidelberg, Germany
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Possenti L, Vitullo P, Cicchetti A, Zunino P, Rancati T. Modeling hypoxia-induced radiation resistance and the impact of radiation sources. Comput Biol Med 2024; 173:108334. [PMID: 38520919 DOI: 10.1016/j.compbiomed.2024.108334] [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: 01/12/2024] [Revised: 02/29/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
Hypoxia contributes significantly to resistance in radiotherapy. Our research rigorously examines the influence of microvascular morphology on radiotherapy outcome, specifically focusing on how microvasculature shapes hypoxia within the microenvironment and affects resistance to a standard treatment regimen (30×2GyRBE). Our computational modeling extends to the effects of different radiation sources. For photons and protons, our analysis establishes a clear correlation between hypoxic volume distribution and treatment effectiveness, with vascular density and regularity playing a crucial role in treatment success. On the contrary, carbon ions exhibit distinct effectiveness, even in areas of intense hypoxia and poor vascularization. This finding points to the potential of carbon-based hadron therapy in overcoming hypoxia-induced resistance to RT. Considering that the spatial scale analyzed in this study is closely aligned with that of imaging data voxels, we also address the implications of these findings in a clinical context envisioning the possibility of detecting subvoxel hypoxia.
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Affiliation(s)
- Luca Possenti
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy.
| | - Piermario Vitullo
- MOX, Department of Mathematics, Politecnico di Milano, P.zza Da Vinci 32, Milan, 20133, Italy
| | - Alessandro Cicchetti
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
| | - Paolo Zunino
- MOX, Department of Mathematics, Politecnico di Milano, P.zza Da Vinci 32, Milan, 20133, Italy
| | - Tiziana Rancati
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
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Glowa C, Saager M, Hintz L, Euler-Lange R, Peschke P, Brons S, Scholz M, Mein S, Mairani A, Karger CP. Relative biological effectiveness of oxygen ion beams in the rat spinal cord: Dependence on linear energy transfer and dose and comparison with model predictions. Phys Imaging Radiat Oncol 2024; 30:100581. [PMID: 38711920 PMCID: PMC11070926 DOI: 10.1016/j.phro.2024.100581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024] Open
Abstract
Background and purpose Ion beams exhibit an increased relative biological effectiveness (RBE) with respect to photons. This study determined the RBE of oxygen ion beams as a function of linear energy transfer (LET) and dose in the rat spinal cord. Materials and methods The spinal cord of rats was irradiated at four different positions of a 6 cm spread-out Bragg-peak (LET: 26, 66, 98 and 141 keV/µm) using increasing levels of single and split oxygen ion doses. Dose-response curves were established for the endpoint paresis grade II and based on ED50 (dose at 50 % effect probability), the RBE was determined and compared to model predictions. Results When LET increased from 26 to 98 keV/µm, ED50 decreased from 17.2 ± 0.3 Gy to 13.5 ± 0.4 Gy for single and from 21.7 ± 0.4 Gy to 15.5 ± 0.5 Gy for split doses, however, at 141 keV/µm, ED50 rose again to 15.8 ± 0.4 Gy and 17.2 ± 0.4 Gy, respectively. As a result, the RBE increased from 1.43 ± 0.05 to 1.82 ± 0.08 (single dose) and from 1.58 ± 0.04 to 2.21 ± 0.08 (split dose), respectively, before declining again to 1.56 ± 0.06 for single and 1.99 ± 0.06 for split doses at the highest LET. Deviations from RBE-predictions were model-dependent. Conclusion This study established first RBE data for the late reacting central nervous system after single and split doses of oxygen ions. The data was used to validate the RBE-dependence on LET and dose of three RBE-models. This study extends the existing data base for protons, helium and carbon ions and provides important information for future patient treatments with oxygen ions.
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Affiliation(s)
- Christin Glowa
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
- Department of Radiation Oncology and Radiotherapy, University Hospital Heidelberg, Germany
| | - Maria Saager
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Lisa Hintz
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Rosemarie Euler-Lange
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
- Department of Radiooncology/Radiobiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Peschke
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Stephan Brons
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany
| | - Michael Scholz
- Department of Biophysics, Helmholtz Center for Heavy Ion Research (GSI), Darmstadt, Germany
| | - Stewart Mein
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrea Mairani
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany
- National Centre of Oncological Hadrontherapy (CNAO), Medical Physics, Pavia, Italy
| | - Christian P. Karger
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
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9
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Thwaites DI, Prokopovich DA, Garrett RF, Haworth A, Rosenfeld A, Ahern V. The rationale for a carbon ion radiation therapy facility in Australia. J Med Radiat Sci 2024; 71 Suppl 2:59-76. [PMID: 38061984 PMCID: PMC11011608 DOI: 10.1002/jmrs.744] [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: 08/08/2023] [Accepted: 11/17/2023] [Indexed: 04/13/2024] Open
Abstract
Australia has taken a collaborative nationally networked approach to achieve particle therapy capability. This supports the under-construction proton therapy facility in Adelaide, other potential proton centres and an under-evaluation proposal for a hybrid carbon ion and proton centre in western Sydney. A wide-ranging overview is presented of the rationale for carbon ion radiation therapy, applying observations to the case for an Australian facility and to the clinical and research potential from such a national centre.
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Affiliation(s)
- David I. Thwaites
- Institute of Medical Physics, School of PhysicsUniversity of SydneySydneyNew South WalesAustralia
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
- Radiotherapy Research Group, Institute of Medical ResearchSt James's Hospital and University of LeedsLeedsUK
| | | | - Richard F. Garrett
- Australian Nuclear Science and Technology OrganisationLucas HeightsNew South WalesAustralia
| | - Annette Haworth
- Institute of Medical Physics, School of PhysicsUniversity of SydneySydneyNew South WalesAustralia
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, School of PhysicsUniversity of WollongongSydneyNew South WalesAustralia
| | - Verity Ahern
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
- Westmead Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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10
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Shamsabadi R, Baghani HR. Impact of gadolinium concentration and cell oxygen levels on radiobiological characteristics of gadolinium neutron capture therapy technique in brain tumor treatment. Radiol Phys Technol 2024; 17:135-142. [PMID: 37989987 DOI: 10.1007/s12194-023-00758-7] [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: 08/28/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/23/2023]
Abstract
Neutron capture therapy (NCT) with various concentrations of gadolinium (157Gd) is one of the treatment modalities for glioblastoma (GBM) tumors. Current study aims to evaluate how variations of 157Gd concentration and cell oxygen levels can affect the relative biological effectiveness (RBE) of gadolinium neutron capture therapy (GdNCT) technique through a hybrid Monte Carlo (MC) simulation approach. At first, Snyder phantom including a spherical tumor was simulated by Geant4 MC code and relevant energy electron spectra to different 157Gd concentrations including 100, 250, 500, and 1000 ppm were calculated following the neutron irradiation of simulated phantom. Scored energy electron spectra were then imported to Monte Carlo damage simulation (MCDS) code to estimate RBE values (both RBESSB and RBEDSB) at different gadolinium concentrations and oxygen levels from 10 to 100%. The results indicate that variations of 157Gd can affect the energy spectrum of released secondary electrons including Auger electrons. Variation of gadolinium concentration from 100 to 1000 ppm in tumor region can change RBESSB and RBEDSB values by about 0.1% and 0.5%, respectively. Besides, maximum variations of 4.3% and 2% were calculated for RBEDSB and RBESSB when cell oxygen level changed from 10 to 100%. From the results, variations of considered gadolinium and oxygen concentrations during GdNCT can influence RBE values. Nevertheless, due to the not remarkable changes in the intensity of Auger electrons, a slight difference in RBE values would be expected at various 157Gd concentrations, although considerable RBE changes were calculated relevant to the oxygen alternations inside tumor tissue.
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Affiliation(s)
- Reza Shamsabadi
- Physics Department, Hakim Sabzevari University, Daneshgah Blvd, P.O. 9617976487, Sabzevar, Iran
| | - Hamid Reza Baghani
- Physics Department, Hakim Sabzevari University, Daneshgah Blvd, P.O. 9617976487, Sabzevar, Iran.
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11
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Aoki S, Ishikawa H, Nakajima M, Yamamoto N, Mori S, Wakatsuki M, Okonogi N, Murata K, Tada Y, Mizobuchi T, Yoshino I, Yamada S. Long-Term Outcomes of Ablative Carbon-Ion Radiotherapy for Central Non-Small Cell Lung Cancer: A Single-Center, Retrospective Study. Cancers (Basel) 2024; 16:933. [PMID: 38473295 DOI: 10.3390/cancers16050933] [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: 01/11/2024] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
The aim of this study is to assess the efficacy and safety of ablative carbon ion radiotherapy (CIRT) for early stage central non-small cell lung cancer (NSCLC). We retrospectively reviewed 30 patients who had received CIRT at 68.4 Gy in 12 fractions for central NSCLC in 2006-2019. The median age was 75 years, and the median Karnofsky Performance Scale score was 90%. All patients had concomitant chronic obstructive pulmonary disease, and 20 patients (67%) were considered inoperable. In DVH analysis, the median lung V5 and V20 were 15.5% and 10.4%, and the median Dmax, D0.5cc, D2cc of proximal bronchial tree was 65.6 Gy, 52.8 Gy, and 10.0 Gy, respectively. At a median follow-up of 43 months, the 3-year overall survival, disease-specific survival, and local control rates were 72.4, 75.8, and 88.7%, respectively. Two patients experienced grade 3 pneumonitis, but no grade ≥3 adverse events involving the mediastinal organs occurred. Ablative CIRT is feasible and effective for central NSCLC and could be considered as a treatment option, especially for patients who are intolerant of other curative treatments.
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Affiliation(s)
- Shuri Aoki
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
- Department of Radiology, University of Tokyo Hospital, 3-7-1 Hongo, Tokyo 113-8655, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Mio Nakajima
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Naoyoshi Yamamoto
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Shinichiro Mori
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo 113-8421, Japan
| | - Kazutoshi Murata
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Yuji Tada
- Department of Pulmonary Medicine, International University of Health and Welfare, Narita Hospital, Hatakeda 852, Chiba 286-8520, Japan
| | - Teruaki Mizobuchi
- Department of Respiratory Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation, Chibaken Saiseikai Narashino Hospital, 1-1-1 Izumi-cho, Chiba 275-8580, Japan
| | - Ichiro Yoshino
- Department of Thoracic Surgery, International University of Health and Welfare, Narita Hospital, Hatakeda 852, Chiba 286-8520, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
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12
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Masuda T, Inaniwa T. Effects of cellular radioresponse on therapeutic helium-, carbon-, oxygen-, and neon-ion beams: a simulation study. Phys Med Biol 2024; 69:045003. [PMID: 38232394 DOI: 10.1088/1361-6560/ad1f87] [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: 11/09/2023] [Accepted: 01/17/2024] [Indexed: 01/19/2024]
Abstract
Objective. Helium, oxygen, and neon ions in addition to carbon ions will be used for hypofractionated multi-ion therapy to maximize the therapeutic effectiveness of charged-particle therapy. To use new ions in cancer treatments based on the dose-fractionation protocols established in carbon-ion therapy, this study examined the cell-line-specific radioresponse to therapeutic helium-, oxygen-, and neon-ion beams within wide dose ranges.Approach. Response of cells to ions was described by the stochastic microdosimetric kinetic model. First, simulations were made for the irradiation of one-field spread-out Bragg peak beams in water with helium, carbon, oxygen, and neon ions to achieve uniform survival fractions at 37%, 10%, and 1% for human salivary gland tumor (HSG) cells, the reference cell line for the Japanese relative biological effectiveness weighted dose system, within the target region defined at depths from 90 to 150 mm. The HSG cells were then replaced by other cell lines with different radioresponses to evaluate differences in the biological dose distributions of each ion beam with respect to those of carbon-ion beams.Main results. For oxygen- and neon-ion beams, the biological dose distributions within the target region were almost equivalent to those of carbon-ion beams, differing by less than 5% in most cases. In contrast, for helium-ion beams, the biological dose distributions within the target region were largely different from those of carbon-ion beams, more than 10% in several cases.Significance.From the standpoint of tumor control evaluated by the clonogenic cell survival, this study suggests that the dose-fractionation protocols established in carbon-ion therapy could be reasonably applied to oxygen- and neon-ion beams while some modifications in dose prescription would be needed when the protocols are applied to helium-ion beams. This study bridges the gap between carbon-ion therapy and hypofractionated multi-ion therapy.
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Affiliation(s)
- Takamitsu Masuda
- Department of Accelerator and Medical Physics, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Taku Inaniwa
- Department of Accelerator and Medical Physics, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
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13
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Jang JY, Kim K, Chen M, Akimoto T, Wang MLC, Kim M, Kim K, Lee TH, Yoo GS, Park HC. A meta-analysis comparing efficacy and safety between proton beam therapy versus carbon ion radiotherapy. Cancer Med 2024; 13:e7023. [PMID: 38396380 PMCID: PMC10891363 DOI: 10.1002/cam4.7023] [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: 01/05/2024] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND This study aimed to compare the outcomes of proton beam therapy (PBT) and carbon ion radiotherapy (CIRT) by a systematic review and meta-analysis of the existing clinical evidence. METHODS A systematic literature search was performed to identify studies comparing the clinical outcomes of PBT and CIRT. The included studies were required to report oncological outcomes (local control [LC], progression-free survival [PFS], or overall survival [OS]) or adverse events. RESULTS Eighteen articles comprising 1857 patients (947 treated with PBT and 910 treated with CIRT) were included in the analysis. The pooled analysis conducted for the overall population yielded average hazard ratios of 0.690 (95% confidence interval (CI), 0.493-0.967, p = 0.031) for LC, 0.952 (95% CI, 0.604-1.500, p = 0.590) for PFS, and 1.183 (0.872-1.607, p = 0.281) for OS with reference to CIRT. The subgroup analyses included patients treated in the head and neck, areas other than the head and neck, and patients with chordomas and chondrosarcomas. These analyses revealed no significant differences in most outcomes, except for LC in the subgroup of patients treated in areas other than the head and neck. Adverse event rates were comparable in both groups, with an odds ratio (OR) of 1.097 (95% CI, 0.744-1.616, p = 0.641). Meta-regression analysis for possible heterogeneity did not demonstrate a significant association between treatment outcomes and the ratio of biologically effective doses between modalities. CONCLUSION This study highlighted the comparability of PBT and CIRT in terms of oncological outcomes and adverse events.
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Affiliation(s)
- Jeong Yun Jang
- Department of Radiation Oncology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Kangpyo Kim
- Department of Radiation Oncology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Miao‐Fen Chen
- Department of Radiation OncologyChang Gung Memorial HospitalTaoyuanTaiwan
| | - Tetsuo Akimoto
- Division of Radiation Oncology and Particle TherapyNational Cancer Center Hospital EastChibaJapan
- Department of Radiation OncologyNational Cancer Center Hospital EastChibaJapan
| | | | - Min‐Ji Kim
- Biomedical Statistics Center, Research Institute for Future MedicineSamsung Medical CenterSeoulRepublic of Korea
| | - Kyunga Kim
- Biomedical Statistics Center, Research Institute for Future MedicineSamsung Medical CenterSeoulRepublic of Korea
| | - Tae Hoon Lee
- Department of Radiation Oncology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
- Department of Radiation OncologyChungbuk National University HospitalCheongjuRepublic of Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
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14
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Feng H, Li W, Zhang Y, Chang C, Hua L, Feng Y, Lai Y, Geng L. Mechanistic modelling of relative biological effectiveness of carbon ion beams and comparison with experiments. Phys Med Biol 2024; 69:035020. [PMID: 38157549 DOI: 10.1088/1361-6560/ad1998] [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: 08/30/2023] [Accepted: 12/29/2023] [Indexed: 01/03/2024]
Abstract
Objective.Relative biological effectiveness (RBE) plays a vital role in carbon ion radiotherapy, which is a promising treatment method for reducing toxic effects on normal tissues and improving treatment efficacy. It is important to have an effective and precise way of obtaining RBE values to support clinical decisions. A method of calculating RBE from a mechanistic perspective is reported.Approach.Ratio of dose to obtain the same number of double strand breaks (DSBs) between different radiation types was used to evaluate RBE. Package gMicroMC was used to simulate DSB yields. The DSB inductions were then analyzed to calculate RBE. The RBE values were compared with experimental results.Main results.Furusawa's experiment yielded RBE values of 1.27, 2.22, 3.00 and 3.37 for carbon ion beam with dose-averaged LET of 30.3 keVμm-1, 54.5 keVμm-1, 88 keVμm-1and 137 keVμm-1, respectively. RBE values computed from gMicroMC simulations were 1.75, 2.22, 2.87 and 2.97. When it came to a more sophisticated carbon ion beam with 6 cm spread-out Bragg peak, RBE values were 1.61, 1.63, 2.19 and 2.36 for proximal, middle, distal and distal end part, respectively. Values simulated by gMicroMC were 1.50, 1.87, 2.19 and 2.34. The simulated results were in reasonable agreement with the experimental data.Significance.As a mechanistic way for the evaluation of RBE for carbon ion radiotherapy by combining the macroscopic simulation of energy spectrum and microscopic simulation of DNA damages, this work provides a promising tool for RBE calculation supporting clinical applications such as treatment planning.
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Affiliation(s)
- Haonan Feng
- School of Physics, Beihang University, Beijing 102206, People's Republic of China
- Department of Medical Management, Chinese Academy of Science Heavy Ion Medicine (CASHIM) Co. Ltd, Beijing 100083, People's Republic of China
| | - Weiguang Li
- School of Physics, Beihang University, Beijing 102206, People's Republic of China
- Department of Medical Management, Chinese Academy of Science Heavy Ion Medicine (CASHIM) Co. Ltd, Beijing 100083, People's Republic of China
| | - Yibao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, People's Republic of China
| | - Cheng Chang
- Department of Medical Management, Chinese Academy of Science Heavy Ion Medicine (CASHIM) Co. Ltd, Beijing 100083, People's Republic of China
| | - Ling Hua
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, People's Republic of China
| | - Yiwen Feng
- Beijing University of Posts and Telecommunications, Beijing 100876, People's Republic of China
| | - Youfang Lai
- Department of Medical Management, Chinese Academy of Science Heavy Ion Medicine (CASHIM) Co. Ltd, Beijing 100083, People's Republic of China
| | - LiSheng Geng
- School of Physics, Beihang University, Beijing 102206, People's Republic of China
- Peng Huanwu Collaborative Center for Research and Education, Beihang University, Beijing 100191, People's Republic of China
- Beijing Key Laboratory of Advanced Nuclear Materials and Physics, Beihang University, Beijing 102206, People's Republic of China
- Southern Center for Nuclear-Science Theory (SCNT), Institute of Modern Physics, Chinese Academy of Sciences, Huizhou 516000, Guangdong Province, People's Republic of China
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15
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Postuma I, Magni C, Marcaccio B, Fatemi S, Vercesi V, Ciocca M, Magro G, Orlandi E, Vischioni B, Ronchi S, Liu YH, Han Y, Geng C, González SJ, Bortolussi S. Using the photon isoeffective dose formalism to compare and combine BNCT and CIRT in a head and neck tumour. Sci Rep 2024; 14:418. [PMID: 38172585 PMCID: PMC10764928 DOI: 10.1038/s41598-023-50522-5] [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: 04/22/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
Boron Neutron Capture Therapy (BNCT) is a radiotherapy technique based on the enrichment of tumour cells with suitable 10-boron concentration and on subsequent neutron irradiation. Low-energy neutron irradiation produces a localized deposition of radiation dose caused by boron neutron capture reactions. Boron is vehiculated into tumour cells via proper borated formulations, able to accumulate in the malignancy more than in normal tissues. The neutron capture releases two high-LET charged particles (i.e., an alpha particle and a lithium ion), losing their energy in a distance comparable to the average dimension of one cell. Thus BNCT is selective at the cell level and characterized by high biological effectiveness. As the radiation field is due to the interaction of neutrons with the components of biological tissues and with boron, the dosimetry requires a formalism to express the absorbed dose into photon-equivalent units. This work analyzes a clinical case of an adenoid cystic carcinoma treated with carbon-ion radiotherapy (CIRT), located close to optic nerve and deep-seated as a practical example of how to apply the formalism of BNCT photon isoeffective dose and how to evaluate the BNCT dose distribution against CIRT. The example allows presenting different dosimetrical and radiobiological quantities and drawing conclusions on the potential of BNCT stemming on the clinical result of the CIRT. The patient received CIRT with a dose constraint on the optic nerve, affecting the peripheral part of the Planning Target Volume (PTV). After the treatment, the tumour recurred in this low-dose region. BNCT was simulated for the primary tumour, with the goal to calculate the dose distribution in isoeffective units and a Tumour Control Probability (TCP) to be compared with the one of the original treatment. BNCT was then evaluated for the recurrence in the underdosed region which was not optimally covered by charged particles due to the proximity of the optic nerve. Finally, a combined treatment consisting in BNCT and carbon ion therapy was considered to show the consistency and the potential of the model. For the primary tumour, the photon isoeffective dose distribution due to BNCT was evaluated and the resulted TCP was higher than that obtained for the CIRT. The formalism produced values that are consistent with those of carbon-ion. For the recurrence, BNCT dosimetry produces a similar TCP than that of primary tumour. A combined treatment was finally simulated, showing a TCP comparable to the BNCT-alone with overall dosimetric advantage in the most peripheral parts of the treatment volume. Isoeffective dose formalism is a robust tool to analyze BNCT dosimetry and to compare it with the photon-equivalent dose calculated for carbon-ion treatment. This study introduces for the first time the possibility to combine the dosimetry obtained by two different treatment modalities, showing the potential of exploiting the cellular targeting of BNCT combined with the precision of charged particles in delivering an homogeneous dose distribution in deep-seated tumours.
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Affiliation(s)
- Ian Postuma
- National Institute of Nuclear Physics, INFN, Unit of Pavia, Pavia, 27100, Italy
| | - Chiara Magni
- National Institute of Nuclear Physics, INFN, Unit of Pavia, Pavia, 27100, Italy
- Department of Physics, University of Pavia, Pavia, 27100, Italy
| | - Barbara Marcaccio
- National Institute of Nuclear Physics, INFN, Unit of Pavia, Pavia, 27100, Italy
- Department of Physics, University of Pavia, Pavia, 27100, Italy
- National University of San Martín, Dan Beninson Institute, Buenos Aires, Argentina
| | - Setareh Fatemi
- National Institute of Nuclear Physics, INFN, Unit of Pavia, Pavia, 27100, Italy
| | - Valerio Vercesi
- National Institute of Nuclear Physics, INFN, Unit of Pavia, Pavia, 27100, Italy
| | - Mario Ciocca
- National Institute of Nuclear Physics, INFN, Unit of Pavia, Pavia, 27100, Italy
- National Centre for Oncological Hadrontherapy, CNAO, Pavia, 27100, Italy
| | - Giuseppe Magro
- National Centre for Oncological Hadrontherapy, CNAO, Pavia, 27100, Italy
| | - Ester Orlandi
- National Centre for Oncological Hadrontherapy, CNAO, Pavia, 27100, Italy
| | - Barbara Vischioni
- National Centre for Oncological Hadrontherapy, CNAO, Pavia, 27100, Italy
| | - Sara Ronchi
- National Centre for Oncological Hadrontherapy, CNAO, Pavia, 27100, Italy
| | - Yuan-Hao Liu
- Neuboron Medtech Ltd, Nanjing, China
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, NUAA, Nanjing, China
| | - Yang Han
- Department of Physics, University of Pavia, Pavia, 27100, Italy
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, NUAA, Nanjing, China
| | - Changran Geng
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, NUAA, Nanjing, China
| | - Sara Josefina González
- National University of San Martín, Dan Beninson Institute, Buenos Aires, Argentina
- National Atomic Energy Commission, CNEA, Buenos Aires, Argentina
- National Scientific and Technical Research Council, CONICET, Buenos Aires, Argentina
| | - Silva Bortolussi
- National Institute of Nuclear Physics, INFN, Unit of Pavia, Pavia, 27100, Italy.
- Department of Physics, University of Pavia, Pavia, 27100, Italy.
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16
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Zhang W, Cai X, Sun J, Wang W, Zhao J, Zhang Q, Jiang G, Wang Z. Pencil Beam Scanning Carbon Ion Radiotherapy for Hepatocellular Carcinoma. J Hepatocell Carcinoma 2023; 10:2397-2409. [PMID: 38169909 PMCID: PMC10759913 DOI: 10.2147/jhc.s429186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose Carbon ion radiotherapy (CIRT) has emerged as a promising treatment modality for hepatocellular carcinoma (HCC). However, evidence of using the pencil beam scanning (PBS) technique to treat moving liver tumors remains lacking. The present study investigated the efficacy and toxicity of PBS CIRT in patients with HCC. Methods Between January 2016 and October 2021, 90 consecutive HCC patients treated with definitive CIRT in our center were retrospectively analyzed. Fifty-eight patients received relative biological effectiveness-weighted doses of 50-70 Gy in 10 fractions, and 32 received 60-67.5 Gy in 15 fractions, which were determined by the tumor location and normal tissue constraints. Active motion-management techniques and necessary strategies were adopted to mitigate interplay effects efficiently. Oncologic outcomes and toxicities were evaluated. Results The median follow-up time was 28.6 months (range 5.7-74.6 months). The objective response rate was 75.0% for all 90 patients with 100 treated lesions. The overall survival rates at 1-, 2- and 3-years were 97.8%, 83.3% and 75.4%, respectively. The local control rates at 1-, 2- and 3-years were 96.4%, 96.4% and 93.1%, respectively. Radiation-induced liver disease was not documented, and 4 patients (4.4%) had their Child-Pugh score elevated by 1 point after CIRT. No grade 3 or higher acute non-hematological toxicities were observed. Six patients (6.7%) experienced grade 3 or higher late toxicities. Conclusion The active scanning technique was clinically feasible to treat HCC by applying necessary mitigation measures for interplay effects. The desirable oncologic outcomes as well as favorable toxicity profiles presented in this study will be a valuable reference for other carbon-ion centers using the PBS technique and local effect model-based system, and add to a growing body of evidence about the role of CIRT in the management of HCC.
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Affiliation(s)
- Wenna Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, People’s Republic of China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, People’s Republic of China
| | - Xin Cai
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, People’s Republic of China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, People’s Republic of China
| | - Jiayao Sun
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, People’s Republic of China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, People’s Republic of China
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, People’s Republic of China
| | - Weiwei Wang
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, People’s Republic of China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, People’s Republic of China
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, People’s Republic of China
| | - Jingfang Zhao
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, People’s Republic of China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, People’s Republic of China
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, People’s Republic of China
| | - Qing Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, People’s Republic of China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, People’s Republic of China
| | - Guoliang Jiang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, People’s Republic of China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, People’s Republic of China
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, People’s Republic of China
| | - Zheng Wang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, People’s Republic of China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, People’s Republic of China
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, People’s Republic of China
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Han Y, Geng C, Altieri S, Bortolussi S, Liu Y, Wahl N, Tang X. Combined BNCT-CIRT treatment planning for glioblastoma using the effect-based optimization. Phys Med Biol 2023; 69:015024. [PMID: 38048635 DOI: 10.1088/1361-6560/ad120f] [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: 09/20/2023] [Accepted: 12/04/2023] [Indexed: 12/06/2023]
Abstract
Objective. Boron neutron capture therapy (BNCT) and carbon ion radiotherapy (CIRT) are emerging treatment modalities for glioblastoma. In this study, we investigated the methodology and feasibility to combine BNCT and CIRT treatments. The combined treatment plan illustrated how the synergistic utilization of BNCT's biological targeting and CIRT's intensity modulation capabilities could lead to optimized treatment outcomes.Approach. The Monte Carlo toolkit, TOPAS, was employed to calculate the dose distribution for BNCT, while matRad was utilized for the optimization of CIRT. The biological effect-based approach, instead of the dose-based approach, was adopted to develop the combined BNCT-CIRT treatment plans for six patients diagnosed with glioblastoma, considering the different radiosensitivity and fraction. Five optional combined treatment plans with specific BNCT effect proportions for each patient were evaluated to identify the optimal treatment that minimizes damage on normal tissue.Main results. Individual BNCT exhibits a significant effect gradient along with the beam direction in the large tumor, while combined BNCT-CIRT treatments can achieve uniform effect delivery within the clinical target volume (CTV) through the effect filling with reversed gradient by the CIRT part. In addition, the increasing BNCT effect proportion in combined treatments can reduce damage in the normal brain tissue near the CTV. Besides, the combined treatments effectively minimize damage to the skin compared to individual BNCT treatments.Significance. The initial endeavor to combine BNCT and CIRT treatment plans is achieved by the effect-based optimization. The observed advantages of the combined treatment suggest its potential applicability for tumors characterized by pleomorphic, infiltrative, radioresistant and voluminous features.
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Affiliation(s)
- Yang Han
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
- Department of Physics, University of Pavia, Pavia, Italy
| | - Changran Geng
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Saverio Altieri
- Department of Physics, University of Pavia, Pavia, Italy
- National Institute of Nuclear Physics, Unit of Pavia, Pavia, Italy
| | - Silva Bortolussi
- Department of Physics, University of Pavia, Pavia, Italy
- National Institute of Nuclear Physics, Unit of Pavia, Pavia, Italy
| | - Yuanhao Liu
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
- Neuboron Medtech. Ltd, Nanjing, People's Republic of China
| | - Niklas Wahl
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Xiaobin Tang
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
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Warmenhoven JW, Henthorn NT, McNamara AL, Ingram SP, Merchant MJ, Kirkby KJ, Schuemann J, Paganetti H, Prise KM, McMahon SJ. Effects of Differing Underlying Assumptions in In Silico Models on Predictions of DNA Damage and Repair. Radiat Res 2023; 200:509-522. [PMID: 38014593 DOI: 10.1667/rade-21-00147.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/05/2023] [Indexed: 11/29/2023]
Abstract
The induction and repair of DNA double-strand breaks (DSBs) are critical factors in the treatment of cancer by radiotherapy. To investigate the relationship between incident radiation and cell death through DSB induction many in silico models have been developed. These models produce and use custom formats of data, specific to the investigative aims of the researchers, and often focus on particular pairings of damage and repair models. In this work we use a standard format for reporting DNA damage to evaluate combinations of different, independently developed, models. We demonstrate the capacity of such inter-comparison to determine the sensitivity of models to both known and implicit assumptions. Specifically, we report on the impact of differences in assumptions regarding patterns of DNA damage induction on predicted initial DSB yield, and the subsequent effects this has on derived DNA repair models. The observed differences highlight the importance of considering initial DNA damage on the scale of nanometres rather than micrometres. We show that the differences in DNA damage models result in subsequent repair models assuming significantly different rates of random DSB end diffusion to compensate. This in turn leads to disagreement on the mechanisms responsible for different biological endpoints, particularly when different damage and repair models are combined, demonstrating the importance of inter-model comparisons to explore underlying model assumptions.
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Affiliation(s)
- John W Warmenhoven
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Nicholas T Henthorn
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Aimee L McNamara
- Physics Division, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Massachusetts
| | - Samuel P Ingram
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Michael J Merchant
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Karen J Kirkby
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jan Schuemann
- Physics Division, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Massachusetts
| | - Harald Paganetti
- Physics Division, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Massachusetts
| | - Kevin M Prise
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Stephen J McMahon
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
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Cai X, Li P, Zhao J, Wang W, Cheng J, Zhang G, Cai S, Zhang Z, Jiang G, Zhang Q, Wang Z. Definitive carbon ion re-irradiation with pencil beam scanning in the treatment of unresectable locally recurrent rectal cancer. JOURNAL OF RADIATION RESEARCH 2023; 64:933-939. [PMID: 37738440 PMCID: PMC10665299 DOI: 10.1093/jrr/rrad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/04/2023] [Indexed: 09/24/2023]
Abstract
This study aimed to evaluate the oncological outcomes and safety of carbon ion re-irradiation with pencil beam scanning (PBS) delivery technique for previously irradiated and unresectable locally recurrent rectal cancer (LRRC). Between June 2017 and September 2021, 24 patients of unresectable LRRC with prior pelvic photon radiotherapy who underwent carbon ion re-irradiation at our institute were retrospectively analyzed. Carbon ion radiotherapy was delivered by raster scanning with a median relative biological effectiveness-weighted dose of 72 Gy in 20 fractions. Weekly CT reviews were carried out, and offline adaptive replanning was performed whenever required. The median follow-up duration was 23.8 months (range, 6.2-47.1 months). At the last follow-up, two patients had a local disease progression, and 11 patients developed distant metastases. The 1- and 2-year local control, progression-free survival and overall survival rates were 100 and 93.3%, 70.8 and 45.0% and 86.7 and 81.3%, respectively. There were no Grade 3 or higher acute toxicities observed. Three patients developed Grade 3 late toxicities, one each with gastrointestinal toxicity, skin reaction and pelvic infection. In conclusion, definitive carbon ion re-irradiation with PBS provided superior oncologic results with tolerable toxicities and may be served as a curative treatment strategy in unresectable LRRC.
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Affiliation(s)
- Xin Cai
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Ping Li
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Jingfang Zhao
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Weiwei Wang
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Jingyi Cheng
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Guangyuan Zhang
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Radiology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Guoliang Jiang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Qing Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Zheng Wang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
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Zhang Z, Pei Y, Hu W, Xue Y, Ning R, Guo X, Sun Y, Zhang Q. The metabolic repression effect of carbon-ion radiotherapy in synchronous hormone-sensitive oligometastatic prostate cancer. Front Endocrinol (Lausanne) 2023; 14:1291653. [PMID: 38027094 PMCID: PMC10680404 DOI: 10.3389/fendo.2023.1291653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Metastatic prostate cancer (PCa) poses a significant public health concern. While radiation therapy (RT) is commonly utilized in the treatment of synchronous oligometastatic hormone sensitive prostate cancer (OM-HSPC), the occurrence of biochemical recurrence still remains. To deepen our understanding and optimize the outcome of OM-HSPC, we conducted this study to investigate the characteristics of PCa progression and explore potential synergistic mechanisms involving carbon-ion radiotherapy (CIRT) and neoadjuvant androgen deprivation treatment (naADT) in OM-HSPC. Methods Metabolomic analysis was conducted with 72 urinary samples (at different timepoints) from 33 Patients (T2-3N0M0-1b) and 18 healthy volunteers by using liquid chromatography-tandem mass spectrometry (LC-MS/MS). MetaboAnalyst website and R software were employed for metabolomic analysis and visualization (using the criteria of p value < 0.05 and |FC|>1.5). The impact of CIRT on metabolism were further verified and explored through in vitro and in vivo experiments. Results We found that most metabolites (223 out of 233) were upregulated in treatment-naïve PCa samples compared to healthy samples. After naADT, 60 core risk metabolites were still significantly related to PCa's progression, and the glutamine level which was significantly higher in OM-HSPC compared to other groups. Remarkably, after CIRT treatment, the glutamine levels in OM-HSPC were significantly reduced to the level of healthy samples. Experiments further confirmed CIRT's ability to suppress glutamine levels in PCa tumors and its potential enhancement with glutamine deprivation intervention. Conclusion CIRT with naADT might synergistically inhibit HS-OMPC development, progression and even the ADT resistance through glutamine metabolism repression, moreover, the glutamine metabolism might be a novel target to further improved the efficacy of CIRT.
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Affiliation(s)
- Zhenshan Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Yulei Pei
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Wei Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Yushan Xue
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Renli Ning
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Research and Development, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Yun Sun
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Research and Development, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Qing Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
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Faddegon B, Blakely EA, Burigo L, Censor Y, Dokic I, Kondo ND, Ortiz R, Méndez JR, Rucinski A, Schubert K, Wahl N, Schulte R. Ionization detail parameters and cluster dose: a mathematical model for selection of nanodosimetric quantities for use in treatment planning in charged particle radiotherapy. Phys Med Biol 2023; 68:10.1088/1361-6560/acea16. [PMID: 37489619 PMCID: PMC10565507 DOI: 10.1088/1361-6560/acea16] [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: 04/19/2022] [Accepted: 07/24/2023] [Indexed: 07/26/2023]
Abstract
Objective. To propose a mathematical model for applying ionization detail (ID), the detailed spatial distribution of ionization along a particle track, to proton and ion beam radiotherapy treatment planning (RTP).Approach. Our model provides for selection of preferred ID parameters (Ip) for RTP, that associate closest to biological effects. Cluster dose is proposed to bridge the large gap between nanoscopicIpand macroscopic RTP. Selection ofIpis demonstrated using published cell survival measurements for protons through argon, comparing results for nineteenIp:Nk,k= 2, 3, …, 10, the number of ionizations in clusters ofkor more per particle, andFk,k= 1, 2, …, 10, the number of clusters ofkor more per particle. We then describe application of the model to ID-based RTP and propose a path to clinical translation.Main results. The preferredIpwereN4andF5for aerobic cells,N5andF7for hypoxic cells. Significant differences were found in cell survival for beams having the same LET or the preferredNk. Conversely, there was no significant difference forF5for aerobic cells andF7for hypoxic cells, regardless of ion beam atomic number or energy. Further, cells irradiated with the same cluster dose for theseIphad the same cell survival. Based on these preliminary results and other compelling results in nanodosimetry, it is reasonable to assert thatIpexist that are more closely associated with biological effects than current LET-based approaches and microdosimetric RBE-based models used in particle RTP. However, more biological variables such as cell line and cycle phase, as well as ion beam pulse structure and rate still need investigation.Significance. Our model provides a practical means to select preferredIpfrom radiobiological data, and to convertIpto the macroscopic cluster dose for particle RTP.
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Affiliation(s)
- Bruce Faddegon
- University of California San Francisco, Department of Radiation Oncology 1600 Divisadero Street, San Francisco, CA 94143 United States of America
| | - Eleanor A. Blakely
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda,CA92350, United States of America
| | - Lucas Burigo
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Yair Censor
- Department of Mathematics, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838, Israel
| | - Ivana Dokic
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University Hospital and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Naoki Domínguez Kondo
- University of California San Francisco, Department of Radiation Oncology 1600 Divisadero Street, San Francisco, CA 94143 United States of America
| | - Ramon Ortiz
- University of California San Francisco, Department of Radiation Oncology 1600 Divisadero Street, San Francisco, CA 94143 United States of America
| | - José Ramos Méndez
- University of California San Francisco, Department of Radiation Oncology 1600 Divisadero Street, San Francisco, CA 94143 United States of America
| | - Antoni Rucinski
- Institute of Nuclear Physics Polish Academy of Sciences, Radzikowskiego 152, 31-342 Kraków, Poland
| | - Keith Schubert
- Baylor University, 1311 S 5th St, Waco, TX 76706, United States of America
| | - Niklas Wahl
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Reinhard Schulte
- Loma Linda University School of Medicine, 11085 Campus St, Loma Linda, CA92350, United States of America
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Alterio D, Zaffaroni M, Bossi P, Dionisi F, Elicin O, Falzone A, Ferrari A, Jereczek-Fossa BA, Sanguineti G, Szturz P, Volpe S, Scricciolo M. Reirradiation of head and neck squamous cell carcinomas: a pragmatic approach, part II: radiation technique and fractionations. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01671-0. [PMID: 37415056 DOI: 10.1007/s11547-023-01671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/25/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Reirradiation (reRT) of local recurrent/second primary tumors of the head and neck represents a potential curative treatment for patients not candidate to a salvage surgery. Aim of the present study is to summarize literature data on modern radiation techniques and fractionations used in this setting of patients. MATERIALS AND METHODS A narrative review of the literature was conducted on three topics: (1) target volume delineation (2) reRT dose and techniques and (3) ongoing studies. Patients treated with postoperative reRT and palliative intent were not considered for the current analysis. RESULTS Recommendations on the target volume contouring have been reported. 3D-Conformal Radiotherapy, Intensity Modulated Radiotherapy, Stereotactic body Radiotherapy Intraoperative Radiotherapy, Brachytherapy and Charged Particles have been analyzed in terms of indication and fractionation in the field of reRT. Ongoing studies on the topic have been reported for IMRT and Charged Particles. Moreover, according to literature data a stepwise approach has been proposed aiming to provide a useful tool to select patients candidate to a curative reRT in daily clinical practice. Two clinical cases were also provided for its application. CONCLUSION Different radiation techniques and fractionations can be used for a second course of radiotherapy in patients with recurrent/second primary tumor of head and neck region. Tumor characteristics as well as radiobiological considerations should be take into account to define the best reRT approach.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Francesco Dionisi
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Falzone
- Unità Operativa Multizonale di Radiologia Ospedale di Rovereto e Arco, Azienda Sanitaria per i Servizi Provinciali di Trento, Trento, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Sanguineti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Petr Szturz
- Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Wang W, Sun W, Shen H, Zhao J. Validation of the relative biological effectiveness of active-energy scanning carbon-ion radiotherapy on a commercial treatment planning system with a microdosimetic kinetic model. Radiat Oncol 2023; 18:82. [PMID: 37198685 DOI: 10.1186/s13014-023-02267-8] [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: 11/18/2022] [Accepted: 04/20/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND The study objective was to validate the relative biological effectiveness (RBE) calculated by the modified microdosimetric kinetic model in RayStation (Ray-MKM) for active-energy scanning carbon-ion radiotherapy. METHODS The Ray-MKM was benchmarked using a spread-out Bragg-peak (SOBP) plan, which was suggested in literature from the National Institute of Radiobiological Science (NIRS) in Japan. The residual RBE differences from the MKM at NIRS (NIRS-MKM) were derived using several SOBP plans with different ranges, SOBP widths, and prescriptions. To investigate the origins of the differences, we compared the saturation-corrected dose-mean specific energy [Formula: see text] of the aforementioned SOBPs. Furthermore, we converted the RBE-weighted doses with the Ray-MKM to those with local effect model I (LEM doses). The purpose was to investigate whether the Ray-MKM could reproduce the RBE-weighted conversion study. RESULTS The benchmark determined the value of the clinical dose scaling factor, [Formula: see text], as 2.40. The target mean RBE deviations between the Ray-MKM and NIRS-MKM were median: 0.6 (minimum: 0.0 to maximum: 1.69) %. The [Formula: see text] difference in-depth led to the RBE difference in-depth and was remarkable at the distal end. The converted LEM doses from the Ray-MKM doses were comparable (the deviation being - 1.8-0.7%) to existing literature. CONCLUSION This study validated the Ray-MKM based on our active-energy scanning carbon-ion beam via phantom studies. The Ray-MKM could generate similar RBEs as the NIRS-MKM after benchmarking. Analysis based on [Formula: see text] indicated that the different beam qualities and fragment spectra caused the RBE differences. Since the absolute dose differences at the distal end were small, we neglected them. Furthermore, each centre may determine its centre-specific [Formula: see text] based on this approach.
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Affiliation(s)
- Weiwei Wang
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 4365 Kangxin Road, Pudong District, Shanghai, 201315, China
- Institute of Modern Physics, Applied Ion Beam Physics Laboratory, Fudan University, Shanghai, 200433, China
| | - Wei Sun
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 4365 Kangxin Road, Pudong District, Shanghai, 201315, China
| | - Hao Shen
- Institute of Modern Physics, Applied Ion Beam Physics Laboratory, Fudan University, Shanghai, 200433, China
| | - Jingfang Zhao
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 4365 Kangxin Road, Pudong District, Shanghai, 201315, China.
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, 270 Dongan Road, Xuhui District, Shanghai, 200032, China.
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Endo M. Creation, evolution, and future challenges of ion beam therapy from a medical physicist's viewpoint (Part 2). Chapter 2. Biophysical model, treatment planning system and image guided radiotherapy. Radiol Phys Technol 2023; 16:137-159. [PMID: 37129777 DOI: 10.1007/s12194-023-00722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023]
Abstract
When an ion beam penetrates deeply into the body, its kinetic energy decreases, and its biological effect increases due to the change of the beam quality. To give a uniform biological effect to the target, it is necessary to reduce the absorbed dose with the depth. A bio-physical model estimating the relationship between ion beam quality and biological effect is necessary to determine the relative biological effectiveness (RBE) of the ion beam that changes with depth. For this reason, Lawrence Berkeley Laboratory, National Institute of Radiological Sciences (NIRS) and GSI have each developed their own model at the starting of the ion beam therapy. Also, NIRS developed a new model at the starting of the scanning irradiation. Although the Local Effect Model (LEM) at the GSI and the modified Microdosimetric Kinetic Model (MKM) at the NIRS, the both are currently used, can similarly predict radiation quality-induced changes in surviving fraction of cultured cell, the clinical RBE-weighted doses for the same absorbed dose are different. This is because the LEM uses X-rays as a reference for clinical RBE, whereas the modified MKM uses carbon ion beam as a reference and multiplies it by a clinical factor of 2.41. Therefore, both are converted through the absorbed dose. In PART 2, I will describe the development of such a bio-physical model, as well as the birth and evolution of a treatment planning system and image guided radiotherapy.
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Affiliation(s)
- Masahiro Endo
- Association for Nuclear Technology in Medicine, Nikkei Bldg., 7-16 Nihombashi-Kodemmacho, Chuo-Ku, Tokyo, Tokyo, 103-0001, Japan.
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25
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Hong Z, Zhang W, Cai X, Yu Z, Sun J, Wang W, Lin L, Zhao J, Cheng J, Zhang G, Zhang Q, Jiang G, Wang Z. Carbon ion radiotherapy with pencil beam scanning for hepatocellular carcinoma: Long-term outcomes from a phase I trial. Cancer Sci 2023; 114:976-983. [PMID: 36310409 PMCID: PMC9986066 DOI: 10.1111/cas.15633] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022] Open
Abstract
This study evaluates the feasibility of the pencil beam scanning technique of carbon ion radiotherapy (CIRT) in the setting of hepatocellular carcinoma (HCC) and establishes the maximum tolerated dose (MTD) calculated by the Local Effect Model version I (LEM-I) with a dose escalation plan. The escalated relative biological effectiveness-weighted dose levels included 55, 60, 65, and 70 Gy in 10 fractions. Active motion management techniques were employed, and several measures were applied to mitigate the interplay effect induced by a moving target. CIRT was planned with the LEM-I-based treatment planning system and delivered by raster scanning. Offline PET/CT imaging was used to verify the beam range. Offline adaptive replanning was performed whenever required. Twenty-three patients with a median tumor size of 4.3 cm (range, 1.7-8.5 cm) were enrolled in the present study. The median follow-up time was 56.1 months (range, 5.7-74.4 months). No dose limiting toxicity was observed until 70 Gy, and MTD had not been reached. No patients experienced radiation-induced liver disease within 6 months after the completion of CIRT. The overall survival rates at 1, 3, and 5 years were 91.3%, 81.9%, and 67.1% after CIRT, respectively. The local progression-free survival and progression-free survival rates at 1, 3 and 5 years were 100%, 94.4%, and 94.4% and 73.6%, 59.2%, and 37.0%, respectively. The raster scanning technique could be used to treat HCC. However, caution should be exercised to mitigate the interplay effect. CIRT up to 70 Gy in 10 fractions over 2 weeks was safe and effective for HCC.
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Affiliation(s)
- Zhengshan Hong
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Wenna Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Xin Cai
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Zhan Yu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Jiayao Sun
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Weiwei Wang
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Lienchun Lin
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Jingfang Zhao
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Jingyi Cheng
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Guangyuan Zhang
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Qing Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Guoliang Jiang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Zheng Wang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
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26
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Varnava M, Musha A, Tashiro M, Kubo N, Okano N, Kawamura H, Ohno T. Dose-volume constraints for head-and-neck cancer in carbon ion radiotherapy: A literature review. Cancer Med 2023; 12:8267-8277. [PMID: 36799088 PMCID: PMC10134371 DOI: 10.1002/cam4.5641] [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: 09/29/2022] [Revised: 12/27/2022] [Accepted: 01/02/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Carbon ion radiotherapy (CIRT) has been applied in cancer treatment for over 25 years. However, guidelines for dose-volume constraints have not been established yet. The aim of this review is to summarize the dose-volume constraints in CIRT for head-and-neck (HN) cancer that were determined through previous clinical studies based on the Japanese models for relative biological effectiveness (RBE). METHODS A literature review was conducted to identify all constraints determined for HN cancer CIRT that are based on the Japanese RBE models. RESULTS Dose-volume constraints are reported for 17 organs at risk (OARs), including the brainstem, ocular structures, masticatory muscles, and skin. Various treatment planning strategies are also presented for reducing the dose delivered to OARs. CONCLUSIONS The reported constraints will provide assistance during treatment planning to ensure that radiation to OARs is minimized, and thus adverse effects are reduced. Although the constraints are given based on the Japanese RBE models, applying the necessary conversion factors will potentially enable their application by institutions worldwide that use the local effect model for RBE.
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Affiliation(s)
- Maria Varnava
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Atsushi Musha
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan.,Department of Oral and Maxillofacial Surgery and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Mutsumi Tashiro
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Nobuteru Kubo
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan.,Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Naoko Okano
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan.,Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hidemasa Kawamura
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan.,Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan.,Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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27
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Parodi K, Yamaya T, Moskal P. Experience and new prospects of PET imaging for ion beam therapy monitoring. Z Med Phys 2023; 33:22-34. [PMID: 36446691 PMCID: PMC10068545 DOI: 10.1016/j.zemedi.2022.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/11/2022] [Accepted: 11/02/2022] [Indexed: 11/27/2022]
Abstract
Pioneering investigations on the usage of positron-emission-tomography (PET) for the monitoring of ion beam therapy with light (protons, helium) and heavier (stable and radioactive neon, carbon and oxygen) ions started shortly after the first realization of planar and tomographic imaging systems, which were able to visualize the annihilation of positrons resulting from irradiation induced or implanted positron emitting nuclei. And while the first clinical experience was challenged by the utilization of instrumentation directly adapted from nuclear medicine applications, new detectors optimized for this unconventional application of PET imaging are currently entering the phase of (pre)clinical testing for more reliable monitoring of treatment delivery during irradiation. Moreover, recent advances in detector technologies and beam production open several new exciting opportunities which will not only improve the performance of PET imaging under the challenging conditions of in-beam applications in ion beam therapy, but will also likely expand its field of application. In particular, the combination of PET and Compton imaging can enable the most efficient utilization of all possible radiative emissions for both stable and radioactive ion beams, while positronium lifetime imaging may enable probing new features of the underlying tumour and normal tissue environment. Thereby, PET imaging will not only provide means for volumetric reconstruction of the delivered treatment and in-vivo verification of the beam range, but can also shed new insights for biological optimization of the treatment or treatment response assessment.
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Affiliation(s)
- Katia Parodi
- Ludwig-Maximilians-Universität München, Lehrstuhl für Experimental Physik - Medizinische Physik, Garching b. München, Germany.
| | - Taiga Yamaya
- National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Pawel Moskal
- M. Smoluchowski Institute of Physics, Jagiellonian University, Krakow, Poland; Center for Theranostics, Jagiellonian University, Krakow, Poland
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28
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Wang Q, Liu R, Zhang Q, Luo H, Wu X, Du T, Chen Y, Tan M, Liu Z, Sun S, Yang K, Tian J, Wang X. Biological effects of cancer stem cells irradiated by charged particle: a systematic review of in vitro studies. J Cancer Res Clin Oncol 2023:10.1007/s00432-022-04561-6. [PMID: 36611110 DOI: 10.1007/s00432-022-04561-6] [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: 11/10/2022] [Accepted: 12/24/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE The existence of cancer stem cells (CSCs) is closely related to tumor recurrence, metastasis, and resistance to chemoradiotherapy. In addition, given the unique physical and biological advantages of charged particle, we hypothesized that charged particle irradiation would produce strong killing effects on CSCs. The purpose of our systematic review is to evaluate the biological effects of CSCs irradiated by charged particle, including proliferation, invasion, migration, and changes in the molecular level. METHODS We searched PubMed, EMBASE, and Web of Science until 17 march 2022 according to the key words. Included studies have to be vitro studies of CSCs irradiated by charged particle. Outcomes included one or more of radiation sensitivity, proliferation, metastasis, invasion, and molecular level changes, like DNA damage after been irradiated. RESULTS Eighteen studies were included in the final analysis. The 18 articles include 12-carbon ion irradiation, 4-proton irradiation, 1 α-particle irradiation, 1-carbon ion combine proton irradiation. CONCLUSION Through the extraction and analysis of data, we came to this conclusion: CSCs have obvious radio-resistance compared with non-CSCs, and charged particle irradiation or in combination with drugs could overcome this resistance, specifically manifested in inhibiting CSCs' proliferation, invasion, migration, and causing more and harder to repair DNA double-stranded breaks (DSB) of CSCs.
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Affiliation(s)
- Qian Wang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China.,The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, China
| | - Ruifeng Liu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China.,Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, 730030, China.,Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, 730030, China
| | - Qiuning Zhang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China.,Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, 730030, China.,Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, 730030, China
| | - Hongtao Luo
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China.,Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, 730030, China.,Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, 730030, China
| | - Xun Wu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China.,The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, China
| | - Tianqi Du
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China.,The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, China
| | - Yanliang Chen
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China.,The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, China
| | - Mingyu Tan
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China.,The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, China
| | - Zhiqiang Liu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China.,Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, 730030, China.,Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, 730030, China
| | - Shilong Sun
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China.,Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, 730030, China.,Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, 730030, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730030, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730030, China
| | - Xiaohu Wang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730030, China. .,Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, 730030, China. .,Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, 730030, China.
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29
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Shin HB, Kim C, Han MC, Hong CS, Park S, Koom WS, Kim JS. Dosimetric comparison of robust angles in carbon-ion radiation therapy for prostate cancer. Front Oncol 2023; 13:1054693. [PMID: 36874141 PMCID: PMC9978491 DOI: 10.3389/fonc.2023.1054693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
The objective of this study is to compare the plan robustness at various beam angles. Hence, the influence of the beam angles on robustness and linear energy transfer (LET) was evaluated in gantry-based carbon-ion radiation therapy (CIRT) for prostate cancer. 10 patients with prostate cancer were considered, and a total dose of 51.6 Gy (Relative biological effectiveness (RBE) was prescribed for the target volume in 12 fractions. Five beam field plans comprising two opposed fields with different angle pairs were characterized. Further, dose parameters were extracted, and the RBE-weighted dose and LET values for all angle pairs were compared. All plans considering the setup uncertainty satisfied the dose regimen. When a parallel beam pair was used for perturbed scenarios to take into account set-up uncertainty in the anterior direction, the LET clinical treatment volume (CTV) D 95% standard deviation was 1.5 times higher, and the standard deviation of RBE-weighted CTV D 95% was 7.9 times higher compared to an oblique pair. The oblique beam fields were superior in terms of dose sparing for the rectum compared to the dose distribution using two conventional lateral opposed fields for prostate cancer.
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Affiliation(s)
- Han-Back Shin
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Changhwan Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Cheol Han
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seyjoon Park
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei Severance Hospital, Seoul, Republic of Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
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30
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Wang W, Huang Z, Sun W, Wang X, Zhao J, Shen H. Calibration and evaluation of the relative biological effectiveness for carbon-ion radiotherapy in a new relative to a clinically applied treatment planning system. Radiat Oncol 2022; 17:219. [PMID: 36587224 PMCID: PMC9805684 DOI: 10.1186/s13014-022-02181-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/15/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The study objective was to validate the relative biological effectiveness (RBE) in RayStation for carbon-ion radiotherapy (CIRT) using the Syngo treatment planning system as reference. METHODS Local effect model I was established in RayStation (Ray-LEM) with the same parameters as in LEM I in Syngo (Syngo-LEM). Three cube plans covering most of the tumors treated at our center were generated with Syngo-LEM. Ray-LEM re-calculated the Syngo plans and compared the RBEs to the Syngo counterparts. The results showed that RayStation RBE was smaller than Syngo RBE. To ensure that Ray-LEM reproduced Syngo RBE, the observed deviations were used to scale the maximum RBE (RBEmax) in Ray-LEM. After this calibration, we further compared the RayStation RBE to Syngo RBE using additional plans in both homogeneous phantoms and patients, to ensure that the calibrated Ray-LEM reproduced Syngo RBE even with more complex planning features. RESULTS The calibration increased the RBEmax by 2.3% to raise the Ray-LEM RBE. The target mean RBE deviations in the phantom evaluation plans were median: 0.0 (minimum: - 1.1 to maximum: 0.7) %, and the target mean RBE deviations of the clinical target volumes of 16 patient cases were - 0.4 (- 1.5 to 0.2) %. CONCLUSIONS The residual RBE difference between RayStation and Syngo was found to be ≤ 1.0%. Thus, we can propose to use RayStation for clinical CIRT treatment planning. However, the potential differences due to the absorbed beam model warrants further exploration.
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Affiliation(s)
- Weiwei Wang
- grid.8547.e0000 0001 0125 2443Institute of Modern Physics, Applied Ion Beam Physics Laboratory, Fudan University, Shanghai, 200433 China ,grid.452404.30000 0004 1808 0942Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 4365 Kangxin Road, Pudong District, Shanghai, 201315 China
| | - Zhijie Huang
- grid.452404.30000 0004 1808 0942Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 4365 Kangxin Road, Pudong District, Shanghai, 201315 China
| | - Wei Sun
- grid.452404.30000 0004 1808 0942Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 4365 Kangxin Road, Pudong District, Shanghai, 201315 China
| | - Xufei Wang
- grid.8547.e0000 0001 0125 2443Institute of Modern Physics, Applied Ion Beam Physics Laboratory, Fudan University, Shanghai, 200433 China
| | - Jingfang Zhao
- grid.452404.30000 0004 1808 0942Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 4365 Kangxin Road, Pudong District, Shanghai, 201315 China ,grid.452404.30000 0004 1808 0942Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, 270 Dongan Road, Xuhui District, Shanghai, 200032 China
| | - Hao Shen
- grid.8547.e0000 0001 0125 2443Institute of Modern Physics, Applied Ion Beam Physics Laboratory, Fudan University, Shanghai, 200433 China
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31
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Wang W, Li P, Shahnazi K, Wu X, Zhao J. Calculating dose-averaged linear energy transfer in an analytical treatment planning system for carbon-ion radiotherapy. J Appl Clin Med Phys 2022; 24:e13866. [PMID: 36527366 PMCID: PMC9924117 DOI: 10.1002/acm2.13866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Compelling evidence shows the association between the relative biological effectiveness (RBE) of carbon-ion radiotherapy (CIRT) and the dose averaged linear energy transfer (LETd). However, the ability to calculate the LETd in commercially available treatment planning systems (TPS) is lacking. PURPOSE This study aims to develop a method of calculating the LETd of CIRT plans that could be robustly carried out in RayStation (V10B, Raysearch, Sweden). METHODS The calculation used the fragment spectra in RayStation for the CIRT treatment planning. The dose-weighted averaging procedure was supported by the microdosimetric kinetic model (MKM). The MKM-based pencil beam dose engine (PBA, v4.2) for calculating RBE-weighted doses was reformulated to become a LET-weighted calculating engine. A separate module was then configured to inversely calculate the LETd from the absorbed dose of a plan and the associated fragment spectra. In this study, the ion and energy-specific LET table in the LETd module was further matched with the values decoded from the baseline data of the Syngo TPS (V13C, Siemens, Germany). The LETd distributions of several monoenergetic and modulated beams were calculated and validated against the values derived from the Syngo TPS and the published data. RESULTS The differences in LETds of the monoenergetic beams between the new method and the traditional method were within 3% in the entrance and Bragg-peak regions. However, a larger difference was observed in the distal region. The results of the modulated beams were in good agreement with the works from the published literature. CONCLUSIONS The method presented herein reformulates the MKM dose engine in the RayStation TPS to inversely calculate LETds. The robustness and accuracy were demonstrated.
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Affiliation(s)
- Weiwei Wang
- Department of Medical PhysicsShanghai Proton and Heavy Ion CenterFudan University Cancer HospitalShanghai Key Laboratory of Radiation Oncology (20dz2261000)Shanghai Engineering Research Center of Proton and Heavy Ion Radiation TherapyShanghaiChina,Institute of Modern PhysicsApplied Ion Beam Physics LaboratoryFudan UniversityShanghaiChina
| | - Ping Li
- Department of Radiation OncologyShanghai Proton and Heavy Ion CenterShanghai Key Laboratory of Radiation Oncology (20dz2261000)Shanghai Engineering Research Center of Proton and Heavy Ion Radiation TherapyShanghaiChina
| | - Kambiz Shahnazi
- Department of Medical PhysicsShanghai Proton and Heavy Ion CenterFudan University Cancer HospitalShanghai Key Laboratory of Radiation Oncology (20dz2261000)Shanghai Engineering Research Center of Proton and Heavy Ion Radiation TherapyShanghaiChina
| | - Xiaodong Wu
- Department of Medical PhysicsShanghai Proton and Heavy Ion CenterFudan University Cancer HospitalShanghai Key Laboratory of Radiation Oncology (20dz2261000)Shanghai Engineering Research Center of Proton and Heavy Ion Radiation TherapyShanghaiChina
| | - Jingfang Zhao
- Department of Medical PhysicsShanghai Proton and Heavy Ion CenterFudan University Cancer HospitalShanghai Key Laboratory of Radiation Oncology (20dz2261000)Shanghai Engineering Research Center of Proton and Heavy Ion Radiation TherapyShanghaiChina,Department of Medical PhysicsShanghai Proton and Heavy Ion CenterFudan University Cancer HospitalShanghaiChina
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32
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Sato YH, Sakata D, Bolst D, Simpson EC, Guatelli S, Haga A. Development of a more accurate Geant4 quantum molecular dynamics model for hadron therapy. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac9a9a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Objective. Although in heavy-ion therapy, the quantum molecular dynamics (QMD) model is one of the most fundamental physics models providing an accurate daughter-ion production yield in the final state, there are still non-negligible differences with the experimental results. The aim of this study is to improve fragment production in water phantoms by developing a more accurate QMD model in Geant4. Approach. A QMD model was developed by implementing modern Skyrme interaction parameter sets, as well as by incorporating with an ad hoc α-cluster model in the initial nuclear state. Two adjusting parameters were selected that can significantly affect the fragment productions in the QMD model: the radius to discriminate a cluster to which nucleons belong after the nucleus–nucleus reaction, denoted by R, and the squared standard deviation of the Gaussian packet, denoted by L. Squared Mahalanobis’s distance of fragment yields and angular distributions with 1, 2, and the higher atomic number for the produced fragments were employed as objective functions, and multi-objective optimization (MOO), which make it possible to compare quantitatively the simulated production yields with the reference experimental data, was performed. Main results. The MOO analysis showed that the QMD model with modern Skyrme parameters coupled with the proposed α-cluster model, denoted as SkM*
α, can drastically improve light fragments yields in water. In addition, the proposed model reproduced the kinetic energy distribution of the fragments accurately. The optimized L in SkM*
α was confirmed to be realistic by the charge radii analysis in the ground state formation. Significance. The proposed framework using MOO was demonstrated to be very useful in judging the superiority of the proposed nuclear model. The optimized QMD model is expected to improve the accuracy of heavy-ion therapy dosimetry.
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33
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Chattaraj A, Selvam TP. Comparison of 126 MeV antiproton and proton—a FLUKA-based microdosimetric approach. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac88b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/10/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. This study aims at comparing dosimetric parameters of 126 MeV antiprotons and protons using microdosimetric approach. Approach. Microdosimetric distributions of 126 MeV proton and antiproton beams at 1 μm site size are calculated using the Monte Carlo-based FLUKA code. The distributions are calculated at various depths along the central axis in water phantom as well as at different off-axis locations. The study also includes calculations of secondary radiations produced by antiprotons and protons. Mean quality factor,
Q
¯
is calculated using the ICRP 60 and ICRU 40 recommendations. The Relative Biological Effectiveness (RBE) of HSG tumour cell at 10% survival level is calculated based on Microdosimetric Kinetic Model. Main results.
Q
¯
I
C
R
P
,
Q
¯
ICRU
and RBE for antiprotons are higher by a factor of about 3.60, 3.41 and 1.24, respectively, at Bragg-peak and higher by a factor of about 1.41, 1.76 and 1.05, respectively, at plateau region of depth-dose profile when compared to protons. At 15 cm depth along the central axis,
Q
¯
ICRP
,
Q
¯
ICRU
and RBE for protons are higher by a factor of about 1.42, 1.66 and 1.26, respectively, when compared to antiprotons. At the off-axis distance (Ld
) of 6 cm (at 11.5 cm depth in water),
Q
¯
ICRP
and
Q
¯
ICRU
of protons are higher than that of antiproton whereas the trend is opposite at off-axis distance of 4 cm. At Ld
= 4 cm (at 11.5 cm depth in water), RBE of antiprotons is higher by about 4% than protons whereas at Ld
= 6 cm, RBE of protons is higher by about 13% than antiprotons. Significance. The study shows that antiproton radiotherapy is advantageous as compared to protons considering enhancements in the absorbed dose and RBE-weighed dose values at the Bragg-peak.
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Vedelago J, Karger CP, Jäkel O. A review on reference dosimetry in radiation therapy with proton and light ion beams: status and impact of new developments. RADIAT MEAS 2022. [DOI: 10.1016/j.radmeas.2022.106844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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35
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Grosshagauer S, Fossati P, Schafasand M, Carlino A, Poljanc K, Radakovits T, Stock M, Hug E, Georg P, Pelak M, Góra J. Organs at risk dose constraints in carbon ion radiotherapy at MedAustron: Translations between LEM and MKM RBE models and preliminary clinical results. Radiother Oncol 2022; 175:73-78. [PMID: 35952977 DOI: 10.1016/j.radonc.2022.08.008] [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: 02/03/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Carbon ion radiotherapy (CIRT) treatment planning is based on relative biological effectiveness (RBE) weighted dose calculations. A large amount of clinical evidence for CIRT was collected in Japan with RBE estimated by the modified microdosimetric kinetic model (MKM) while all European centres apply the first version of the local effect model (LEM). Japanese schedules have been used in Europe with adapted prescription dose and organs at risk (OAR) dose constraints. Recently, less conservative adapted LEM constraints have been implemented in clinical practice. The aim of this study was to analyse the new set of LEM dose constraints for brain parenchyma, brainstem and optic system considering both RBE models and evaluating early clinical data. MATERIAL AND METHODS 31 patients receiving CIRT at MedAustron were analysed using the RayStation v9A planning system by recalculating clinical LEM-based plans in MKM. Dose statistics (D1cm3, D5cm3, D0.1cm3, D0.7cm3, D10%, D20%) were extracted for relevant critical OARs. Curve fitting for those values was performed, resulting in linear quadratic translation models. Clinical and radiological toxicity was evaluated. RESULTS Based on derived fits, currently applied LEM constraints matched recommended MKM constraints with deviations between -8% and +3.9%. For particular cases, data did not follow the expected LEM vs MKM trends resulting in outliers. Radiological (asymptomatic) toxicity was detected in two outlier cases. CONCLUSION Respecting LEM constraints does not automatically ensure that MKM constraints are met. Constraints for both RBE models need to be fulfilled for future CIRT patients at MedAustron. Careful selection of planning strategies is essential.
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Affiliation(s)
- Sarah Grosshagauer
- MedAustron Ion Therapy Center, Austria; Technical University of Vienna, Austria
| | | | - Mansure Schafasand
- MedAustron Ion Therapy Center, Austria; Medical University of Vienna, Austria
| | | | | | | | | | - Eugen Hug
- MedAustron Ion Therapy Center, Austria
| | | | | | | |
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Mairani A, Mein S, Blakely E, Debus J, Durante M, Ferrari A, Fuchs H, Georg D, Grosshans DR, Guan F, Haberer T, Harrabi S, Horst F, Inaniwa T, Karger CP, Mohan R, Paganetti H, Parodi K, Sala P, Schuy C, Tessonnier T, Titt U, Weber U. Roadmap: helium ion therapy. Phys Med Biol 2022; 67. [PMID: 35395649 DOI: 10.1088/1361-6560/ac65d3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/08/2022] [Indexed: 12/16/2022]
Abstract
Helium ion beam therapy for the treatment of cancer was one of several developed and studied particle treatments in the 1950s, leading to clinical trials beginning in 1975 at the Lawrence Berkeley National Laboratory. The trial shutdown was followed by decades of research and clinical silence on the topic while proton and carbon ion therapy made debuts at research facilities and academic hospitals worldwide. The lack of progression in understanding the principle facets of helium ion beam therapy in terms of physics, biological and clinical findings persists today, mainly attributable to its highly limited availability. Despite this major setback, there is an increasing focus on evaluating and establishing clinical and research programs using helium ion beams, with both therapy and imaging initiatives to supplement the clinical palette of radiotherapy in the treatment of aggressive disease and sensitive clinical cases. Moreover, due its intermediate physical and radio-biological properties between proton and carbon ion beams, helium ions may provide a streamlined economic steppingstone towards an era of widespread use of different particle species in light and heavy ion therapy. With respect to the clinical proton beams, helium ions exhibit superior physical properties such as reduced lateral scattering and range straggling with higher relative biological effectiveness (RBE) and dose-weighted linear energy transfer (LETd) ranging from ∼4 keVμm-1to ∼40 keVμm-1. In the frame of heavy ion therapy using carbon, oxygen or neon ions, where LETdincreases beyond 100 keVμm-1, helium ions exhibit similar physical attributes such as a sharp lateral penumbra, however, with reduced radio-biological uncertainties and without potentially spoiling dose distributions due to excess fragmentation of heavier ion beams, particularly for higher penetration depths. This roadmap presents an overview of the current state-of-the-art and future directions of helium ion therapy: understanding physics and improving modeling, understanding biology and improving modeling, imaging techniques using helium ions and refining and establishing clinical approaches and aims from learned experience with protons. These topics are organized and presented into three main sections, outlining current and future tasks in establishing clinical and research programs using helium ion beams-A. Physics B. Biological and C. Clinical Perspectives.
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Affiliation(s)
- Andrea Mairani
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Centre of Oncological Hadrontherapy (CNAO), Medical Physics, Pavia, Italy.,Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Stewart Mein
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eleanor Blakely
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, United States of America
| | - Jürgen Debus
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany.,Technische Universität Darmstadt, Institut für Physik Kondensierter Materie, Darmstadt, Germany
| | - Alfredo Ferrari
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hermann Fuchs
- Division of Medical Physics, Department of Radiation Oncology, Medical University of Vienna, Austria.,MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Dietmar Georg
- Division of Medical Physics, Department of Radiation Oncology, Medical University of Vienna, Austria.,MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - David R Grosshans
- The University of Texas MD Anderson cancer Center, Houston, Texas, United States of America
| | - Fada Guan
- The University of Texas MD Anderson cancer Center, Houston, Texas, United States of America.,Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, 06510, United States of America
| | - Thomas Haberer
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Semi Harrabi
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Felix Horst
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - Taku Inaniwa
- Department of Accelerator and Medical Physics, Institute for Quantum Medical Science, QST, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan.,Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Christian P Karger
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Radhe Mohan
- The University of Texas MD Anderson cancer Center, Houston, Texas, United States of America
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, United States of America.,Harvard Medical School, Boston, United States of America
| | - Katia Parodi
- Ludwig-Maximilians-Universität München, Department of Experimental Physics-Medical Physics, Munich, Germany
| | - Paola Sala
- Ludwig-Maximilians-Universität München, Department of Experimental Physics-Medical Physics, Munich, Germany
| | - Christoph Schuy
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Uwe Titt
- The University of Texas MD Anderson cancer Center, Houston, Texas, United States of America
| | - Ulrich Weber
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
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Held T, Tessonnier T, Franke H, Regnery S, Bauer L, Weusthof K, Harrabi S, Herfarth K, Mairani A, Debus J, Adeberg S. Ways to unravel the clinical potential of carbon ions for head and neck cancer reirradiation: dosimetric comparison and local failure pattern analysis as part of the prospective randomized CARE trial. Radiat Oncol 2022; 17:121. [PMID: 35804448 PMCID: PMC9264522 DOI: 10.1186/s13014-022-02093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background Carbon ion radiotherapy (CIRT) yields biophysical advantages compared to photons but randomized studies for the reirradiation setting are pending. The aim of the current project was to evaluate potential clinical benefits and drawbacks of CIRT compared to volumetric modulated arc therapy (VMAT) in recurrent head and neck cancer. Methods Dose-volume parameters and local failure patterns of CIRT compared to VMAT were evaluate in 16 patients from the randomized CARE trial on head and neck cancer reirradiation. Results Despite an increased target dose, CIRT resulted in significantly reduced organ at risk (OAR) dose across all patients (− 8.7% Dmean). The dose-volume benefits were most pronounced in the brainstem (− 20.7% Dmax) and the optic chiasma (− 13.0% Dmax). The most frequent local failure was type E (extraneous; 50%), followed type B (peripheral; 33%) and type A (central; 17%). In one patient with type A biological and/or dosimetric failure after CIRT, mMKM dose recalculation revealed reduced target coverage. Conclusions CIRT resulted in highly improved critical OAR sparing compared to VMAT across all head and neck cancer reirradiation scenarios despite an increased prescription dose. Local failure pattern analysis revealed further potential CIRT specific clinical benefits and potential pitfalls with regard to image-guidance and biological dose-optimization. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02093-4.
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Affiliation(s)
- Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany. .,National Center for Tumor Diseases (NCT), Heidelberg, Germany. .,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.
| | - Thomas Tessonnier
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany
| | - Henrik Franke
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Lukas Bauer
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Katharina Weusthof
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Semi Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrea Mairani
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Physics, National Centre of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
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38
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Tian L, Hahn C, Lühr A. An ion-independent phenomenological relative biological effectiveness (RBE) model for proton therapy. Radiother Oncol 2022; 174:69-76. [PMID: 35803365 DOI: 10.1016/j.radonc.2022.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND A relative biological effectiveness (RBE) of 1.1 is used for proton therapy though clinical evidence of varying RBE was raised. Clinical studies on RBE variability have been conducted for decades for carbon radiation, which could advance the understanding of the clinical proton RBE given an ion-independent RBE model. In this work, such a model, linear and simple, using the beam quantity Q = Z2/E (Z = ion charge, E = kinetic energy per nucleon) was tested and compared to the commonly used, proton-specific and linear energy transfer (LET) based Wedenberg RBE model. MATERIAL AND METHODS The Wedenberg and Q models, both predicting RBEmax and RBEmin (i.e., RBE at vanishing and very high dose, respectively), are compared in terms of ion-dependence and prediction power. An experimental in-vitro data ensemble covering 115 publications for various ions was used as dataset. RESULTS The model parameter of the Q model was observed to be similar for different ions (in contrast to LET). The Q model was trained without any prior knowledge of proton data. For proton RBE, the differences between experimental data and corresponding predictions of the Wedenberg or the Q model were highly comparable. CONCLUSIONS A simple linear RBE model using Q instead of LET was proposed and tested to be able to predict proton RBE using model parameter trained based on only RBE data of other particles in a clinical proton energy range for a large in-vitro dataset. Adding (pre)clinical knowledge from carbon ion therapy may, therefore, reduce the dominating biological uncertainty in proton RBE modelling. This would translate in reduced RBE related uncertainty in proton therapy treatment planning.
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Affiliation(s)
- Liheng Tian
- TU Dortmund University, Department of Physics, Dortmund, Germany.
| | - Christian Hahn
- TU Dortmund University, Department of Physics, Dortmund, Germany; OncoRay, National Center for Radiation Research in Oncology, Faculty of Medicine, and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Armin Lühr
- TU Dortmund University, Department of Physics, Dortmund, Germany.
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Loan M, Bhat A. Effect of overdispersion of lethal lesions on cell survival curves. Biomed Phys Eng Express 2022; 8. [PMID: 35671734 DOI: 10.1088/2057-1976/ac7667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/07/2022] [Indexed: 01/03/2023]
Abstract
The linear-quadratic (LQ) model is the most commonly used mechanism to predict radiobiological outcomes. It has been used extensively to describe dose-responsein vitroandin vivo. There are, however, some questions about its applicability in terms of its capacity to represent some profound mechanistic behaviour. Specifically, empirical evidence suggests that the LQ model underestimates the survival of cells at low doses while overestimating cell death at higher doses. It is believed to be driven from the usual LQ model assumption that radiogenic lesions are Poisson distributed. In this context, we use a negative binomial (NB) distribution to study the effect of overdispersion on the shapes and the possibility of reducing dose-response curvature at higher doses. We develop an overdispersion model for cell survival using the non-homologous end-joining (NHEJ) pathway double-strand break (DSB) repair mechanism to investigate the effects of the overdispersion on probabilities of repair of DSBs. The error distribution is customised to ensure that the refined overdispersion parameter depends on the mean of the distribution. The predicted cell survival responses for V79, AG and HSG cells exposed to protons, helium and carbon ions are compared with the experimental data in low and high dose regions at various linear energy transfer (LET) values. The results indicate straightening of dose-response and approaching a log-linear behaviour at higher doses. The model predictions with the measured data show that the NB modelled survival curves agree with the data following medium and high doses. Model predictions are not validated at very tiny and very high doses; the approach presented provides an analysis of mechanisms at the microscopic level. This may help improve the understanding of radiobiological responses of survival curves and resolve discrepancies between experimental and theoretical predictions of cell survival models.
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Affiliation(s)
- M Loan
- ANU College, Australian National University, Canberra, 2600, Australia
| | - A Bhat
- Department of Oncology, East Tennessee State University, TN, 37614, United States of America
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40
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Eichkorn T, Karger CP, Brons S, Koerber SA, Mielke T, Haberer T, Debus J, Herfarth K. Results of a prospective randomized trial on long-term effectiveness of protons and carbon ions in prostate cancer: LEM I and α/β = 2 Gy overestimates the RBE. Radiother Oncol 2022; 173:223-230. [PMID: 35714806 DOI: 10.1016/j.radonc.2022.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
Abstract
AIM To analyze the long-term effectiveness of carbon ions relative to protons in the prospective randomized controlled ion prostate irradiation (IPI) trial. METHODS Effectiveness via PSA assessment in a randomized study on prostate irradiation with 20x3.3 Gy(RBE) protons versus carbon ions was analyzed in 92 patients. Proton RBE was based on a fixed RBE of 1.1 while the local effect model (LEM) I and an α/β = 2 Gy was used for carbon ions. The dose in the prostate was recalculated based on the delivered treatment plan using LEM I and LEM IV and different α/β values. RESULTS Five-year overall and progression free survival was 98% and 85% with protons and 91% and 50% with carbon ions, respectively, with the latter being unexpectedly low compared to Japanese carbon ion data and rather corresponding to a photon dose <72 Gy in 2 Gy fractions. According to LEM I and the applied α/β-value of 2 Gy, the applied carbon ion dose in 2 Gy(RBE) fractions (EQD2) was 87.46 Gy(RBE). Recalculations confirmed a strong dependence of RBE-weighted dose on the α/β ratio as well as on the RBE-model. CONCLUSION The data demonstrate a significant lower effectiveness of the calculated RBE-weighted dose in the carbon ion as compared to the proton arm. LEM I and an α/β = 2 Gy overestimates the RBE for carbon ions in prostate cancer treatment. Adjusting the biological dose calculation by using LEM I with α/β = 4 Gy could be a pragmatic way to safely escalate dose in carbon ion radiotherapy for prostate cancer.
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Affiliation(s)
- Tanja Eichkorn
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.
| | - Christian P Karger
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Germany; Dept. of Medical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
| | - Stephan Brons
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Germany.
| | - Stefan Alexander Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.
| | - Thomas Mielke
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.
| | - Thomas Haberer
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Germany; Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology (E050), German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany; German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), Germany.
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.
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Kozłowska WS, Carante MP, Aricò G, Embriaco A, Ferrari A, Magro G, Mairani A, Ramos R, Sala P, Georg D, Ballarini F. First application of the BIANCA biophysical model to carbon-ion patient cases. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac702b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/16/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. The main objective of this work consists of applying, for the first time, the BIANCA (BIophysical ANalysis of Cell death and chromosome Aberrations) biophysical model to the RBE calculation for C-ion cancer patients, and comparing the outcomes with those obtained by the LEM I model, which is applied in clinics. Indeed, the continuous development of heavy-ion cancer therapy requires modelling of biological effects of ion beams on tumours and normal tissues. The relative biological effectiveness (RBE) of heavy ions is higher than that of protons, with a significant variation along the beam path. Therefore, it requires a precise modelling, especially for the pencil-beam scanning technique. Currently, two radiobiological models, LEM I and MKM, are in use for heavy ions in scanned pencil-beam facilities. Approach. Utilizing an interface with the FLUKA Particle Therapy Tool, BIANCA was applied to re-calculate the RBE-weighted dose distribution for carbon-ion treatment of three patients (chordoma, head-and-neck and prostate) previously irradiated at CNAO, where radiobiological optimization was based on LEM I. The predictions obtained by BIANCA were based either on chordoma cell survival (RBE
surv
), or on dicentric aberrations in peripheral blood lymphocytes (RBE
ab
), which are indicators of late normal tissue damage, including secondary tumours. The simulation outcomes were then compared with those provided by LEM I. Main results. While in the target and in the entrance channel BIANCA predictions were lower than those obtained by LEM I, the two models provided very similar results in the considered OAR. The observed differences between RBE
surv
and RBE
ab
(which were also dependent on fractional dose and LET) suggest that in normal tissues the information on cell survival should be integrated by information more closely related to the induction of late damage, such as chromosome aberrations. Significance. This work showed that BIANCA is suitable for treatment plan optimization in ion-beam therapy, especially considering that it can predict both cell survival and chromosome aberrations and has previously shown good agreement with carbon-ion experimental data.
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A Consistent Protocol Reveals a Large Heterogeneity in the Biological Effectiveness of Proton and Carbon-Ion Beams for Various Sarcoma and Normal-Tissue-Derived Cell Lines. Cancers (Basel) 2022; 14:cancers14082009. [PMID: 35454915 PMCID: PMC9029457 DOI: 10.3390/cancers14082009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Using a consistent experimental protocol, we found a large heterogeneity in the relative biological effectiveness (RBE) values of both proton and carbon-ion beams in various sarcomas and normal-tissue-derived cell lines. Our data suggest that proton beam therapy may be more beneficial for some types of tumors. In carbon-ion therapy, for some types of tumors, large heterogeneity in RBE should prompt consideration of dose reduction or an increased dose per fraction. In particular, a higher RBE value in normal tissues requires caution. Specific dose evaluations for tumor and normal tissues are needed for both proton and carbon-ion therapies. Abstract This study investigated variations in the relative biological effectiveness (RBE) values among various sarcoma and normal-tissue-derived cell lines (normal cell line) in proton beam and carbon-ion irradiations. We used a consistent protocol that specified the timing of irradiation after plating cells and detailed the colony formation assay. We examined the cell type dependence of RBE for proton beam and carbon-ion irradiations using four human sarcoma cell lines (MG63 osteosarcoma, HT1080 fibrosarcoma, SW872 liposarcoma, and SW1353 chondrosarcoma) and three normal cell lines (HDF human dermal fibroblast, hTERT-HME1 mammary gland, and NuLi-1 bronchus epithelium). The cells were irradiated with gamma rays, proton beams at the center of the spread-out Bragg peak, or carbon-ion beams at 54.4 keV/μm linear energy transfer. In all sarcoma and normal cell lines, the average RBE values in proton beam and carbon-ion irradiations were 1.08 ± 0.11 and 2.08 ± 0.36, which were consistent with the values of 1.1 and 2.13 used in current treatment planning systems, respectively. Up to 34% difference in the RBE of the proton beam was observed between MG63 and HT1080. Similarly, a 32% difference in the RBE of the carbon-ion beam was observed between SW872 and the other sarcoma cell lines. In proton beam irradiation, normal cell lines had less variation in RBE values (within 10%), whereas in carbon-ion irradiation, RBE values differed by up to 48% between hTERT-HME1 and NuLi-1. Our results suggest that specific dose evaluations for tumor and normal tissues are necessary for treatment planning in both proton and carbon-ion therapies.
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Yang S, Zhao J, Zhuo W, Shen H, Chen B. Changes of the linear energy transfer (LET) and beam width of therapeutic carbon ion beam in density heterogeneous phantoms. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021518. [PMID: 35320782 DOI: 10.1088/1361-6498/ac6044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
This work aims to investigate the changes in the linear energy transfer (LET) spectra distribution and the beam spot width of a therapeutic carbon ion beam in density heterogeneous phantoms. Three different heterogeneous phantoms were fabricated using a combination of solid water, lung, and bone tissue slabs and irradiated by a single energy carbon beam (276.5 MeV u-1). CR-39 detectors were used for experimental measurements and the Monte Carlo toolkit Geant4 was employed for theoretical simulations. The results demonstrated that the measured LET spectra agree well with the simulation results. The lung and bone tissues displayed no obvious effect on the spectral distribution of LET. The dose-average LET was invariant and showed no obvious difference in the different materials, while the track-average LET increased in the lung and decreased in the bone materials. Similarly, the beam spot size increased in the lung, and decreased in the bone materials. Additionally, the fluence of the secondary fragments varied in different tissues. These findings are expected to provide cross-validation data for the quality assurance of carbon ion therapy and to be beneficial for validating the base data in treatment planning systems.
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Affiliation(s)
- Shiyan Yang
- Institute of Modern Physics, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Nuclear Physics and Ion-beam Application (MOE), Fudan University, Shanghai, People's Republic of China
| | - Jingfang Zhao
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, People's Republic of China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, People's Republic of China
| | - Weihai Zhuo
- Key Laboratory of Nuclear Physics and Ion-beam Application (MOE), Fudan University, Shanghai, People's Republic of China
- Institute of Radiation Medicine, Fudan University, Shanghai, People's Republic of China
| | - Hao Shen
- Institute of Modern Physics, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Nuclear Physics and Ion-beam Application (MOE), Fudan University, Shanghai, People's Republic of China
| | - Bo Chen
- Institute of Radiation Medicine, Fudan University, Shanghai, People's Republic of China
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Relative biological effectiveness of single and split helium ion doses in the rat spinal cord increases strongly with linear energy transfer. Radiother Oncol 2022; 170:224-230. [PMID: 35367526 DOI: 10.1016/j.radonc.2022.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Determination of the relative biological effectiveness (RBE) of helium ions as a function of linear energy transfer (LET) for single and split doses using the rat cervical spinal cord as model system for late-responding normal tissue. MATERIAL AND METHODS The rat cervical spinal cord was irradiated at four different positions within a 6 cm spread-out Bragg-peak (SOBP) (LET 2.9, 9.4, 14.4 and 20.7 keV/µm) using increasing levels of single or split doses of helium ions. Dose-response curves were determined and based on TD50-values (dose at 50% effect probability using paresis II as endpoint), RBE-values were derived for the endpoint of radiation-induced myelopathy. RESULTS With increasing LET, RBE-values increased from 1.13 ± 0.04 to 1.42 ± 0.05 (single dose) and 1.12 ± 0.03 to 1.50 ± 0.04 (split doses) as TD50-values decreased from 21.7 ± 0.3 Gy to 17.3 ± 0.3 Gy (single dose) and 30.6 ± 0.3 Gy to 22.9 ± 0.3 Gy (split doses), respectively. RBE-models (LEM I and IV, mMKM) deviated differently for single and split doses but described the RBE variation in the high-LET region sufficiently accurate. CONCLUSION This study established the LET-dependence of the RBE for late effects in the central nervous system after single and split doses of helium ions. The results extend the existing database for protons and carbon ions and allow systematic testing of RBE-models. While the RBE-values of helium were generally lower than for carbon ions, the increase at the distal edge of the Bragg-peak was larger than for protons, making detailed RBE-modeling necessary.
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Ali Y, Monini C, Russeil E, Létang JM, Testa E, Maigne L, Beuve M. Estimate of the Biological Dose in Hadrontherapy Using GATE. Cancers (Basel) 2022; 14:1667. [PMID: 35406438 PMCID: PMC8996851 DOI: 10.3390/cancers14071667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 12/10/2022] Open
Abstract
For the evaluation of the biological effects, Monte Carlo toolkits were used to provide an RBE-weighted dose using databases of survival fraction coefficients predicted through biophysical models. Biophysics models, such as the mMKM and NanOx models, have previously been developed to estimate a biological dose. Using the mMKM model, we calculated the saturation corrected dose mean specific energy z1D* (Gy) and the dose at 10% D10 for human salivary gland (HSG) cells using Monte Carlo Track Structure codes LPCHEM and Geant4-DNA, and compared these with data from the literature for monoenergetic ions. These two models were used to create databases of survival fraction coefficients for several ion types (hydrogen, carbon, helium and oxygen) and for energies ranging from 0.1 to 400 MeV/n. We calculated α values as a function of LET with the mMKM and the NanOx models, and compared these with the literature. In order to estimate the biological dose for SOBPs, these databases were used with a Monte Carlo toolkit. We considered GATE, an open-source software based on the GEANT4 Monte Carlo toolkit. We implemented a tool, the BioDoseActor, in GATE, using the mMKM and NanOx databases of cell survival predictions as input, to estimate, at a voxel scale, biological outcomes when treating a patient. We modeled the HIBMC 320 MeV/u carbon-ion beam line. We then tested the BioDoseActor for the estimation of biological dose, the relative biological effectiveness (RBE) and the cell survival fraction for the irradiation of the HSG cell line. We then tested the implementation for the prediction of cell survival fraction, RBE and biological dose for the HIBMC 320 MeV/u carbon-ion beamline. For the cell survival fraction, we obtained satisfying results. Concerning the prediction of the biological dose, a 10% relative difference between mMKM and NanOx was reported.
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Affiliation(s)
- Yasmine Ali
- Institut de Physique des 2 Infinis de Lyon, Université Claude Bernard Lyon 1, CNRS/IN2P3, 4 rue Enrico Fermi, 69622 Villeurbanne, France; (Y.A.); (C.M.); (E.T.); (M.B.)
| | - Caterina Monini
- Institut de Physique des 2 Infinis de Lyon, Université Claude Bernard Lyon 1, CNRS/IN2P3, 4 rue Enrico Fermi, 69622 Villeurbanne, France; (Y.A.); (C.M.); (E.T.); (M.B.)
| | - Etienne Russeil
- Laboratoire de Physique de Clermont, Université Clermont Auvergne, CNRS/IN2P3, 4 Avenue Blaise Pascal, 63178 Aubière, France;
| | - Jean Michel Létang
- CREATIS, Université Claude Bernard Lyon 1, CNRS UMR5220, Inserm U1294, INSA-Lyon, Université Lyon 1, 69373 Lyon, France;
| | - Etienne Testa
- Institut de Physique des 2 Infinis de Lyon, Université Claude Bernard Lyon 1, CNRS/IN2P3, 4 rue Enrico Fermi, 69622 Villeurbanne, France; (Y.A.); (C.M.); (E.T.); (M.B.)
| | - Lydia Maigne
- Laboratoire de Physique de Clermont, Université Clermont Auvergne, CNRS/IN2P3, 4 Avenue Blaise Pascal, 63178 Aubière, France;
| | - Michael Beuve
- Institut de Physique des 2 Infinis de Lyon, Université Claude Bernard Lyon 1, CNRS/IN2P3, 4 rue Enrico Fermi, 69622 Villeurbanne, France; (Y.A.); (C.M.); (E.T.); (M.B.)
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Carbon ion radiotherapy in the management of non‐small cell lung cancer. PRECISION RADIATION ONCOLOGY 2022. [DOI: 10.1002/pro6.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Li Y, Sakai M, Tsunoda A, Kubo N, Kitada Y, Kubota Y, Matsumura A, Zhou Y, Ohno T. Normal Tissue Complication Probability Model for Acute Radiation Dermatitis in Patients with Head and Neck Cancer Treated with Carbon Ion Radiotherapy. Int J Radiat Oncol Biol Phys 2022; 113:675-684. [PMID: 35278673 DOI: 10.1016/j.ijrobp.2022.03.002] [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: 09/10/2021] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to explore the prognostic factors associated with acute radiation dermatitis (ARD). A normal tissue complication probability (NTCP) model for ARD in patients with head and neck cancer (HNC) treated with carbon ion radiotherapy (CIRT) was developed. MATERIALS AND METHODS A total of 187 patients were included in the analysis, and the endpoint was ≥grade 2 ARD. The biological and physical dose-surface parameters associated with ARD were used in the logistic regression model. The mean areas under the receiver operating characteristic curve (AUC) in the internal cross-validation and Akaike's corrected Information Criterion (AICc) were examined for model evaluation and selection. The multivariate logistic regression NTCP models were established based on factors with weak correlation. RESULTS Tumour volume, planning target volume to the skin, radiation technique and all dose-surface parameters were significantly associated with ARD (P < 0.05). Models with high performance for grade 2-3 ARD were constructed. The most significant prognostic predictors were S40 Gy (relative biological effectiveness, RBE) and S20 Gy [absolute surface area receiving RBE-weighted dose of 40 Gy (RBE) or physical dose of 20 Gy]. The internal cross-validation-based AUCs for models with S40 Gy (RBE) and S20 Gy were 0.78 and 0.77, respectively. The biological and physical dose-surface parameters had similar performance at various dose levels. However, the performance of the multivariate NTCP models based on two factors was not better than that of the univariate models. CONCLUSIONS NTCP models for ARD may provide a basis for the development of individualised treatment strategies and reduce the incidence of severe ARD in patients with HNC receiving CIRT. Furthermore, biological and physical dose-surface parameter-based models are comparable. However, further validation with more evaluation parameters is warranted.
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Affiliation(s)
- Yang Li
- Gunma University Heavy Ion Medical Center, Maebashi, Japan; Department of Radiation Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Makoto Sakai
- Gunma University Heavy Ion Medical Center, Maebashi, Japan.
| | - Anna Tsunoda
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Nobuteru Kubo
- Gunma University Heavy Ion Medical Center, Maebashi, Japan; Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoko Kitada
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Yoshiki Kubota
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | - Yuan Zhou
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan; Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
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48
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Eberle F, Engenhart-Cabillic R, Schymalla MM, Dumke C, Schötz U, Subtil FSB, Baumann KS, Stuck BA, Langer C, Jensen AD, Hauswald H, Lautenschläger S. Carbon Ion Beam Boost Irradiation in Malignant Tumors of the Nasal Vestibule and the Anterior Nasal Cavity as an Organ-Preserving Therapy. Front Oncol 2022; 12:814082. [PMID: 35242709 PMCID: PMC8886023 DOI: 10.3389/fonc.2022.814082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/19/2022] [Indexed: 11/20/2022] Open
Abstract
Background Surgery and radiotherapy are current therapeutic options for malignant tumors involving the nasal vestibule. Depending on the location, organ-preserving resection is not always possible, even for small tumors. Definitive radiotherapy is an alternative as an organ-preserving procedure. Carbon ion beam radiotherapy offers highly conformal dose distributions and more complex biological radiation effects eventually resulting in optimized normal tissue sparing and improved outcome. The aim of the current study was to analyze toxicity, local control (LC), and organ preserving survival (OPS) after irradiation of carcinoma of the nasal vestibule with raster-scanned carbon ion radiotherapy boost (CIRT-B) combined with volumetric intensity modulated arc therapy (VMAT) with photons. Methods Between 12/2015 and 05/2021, 21 patients with malignant tumors involving the nasal vestibule were irradiated with CIRT-B combined with VMAT and retrospectively analyzed. Diagnosis was based on histologic findings. A total of 17 patients had squamous cell carcinoma (SCC) and 4 had other histologies. In this series, 10%, 67%, and 24% of patients had Wang stages 1, 2, and 3 tumors, respectively. Three patients had pathologic cervical nodes on MRI. The median CIRT-B dose was 24 Gy(RBE), while the median VMAT dose was 50 Gy. All patients with pathologic cervical nodes received simultaneously integrated boost with photons (SIB) up to a median dose of 62.5 Gy to the pathological lymph nodes. Eight patients received cisplatin chemotherapy. All patients received regular follow-up imaging after irradiation. Kaplan–Meier estimation was used for statistical assessment. Results The median follow-up after irradiation was 18.9 months. There were no common toxicity criteria grade 5 or 4 adverse events. A total of 20 patients showed grade 3 adverse events mainly on skin and mucosa. All patients were alive at the end of follow-up. The median OPS after treatment was 56.5 months. The 6- and 24-month OPS were 100% and 83.3%, respectively. All local recurrences occurred within 12 months after radiotherapy. The median progression free survival (PFS) after treatment was 52.4 months. The 6-, 12-, and 24-month PFS rates were 95%, 83.6%, and 74.3%, respectively. Conclusion CIRT-B combined with VMAT in malignant tumors of the nasal vestibule is safe and feasible, results in high local control rates, and thus is a good option as organ-preserving therapy. No radiation-associated grade 4 or 5 acute or late AE was documented.
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Affiliation(s)
- Fabian Eberle
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Rita Engenhart-Cabillic
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Markus M Schymalla
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Christoph Dumke
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Ulrike Schötz
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Florentine S B Subtil
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Kilian-Simon Baumann
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Boris A Stuck
- Department of Otolaryngology/Head & Neck Surgery, Marburg University Hospital, Marburg, Germany
| | - Christine Langer
- Department of Otolaryngology/Head & Neck Surgery, Gießen University Hospital, Gießen, Germany
| | - Alexandra D Jensen
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Department of Radiation Oncology, Gießen University Hospital, Gießen, Germany
| | - Henrik Hauswald
- Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Lautenschläger
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
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Niklas M, Schlegel J, Liew H, Zimmermann F, Rein K, Walsh DW, Dzyubachyk O, Holland-Letz T, Rahmanian S, Greilich S, Runz A, Jäkel O, Debus J, Abdollahi A. Biosensor for deconvolution of individual cell fate in response to ion beam irradiation. CELL REPORTS METHODS 2022; 2:100169. [PMID: 35474967 PMCID: PMC9017136 DOI: 10.1016/j.crmeth.2022.100169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/10/2021] [Accepted: 01/25/2022] [Indexed: 12/25/2022]
Abstract
Clonogenic survival assay constitutes the gold standard method for quantifying radiobiological effects. However, it neglects cellular radiation response variability and heterogeneous energy deposition by ion beams on the microscopic scale. We introduce "Cell-Fit-HD4D" a biosensor that enables a deconvolution of individual cell fate in response to the microscopic energy deposition as visualized by optical microscopy. Cell-Fit-HD4D enables single-cell dosimetry in clinically relevant complex radiation fields by correlating microscopic beam parameters with biological endpoints. Decrypting the ion beam's energy deposition and molecular effects at the single-cell level has the potential to improve our understanding of radiobiological dose concepts as well as radiobiological study approaches in general.
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Affiliation(s)
- Martin Niklas
- Division of Molecular and Translational Radiation Oncology and Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Research Center (DKFZ) and Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases, German Cancer Consortium, Heidelberg Institute of Radiation Oncology and National Center for Radiation Oncology, 69120 Heidelberg, Germany
| | - Julian Schlegel
- Division of Molecular and Translational Radiation Oncology and Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Research Center (DKFZ) and Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases, German Cancer Consortium, Heidelberg Institute of Radiation Oncology and National Center for Radiation Oncology, 69120 Heidelberg, Germany
| | - Hans Liew
- Division of Molecular and Translational Radiation Oncology and Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Research Center (DKFZ) and Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases, German Cancer Consortium, Heidelberg Institute of Radiation Oncology and National Center for Radiation Oncology, 69120 Heidelberg, Germany
| | - Ferdinand Zimmermann
- Division of Molecular and Translational Radiation Oncology and Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Research Center (DKFZ) and Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases, German Cancer Consortium, Heidelberg Institute of Radiation Oncology and National Center for Radiation Oncology, 69120 Heidelberg, Germany
| | - Katrin Rein
- Division of Molecular and Translational Radiation Oncology and Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Research Center (DKFZ) and Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases, German Cancer Consortium, Heidelberg Institute of Radiation Oncology and National Center for Radiation Oncology, 69120 Heidelberg, Germany
| | - Dietrich W.M. Walsh
- Division of Molecular and Translational Radiation Oncology and Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Research Center (DKFZ) and Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases, German Cancer Consortium, Heidelberg Institute of Radiation Oncology and National Center for Radiation Oncology, 69120 Heidelberg, Germany
| | - Oleh Dzyubachyk
- Department of Radiology and Department of Cell and Chemical Biology, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands
| | - Tim Holland-Letz
- Division of Biostatistics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Shirin Rahmanian
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Steffen Greilich
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Armin Runz
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Oliver Jäkel
- National Center for Tumor Diseases, German Cancer Consortium, Heidelberg Institute of Radiation Oncology and National Center for Radiation Oncology, 69120 Heidelberg, Germany
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
| | - Jürgen Debus
- Division of Molecular and Translational Radiation Oncology and Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Research Center (DKFZ) and Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases, German Cancer Consortium, Heidelberg Institute of Radiation Oncology and National Center for Radiation Oncology, 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
| | - Amir Abdollahi
- Division of Molecular and Translational Radiation Oncology and Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Research Center (DKFZ) and Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases, German Cancer Consortium, Heidelberg Institute of Radiation Oncology and National Center for Radiation Oncology, 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
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Li Y, Li X, Yang J, Wang S, Tang M, Xia J, Gao Y. Flourish of Proton and Carbon Ion Radiotherapy in China. Front Oncol 2022; 12:819905. [PMID: 35237518 PMCID: PMC8882681 DOI: 10.3389/fonc.2022.819905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Proton and heavy ion therapy offer superior relative biological effectiveness (RBE) in the treatment of deep-seated tumors compared with conventional photon radiotherapy due to its Bragg-peak feature of energy deposition in organs. Many proton and carbon ion therapy centers are active all over the world. At present, five particle radiotherapy institutes have been built and are receiving patient in China, mainly including Wanjie Proton Therapy Center (WPTC), Shanghai Proton Heavy Ion Center (SPHIC), Heavy Ion Cancer Treatment Center (HIMM), Chang Gung Memorial Hospital (CGMH), and Ruijin Hospital affiliated with Jiao Tong University. Many cancer patients have benefited from ion therapy, showing unique advantages over surgery and chemotherapy. By the end of 2020, nearly 8,000 patients had been treated with proton, carbon ion or carbon ion combined with proton therapy. So far, there is no systemic review for proton and carbon ion therapy facility and clinical outcome in China. We reviewed the development of proton and heavy ion therapy, as well as providing the representative clinical data and future directions for particle therapy in China. It has important guiding significance for the design and construction of new particle therapy center and patients’ choice of treatment equipment.
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Affiliation(s)
- Yue Li
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- *Correspondence: Yue Li,
| | - Xiaoman Li
- Department of Radiation Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Jiancheng Yang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
| | - Sicheng Wang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
| | - Meitang Tang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
| | - Jiawen Xia
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- Huizhou Research Center of Ion Science, Chinese Academy of Sciences, Huizhou, China
| | - Yunzhe Gao
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, China
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