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Lin Y, Li W, Johnson D, Prezado Y, Gan GN, Gao H. Development and characterization of the first proton minibeam system for single-gantry proton facility. Med Phys 2024; 51:3995-4006. [PMID: 38642468 DOI: 10.1002/mp.17074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Minibeam represents a preclinical spatially fractionated radiotherapy modality with great translational potential. The advantage lies in its high therapeutic index (compared to GRID and LATTICE) and ability to treat at greater depth (compared to microbeam). Proton minibeam radiotherapy (pMBRT) is a synergy of proton and minibeam. While the single-gantry proton facility has gained popularity due to its affordability and compact design, it often has limited beam time available for research purposes. Conversely, given the current requirement of pMBRT on specific minibeam hardware collimators, necessitates a reproducible and fast setup to minimize pMBRT treatment time and streamline the switching time between pMBRT and conventional treatment for clinically translation. PURPOSE The contribution of this work is the development and characterization of the first pMBRT system tailored for single-gantry proton facility. The system allows for efficient and reproducible plug-and-play setup, achievable within minutes. METHODS The single room pMBRT system is constructed based on IBA ProteusONE proton machine. The end of nozzle is attached with beam modifying accessories though an accessory drawer. A small snout is attached to the accessory drawer and used to hold apertures and range shifters. The minibeam aperture consists of two components: a fitting ring and an aperture body. Three minibeam apertures were manufactured. The first-generation apertures underwent qualitatively analysis with film, and the second generation aperture underwent more comprehensive quantitative measurement. The reproducibility of the setup is accessed, and the film measurements are performed to characterize the pMBRT system in cross validation with Monte Carlo (MC) simulations. RESULTS We presented initial results of large field pMBRT aperture and the film measurements indicates the effect of source-to-isocenter distance = 930 cm in Y proton scanning direction. Consistent with TOPAS MC simulation, the dose uniformity of pMBRT field <2 cm is demonstrated to be better than 2%, rendering its suitability for pre-clinical studies. Subsequently, we developed the second generation of aperture with five slits and characterized the aperture with film dosimetry studies and compared the results to the benchmark MC. Comprehensive film measurements were also performed to evaluate the effect of divergence, air gap and gantry-angle dependency and repeatability and revealing a consistent performance within 5%. Furthermore, the 2D gamma analysis indicated a passing rate exceeding 99% using 3% dose difference and 0.2 mm distance agreement criteria. We also establish the peak valley dose ratio and the depth dose profile measurements, and the results are within 10% from MC simulation. CONCLUSIONS We have developed the first pMBRT system tailored for a single-gantry proton facility, which has demonstrated accuracy in benchmark with MC simulations, and allows for efficient plug-and-play setup, emphasizing efficiency.
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Affiliation(s)
- Yuting Lin
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Wangyao Li
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Daniel Johnson
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yolanda Prezado
- Institut Curie, University PSL, CNRS UMR3347, INSERM U1021, Orsay, France
| | - Gregory N Gan
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hao Gao
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Masilela TAM, Prezado Y. Monte Carlo study of the free radical yields in minibeam radiation therapy. Med Phys 2023; 50:5115-5134. [PMID: 37211907 DOI: 10.1002/mp.16475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 02/24/2023] [Accepted: 05/01/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Minibeam radiation therapy (MBRT) is a novel technique which has been shown to widen the therapeutic window through significant normal tissue sparing. Despite the heterogeneous dose distributions, tumor control is still ensured. Nevertheless the exact radiobiological mechanisms responsible for MBRT efficacy are not fully understood. PURPOSE Reactive oxygen species (ROS) resulting from water radiolysis were investigated given their implications not only on targeted DNA damage, but also for their role in the immune response and non-targeted cell signalling effects: two potential drivers of MBRT efficacy. METHODS Monte Carlo simulations were performed using TOPAS-nBio to carry out the irradiation of a water phantom with beams of protons (pMBRT), photons (xMBRT), 4 He ions (HeMBRT), and 12 C ions (CMBRT). Primary yields at the end of the chemical stage were calculated in spheres of 20 μm diameter, located in the peaks and valleys at various depths up to the Bragg peak. The chemical stage was limited to 1 ns to approximate biological scavenging, and the yield of · OH, H2 O2 , ande aq - ${\rm e}^{-}_{\rm aq}$ was recorded. RESULTS Beyond 10 mm, there were no substantial differences in the primary yields between peaks and valleys of the pMBRT and HeMBRT modalities. For xMBRT, there was a lower primary yield of the radical species · OH ande aq - ${\rm e}^{-}_{\rm aq}$ at all depths in the valleys compared to the peaks, and a higher primary yield of H2 O2 . Compared to the peaks, the valleys of the CMBRT modality were subject to a higher · OH ande aq - ${\rm e}^{-}_{\rm aq}$ yield, and lower H2 O2 yield. This difference between peaks and valleys became more severe in depth. Near the Bragg peak, the increase in the primary yield of the valleys over the peaks was 6% and 4% for · OH ande aq - ${\rm e}^{-}_{\rm aq}$ respectively, while there was a decrease in the yield of H2 O2 by 16%. Given the similar ROS primary yields in the peaks and valleys of pMBRT and HeMBRT, the level of indirect DNA damage is expected to be directly proportional to the peak to valley dose ratio (PVDR). The difference in the primary yields implicates a lower level of indirect DNA damage in the valleys compared to the peaks than what would be suggested by the PVDR for xMBRT, and a higher level for CMBRT. CONCLUSIONS These results highlight the notion that depending on the particle chosen, one can expect different levels of ROS in the peaks and valley that goes beyond what would be expected by the macroscopic PVDR. The combination of MBRT with heavier ions is shown to be particularly interesting as the primary yield in the valleys progressively diverges from the level observed in the peaks as the LET increases. While differences in the reported · OH yields of this work implicated the indirect DNA damage, H2 O2 yields particularly implicate non-targeted cell signalling effects, and therefore this work provides a point of reference for future simulations in which the distribution of this species at more biologically relevant timescales could be investigated.
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Affiliation(s)
- Thongchai A M Masilela
- Signalisation radiobiologie et cancer, Institut Curie, Université PSL, Orsay, France
- Signalisation radiobiologie et cancer, Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Orsay, France
| | - Yolanda Prezado
- Signalisation radiobiologie et cancer, Institut Curie, Université PSL, Orsay, France
- Signalisation radiobiologie et cancer, Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Orsay, France
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Schneider T, Malaise D, Pouzoulet F, Prezado Y. Orthovoltage X-ray Minibeam Radiation Therapy for the Treatment of Ocular Tumours-An In Silico Evaluation. Cancers (Basel) 2023; 15:cancers15030679. [PMID: 36765637 PMCID: PMC9913874 DOI: 10.3390/cancers15030679] [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: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
(1) Background: Radiotherapeutic treatments of ocular tumors are often challenging because of nearby radiosensitive structures and the high doses required to treat radioresistant cancers such as uveal melanomas. Although increased local control rates can be obtained with advanced techniques such as proton therapy and stereotactic radiosurgery, these modalities are not always accessible to patients (due to high costs or low availability) and side effects in structures such as the lens, eyelids or anterior chamber remain an issue. Minibeam radiation therapy (MBRT) could represent a promising alternative in this regard. MBRT is an innovative new treatment approach where the irradiation field is composed of multiple sub-millimetric beamlets, spaced apart by a few millimetres. This creates a so-called spatial fractionation of the dose which, in small animal experiments, has been shown to increase normal tissue sparing while simultaneously providing high tumour control rates. Moreover, MBRT with orthovoltage X-rays could be easily implemented in widely available and comparably inexpensive irradiation platforms. (2) Methods: Monte Carlo simulations were performed using the TOPAS toolkit to evaluate orthovoltage X-ray MBRT as a potential alternative for treating ocular tumours. Dose distributions were simulated in CT images of a human head, considering six different irradiation configurations. (3) Results: The mean, peak and valley doses were assessed in a generic target region and in different organs at risk. The obtained doses were comparable to those reported in previous X-ray MBRT animal studies where good normal tissue sparing and tumour control (rat glioma models) were found. (4) Conclusions: A proof-of-concept study for the application of orthovoltage X-ray MBRT to ocular tumours was performed. The simulation results encourage the realisation of dedicated animal studies considering minibeam irradiations of the eye to specifically assess ocular and orbital toxicities as well as tumour response. If proven successful, orthovoltage X-ray minibeams could become a cost-effective treatment alternative, in particular for developing countries.
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Affiliation(s)
- Tim Schneider
- Institut Curie, Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
- Correspondence:
| | - Denis Malaise
- Department of Ophthalmology, Institut Curie, 75005 Paris, France
- LITO, INSERM U1288, Institut Curie, PSL University, 91898 Orsay, France
| | - Frédéric Pouzoulet
- LITO, INSERM U1288, Institut Curie, PSL University, 91898 Orsay, France
- Département de Recherche Translationnelle, CurieCoreTech-Experimental Radiotherapy (RadeXp), Institut Curie, PSL University, 91400 Orsay, France
| | - Yolanda Prezado
- Institut Curie, Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
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Laurent PA, Morel D, Meziani L, Depil S, Deutsch E. Radiotherapy as a means to increase the efficacy of T-cell therapy in solid tumors. Oncoimmunology 2022; 12:2158013. [PMID: 36567802 PMCID: PMC9788698 DOI: 10.1080/2162402x.2022.2158013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Chimeric antigen receptor (CAR)-T cells have demonstrated significant improvements in the treatment of refractory B-cell malignancies that previously showed limited survival. In contrast, early-phase clinical studies targeting solid tumors have been disappointing. This may be due to both a lack of specific and homogeneously expressed targets at the surface of tumor cells, as well as intrinsic properties of the solid tumor microenvironment that limit homing and activation of adoptive T cells. Faced with these antagonistic conditions, radiotherapy (RT) has the potential to change the overall tumor landscape, from depleting tumor cells to reshaping the tumor microenvironment. In this article, we describe the current landscape and discuss how RT may play a pivotal role for enhancing the efficacy of adoptive T-cell therapies in solid tumors. Indeed, by improving homing, expansion and activation of infused T cells while reducing tumor volume and heterogeneity, the use of RT could help the implementation of engineered T cells in the treatment of solid tumors.
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Affiliation(s)
- Pierre-Antoine Laurent
- Department of Radiation Oncology, Gustave Roussy Cancer Campus; UNICANCER, Villejuif, France,INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay, SIRIC SOCRATE, Villejuif, France,CONTACT Pierre-Antoine Laurent Department of Radiation Oncology, Gustave Roussy Cancer Campus, UNICANCER, Villejuif94805, France; INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay; SIRIC SOCRATE, Villejuif, France
| | - Daphne Morel
- Drug Development Department (D.I.T.E.P), Gustave Roussy Cancer Campus; UNICANCER, Villejuif, France
| | - Lydia Meziani
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay, SIRIC SOCRATE, Villejuif, France
| | | | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy Cancer Campus; UNICANCER, Villejuif, France,INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay, SIRIC SOCRATE, Villejuif, France
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Lattice Radiation Therapy in clinical practice: A systematic review. Clin Transl Radiat Oncol 2022; 39:100569. [PMID: 36590825 PMCID: PMC9800252 DOI: 10.1016/j.ctro.2022.100569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Lattice radiation therapy (LRT) is an innovative type of spatially fractionated radiation therapy. It aims to increase large tumors control probability by administering ablative doses without an increased toxicity. Considering the rising number of positive clinical experiences, the objective of this work is to evaluate LRT safety and efficacy. Method Reports about LRT clinical experience were identified with a systematic review conducted on four different databases (namely, Medline, Embase, Scopus, and Cochrane Library) through the August 2022. Only LRT clinical reports published in English and with the access to the full manuscript text were considered as eligible. The 2020 update version PRISMA statement was followed. Results Data extraction was performed from 12 eligible records encompassing 7 case reports, 1 case series, and 4 clinical studies. 81 patients (84 lesions) with a large lesion ranging from 63.2 cc to 3713.5 cc were subjected to exclusive, hybrid, and metabolism guided LRT. Excluding two very severe toxicity with a questionable relation with LRT, available clinical experience seem to confirm LRT safety. When a complete response was not achieved 3-6 months after LRT, a median lesion reduction approximately ≥50 % was registered. Conclusion This systematic review appear to suggest LRT safety, especially for exclusive LRT. The very low level of evidence and the studies heterogeneity preclude drawing definitive conclusions on LRT efficacy, even though an interesting trend in terms of lesions reduction has been described.
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Sharp dose profiles for high precision proton therapy using strongly focused proton beams. Sci Rep 2022; 12:18919. [PMID: 36344543 PMCID: PMC9640624 DOI: 10.1038/s41598-022-22677-0] [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: 04/14/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
The main objective of radiotherapy is to exploit the curative potential of ionizing radiation while inflicting minimal radiation-induced damage to healthy tissue and sensitive organs. Proton beam therapy has been developed to irradiate the tumor with higher precision and dose conformity compared to conventional X-ray irradiation. The dose conformity of this treatment modality may be further improved if narrower proton beams are used. Still, this is limited by multiple Coulomb scattering of protons through tissue. The primary aim of this work was to develop techniques to produce narrow proton beams and investigate the resulting dose profiles. We introduced and assessed three different proton beam shaping techniques: (1) metal collimators (100/150 MeV), (2) focusing of conventional- (100/150 MeV), and (3) focusing of high-energy (350 MeV, shoot-through) proton beams. Focusing was governed by the initial value of the Twiss parameter [Formula: see text] ([Formula: see text]), and can be implemented with magnetic particle accelerator optics. The dose distributions in water were calculated by Monte Carlo simulations using Geant4, and evaluated by target to surface dose ratio (TSDR) in addition to the transverse beam size ([Formula: see text]) at the target. The target was defined as the location of the Bragg peak or the focal point. The different techniques showed greatly differing dose profiles, where focusing gave pronouncedly higher relative target dose and efficient use of primary protons. Metal collimators with radii [Formula: see text] gave low TSDRs ([Formula: see text]) and large [Formula: see text]([Formula: see text]). In contrast, a focused beam of conventional ([Formula: see text]) energy produced a very high TSDR ([Formula: see text]) with similar [Formula: see text] as a collimated beam. High-energy focused beams were able to produce TSDRs [Formula: see text] and [Formula: see text] around 1.5 mm. From this study, it appears very attractive to implement magnetically focused proton beams in radiotherapy of small lesions or tumors in close vicinity to healthy organs at risk. This can also lead to a paradigm change in spatially fractionated radiotherapy. Magnetic focusing would facilitate FLASH irradiation due to low losses of primary protons.
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Baiocco G, Bartzsch S, Conte V, Friedrich T, Jakob B, Tartas A, Villagrasa C, Prise KM. A matter of space: how the spatial heterogeneity in energy deposition determines the biological outcome of radiation exposure. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2022; 61:545-559. [PMID: 36220965 PMCID: PMC9630194 DOI: 10.1007/s00411-022-00989-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/03/2022] [Indexed: 05/10/2023]
Abstract
The outcome of the exposure of living organisms to ionizing radiation is determined by the distribution of the associated energy deposition at different spatial scales. Radiation proceeds through ionizations and excitations of hit molecules with an ~ nm spacing. Approaches such as nanodosimetry/microdosimetry and Monte Carlo track-structure simulations have been successfully adopted to investigate radiation quality effects: they allow to explore correlations between the spatial clustering of such energy depositions at the scales of DNA or chromosome domains and their biological consequences at the cellular level. Physical features alone, however, are not enough to assess the entity and complexity of radiation-induced DNA damage: this latter is the result of an interplay between radiation track structure and the spatial architecture of chromatin, and further depends on the chromatin dynamic response, affecting the activation and efficiency of the repair machinery. The heterogeneity of radiation energy depositions at the single-cell level affects the trade-off between cell inactivation and induction of viable mutations and hence influences radiation-induced carcinogenesis. In radiation therapy, where the goal is cancer cell inactivation, the delivery of a homogenous dose to the tumour has been the traditional approach in clinical practice. However, evidence is accumulating that introducing heterogeneity with spatially fractionated beams (mini- and microbeam therapy) can lead to significant advantages, particularly in sparing normal tissues. Such findings cannot be explained in merely physical terms, and their interpretation requires considering the scales at play in the underlying biological mechanisms, suggesting a systemic response to radiation.
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Affiliation(s)
- Giorgio Baiocco
- Radiation Biophysics and Radiobiology Group, Physics Department, University of Pavia, Pavia, Italy.
| | - Stefan Bartzsch
- Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany
| | - Valeria Conte
- Istituto Nazionale Di Fisica Nucleare INFN, Laboratori Nazionali Di Legnaro, Legnaro, Italy
| | - Thomas Friedrich
- Department of Biophysics, GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
| | - Burkhard Jakob
- Department of Biophysics, GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
| | - Adrianna Tartas
- Biomedical Physics Division, Institute of Experimental Physics, University of Warsaw, Warsaw, Poland
| | - Carmen Villagrasa
- IRSN, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
| | - Kevin M Prise
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
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Sotiropoulos M, Prezado Y. Radiation quality correction factors for improved dosimetry in preclinical minibeam radiotherapy. Med Phys 2022; 49:6716-6727. [PMID: 35904962 DOI: 10.1002/mp.15838] [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: 12/24/2021] [Revised: 06/03/2022] [Accepted: 06/19/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In reference dosimetry, radiation quality correction factors are used in order to account for changes in the detector's response among different radiation qualities, improving dosimetric accuracy. PURPOSE Reference dosimetry radiation quality corrections factors for the PTW microDiamond were calculated for preclinical X-ray and proton minibeams, and their impact in dosimetric accuracy was evaluated. METHODS A formalism for the calculation of radiation quality correction factors for absolute dosimetry in minibeam fields was developed. Following our formalism, radiation quality correction factors were calculated for the PTW microDiamond detector, using the Monte Carlo method. Models of the detector, and X-ray and proton irradiation platform, were imported into the TOPAS Monte Carlo simulation toolkit. The radiation quality correction factors were calculated in the following scenarios: (i) reference dosimetry open field to minibeam center of the central peak, (ii) different positions at the minibeam profile (along the peaks and valleys direction) to the center of the central minibeam, and (iii) some representative depth positions. In addition, the radiation quality correction factors needed for the calculation of the peak-to-valley dose ratio at different depths were calculated. RESULTS An important overestimation of the dose (about 10%) was found in the case of the open to minibeam field for both X-rays and proton beams, when the correction factors were used. Smaller differences were observed in the other cases. CONCLUSIONS The usage of the PTW microDiamond detector requires radiation quality correction factors in order to be used in minibeam reference dosimetry.
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Affiliation(s)
- Marios Sotiropoulos
- Signalisation Radiobiologie et Cancer, CNRS UMR3347, Inserm U1021, Institut Curie, Université PSL, Orsay, France
| | - Yolanda Prezado
- Signalisation Radiobiologie et Cancer, CNRS UMR3347, Inserm U1021, Institut Curie, Université PSL, Orsay, France
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Schneider T, Fernandez-Palomo C, Bertho A, Fazzari J, Iturri L, Martin OA, Trappetti V, Djonov V, Prezado Y. Combining FLASH and spatially fractionated radiation therapy: The best of both worlds. Radiother Oncol 2022; 175:169-177. [PMID: 35952978 DOI: 10.1016/j.radonc.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/23/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022]
Abstract
FLASH radiotherapy (FLASH-RT) and spatially fractionated radiation therapy (SFRT) are two new therapeutical strategies that use non-standard dose delivery methods to reduce normal tissue toxicity and increase the therapeutic index. Although likely based on different mechanisms, both FLASH-RT and SFRT have shown to elicit radiobiological effects that significantly differ from those induced by conventional radiotherapy. With the therapeutic potential having been established separately for each technique, the combination of FLASH-RT and SFRT could therefore represent a winning alliance. In this review, we discuss the state of the art, advantages and current limitations, potential synergies, and where a combination of these two techniques could be implemented today or in the near future.
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Affiliation(s)
- Tim Schneider
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | | | - Annaïg Bertho
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Lorea Iturri
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Olga A Martin
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland; Division of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; University of Melbourne, Parkville, VIC 3010, Australia
| | - Verdiana Trappetti
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France.
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Technical aspects of proton minibeam radiation therapy: Minibeam generation and delivery. Phys Med 2022; 100:64-71. [PMID: 35750002 DOI: 10.1016/j.ejmp.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Proton minibeam radiation therapy (pMBRT) is a novel therapeutic strategy that combines the normal tissue sparing of sub-millimetric, spatially fractionated beams with the improved ballistics of protons. This may allow a safe dose escalation in the tumour and has already proven to provide a remarkable increase of the therapeutic index for high-grade gliomas in animal experiments. One of the main challenges in pMBRT concerns the generation of minibeams and the implementation in a clinical environment. This article reviews the different approaches for generating minibeams, using mechanical collimators and focussing magnets, and discusses the technical aspects of the implementation and delivery of pMBRT.
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McAuley GA, Lim CJ, Teran AV, Slater JD, Wroe AJ. Monte Carlo evaluation of high-gradient magnetically focused planar proton minibeams in a passive nozzle. Phys Med Biol 2022; 67. [PMID: 35421853 DOI: 10.1088/1361-6560/ac678b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/14/2022] [Indexed: 11/12/2022]
Abstract
Objective. To investigate the potential of using a single quadrupole magnet with a high magnetic field gradient to create planar minibeams suitable for clinical applications of proton minibeam radiation therapy.Approach. We performed Monte Carlo simulations involving single quadrupole Halbach cylinders in a passively scattered nozzle in clinical use for proton therapy. Pencil beams produced by the nozzle of 10-15 mm initial diameters and particle range of ∼10-20 cm in water were focused by magnets with field gradients of 225-350 T m-1and cylinder lengths of 80-110 mm to produce very narrow elongated (planar) beamlets. The corresponding dose distributions were scored in a water phantom. Composite minibeam dose distributions composed from three beamlets were created by laterally shifting copies of the single beamlet distribution to either side of a central beamlet. Modulated beamlets (with 18-30 mm nominal central SOBP) and corresponding composite dose distributions were created in a similar manner. Collimated minibeams were also compared with beams focused using one magnet/particle range combination.Main results. The focusing magnets produced planar beamlets with minimum lateral FWHM of ∼1.1-1.6 mm. Dose distributions composed from three unmodulated beamlets showed a high degree of proximal spatial fractionation and a homogeneous target dose. Maximal peak-to-valley dose ratios (PVDR) for the unmodulated beams ranged from 32 to 324, and composite modulated beam showed maximal PVDR ranging from 32 to 102 and SOBPs with good target dose coverage.Significance.Advantages of the high-gradient magnets include the ability to focus beams with phase space parameters that reflect beams in operation today, and post-waist particle divergence allowing larger beamlet separations and thus larger PVDR. Our results suggest that high gradient quadrupole magnets could be useful to focus beams of moderate emittance in clinical proton therapy.
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Affiliation(s)
- Grant A McAuley
- Department of Radiation Medicine, Loma Linda University, Loma Linda CA, United States of America
| | - Crystal J Lim
- School of Medicine, Loma Linda University, Loma Linda, CA United States of America
| | - Anthony V Teran
- Department of Radiation Medicine, Loma Linda University, Loma Linda CA, United States of America.,Orange County CyberKnife and Radiation Oncology Center, Fountain Valley, CA, United States of America
| | - Jerry D Slater
- Department of Radiation Medicine, Loma Linda University, Loma Linda CA, United States of America
| | - Andrew J Wroe
- School of Medicine, Loma Linda University, Loma Linda, CA United States of America.,Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, United States of America.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
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Abstract
AbstractSpatially fractionated radiation therapy (SFRT) challenges some of the classical dogmas in conventional radiotherapy. The highly modulated spatial dose distributions in SFRT have been shown to lead, both in early clinical trials and in small animal experiments, to a significant increase in normal tissue dose tolerances. Tumour control effectiveness is maintained or even enhanced in some configurations as compared with conventional radiotherapy. SFRT seems to activate distinct radiobiological mechanisms, which have been postulated to involve bystander effects, microvascular alterations and/or immunomodulation. Currently, it is unclear which is the dosimetric parameter which correlates the most with both tumour control and normal tissue sparing in SFRT. Additional biological experiments aiming at parametrizing the relationship between the irradiation parameters (beam width, spacing, peak-to-valley dose ratio, peak and valley doses) and the radiobiology are needed. A sound knowledge of the interrelation between the physical parameters in SFRT and the biological response would expand its clinical use, with a higher level of homogenisation in the realisation of clinical trials. This manuscript reviews the state of the art of this promising therapeutic modality, the current radiobiological knowledge and elaborates on future perspectives.
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13
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Cavallone M, Prezado Y, De Marzi L. Converging Proton Minibeams with Magnetic Fields for Optimized Radiation Therapy: A Proof of Concept. Cancers (Basel) 2021; 14:cancers14010026. [PMID: 35008189 PMCID: PMC8750079 DOI: 10.3390/cancers14010026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022] Open
Abstract
Proton MiniBeam Radiation Therapy (pMBRT) is a novel strategy that combines the benefits of minibeam radiation therapy with the more precise ballistics of protons to further optimize the dose distribution and reduce radiation side effects. The aim of this study is to investigate possible strategies to couple pMBRT with dipole magnetic fields to generate a converging minibeam pattern and increase the center-to-center distance between minibeams. Magnetic field optimization was performed so as to obtain the same transverse dose profile at the Bragg peak position as in a reference configuration with no magnetic field. Monte Carlo simulations reproducing realistic pencil beam scanning settings were used to compute the dose in a water phantom. We analyzed different minibeam generation techniques, such as the use of a static multislit collimator or a dynamic aperture, and different magnetic field positions, i.e., before or within the water phantom. The best results were obtained using a dynamic aperture coupled with a magnetic field within the water phantom. For a center-to-center distance increase from 4 mm to 6 mm, we obtained an increase of peak-to-valley dose ratio and decrease of valley dose above 50%. The results indicate that magnetic fields can be effectively used to improve the spatial modulation at shallow depth for enhanced healthy tissue sparing.
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Affiliation(s)
- Marco Cavallone
- Centre de Protonthérapie d’Orsay, Department of Radiation Oncology, Institut Curie, Campus Universitaire, PSL Research University, 91898 Orsay, France
- Correspondence: (M.C.); (L.D.M.)
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France;
| | - Ludovic De Marzi
- Centre de Protonthérapie d’Orsay, Department of Radiation Oncology, Institut Curie, Campus Universitaire, PSL Research University, 91898 Orsay, France
- Institut Curie, Campus Universitaire, PSL Research University, University Paris Saclay, INSERM LITO, 91898 Orsay, France
- Correspondence: (M.C.); (L.D.M.)
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14
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Eley JG, Haga CW, Keller A, Lazenby EM, Raver C, Rusek A, Dilmanian FA, Krishnan S, Waddell J. Heavy Ion Minibeam Therapy: Side Effects in Normal Brain. Cancers (Basel) 2021; 13:cancers13246207. [PMID: 34944825 PMCID: PMC8699126 DOI: 10.3390/cancers13246207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this work was to investigate whether minibeam therapy with heavy ions might offer improvements of the therapeutic ratio for the treatment of human brain cancers. To assess neurotoxicity, we irradiated normal juvenile rats using 120 MeV lithium-7 ions at an absorbed integral dose of 20 Gy. Beams were configured either as a solid parallel circular beam or as an array of planar parallel minibeams having 300-micron width and 1-mm center-to-center spacing within a circular array. We followed animals for 6 months after treatment and utilized behavioral testing and immunohistochemical studies to investigate the resulting cognitive impairment and chronic pathologic changes. We found both solid-beam therapy and minibeam therapy to result in cognitive impairment compared with sham controls, with no apparent reduction in neurotoxicity using heavy ion minibeams instead of solid beams under the conditions of this study.
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Affiliation(s)
- John G. Eley
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA;
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Correspondence:
| | - Catherine W. Haga
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Asaf Keller
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.K.); (C.R.)
| | - Ellis M. Lazenby
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA;
| | - Charles Raver
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.K.); (C.R.)
| | - Adam Rusek
- Brookhaven National Laboratory, Upton, NY 11973, USA;
- NASA Space Radiation Laboratory, Upton, NY 11973, USA
| | - Farrokh Avraham Dilmanian
- Health Sciences Center, Departments of Radiation Oncology, Radiology, and Neurology, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Sunil Krishnan
- Mayo Clinic Cancer Center, Department of Radiation Oncology, Jacksonville, FL 32224, USA;
| | - Jaylyn Waddell
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
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15
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Mayerhofer M, Bergmaier A, Datzmann G, Hagn H, Helm R, Mitteneder J, Schubert R, Picardi L, Nenzi P, Ronsivalle C, Wirth HF, Dollinger G. Concept and performance evaluation of two 3 GHz buncher units optimizing the dose rate of a novel preclinical proton minibeam irradiation facility. PLoS One 2021; 16:e0258477. [PMID: 34634079 PMCID: PMC8504737 DOI: 10.1371/journal.pone.0258477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
To demonstrate the large potential of proton minibeam radiotherapy (pMBRT) as a new method to treat tumor diseases, a preclinical proton minibeam radiation facility was designed. It is based on a tandem Van-de-Graaff accelerator providing a 16 MeV proton beam and a 3 GHz linac post-accelerator (designs: AVO-ADAM S.A, Geneva, Switzerland and ENEA, Frascati, Italy). To enhance the transmission of the tandem beam through the post-accelerator by a factor of 3, two drift tube buncher units were designed and constructed: A brazed 5-gap structure (adapted SCDTL tank of the TOP-IMPLART project (ENEA)) and a non-brazed low budget 4-gap structure. Both are made of copper. The performance of the two differently manufactured units was evaluated using a 16 MeV tandem accelerator beam and a Q3D magnetic spectrograph. Both buncher units achieve the required summed voltage amplitude of 42 kV and amplitude stability at a power feed of less than 800 W.
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Affiliation(s)
- Michael Mayerhofer
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | - Andreas Bergmaier
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | - Gerd Datzmann
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | - Hermann Hagn
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | - Ricardo Helm
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | - Johannes Mitteneder
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | - Ralf Schubert
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | | | | | | | - Hans-Friedrich Wirth
- Ludwig-Maximilians-Universität München, Fakultät für Physik, München, Bavaria, Germany
| | - Günther Dollinger
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
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16
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Bertho A, Ortiz R, Juchaux M, Gilbert C, Lamirault C, Pouzoulet F, Polledo L, Liens A, Warfving N, Sebrie C, Jourdain L, Patriarca A, de Marzi L, Prezado Y. First Evaluation of Temporal and Spatial Fractionation in Proton Minibeam Radiation Therapy of Glioma-Bearing Rats. Cancers (Basel) 2021; 13:cancers13194865. [PMID: 34638352 PMCID: PMC8507607 DOI: 10.3390/cancers13194865] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 01/11/2023] Open
Abstract
Simple Summary Proton minibeam radiation therapy (pMBRT) is a novel therapeutic approach based on a distinct dose delivery method: the dose distributions follow a pattern with regions of peaks (high doses) and valleys (low doses). pMBRT was shown to be able to widen the therapeutic window in glioma-bearing rats. In previous studies the irradiation was performed in one single fraction. The work reported in this manuscript is the first evaluation detailing the response of glioma-bearing rats to a temporal fractionation in proton minibeam radiation therapy, delivered under a crossfire geometry. A significant increase of the median survival time was obtained when the dose was delivered over two sessions as opposed to in a single fraction. This result could facilitate the path towards pMBRT treatments. Abstract (1) Background: Proton minibeam radiation therapy (pMBRT) is a new radiotherapy technique using spatially modulated narrow proton beams. pMBRT results in a significantly reduced local tissue toxicity while maintaining or even increasing the tumor control efficacy as compared to conventional radiotherapy in small animal experiments. In all the experiments performed up to date in tumor bearing animals, the dose was delivered in one single fraction. This is the first assessment on the impact of a temporal fractionation scheme on the response of glioma-bearing animals to pMBRT. (2) Methods: glioma-bearing rats were irradiated with pMBRT using a crossfire geometry. The response of the irradiated animals in one and two fractions was compared. An additional group of animals was also treated with conventional broad beam irradiations. (3) Results: pMBRT delivered in two fractions at the biological equivalent dose corresponding to one fraction resulted in the highest median survival time, with 80% long-term survivors free of tumors. No increase in local toxicity was noted in this group with respect to the other pMBRT irradiated groups. Conventional broad beam irradiations resulted in the most severe local toxicity. (4) Conclusion: Temporal fractionation increases the therapeutic index in pMBRT and could ease the path towards clinical trials.
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Affiliation(s)
- Annaïg Bertho
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; (A.B.); (R.O.); (M.J.); (C.G.)
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Ramon Ortiz
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; (A.B.); (R.O.); (M.J.); (C.G.)
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Marjorie Juchaux
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; (A.B.); (R.O.); (M.J.); (C.G.)
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Cristèle Gilbert
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; (A.B.); (R.O.); (M.J.); (C.G.)
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Charlotte Lamirault
- Translational Research Department, Institut Curie, Experimental Radiotherapy Platform, Université Paris Saclay, 91400 Orsay, France; (C.L.); (F.P.)
| | - Frederic Pouzoulet
- Translational Research Department, Institut Curie, Experimental Radiotherapy Platform, Université Paris Saclay, 91400 Orsay, France; (C.L.); (F.P.)
| | - Laura Polledo
- AnaPath GmbH, AnaPath Services, Hammerstrasse 49, 4410 Liestal, Switzerland; (L.P.); (A.L.); (N.W.)
| | - Alethea Liens
- AnaPath GmbH, AnaPath Services, Hammerstrasse 49, 4410 Liestal, Switzerland; (L.P.); (A.L.); (N.W.)
| | - Nils Warfving
- AnaPath GmbH, AnaPath Services, Hammerstrasse 49, 4410 Liestal, Switzerland; (L.P.); (A.L.); (N.W.)
| | - Catherine Sebrie
- CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, BIOMAPS Université Paris-Saclay, 91401 Orsay, France; (C.S.); (L.J.)
| | - Laurène Jourdain
- CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, BIOMAPS Université Paris-Saclay, 91401 Orsay, France; (C.S.); (L.J.)
| | - Annalisa Patriarca
- Centre de Protonthérapie d’Orsay, Radiation Oncology Department, Campus Universitaire, Institut Curie, PSL Research University, 91898 Orsay, France; (A.P.); (L.d.M.)
| | - Ludovic de Marzi
- Centre de Protonthérapie d’Orsay, Radiation Oncology Department, Campus Universitaire, Institut Curie, PSL Research University, 91898 Orsay, France; (A.P.); (L.d.M.)
- Institut Curie, Campus Universitaire, PSL Research University, University Paris Saclay, INSERM LITO, 91898 Orsay, France
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; (A.B.); (R.O.); (M.J.); (C.G.)
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
- Correspondence:
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17
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Sotiropoulos M, Prezado Y. A scanning dynamic collimator for spot-scanning proton minibeam production. Sci Rep 2021; 11:18321. [PMID: 34526628 PMCID: PMC8443660 DOI: 10.1038/s41598-021-97941-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
In proton minibeam radiation therapy, proton minibeams are typically produced by modulating a uniform field using a multislit collimator. Multislit collimators produce minibeams of fixed length and width, and a new collimator has to be manufactured each time a new minibeam array is required, limiting its flexibility. In this work, we propose a scanning dynamic collimator for the generation of proton minibeams arrays. The new collimator system proposed is able to produce any minibeam required on an on-line basis by modulating the pencil beam spots of modern proton therapy machines, rather than a uniform field. The new collimator is evaluated through Monte Carlo simulations and the produced proton minibeams are compared with that of a multislit collimator. Furthermore, a proof of concept experiment is conducted to demonstrate the feasibility of producing a minibeam array by repositioning (i.e. scanning) a collimator. It is concluded that besides the technical challenges, the new collimator design is producing equivalent minibeam arrays to the multislit collimator, whilst is flexible to produce any minibeam array desired.
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Affiliation(s)
- Marios Sotiropoulos
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400, Orsay, France.
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400, Orsay, France
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18
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A Brief Overview of the Preclinical and Clinical Radiobiology of Microbeam Radiotherapy. Clin Oncol (R Coll Radiol) 2021; 33:705-712. [PMID: 34454806 DOI: 10.1016/j.clon.2021.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022]
Abstract
Microbeam radiotherapy (MRT) is the delivery of spatially fractionated beams that have the potential to offer significant improvements in the therapeutic ratio due to the delivery of micron-sized high dose and dose rate beams. They build on longstanding clinical experience of GRID radiotherapy and more recently lattice-based approaches. Here we briefly overview the preclinical evidence for MRT efficacy and highlight the challenges for bringing this to clinical utility. The biological mechanisms underpinning MRT efficacy are still unclear, but involve vascular, bystander, stem cell and potentially immune responses. There is probably significant overlap in the mechanisms underpinning MRT responses and FLASH radiotherapy that needs to be further defined.
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19
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Mazal A, Vera Sanchez JA, Sanchez-Parcerisa D, Udias JM, España S, Sanchez-Tembleque V, Fraile LM, Bragado P, Gutierrez-Uzquiza A, Gordillo N, Garcia G, Castro Novais J, Perez Moreno JM, Mayorga Ortiz L, Ilundain Idoate A, Cremades Sendino M, Ares C, Miralbell R, Schreuder N. Biological and Mechanical Synergies to Deal With Proton Therapy Pitfalls: Minibeams, FLASH, Arcs, and Gantryless Rooms. Front Oncol 2021; 10:613669. [PMID: 33585238 PMCID: PMC7874206 DOI: 10.3389/fonc.2020.613669] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/02/2020] [Indexed: 12/28/2022] Open
Abstract
Proton therapy has advantages and pitfalls comparing with photon therapy in radiation therapy. Among the limitations of protons in clinical practice we can selectively mention: uncertainties in range, lateral penumbra, deposition of higher LET outside the target, entrance dose, dose in the beam path, dose constraints in critical organs close to the target volume, organ movements and cost. In this review, we combine proposals under study to mitigate those pitfalls by using individually or in combination: (a) biological approaches of beam management in time (very high dose rate “FLASH” irradiations in the order of 100 Gy/s) and (b) modulation in space (a combination of mini-beams of millimetric extent), together with mechanical approaches such as (c) rotational techniques (optimized in partial arcs) and, in an effort to reduce cost, (d) gantry-less delivery systems. In some cases, these proposals are synergic (e.g., FLASH and minibeams), in others they are hardly compatible (mini-beam and rotation). Fixed lines have been used in pioneer centers, or for specific indications (ophthalmic, radiosurgery,…), they logically evolved to isocentric gantries. The present proposals to produce fixed lines are somewhat controversial. Rotational techniques, minibeams and FLASH in proton therapy are making their way, with an increasing degree of complexity in these three approaches, but with a high interest in the basic science and clinical communities. All of them must be proven in clinical applications.
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Affiliation(s)
| | | | - Daniel Sanchez-Parcerisa
- Grupo de Física Nuclear and IPARCOS, U. Complutense Madrid, CEI Moncloa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Sedecal Molecular Imaging, Madrid, Spain
| | - Jose Manuel Udias
- Grupo de Física Nuclear and IPARCOS, U. Complutense Madrid, CEI Moncloa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Samuel España
- Grupo de Física Nuclear and IPARCOS, U. Complutense Madrid, CEI Moncloa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Victor Sanchez-Tembleque
- Grupo de Física Nuclear and IPARCOS, U. Complutense Madrid, CEI Moncloa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Mario Fraile
- Grupo de Física Nuclear and IPARCOS, U. Complutense Madrid, CEI Moncloa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Paloma Bragado
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Department of Biochemistry and Molecular Biology. U. Complutense, Madrid, Spain
| | - Alvaro Gutierrez-Uzquiza
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Department of Biochemistry and Molecular Biology. U. Complutense, Madrid, Spain
| | - Nuria Gordillo
- Department of Applied Physics, U. Autonoma de Madrid, Madrid, Spain.,Center for Materials Microanalysis, (CMAM), U. Autonoma de Madrid, Madrid, Spain
| | - Gaston Garcia
- Center for Materials Microanalysis, (CMAM), U. Autonoma de Madrid, Madrid, Spain
| | | | | | | | | | | | - Carme Ares
- Centro de Protonterapia Quironsalud, Madrid, Spain
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20
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Charyyev S, Artz M, Szalkowski G, Chang C, Stanforth A, Lin L, Zhang R, Wang CC. Optimization of hexagonal‐pattern minibeams for spatially fractionated radiotherapy using proton beam scanning. Med Phys 2020; 47:3485-3495. [DOI: 10.1002/mp.14192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Serdar Charyyev
- Medical Physics Program Georgia Institute of Technology Atlanta GA 30332 USA
- Department of Radiation Oncology Emory University Atlanta GA 30322 USA
| | - Mark Artz
- UF Health Proton Therapy Institute Jacksonville FL 32206 USA
| | - Gregory Szalkowski
- Medical Physics Program Georgia Institute of Technology Atlanta GA 30332 USA
- Department of Radiation Oncology University of North Carolina Chapel Hill NC 27514 USA
| | - Chih‐Wei Chang
- Department of Radiation Oncology Emory University Atlanta GA 30322 USA
| | | | - Liyong Lin
- Department of Radiation Oncology Emory University Atlanta GA 30322 USA
| | - Rongxiao Zhang
- Department of Radiation Oncology Dartmouth College Hanover NH 03755 USA
| | - C.‐K. Chris Wang
- Medical Physics Program Georgia Institute of Technology Atlanta GA 30332 USA
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21
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Mazal A, Prezado Y, Ares C, de Marzi L, Patriarca A, Miralbell R, Favaudon V. FLASH and minibeams in radiation therapy: the effect of microstructures on time and space and their potential application to protontherapy. Br J Radiol 2020; 93:20190807. [PMID: 32003574 PMCID: PMC7066940 DOI: 10.1259/bjr.20190807] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
After years of lethargy, studies on two non-conventional microstructures in time and space of the beams used in radiation therapy are enjoying a huge revival. The first effect called “FLASH” is based on very high dose-rate irradiation (pulse amplitude ≥106 Gy/s), short beam-on times (≤100 ms) and large single doses (≥10 Gy) as experimental parameters established so far to give biological and potential clinical effects. The second effect relies on the use of arrays of minibeams (e.g., 0.5–1 mm, spaced 1–3.5 mm). Both approaches have been shown to protect healthy tissues as an endpoint that must be clearly specified and could be combined with each other (e.g., minibeams under FLASH conditions). FLASH depends on the presence of oxygen and could proceed from the chemistry of peroxyradicals and a reduced incidence on DNA and membrane damage. Minibeams action could be based on abscopal effects, cell signalling and/or migration of cells between “valleys and hills” present in the non-uniform irradiation field as well as faster repair of vascular damage. Both effects are expected to maintain intact the tumour control probability and might even preserve antitumoural immunological reactions. FLASH in vivo experiments involving Zebrafish, mice, pig and cats have been done with electron beams, while minibeams are an intermediate approach between X-GRID and synchrotron X-ray microbeams radiation. Both have an excellent rationale to converge and be applied with proton beams, combining focusing properties and high dose rates in the beam path of pencil beams, and the inherent advantage of a controlled limited range. A first treatment with electron FLASH (cutaneous lymphoma) has recently been achieved, but clinical trials have neither been presented for FLASH with protons, nor under the minibeam conditions. Better understanding of physical, chemical and biological mechanisms of both effects is essential to optimize the technical developments and devise clinical trials.
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Affiliation(s)
| | - Yolanda Prezado
- IMNC, University Paris-Sud and Paris-Saclay, CNRS/IN2P3, Orsay, France
| | - Carme Ares
- Centro de Protonterapia Quironsalud, Madrid, Spain
| | - Ludovic de Marzi
- Institut Curie, Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay 91898, France.,Institut Curie, Inserm U 1021-CNRS UMR 3347, Paris-Saclay and PSL Research Universities, Orsay, France
| | - Annalisa Patriarca
- Institut Curie, Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay 91898, France
| | | | - Vincent Favaudon
- Institut Curie, Inserm U 1021-CNRS UMR 3347, Paris-Saclay and PSL Research Universities, Orsay, France
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22
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Dilmanian FA, Venkatesulu BP, Sahoo N, Wu X, Nassimi JR, Herchko S, Lu J, Dwarakanath BS, Eley JG, Krishnan S. Proton minibeams-a springboard for physics, biology and clinical creativity. Br J Radiol 2020; 93:20190332. [PMID: 31944824 DOI: 10.1259/bjr.20190332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Proton minibeam therapy (PMBT) is a form of spatially fractionated radiotherapy wherein broad beam radiation is replaced with segmented minibeams-either parallel, planar minibeam arrays generated by a multislit collimator or scanned pencil beams that converge laterally at depth to create a uniform dose layer at the tumor. By doing so, the spatial pattern of entrance dose is considerably modified while still maintaining tumor dose and efficacy. Recent studies using computational modeling, phantom experiments, in vitro and in vivo preclinical models, and early clinical feasibility assessments suggest that unique physical and biological attributes of PMBT can be exploited for future clinical benefit. We outline some of the guiding principle of PMBT in this concise overview of this emerging area of preclinical and clinical research inquiry.
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Affiliation(s)
- F Avraham Dilmanian
- Departments of Radiology, Health Sciences Center and Cancer Center, Stony Brook University, Stony Brook, NY, USA.,Departments of Radiation Oncology, Health Sciences Center and Cancer Center, Stony Brook University, Stony Brook, NY, USA.,Departments of Neurology, Health Sciences Center and Cancer Center, Stony Brook University, Stony Brook, NY, USA.,Departments of Psychiatry, Health Sciences Center and Cancer Center, Stony Brook University, Stony Brook, NY, USA
| | - Bhanu P Venkatesulu
- Department of Experimental Radiation Oncology, Health Sciences Center and Cancer Center, Stony Brook University, Stony Brook, NY, USA
| | - Narayan Sahoo
- Departments of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiaodong Wu
- Biophysics Research Institute of America, Miami, FL, USA.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Jessica R Nassimi
- Departments of Radiology, Health Sciences Center and Cancer Center, Stony Brook University, Stony Brook, NY, USA
| | - Steven Herchko
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Jiade Lu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | | | - John G Eley
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
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23
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Novel treatment planning approaches to enhance the therapeutic ratio: targeting the molecular mechanisms of radiation therapy. Clin Transl Oncol 2019; 22:447-456. [PMID: 31254253 DOI: 10.1007/s12094-019-02165-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/16/2019] [Indexed: 12/16/2022]
Abstract
Radiation acts not only through cell death but has also angiogenic, immunomodulatory and bystander effects. The realization of its systemic implications has led to extensive research on the combination of radiotherapy with systemic treatments, including immunotherapy and antiangiogenic agents. Parameters such as dose, fractionation and sequencing of treatments are key determinants of the outcome. However, recent high-quality research indicates that these are not the only radiation therapy parameters that influence its systemic effect. To effectively integrate systemic agents with radiation therapy, these new aspects of radiation therapy planning will have to be taken into consideration in future clinical trials. Our aim is to review these new treatment planning parameters that can influence the balance between contradicting effects of radiation therapy so as to enhance the therapeutic ratio.
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24
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Verhaegen F, Vaz P, Prise KM. Small animal image-guided radiotherapy. Br J Radiol 2019. [DOI: 10.1259/bjr.20199002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Pedro Vaz
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Portugal
| | - Kevin M Prise
- Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, United Kingdom
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