Radiation injury of boron neutron capture therapy using mixed epithermal- and thermal neutron beams in patients with malignant glioma

The use of radiosensitizing agents in the therapy of glioblastoma multiforme-a comprehensive review

BACKGROUND

Glioblastoma is the most common malignant brain tumor in human adults. Despite several improvements in resective as well as adjuvant therapy over the last decades, its overall prognosis remains poor. As a means of improving patient outcome, the possibility of enhancing radiation response by using radiosensitizing agents has been tested in an array of studies.

METHODS

A comprehensive review of clinical trials involving radiation therapy in combination with radiosensitizing agents on patients diagnosed with glioblastoma was performed in the National Center for Biotechnology Information's PubMed database.

RESULTS

A total of 96 papers addressing this matter were published between 1976 and 2021, of which 63 matched the subject of this paper. All papers were reviewed, and their findings discussed in the context of their underlining mechanisms of radiosensitization.

CONCLUSION

In the history of glioblastoma treatment, several approaches of optimizing radiation-effectiveness using radiosensitizers have been made. Even though several different strategies and agents have been explored, clear evidence of improved patient outcome is still missing. Tissue-selectiveness and penetration of the blood-brain barrier seem to be major roadblocks; nevertheless, modern strategies try to circumvent these obstacles, using novel sensitizers based on preclinical data or alternative ways of delivery.

Modification of the radial beam port of ITU TRIGA Mark II research reactor for BNCT applications

This paper aims to describe the modification of the radial beam port of ITU (İstanbul Technical University) TRIGA Mark II research reactor for BNCT applications. Radial beam port is modified with Polyethylene and Cerrobend collimators. Neutron flux values are measured by neutron activation analysis (Au-Cd foils). Experimental results are verified with Monte Carlo results. The results of neutron/photon spectrum, thermal/epithermal neutron flux, fast group photon fluence and change of the neutron fluxes with the beam port length are presented.

A treatment planning study on glioblastoma with different techniques using boron neutron capture therapy, 3-dimensional conformal radiotherapy, and intensity modulated radiotherapy

To propose adequate indices predicting efficacy of boron neutron capture therapy (BNCT) for glioblastoma, a comparative treatment planning study between BNCT, 3-dimensional conformal radiotherapy (3D-CRT), and intensity-modulated radiotherapy (IMRT) was performed, and dose-volume histograms (DVHs) on planning target volume (PTV) and normal brain were calculated. Therapeutic benefit of BNCT was quantitatively evaluated using conformity indices, which have been previously suggested by radiation therapy oncology group (RTOG) and Saint-Anne, Lariboisière, Tenon (SALT). Although dose homogeneities from the BNCT plans were poor than the other modalities due to simple irradiation fields, lesion coverage factor, CVF, from the BNCT plans were comparable to those from the 3D-CRT and IMRT plans (median values, 0.991, 0.989, and 0.961, respectively). The geometrical factors, g, from the BNCT plans, which describes target volumes receiving doses under the prescribed doses and normal brain volume covered by the prescribed doses, were lowest compared to those for the other modalities (median values, 0.009, 0.115, and 0.043). For the BNCT plans, maximum dose escalation up to 2.080 times the prescribed dose was possible without exceeding normal brain tolerance dose. As the indices can evaluate the quantitative benefit of BNCT and maximum dose escalation for the individual patient, it is expected that the indices can effectively evaluate the treatment plan of BNCT.

Acute effects of fast neutron irradiation on mouse liver

Until now, the multiple biological effects of ionizing radiation on liver have been reported. However, there has not been any reports of fast neutron-mediated liver injuries including liver regeneration or fibrosis. Here, we described the biological effects of acute fast neutron irradiation on the liver. After the fast neutron irradiation of 0, 0.25, 1, 2, 4 and 8 Gy on mice, hepatocyte necrosis and a decrease in the total number of hepatocytes were induced dose-dependently. Binucleated hepatocytes and PCNA positive hepatocytes increased significantly at 0.25 and 1 Gy, but decreased markedly at 2, 4 and 8 Gy. The expression of cytochrome P450 2E1 (CYP2E1) showed a dose-dependent increase after fast neutron irradiation. The activation of p-Smad2/3, signaling intermediates of transforming growth factor-beta (TGF-beta), increased in hepatocytes after exposure of 0.25, 1, and 2 Gy of fast neutrons, but it was not detected in hepatic stellate cells (HSCs). In conclusion, fast neutron-induced liver damages, likely loss of hepatocytes, necrotic foci and vacuolar changes, were note on the dose dependent manner and hepatocellular regeneration were significantly diminished at doses of 2, 4 and 8Gy in a dose-dependent manner. These alterations may at least in part be associated with dose-dependent increase in CYP2E1 and p-Smad2/3. These results show promise as an approach for the treatment of fast neutrons on liver tumors and in the study of pathogenesis regarding the fast neutron-irradiated damages of the liver.