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Rahimi R, Taylor M, Li X, Chen KL, MacLennan G, Murdoch E, Chang L, Parniani A, Wang P, Chawla A, Fan J, Kim D. Fetal dose assessment in a pregnant patient with brain tumor: A comparative study of proton PBS and 3DCRT/VMAT radiation therapy techniques. J Appl Clin Med Phys 2024:e14394. [PMID: 38887816 DOI: 10.1002/acm2.14394] [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: 02/22/2024] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE The treatment of brain tumors in pregnant patients poses challenges, as the out-of-field dose exposure to the fetus can potentially be harmful. A pregnant patient with prior radiation treatment was presented with a brain tumor at our clinic. This work reports on our pre-treatment study that compared fetal dose exposure between intensity-modulated proton therapy (IMPT) using pencil beam scanning (PBS) and conventional photon 3D conformal radiation therapy (3DCRT) and volumetric-modulated arc therapy (VMAT), and the subsequent pregnant patient's radiation treatment. MATERIALS AND METHODS Pre-treatment measurements of clinical plans, 3DCRT, VMAT, and IMPT, were conducted on a phantom. Measurements were performed using a device capable of neutron detections, closely following AAPM guidelines, TG158. For photon measurements, fetus shielding was utilized. On patient treatment days, which was determined to be proton treatment, shielding was used only during daily imaging for patient setup. Additionally, an in vivo measurement was conducted on the patient. RESULTS Measurements showed that IMPT delivered the lowest fetal dose, considering both photon and neutron out-of-field doses to the fetus, even when shielding was implemented for photon measurements. Additionally, the proton plans demonstrated superior treatment for the mother, a reirradiation case. CONCLUSION The patient was treated with proton therapy, and the baby was subsequently delivered at full term with no complications. This case study supports previous clinical findings and advocates for the expanded use of proton therapy in this patient population.
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Affiliation(s)
- Robabeh Rahimi
- Radiation Oncology Department, Inova Health System, Fairfax, Virginia, USA
| | - Michael Taylor
- Radiation Oncology Department, Inova Health System, Fairfax, Virginia, USA
| | - Xing Li
- Radiation Oncology Department, Inova Health System, Fairfax, Virginia, USA
| | - Kuan Ling Chen
- Radiation Oncology Department, Inova Health System, Fairfax, Virginia, USA
| | - Grayden MacLennan
- Radiation Oncology Department, Inova Health System, Fairfax, Virginia, USA
| | - Erin Murdoch
- Radiation Oncology Department, Inova Health System, Fairfax, Virginia, USA
| | - Lienard Chang
- Radiation Oncology Department, Inova Health System, Fairfax, Virginia, USA
| | - Ashkan Parniani
- Radiation Oncology Department, Inova Health System, Fairfax, Virginia, USA
| | - Peng Wang
- Radiation Oncology Department, Inova Health System, Fairfax, Virginia, USA
| | - Ashish Chawla
- Radiation Oncology Department, Inova Health System, Fairfax, Virginia, USA
| | - Jiajin Fan
- Radiation Oncology Department, Inova Health System, Fairfax, Virginia, USA
| | - Daniel Kim
- Radiation Oncology Department, Inova Health System, Fairfax, Virginia, USA
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Blommaert J, De Saint‐Hubert M, Depuydt T, Oldehinkel E, Poortmans P, Amant F, Lambrecht M. Challenges and opportunities for proton therapy during pregnancy. Acta Obstet Gynecol Scand 2024; 103:767-774. [PMID: 37491770 PMCID: PMC10993337 DOI: 10.1111/aogs.14645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
During pregnancy, the use of radiation therapy for cancer treatment is often considered impossible due to the assumed associated fetal risks. However, suboptimal treatment of pregnant cancer patients and unjustifiable delay in radiation therapy until after delivery can be harmful for both patient and child. In non-pregnant patients, proton-radiation therapy is increasingly administered because of its favorable dosimetric properties compared with photon-radiation therapy. Although data on the use of pencil beam scanning proton-radiation therapy during pregnancy are scarce, different case reports and dosimetric studies have indicated a more than 10-fold reduction in fetal radiation exposure compared with photon-radiation therapy. Nonetheless, the implementation of proton-radiation therapy during pregnancy requires complex fetal dosimetry for the neutron-dominated out-of-field radiation dose and faces a lack of clinical guidelines. Further exploration and standardization of proton-radiation therapy during pregnancy will be necessary to improve radiotherapeutic management of pregnant women with cancer and further reduce risks for their offspring.
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Affiliation(s)
| | | | - Tom Depuydt
- Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Edwin Oldehinkel
- Department of Radiation OncologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Philip Poortmans
- Radiation OncologyIridium Netwerk & University of AntwerpWilrijkBelgium
| | - Frederic Amant
- Department of OncologyKU LeuvenLeuvenBelgium
- Gynecologic Oncology, Antoni van LeeuwenhoekNetherlands Cancer InstituteAmsterdamThe Netherlands
- Division Gynecologic OncologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Maarten Lambrecht
- Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
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Manalad J, Montgomery L, Kildea J. A Monte Carlo study on the impact of indirect action on neutron relative biological effectiveness. RADIATION PROTECTION DOSIMETRY 2023; 199:1917-1921. [PMID: 37819307 DOI: 10.1093/rpd/ncad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/10/2023] [Accepted: 04/12/2023] [Indexed: 10/13/2023]
Abstract
Recent Monte Carlo studies have linked the energy-dependent risk of neutron-induced stochastic effects to the relative biological effectiveness (RBE) of neutrons in inflicting difficult-to-repair clusters of lesions in nuclear deoxyribonucleic acid (DNA). However, an investigation on the damaging effects of indirect radiation action is missing from such studies. In this work, we extended our group's existing simulation pipeline by incorporating and validating a model for indirect action. Our updated simulation pipeline was used to study the impact of indirect action and estimate neutron RBE for inflicting clustered lesions in DNA. In our results, although indirect action significantly increased the average yield of DNA damage clusters, our neutron RBE values are lower in magnitude than previous estimates due to model limitations and the greater relative impact of indirect action in lower-linear energy transfer (LET) radiation than in higher-LET radiation.
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Affiliation(s)
- James Manalad
- Medical Physics Unit, McGill University, Montreal, QC H4A 3J1, Canada
| | - Logan Montgomery
- Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Kingston, ON K7L 5P9, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC H4A 3J1, Canada
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Mathew F, Manalad J, Yeo J, Galarneau L, Ybarra N, Wang YC, Tonin PN, Ragoussis I, Kildea J. Single-cell DNA sequencing-a potential dosimetric tool. RADIATION PROTECTION DOSIMETRY 2023; 199:2047-2052. [PMID: 37819315 DOI: 10.1093/rpd/ncad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 10/13/2023]
Abstract
We hypothesised that single-cell whole-genome sequencing has the potential to detect mutational differences in the genomes of the cells that are irradiated with different doses of radiation and we set out to test our hypothesis using in silico and in vitro experiments. In this manuscript, we present our findings from a Monte Carlo single-cell irradiation simulation performed in TOPAS-nBio using a custom-built geometric nuclear deoxyribonucleic acid (DNA) model, which predicts a significant dose dependence of the number of cluster damages per cell as a function of radiation dose. We also present preliminary experimental results, obtained from single-cell whole-genome DNA sequencing analysis performed on cells irradiated with different doses of radiation, showing promising agreement with the simulation results.
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Affiliation(s)
- Felix Mathew
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - James Manalad
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Jonathan Yeo
- Singapore Nuclear Research and Safety Initiative, National University of Singapore, Singapore
| | - Luc Galarneau
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Norma Ybarra
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Yu Chang Wang
- McGill Genome Centre, McGill University, Montreal, Quebec, Canada
| | - Patricia N Tonin
- Departments of Medicine and Human Genetics, McGill University, Montreal, Quebec, Canada
- Cancer Research Program, Research Institute-McGill University Health Centre, Montreal, Quebec, Canada
| | | | - John Kildea
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
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Han Y, Geng C, Liu Y, Wu R, Li M, Yu C, Altieri S, Tang X. Calculation of the DNA damage yield and relative biological effectiveness in boron neutron capture therapy via the Monte Carlo track structure simulation. Phys Med Biol 2023; 68:175028. [PMID: 37524085 DOI: 10.1088/1361-6560/acec2a] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/31/2023] [Indexed: 08/02/2023]
Abstract
Objective.Boron neutron capture therapy (BNCT) is an advanced cellular-level hadron therapy that has exhibited remarkable therapeutic efficacy in the treatment of locally invasive malignancies. Despite its clinical success, the intricate nature of relative biological effectiveness (RBE) and mechanisms responsible for DNA damage remains elusive. This work aims to quantify the RBE of compound particles (i.e. alpha and lithium) in BNCT based on the calculation of DNA damage yields via the Monte Carlo track structure (MCTS) simulation.Approach. The TOPAS-nBio toolkit was employed to conduct MCTS simulations. The calculations encompassed four steps: determination of the angle and energy spectra on the nuclear membrane, quantification of the database containing DNA damage yields for ions with specific angle and energy, accumulation of the database and spectra to obtain the DNA damage yields of compound particles, and calculation of the RBE by comparison yields of double-strand break (DSB) with the reference gamma-ray. Furthermore, the impact of cell size and microscopic boron distribution was thoroughly discussed.Main results. The DSB yields induced by compound particles in three types of spherical cells (radius equal to 10, 8, and 6μm) were found to be 13.28, 17.34, 22.15 Gy Gbp-1for boronophenylalanine (BPA), and 1.07, 3.45, 8.32 Gy Gbp-1for sodium borocaptate (BSH). The corresponding DSB-based RBE values were determined to be 1.90, 2.48, 3.16 for BPA and 0.15, 0.49, 1.19 for BSH. The calculated DSB-based RBE showed agreement with experimentally values of compound biological effectiveness for melanoma and gliosarcoma. Besides, the DNA damage yield and DSB-based RBE value exhibited an increasing trend as the cell radius decreased. The impact of the boron concentration ratio on RBE diminished once the drug enrichment surpasses a certain threshold.Significance. This work is potential to provide valuable guidance for accurate biological-weighted dose evaluation in BNCT.
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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
| | - 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
| | - Renyao Wu
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Mingzhu Li
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Chenxi Yu
- 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
- Istituto Nazionale di Fisica Nucleare (INFN), the section of Pavia, Pavia, Italy
| | - Xiaobin Tang
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
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Zhu K, Wu C, Peng X, Ji X, Luo S, Liu Y, Wang X. Nanoscale Calculation of Proton-Induced DNA Damage Using a Chromatin Geometry Model with Geant4-DNA. Int J Mol Sci 2022; 23:ijms23116343. [PMID: 35683021 PMCID: PMC9181653 DOI: 10.3390/ijms23116343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Monte Carlo simulations can quantify various types of DNA damage to evaluate the biological effects of ionizing radiation at the nanometer scale. This work presents a study simulating the DNA target response after proton irradiation. A chromatin fiber model and new physics constructors with the ELastic Scattering of Electrons and Positrons by neutral Atoms (ELSEPA) model were used to describe the DNA geometry and the physical stage of water radiolysis with the Geant4-DNA toolkit, respectively. Three key parameters (the energy threshold model for strand breaks, the physics model and the maximum distance to distinguish DSB clusters) of scoring DNA damage were studied to investigate the impact on the uncertainties of DNA damage. On the basis of comparison of our results with experimental data and published findings, we were able to accurately predict the yield of various types of DNA damage. Our results indicated that the difference in physics constructor can cause up to 56.4% in the DNA double-strand break (DSB) yields. The DSB yields were quite sensitive to the energy threshold for strand breaks (SB) and the maximum distance to classify the DSB clusters, which were even more than 100 times and four times than the default configurations, respectively.
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Affiliation(s)
- Kun Zhu
- School of Nuclear Science and Technology, University of South China, Hengyang 421001, China; (K.Z.); (X.P.); (X.J.); (S.L.); (Y.L.)
| | - Chun Wu
- School of Nursing, University of South China, Hengyang 421001, China;
| | - Xiaoyu Peng
- School of Nuclear Science and Technology, University of South China, Hengyang 421001, China; (K.Z.); (X.P.); (X.J.); (S.L.); (Y.L.)
| | - Xuantao Ji
- School of Nuclear Science and Technology, University of South China, Hengyang 421001, China; (K.Z.); (X.P.); (X.J.); (S.L.); (Y.L.)
| | - Siyuan Luo
- School of Nuclear Science and Technology, University of South China, Hengyang 421001, China; (K.Z.); (X.P.); (X.J.); (S.L.); (Y.L.)
| | - Yuchen Liu
- School of Nuclear Science and Technology, University of South China, Hengyang 421001, China; (K.Z.); (X.P.); (X.J.); (S.L.); (Y.L.)
| | - Xiaodong Wang
- School of Nuclear Science and Technology, University of South China, Hengyang 421001, China; (K.Z.); (X.P.); (X.J.); (S.L.); (Y.L.)
- Correspondence:
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High-Accuracy Relative Biological Effectiveness Values Following Low-Dose Thermal Neutron Exposures Support Bimodal Quality Factor Response with Neutron Energy. Int J Mol Sci 2022; 23:ijms23020878. [PMID: 35055062 PMCID: PMC8779315 DOI: 10.3390/ijms23020878] [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: 11/30/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 12/04/2022] Open
Abstract
Theoretical evaluations indicate the radiation weighting factor for thermal neutrons differs from the current International Commission on Radiological Protection (ICRP) recommended value of 2.5, which has radiation protection implications for high-energy radiotherapy, inside spacecraft, on the lunar or Martian surface, and in nuclear reactor workplaces. We examined the relative biological effectiveness (RBE) of DNA damage generated by thermal neutrons compared to gamma radiation. Whole blood was irradiated by 64 meV thermal neutrons from the National Research Universal reactor. DNA damage and erroneous DNA double-strand break repair was evaluated by dicentric chromosome assay (DCA) and cytokinesis-block micronucleus (CBMN) assay with low doses ranging 6–85 mGy. Linear dose responses were observed. Significant DNA aberration clustering was found indicative of high ionizing density radiation. When the dose contribution of both the 14N(n,p)14C and 1H(n,γ)2H capture reactions were considered, the DCA and the CBMN assays generated similar maximum RBE values of 11.3 ± 1.6 and 9.0 ± 1.1, respectively. Consequently, thermal neutron RBE is approximately four times higher than the current ICRP radiation weighting factor value of 2.5. This lends support to bimodal peaks in the quality factor for RBE neutron energy response, underlining the importance of radiological protection against thermal neutron exposures.
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