The safety and usefulness of neutron brachytherapy and external beam radiation in the treatment of patients with gastroesophageal junction adenocarcinoma with or without chemotherapy

Neutron brachytherapy in the modern era: Indications and evidence

Hadrontherapy is a form of radiation therapy (RT) that relies on heavy particles, such as proton, heavy ions, or neutrons, to enhance anti-tumoral efficacy based on their specific dosimetric and radio-biological properties. Neutrons are characterized by specific radiobiological properties that might deserve greater consideration, including the high linear energy transfer and the low oxygen enhancement ratio. Neutron brachytherapy, relying on interstitial or intracavitary neutron sources, has been developed since the 1950s using Californium-252 (252Cf) as a mixed emitter of fission fast neutrons and γ-photos. However, the place of NBT in the era of modern radiation therapy is yet to be precisely defined. In this systematic review, we aim to provide an up-to-date analysis of current experience and clinical evidence of NBT in the XXI ^th century, by answering the following clinical questions: How is NBT currently delivered? What are the current efficacy data and tolerance profiles of NBT?

A simulation study on using 252Cf for the treatment of esophagus tumor in human phantom

Due to the sensitivity of this tissue, and the potential for metastasis of its cancer as well, finding accurate methods to be employed for the treatment of esophagus tumors is of especial interest for the researchers. The present study deals with a Monte Carlo simulation of ²⁵²Cf neutron brachytherapy for treating these tumors using MCNPX (Version 2.6.0) code. The widely accepted AAPM TG-43 protocol has been used to benchmark the simulated source and to examine the accuracy of the modeling. The MIRD human phantom has been used for dose evaluation in the mentioned tumor and in the surrounding normal tissues as well. To decrease the dose delivered to the healthy tissue, using appropriate shields has been proposed. Through dosimetric calculations for several candidates, Pt-Ir 10% with a thickness of 1 cm has been selected as the optimized shield. The depth-dose results as well as the isodose curves corresponding to the presence of the shielded ²⁵²Cf neutron source in the center of the simulated tumor offer this source as an appropriate candidate to be used for the treatment of the esophagus tumors and sparing normal tissues. For a suggested clinical condition of positioning the source inside the esophagus, the damage to the first depth in spine can be avoided by managing the treatment time.

Tissue composition effect on dose distribution in neutron brachytherapy/neutron capture therapy

AIM

The aim of this study is to assess the effect of the compositions of various soft tissues and tissue-equivalent materials on dose distribution in neutron brachytherapy/neutron capture therapy.

BACKGROUND

Neutron brachytherapy and neutron capture therapy are two common radiotherapy modalities.

MATERIALS AND METHODS

Dose distributions were calculated around a low dose rate (252)Cf source located in a spherical phantom with radius of 20.0 cm using the MCNPX code for seven soft tissues and three tissue-equivalent materials. Relative total dose rate, relative neutron dose rate, total dose rate, and neutron dose rate were calculated for each material. These values were determined at various radial distances ranging from 0.3 to 15.0 cm from the source.

RESULTS

Among the soft tissues and tissue-equivalent materials studied, adipose tissue and plexiglass demonstrated the greatest differences for total dose rate compared to 9-component soft tissue. The difference in dose rate with respect to 9-component soft tissue varied with compositions of the materials and the radial distance from the source. Furthermore, the total dose rate in water was different from that in 9-component soft tissue.

CONCLUSION

Taking the same composition for various soft tissues and tissue-equivalent media can lead to error in treatment planning in neutron brachytherapy/neutron capture therapy. Since the International Commission on Radiation Units and Measurements (ICRU) recommends that the total dosimetric uncertainty in dose delivery in radiotherapy should be within ±5%, the compositions of various soft tissues and tissue-equivalent materials should be considered in dose calculation and treatment planning in neutron brachytherapy/neutron capture therapy.