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Ronchi S, Cicchetti A, Bonora M, Ingargiola R, Camarda AM, Russo S, Imparato S, Castelnuovo P, Pasquini E, Nicolai P, Ansarin M, Del Vecchio M, Benazzo M, Orlandi E, Vischioni B. Curative carbon ion radiotherapy in a head and neck mucosal melanoma series: Facing the future within multidisciplinarity. Radiother Oncol 2024; 190:110003. [PMID: 37956889 DOI: 10.1016/j.radonc.2023.110003] [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: 04/26/2023] [Revised: 11/05/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To evaluate efficacy and toxicity of carbon ion radiotherapy (CIRT) in locally advanced head and neck mucosal melanoma (HNMM) patients treated at our Institute. MATERIALS AND METHODS Between June 2013 and June 2020, 40 HNMM patients were treated with CIRT. Prescription dose was 65.6-68.8 Gy relative biological effectiveness [RBE] in 16 fractions. Twelve (30%) patients received only biopsy, 28 (70%) surgical resection before CIRT. Immunotherapy was administered before and/or after CIRT in 45% of patients, mainly for distant progression (89%). RESULTS Median follow-up was 18 months. 2-year Local Relapse Free Survival (LRFS), Overall Survival (OS), Progression Free Survival (PFS) and Distant Metastasis Free Survival (DMFS) were 84.5%, 58.6%, 33.2% and 37.3%, respectively. At univariate analysis, LRFS was significantly better for non-recurrent status, < 2 surgeries before CIRT and treatment started < 9 months from the initial diagnosis, with no significant differences for operated versus unresected patients. After relapse, immunotherapy provided longer median OS (17 months vs 3.6, p-value<0.001). Late toxicity ≥ G3 (graded with CTCAE 5.0 scale) was reported in 10% of patients. CONCLUSION CIRT in advanced HNMM patients is safe and locally effective. Prospective trials are warranted to assess the role of targeted/immune- systemic therapy to improve OS.
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Affiliation(s)
- Sara Ronchi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
| | - Alessandro Cicchetti
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - Maria Bonora
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rossana Ingargiola
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Anna Maria Camarda
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefania Russo
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Imparato
- Radiology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Ernesto Pasquini
- Azienda USL di Bologna, ENT Department, Bellaria Hospital, Bologna, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Michele Del Vecchio
- Unit of Melanoma Medical Oncology, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, Milan 20133, Italy
| | - Marco Benazzo
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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Shahmohammadi Beni M, Islam MR, Kim KM, Krstic D, Nikezic D, Yu KN, Watabe H. On the effectiveness of proton boron fusion therapy (PBFT) at cellular level. Sci Rep 2022; 12:18098. [PMID: 36302927 PMCID: PMC9613677 DOI: 10.1038/s41598-022-23077-0] [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: 05/06/2022] [Accepted: 10/25/2022] [Indexed: 12/30/2022] Open
Abstract
The present work introduced a framework to investigate the effectiveness of proton boron fusion therapy (PBFT) at the cellular level. The framework consisted of a cell array generator program coupled with PHITS Monte Carlo package with a dedicated terminal-based code editor that was developed in this work. The framework enabled users to model large cell arrays with normal, all boron, and random boron filled cytoplasm, to investigate the underlying mechanism of PBFT. It was found that alpha particles and neutrons could be produced in absence of boron mainly because of nuclear reaction induced by proton interaction with 16O, 12C and 14N nuclei. The effectiveness of PBFT is highly dependent on the incident proton energy, source size, cell array size, buffer medium thickness layer, concentration and distribution of boron in the cell array. To quantitatively assess the effectiveness of PBFT, of the total energy deposition by alpha particle for different cases were determined. The number of alpha particle hits in cell cytoplasm and nucleus for normal and 100 ppm boron were determined. The obtained results and the developed tools would be useful for future development of PBFT to objectively determine the effectiveness of this treatment modality.
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Affiliation(s)
- Mehrdad Shahmohammadi Beni
- grid.35030.350000 0004 1792 6846Department of Physics, City University of Hong Kong, Tat Chee Avenue, Kowloon Tong, Hong Kong, China ,grid.69566.3a0000 0001 2248 6943Division of Radiation Protection and Safety Control, Cyclotron and Radioisotope Center, Tohoku University, 6-3 Aoba, Aramaki, Aoba-Ku, Sendai, Miyagi 980-8578 Japan
| | - M. Rafiqul Islam
- grid.69566.3a0000 0001 2248 6943Graduate School of Biomedical Engineering, Tohoku University, Sendai, 980-8579 Japan
| | - Kyeong Min Kim
- grid.415464.60000 0000 9489 1588Korea Institute of Radiological & Medical Sciences, 75, Nowon-Ro, Nowon-Gu, Seoul, Korea
| | - Dragana Krstic
- grid.413004.20000 0000 8615 0106Faculty of Science, University of Kragujevac, Kragujevac, Serbia
| | - Dragoslav Nikezic
- grid.413004.20000 0000 8615 0106Faculty of Science, University of Kragujevac, Kragujevac, Serbia ,grid.445145.50000 0004 5899 9718State University of Novi Pazar, Novi Pazar, Serbia
| | - Kwan Ngok Yu
- grid.35030.350000 0004 1792 6846Department of Physics, City University of Hong Kong, Tat Chee Avenue, Kowloon Tong, Hong Kong, China
| | - Hiroshi Watabe
- grid.69566.3a0000 0001 2248 6943Division of Radiation Protection and Safety Control, Cyclotron and Radioisotope Center, Tohoku University, 6-3 Aoba, Aramaki, Aoba-Ku, Sendai, Miyagi 980-8578 Japan
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3
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Vischioni B, Russo S, Meuli M, Bonora M, Ronchi S, Ingargiola R, Camarda AM, Imparato S, Preda L, Ciocca M, Molinelli S, Orlandi E. Dosimetric and Clinical Risk Factors for the Development of Maxillary Osteoradionecrosis in Adenoid Cystic Carcinoma (ACC) Patients Treated With Carbon Ion Radiotherapy. Front Oncol 2022; 12:829502. [PMID: 35311095 PMCID: PMC8924362 DOI: 10.3389/fonc.2022.829502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background The present study aims to evaluate dosimetric and clinical risk factors for the development of maxillary osteoradionecrosis (ORN) in head and neck adenoid cystic carcinoma (ACC) patients treated with carbon ion radiotherapy (CIRT). Methods Clinical data and treatment plans of ACC patients, consecutively treated from January 2013 to September 2016 within the phase II clinical trial CNAO S9/2012/C, were retrospectively reviewed. ORN and other treatment-related toxicity were graded according to the Common Terminology Criteria for Adverse Events (CTACE), version 4.0. The maxillary bone was contoured on the planning CT, and only patients receiving more than 10% of the prescription dose at their maxilla were considered for the analysis (67 patients). The volumes of maxilla receiving doses from 10 Gy (RBE) to 60 Gy (RBE) (VD), with an increment of 10 Gy (RBE), and additional clinical factors were correlated to the incidence of ORN with univariate analysis (Chi-square test). The logistic regression model was subsequently applied for multivariate analysis. Treatment plans calculated with a local effect model (LEM)-based optimization were recalculated with the modified microdosimetric kinetic model (MKM), and compared with literature data from the Japanese experience. Results The median time interval from the start of CIRT to ORN appearance was 24 months (range, 8–54 months). Maxillary ORN was observed in 11 patients (16.4%). Grade 1 ORN was observed in 2 patients (18.1%), G2 in 4 (36.3%), G3 in 4 (36.3%) and G4 in 1 (9.3%). From univariate analysis, the site of the tumor, the presence of teeth within the PTV and acute mucositis correlated with the development of maxillary ORN. VD were significantly higher for all the dose levels tested in patients with maxillary ORN than patients without necrosis, according to both radiobiological models. The multivariate analysis showed that V60 significantly correlated with ORN risk. Conclusion The volume of maxilla irradiated with high dose values was relevant for ORN development in our cohort of ACC patients. These results are in line with previously published data obtained with a different radiobiological model. Our findings might be helpful to prevent the risk of ORN in patients receiving CIRT.
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Affiliation(s)
- Barbara Vischioni
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Stefania Russo
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Martino Meuli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Maria Bonora
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Sara Ronchi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Rossana Ingargiola
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Anna Maria Camarda
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO) European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Sara Imparato
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Lorenzo Preda
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Mario Ciocca
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Silvia Molinelli
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
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4
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Ferrari B, Roda E, Priori EC, De Luca F, Facoetti A, Ravera M, Brandalise F, Locatelli CA, Rossi P, Bottone MG. A New Platinum-Based Prodrug Candidate for Chemotherapy and Its Synergistic Effect With Hadrontherapy: Novel Strategy to Treat Glioblastoma. Front Neurosci 2021; 15:589906. [PMID: 33828444 PMCID: PMC8019820 DOI: 10.3389/fnins.2021.589906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/08/2021] [Indexed: 12/18/2022] Open
Abstract
Glioblastoma (GBM) is the most common tumor of the central nervous system. Current therapies, often associated with severe side effects, are inefficacious to contrast the GBM relapsing forms. In trying to overcome these drawbacks, (OC-6-44)-acetatodiamminedichlorido(2-(2-propynyl)octanoato)platinum(IV), also called Pt(IV)Ac-POA, has been recently synthesized. This new prodrug bearing as axial ligand (2-propynyl)octanoic acid (POA), a histone deacetylase inhibitor, has a higher activity due to (i) its high cellular accumulation by virtue of its high lipophilicity and (ii) the inhibition of histone deacetylase, which leads to the increased exposure of nuclear DNA, permitting higher platination and promoting cancer cell death. In the present study, we investigated the effects induced by Pt(IV)Ac-POA and its potential antitumor activity in human U251 glioblastoma cell line using a battery of complementary techniques, i.e., flow cytometry, immunocytochemistry, TEM, and Western blotting analyses. In addition, the synergistic effect of Pt(IV)Ac-POA associated with the innovative oncological hadrontherapy with carbon ions was investigated, with the aim to identify the most efficient anticancer treatment combination. Our in vitro data demonstrated that Pt(IV)Ac-POA is able to induce cell death, through different pathways, at concentrations lower than those tested for other platinum analogs. In particular, an enduring Pt(IV)Ac-POA antitumor effect, persisting in long-term treatment, was demonstrated. Interestingly, this effect was further amplified by the combined exposure to carbon ion radiation. In conclusion, Pt(IV)Ac-POA represents a promising prodrug to be incorporated into the treatment regimen for GBM. Moreover, the synergistic efficacy of the combined protocol using chemotherapeutic Pt(IV)Ac-POA followed by carbon ion radiation may represent a promising approach, which may overcome some typical limitations of conventional therapeutic protocols for GBM treatment.
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Affiliation(s)
- Beatrice Ferrari
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - Elisa Roda
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy.,Laboratory of Clinical & Experimental Toxicology, Pavia Poison Centre, National Toxicology Information Centre, Toxicology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Erica Cecilia Priori
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - Fabrizio De Luca
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - Angelica Facoetti
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Mauro Ravera
- Department of Sciences and Technological Innovation (DiSIT), University of Piemonte Orientale "A. Avogadro", Alessandria, Italy
| | - Federico Brandalise
- Department of Fundamental Neurosciences (NEUFO), University of Geneva, Geneva, Switzerland
| | - Carlo Alessandro Locatelli
- Laboratory of Clinical & Experimental Toxicology, Pavia Poison Centre, National Toxicology Information Centre, Toxicology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Paola Rossi
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - Maria Grazia Bottone
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
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5
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Dale JE, Molinelli S, Vischioni B, Vitolo V, Bonora M, Magro G, Mairani A, Hasegawa A, Ohno T, Dahl O, Valvo F, Fossati P. Brainstem NTCP and Dose Constraints for Carbon Ion RT-Application and Translation From Japanese to European RBE-Weighted Dose. Front Oncol 2020; 10:531344. [PMID: 33330020 PMCID: PMC7735105 DOI: 10.3389/fonc.2020.531344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/04/2020] [Indexed: 12/19/2022] Open
Abstract
Background and Purpose The Italian National Center of Oncological Hadrontherapy (CNAO) has applied dose constraints for carbon ion RT (CIRT) as defined by Japan’s National Institute of Radiological Sciences (NIRS). However, these institutions use different models to predict the relative biological effectiveness (RBE). CNAO applies the Local Effect Model I (LEM I), which in most clinical situations predicts higher RBE than NIRS’s Microdosimetric Kinetic Model (MKM). Equal constraints therefore become more restrictive at CNAO. Tolerance doses for the brainstem have not been validated for LEM I-weighted dose (DLEM I). However, brainstem constraints and a Normal Tissue Complication Probability (NTCP) model were recently reported for MKM-weighted dose (DMKM), showing that a constraint relaxation to DMKM|0.7 cm3 <30 Gy (RBE) and DMKM|0.1 cm3 <40 Gy (RBE) was feasible. The aim of this work was to evaluate the brainstem NTCP associated with CNAO’s current clinical practice and to propose new brainstem constraints for LEM I-optimized CIRT at CNAO. Material and Methods We reproduced the absorbed dose of 30 representative patient treatment plans from CNAO. Subsequently, we calculated both DLEM I and DMKM, and the relationship between DMKM and DLEM I for various brainstem dose metrics was analyzed. Furthermore, the NTCP model developed for DMKM was applied to estimate the NTCPs of the delivered plans. Results The translation of CNAO treatment plans to DMKM confirmed that the former CNAO constraints were conservative compared with DMKM constraints. Estimated NTCPs were 0% for all but one case, in which the NTCP was 2%. The relationship DMKM/DLEM I could be described by a quadratic regression model which revealed that the validated DMKM constraints corresponded to DLEM I|0.7 cm3 <41 Gy (RBE) (95% CI, 38–44 Gy (RBE)) and DLEM I|0.1 cm3 <49 Gy (RBE) (95% CI, 46–52 Gy (RBE)). Conclusion Our study demonstrates that RBE-weighted dose translation is of crucial importance in order to exchange experience and thus harmonize CIRT treatments globally. To mitigate uncertainties involved, we propose to use the lower bound of the 95% CI of the translation estimates, i.e., DLEM I|0.7 cm3 <38 Gy (RBE) and DLEM I|0.1 cm3 <46 Gy (RBE) as brainstem dose constraints for 16 fraction CIRT treatments optimized with LEM I.
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Affiliation(s)
- Jon Espen Dale
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | | | | | - Viviana Vitolo
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Maria Bonora
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Giuseppe Magro
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Andrea Mairani
- National Center of Oncological Hadrontherapy, Pavia, Italy.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - Azusa Hasegawa
- National Center of Oncological Hadrontherapy, Pavia, Italy.,Osaka Heavy Ion Therapy Center, Osaka, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Olav Dahl
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Piero Fossati
- National Center of Oncological Hadrontherapy, Pavia, Italy.,MedAustron Ion Therapy Center, Wiener Neustadt, Austria
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6
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Berardinelli F, Sgura A, Facoetti A, Leone S, Vischioni B, Ciocca M, Antoccia A. The G-quadruplex-stabilizing ligand RHPS4 enhances sensitivity of U251MG glioblastoma cells to clinical carbon ion beams. FEBS J 2018; 285:1226-1236. [PMID: 29484821 DOI: 10.1111/febs.14415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/11/2018] [Accepted: 02/19/2018] [Indexed: 11/27/2022]
Abstract
The pentacyclic acridine RHPS4 is a highly potent and specific G-quadruplex (G4) ligand, which binds and stabilizes telomeric G4 leading to the block of the replication forks at telomeres and consequently to telomere dysfunctionalization. In turn, the cell recognizes unprotected telomeres as DNA double-strand breaks with consequent activation of DNA repair response at telomeres, cellular growth impairment, and death. Data from the literature showed the capability of this compound to sensitize U251MG glioblastoma radioresistant cell line to X-rays sparsely ionizing radiations. In the present paper, it was investigated whether RHPS4 is also able to increase the effect of clinical carbon ion beams (cells irradiated in the middle of a spread-out Bragg peak, in the energy range of 246-312 MeV·μm-1 and a dose-averaged linear energy transfer of 46 keV·μm-1 ). Interestingly, also for charged particles whose damage inflicted to DNA is more complex than that of sparsely ionizing radiations and results in higher Relative Biological Effectiveness (RBE), RHPS4 significantly potentiated the radiation effect in terms of cell killing, delayed rejoining of DNA double-strand breaks (γ-H2AX and 53BBP1 immunofluorescence staining), chromosome aberrations (pan-centromeric/telomeric FISH and multicolor FISH), and G2 /M-phase accumulation in GBM cells. Overall, the results provide the first evidence that the combined administration of the G4-ligand RHPS4 with charged particles interfere with cellular processes involved in cell survival leading to radiosensitization of highly radioresistant tumor cells.
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Affiliation(s)
| | - Antonella Sgura
- Dipartimento Di Scienze, Università Roma Tre, Italy.,INFN Sezione di Roma Tre, Italy
| | | | | | | | | | - Antonio Antoccia
- Dipartimento Di Scienze, Università Roma Tre, Italy.,INFN Sezione di Roma Tre, Italy
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7
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Cirrone GAP, Manti L, Margarone D, Petringa G, Giuffrida L, Minopoli A, Picciotto A, Russo G, Cammarata F, Pisciotta P, Perozziello FM, Romano F, Marchese V, Milluzzo G, Scuderi V, Cuttone G, Korn G. First experimental proof of Proton Boron Capture Therapy (PBCT) to enhance protontherapy effectiveness. Sci Rep 2018; 8:1141. [PMID: 29348437 PMCID: PMC5773549 DOI: 10.1038/s41598-018-19258-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 12/27/2017] [Indexed: 01/16/2023] Open
Abstract
Protontherapy is hadrontherapy's fastest-growing modality and a pillar in the battle against cancer. Hadrontherapy's superiority lies in its inverted depth-dose profile, hence tumour-confined irradiation. Protons, however, lack distinct radiobiological advantages over photons or electrons. Higher LET (Linear Energy Transfer) 12C-ions can overcome cancer radioresistance: DNA lesion complexity increases with LET, resulting in efficient cell killing, i.e. higher Relative Biological Effectiveness (RBE). However, economic and radiobiological issues hamper 12C-ion clinical amenability. Thus, enhancing proton RBE is desirable. To this end, we exploited the p + 11B → 3α reaction to generate high-LET alpha particles with a clinical proton beam. To maximize the reaction rate, we used sodium borocaptate (BSH) with natural boron content. Boron-Neutron Capture Therapy (BNCT) uses 10B-enriched BSH for neutron irradiation-triggered alpha particles. We recorded significantly increased cellular lethality and chromosome aberration complexity. A strategy combining protontherapy's ballistic precision with the higher RBE promised by BNCT and 12C-ion therapy is thus demonstrated.
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Affiliation(s)
- G A P Cirrone
- Istituto Nazionale di Fisica Nucleare- Laboratori Nazionali dei Sud, via S. Sofia, 62, Catania, Italy.
| | - L Manti
- Physics Department, University of Naples Federico II, Naples, Italy
- INFN Naples Section, Complesso Universitario di Monte S. Angelo, Via Cintia, Naples, Italy
| | - D Margarone
- Institute of Physics ASCR, v.v.i. (FZU), ELI-Beamlines Project, Na Slovance 2, Prague, 18221, Czech Republic
| | - G Petringa
- Istituto Nazionale di Fisica Nucleare- Laboratori Nazionali dei Sud, via S. Sofia, 62, Catania, Italy
- Physics Department, University of Catania, via S. Sofia, 64, Catania, Italy
| | - L Giuffrida
- Institute of Physics ASCR, v.v.i. (FZU), ELI-Beamlines Project, Na Slovance 2, Prague, 18221, Czech Republic
| | - A Minopoli
- Physics Department, University of Naples Federico II, Naples, Italy
| | - A Picciotto
- Fondazione Bruno Kessler, Micro-Nano Facility, Via Sommarive 18, 38123, Povo-Trento, Italy
| | - G Russo
- Istituto Nazionale di Fisica Nucleare- Laboratori Nazionali dei Sud, via S. Sofia, 62, Catania, Italy
- Institute of Molecular Bioimaging and Physiology - National Research Council - (IBFM-CNR), Cefalù, (PA), Italy
| | - F Cammarata
- Istituto Nazionale di Fisica Nucleare- Laboratori Nazionali dei Sud, via S. Sofia, 62, Catania, Italy
- Institute of Molecular Bioimaging and Physiology - National Research Council - (IBFM-CNR), Cefalù, (PA), Italy
| | - P Pisciotta
- Istituto Nazionale di Fisica Nucleare- Laboratori Nazionali dei Sud, via S. Sofia, 62, Catania, Italy
- Physics Department, University of Catania, via S. Sofia, 64, Catania, Italy
| | - F M Perozziello
- Physics Department, University of Naples Federico II, Naples, Italy
- INFN Naples Section, Complesso Universitario di Monte S. Angelo, Via Cintia, Naples, Italy
| | - F Romano
- Istituto Nazionale di Fisica Nucleare- Laboratori Nazionali dei Sud, via S. Sofia, 62, Catania, Italy
- National Physical Laboratory, Acoustic and Ionizing Radiation Division, Teddington, TW11 0LW, Middlesex, United Kingdom
| | - V Marchese
- Istituto Nazionale di Fisica Nucleare- Laboratori Nazionali dei Sud, via S. Sofia, 62, Catania, Italy
| | - G Milluzzo
- Istituto Nazionale di Fisica Nucleare- Laboratori Nazionali dei Sud, via S. Sofia, 62, Catania, Italy
- Physics Department, University of Catania, via S. Sofia, 64, Catania, Italy
| | - V Scuderi
- Istituto Nazionale di Fisica Nucleare- Laboratori Nazionali dei Sud, via S. Sofia, 62, Catania, Italy
- Institute of Physics ASCR, v.v.i. (FZU), ELI-Beamlines Project, Na Slovance 2, Prague, 18221, Czech Republic
| | - G Cuttone
- Istituto Nazionale di Fisica Nucleare- Laboratori Nazionali dei Sud, via S. Sofia, 62, Catania, Italy
| | - G Korn
- Institute of Physics ASCR, v.v.i. (FZU), ELI-Beamlines Project, Na Slovance 2, Prague, 18221, Czech Republic
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Uptake of 18F-FET and 18F-FCH in Human Glioblastoma T98G Cell Line after Irradiation with Photons or Carbon Ions. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:6491674. [PMID: 29097931 PMCID: PMC5612615 DOI: 10.1155/2017/6491674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/10/2016] [Accepted: 12/26/2016] [Indexed: 12/02/2022]
Abstract
The differential diagnosis between recurrence of gliomas or brain metastases and this phenomenon is important in order to choose the best therapy and predict the prognosis but is still a big problem for physicians. The new emerging MRI, CT, and PET diagnostic modalities still lack sufficient accuracy. Radiolabeled choline and amino acids have been reported to show great tumor specificity. We studied the uptake kinetics of [18F]fluoromethyl-choline (FCH) and O-(2-[18F]fluoroethyl)-L-tyrosine (FET) by the T98G human glioblastoma cells from 20 to 120 min after irradiation either with photons at 2-10-20 Gy or with carbon ions at 2 Gy (at the National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy). We also evaluated the cell death and morphology changes induced by radiation treatment. Both FET and FCH are able to trace tumor behavior in terms of higher uptake for increased doses of radiation treatment, due to the upregulation of cells attempts to repair nonlethal damage. Our data suggest that both FCH and FET could be useful to analyze the metabolic pathways of glioblastoma cells before and after radiotherapy. Physicians will have to consider the different kinetics pathways of uptake concerning the two radiopharmaceuticals.
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Phase II multi-institutional clinical trial on a new mixed beam RT scheme of IMRT on pelvis combined with a carbon ion boost for high-risk prostate cancer patients. TUMORI JOURNAL 2016; 103:314-318. [PMID: 28009421 DOI: 10.5301/tj.5000587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Definition of the optimal treatment schedule for high-risk prostate cancer is under debate. A combination of photon intensity modulated radiotherapy (IMRT) on pelvis with a carbon ion boost might be the optimal treatment scheme to escalate the dose on prostate and deliver curative dose with respect to normal tissue and quality of dose distributions. In fact, carbon ion beams offer the advantage to deliver hypofractionated radiotherapy (RT) using a significantly smaller number of fractions compared to conventional RT without increasing risks of late effects. METHODS This study is a prospective phase II clinical trial exploring safety and feasibility of a mixed beam scheme of carbon ion prostate boost followed by photon IMRT on pelvis. The study is designed to enroll 65 patients with localized high-risk prostate cancer at 3 different oncologic hospitals: Istituto Europeo di Oncologia, Fondazione IRCCS Istituto Nazionale dei Tumori, and Centro Nazionale di Adroterapia Oncologica. The primary endpoint is the evaluation of safety and feasibility with acute toxicity scored up to 1 month after the end of RT. Secondary endpoints are treatment early (3 months after the end of RT) and long-term tolerability, quality of life, and efficacy. RESULTS The study is not yet recruiting; in silico studies are ongoing and we expect to start recruitment by 2017. CONCLUSIONS The present clinical trial aims at improving the current treatment for high-risk prostate cancer, evaluating safety and feasibility of a new RT mixed-beam scheme including photons and carbon ions. Encouraging results are coming from carbon ion facilities worldwide on the treatment of different tumors including prostate cancers. Carbon ions combine physical properties allowing for high dose conformity and advantageous radiobiological characteristics. The proposed mixed beam treatment has the advantage to combine a photon high conformity standard of care IMRT phase with a hypofractionated carbon ion RT boost delivered in a short overall treatment time.
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Lorenzo C, Andrea P, Barbara V, Denis P, Rosaria FM, Piero F, Viviana V, Alberto I, Mario C, Brugnatelli S, Tommaso D, Bugada D, Marcello M, Mario A, Francesca V, Roberto O, Paolo D. Surgical spacer placement prior carbon ion radiotherapy (CIRT): an effective feasible strategy to improve the treatment for sacral chordoma. World J Surg Oncol 2016; 14:211. [PMID: 27507254 PMCID: PMC4977725 DOI: 10.1186/s12957-016-0966-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/02/2016] [Indexed: 11/10/2022] Open
Abstract
Background Sacral chordoma (SC) is a neoplasm arising from residual notochordal cells degeneration. SC is difficult to manage mainly because of anatomic location and tendency to extensive spread. Carbon ion radiotherapy (CIRT) is highly precise to selectively deliver high biological effective dose to the tumor target sparing the anatomical structure on its path even if when SC is contiguous to the intestine, and a surgical spacer might be an advantageous tool to create a distance around the target volume allowing radical curative dose delivery with a safe dose gradient to the surrounding organs. This paper describes a double approach—open and hand-assisted laparoscopic—for a silicon spacer placement in patients affected by sacral chordoma undergoing carbon ion radiotherapy. Methods Six consecutive patients have been enrolled for surgical spacer placement—open (three) or hand-assisted (three)—prior carbon ion radiotherapy treatment in order to increase efficacy of carbon ion radiotherapy minimizing its side effects. Results Results showed that silicon spacer placement for SC treatment is feasible both via laparoscopic and laparotomic approach. Conclusions Its use might improve CIRT safety and thus efficacy for SC treatment.
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Affiliation(s)
- Cobianchi Lorenzo
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy. .,IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy. .,Department of General Surgery, IRCCS San Matteo Foundation, University of Pavia, Piazzale Golgi, Pavia, 27100, Italy.
| | - Peloso Andrea
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy
| | - Vischioni Barbara
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Panizza Denis
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Fiore Maria Rosaria
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Fossati Piero
- Department of Radiation Oncology, European Institute of Oncology (IEO), Milan, Italy
| | - Vitolo Viviana
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Iannalfi Alberto
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Ciocca Mario
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Silvia Brugnatelli
- IRCCS Policlinico San Matteo Foundation, Department of Onco-Hematology, Oncology Section, Pavia, Italy
| | - Dominioni Tommaso
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy
| | - Dario Bugada
- Department of Surgical Science, University of Parma, Parma, Italy
| | - Maestri Marcello
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy
| | - Alessiani Mario
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy
| | - Valvo Francesca
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Orecchia Roberto
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy.,Department of Radiation Oncology, European Institute of Oncology (IEO), Milan, Italy
| | - Dionigi Paolo
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy
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Dose prescription in carbon ion radiotherapy: How to compare two different RBE-weighted dose calculation systems. Radiother Oncol 2016; 120:307-12. [DOI: 10.1016/j.radonc.2016.05.031] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 02/03/2023]
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Mirandola A, Molinelli S, Vilches Freixas G, Mairani A, Gallio E, Panizza D, Russo S, Ciocca M, Donetti M, Magro G, Giordanengo S, Orecchia R. Dosimetric commissioning and quality assurance of scanned ion beams at the Italian National Center for Oncological Hadrontherapy. Med Phys 2016; 42:5287-300. [PMID: 26328978 DOI: 10.1118/1.4928397] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To describe the dosimetric commissioning and quality assurance (QA) of the actively scanned proton and carbon ion beams at the Italian National Center for Oncological Hadrontherapy. METHODS The laterally integrated depth-dose-distributions (IDDs) were acquired with the PTW Peakfinder, a variable depth water column, equipped with two Bragg peak ionization chambers. fluka Monte Carlo code was used to generate the energy libraries, the IDDs in water, and the fragment spectra for carbon beams. EBT3 films were used for spot size measurements, beam position over the scan field, and homogeneity in 2D-fields. Beam monitor calibration was performed in terms of number of particles per monitor unit using both a Farmer-type and an Advanced Markus ionization chamber. The beam position at the isocenter, beam monitor calibration curve, dose constancy in the center of the spread-out-Bragg-peak, dose homogeneity in 2D-fields, beam energy, spot size, and spot position over the scan field are all checked on a daily basis for both protons and carbon ions and on all beam lines. RESULTS The simulated IDDs showed an excellent agreement with the measured experimental curves. The measured full width at half maximum (FWHM) of the pencil beam in air at the isocenter was energy-dependent for both particle species: in particular, for protons, the spot size ranged from 0.7 to 2.2 cm. For carbon ions, two sets of spot size are available: FWHM ranged from 0.4 to 0.8 cm (for the smaller spot size) and from 0.8 to 1.1 cm (for the larger one). The spot position was accurate to within ± 1 mm over the whole 20 × 20 cm(2) scan field; homogeneity in a uniform squared field was within ± 5% for both particle types at any energy. QA results exceeding tolerance levels were rarely found. In the reporting period, the machine downtime was around 6%, of which 4.5% was due to planned maintenance shutdowns. CONCLUSIONS After successful dosimetric beam commissioning, quality assurance measurements performed during a 24-month period show very stable beam characteristics, which are therefore suitable for performing safe and accurate patient treatments.
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Affiliation(s)
| | - S Molinelli
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | | | - A Mairani
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | - E Gallio
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | - D Panizza
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | - S Russo
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | - M Ciocca
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | - M Donetti
- INFN, Torino 10125, Italy and Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | - G Magro
- INFN-Dipartimento di Fisica, Università degli Studi di Pavia, Via U. Bassi 6, Pavia 27100, Italy and Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | | | - R Orecchia
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy and Radiotherapy Division, European Institute of Oncology, Via Ripamonti 435, Milano 20141, Italy
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Rossi S. The National Centre for Oncological Hadrontherapy (CNAO): Status and perspectives. Phys Med 2015; 31:333-51. [DOI: 10.1016/j.ejmp.2015.03.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/05/2015] [Accepted: 03/04/2015] [Indexed: 11/27/2022] Open
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