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Large MJ, Kanxheri K, Posar J, Aziz S, Bashiri A, Calcagnile L, Calvo D, Caputo D, Caricato AP, Catalano R, Cirio R, Cirrone GAP, Croci T, Cuttone G, De Cesare G, De Remigis P, Dunand S, Fabi M, Frontini L, Grimani C, Guarrera M, Ionica M, Lenta F, Liberali V, Lovecchio N, Martino M, Maruccio G, Mazza G, Menichelli M, Monteduro AG, Morozzi A, Moscatelli F, Nascetti A, Pallotta S, Passeri D, Pedio M, Petringa G, Peverini F, Placidi P, Quarta G, Rizzato S, Sabbatini F, Servoli L, Stabile A, Thomet JE, Tosti L, Villani M, Wheadon RJ, Wyrsch N, Zema N, Petasecca M, Talamonti C. Dosimetry of microbeam radiotherapy by flexible hydrogenated amorphous silicon detectors. Phys Med Biol 2024; 69:155022. [PMID: 39019068 DOI: 10.1088/1361-6560/ad64b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/17/2024] [Indexed: 07/19/2024]
Abstract
Objective.Detectors that can provide accurate dosimetry for microbeam radiation therapy (MRT) must possess intrinsic radiation hardness, a high dynamic range, and a micron-scale spatial resolution. In this work we characterize hydrogenated amorphous silicon detectors for MRT dosimetry, presenting a novel combination of flexible, ultra-thin and radiation-hard features.Approach.Two detectors are explored: an n-type/intrinsic/p-type planar diode (NIP) and an NIP with an additional charge selective layer (NIP + CSC).Results.The sensitivity of the NIP + CSC detector was greater than the NIP detector for all measurement conditions. At 1 V and 0 kGy under the 3T Cu-Cu synchrotron broadbeam, the NIP + CSC detector sensitivity of (7.76 ± 0.01) pC cGy-1outperformed the NIP detector sensitivity of (3.55 ± 0.23) pC cGy-1by 219%. The energy dependence of both detectors matches closely to the attenuation coefficient ratio of silicon against water. Radiation damage measurements of both detectors out to 40 kGy revealed a higher radiation tolerance in the NIP detector compared to the NIP + CSC (17.2% and 33.5% degradations, respectively). Percentage depth dose profiles matched the PTW microDiamond detector's performance to within ±6% for all beam filtrations except in 3T Al-Al due to energy dependence. The 3T Cu-Cu microbeam field profile was reconstructed and returned microbeam width and peak-to-peak values of (51 ± 1)μm and (405 ± 5)μm, respectively. The peak-to-valley dose ratio was measured as a function of depth and agrees within error to the values obtained with the PTW microDiamond. X-ray beam induced charge mapping of the detector revealed minimal dose perturbations from extra-cameral materials.Significance.The detectors are comparable to commercially available dosimeters for quality assurance in MRT. With added benefits of being micron-sized and possessing a flexible water-equivalent substrate, these detectors are attractive candidates for quality assurance,in-vivodosimetry and in-line beam monitoring for MRT and FLASH therapy.
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Affiliation(s)
- Matthew James Large
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Keida Kanxheri
- Dip. di Fisica e Geologia dell'Università degli Studi di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
| | - Jessie Posar
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Saba Aziz
- INFN Sezione di Lecce, via per Arnesano, 73100 Lecce, Italy
- Department of Mathematics and Physics 'Ennio de Giorgi', University of Salento, via per Arnesano, 73100 Lecce, Italy
| | - Aishah Bashiri
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
- Najran University, King Abdulaziz Rd, Najran, Saudi Arabia
| | - Lucio Calcagnile
- INFN Sezione di Lecce, via per Arnesano, 73100 Lecce, Italy
- Department of Mathematics and Physics 'Ennio de Giorgi', University of Salento, via per Arnesano, 73100 Lecce, Italy
| | - Daniela Calvo
- INFN Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
| | - Domenico Caputo
- Dipartimento Ingegneria dell'Informazione, Elettronica e Telecomunicazioni, dell'Università degli studi di Roma 'La Sapienza', via Eudossiana 18, 00184 Roma, Italy
- INFN Sezione di Roma 1, Piazzale Aldo Moro 2, Roma, Italy
| | - Anna Paola Caricato
- INFN Sezione di Lecce, via per Arnesano, 73100 Lecce, Italy
- Department of Mathematics and Physics 'Ennio de Giorgi', University of Salento, via per Arnesano, 73100 Lecce, Italy
| | - Roberto Catalano
- INFN Laboratori Nazionali del Sud, Via S.Sofia 62, 95123 Catania, Italy
| | - Roberto Cirio
- INFN Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
| | | | - Tommaso Croci
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
- Dip. di Ingegneria dell'Università degli studi di Perugia, via G.Duranti, 06125 Perugia, Italy
| | - Giacomo Cuttone
- INFN Laboratori Nazionali del Sud, Via S.Sofia 62, 95123 Catania, Italy
| | - Gianpiero De Cesare
- Dipartimento Ingegneria dell'Informazione, Elettronica e Telecomunicazioni, dell'Università degli studi di Roma 'La Sapienza', via Eudossiana 18, 00184 Roma, Italy
- INFN Sezione di Roma 1, Piazzale Aldo Moro 2, Roma, Italy
| | - Paolo De Remigis
- INFN Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
| | - Sylvain Dunand
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Photovoltaics and Thin-Film Electronics Laboratory (PV-Lab), Rue de la Maladière 71b, 2000 Neuchâtel, Switzerland
| | - Michele Fabi
- DiSPeA, Università di Urbino Carlo Bo, 61029 Urbino (PU), Italy
- INFN Sezione di Firenze, Via Sansone 1, 50019 Sesto Fiorentino, Firenze, Italy
| | - Luca Frontini
- INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy
| | - Catia Grimani
- DiSPeA, Università di Urbino Carlo Bo, 61029 Urbino (PU), Italy
- INFN Sezione di Firenze, Via Sansone 1, 50019 Sesto Fiorentino, Firenze, Italy
| | | | - Maria Ionica
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
| | - Francesca Lenta
- INFN Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
- Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
| | - Valentino Liberali
- INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy
- Dipartimento di Fisica dell'Università degli Studi di Milano, via Celoria 16, 20133 Milano, Italy
| | - Nicola Lovecchio
- Dipartimento Ingegneria dell'Informazione, Elettronica e Telecomunicazioni, dell'Università degli studi di Roma 'La Sapienza', via Eudossiana 18, 00184 Roma, Italy
- INFN Sezione di Roma 1, Piazzale Aldo Moro 2, Roma, Italy
| | - Maurizio Martino
- INFN Sezione di Lecce, via per Arnesano, 73100 Lecce, Italy
- Department of Mathematics and Physics 'Ennio de Giorgi', University of Salento, via per Arnesano, 73100 Lecce, Italy
| | - Giuseppe Maruccio
- INFN Sezione di Lecce, via per Arnesano, 73100 Lecce, Italy
- Department of Mathematics and Physics 'Ennio de Giorgi', University of Salento, via per Arnesano, 73100 Lecce, Italy
| | - Giovanni Mazza
- INFN Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
| | - Mauro Menichelli
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
| | - Anna Grazia Monteduro
- INFN Sezione di Lecce, via per Arnesano, 73100 Lecce, Italy
- Department of Mathematics and Physics 'Ennio de Giorgi', University of Salento, via per Arnesano, 73100 Lecce, Italy
| | - Arianna Morozzi
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
| | - Francesco Moscatelli
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
- CNR Istituto Officina dei Materiali (IOM), via Pascoli s.n.c., 06123 Perugia, Italy
| | - Augusto Nascetti
- INFN Sezione di Roma 1, Piazzale Aldo Moro 2, Roma, Italy
- Scuola di Ingegneria Aerospaziale Università degli studi di Roma 'La Sapienza', Via Salaria 851/881, 00138 Roma, Italy
| | - Stefania Pallotta
- INFN Sezione di Firenze, Via Sansone 1, 50019 Sesto Fiorentino, Firenze, Italy
- Dipartimento di Scienze Biomediche sperimentali e Cliniche 'Mario Serio', University of Florence Viale Morgagni 50, 50134 Firenze (FI), Italy
| | - Daniele Passeri
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
- Dip. di Ingegneria dell'Università degli studi di Perugia, via G.Duranti, 06125 Perugia, Italy
| | - Maddalena Pedio
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
- CNR Istituto Officina dei Materiali (IOM), via Pascoli s.n.c., 06123 Perugia, Italy
| | - Giada Petringa
- INFN Laboratori Nazionali del Sud, Via S.Sofia 62, 95123 Catania, Italy
| | - Francesca Peverini
- Dip. di Fisica e Geologia dell'Università degli Studi di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
| | - Pisana Placidi
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
- Dip. di Ingegneria dell'Università degli studi di Perugia, via G.Duranti, 06125 Perugia, Italy
| | - Gianluca Quarta
- INFN Sezione di Lecce, via per Arnesano, 73100 Lecce, Italy
- Department of Mathematics and Physics 'Ennio de Giorgi', University of Salento, via per Arnesano, 73100 Lecce, Italy
| | - Silvia Rizzato
- INFN Sezione di Lecce, via per Arnesano, 73100 Lecce, Italy
- Department of Mathematics and Physics 'Ennio de Giorgi', University of Salento, via per Arnesano, 73100 Lecce, Italy
| | - Federico Sabbatini
- DiSPeA, Università di Urbino Carlo Bo, 61029 Urbino (PU), Italy
- INFN Sezione di Firenze, Via Sansone 1, 50019 Sesto Fiorentino, Firenze, Italy
| | - Leonello Servoli
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
| | - Alberto Stabile
- INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy
- Dipartimento di Fisica dell'Università degli Studi di Milano, via Celoria 16, 20133 Milano, Italy
| | - Jonathan Emanuel Thomet
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Photovoltaics and Thin-Film Electronics Laboratory (PV-Lab), Rue de la Maladière 71b, 2000 Neuchâtel, Switzerland
| | - Luca Tosti
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
| | - Mattia Villani
- DiSPeA, Università di Urbino Carlo Bo, 61029 Urbino (PU), Italy
- INFN Sezione di Firenze, Via Sansone 1, 50019 Sesto Fiorentino, Firenze, Italy
| | | | - Nicolas Wyrsch
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Photovoltaics and Thin-Film Electronics Laboratory (PV-Lab), Rue de la Maladière 71b, 2000 Neuchâtel, Switzerland
| | - Nicola Zema
- INFN Sezione di Perugia, via Pascoli s.n.c., 06123 Perugia, Italy
- CNR Istituto struttura della Materia, Via Fosso del Cavaliere 100, Roma, Italy
| | - Marco Petasecca
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Cinzia Talamonti
- INFN Sezione di Firenze, Via Sansone 1, 50019 Sesto Fiorentino, Firenze, Italy
- Dipartimento di Scienze Biomediche sperimentali e Cliniche 'Mario Serio', University of Florence Viale Morgagni 50, 50134 Firenze (FI), Italy
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Samalens L, Courivaud C, Adam JF, Barbier EL, Serduc R, Depaulis A. Innovative minimally invasive options to treat drug-resistant epilepsies. Rev Neurol (Paris) 2023:S0035-3787(23)01038-X. [PMID: 37798162 DOI: 10.1016/j.neurol.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/20/2023] [Accepted: 05/14/2023] [Indexed: 10/07/2023]
Abstract
Despite the regular discovery of new molecules, one-third of epileptic patients are resistant to antiepileptic drugs. Only a few can benefit from resective surgery, the current gold standard. Although effective in 50-70% of cases, this therapy remains risky, costly, and can be associated with long-term cognitive or neurological side effects. In addition, patients are increasingly reluctant to have a craniotomy, emphasizing the need for new less invasive therapies for focal drug-resistant epilepsies. Here, we review different minimally invasive approaches already in use in the clinic or under preclinical development to treat drug-resistant epilepsies. Localized thermolesion of the epileptogenic zone has been developed in the clinic using high-frequency thermo-coagulations or magnetic resonance imaging-guided laser or ultrasounds. Although less invasive, they have not yet significantly improved the outcomes when compared with resective surgery. Radiosurgery techniques have been used in the clinic for the last 20years and have proven efficiency. However, their efficacy is not better than resective surgery, and various side effects have been reported as well as the potential risk of sudden unexpected death associated with epilepsy. Recently, a new strategy of radiosurgery has emerged using synchrotron-generated X-ray microbeams: microbeam radiation therapy (MRT). The low divergence and high-flux of the synchrotron beams and the unique tolerance to MRT by healthy brain tissues, allows a precise targeting of specific brain regions with minimal invasiveness and limited behavioral or functional consequences in animals. Antiepileptic effects over several months have been recorded in animal models, and histological and synaptic tracing analysis suggest a reduction of neuronal connectivity as a mechanism of action. The possibility of transferring this approach to epileptic patients is discussed in this review.
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Affiliation(s)
- L Samalens
- Université Grenoble-Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; Université Grenoble-Alpes, Inserm, UA7, STROBE, 38000 Grenoble, France
| | - C Courivaud
- Université Grenoble-Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - J-F Adam
- Université Grenoble-Alpes, Inserm, UA7, STROBE, 38000 Grenoble, France; Centre Hospitalier Universitaire Grenoble-Alpes, 38700 La Tronche, France
| | - E L Barbier
- Université Grenoble-Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - R Serduc
- Université Grenoble-Alpes, Inserm, UA7, STROBE, 38000 Grenoble, France
| | - A Depaulis
- Université Grenoble-Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France.
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3
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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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Griffin RJ, Ahmed MM, Amendola B, Belyakov O, Bentzen SM, Butterworth KT, Chang S, Coleman CN, Djonov V, Formenti SC, Glatstein E, Guha C, Kalnicki S, Le QT, Loo BW, Mahadevan A, Massaccesi M, Maxim PG, Mohiuddin M, Mohiuddin M, Mayr NA, Obcemea C, Petersson K, Regine W, Roach M, Romanelli P, Simone CB, Snider JW, Spitz DR, Vikram B, Vozenin MC, Abdel-Wahab M, Welsh J, Wu X, Limoli CL. Understanding High-Dose, Ultra-High Dose Rate, and Spatially Fractionated Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 107:766-778. [PMID: 32298811 DOI: 10.1016/j.ijrobp.2020.03.028] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/12/2022]
Abstract
The National Cancer Institute's Radiation Research Program, in collaboration with the Radiosurgery Society, hosted a workshop called Understanding High-Dose, Ultra-High Dose Rate and Spatially Fractionated Radiotherapy on August 20 and 21, 2018 to bring together experts in experimental and clinical experience in these and related fields. Critically, the overall aims were to understand the biological underpinning of these emerging techniques and the technical/physical parameters that must be further defined to drive clinical practice through innovative biologically based clinical trials.
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Affiliation(s)
- Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mansoor M Ahmed
- Division of Cancer Treatment and Diagnosis, Rockville, Maryland
| | | | - Oleg Belyakov
- International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Søren M Bentzen
- Division of Biostatistics and Bioinformatics, University of Maryland, Baltimore, Maryland
| | - Karl T Butterworth
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, United Kingdom
| | - Sha Chang
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Valentin Djonov
- Bern Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Sylvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Eli Glatstein
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chandan Guha
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Health Systems, Danville, Pennsylvania
| | - Mariangela Massaccesi
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Peter G Maxim
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Nina A Mayr
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington
| | | | - Kristoffer Petersson
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - William Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mack Roach
- Department of Radiation Oncology & Urology, University of California, San Francisco, San Francisco, California
| | | | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - James W Snider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Douglas R Spitz
- Free Radical & Radiation Biology Program, University of Iowa, Iowa City, Iowa
| | | | - Marie-Catherine Vozenin
- Laboratory of Radiation Oncology/DO/Radio-Oncology/CHUV, Lausanne University Hospital, Switzerland
| | - May Abdel-Wahab
- International Atomic Energy Agency Headquarters, Vienna International Centre, Vienna, Austria
| | - James Welsh
- Edward Hines VA Medical Center and Loyola University Stritch School of Medicine, Chicago, Illinois
| | - Xiaodong Wu
- Executive Medical Physics Associates, Miami, Florida; Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Charles L Limoli
- Department of Radiation Oncology, University of California-Irvine, Irvine, California.
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Fernandez-Palomo C, Fazzari J, Trappetti V, Smyth L, Janka H, Laissue J, Djonov V. Animal Models in Microbeam Radiation Therapy: A Scoping Review. Cancers (Basel) 2020; 12:cancers12030527. [PMID: 32106397 PMCID: PMC7139755 DOI: 10.3390/cancers12030527] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Microbeam Radiation Therapy (MRT) is an innovative approach in radiation oncology where a collimator subdivides the homogeneous radiation field into an array of co-planar, high-dose beams which are tens of micrometres wide and separated by a few hundred micrometres. OBJECTIVE This scoping review was conducted to map the available evidence and provide a comprehensive overview of the similarities, differences, and outcomes of all experiments that have employed animal models in MRT. METHODS We considered articles that employed animal models for the purpose of studying the effects of MRT. We searched in seven databases for published and unpublished literature. Two independent reviewers screened citations for inclusion. Data extraction was done by three reviewers. RESULTS After screening 5688 citations and 159 full-text papers, 95 articles were included, of which 72 were experimental articles. Here we present the animal models and pre-clinical radiation parameters employed in the existing MRT literature according to their use in cancer treatment, non-neoplastic diseases, or normal tissue studies. CONCLUSIONS The study of MRT is concentrated in brain-related diseases performed mostly in rat models. An appropriate comparison between MRT and conventional radiotherapy (instead of synchrotron broad beam) is needed. Recommendations are provided for future studies involving MRT.
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Affiliation(s)
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
| | - Verdiana Trappetti
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
| | - Lloyd Smyth
- Department of Obstetrics & Gynaecology, University of Melbourne, 3057 Parkville, Australia;
| | - Heidrun Janka
- Medical Library, University Library Bern, University of Bern, 3012 Bern, Switzerland;
| | - Jean Laissue
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
- Correspondence: ; Tel.: +41-31-631-8432
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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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7
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Fardone E, Pouyatos B, Bräuer-Krisch E, Bartzsch S, Mathieu H, Requardt H, Bucci D, Barbone G, Coan P, Battaglia G, Le Duc G, Bravin A, Romanelli P. Synchrotron-generated microbeams induce hippocampal transections in rats. Sci Rep 2018; 8:184. [PMID: 29317649 PMCID: PMC5760574 DOI: 10.1038/s41598-017-18000-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 12/04/2017] [Indexed: 12/22/2022] Open
Abstract
Synchrotron-generated microplanar beams (microbeams) provide the most stereo-selective irradiation modality known today. This novel irradiation modality has been shown to control seizures originating from eloquent cortex causing no neurological deficit in experimental animals. To test the hypothesis that application of microbeams in the hippocampus, the most common source of refractory seizures, is safe and does not induce severe side effects, we used microbeams to induce transections to the hippocampus of healthy rats. An array of parallel microbeams carrying an incident dose of 600 Gy was delivered to the rat hippocampus. Immunohistochemistry of phosphorylated γ-H2AX showed cell death along the microbeam irradiation paths in rats 48 hours after irradiation. No evident behavioral or neurological deficits were observed during the 3-month period of observation. MR imaging showed no signs of radio-induced edema or radionecrosis 3 months after irradiation. Histological analysis showed a very well preserved hippocampal cytoarchitecture and confirmed the presence of clear-cut microscopic transections across the hippocampus. These data support the use of synchrotron-generated microbeams as a novel tool to slice the hippocampus of living rats in a minimally invasive way, providing (i) a novel experimental model to study hippocampal function and (ii) a new treatment tool for patients affected by refractory epilepsy induced by mesial temporal sclerosis.
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Affiliation(s)
- Erminia Fardone
- European Synchrotron Radiation Facility (ESRF), Grenoble, France.,Department of Biological Science and Program in Neuroscience, Florida State University, Tallahassee, FL, USA
| | - Benoît Pouyatos
- Grenoble Institut des Neurosciences, Inserm U836, Université Joseph Fourier, Grenoble, France
| | | | - Stefan Bartzsch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,The Institute of Cancer Research, London, United Kingdom
| | - Hervè Mathieu
- Grenoble Institut des Neurosciences, Inserm U836, Université Joseph Fourier, Grenoble, France
| | - Herwig Requardt
- European Synchrotron Radiation Facility (ESRF), Grenoble, France
| | | | - Giacomo Barbone
- Department of Physics, Ludwig Maximilians University, Garching, Germany
| | - Paola Coan
- Department of Physics, Ludwig Maximilians University, Garching, Germany.,Department of Clinical Radiology, Ludwig Maximilians University, Munich, Germany
| | | | - Geraldine Le Duc
- European Synchrotron Radiation Facility (ESRF), Grenoble, France
| | - Alberto Bravin
- European Synchrotron Radiation Facility (ESRF), Grenoble, France
| | - Pantaleo Romanelli
- Brain Radiosurgery, Cyberknife Center, Centro Diagnostico Italiano (CDI), Milano, Italy.
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8
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Zeinali-Rafsanjani B, Mosleh-Shirazi MA, Haghighatafshar M, Jalli R, Saeedi-Moghadam M. Assessment of the dose distribution of Minibeam radiotherapy for lung tumors in an anthropomorphic phantom: A feasibility study. Technol Health Care 2017; 25:683-692. [DOI: 10.3233/thc-170818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Banafsheh Zeinali-Rafsanjani
- Nuclear Medicine and Molecular Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Amin Mosleh-Shirazi
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Radiotherapy and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Haghighatafshar
- Nuclear Medicine and Molecular Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jalli
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Saeedi-Moghadam
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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9
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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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Davis W, Crewson C, Alexander A, Kundapur V, Cranmer-Sargison G. Dosimetric characterization of an accessory mounted mini-beam collimator across clinically beam matched medical linear accelerators. Biomed Phys Eng Express 2017. [DOI: 10.1088/2057-1976/aa586d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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11
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Mukumoto N, Nakayama M, Akasaka H, Shimizu Y, Osuga S, Miyawaki D, Yoshida K, Ejima Y, Miura Y, Umetani K, Kondoh T, Sasaki R. Sparing of tissue by using micro-slit-beam radiation therapy reduces neurotoxicity compared with broad-beam radiation therapy. JOURNAL OF RADIATION RESEARCH 2017; 58:17-23. [PMID: 27422939 PMCID: PMC5321181 DOI: 10.1093/jrr/rrw065] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 06/06/2023]
Abstract
Micro-slit-beam radiation therapy (MRT) using synchrotron-generated X-ray beams allows for extremely high-dose irradiation. However, the toxicity of MRT in central nervous system (CNS) use is still unknown. To gather baseline toxicological data, we evaluated mortality in normal mice following CNS-targeted MRT. Male C57BL/6 J mice were head-fixed in a stereotaxic frame. Synchrotron X-ray-beam radiation was provided by the SPring-8 BL28B2 beam-line. For MRT, radiation was delivered to groups of mice in a 10 × 12 mm unidirectional array consisting of 25-μm-wide beams spaced 100, 200 or 300 μm apart; another group of mice received the equivalent broad-beam radiation therapy (BRT) for comparison. Peak and valley dose rates of the MRT were 120 and 0.7 Gy/s, respectively. Delivered doses were 96-960 Gy for MRT, and 24-120 Gy for BRT. Mortality was monitored for 90 days post-irradiation. Brain tissue was stained using hematoxylin and eosin to evaluate neural structure. Demyelination was evaluated by Klüver-Barrera staining. The LD50 and LD100 when using MRT were 600 Gy and 720 Gy, respectively, and when using BRT they were 80 Gy and 96 Gy, respectively. In MRT, mortality decreased as the center-to-center beam spacing increased from 100 μm to 300 μm. Cortical architecture was well preserved in MRT, whereas BRT induced various degrees of cerebral hemorrhage and demyelination. MRT was able to deliver extremely high doses of radiation, while still minimizing neuronal death. The valley doses, influenced by beam spacing and irradiated dose, could represent important survival factors for MRT.
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Affiliation(s)
- Naritoshi Mukumoto
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Masao Nakayama
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Hiroaki Akasaka
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Yasuyuki Shimizu
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Saki Osuga
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Daisuke Miyawaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Kenji Yoshida
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Yasuo Ejima
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Yasushi Miura
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | - Keiji Umetani
- Japan Synchrotron Radiation Research Institute, Sayo, Hyogo, Japan
| | - Takeshi Kondoh
- Department of Neurosurgery, Shinsuma Hospital, Kobe, Hyogo, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
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12
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Studer F, Serduc R, Pouyatos B, Chabrol T, Bräuer-Krisch E, Donzelli M, Nemoz C, Laissue J, Estève F, Depaulis A. Synchrotron X-ray microbeams: A promising tool for drug-resistant epilepsy treatment. Phys Med 2015; 31:607-14. [DOI: 10.1016/j.ejmp.2015.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/07/2015] [Accepted: 04/09/2015] [Indexed: 12/26/2022] Open
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13
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Hadsell M, Zhang J, Laganis P, Sprenger F, Shan J, Zhang L, Burk L, Yuan H, Chang S, Lu J, Zhou O. A first generation compact microbeam radiation therapy system based on carbon nanotube X-ray technology. APPLIED PHYSICS LETTERS 2013; 103:183505. [PMID: 24273330 PMCID: PMC3829915 DOI: 10.1063/1.4826587] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/22/2013] [Indexed: 06/02/2023]
Abstract
We have developed a compact microbeam radiation therapy device using carbon nanotube cathodes to create a linear array of narrow focal line segments on a tungsten anode and a custom collimator assembly to select a slice of the resulting wedge-shaped radiation pattern. Effective focal line width was measured to be 131 μm, resulting in a microbeam width of ∼300 μm. The instantaneous dose rate was projected to be 2 Gy/s at full-power. Peak to valley dose ratio was measured to be >17 when a 1.4 mm microbeam separation was employed. Finally, multiple microbeams were delivered to a mouse with beam paths verified through histology.
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Affiliation(s)
- M Hadsell
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
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14
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Synchrotron-generated microbeam sensorimotor cortex transections induce seizure control without disruption of neurological functions. PLoS One 2013; 8:e53549. [PMID: 23341950 PMCID: PMC3544911 DOI: 10.1371/journal.pone.0053549] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 12/03/2012] [Indexed: 11/19/2022] Open
Abstract
Synchrotron-generated X-ray microplanar beams (microbeams) are characterized by the ability to deliver extremely high doses of radiation to spatially restricted volumes of tissue. Minimal dose spreading outside the beam path provides an exceptional degree of protection from radio-induced damage to the neurons and glia adjacent to the microscopic slices of tissue irradiated. The preservation of cortical architecture following high-dose microbeam irradiation and the ability to induce non-invasively the equivalent of a surgical cut over the cortex is of great interest for the development of novel experimental models in neurobiology and new treatment avenues for a variety of brain disorders. Microbeams (size 100 µm/600 µm, center-to-center distance of 400 µm/1200 µm, peak entrance doses of 360-240 Gy/150-100 Gy) delivered to the sensorimotor cortex of six 2-month-old naïve rats generated histologically evident cortical transections, without modifying motor behavior and weight gain up to 7 months. Microbeam transections of the sensorimotor cortex dramatically reduced convulsive seizure duration in a further group of 12 rats receiving local infusion of kainic acid. No subsequent neurological deficit was associated with the treatment. These data provide a novel tool to study the functions of the cortex and pave the way for the development of new therapeutic strategies for epilepsy and other neurological diseases.
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