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Nusrat H, Karim-Picco S, Pang G, Paudel M, Sarfehnia A. Maximum RBE change in 192Ir, 125I, and 169Yb brachytherapy and the corresponding effect on treatment planning. Biomed Phys Eng Express 2020; 6:015021. [PMID: 33438609 DOI: 10.1088/2057-1976/ab638e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to examine RBE variation as a function of distance from the radioactive source, and the potential impact of this variation on a realistic prostate brachytherapy treatment plan. METHODS Three brachytherapy sources (125I, 192Ir, and 169Yb) were modelled in Geant4 Monte Carlo code, and the resulting electron energy spectrum in water in 3D space around these sources was scored (voxel size of 2 mm3). With this energy spectrum, microdosimetric techniques were used to calculate the maximum RBE, RBEM, as a function of distance from the source. RBEM of 125I relative to 192Ir was calculated in order to validate simulations against literature; all other RBEM calculations were done by normalizing electron fluence at various distances to the source position. In order to examine the impact of RBEM variation in treatment planning, a realistic 192Ir prostate plan was re-evaluated in terms of RBE instead of absorbed dose. RESULTS The RBEM of 125I, 192Ir, and 169Yb at 8 cm away from the source was 0.994 (+/-0.002), 1.030 (+/-0.003), and 1.066 (+/-0.008), respectively. RBEM in the HDR prostate treatment plan exhibited several hot (+3.6% in RBEM) spots. CONCLUSIONS The large increase RBEM observed in 169Yb has not yet been described in the literature. Despite the presence of radiobiological hotspots in the HDR treatment, these variations are likely nominal and clinically insignificant.
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Affiliation(s)
- Humza Nusrat
- Department of Physics, Ryerson University, 350 Victoria St., M5B 2K3 Toronto, ON, Canada
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Nath R, Rivard MJ, DeWerd LA, Dezarn WA, Thompson Heaton H, Ibbott GS, Meigooni AS, Ouhib Z, Rusch TW, Siebert FA, Venselaar JLM. Guidelines by the AAPM and GEC-ESTRO on the use of innovative brachytherapy devices and applications: Report of Task Group 167. Med Phys 2017; 43:3178-3205. [PMID: 27277063 DOI: 10.1118/1.4951734] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Although a multicenter, Phase III, prospective, randomized trial is the gold standard for evidence-based medicine, it is rarely used in the evaluation of innovative devices because of many practical and ethical reasons. It is usually sufficient to compare the dose distributions and dose rates for determining the equivalence of the innovative treatment modality to an existing one. Thus, quantitative evaluation of the dosimetric characteristics of innovative radiotherapy devices or applications is a critical part in which physicists should be actively involved. The physicist's role, along with physician colleagues, in this process is highlighted for innovative brachytherapy devices and applications and includes evaluation of (1) dosimetric considerations for clinical implementation (including calibrations, dose calculations, and radiobiological aspects) to comply with existing societal dosimetric prerequisites for sources in routine clinical use, (2) risks and benefits from a regulatory and safety perspective, and (3) resource assessment and preparedness. Further, it is suggested that any developed calibration methods be traceable to a primary standards dosimetry laboratory (PSDL) such as the National Institute of Standards and Technology in the U.S. or to other PSDLs located elsewhere such as in Europe. Clinical users should follow standards as approved by their country's regulatory agencies that approved such a brachytherapy device. Integration of this system into the medical source calibration infrastructure of secondary standard dosimetry laboratories such as the Accredited Dosimetry Calibration Laboratories in the U.S. is encouraged before a source is introduced into widespread routine clinical use. The American Association of Physicists in Medicine and the Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology (GEC-ESTRO) have developed guidelines for the safe and consistent application of brachytherapy using innovative devices and applications. The current report covers regulatory approvals, calibration, dose calculations, radiobiological issues, and overall safety concerns that should be addressed during the commissioning stage preceding clinical use. These guidelines are based on review of requirements of the U.S. Nuclear Regulatory Commission, U.S. Department of Transportation, International Electrotechnical Commission Medical Electrical Equipment Standard 60601, U.S. Food and Drug Administration, European Commission for CE Marking (Conformité Européenne), and institutional review boards and radiation safety committees.
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Affiliation(s)
- Ravinder Nath
- Department of Therapeutic Radiology, School of Medicine, Yale University, New Haven, Connecticut 06510
| | - Mark J Rivard
- Department of Radiation Oncology, School of Medicine, Tufts University, Boston, Massachusetts 02111
| | - Larry A DeWerd
- Accredited Dosimetry and Calibration Laboratory, University of Wisconsin, Madison, Wisconsin 53706
| | - William A Dezarn
- Department of Radiation Oncology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157
| | | | - Geoffrey S Ibbott
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Ali S Meigooni
- Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada 89169
| | - Zoubir Ouhib
- Radiation Oncology, Lynn Regional Cancer Center, Delray Beach, Florida 33484
| | - Thomas W Rusch
- Xoft, Inc., A Subsidiary of iCAD, Inc., San Jose, California 95134
| | - Frank-André Siebert
- Clinic of Radiotherapy, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel 24105, Germany
| | - Jack L M Venselaar
- Department of Medical Physics and Engineering, Instituut Verbeeten, Tilburg LA 5000, The Netherlands
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Ulinskas K, Janulionis E, Valuckas K, Samerdokiene V, Atkocius V, Rivard M. Long-term results for Stage IIIB cervical cancer patients receiving external beam radiotherapy combined with either HDR 252Cf or HDR 60Co intracavitary brachytherapy. Brachytherapy 2016; 15:353-360. [DOI: 10.1016/j.brachy.2016.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/29/2015] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
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Samerdokiene V, Valuckas KP, Janulionis E, Atkocius V, Rivard MJ. Second primary malignancies after radiotherapy including HDR (252)Cf brachytherapy for cervical cancer. Brachytherapy 2015; 14:898-904. [PMID: 26194049 DOI: 10.1016/j.brachy.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/28/2015] [Accepted: 06/16/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Second primary malignancies (SPMs) are among the most serious late adverse effects after radiotherapy experienced over time by the increasing population of cancer survivors worldwide. The study aim was to determine the rate and distribution of SPMs for neutron- and photon-emitting brachytherapy (BT) sources for patients treated for cervical cancer. METHODS AND MATERIALS The cohort comprised 662 patients with invasive cervical cancer (Stages IIB and IIIB) and contributed 5,224 patient-years (PY) of observation. These patients were treated by radiotherapy during the 1989-1999 year period with cobalt-60 source ((60)Co) teletherapy. The first group of patients (N = 375; 3,154 PY) received high-dose-rate (HDR) californium-252 source ((252)Cf) BT, whereas the second group (N = 287; 2,070 PY) received HDR (60)Co BT. RESULTS Over a 25-year period, 35 SPMs were observed, amounting to 5.3% of all observed patients: in 16 (2.4%) heavily, 2 (0.3%) moderately, 14 (2.1%) lightly irradiated body sites, and 3 (0.5%) other sites. Of these, 21 cases (5.6%) were observed in the HDR (252)Cf BT group, whereas 14 cases (4.9%) were observed in the HDR (60)Co BT group. Exposures received during (60)Co teletherapy and HDR BT with either (252)Cf or (60)Co had statistically equivalent (p = 0.68) effects on SPM development. CONCLUSIONS Cure rates are improving, and therefore, there are more long-term survivors from cervical cancer. This study shows no significant difference in rates or distribution of SPMs in women treated with neutron BT compared with photon BT (p = 0.68). After reviewing related literature and our research results, it is evident that a detailed investigation of SPM frequency, localization, and dose to adjacent organs is a suitable topic for further research.
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Affiliation(s)
- Vitalija Samerdokiene
- Scientific Research Center, National Cancer Institute, Vilnius University, Vilnius, Lithuania.
| | | | - Ernestas Janulionis
- Radiation and Medical Oncology Center, National Cancer Institute, Vilnius University, Vilnius, Lithuania
| | - Vydmantas Atkocius
- Scientific Research Center, National Cancer Institute, Vilnius University, Vilnius, Lithuania
| | - Mark J Rivard
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA
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Valuckas KP, Atkocius V, Kuzmickiene I, Aleknavicius E, Liukpetryte S, Ostapenko V. Second malignancies following conventional or combined ²⁵²Cf neutron brachytherapy with external beam radiotherapy for breast cancer. JOURNAL OF RADIATION RESEARCH 2013; 54:872-9. [PMID: 23397075 PMCID: PMC3766283 DOI: 10.1093/jrr/rrt009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/28/2012] [Accepted: 01/14/2013] [Indexed: 06/01/2023]
Abstract
We retrospectively evaluated the risk of second malignancies among 832 patients with inner or central breast cancer treated with conventional external beam schedule (CRT group), or neutron brachytherapy using Californium-252 (²⁵²Cf) sources and hypofractionated external beam radiotherapy (HRTC group), between 1987 and 1996 at the Institute of Oncology, Vilnius University. Patients were observed until the occurrences of death or development of a second malignancy, or until 31 December 2009, whichever was earlier. Median follow-up time was 10.4 years (range, 1.2-24.1 years). Risk of second primary cancers was quantified using standardized incidence ratios (SIRs). Cox proportional hazards regression models were used to estimate hazard ratios (HRs). There was a significant increase in the risk of second primary cancers compared with the general population (SIR 1.3, 95% CI 1.1-1.5). The observed number of second primary cancers was also higher than expected for breast (SIR 1.8, 95% CI 1.3-2.4) and lung cancer (SIR 3.8, 95% CI 2.0-6.7). For second breast cancer, no raised relative risk was observed during the period ≥10 or more years after radiotherapy. Compared with the CRT group, HRTC patients had a not statistically significant higher risk of breast cancer. Increased relative risks were observed specifically for age at initial diagnosis of <50 years (HR 2.9, 95% CI 1.6-5.2) and for obesity (HR 2.8, 95% CI 1.1-7.2).
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Affiliation(s)
| | | | - Irena Kuzmickiene
- Institute of Oncology, Vilnius University, Santariskiu̧ 1, LT-08660 Vilnius, Lithuania
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Paul S, Roy PK. The effect of stochastic fluctuation in radiation dose-rate on cell survival following fractionated radiation therapy. Phys Med Biol 2012; 57:1561-73. [PMID: 22391148 DOI: 10.1088/0031-9155/57/6/1561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In radiobiological models, it is often assumed that the radiation dose rate remains constant during the course of radiation delivery. However, instantaneous radiation dose rate undergoes random (stochastic) temporal fluctuation. The effect of stochastic dose rate in fractionated radiation therapy is unknown and there has been no analytical formulation of stochastic dose-rate fluctuation effect in fractionated radiation therapy which we endeavor to pursue here. We have obtained the quantitative expression of cellular survival fraction considering stochastic temporal fluctuation or noise in dose rate. We have shown that the constant dose-rate approximation overestimates the survival fraction compared to that under stochastic dose rate in a fractionated radiation therapy situation and this overestimation effect increases appreciably with the increase in the fluctuation level in dose rate. However, for a given level of fluctuation in dose rate, overestimation of survival fraction also depends on the value of cellular radiation sensitivity parameter β and the repair rate of DNA lesion. This overestimation effect is higher for the cells which have a higher value of β parameter or have a lower repair rate. Our study draws attention to stochastic temporal fluctuation in the radiation dose rate and its potential contribution to cell survival following fractionated radiotherapy.
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Affiliation(s)
- Subhadip Paul
- National Brain Research Centre, Manesar, Gurgaon, Haryana 122050, India
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Wang CKC, Zhang X, Gifford I, Burgett E, Adams V, Al-Sheikhly M. Experimental validation of the new nanodosimetry-based cell survival model for mixed neutron and gamma-ray irradiation. Phys Med Biol 2007; 52:N367-74. [PMID: 17762072 DOI: 10.1088/0031-9155/52/17/n01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The new nanodosimetry-based linear-quadratic (LQ) formula has been reviewed for mixed-LET irradiation. V-79 Chinese hamster cells have been irradiated with a mixed-LET field of fission neutrons and gamma rays at the University of Maryland Training Reactor (MUTR). The results show that the experimental survival curve agrees well with that predicted by the new nanodosimetry-based LQ model. The experimental study described in this note, therefore, serves as a validation for the new model to be used for mixed-LET radiotherapies, e.g. 252Cf brachytherapy.
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Affiliation(s)
- C-K Chris Wang
- Nuclear/Radiological Engineering/Medical Physics Program Neely Research Center, Georgia Institute of Technology, 900 Atlantic Drive, Atlanta, GA 30332-0425, USA.
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Chris Wang CK, Zhang X. A nanodosimetry-based linear-quadratic model of cell survival for mixed-LET radiations. Phys Med Biol 2006; 51:6087-98. [PMID: 17110772 DOI: 10.1088/0031-9155/51/23/010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A new nanodosimetry-based linear-quadratic (LQ) model of cell survival for mixed-LET radiations has been developed. The new model employs three physical quantities and three biological quantities. The three physical quantities are related to energy depositions at two nanometre scales, 5 nm and 25 nm. The three biological quantities are related to the lesion production and interaction probabilities and the lesion repair rate. The coefficients alpha and beta of the LQ formula (alpha D + beta D(2)) are explicitly expressed in terms of the three physical quantities and the three biological quantities. The new model is shown to be consistent with the previously published cell survival curves of V-79 cells. The advantage of this new model is that it can be conveniently adopted to estimate the iso-effect for radiotherapies that involve ionizing radiation of mixed LET. An example is given to estimate the cell survival fractions for a high-dose-rate mixed neutron and gamma-ray field from a (252)Cf source.
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Affiliation(s)
- C-K Chris Wang
- Nuclear/Radiological Engineering/Medical Physics Program, Neely Research Center, Georgia Institute of Technology, 900 Atlantic Drive, Atlanta, GA 30332-0425, USA.
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