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Aristei C, Camilli F, Epifani V, Borghesi S, Palumbo I, Bini V, Poortmans P. A systematic review and meta-analysis of intraoperative electron radiation therapy delivered with a dedicated mobile linac for partial breast irradiation in early breast cancer. Breast 2024; 76:103759. [PMID: 38851057 DOI: 10.1016/j.breast.2024.103759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024] Open
Affiliation(s)
- Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Radiation Oncology Section, Perugia General Hospital, Perugia, Italy.
| | - Federico Camilli
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Valeria Epifani
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - Isabella Palumbo
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Radiation Oncology Section, Perugia General Hospital, Perugia, Italy
| | - Vittorio Bini
- Internal Medicine, Endocrine and Metabolic Science Section, University of Perugia, Perugia, Italy
| | - Philip Poortmans
- University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium; Iridium Netwerk, Department of Radiation Oncology, Antwerp, Belgium
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2
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Franciosini G, Carlotti D, Cattani F, De Gregorio A, De Liso V, De Rosa F, Di Francesco M, Di Martino F, Felici G, Pensavalle JH, Leonardi MC, Marafini M, Muscato A, Paiar F, Patera V, Poortmans P, Sciubba A, Schiavi A, Toppi M, Traini G, Trigilio A, Sarti A. IOeRT conventional and FLASH treatment planning system implementation exploiting fast GPU Monte Carlo: The case of breast cancer. Phys Med 2024; 121:103346. [PMID: 38608421 DOI: 10.1016/j.ejmp.2024.103346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/13/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Partial breast irradiation for the treatment of early-stage breast cancer patients can be performed by means of Intra Operative electron Radiation Therapy (IOeRT). One of the main limitations of this technique is the absence of a treatment planning system (TPS) that could greatly help in ensuring a proper coverage of the target volume during irradiation. An IOeRT TPS has been developed using a fast Monte Carlo (MC) and an ultrasound imaging system to provide the best irradiation strategy (electron beam energy, applicator position and bevel angle) and to facilitate the optimisation of dose prescription and delivery to the target volume while maximising the organs at risk sparing. The study has been performed in silico, exploiting MC simulations of a breast cancer treatment. Ultrasound-based input has been used to compute the absorbed dose maps in different irradiation strategies and a quantitative comparison between the different options was carried out using Dose Volume Histograms. The system was capable of exploring different beam energies and applicator positions in few minutes, identifying the best strategy with an overall computation time that was found to be completely compatible with clinical implementation. The systematic uncertainty related to tissue deformation during treatment delivery with respect to imaging acquisition was taken into account. The potential and feasibility of a GPU based full MC TPS implementation of IOeRT breast cancer treatments has been demonstrated in-silico. This long awaited tool will greatly improve the treatment safety and efficacy, overcoming the limits identified within the clinical trials carried out so far.
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Affiliation(s)
- G Franciosini
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - D Carlotti
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitatio Campus-Bio Medico, Rome, Italy
| | - F Cattani
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - A De Gregorio
- National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy; Sapienza, University of Rome, Department of Physics, Rome, Italy
| | - V De Liso
- S.I.T. Sordina IORT Technologies S.p.A, Aprilia, Italy
| | - F De Rosa
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy
| | | | - F Di Martino
- Centro Pisano Multidisciplinare sulla Ricerca e Implementazione Clinica della Flash Radiotherapy (CPFR), Pisa, Italy; University of Pisa, Department of Physics, Pisa, Italy; Azienda Ospedaliero Universitaria Pisa (AOUP), Fisica Sanitaria, Pisa, Italy; National Institute of Nuclear Physics, INFN, Section of Pisa, Pisa, Italy
| | - G Felici
- S.I.T. Sordina IORT Technologies S.p.A, Aprilia, Italy
| | - J Harold Pensavalle
- S.I.T. Sordina IORT Technologies S.p.A, Aprilia, Italy; Centro Pisano Multidisciplinare sulla Ricerca e Implementazione Clinica della Flash Radiotherapy (CPFR), Pisa, Italy; National Institute of Nuclear Physics, INFN, Section of Pisa, Pisa, Italy
| | - M C Leonardi
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - M Marafini
- National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy; Museo Storico della Fisica e Centro Studi e Ricerche "E. Fermi", Rome, Italy
| | - A Muscato
- National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy; Specialty School of Medical Physics, La Sapienza University of Rome, Rome, Italy
| | - F Paiar
- Centro Pisano Multidisciplinare sulla Ricerca e Implementazione Clinica della Flash Radiotherapy (CPFR), Pisa, Italy; Azienda Ospedaliero Universitaria Pisa (AOUP), Fisica Sanitaria, Pisa, Italy
| | - V Patera
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - P Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | - A Sciubba
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Frascati National Laboratories (LNF), Rome, Italy
| | - A Schiavi
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - M Toppi
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - G Traini
- National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - A Trigilio
- Sapienza, University of Rome, Department of Physics, Rome, Italy; National Institute of Nuclear Physics, INFN, Frascati National Laboratories (LNF), Rome, Italy
| | - A Sarti
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy.
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3
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Iturri L, Bertho A, Lamirault C, Brisebard E, Juchaux M, Gilbert C, Espenon J, Sébrié C, Jourdain L, de Marzi L, Pouzoulet F, Muret J, Verrelle P, Prezado Y. Oxygen supplementation in anesthesia can block FLASH effect and anti-tumor immunity in conventional proton therapy. COMMUNICATIONS MEDICINE 2023; 3:183. [PMID: 38102219 PMCID: PMC10724215 DOI: 10.1038/s43856-023-00411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Radiation-induced neurocognitive dysfunction is a major adverse effect of brain radiation therapy and has specific relevance in pediatric oncology, where serious cognitive deficits have been reported in survivors of pediatric brain tumors. Moreover, many pediatric patients receive proton therapy under general anesthesia or sedation to guarantee precise ballistics with a high oxygen content for safety. The present study addresses the relevant question of the potential effect of supplemental oxygen administered during anesthesia on normal tissue toxicity and investigates the anti-tumor immune response generated following conventional and FLASH proton therapy. METHODS Rats (Fischer 344) were cranially irradiated with a single high dose of proton therapy (15 Gy or 25 Gy) using FLASH dose rate proton irradiation (257 ± 2 Gy/s) or conventional dose rate proton irradiation (4 ± 0.02 Gy/s), and the toxicities in the normal tissue were examined by histological, cytometric and behavioral analysis. Glioblastoma-bearing rats were irradiated in the same manner and tumor-infiltrating leukocytes were quantified by flow cytometry. RESULTS Our findings indicate that supplemental oxygen has an adverse impact on both functional and anatomical evaluations of normal brain following conventional and FLASH proton therapy. In addition, oxygen supplementation in anesthesia is particularly detrimental for anti-tumor immune response by preventing a strong immune cell infiltration into tumoral tissues following conventional proton therapy. CONCLUSIONS These results demonstrate the need to further optimize anesthesia protocols used in radiotherapy with the goal of preserving normal tissues and achieving tumor control, specifically in combination with immunotherapy agents.
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Affiliation(s)
- Lorea Iturri
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Annaïg Bertho
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Charlotte Lamirault
- Translational Research Department, Institut Curie, Experimental Radiotherapy Platform, Université Paris Saclay, Orsay, France
| | | | - Marjorie Juchaux
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Cristèle Gilbert
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Julie Espenon
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Catherine Sébrié
- Service Hospitalier Frederic Joliot, CEA, CNRS, Inserm, BIOMAPS Universite Paris-Saclay, Orsay, France
| | - Laurène Jourdain
- Service Hospitalier Frederic Joliot, CEA, CNRS, Inserm, BIOMAPS Universite Paris-Saclay, Orsay, France
| | - Ludovic de Marzi
- Institut Curie, Université PSL, Université Paris-Saclay, Inserm U1288, Laboratoire de Recherche Translationnelle en Oncologie (LITO), Orsay, France
- Institut Curie, Radiation Oncology Department, Campus universitaire, Orsay, France
| | - Frédéric Pouzoulet
- Translational Research Department, Institut Curie, Experimental Radiotherapy Platform, Université Paris Saclay, Orsay, France
- Institut Curie, Université PSL, Université Paris-Saclay, Inserm U1288, Laboratoire de Recherche Translationnelle en Oncologie (LITO), Orsay, France
| | - Jane Muret
- Institut Curie, Université PSL, Department of Anesthesia and Intensive Care, Paris, France
| | - Pierre Verrelle
- Institut Curie, Radiation Oncology Department, Campus universitaire, Orsay, France
- Institut Curie, Université Paris-Saclay, Inserm U1196, CNRS UMR9187, Chimie et Modélisation pour la Biologie du Cancer (CMBC), Orsay, France
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France.
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France.
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Lozano AI, Álvarez L, García-Abenza A, Guerra C, Kossoski F, Rosado J, Blanco F, Oller JC, Hasan M, Centurion M, Weber T, Slaughter DS, Mootheril DM, Dorn A, Kumar S, Limão-Vieira P, Colmenares R, García G. Electron Scattering from 1-Methyl-5-Nitroimidazole: Cross-Sections for Modeling Electron Transport through Potential Radiosensitizers. Int J Mol Sci 2023; 24:12182. [PMID: 37569557 PMCID: PMC10418670 DOI: 10.3390/ijms241512182] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
In this study, we present a complete set of electron scattering cross-sections from 1-Methyl-5-Nitroimidazole (1M5NI) molecules for impact energies ranging from 0.1 to 1000 eV. This information is relevant to evaluate the potential role of 1M5NI as a molecular radiosensitizers. The total electron scattering cross-sections (TCS) that we previously measured with a magnetically confined electron transmission apparatus were considered as the reference values for the present analysis. Elastic scattering cross-sections were calculated by means of two different schemes: The Schwinger multichannel (SMC) method for the lower energies (below 15 eV) and the independent atom model-based screening-corrected additivity rule with interferences (IAM-SCARI) for higher energies (above 15 eV). The latter was also applied to calculate the total ionization cross-sections, which were complemented with experimental values of the induced cationic fragmentation by electron impact. Double differential ionization cross-sections were measured with a reaction microscope multi-particle coincidence spectrometer. Using a momentum imaging spectrometer, direct measurements of the anion fragment yields and kinetic energies by the dissociative electron attachment are also presented. Cross-sections for the other inelastic channels were derived with a self-consistent procedure by sampling their values at a given energy to ensure that the sum of the cross-sections of all the scattering processes available at that energy coincides with the corresponding TCS. This cross-section data set is ready to be used for modelling electron-induced radiation damage at the molecular level to biologically relevant media containing 1M5NI as a potential radiosensitizer. Nonetheless, a proper evaluation of its radiosensitizing effects would require further radiobiological experiments.
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Affiliation(s)
- Ana I. Lozano
- Instituto de Física Fundamental, Consejo Superior de Investigaciones Científicas-CSIC, Serrano 113-bis, 28006 Madrid, Spain or (A.I.L.); (L.Á.); (A.G.-A.); (C.G.)
- Laboratório de Colisões Atómicas e Moleculares, CEFITEC, Departamento de Física, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal (P.L.-V.)
| | - Lidia Álvarez
- Instituto de Física Fundamental, Consejo Superior de Investigaciones Científicas-CSIC, Serrano 113-bis, 28006 Madrid, Spain or (A.I.L.); (L.Á.); (A.G.-A.); (C.G.)
| | - Adrián García-Abenza
- Instituto de Física Fundamental, Consejo Superior de Investigaciones Científicas-CSIC, Serrano 113-bis, 28006 Madrid, Spain or (A.I.L.); (L.Á.); (A.G.-A.); (C.G.)
| | - Carlos Guerra
- Instituto de Física Fundamental, Consejo Superior de Investigaciones Científicas-CSIC, Serrano 113-bis, 28006 Madrid, Spain or (A.I.L.); (L.Á.); (A.G.-A.); (C.G.)
| | - Fábris Kossoski
- Laboratoire de Chimie et Physique Quantiques (UMR 5626), Université de Toulouse, CNRS, UPS, 31062 Toulouse, France;
| | - Jaime Rosado
- Departamento de Estructura de la Materia, Física Térmica y Electrónica e IPARCOS, Universidad Complutense de Madrid, Avenida Complutense, 28040 Madrid, Spain; (J.R.); (F.B.)
| | - Francisco Blanco
- Departamento de Estructura de la Materia, Física Térmica y Electrónica e IPARCOS, Universidad Complutense de Madrid, Avenida Complutense, 28040 Madrid, Spain; (J.R.); (F.B.)
| | - Juan Carlos Oller
- Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 22, 28040 Madrid, Spain;
| | - Mahmudul Hasan
- Chemical Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA; (M.H.); (T.W.); (D.S.S.)
- Department of Physics and Astronomy, University of Nebraska-Lincoln, Lincoln, NE 68588, USA;
| | - Martin Centurion
- Department of Physics and Astronomy, University of Nebraska-Lincoln, Lincoln, NE 68588, USA;
| | - Thorsten Weber
- Chemical Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA; (M.H.); (T.W.); (D.S.S.)
| | - Daniel S. Slaughter
- Chemical Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA; (M.H.); (T.W.); (D.S.S.)
| | | | - Alexander Dorn
- Max Planck Institute for Nuclear Physics, 69117 Heidelberg, Germany; (D.M.M.)
| | - Sarvesh Kumar
- Laboratório de Colisões Atómicas e Moleculares, CEFITEC, Departamento de Física, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal (P.L.-V.)
- Chemical Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA; (M.H.); (T.W.); (D.S.S.)
| | - Paulo Limão-Vieira
- Laboratório de Colisões Atómicas e Moleculares, CEFITEC, Departamento de Física, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal (P.L.-V.)
| | - Rafael Colmenares
- Servicio de Radiofísica, IRYCIS-Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo Km. 9.100, 28034 Madrid, Spain
| | - Gustavo García
- Instituto de Física Fundamental, Consejo Superior de Investigaciones Científicas-CSIC, Serrano 113-bis, 28006 Madrid, Spain or (A.I.L.); (L.Á.); (A.G.-A.); (C.G.)
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522, Australia
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5
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Colmenares R, Carrión-Marchante R, Martín ME, Salinas Muñoz L, García-Bermejo ML, Oller JC, Muñoz A, Blanco F, Rosado J, Lozano AI, Álvarez S, García-Vicente F, García G. Dependence of Induced Biological Damage on the Energy Distribution and Intensity of Clinical Intra-Operative Radiotherapy Electron Beams. Int J Mol Sci 2023; 24:10816. [PMID: 37445992 DOI: 10.3390/ijms241310816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
The survival fraction of epithelial HaCaT cells was analysed to assess the biological damage caused by intraoperative radiotherapy electron beams with varying energy spectra and intensities. These conditions were achieved by irradiating the cells at different depths in water using nominal 6 MeV electron beams while consistently delivering a dose of 5 Gy to the cell layer. Furthermore, a Monte Carlo simulation of the entire irradiation procedure was performed to evaluate the molecular damage in terms of molecular dissociations induced by the radiation. A significant agreement was found between the molecular damage predicted by the simulation and the damage derived from the analysis of the survival fraction. In both cases, a linear relationship was evident, indicating a clear tendency for increased damage as the averaged incident electron energy and intensity decreased for a constant absorbed dose, lowering the dose rate. This trend suggests that the radiation may have a more pronounced impact on surrounding healthy tissues than initially anticipated. However, it is crucial to conduct additional experiments with different target geometries to confirm this tendency and quantify the extent of this effect.
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Affiliation(s)
- Rafael Colmenares
- Servicio de Radiofísica, IRYCIS-Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo km 9100, 28034 Madrid, Spain
| | - Rebeca Carrión-Marchante
- Grupo de Aptámeros, Departamento de Bioquímica-Investigación, IRYCIS-Hospital Universitario Ramón y Carretera de Colmenar Viejo km 9100, 28034 Madrid, Spain
| | - M Elena Martín
- Grupo de Aptámeros, Departamento de Bioquímica-Investigación, IRYCIS-Hospital Universitario Ramón y Carretera de Colmenar Viejo km 9100, 28034 Madrid, Spain
| | - Laura Salinas Muñoz
- Biomarkers and Therapeutic Targets Group, IRYCIS, RedinREN, Hospital Universitario Ramón y Cajal, Carretera de Colmenar km 9100, 28034 Madrid, Spain
| | - María Laura García-Bermejo
- Biomarkers and Therapeutic Targets Group, IRYCIS, RedinREN, Hospital Universitario Ramón y Cajal, Carretera de Colmenar km 9100, 28034 Madrid, Spain
| | - Juan C Oller
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas-CIEMAT, 28040 Madrid, Spain
| | - Antonio Muñoz
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas-CIEMAT, 28040 Madrid, Spain
| | - Francisco Blanco
- Departamento de Estructura de la Materia, Física Térmica y Electrónica e IPARCOS, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jaime Rosado
- Departamento de Estructura de la Materia, Física Térmica y Electrónica e IPARCOS, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Ana I Lozano
- Instituto de Física Fundamental, Consejo Superior de Investigaciones Científicas, 28006 Madrid, Spain
| | - Sofía Álvarez
- Instituto de Física Fundamental, Consejo Superior de Investigaciones Científicas, 28006 Madrid, Spain
| | - Feliciano García-Vicente
- Servicio de Radiofísica, IRYCIS-Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo km 9100, 28034 Madrid, Spain
| | - Gustavo García
- Instituto de Física Fundamental, Consejo Superior de Investigaciones Científicas, 28006 Madrid, Spain
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522, Australia
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