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Potez M, Rome C, Lemasson B, Heemeryck P, Laissue JA, Stupar V, Mathieu H, Collomb N, Barbier EL, Djonov V, Bouchet A. Microbeam Radiation Therapy Opens a Several Days' Vessel Permeability Window for Small Molecules in Brain Tumor Vessels. Int J Radiat Oncol Biol Phys 2024; 119:1506-1516. [PMID: 38373658 DOI: 10.1016/j.ijrobp.2024.02.007] [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: 09/04/2023] [Revised: 12/27/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Synchrotron microbeam radiation therapy (MRT), based on an inhomogeneous geometric and microscopic irradiation pattern of the tissues with high-dose and high-dose-rate x-rays, enhances the permeability of brain tumor vessels. This study attempted to determine the time and size range of the permeability window induced by MRT in the blood-brain (tumor) barrier. METHODS AND MATERIALS Rats-bearing 9L gliomas were exposed to MRT, either unidirectional (tumor dose, 406 Gy) or bidirectional (crossfired) (2 × 203 Gy). We measured vessel permeability to molecules of 3 sizes (Gd-DOTA, Dotarem, 0.56 kDa; gadolinium-labeled albumin, ∼74 kDa; and gadolinium-labeled IgG, 160 kDa) by daily in vivo magnetic resonance imaging, from 1 day before to 10 days after irradiation. RESULTS An equivalent tumor dose of bidirectional MRT delivered from 2 orthogonal directions increased tumor vessel permeability for the smallest molecule tested more effectively than unidirectional MRT. Bidirectional MRT also affected the permeability of normal contralateral vessels to a different extent than unidirectional MRT. Conversely, bidirectional MRT did not modify the permeability of normal or tumor vessels for both larger molecules (74 and 160 kDa). CONCLUSIONS High-dose bidirectional (cross-fired) MRT induced a significant increase in tumor vessel permeability for small molecules between the first and the seventh day after irradiation, whereas permeability of vessels in normal brain tissue remained stable. Such a permeability window could facilitate an efficient and safe delivery of intravenous small molecules (≤0.56 kDa) to tumoral tissues. A permeability window was not achieved by molecules larger than gado-grafted albumin (74 kDa). Vascular permeability for molecules between these 2 sizes has not been determined.
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Affiliation(s)
- Marine Potez
- Institute of Anatomy, Group Topographic and Clinical Anatomy, University of Bern, Bern, Switzerland
| | - Claire Rome
- University Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, La Tronche, France
| | - Benjamin Lemasson
- University Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, La Tronche, France
| | - Pierre Heemeryck
- Inserm U1296 "Radiation: Defense, Health, Environment," Lyon, France
| | | | - Vasile Stupar
- University Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, La Tronche, France; University Grenoble Alpes, Inserm, CNRS, CHU Grenoble Alpes, IRMaGe, Grenoble, France
| | - Hervé Mathieu
- University Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, La Tronche, France; University Grenoble Alpes, Inserm, CNRS, CHU Grenoble Alpes, IRMaGe, Grenoble, France
| | - Nora Collomb
- University Grenoble Alpes, Inserm, CNRS, CHU Grenoble Alpes, IRMaGe, Grenoble, France
| | - Emmanuel L Barbier
- University Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, La Tronche, France; University Grenoble Alpes, Inserm, CNRS, CHU Grenoble Alpes, IRMaGe, Grenoble, France.
| | - Valentin Djonov
- Institute of Anatomy, Group Topographic and Clinical Anatomy, University of Bern, Bern, Switzerland
| | - Audrey Bouchet
- Institute of Anatomy, Group Topographic and Clinical Anatomy, University of Bern, Bern, Switzerland; Inserm U1296 "Radiation: Defense, Health, Environment," Lyon, France.
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Schültke E, Jaekel F, Bartzsch S, Bräuer-Krisch E, Requardt H, Laissue JA, Blattmann H, Hildebrandt G. Good Timing Matters: The Spatially Fractionated High Dose Rate Boost Should Come First. Cancers (Basel) 2022; 14:cancers14235964. [PMID: 36497446 PMCID: PMC9738329 DOI: 10.3390/cancers14235964] [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: 11/01/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
Monoplanar microbeam irradiation (MBI) and pencilbeam irradiation (PBI) are two new concepts of high dose rate radiotherapy, combined with spatial dose fractionation at the micrometre range. In a small animal model, we have explored the concept of integrating MBI or PBI as a simultaneously integrated boost (SIB), either at the beginning or at the end of a conventional, low-dose rate schedule of 5x4 Gy broad beam (BB) whole brain radiotherapy (WBRT). MBI was administered as array of 50 µm wide, quasi-parallel microbeams. For PBI, the target was covered with an array of 50 µm × 50 µm pencilbeams. In both techniques, the centre-to-centre distance was 400 µm. To assure that the entire brain received a dose of at least 4 Gy in all irradiated animals, the peak doses were calculated based on the daily BB fraction to approximate the valley dose. The results of our study have shown that the sequence of the BB irradiation fractions and the microbeam SIB is important to limit the risk of acute adverse effects, including epileptic seizures and death. The microbeam SIB should be integrated early rather than late in the irradiation schedule.
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Affiliation(s)
- Elisabeth Schültke
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany
- Correspondence:
| | - Felix Jaekel
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany
| | - Stefan Bartzsch
- Department of Radiooncology, Technical University of Munich, 81675 Munich, Germany
- Institute for Radiation Medicine, Helmholtz Center Munich, 85764 Munich, Germany
| | - Elke Bräuer-Krisch
- Biomedical Beamline ID 17, European Synchrotron Radiation Facility (ESRF), 38043 Grenoble, France
| | - Herwig Requardt
- Biomedical Beamline ID 17, European Synchrotron Radiation Facility (ESRF), 38043 Grenoble, France
| | | | - Hans Blattmann
- Independent Researcher, 5417 Untersiggenthal, Switzerland
| | - Guido Hildebrandt
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany
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3
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Jaekel F, Bräuer-Krisch E, Bartzsch S, Laissue J, Blattmann H, Scholz M, Soloviova J, Hildebrandt G, Schültke E. Microbeam Irradiation as a Simultaneously Integrated Boost in a Conventional Whole-Brain Radiotherapy Protocol. Int J Mol Sci 2022; 23:ijms23158319. [PMID: 35955454 PMCID: PMC9368396 DOI: 10.3390/ijms23158319] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
Microbeam radiotherapy (MRT), an experimental high-dose rate concept with spatial fractionation at the micrometre range, has shown a high therapeutic potential as well as good preservation of normal tissue function in pre-clinical studies. We investigated the suitability of MRT as a simultaneously integrated boost (SIB) in conventional whole-brain irradiation (WBRT). A 174 Gy MRT SIB was administered with an array of quasi-parallel, 50 µm wide microbeams spaced at a centre-to-centre distance of 400 µm either on the first or last day of a 5 × 4 Gy radiotherapy schedule in healthy adult C57 BL/6J mice and in F98 glioma cell cultures. The animals were observed for signs of intracranial pressure and focal neurologic signs. Colony counts were conducted in F98 glioma cell cultures. No signs of acute adverse effects were observed in any of the irradiated animals within 3 days after the last irradiation fraction. The tumoricidal effect on F98 cell in vitro was higher when the MRT boost was delivered on the first day of the irradiation course, as opposed to the last day. Therefore, the MRT SIB should be integrated into a clinical radiotherapy schedule as early as possible.
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Affiliation(s)
- Felix Jaekel
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany; (F.J.); (M.S.); (J.S.); (G.H.)
| | - Elke Bräuer-Krisch
- Biomedical Beamline ID 17, European Synchrotron Radiation Facility (ESRF), 38043 Grenoble, France;
| | - Stefan Bartzsch
- Department of Radiooncology, Technical University of Munich, 81675 Munich, Germany;
- Institute for Radiation Medicine, Helmholtz Center Munich, 85764 Munich, Germany
| | - Jean Laissue
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland;
| | | | - Marten Scholz
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany; (F.J.); (M.S.); (J.S.); (G.H.)
| | - Julia Soloviova
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany; (F.J.); (M.S.); (J.S.); (G.H.)
- Department of Paediatric Surgery, Leipzig University Medical Centre, 04103 Leipzig, Germany
| | - Guido Hildebrandt
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany; (F.J.); (M.S.); (J.S.); (G.H.)
| | - Elisabeth Schültke
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany; (F.J.); (M.S.); (J.S.); (G.H.)
- Correspondence:
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Romano F, Bailat C, Jorge PG, Lerch MLF, Darafsheh A. Ultra‐high dose rate dosimetry: challenges and opportunities for FLASH radiation therapy. Med Phys 2022; 49:4912-4932. [PMID: 35404484 PMCID: PMC9544810 DOI: 10.1002/mp.15649] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/03/2022] [Accepted: 02/20/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Francesco Romano
- Istituto Nazionale di Fisica Nucleare Sezione di Catania Catania Italy
| | - Claude Bailat
- Institute of Radiation Physics Lausanne University Hospital Lausanne University Switzerland
| | - Patrik Gonçalves Jorge
- Institute of Radiation Physics Lausanne University Hospital Lausanne University Switzerland
- Department of Radiation Oncology Lausanne University Hospital Lausanne Switzerland
- Radio‐Oncology Laboratory DO/CHUV Lausanne University Hospital Lausanne Switzerland
| | | | - Arash Darafsheh
- Department of Radiation Oncology Washington University School of Medicine St. Louis MO 63110 USA
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5
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Towards neuro-oncologic clinical trials of high dose rate synchrotron Microbeam Radiation Therapy: first treatment of a spontaneous canine brain tumor. Int J Radiat Oncol Biol Phys 2022; 113:967-973. [DOI: 10.1016/j.ijrobp.2022.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/13/2022] [Accepted: 04/16/2022] [Indexed: 11/22/2022]
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Kim MM, Darafsheh A, Schuemann J, Dokic I, Lundh O, Zhao T, Ramos-Méndez J, Dong L, Petersson K. Development of Ultra-High Dose-Rate (FLASH) Particle Therapy. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2022; 6:252-262. [PMID: 36092270 PMCID: PMC9457346 DOI: 10.1109/trpms.2021.3091406] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Research efforts in FLASH radiotherapy have increased at an accelerated pace recently. FLASH radiotherapy involves ultra-high dose rates and has shown to reduce toxicity to normal tissue while maintaining tumor response in pre-clinical studies when compared to conventional dose rate radiotherapy. The goal of this review is to summarize the studies performed to-date with proton, electron, and heavy ion FLASH radiotherapy, with particular emphasis on the physical aspects of each study and the advantages and disadvantages of each modality. Beam delivery parameters, experimental set-up, and the dosimetry tools used are described for each FLASH modality. In addition, modeling efforts and treatment planning for FLASH radiotherapy is discussed along with potential drawbacks when translated into the clinical setting. The final section concludes with further questions that have yet to be answered before safe clinical implementation of FLASH radiotherapy.
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Affiliation(s)
- Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arash Darafsheh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jan Schuemann
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ivana Dokic
- Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 460, Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Department of Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 222, Heidelberg, Germany
| | - Olle Lundh
- Department of Physics, Lund University, Lund, Sweden
| | - Tianyu Zhao
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - José Ramos-Méndez
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristoffer Petersson
- Department of Oncology, The Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
- Radiation Physics, Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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7
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Non-Targeted Effects of Synchrotron Radiation: Lessons from Experiments at the Australian and European Synchrotrons. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12042079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Studies have been conducted at synchrotron facilities in Europe and Australia to explore a variety of applications of synchrotron X-rays in medicine and biology. We discuss the major technical aspects of the synchrotron irradiation setups, paying specific attention to the Australian Synchrotron (AS) and the European Synchrotron Radiation Facility (ESRF) as those best configured for a wide range of biomedical research involving animals and future cancer patients. Due to ultra-high dose rates, treatment doses can be delivered within milliseconds, abiding by FLASH radiotherapy principles. In addition, a homogeneous radiation field can be spatially fractionated into a geometric pattern called microbeam radiotherapy (MRT); a coplanar array of thin beams of microscopic dimensions. Both are clinically promising radiotherapy modalities because they trigger a cascade of biological effects that improve tumor control, while increasing normal tissue tolerance compared to conventional radiation. Synchrotrons can deliver high doses to a very small volume with low beam divergence, thus facilitating the study of non-targeted effects of these novel radiation modalities in both in-vitro and in-vivo models. Non-targeted radiation effects studied at the AS and ESRF include monitoring cell–cell communication after partial irradiation of a cell population (radiation-induced bystander effect, RIBE), the response of tissues outside the irradiated field (radiation-induced abscopal effect, RIAE), and the influence of irradiated animals on non-irradiated ones in close proximity (inter-animal RIBE). Here we provide a summary of these experiments and perspectives on their implications for non-targeted effects in biomedical fields.
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8
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Laissue JA, Barré S, Bartzsch S, Blattmann H, Bouchet AM, Djonov VG, Haberthür D, Hlushchuk R, Kaser-Hotz B, Laissue PP, LeDuc G, Reding SO, Serduc R. Tolerance of Normal Rabbit Facial Bones and Teeth to Synchrotron X-Ray Microbeam Irradiation. Radiat Res 2021; 197:233-241. [PMID: 34755190 DOI: 10.1667/rade-21-00032.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/30/2021] [Indexed: 11/03/2022]
Abstract
Microbeam radiation therapy, an alternative radiosurgical treatment under preclinical investigation, aims to safely treat muzzle tumors in pet animals. This will require data on the largely unknown radiation toxicity of microbeam arrays for bones and teeth. To this end, the muzzle of six young adult New Zealand rabbits was irradiated by a lateral array of microplanar beamlets with peak entrance doses of 200, 330 or 500 Gy. The muzzles were examined 431 days postirradiation by computed microtomographic imaging (micro-CT) ex vivo, and extensive histopathology. The boundaries of the radiation field were identified histologically by microbeam tracks in cartilage and other tissues. There was no radionecrosis of facial bones in any rabbit. Conversely, normal incisor teeth exposed to peak entrance doses of 330 Gy or 500 Gy developed marked caries-like damage, whereas the incisors of the two rabbits exposed to 200 Gy remained unscathed. A single, unidirectional array of microbeams with a peak entrance dose ≤200 Gy (valley dose14 Gy) did not damage normal bone, teeth and soft tissues of the muzzle of normal rabbits longer than one year after irradiation. Because of that, Microbeam radiation therapy of muzzle tumors in pet animals is unlikely to cause sizeable damage to normal teeth, bone and soft tissues, if a single array as used here delivers a limited entrance dose of 200 Gy and a valley dose of ≤14 Gy.
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Affiliation(s)
- Jean Albert Laissue
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, CH -3012 Bern, Switzerland
| | - Sébastien Barré
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, CH -3012 Bern, Switzerland
| | - Stefan Bartzsch
- Department of Radiation Oncology, Klinikum rechts der Isar - TU Munich, Germany
| | - Hans Blattmann
- Niederwiesstrasse 13C, CH-5417 Untersiggenthal, Switzerland
| | - Audrey M Bouchet
- INSERM UA8, "Radiations : Défense, Santé, Environnement," 69008 Lyon, France
| | | | - David Haberthür
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, CH -3012 Bern, Switzerland
| | - Ruslan Hlushchuk
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, CH -3012 Bern, Switzerland
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9
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Sampayan SE, Sampayan KC, Caporaso GJ, Chen YJ, Falabella S, Hawkins SA, Hearn J, Watson JA, Zentler JM. Megavolt bremsstrahlung measurements from linear induction accelerators demonstrate possible use as a FLASH radiotherapy source to reduce acute toxicity. Sci Rep 2021; 11:17104. [PMID: 34429440 PMCID: PMC8385032 DOI: 10.1038/s41598-021-95807-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/26/2021] [Indexed: 11/11/2022] Open
Abstract
Recent studies indicate better efficacy and healthy tissue sparing with high dose-rate FLASH radiotherapy (FLASH-RT) cancer treatment. This technique delivers a prompt high radiation dose rather than fractional doses over time. While some suggest thresholds of > 40 Gy s−1 with a maximal effect at > 100 Gy s−1, accumulated evidence shows that instantaneous dose-rate and irradiation time are critical. Mechanisms are still debated, but toxicity is minimized while inducing apoptosis in malignant tissue. Delivery technologies to date show that a capability gap exists with clinic scale, broad area, deep penetrating, high dose rate systems. Based on these trends, if FLASH-RT is adopted, it may become a dominant approach except in the least technologically advanced countries. The linear induction accelerator (LIA) developed for high instantaneous and high average dose-rate, species independent charged particle acceleration, has yet to be considered for this application. We review the status of LIA technology, explore the physics of bremsstrahlung-converter-target interactions and our work on stabilizing the electron beam. While the gradient of the LIA is low, we present our preliminary work to improve the gradient by an order of magnitude, presenting a point design for a multibeam FLASH-RT system using a single accelerator for application to conformal FLASH-RT.
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Affiliation(s)
- Stephen E Sampayan
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, CA, 94551, USA. .,Opcondys, Inc., 600 Commerce Court, Manteca, CA, 95336, USA.
| | | | - George J Caporaso
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, CA, 94551, USA
| | - Yu-Jiuan Chen
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, CA, 94551, USA
| | - Steve Falabella
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, CA, 94551, USA
| | - Steven A Hawkins
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, CA, 94551, USA
| | - Jason Hearn
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - James A Watson
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, CA, 94551, USA
| | - Jan-Mark Zentler
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, CA, 94551, USA
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10
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Laissue JA. Elke Bräuer-Krisch: dedication, creativity and generosity: May 17, 1961-September 10, 2018. Int J Radiat Biol 2021; 98:280-287. [PMID: 34129423 DOI: 10.1080/09553002.2021.1941385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This extraordinary woman worked her professional way from a radiation protection engineer to become the successful principal investigator of a prestigious international European project for a new radiation therapy (ERC Synergy grant, HORIZON 2020). The evaluation of the submitted proposal was very positive. The panel proposed that it be funded. Elke tragically passed away a few days before this conclusion of the panel. The present account describes her gradual career development; it includes many episodes that Elke personally chronicled in her curriculum of 2017. METHODS An internet literature search was performed using Google Scholar and other sources to assist in the writing of this narrative review and account. CONCLUSIONS In parallel to the development of the new Biomedical Beamline ID17 at the European Synchrotron Radiation Facility in Grenoble in the late nineties, Elke focused her interest and her personal and professional priorities on MRT, particularly on its clinical goals. She outlined her main objectives in several documents: (1) develop a new paradigm of cancer care by broadening the foundation for MRT. (2) Filling the gaps in basic biological knowledge about the mechanisms of MRT effects on normal and neoplastic tissues. (3) Broaden the preclinical level of evidence for the low normal organ toxicity of MRT versus standard X-ray irradiations; preclinical experiments involved the application of MRT to animal tumor patients, to animals of larger size than laboratory rodents, using larger radiation field sizes, and irradiating in a real-time scenario comparable to the one planned for human patients. (4) To foster the specific purpose of radiosurgical MRT of tumor patients at the ESRF that required development of new, specific state of the art modalities and tools for treatment planning, dosimetry, dose calculation, patient positioning and, of particular importance, redundant levels of patient safety. Just as she was about to take responsibility as principal investigator for a prestigious international European project on a new radiation therapy, death called Elke in.
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Affiliation(s)
- Jean A Laissue
- Institute of Pathology, University of Bern, Bern, Switzerland
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11
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Pellicioli P, Donzelli M, Davis JA, Estève F, Hugtenburg R, Guatelli S, Petasecca M, Lerch MLF, Bräuer-Krisch E, Krisch M. Study of the X-ray radiation interaction with a multislit collimator for the creation of microbeams in radiation therapy. JOURNAL OF SYNCHROTRON RADIATION 2021; 28:392-403. [PMID: 33650550 DOI: 10.1107/s1600577520016811] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
Microbeam radiation therapy (MRT) is a developing radiotherapy, based on the use of beams only a few tens of micrometres wide, generated by synchrotron X-ray sources. The spatial fractionation of the homogeneous beam into an array of microbeams is possible using a multislit collimator (MSC), i.e. a machined metal block with regular apertures. Dosimetry in MRT is challenging and previous works still show differences between calculated and experimental dose profiles of 10-30%, which are not acceptable for a clinical implementation of treatment. The interaction of the X-rays with the MSC may contribute to the observed discrepancies; the present study therefore investigates the dose contribution due to radiation interaction with the MSC inner walls and radiation leakage of the MSC. Dose distributions inside a water-equivalent phantom were evaluated for different field sizes and three typical spectra used for MRT studies at the European Synchrotron Biomedical beamline ID17. Film dosimetry was utilized to determine the contribution of radiation interaction with the MSC inner walls; Monte Carlo simulations were implemented to calculate the radiation leakage contribution. Both factors turned out to be relevant for the dose deposition, especially for small fields. Photons interacting with the MSC walls may bring up to 16% more dose in the valley regions, between the microbeams. Depending on the chosen spectrum, the radiation leakage close to the phantom surface can contribute up to 50% of the valley dose for a 5 mm × 5 mm field. The current study underlines that a detailed characterization of the MSC must be performed systematically and accurate MRT dosimetry protocols must include the contribution of radiation leakage and radiation interaction with the MSC in order to avoid significant errors in the dose evaluation at the micrometric scale.
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Affiliation(s)
- P Pellicioli
- ID17 Biomedical Beamline, ESRF - The European Synchrotron, 71 avenue des Martyrs, Grenoble, France
| | - M Donzelli
- ID17 Biomedical Beamline, ESRF - The European Synchrotron, 71 avenue des Martyrs, Grenoble, France
| | - J A Davis
- School of Physics, University of Wollongong, Wollongong, Australia
| | - F Estève
- STROBE - Synchrotron Radiation for Biomedicine, Grenoble, France
| | - R Hugtenburg
- Swansea University Medical School, Singleton Park, Swansea, United Kingdom
| | - S Guatelli
- School of Physics, University of Wollongong, Wollongong, Australia
| | - M Petasecca
- School of Physics, University of Wollongong, Wollongong, Australia
| | - M L F Lerch
- School of Physics, University of Wollongong, Wollongong, Australia
| | - E Bräuer-Krisch
- ID17 Biomedical Beamline, ESRF - The European Synchrotron, 71 avenue des Martyrs, Grenoble, France
| | - M Krisch
- ID17 Biomedical Beamline, ESRF - The European Synchrotron, 71 avenue des Martyrs, Grenoble, France
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12
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Clinical microbeam radiation therapy with a compact source: specifications of the line-focus X-ray tube. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 14:74-81. [PMID: 33458318 PMCID: PMC7807643 DOI: 10.1016/j.phro.2020.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 02/02/2023]
Abstract
Line-focus X-ray tubes are suitable for clinical microbeam radiation therapy (MRT). A modular high-voltage supply safely enables high electron beam powers. An electron accelerator was designed to generate an eccentric focal spot. We simulated a peak-to-valley dose ratio above 20 for single-field MRT. Microbeam arc therapy spares healthy brain tissue compared to single-field MRT.
Background and purpose Microbeam radiotherapy (MRT) is a preclinical concept in radiation oncology with arrays of alternating micrometer-wide high-dose peaks and low-dose valleys. Experiments demonstrated a superior normal tissue sparing at similar tumor control rates with MRT compared to conventional radiotherapy. Possible clinical applications are currently limited to large third-generation synchrotrons. Here, we investigated the line-focus X-ray tube as an alternative microbeam source. Materials and methods We developed a concept for a high-voltage supply and an electron source. In Monte Carlo simulations, we assessed the influence of X-ray spectrum, focal spot size, electron incidence angle, and photon emission angle on the microbeam dose distribution. We further assessed the dose distribution of microbeam arc therapy and suggested to interpret this complex dose distribution by equivalent uniform dose. Results An adapted modular multi-level converter can supply high-voltage powers in the megawatt range for a few seconds. The electron source with a thermionic cathode and a quadrupole can generate an eccentric, high-power electron beam of several 100 keV energy. Highest dose rates and peak-to-valley dose ratios (PVDRs) were achieved for an electron beam impinging perpendicular onto the target surface and a focal spot smaller than the microbeam cross-section. The line-focus X-ray tube simulations demonstrated PVDRs above 20. Conclusion The line-focus X-ray tube is a suitable compact source for clinical MRT. We demonstrated its technical feasibility based on state-of-the-art high-voltage and electron-beam technology. Microbeam arc therapy is an effective concept to increase the target-to-entrance dose ratio of orthovoltage microbeams.
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Esplen N, Mendonca MS, Bazalova-Carter M. Physics and biology of ultrahigh dose-rate (FLASH) radiotherapy: a topical review. Phys Med Biol 2020; 65:23TR03. [PMID: 32721941 DOI: 10.1088/1361-6560/abaa28] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ultrahigh dose-rate radiotherapy (RT), or 'FLASH' therapy, has gained significant momentum following various in vivo studies published since 2014 which have demonstrated a reduction in normal tissue toxicity and similar tumor control for FLASH-RT when compared with conventional dose-rate RT. Subsequent studies have sought to investigate the potential for FLASH normal tissue protection and the literature has been since been inundated with publications on FLASH therapies. Today, FLASH-RT is considered by some as having the potential to 'revolutionize radiotherapy'. FLASH-RT is considered by some as having the potential to 'revolutionize radiotherapy'. The goal of this review article is to present the current state of this intriguing RT technique and to review existing publications on FLASH-RT in terms of its physical and biological aspects. In the physics section, the current landscape of ultrahigh dose-rate radiation delivery and dosimetry is presented. Specifically, electron, photon and proton radiation sources capable of delivering ultrahigh dose-rates along with their beam delivery parameters are thoroughly discussed. Additionally, the benefits and drawbacks of radiation detectors suitable for dosimetry in FLASH-RT are presented. The biology section comprises a summary of pioneering in vitro ultrahigh dose-rate studies performed in the 1960s and early 1970s and continues with a summary of the recent literature investigating normal and tumor tissue responses in electron, photon and proton beams. The section is concluded with possible mechanistic explanations of the FLASH normal-tissue protection effect (FLASH effect). Finally, challenges associated with clinical translation of FLASH-RT and its future prospects are critically discussed; specifically, proposed treatment machines and publications on treatment planning for FLASH-RT are reviewed.
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Affiliation(s)
- Nolan Esplen
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
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Günther B, Gradl R, Jud C, Eggl E, Huang J, Kulpe S, Achterhold K, Gleich B, Dierolf M, Pfeiffer F. The versatile X-ray beamline of the Munich Compact Light Source: design, instrumentation and applications. JOURNAL OF SYNCHROTRON RADIATION 2020; 27:1395-1414. [PMID: 32876618 PMCID: PMC7467334 DOI: 10.1107/s1600577520008309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/22/2020] [Indexed: 05/08/2023]
Abstract
Inverse Compton scattering provides means to generate low-divergence partially coherent quasi-monochromatic, i.e. synchrotron-like, X-ray radiation on a laboratory scale. This enables the transfer of synchrotron techniques into university or industrial environments. Here, the Munich Compact Light Source is presented, which is such a compact synchrotron radiation facility based on an inverse Compton X-ray source (ICS). The recent improvements of the ICS are reported first and then the various experimental techniques which are most suited to the ICS installed at the Technical University of Munich are reviewed. For the latter, a multipurpose X-ray application beamline with two end-stations was designed. The beamline's design and geometry are presented in detail including the different set-ups as well as the available detector options. Application examples of the classes of experiments that can be performed are summarized afterwards. Among them are dynamic in vivo respiratory imaging, propagation-based phase-contrast imaging, grating-based phase-contrast imaging, X-ray microtomography, K-edge subtraction imaging and X-ray spectroscopy. Finally, plans to upgrade the beamline in order to enhance its capabilities are discussed.
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Affiliation(s)
- Benedikt Günther
- Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748 Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748 Garching, Germany
| | - Regine Gradl
- Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748 Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748 Garching, Germany
| | - Christoph Jud
- Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748 Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748 Garching, Germany
| | - Elena Eggl
- Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748 Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748 Garching, Germany
| | - Juanjuan Huang
- Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748 Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748 Garching, Germany
| | - Stephanie Kulpe
- Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748 Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748 Garching, Germany
| | - Klaus Achterhold
- Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748 Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748 Garching, Germany
| | - Bernhard Gleich
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748 Garching, Germany
| | - Martin Dierolf
- Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748 Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748 Garching, Germany
| | - Franz Pfeiffer
- Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748 Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748 Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
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Mittone A, Fardin L, Di Lillo F, Fratini M, Requardt H, Mauro A, Homs-Regojo RA, Douissard PA, Barbone GE, Stroebel J, Romano M, Massimi L, Begani-Provinciali G, Palermo F, Bayat S, Cedola A, Coan P, Bravin A. Multiscale pink-beam microCT imaging at the ESRF-ID17 biomedical beamline. JOURNAL OF SYNCHROTRON RADIATION 2020; 27:1347-1357. [PMID: 32876610 DOI: 10.1107/s160057752000911x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Abstract
Recent trends in hard X-ray micro-computed tomography (microCT) aim at increasing both spatial and temporal resolutions. These challenges require intense photon beams. Filtered synchrotron radiation beams, also referred to as `pink beams', which are emitted by wigglers or bending magnets, meet this need, owing to their broad energy range. In this work, the new microCT station installed at the biomedical beamline ID17 of the European Synchrotron is described and an overview of the preliminary results obtained for different biomedical-imaging applications is given. This new instrument expands the capabilities of the beamline towards sub-micrometre voxel size scale and simultaneous multi-resolution imaging. The current setup allows the acquisition of tomographic datasets more than one order of magnitude faster than with a monochromatic beam configuration.
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Affiliation(s)
- Alberto Mittone
- CELLS - ALBA Synchrotron Light Source, Carrer de la Llum 2-26, 08290 Cerdanyola del Valles, Barcelona, Spain
| | - Luca Fardin
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38000 Grenoble, France
| | - Francesca Di Lillo
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38000 Grenoble, France
| | - Michela Fratini
- CNR-Nanotec (Roma Unit), c/o Department of Physics, La Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Herwig Requardt
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38000 Grenoble, France
| | - Anthony Mauro
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38000 Grenoble, France
| | | | | | - Giacomo E Barbone
- Ludwig Maximilian University, Am Coulombwall 1, D-85748 Munich, Germany
| | - Johannes Stroebel
- Ludwig Maximilian University, Am Coulombwall 1, D-85748 Munich, Germany
| | - Mariele Romano
- Ludwig Maximilian University, Am Coulombwall 1, D-85748 Munich, Germany
| | - Lorenzo Massimi
- CNR-Nanotec (Roma Unit), c/o Department of Physics, La Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Ginevra Begani-Provinciali
- CNR-Nanotec (Roma Unit), c/o Department of Physics, La Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Francesca Palermo
- CNR-Nanotec (Roma Unit), c/o Department of Physics, La Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Sam Bayat
- STROBE Laboratory, INSERM UA7, 71 Avenue des Martyrs, 38000 Grenoble, France
| | - Alessia Cedola
- CNR-Nanotec (Roma Unit), c/o Department of Physics, La Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Paola Coan
- Ludwig Maximilian University, Am Coulombwall 1, D-85748 Munich, Germany
| | - Alberto Bravin
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38000 Grenoble, France
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Hombrink G, Wilkens JJ, Combs SE, Bartzsch S. Simulation and measurement of microbeam dose distribution in lung tissue. Phys Med 2020; 75:77-82. [PMID: 32559648 DOI: 10.1016/j.ejmp.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/01/2020] [Indexed: 11/26/2022] Open
Abstract
Microbeam radiation therapy (MRT), a so far preclinical method in radiation oncology, modulates treatment doses on a micrometre scale. MRT uses treatment fields with a few ten micrometre wide high dose regions (peaks) separated by a few hundred micrometre wide low dose regions (valleys) and was shown to spare tissue much more effectively than conventional radiation therapy at similar tumour control rates. While preclinical research focused primarily on tumours of the central nervous system, recently also lung tumours have been suggested as a potential target for MRT. This study investigates the effect of the lung microstructure, comprising air cavities of a few hundred micrometre diameter, on the microbeam dose distribution in lung. In Monte Carlo simulations different models of heterogeneous lung tissue are compared with pure water and homogeneous air-water mixtures. Experimentally, microbeam dose distributions in porous foam material with cavity sizes similar to the size of lung alveoli were measured with film dosimetry at the European Synchrotron Radiation Facility (ESRF) in Grenoble, France. Simulations and experiments show that the microstructure of the lung has a huge impact on the local doses in the microbeam fields. Locally, material inhomogeneities may change the dose by a factor of 1.7, and also average peak and valley doses substantially differ from those in homogeneous material. Our results imply that accurate dose prediction for MRT in lung requires adequate models of the lung microstructure. Even if only average peak and valley doses are of interest, the assumption of a simple homogeneous air-water mixture is not sufficient. Since anatomic information on a micrometre scale are unavailable for clinical treatment planning, alternative methods and models have to be developed.
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Affiliation(s)
- Gerrit Hombrink
- University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Physics Department, Technical University of Munich, Garching, Germany; Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
| | - Jan J Wilkens
- University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Physics Department, Technical University of Munich, Garching, Germany
| | - Stephanie E Combs
- University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
| | - Stefan Bartzsch
- University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
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Darafsheh A, Hao Y, Zwart T, Wagner M, Catanzano D, Williamson JF, Knutson N, Sun B, Mutic S, Zhao T. Feasibility of proton FLASH irradiation using a synchrocyclotron for preclinical studies. Med Phys 2020; 47:4348-4355. [DOI: 10.1002/mp.14253] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Arash Darafsheh
- Department of Radiation Oncology Washington University School of Medicine St. Louis MO 63110 USA
| | - Yao Hao
- Department of Radiation Oncology Washington University School of Medicine St. Louis MO 63110 USA
| | - Townsend Zwart
- Mevion Medical Systems 300 Foster St. Littleton MA 01460 USA
| | - Miles Wagner
- Mevion Medical Systems 300 Foster St. Littleton MA 01460 USA
| | | | - Jeffrey F. Williamson
- Department of Radiation Oncology Washington University School of Medicine St. Louis MO 63110 USA
| | - Nels Knutson
- Department of Radiation Oncology Washington University School of Medicine St. Louis MO 63110 USA
| | - Baozhou Sun
- Department of Radiation Oncology Washington University School of Medicine St. Louis MO 63110 USA
| | - Sasa Mutic
- Department of Radiation Oncology Washington University School of Medicine St. Louis MO 63110 USA
| | - Tianyu Zhao
- Department of Radiation Oncology Washington University School of Medicine St. Louis MO 63110 USA
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A comparative dosimetry study of an alanine dosimeter with a PTW PinPoint chamber at ultra-high dose rates of synchrotron radiation. Phys Med 2020; 71:161-167. [DOI: 10.1016/j.ejmp.2020.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 01/01/2023] Open
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Bartzsch S, Corde S, Crosbie JC, Day L, Donzelli M, Krisch M, Lerch M, Pellicioli P, Smyth LML, Tehei M. Technical advances in x-ray microbeam radiation therapy. Phys Med Biol 2020; 65:02TR01. [PMID: 31694009 DOI: 10.1088/1361-6560/ab5507] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In the last 25 years microbeam radiation therapy (MRT) has emerged as a promising alternative to conventional radiation therapy at large, third generation synchrotrons. In MRT, a multi-slit collimator modulates a kilovoltage x-ray beam on a micrometer scale, creating peak dose areas with unconventionally high doses of several hundred Grays separated by low dose valley regions, where the dose remains well below the tissue tolerance level. Pre-clinical evidence demonstrates that such beam geometries lead to substantially reduced damage to normal tissue at equal tumour control rates and hence drastically increase the therapeutic window. Although the mechanisms behind MRT are still to be elucidated, previous studies indicate that immune response, tumour microenvironment, and the microvasculature may play a crucial role. Beyond tumour therapy, MRT has also been suggested as a microsurgical tool in neurological disorders and as a primer for drug delivery. The physical properties of MRT demand innovative medical physics and engineering solutions for safe treatment delivery. This article reviews technical developments in MRT and discusses existing solutions for dosimetric validation, reliable treatment planning and safety. Instrumentation at synchrotron facilities, including beam production, collimators and patient positioning systems, is also discussed. Specific solutions reviewed in this article include: dosimetry techniques that can cope with high spatial resolution, low photon energies and extremely high dose rates of up to 15 000 Gy s-1, dose calculation algorithms-apart from pure Monte Carlo Simulations-to overcome the challenge of small voxel sizes and a wide dynamic dose-range, and the use of dose-enhancing nanoparticles to combat the limited penetrability of a kilovoltage energy spectrum. Finally, concepts for alternative compact microbeam sources are presented, such as inverse Compton scattering set-ups and carbon nanotube x-ray tubes, that may facilitate the transfer of MRT into a hospital-based clinical environment. Intensive research in recent years has resulted in practical solutions to most of the technical challenges in MRT. Treatment planning, dosimetry and patient safety systems at synchrotrons have matured to a point that first veterinary and clinical studies in MRT are within reach. Should these studies confirm the promising results of pre-clinical studies, the authors are confident that MRT will become an effective new radiotherapy option for certain patients.
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Affiliation(s)
- Stefan Bartzsch
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany. Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
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20
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First experimental measurement of the effect of cardio‐synchronous brain motion on the dose distribution during microbeam radiation therapy. Med Phys 2019; 47:213-222. [DOI: 10.1002/mp.13899] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/16/2019] [Accepted: 10/21/2019] [Indexed: 01/03/2023] Open
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21
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Pellicioli P, Bartzsch S, Donzelli M, Krisch M, Bräuer-Krisch E. High resolution radiochromic film dosimetry: Comparison of a microdensitometer and an optical microscope. Phys Med 2019; 65:106-113. [PMID: 31450120 DOI: 10.1016/j.ejmp.2019.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Microbeam radiation therapy is a developing technique that promises superior tumour control and better normal tissue tolerance using spatially fractionated X-ray beams only tens of micrometres wide. Radiochromic film dosimetry at micrometric scale was performed using a microdensitometer, but this instrument presents limitations in accuracy and precision, therefore the use of a microscope is suggested as alternative. The detailed procedures developed to use the two devices are reported allowing a comparison. METHODS Films were irradiated with single microbeams and with arrays of 50 µm wide microbeams spaced by a 400 µm pitch, using a polychromatic beam with mean energy of 100 keV. The film dose measurements were performed using two independent instruments: a microdensitometer (MDM) and an optical microscope (OM). RESULTS The mean values of the absolute dose measured with the two instruments differ by less than 5% but the OM provides reproducibility with a standard deviation of 1.2% compared to up to 7% for the MDM. The resolution of the OM was determined to be ~ 1 to 2 µm in both planar directions able to resolve pencil beams irradiation, while the MDM reaches at the best 20 µm resolution along scanning direction. The uncertainties related to the data acquisition are 2.5-3% for the OM and 9-15% for the MDM. CONCLUSION The comparison between the two devices validates that the OM provides equivalent results to the MDM with better precision, reproducibility and resolution. In addition, the possibility to study dose distributions in two-dimensions over wider areas definitely sanctions the OM as substitute of the MDM.
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Affiliation(s)
- P Pellicioli
- The European Synchrotron Radiation Facility, ID17 Biomedical Beamline, Grenoble, France; Inserm UA7 STROBE, Grenoble Alpes University, Grenoble, France; Swansea University Medical School, Singleton Park, Swansea SA2 8PP, United Kingdom.
| | - S Bartzsch
- Helmholtz-Centre Munich, Institute of Innovative Radiation Therapy, Munich, Germany; Klinikum rechts der Isar, Department for Radiation Oncology, Technical University of Munich, Germany
| | - M Donzelli
- The European Synchrotron Radiation Facility, ID17 Biomedical Beamline, Grenoble, France; ICR - The Institute of Cancer Research, London, United Kingdom
| | - M Krisch
- The European Synchrotron Radiation Facility, ID17 Biomedical Beamline, Grenoble, France
| | - E Bräuer-Krisch
- The European Synchrotron Radiation Facility, ID17 Biomedical Beamline, Grenoble, France
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22
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Film dosimetry studies for patient specific quality assurance in microbeam radiation therapy. Phys Med 2019; 65:227-237. [DOI: 10.1016/j.ejmp.2019.09.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/02/2019] [Accepted: 09/05/2019] [Indexed: 11/21/2022] Open
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23
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Identifying optimal clinical scenarios for synchrotron microbeam radiation therapy: A treatment planning study. Phys Med 2019; 60:111-119. [DOI: 10.1016/j.ejmp.2019.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/20/2019] [Accepted: 03/19/2019] [Indexed: 12/25/2022] Open
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Donzelli M, Oelfke U, Bräuer-Krisch E. Introducing the concept of spiral microbeam radiation therapy (spiralMRT). Phys Med Biol 2019; 64:065005. [PMID: 30650386 DOI: 10.1088/1361-6560/aaff23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
MOTIVATION With interlaced microbeam radiation therapy (MRT) a first kilovoltage radiotherapy (RT) concept combining spatially fractionated entrance beams and homogeneous dose distribution at the target exists. However, this technique suffers from its high sensitivity to positioning errors of the target relative to the radiation source. With spiral microbeam radiation therapy (spiralMRT), this publication introduces a new irradiation geometry, offering similar spatial fractionation properties as interlaced MRT, while being less vulnerable to target positioning uncertainties. METHODS The dose distributions achievable with spiralMRT in a simplified human head geometry were calculated with Monte Carlo simulations based on Geant4 and the dependence of the result on the microbeam pitch, total field size, and photon energy were analysed. A comparison with interlaced MRT and conventional megavoltage tomotherapy was carried out. RESULTS SpiralMRT can deliver homogeneous dose distributions, while using spatially fractionated entrance beams. The valley dose of spiralMRT entrance beams is by up to 40% lower than the corresponding tomotherapy dose, thus indicating a better normal tissue sparing. The optimum photon energy is found to be around [Formula: see text]. CONCLUSIONS SpiralMRT is a promising approach to delivering homogeneous dose distributions with spatially fractionated entrance beams, possibly decreasing normal tissue side effects in hypofractionated RT.
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Affiliation(s)
- Mattia Donzelli
- European Synchrotron Radiation Facility, Biomedical beamline ID17, Grenoble, France. Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom. Author to whom any correspondence should be addressed
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25
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Montay-Gruel P, Bouchet A, Jaccard M, Patin D, Serduc R, Aim W, Petersson K, Petit B, Bailat C, Bourhis J, Bräuer-Krisch E, Vozenin MC. X-rays can trigger the FLASH effect: Ultra-high dose-rate synchrotron light source prevents normal brain injury after whole brain irradiation in mice. Radiother Oncol 2018; 129:582-588. [DOI: 10.1016/j.radonc.2018.08.016] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/06/2018] [Accepted: 08/23/2018] [Indexed: 11/16/2022]
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26
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Schültke E, Bräuer-Krisch E, Blattmann H, Requardt H, Laissue JA, Hildebrandt G. Survival of rats bearing advanced intracerebral F 98 tumors after glutathione depletion and microbeam radiation therapy: conclusions from a pilot project. Radiat Oncol 2018; 13:89. [PMID: 29747666 PMCID: PMC5946497 DOI: 10.1186/s13014-018-1038-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/30/2018] [Indexed: 12/24/2022] Open
Abstract
Background Resistance to radiotherapy is frequently encountered in patients with glioblastoma multiforme. It is caused at least partially by the high glutathione content in the tumour tissue. Therefore, the administration of the glutathione synthesis inhibitor Buthionine-SR-Sulfoximine (BSO) should increase survival time. Methods BSO was tested in combination with an experimental synchrotron-based treatment, microbeam radiation therapy (MRT), characterized by spatially and periodically alternating microscopic dose distribution. One hundred thousand F98 glioma cells were injected into the right cerebral hemisphere of adult male Fischer rats to generate an orthotopic small animal model of a highly malignant brain tumour in a very advanced stage. Therapy was scheduled for day 13 after tumour cell implantation. At this time, 12.5% of the animals had already died from their disease. The surviving 24 tumour-bearing animals were randomly distributed in three experimental groups: subjected to MRT alone (Group A), to MRT plus BSO (Group B) and tumour-bearing untreated controls (Group C). Thus, half of the irradiated animals received an injection of 100 μM BSO into the tumour two hours before radiotherapy. Additional tumour-free animals, mirroring the treatment of the tumour-bearing animals, were included in the experiment. MRT was administered in bi-directional mode with arrays of quasi-parallel beams crossing at the tumour location. The width of the microbeams was ≈28 μm with a center-to-center distance of ≈400 μm, a peak dose of 350 Gy, and a valley dose of 9 Gy in the normal tissue and 18 Gy at the tumour location; thus, the peak to valley dose ratio (PVDR) was 31. Results After tumour-cell implantation, otherwise untreated rats had a mean survival time of 15 days. Twenty days after implantation, 62.5% of the animals receiving MRT alone (group A) and 75% of the rats given MRT + BSO (group B) were still alive. Thirty days after implantation, survival was 12.5% in Group A and 62.5% in Group B. There were no survivors on or beyond day 35 in Group A, but 25% were still alive in Group B. Thus, rats which underwent MRT with adjuvant BSO injection experienced the largest survival gain. Conclusions In this pilot project using an orthotopic small animal model of advanced malignant brain tumour, the injection of the glutathione inhibitor BSO with MRT significantly increased mean survival time.
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Affiliation(s)
- E Schültke
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059, Rostock, Germany.
| | - E Bräuer-Krisch
- European Synchrotron Radiation Facility (ESRF), Grenoble, France
| | | | - H Requardt
- European Synchrotron Radiation Facility (ESRF), Grenoble, France
| | - J A Laissue
- Institute of Anatomy, University of Bern, Bern, Switzerland
| | - G Hildebrandt
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059, Rostock, Germany
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Potez M, Bouchet A, Wagner J, Donzelli M, Bräuer-Krisch E, Hopewell JW, Laissue J, Djonov V. Effects of Synchrotron X-Ray Micro-beam Irradiation on Normal Mouse Ear Pinnae. Int J Radiat Oncol Biol Phys 2018; 101:680-689. [PMID: 29559293 DOI: 10.1016/j.ijrobp.2018.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/20/2017] [Accepted: 02/05/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To analyze the effects of micro-beam irradiation (MBI) on the normal tissues of the mouse ear. METHODS AND MATERIALS Normal mouse ears are a unique model, which in addition to skin contain striated muscles, cartilage, blood and lymphatic vessels, and few hair follicles. This renders the mouse ear an excellent model for complex tissue studies. The ears of C57BL6 mice were exposed to MBI (50-μm-wide micro-beams, spaced 200 μm between centers) with peak entrance doses of 200, 400, or 800 Gy (at ultra-high dose rates). Tissue samples were examined histopathologically, with conventional light and electron microscopy, at 2, 7, 15, 30, and 240 days after irradiation (dpi). Sham-irradiated animals acted as controls. RESULTS Only an entrance dose of 800 Gy caused a significant increase in the thickness of both epidermal and dermal ear compartments seen from 15 to 30 dpi; the number of sebaceous glands was significantly reduced by 30 dpi. The numbers of apoptotic bodies and infiltrating leukocytes peaked between 15 and 30 dpi. Lymphatic vessels were prominently enlarged at 15 up to 240 dpi. Sarcomere lesions in striated muscle were observed after all doses, starting from 2 dpi; scar tissue within individual beam paths remained visible up to 240 dpi. Cartilage and blood vessel changes remained histologically inconspicuous. CONCLUSIONS Normal tissues such as skin, cartilage, and blood and lymphatic vessels are highly tolerant to MBI after entrance doses up to 400 Gy. The striated muscles appeared to be the most sensitive to MBI. Those findings should be taken into consideration in future micro-beam radiation therapy treatment schedules.
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Affiliation(s)
- Marine Potez
- Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Audrey Bouchet
- Institute of Anatomy, University of Bern, Bern, Switzerland
| | | | - Mattia Donzelli
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, France; Joint Department of Physics, The Institute of Cancer Research and the Royal Marsden Hospital, London, United Kingdom
| | - Elke Bräuer-Krisch
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, France
| | - John W Hopewell
- Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Jean Laissue
- Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, Bern, Switzerland.
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Donzelli M, Bräuer-Krisch E, Oelfke U, Wilkens JJ, Bartzsch S. Hybrid dose calculation: a dose calculation algorithm for microbeam radiation therapy. Phys Med Biol 2018; 63:045013. [PMID: 29324439 PMCID: PMC5964549 DOI: 10.1088/1361-6560/aaa705] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/07/2017] [Accepted: 01/11/2018] [Indexed: 12/17/2022]
Abstract
Microbeam radiation therapy (MRT) is still a preclinical approach in radiation oncology that uses planar micrometre wide beamlets with extremely high peak doses, separated by a few hundred micrometre wide low dose regions. Abundant preclinical evidence demonstrates that MRT spares normal tissue more effectively than conventional radiation therapy, at equivalent tumour control. In order to launch first clinical trials, accurate and efficient dose calculation methods are an inevitable prerequisite. In this work a hybrid dose calculation approach is presented that is based on a combination of Monte Carlo and kernel based dose calculation. In various examples the performance of the algorithm is compared to purely Monte Carlo and purely kernel based dose calculations. The accuracy of the developed algorithm is comparable to conventional pure Monte Carlo calculations. In particular for inhomogeneous materials the hybrid dose calculation algorithm out-performs purely convolution based dose calculation approaches. It is demonstrated that the hybrid algorithm can efficiently calculate even complicated pencil beam and cross firing beam geometries. The required calculation times are substantially lower than for pure Monte Carlo calculations.
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Affiliation(s)
- Mattia Donzelli
- The European
Synchrotron Radiation Facility, 71 Avenue des Martyrs 38000,
Grenoble, France
- The Institute of
Cancer Research, 15 Cotswold Road, Sutton, London SM2 5NG,
United Kingdom
- Author to whom any correspondence should be
addressed
| | - Elke Bräuer-Krisch
- The European
Synchrotron Radiation Facility, 71 Avenue des Martyrs 38000,
Grenoble, France
| | - Uwe Oelfke
- The Institute of
Cancer Research, 15 Cotswold Road, Sutton, London SM2 5NG,
United Kingdom
| | - Jan J Wilkens
- Department of Radiation Oncology, Klinikum rechts
der Isar, Technical University of
Munich, Ismaninger Straße 22, 81675 Munich,
Germany
| | - Stefan Bartzsch
- The Institute of
Cancer Research, 15 Cotswold Road, Sutton, London SM2 5NG,
United Kingdom
- Department of Radiation Oncology, Klinikum rechts
der Isar, Technical University of
Munich, Ismaninger Straße 22, 81675 Munich,
Germany
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29
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Ghita M, Fernandez-Palomo C, Fukunaga H, Fredericia PM, Schettino G, Bräuer-Krisch E, Butterworth KT, McMahon SJ, Prise KM. Microbeam evolution: from single cell irradiation to pre-clinical studies. Int J Radiat Biol 2018; 94:708-718. [PMID: 29309203 DOI: 10.1080/09553002.2018.1425807] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE This review follows the development of microbeam technology from the early days of single cell irradiations, to investigations of specific cellular mechanisms and to the development of new treatment modalities in vivo. A number of microbeam applications are discussed with a focus on pre-clinical modalities and translation towards clinical application. CONCLUSIONS The development of radiation microbeams has been a valuable tool for the exploration of fundamental radiobiological response mechanisms. The strength of micro-irradiation techniques lies in their ability to deliver precise doses of radiation to selected individual cells in vitro or even to target subcellular organelles. These abilities have led to the development of a range of microbeam facilities around the world allowing the delivery of precisely defined beams of charged particles, X-rays, or electrons. In addition, microbeams have acted as mechanistic probes to dissect the underlying molecular events of the DNA damage response following highly localized dose deposition. Further advances in very precise beam delivery have also enabled the transition towards new and exciting therapeutic modalities developed at synchrotrons to deliver radiotherapy using plane parallel microbeams, in Microbeam Radiotherapy (MRT).
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Affiliation(s)
- Mihaela Ghita
- a Centre for Cancer Research and Cell Biology , Queen's University Belfast , Belfast , UK
| | | | - Hisanori Fukunaga
- a Centre for Cancer Research and Cell Biology , Queen's University Belfast , Belfast , UK
| | - Pil M Fredericia
- c Centre for Nuclear Technologies , Technical University of Denmark , Roskilde , Denmark
| | | | | | - Karl T Butterworth
- a Centre for Cancer Research and Cell Biology , Queen's University Belfast , Belfast , UK
| | - Stephen J McMahon
- a Centre for Cancer Research and Cell Biology , Queen's University Belfast , Belfast , UK
| | - Kevin M Prise
- a Centre for Cancer Research and Cell Biology , Queen's University Belfast , Belfast , UK
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30
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Schültke E, Balosso J, Breslin T, Cavaletti G, Djonov V, Esteve F, Grotzer M, Hildebrandt G, Valdman A, Laissue J. Microbeam radiation therapy - grid therapy and beyond: a clinical perspective. Br J Radiol 2017; 90:20170073. [PMID: 28749174 PMCID: PMC5853350 DOI: 10.1259/bjr.20170073] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Microbeam irradiation is spatially fractionated radiation on a micrometer scale. Microbeam irradiation with therapeutic intent has become known as microbeam radiation therapy (MRT). The basic concept of MRT was developed in the 1980s, but it has not yet been tested in any human clinical trial, even though there is now a large number of animal studies demonstrating its marked therapeutic potential with an exceptional normal tissue sparing effect. Furthermore, MRT is conceptually similar to macroscopic grid based radiation therapy which has been used in clinical practice for decades. In this review, the potential clinical applications of MRT are analysed for both malignant and non-malignant diseases.
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Affiliation(s)
- Elisabeth Schültke
- 1 Department of Radiooncology, Rostock University Medical Center, Rostock, Germany
| | - Jacques Balosso
- 2 Departement of Radiation Oncology and Medical Physics, University Grenoble Alpes (UGA) and Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Grenoble, France
| | - Thomas Breslin
- 3 Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden.,4 Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Guido Cavaletti
- 5 Experimental Neurology Unit and Milan Center for Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Valentin Djonov
- 6 Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Francois Esteve
- 2 Departement of Radiation Oncology and Medical Physics, University Grenoble Alpes (UGA) and Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Grenoble, France
| | - Michael Grotzer
- 7 Department of Oncology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Guido Hildebrandt
- 1 Department of Radiooncology, Rostock University Medical Center, Rostock, Germany
| | - Alexander Valdman
- 8 Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Jean Laissue
- 6 Institute of Anatomy, University of Bern, Bern, Switzerland
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31
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Merrem A, Bartzsch S, Laissue J, Oelfke U. Computational modelling of the cerebral cortical microvasculature: effect of x-ray microbeams versus broad beam irradiation. Phys Med Biol 2017; 62:3902-3922. [PMID: 28333689 PMCID: PMC6050522 DOI: 10.1088/1361-6560/aa68d5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/15/2017] [Accepted: 03/23/2017] [Indexed: 12/31/2022]
Abstract
Microbeam Radiation Therapy is an innovative pre-clinical strategy which uses arrays of parallel, tens of micrometres wide kilo-voltage photon beams to treat tumours. These x-ray beams are typically generated on a synchrotron source. It was shown that these beam geometries allow exceptional normal tissue sparing from radiation damage while still being effective in tumour ablation. A final biological explanation for this enhanced therapeutic ratio has still not been found, some experimental data support an important role of the vasculature. In this work, the effect of microbeams on a normal microvascular network of the cerebral cortex was assessed in computer simulations and compared to the effect of homogeneous, seamless exposures at equal energy absorption. The anatomy of a cerebral microvascular network and the inflicted radiation damage were simulated to closely mimic experimental data using a novel probabilistic model of radiation damage to blood vessels. It was found that the spatial dose fractionation by microbeam arrays significantly decreased the vascular damage. The higher the peak-to-valley dose ratio, the more pronounced the sparing effect. Simulations of the radiation damage as a function of morphological parameters of the vascular network demonstrated that the distribution of blood vessel radii is a key parameter determining both the overall radiation damage of the vasculature and the dose-dependent differential effect of microbeam irradiation.
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Affiliation(s)
- A Merrem
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Am Fassberg 11, 37077 Göttingen, Germany
- This work was carried out at the German Cancer Research Center, Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
| | - S Bartzsch
- Klinikum Rechts der Isar, Ismaninger Str. 2, 81675 München, Germany
- The Institute of Cancer Research, Royal Marsden Hospital, Fulham Rd, London SW3 6JJ, United Kingdom
- This work was carried out at the German Cancer Research Center, Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
| | - J Laissue
- University of Bern, Hochschulstrasse 4, 3012 Bern, Switzerland
| | - U Oelfke
- The Institute of Cancer Research, Royal Marsden Hospital, Fulham Rd, London SW3 6JJ, United Kingdom
- This work was carried out at the German Cancer Research Center, Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
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32
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Bouchet A, Potez M, Coquery N, Rome C, Lemasson B, Bräuer-Krisch E, Rémy C, Laissue J, Barbier EL, Djonov V, Serduc R. Permeability of Brain Tumor Vessels Induced by Uniform or Spatially Microfractionated Synchrotron Radiation Therapies. Int J Radiat Oncol Biol Phys 2017; 98:1174-1182. [PMID: 28721902 DOI: 10.1016/j.ijrobp.2017.03.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/01/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the blood-brain barrier permeability changes induced by synchrotron microbeam radiation therapy (MRT, which relies on spatial fractionation of the incident x-ray beam into parallel micron-wide beams) with changes induced by a spatially uniform synchrotron x-ray radiation therapy. METHODS AND MATERIALS Male rats bearing malignant intracranial F98 gliomas were randomized into 3 groups: untreated, exposed to MRT (peak and valley dose: 241 and 10.5 Gy, respectively), or exposed to broad beam irradiation (BB) delivered at comparable doses (ie, equivalent to MRT valley dose); both applied by 2 arrays, intersecting orthogonally the tumor region. Vessel permeability was monitored in vivo by magnetic resonance imaging 1 day before (T-1) and 1, 2, 7, and 14 days after treatment start. To determine whether physiologic parameters influence vascular permeability, we evaluated vessel integrity in the tumor area with different values for cerebral blood flow, blood volume, edema, and tissue oxygenation. RESULTS Microbeam radiation therapy does not modify the vascular permeability of normal brain tissue. Microbeam radiation therapy-induced increase of tumor vascular permeability was detectable from T2 with a maximum at T7 after exposure, whereas BB enhanced vessel permeability only at T7. At this stage MRT was more efficient at increasing tumor vessel permeability (BB vs untreated: +19.1%; P=.0467; MRT vs untreated: +44.8%; P<.0001), and its effects lasted until T14 (MRT vs BB, +22.6%; P=.0199). We also showed that MRT was more efficient at targeting highly oxygenated (high blood volume and flow) and more proliferative parts of the tumor than BB. CONCLUSIONS Microbeam radiation therapy-induced increased tumor vascular permeability is: (1) significantly greater; (2) earlier and more prolonged than that induced by BB irradiation, especially in highly proliferative tumor areas; and (3) targets all tumor areas discriminated by physiologic characteristics, including those not damaged by homogeneous irradiation.
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Affiliation(s)
- Audrey Bouchet
- Group Topographic and Clinical Anatomy, Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Marine Potez
- Rayonnement synchrotron et Recherche médicale, Université Grenoble Alpes, Grenoble, France
| | - Nicolas Coquery
- Team Functional NeuroImaging and Brain Perfusion, INSERM U1216, La Tronche, France; Grenoble Institut des Neurosciences, Université Grenoble Alpes, La Tronche, France
| | - Claire Rome
- Team Functional NeuroImaging and Brain Perfusion, INSERM U1216, La Tronche, France; Grenoble Institut des Neurosciences, Université Grenoble Alpes, La Tronche, France
| | - Benjamin Lemasson
- Team Functional NeuroImaging and Brain Perfusion, INSERM U1216, La Tronche, France; Grenoble Institut des Neurosciences, Université Grenoble Alpes, La Tronche, France
| | - Elke Bräuer-Krisch
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, France
| | - Chantal Rémy
- Team Functional NeuroImaging and Brain Perfusion, INSERM U1216, La Tronche, France; Grenoble Institut des Neurosciences, Université Grenoble Alpes, La Tronche, France
| | | | - Emmanuel L Barbier
- Team Functional NeuroImaging and Brain Perfusion, INSERM U1216, La Tronche, France; Grenoble Institut des Neurosciences, Université Grenoble Alpes, La Tronche, France.
| | - Valentin Djonov
- Group Topographic and Clinical Anatomy, Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Raphael Serduc
- Rayonnement synchrotron et Recherche médicale, Université Grenoble Alpes, Grenoble, France
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Stevenson AW, Crosbie JC, Hall CJ, Häusermann D, Livingstone J, Lye JE. Quantitative characterization of the X-ray beam at the Australian Synchrotron Imaging and Medical Beamline (IMBL). JOURNAL OF SYNCHROTRON RADIATION 2017; 24:110-141. [PMID: 28009552 DOI: 10.1107/s1600577516015563] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/04/2016] [Indexed: 06/06/2023]
Abstract
A critical early phase for any synchrotron beamline involves detailed testing, characterization and commissioning; this is especially true of a beamline as ambitious and complex as the Imaging & Medical Beamline (IMBL) at the Australian Synchrotron. IMBL staff and expert users have been performing precise experiments aimed at quantitative characterization of the primary polychromatic and monochromatic X-ray beams, with particular emphasis placed on the wiggler insertion devices (IDs), the primary-slit system and any in vacuo and ex vacuo filters. The findings from these studies will be described herein. These results will benefit IMBL and other users in the future, especially those for whom detailed knowledge of the X-ray beam spectrum (or `quality') and flux density is important. This information is critical for radiotherapy and radiobiology users, who ultimately need to know (to better than 5%) what X-ray dose or dose rate is being delivered to their samples. Various correction factors associated with ionization-chamber (IC) dosimetry have been accounted for, e.g. ion recombination, electron-loss effects. A new and innovative approach has been developed in this regard, which can provide confirmation of key parameter values such as the magnetic field in the wiggler and the effective thickness of key filters. IMBL commenced operation in December 2008 with an Advanced Photon Source (APS) wiggler as the (interim) ID. A superconducting multi-pole wiggler was installed and operational in January 2013. Results are obtained for both of these IDs and useful comparisons are made. A comprehensive model of the IMBL has been developed, embodied in a new computer program named spec.exe, which has been validated against a variety of experimental measurements. Having demonstrated the reliability and robustness of the model, it is then possible to use it in a practical and predictive manner. It is hoped that spec.exe will prove to be a useful resource for synchrotron science in general, and for hard X-ray beamlines, whether they are based on bending magnets or insertion devices, in particular. In due course, it is planned to make spec.exe freely available to other synchrotron scientists.
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Affiliation(s)
- Andrew W Stevenson
- Australian Synchrotron, 800 Blackburn Road, Clayton, Victoria 3168, Australia
| | - Jeffrey C Crosbie
- School of Science, RMIT University, GPO Box 2476, Melbourne, Victoria 3001, Australia
| | - Christopher J Hall
- Australian Synchrotron, 800 Blackburn Road, Clayton, Victoria 3168, Australia
| | - Daniel Häusermann
- Australian Synchrotron, 800 Blackburn Road, Clayton, Victoria 3168, Australia
| | - Jayde Livingstone
- Australian Synchrotron, 800 Blackburn Road, Clayton, Victoria 3168, Australia
| | - Jessica E Lye
- School of Science, RMIT University, GPO Box 2476, Melbourne, Victoria 3001, Australia
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34
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Fournier P, Cornelius I, Donzelli M, Requardt H, Nemoz C, Petasecca M, Bräuer-Krisch E, Rosenfeld A, Lerch M. X-Tream quality assurance in synchrotron X-ray microbeam radiation therapy. JOURNAL OF SYNCHROTRON RADIATION 2016; 23:1180-1190. [PMID: 27577773 DOI: 10.1107/s1600577516009322] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/08/2016] [Indexed: 06/06/2023]
Abstract
Microbeam radiation therapy (MRT) is a novel irradiation technique for brain tumours treatment currently under development at the European Synchrotron Radiation Facility in Grenoble, France. The technique is based on the spatial fractionation of a highly brilliant synchrotron X-ray beam into an array of microbeams using a multi-slit collimator (MSC). After promising pre-clinical results, veterinary trials have recently commenced requiring the need for dedicated quality assurance (QA) procedures. The quality of MRT treatment demands reproducible and precise spatial fractionation of the incoming synchrotron beam. The intensity profile of the microbeams must also be quickly and quantitatively characterized prior to each treatment for comparison with that used for input to the dose-planning calculations. The Centre for Medical Radiation Physics (University of Wollongong, Australia) has developed an X-ray treatment monitoring system (X-Tream) which incorporates a high-spatial-resolution silicon strip detector (SSD) specifically designed for MRT. In-air measurements of the horizontal profile of the intrinsic microbeam X-ray field in order to determine the relative intensity of each microbeam are presented, and the alignment of the MSC is also assessed. The results show that the SSD is able to resolve individual microbeams which therefore provides invaluable QA of the horizontal field size and microbeam number and shape. They also demonstrate that the SSD used in the X-Tream system is very sensitive to any small misalignment of the MSC. In order to allow as rapid QA as possible, a fast alignment procedure of the SSD based on X-ray imaging with a low-intensity low-energy beam has been developed and is presented in this publication.
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Affiliation(s)
- Pauline Fournier
- Centre for Medical Radiation Physics, University of Wollongong, Australia
| | - Iwan Cornelius
- Centre for Medical Radiation Physics, University of Wollongong, Australia
| | | | | | | | - Marco Petasecca
- Centre for Medical Radiation Physics, University of Wollongong, Australia
| | | | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Australia
| | - Michael Lerch
- Centre for Medical Radiation Physics, University of Wollongong, Australia
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35
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Bouchet A, Bräuer-Krisch E, Prezado Y, El Atifi M, Rogalev L, Le Clec'h C, Laissue JA, Pelletier L, Le Duc G. Better Efficacy of Synchrotron Spatially Microfractionated Radiation Therapy Than Uniform Radiation Therapy on Glioma. Int J Radiat Oncol Biol Phys 2016; 95:1485-1494. [DOI: 10.1016/j.ijrobp.2016.03.040] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/23/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
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36
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Fournier P, Crosbie JC, Cornelius I, Berkvens P, Donzelli M, Clavel AH, Rosenfeld AB, Petasecca M, Lerch MLF, Bräuer-Krisch E. Absorbed dose-to-water protocol applied to synchrotron-generated x-rays at very high dose rates. Phys Med Biol 2016; 61:N349-61. [DOI: 10.1088/0031-9155/61/14/n349] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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37
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Bartzsch S, Lott J, Welsch K, Bräuer-Krisch E, Oelfke U. Micrometer-resolved film dosimetry using a microscope in microbeam radiation therapy. Med Phys 2015; 42:4069-79. [PMID: 26133607 DOI: 10.1118/1.4922001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024] Open
Abstract
PURPOSE Microbeam radiation therapy (MRT) is a still preclinical tumor therapy approach that uses arrays of a few tens of micrometer wide parallel beams separated by a few 100 μm. The production, measurement, and planning of such radiation fields are a challenge up to now. Here, the authors investigate the feasibility of radiochromic film dosimetry in combination with a microscopic readout as a tool to validate peak and valley doses in MRT, which is an important requirement for a future clinical application of the therapy. METHODS Gafchromic(®) HD-810 and HD-V2 films are exposed to MRT fields at the biomedical beamline ID17 of the European Synchrotron Radiation Facility (ESRF) and are afterward scanned with a microscope. The measured dose is compared with Monte Carlo calculations. Image analysis tools and film handling protocols are developed that allow accurate and reproducible dosimetry. The performance of HD-810 and HD-V2 films is compared and a detailed analysis of the resolution, noise, and energy dependence is carried out. Measurement uncertainties are identified and analyzed. RESULTS The dose was measured with a resolution of 5 × 1000 μm(2) and an accuracy of 5% in the peak and between 10% and 15% in the valley region. As main causes for dosimetry uncertainties, statistical noise, film inhomogeneities, and calibration errors were identified. Calibration errors strongly increase at low doses and exceeded 3% for doses below 50 and 70 Gy for HD-V2 and HD-810 films, respectively. While the grain size of both film types is approximately 2 μm, the statistical noise in HD-V2 is much higher than in HD-810 films. However, HD-810 films show a higher energy dependence at low photon energies. CONCLUSIONS Both film types are appropriate for dosimetry in MRT and the microscope is superior to the microdensitometer used before at the ESRF with respect to resolution and reproducibility. However, a very careful analysis of the image data is required. Dosimetry at low photon energies should be performed with great caution due to the energy sensitivity of the films. In this respect, HD-V2 films showed to have an advantage over HD-810 films. However, HD-810 films have a lower statistical noise level. When a higher resolution is required, e.g., for the dosimetry of pencil beam irradiations, noise may render HD-V2 films inapplicable.
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Affiliation(s)
- Stefan Bartzsch
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, United Kingdom
| | - Johanna Lott
- Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany
| | - Katrin Welsch
- Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany
| | - Elke Bräuer-Krisch
- European Synchrotron Radiation Facility, 6 rue Jules Horowitz, Grenoble Cedex 9 38043, France
| | - Uwe Oelfke
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, United Kingdom
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