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Prezado Y, Grams M, Jouglar E, Martínez-Rovira I, Ortiz R, Seco J, Chang S. Spatially fractionated radiation therapy: a critical review on current status of clinical and preclinical studies and knowledge gaps. Phys Med Biol 2024; 69:10TR02. [PMID: 38648789 DOI: 10.1088/1361-6560/ad4192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/22/2024] [Indexed: 04/25/2024]
Abstract
Spatially fractionated radiation therapy (SFRT) is a therapeutic approach with the potential to disrupt the classical paradigms of conventional radiation therapy. The high spatial dose modulation in SFRT activates distinct radiobiological mechanisms which lead to a remarkable increase in normal tissue tolerances. Several decades of clinical use and numerous preclinical experiments suggest that SFRT has the potential to increase the therapeutic index, especially in bulky and radioresistant tumors. To unleash the full potential of SFRT a deeper understanding of the underlying biology and its relationship with the complex dosimetry of SFRT is needed. This review provides a critical analysis of the field, discussing not only the main clinical and preclinical findings but also analyzing the main knowledge gaps in a holistic way.
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Affiliation(s)
- Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, F-91400, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, F-91400, Orsay, France
- New Approaches in Radiotherapy Lab, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Instituto de investigación Sanitaria de Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, A Coruña, E-15706, Spain
- Oportunius Program, Galician Agency of Innovation (GAIN), Xunta de Galicia, Santiago de Compostela, A Coruña, Spain
| | - Michael Grams
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America
| | - Emmanuel Jouglar
- Institut Curie, PSL Research University, Department of Radiation Oncology, F-75005, Paris and Orsay Protontherapy Center, F-91400, Orsay, France
| | - Immaculada Martínez-Rovira
- Physics Department, Universitat Auto`noma de Barcelona, E-08193, Cerdanyola del Valle`s (Barcelona), Spain
| | - Ramon Ortiz
- University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero Street, San Francisco, CA 94143, United States of America
| | - Joao Seco
- Division of Biomedical physics in Radiation Oncology, DKFZ-German Cancer Research Center, Heidelberg, Germany
- Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Sha Chang
- Dept of Radiation Oncology and Department of Biomedical Engineering, University of North Carolina School of Medicine, United States of America
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolin State University, United States of America
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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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Dose Profile Modulation of Proton Minibeam for Clinical Application. Cancers (Basel) 2022; 14:cancers14122888. [PMID: 35740553 PMCID: PMC9221247 DOI: 10.3390/cancers14122888] [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: 03/25/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 01/25/2023] Open
Abstract
Simple Summary Proton minibeam radiation therapy (pMBRT) using multislit collimator (MSC) and scatterers has been proposed to spare healthy tissues and organs on the beam path and beyond the Bragg peak. An MSC that was much thicker than the maximum range of the proton beam could provide a sufficiently high peak-to-valley dose ratio at the patient’s skin, and the scatterers could actively convert the spatially fractionated proton beam to a uniform and broad beam in tumors by changing their thickness. The combination of the MSC and the scatterers can be a good solution for implementing pMBRT in clinical proton therapy facilities. Abstract The feasibility of proton minibeam radiation therapy (pMBRT) using a multislit collimator (MSC) and a scattering device was evaluated for clinical use at a clinical proton therapy facility. We fabricated, through Monte Carlo (MC) simulations, not only an MSC with a high peak-to-valley dose ratio (PVDR) at the entrance of the proton beam, to prevent radiation toxicity, but also a scattering device to modulate the PVDR in depth. The slit width and center-to-center distance of the diverging MSC were 2.5 mm and 5.0 mm at the large end, respectively, and its thickness and available field size were 100 mm and 76 × 77.5 mm2, respectively. Spatially fractionated dose distributions were measured at various depths using radiochromic EBT3 films and also tested on bacterial cells. MC simulation showed that the thicker the MSC, the higher the PVDR at the phantom surface. Dosimetric evaluations showed that lateral dose profiles varied according to the scatterer’s thickness, and the depths satisfying PVDR = 1.1 moved toward the surface as their thickness increased. The response of the bacterial cells to the proton minibeams’ depth was also established, in a manner similar to the dosimetric pattern. Conclusively, these results strongly suggest that pMBRT can be implemented in clinical centers by using MSC and scatterers.
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Buonanno M, Gonon G, Pandey BN, Azzam EI. The intercellular communications mediating radiation-induced bystander effects and their relevance to environmental, occupational, and therapeutic exposures. Int J Radiat Biol 2022; 99:964-982. [PMID: 35559659 PMCID: PMC9809126 DOI: 10.1080/09553002.2022.2078006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The assumption that traversal of the cell nucleus by ionizing radiation is a prerequisite to induce genetic damage, or other important biological responses, has been challenged by studies showing that oxidative alterations extend beyond the irradiated cells and occur also in neighboring bystander cells. Cells and tissues outside the radiation field experience significant biochemical and phenotypic changes that are often similar to those observed in the irradiated cells and tissues. With relevance to the assessment of long-term health risks of occupational, environmental and clinical exposures, measurable genetic, epigenetic, and metabolic changes have been also detected in the progeny of bystander cells. How the oxidative damage spreads from the irradiated cells to their neighboring bystander cells has been under intense investigation. Following a brief summary of the trends in radiobiology leading to this paradigm shift in the field, we review key findings of bystander effects induced by low and high doses of various types of radiation that differ in their biophysical characteristics. While notable mechanistic insights continue to emerge, here the focus is on the many means of intercellular communication that mediate these effects, namely junctional channels, secreted molecules and extracellular vesicles, and immune pathways. CONCLUSIONS The insights gained by studying radiation bystander effects are leading to a basic understanding of the intercellular communications that occur under mild and severe oxidative stress in both normal and cancerous tissues. Understanding the mechanisms underlying these communications will likely contribute to reducing the uncertainty of predicting adverse health effects following exposure to low dose/low fluence ionizing radiation, guide novel interventions that mitigate adverse out-of-field effects, and contribute to better outcomes of radiotherapeutic treatments of cancer. In this review, we highlight novel routes of intercellular communication for investigation, and raise the rationale for reconsidering classification of bystander responses, abscopal effects, and expression of genomic instability as non-targeted effects of radiation.
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Affiliation(s)
- Manuela Buonanno
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York, 10032, USA
| | - Géraldine Gonon
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSESANTE/SERAMED/LRAcc, 92262, Fontenay-aux-Roses, France
| | - Badri N. Pandey
- Bhabha Atomic Research Centre, Radiation Biology and Health Sciences Division, Trombay, Mumbai 400 085, India
| | - Edouard I. Azzam
- Radiobiology and Health Branch, Isotopes, Radiobiology & Environment Directorate (IRED), Canadian Nuclear Laboratories (CNL), Chalk River, ON K0J 1J0, Canada
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
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Ortiz R, De Marzi L, Prezado Y. Preclinical dosimetry in proton minibeam radiation therapy: robustness analysis and guidelines. Med Phys 2022; 49:5551-5561. [PMID: 35621386 PMCID: PMC9544651 DOI: 10.1002/mp.15780] [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: 02/24/2022] [Revised: 05/03/2022] [Accepted: 05/22/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Proton minibeam radiation therapy (pMBRT) is a new radiotherapy approach that has shown a significant increase in the therapeutic window in glioma‐bearing rats compared to conventional proton therapy. The dosimetry of pMBRT is challenging and error prone due to the submillimetric beamlet sizes used. The aim of this study was to perform a robustness analysis on the setup parameters utilized in current preclinical trials and provide guidelines for reproducible dosimetry. The results of this work are intended to guide upcoming implementations of pMBRT worldwide, as well as pave the way for future clinical implementations. Methods Monte Carlo simulations and experimental data were used to evaluate the impact of variations in setup parameters and uncertainties in collimator specifications on lateral pMBRT dose distributions. The value of each parameter was modified individually to evaluate their effect on dose distributions. Experimental dosimetry was performed by means of high‐resolution detectors, that is, radiochromic films, the IBA Razor and the Microdiamond detector. New guidelines were proposed to optimize the experimental setup in pMBRT studies and perform reproducible dosimetry. Results The sensitivity of dose distributions to uncertainties and variations in setup parameters was quantified. Quantities that define pMBRT lateral profiles (i.e., the peak‐to‐valley dose ratio [PVDR], peak and valley doses, and peak width) are significantly influenced by small‐scale fluctuations in several of those parameters. The setup implemented at the Orsay proton therapy center for pMBRT irradiation was optimized to increase PVDRs and peak symmetry. In addition, we proposed guidelines to perform accurate and reproducible dosimetry in preclinical studies. Conclusions This study revealed the importance of adopting guidelines and protocols tailored to the distinct dose delivery method and dose distributions in pMBRT. This new methodology leads to reproducible dosimetry, which is imperative in preclinical trials. The results and guidelines presented in this manuscript can ease the initiation of pMBRT investigations in other centers.
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Affiliation(s)
- Ramon Ortiz
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, 91400, France.,Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, 91400, France
| | - Ludovic De Marzi
- Centre de Protonthérapie d'Orsay, Radiation Oncology Department, Campus Universitaire, Institut Curie, PSL Research University, Orsay, 91898, France.,Institut Curie, Campus Universitaire, PSL Research University, University Paris Saclay, INSERM LITO, Orsay, 91898, France
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, 91400, France.,Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, 91400, France
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6
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Scherthan H, Wagner SQ, Grundhöfer J, Matejka N, Müller J, Müller S, Rudigkeit S, Sammer M, Schoof S, Port M, Reindl J. Planar Proton Minibeam Irradiation Elicits Spatially Confined DNA Damage in a Human Epidermis Model. Cancers (Basel) 2022; 14:cancers14061545. [PMID: 35326696 PMCID: PMC8946044 DOI: 10.3390/cancers14061545] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose: High doses of ionizing radiation in radiotherapy can elicit undesirable side effects to the skin. Proton minibeam radiotherapy (pMBRT) may circumvent such limitations due to tissue-sparing effects observed at the macro scale. Here, we mapped DNA damage dynamics in a 3D tissue context at the sub-cellular level. Methods: Epidermis models were irradiated with planar proton minibeams of 66 µm, 408 µm and 920 µm widths and inter-beam-distances of 2.5 mm at an average dose of 2 Gy using the scanning-ion-microscope SNAKE in Garching, GER. γ-H2AX + 53BP1 and cleaved-caspase-3 immunostaining revealed dsDNA damage and cell death, respectively, in time courses from 0.5 to 72 h after irradiation. Results: Focused 66 µm pMBRT induced sharply localized severe DNA damage (pan-γ-H2AX) in cells at the dose peaks, while damage in the dose valleys was similar to sham control. pMBRT with 408 µm and 920 µm minibeams induced DSB foci in all cells. At 72 h after irradiation, DNA damage had reached sham levels, indicating successful DNA repair. Increased frequencies of active-caspase-3 and pan-γ-H2AX-positive cells revealed incipient cell death at late time points. Conclusions: The spatially confined distribution of DNA damage appears to underlie the tissue-sparing effect after focused pMBRT. Thus, pMBRT may be the method of choice in radiotherapy to reduce side effects to the skin.
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Affiliation(s)
- Harry Scherthan
- Institut für Radiobiologie der Bundeswehr in Verb. mit der Universität Ulm, Neuherbergstr. 11, 80937 München, Germany; (S.-Q.W.); (J.M.); (S.M.); (S.S.); (M.P.)
- Correspondence: (H.S.); (J.R.)
| | - Stephanie-Quinta Wagner
- Institut für Radiobiologie der Bundeswehr in Verb. mit der Universität Ulm, Neuherbergstr. 11, 80937 München, Germany; (S.-Q.W.); (J.M.); (S.M.); (S.S.); (M.P.)
| | - Jan Grundhöfer
- Angewandte Physik und Messtechnik, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, 85577 Neubiberg, Germany; (N.M.); (J.G.); (S.R.); (M.S.)
| | - Nicole Matejka
- Angewandte Physik und Messtechnik, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, 85577 Neubiberg, Germany; (N.M.); (J.G.); (S.R.); (M.S.)
| | - Jessica Müller
- Institut für Radiobiologie der Bundeswehr in Verb. mit der Universität Ulm, Neuherbergstr. 11, 80937 München, Germany; (S.-Q.W.); (J.M.); (S.M.); (S.S.); (M.P.)
| | - Steffen Müller
- Institut für Radiobiologie der Bundeswehr in Verb. mit der Universität Ulm, Neuherbergstr. 11, 80937 München, Germany; (S.-Q.W.); (J.M.); (S.M.); (S.S.); (M.P.)
| | - Sarah Rudigkeit
- Angewandte Physik und Messtechnik, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, 85577 Neubiberg, Germany; (N.M.); (J.G.); (S.R.); (M.S.)
| | - Matthias Sammer
- Angewandte Physik und Messtechnik, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, 85577 Neubiberg, Germany; (N.M.); (J.G.); (S.R.); (M.S.)
| | - Sarah Schoof
- Institut für Radiobiologie der Bundeswehr in Verb. mit der Universität Ulm, Neuherbergstr. 11, 80937 München, Germany; (S.-Q.W.); (J.M.); (S.M.); (S.S.); (M.P.)
| | - Matthias Port
- Institut für Radiobiologie der Bundeswehr in Verb. mit der Universität Ulm, Neuherbergstr. 11, 80937 München, Germany; (S.-Q.W.); (J.M.); (S.M.); (S.S.); (M.P.)
| | - Judith Reindl
- Angewandte Physik und Messtechnik, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, 85577 Neubiberg, Germany; (N.M.); (J.G.); (S.R.); (M.S.)
- Correspondence: (H.S.); (J.R.)
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Non-Targeted Effects of Synchrotron Radiation: Lessons from Experiments at the Australian and European Synchrotrons. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12042079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Studies have been conducted at synchrotron facilities in Europe and Australia to explore a variety of applications of synchrotron X-rays in medicine and biology. We discuss the major technical aspects of the synchrotron irradiation setups, paying specific attention to the Australian Synchrotron (AS) and the European Synchrotron Radiation Facility (ESRF) as those best configured for a wide range of biomedical research involving animals and future cancer patients. Due to ultra-high dose rates, treatment doses can be delivered within milliseconds, abiding by FLASH radiotherapy principles. In addition, a homogeneous radiation field can be spatially fractionated into a geometric pattern called microbeam radiotherapy (MRT); a coplanar array of thin beams of microscopic dimensions. Both are clinically promising radiotherapy modalities because they trigger a cascade of biological effects that improve tumor control, while increasing normal tissue tolerance compared to conventional radiation. Synchrotrons can deliver high doses to a very small volume with low beam divergence, thus facilitating the study of non-targeted effects of these novel radiation modalities in both in-vitro and in-vivo models. Non-targeted radiation effects studied at the AS and ESRF include monitoring cell–cell communication after partial irradiation of a cell population (radiation-induced bystander effect, RIBE), the response of tissues outside the irradiated field (radiation-induced abscopal effect, RIAE), and the influence of irradiated animals on non-irradiated ones in close proximity (inter-animal RIBE). Here we provide a summary of these experiments and perspectives on their implications for non-targeted effects in biomedical fields.
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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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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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Wright MD, Romanelli P, Bravin A, Le Duc G, Brauer-Krisch E, Requardt H, Bartzsch S, Hlushchuk R, Laissue JA, Djonov V. Non-conventional Ultra-High Dose Rate (FLASH) Microbeam Radiotherapy Provides Superior Normal Tissue Sparing in Rat Lung Compared to Non-conventional Ultra-High Dose Rate (FLASH) Radiotherapy. Cureus 2021; 13:e19317. [PMID: 35223216 PMCID: PMC8864723 DOI: 10.7759/cureus.19317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 12/12/2022] Open
Abstract
Conventional radiotherapy is a widely used non-invasive form of treatment for many types of cancer. However, due to a low threshold in the lung for radiation-induced normal tissue damage, it is of less utility in treating lung cancer. For this reason, surgery is the preferred treatment for lung cancer, which has the detriment of being highly invasive. Non-conventional ultra-high dose rate (FLASH) radiotherapy is currently of great interest in the radiotherapy community due to demonstrations of reduced normal tissue toxicity in lung and other anatomy. This study investigates the effects of FLASH microbeam radiotherapy, which in addition to ultra-high dose rate incorporates a spatial segmentation of the radiation field, on the normal lung tissue of rats. With a focus on fibrotic damage, this work demonstrates that FLASH microbeam radiotherapy provides an order of magnitude increase in normal tissue radio-resistance compared to FLASH radiotherapy. This result suggests FLASH microbeam radiotherapy holds promise for much improved non-invasive control of lung cancer.
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Affiliation(s)
- Michael D Wright
- Ginzton Technology Center, Varian Medical Systems, Palo Alto, USA.,Research & Development Center, Avail Medical Devices, Roseville, USA
| | | | - Alberto Bravin
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, FRA
| | - Geraldine Le Duc
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, FRA.,Pharmaceutics, NH TherAguix, Lyon, FRA
| | - Elke Brauer-Krisch
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, FRA
| | - Herwig Requardt
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, FRA
| | - Stefan Bartzsch
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Munich, DEU.,Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, DEU
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11
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Fukunaga H. Stem Cell Migration: A Possible Mechanism for the Tissue-Sparing Effect of Spatially Fractionated Radiation. Radiat Res 2021; 196:680-685. [PMID: 34496025 DOI: 10.1667/rade-21-00134.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/17/2021] [Indexed: 11/03/2022]
Abstract
Stem cell responses in tissues after exposure to radiation are of significance for maintaining tissue functions. From the point of view of stem cell characteristics, this article seeks to illustrate some contributions of microbeam research to spatially fractionated radiotherapy (SFRT), such as grid radiotherapy and microbeam radiotherapy. Although the tissue-sparing response after SFRT was first reported more than a century ago, current radiation dose-volume metrics are still unable to accurately predict such tissue-level changes in response to spatially fractionated radiation fields. However, microbeam approaches could contribute to uncovering the mechanisms of tissue response, significantly improving the outcomes of SFRT and reducing its adverse effects. Studies with microbeams have shown that the testicular tissue-sparing effect for maintaining spermatogenesis after exposure to spatially fractionated radiation depends on biological parameters, such as the radiation dose distribution at the microscale level for tissue-specific stem cells and the microenvironment, or niche. This indicates that stem cell survival, migration, and repopulation are involved in the tissue-level changes during or after SFRT. The illustration of microbeam applications in this article focuses on the stem cell migration as a possible mechanism of the tissue-sparing effect for preserving functionality.
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Affiliation(s)
- Hisanori Fukunaga
- Center for Environmental and Health Sciences, Hokkaido University, N12 W7 Kita-ku, Sapporo 060-0812, Japan
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12
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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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13
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Lobachevsky P, Forrester HB, Ivashkevich A, Mason J, Stevenson AW, Hall CJ, Sprung CN, Djonov VG, Martin OA. Synchrotron X-Ray Radiation-Induced Bystander Effect: An Impact of the Scattered Radiation, Distance From the Irradiated Site and p53 Cell Status. Front Oncol 2021; 11:685598. [PMID: 34094987 PMCID: PMC8175890 DOI: 10.3389/fonc.2021.685598] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
Synchrotron radiation, especially microbeam radiotherapy (MRT), has a great potential to improve cancer radiotherapy, but non-targeted effects of synchrotron radiation have not yet been sufficiently explored. We have previously demonstrated that scattered synchrotron radiation induces measurable γ-H2AX foci, a biomarker of DNA double-strand breaks, at biologically relevant distances from the irradiated field that could contribute to the apparent accumulation of bystander DNA damage detected in cells and tissues outside of the irradiated area. Here, we quantified an impact of scattered radiation to DNA damage response in "naïve" cells sharing the medium with the cells that were exposed to synchrotron radiation. To understand the effect of genetic alterations in naïve cells, we utilised p53-null and p53-wild-type human colon cancer cells HCT116. The cells were grown in two-well chamber slides, with only one of nine zones (of equal area) of one well irradiated with broad beam or MRT. γ-H2AX foci per cell values induced by scattered radiation in selected zones of the unirradiated well were compared to the commensurate values from selected zones in the irradiated well, with matching distances from the irradiated zone. Scattered radiation highly impacted the DNA damage response in both wells and a pronounced distance-independent bystander DNA damage was generated by broad-beam irradiations, while MRT-generated bystander response was negligible. For p53-null cells, a trend for a reduced response to scattered irradiation was observed, but not to bystander signalling. These results will be taken into account for the assessment of genotoxic effects in surrounding non-targeted tissues in preclinical experiments designed to optimise conditions for clinical MRT and for cancer treatment in patients.
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Affiliation(s)
- Pavel Lobachevsky
- Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Advanced Analytical Technologies, Melbourne, VIC, Australia
| | - Helen B Forrester
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia.,School of Science, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC, Australia
| | - Alesia Ivashkevich
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Therapeutic Goods Administration, Canberra, ACT, Australia
| | - Joel Mason
- Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Andrew W Stevenson
- Commonwealth Scientific and Industrial Organisation (CSIRO) Future Industries, Clayton, VIC, Australia.,Australian Nuclear Science and Technology Organisation (ANSTO)/Australian Synchrotron, Clayton, VIC, Australia
| | - Chris J Hall
- Australian Nuclear Science and Technology Organisation (ANSTO)/Australian Synchrotron, Clayton, VIC, Australia
| | - Carl N Sprung
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia
| | | | - Olga A Martin
- Institute of Anatomy, University of Bern, Bern, Switzerland.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
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14
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Prezado Y, Hirayama R, Matsufuji N, Inaniwa T, Martínez-Rovira I, Seksek O, Bertho A, Koike S, Labiod D, Pouzoulet F, Polledo L, Warfving N, Liens A, Bergs J, Shimokawa T. A Potential Renewed Use of Very Heavy Ions for Therapy: Neon Minibeam Radiation Therapy. Cancers (Basel) 2021; 13:cancers13061356. [PMID: 33802835 PMCID: PMC8002595 DOI: 10.3390/cancers13061356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 01/13/2023] Open
Abstract
Simple Summary The treatment of hypoxic tumours continues to be one of the main challenges for radiation therapy. Minibeam radiation therapy (MBRT) shows a highly promising reduction of to-xicity in normal tissue, so that very heavy ions, such as Neon (Ne) or Argon (Ar), with extremely high LET, might become applicable to clinical situations. The high LET in the target would be unrivalled to overcome hypoxia, while MBRT might limit the side effects normally preventing the use of those heavy ions in a conventional radiotherapeutic setting. The work reported in this manuscript is the first experimental proof of the remarkable reduction of normal tissue (skin) toxicities after Ne MBRT irradiations as compared to conventional Ne irradiations. This result might allow for a renewed use of very heavy ions for cancer therapy. Abstract (1) Background: among all types of radiation, very heavy ions, such as Neon (Ne) or Argon (Ar), are the optimum candidates for hypoxic tumor treatments due to their reduced oxygen enhancement effect. However, their pioneering clinical use in the 1970s was halted due to severe side effects. The aim of this work was to provide a first proof that the combination of very heavy ions with minibeam radiation therapy leads to a minimization of toxicities and, thus, opening the door for a renewed use of heavy ions for therapy; (2) Methods: mouse legs were irradiated with either Ne MBRT or Ne broad beams at the same average dose. Skin toxicity was scored for a period of four weeks. Histopathology evaluations were carried out at the end of the study; (3) Results: a significant difference in toxicity was observed between the two irradiated groups. While severe da-mage, including necrosis, was observed in the broad beam group, only light to mild erythema was present in the MBRT group; (4) Conclusion: Ne MBRT is significantly better tolerated than conventional broad beam irradiations.
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Affiliation(s)
- 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
- Correspondence:
| | - Ryochi Hirayama
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (R.H.); (N.M.); (T.I.); (S.K.); (T.S.)
| | - Naruhiro Matsufuji
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (R.H.); (N.M.); (T.I.); (S.K.); (T.S.)
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Taku Inaniwa
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (R.H.); (N.M.); (T.I.); (S.K.); (T.S.)
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Immaculada Martínez-Rovira
- Ionizing Radiation Research Group, Physics Department, Universitat Autònoma de Barcelona (UAB), E-08193 Cerdanyola del Vallès, Spain;
| | - Olivier Seksek
- Université Paris-Saclay, CNRS/IN2P3, Université de Paris, IJCLab, Pole Santé, 91405 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
| | - Sachiko Koike
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (R.H.); (N.M.); (T.I.); (S.K.); (T.S.)
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Dalila Labiod
- Experimental Radiotherapy Platform, Translational Research Department, Institut Curie, Université Paris Saclay, 91400 Orsay, France; (D.L.); (F.P.)
| | - Frederic Pouzoulet
- Experimental Radiotherapy Platform, Translational Research Department, Institut Curie, Université Paris Saclay, 91400 Orsay, France; (D.L.); (F.P.)
| | - Laura Polledo
- AnaPath Services GmbH, Hammerstrasse 49, 4410 Liestal, Switzerland; (L.P.); (N.W.); (A.L.)
| | - Nils Warfving
- AnaPath Services GmbH, Hammerstrasse 49, 4410 Liestal, Switzerland; (L.P.); (N.W.); (A.L.)
| | - Aléthéa Liens
- AnaPath Services GmbH, Hammerstrasse 49, 4410 Liestal, Switzerland; (L.P.); (N.W.); (A.L.)
| | - Judith Bergs
- Department of Radiology Charité—Universitätsmedizin Berlin, CCM Charitéplatz 1, 10117 Berlin, Germany;
| | - Takashi Shimokawa
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (R.H.); (N.M.); (T.I.); (S.K.); (T.S.)
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
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15
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Lamirault C, Brisebard E, Patriarca A, Juchaux M, Crepin D, Labiod D, Pouzoulet F, Sebrie C, Jourdain L, Le Dudal M, Hardy D, De Marzi L, Dendale R, Jouvion G, Prezado Y. Spatially Modulated Proton Minibeams Results in the Same Increase of Lifespan as a Uniform Target Dose Coverage in F98-Glioma-Bearing Rats. Radiat Res 2021; 194:715-723. [PMID: 32991712 DOI: 10.1667/rade-19-00013.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 08/14/2020] [Indexed: 11/03/2022]
Abstract
Proton minibeam radiation therapy (pMBRT) is a new approach in proton radiotherapy, by which a significant increase in the therapeutic index has already been demonstrated in RG2 glioma-bearing rats. In the current study we investigated the response of other types of glioma (F98) and performed a comparative evaluation of tumor control effectiveness by pMBRT (with different levels of dose heterogeneity) versus conventional proton therapy. The results of our study showed an equivalent increase in the lifespan for all evaluated groups (conventional proton irradiation and pMBRT) and no significant differences in the histopathological analysis of the tumors or remaining brain tissue. The reduced long-term toxicity observed with pMBRT in previous evaluations at the same dose suggests a possible use of pMBRT to treat glioma with less side effects while ensuring the same tumor control achieved with standard proton therapy.
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Affiliation(s)
- Charlotte Lamirault
- Laboratoire Imagerie et Modelisation pour la Neurobiologie et la Cancerologie, CNRS-Paris 7-Paris 11, Campus d'Orsay, France
| | - Elise Brisebard
- Department of Global Health, Experimental Neuropathology Unit, Institut Pasteur, 75015 Paris, France.,Laboratoire d'Histopathologie, VetAgro-Sup, Université de Lyon, Marcy l'Etoile, Lyon, France
| | - Annalisa Patriarca
- Radiation Oncology Department, Centre de Protonthérapie d'Orsay, University Paris Saclay, Orsay, France
| | - Marjorie Juchaux
- Laboratoire Imagerie et Modelisation pour la Neurobiologie et la Cancerologie, CNRS-Paris 7-Paris 11, Campus d'Orsay, France
| | - Delphine Crepin
- Laboratoire Imagerie et Modelisation pour la Neurobiologie et la Cancerologie, CNRS-Paris 7-Paris 11, Campus d'Orsay, France
| | - Dalila Labiod
- Experimental Radiotherapy Platform Institut Curie, University Paris Saclay, Orsay, France
| | - Frederic Pouzoulet
- Experimental Radiotherapy Platform Institut Curie, University Paris Saclay, Orsay, France
| | - Catherine Sebrie
- BioMaps, Université Paris-Saclay, CEA, CNRS, Inserm,Service Hospitalier Frédéric Joliot, 91401 Orsay, France
| | - Laurene Jourdain
- BioMaps, Université Paris-Saclay, CEA, CNRS, Inserm,Service Hospitalier Frédéric Joliot, 91401 Orsay, France
| | - Marine Le Dudal
- Department of Global Health, Experimental Neuropathology Unit, Institut Pasteur, 75015 Paris, France.,Histologie, Embryologie et Anatomie Pathologique, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France
| | - David Hardy
- Department of Global Health, Experimental Neuropathology Unit, Institut Pasteur, 75015 Paris, France
| | - Ludovic De Marzi
- Radiation Oncology Department, Centre de Protonthérapie d'Orsay, University Paris Saclay, Orsay, France.,Institut Curie, University Paris Saclay, PSL Research University, Inserm U 1021-CNRS UMR 3347, Orsay, France
| | - Remi Dendale
- Radiation Oncology Department, Centre de Protonthérapie d'Orsay, University Paris Saclay, Orsay, France
| | - Gregory Jouvion
- Department of Global Health, Experimental Neuropathology Unit, Institut Pasteur, 75015 Paris, France.,Sorbonne Université, INSERM, Pathophysiology of Pediatric Genetic Diseases, Assistance Publique - Hôpitaux de Paris, Hôpital Armand-Trousseau, UF Génétique Moléculaire, Paris, France
| | - Yolanda Prezado
- Institut Curie, University Paris Saclay, PSL Research University, Inserm U 1021-CNRS UMR 3347, Orsay, France
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16
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Fukunaga H, Kaminaga K, Sato T, Butterworth KT, Watanabe R, Usami N, Ogawa T, Yokoya A, Prise KM. Spatially Fractionated Microbeam Analysis of Tissue-sparing Effect for Spermatogenesis. Radiat Res 2021; 194:698-706. [PMID: 33348374 DOI: 10.1667/rade-19-00018.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/18/2020] [Indexed: 11/03/2022]
Abstract
Spatially fractionated radiation therapy (SFRT) has been based on the delivery of a single high-dose fraction to a large treatment area that has been divided into several smaller fields, reducing the overall toxicity and adverse effects. Complementary microbeam studies have also shown an effective tissue-sparing effect (TSE) in various tissue types and species after spatially fractionated irradiation at the microscale level; however, the underlying biological mechanism remains elusive. In the current study, using the combination of an ex vivo mouse spermatogenesis model and high-precision X-ray microbeams, we revealed the significant TSE for maintaining spermatogenesis after spatially fractionated microbeam irradiation. We used the following ratios of the irradiated to nonirradiated areas: 50:50, 150:50 and 350:50 µm-slit, where approximately 50, 75 and 87.5% of the sample was irradiated (using center-to-center distances of 100, 200 and 400 µm, respectively). We found that the 50 and 75% micro-slit irradiated testicular tissues showed an almost unadulterated TSE for spermatogenesis, whereas the 87.5% micro-slit irradiated tissues showed an incomplete TSE. This suggests that the TSE efficiency for spermatogenesis is dependent on the size of the nonirradiated spermatogonial stem cell pool in the irradiated testicular tissues. In addition, there would be a spatiotemporal limitation of stem cell migration/competition, resulting in the insufficient TSE for 87.5% micro-slit irradiated tissues. These stem cell characteristics are essential for the accurate prediction of tissue-level responses during or after SFRT, indicating the clinical potential for achieving better outcomes while preventing adverse effects.
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Affiliation(s)
- Hisanori Fukunaga
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast BT9 7AE, United Kingdom.,Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Kiichi Kaminaga
- Institute for Quantum Life Science, National Institutes for Quantum and Radiological Science and Technology (QST), Tokai 319-1106, Japan
| | - Takuya Sato
- Institute of Molecular Medicine and Life Science, Yokohama City University Association of Medical Science, Yokohama 236-0004, Japan
| | - Karl T Butterworth
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast BT9 7AE, United Kingdom
| | - Ritsuko Watanabe
- Institute for Quantum Life Science, National Institutes for Quantum and Radiological Science and Technology (QST), Tokai 319-1106, Japan
| | - Noriko Usami
- Photon Factory, High Energy Accelerator Research Organization, Tsukuba 305-0801, Japan
| | - Takehiko Ogawa
- Institute of Molecular Medicine and Life Science, Yokohama City University Association of Medical Science, Yokohama 236-0004, Japan
| | - Akinari Yokoya
- Institute for Quantum Life Science, National Institutes for Quantum and Radiological Science and Technology (QST), Tokai 319-1106, Japan
| | - Kevin M Prise
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast BT9 7AE, United Kingdom
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17
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Day LRJ, Donzelli M, Pellicioli P, Smyth LML, Barnes M, Bartzsch S, Crosbie JC. A commercial treatment planning system with a hybrid dose calculation algorithm for synchrotron radiotherapy trials. Phys Med Biol 2021; 66:055016. [PMID: 33373979 DOI: 10.1088/1361-6560/abd737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Synchrotron Radiotherapy (SyncRT) is a preclinical radiation treatment which delivers synchrotron x-rays to cancer targets. SyncRT allows for novel treatments such as Microbeam Radiotherapy, which has been shown to have exceptional healthy tissue sparing capabilities while maintaining good tumour control. Veterinary trials in SyncRT are anticipated to take place in the near future at the Australian Synchrotron's Imaging and Medical Beamline (IMBL). However, before veterinary trials can commence, a computerised treatment planning system (TPS) is required, which can quickly and accurately calculate the synchrotron x-ray dose through patient CT images. Furthermore, SyncRT TPS's must be familiar and intuitive to radiotherapy planners in order to alleviate necessary training and reduce user error. We have paired an accurate and fast Monte Carlo (MC) based SyncRT dose calculation algorithm with EclipseTM, the most widely implemented commercial TPS in the clinic. Using EclipseTM, we have performed preliminary SyncRT trials on dog cadavers at the IMBL, and verified calculated doses against dosimetric measurement to within 5% for heterogeneous tissue-equivalent phantoms. We have also performed a validation of the TPS against a full MC simulation for constructed heterogeneous phantoms in EclipseTM, and showed good agreement for a range of water-like tissues to within 5%-8%. Our custom EclipseTM TPS for SyncRT is ready to perform live veterinary trials at the IMBL.
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Affiliation(s)
- L R J Day
- School of Science, RMIT University, Melbourne, Australia
| | - M Donzelli
- The European Synchrotron Radiation Facility, ID17 Biomedical Beamline, Grenoble, France.,Institute of Cancer Research, London, United Kingdom
| | - P Pellicioli
- The European Synchrotron Radiation Facility, ID17 Biomedical Beamline, Grenoble, France.,Inserm UA7 STROBE, Grenoble Alps University, Grenoble, France.,Swansea University Medical School, Singleton Park, Swansea, United Kingdom
| | - L M L Smyth
- Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia
| | - M Barnes
- School of Science, RMIT University, Melbourne, Australia.,Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia.,The Australian Synchrotron, Imaging and Medical Beamline, Melbourne, Australia
| | - S Bartzsch
- Institute of Cancer Research, London, United Kingdom.,Technical University of Munich, Munich, Germany
| | - J C Crosbie
- School of Science, RMIT University, Melbourne, Australia
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18
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The Effect of Low Temperatures on Environmental Radiation Damage in Living Systems: Does Hypothermia Show Promise for Space Travel? Int J Mol Sci 2020; 21:ijms21176349. [PMID: 32882991 PMCID: PMC7504535 DOI: 10.3390/ijms21176349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/23/2022] Open
Abstract
Low-temperature treatments (i.e., hypothermia) may be one way of regulating environmental radiation damage in living systems. With this in mind, hibernation under hypothermic conditions has been proposed as a useful approach for long-term human space flight. However, the underlying mechanisms of hypothermia-induced radioresistance are as yet undetermined, and the conventional risk assessment of radiation exposure during hibernation remains insufficient for estimating the effects of chronic exposure to galactic cosmic rays (GCRs). To promote scientific discussions on the application of hibernation in space travel, this literature review provides an overview of the progress to date in the interdisciplinary research field of radiation biology and hypothermia and addresses possible issues related to hypothermic treatments as countermeasures against GCRs. At present, there are concerns about the potential effects of chronic radiation exposure on neurological disorders, carcinogenesis, ischemia heat failures, and infertility in astronauts; these require further study. These concerns may be resolved by comparing and integrating data gleaned from experimental and epidemiological studies.
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19
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Sammer M, Dombrowsky AC, Schauer J, Oleksenko K, Bicher S, Schwarz B, Rudigkeit S, Matejka N, Reindl J, Bartzsch S, Blutke A, Feuchtinger A, Combs SE, Dollinger G, Schmid TE. Normal Tissue Response of Combined Temporal and Spatial Fractionation in Proton Minibeam Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 109:76-83. [PMID: 32805301 DOI: 10.1016/j.ijrobp.2020.08.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Proton minibeam radiation therapy, a spatial fractionation concept, widens the therapeutic window. By reducing normal tissue toxicities, it allows a temporally fractionated regime with high daily doses. However, an array shift between daily fractions can affect the tissue-sparing effect by decreasing the total peak-to-valley dose ratio. Therefore, combining temporal fractions with spatial fractionation raises questions about the impact of daily applied dose modulations, reirradiation accuracies, and total dose modulations. METHODS AND MATERIALS Healthy mouse ear pinnae were irradiated with 4 daily fractions of 30 Gy mean dose, applying proton pencil minibeams (pMB) of Gaussian σ = 222 μm in 3 different schemes: a 16 pMB array with a center-to-center distance of 1.8 mm irradiated the same position in all sessions (FS1) or was shifted by 0.9 mm to never hit the previously irradiated tissue in each session (FS2), or a 64 pMB array with a center-to-center distance of 0.9 mm irradiated the same position in all sessions (FS3), resulting in the same total dose distribution as FS2. Reirradiation positioning and its accuracy were obtained from image guidance using the unique vessel structure of ears. Acute toxicities (swelling, erythema, and desquamation) were evaluated for 153 days after the first fraction. Late toxicities (fibrous tissue, inflammation) were analyzed on day 153. RESULTS Reirradiation of highly dose-modulated arrays at a positioning accuracy of 110 ± 52 μm induced the least severe acute and late toxicities. A shift of the same array in FS2 led to significantly inducted acute toxicities, a higher otitis score, and a slight increase in fibrous tissue. FS3 led to the strongest increase in acute and late toxicities. CONCLUSIONS The highest normal-tissue sparing is achieved after accurate reirradiation of a highly dose modulated pMB array, although high positioning accuracies are challenging in a clinical environment. Nevertheless, the same integral dose applied in highly dose-modulated fractions is superior to low daily dose-modulated fractions.
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Affiliation(s)
- Matthias Sammer
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Annique C Dombrowsky
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, Neuherberg, Germany; Department of Radiation Oncology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany.
| | - Jannis Schauer
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Kateryna Oleksenko
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, Neuherberg, Germany
| | - Sandra Bicher
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, Neuherberg, Germany; Department of Radiation Oncology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Benjamin Schwarz
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Sarah Rudigkeit
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Nicole Matejka
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Judith Reindl
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Stefan Bartzsch
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, Neuherberg, Germany; Department of Radiation Oncology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Andreas Blutke
- Research Unit Analytical Pathology, Helmholtz Zentrum München GmbH, Neuherberg, Germany
| | - Annette Feuchtinger
- Research Unit Analytical Pathology, Helmholtz Zentrum München GmbH, Neuherberg, Germany
| | - Stephanie E Combs
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, Neuherberg, Germany; Department of Radiation Oncology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Günther Dollinger
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Thomas E Schmid
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, Neuherberg, Germany; Department of Radiation Oncology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany
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20
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Burger K, Urban T, Dombrowsky AC, Dierolf M, Günther B, Bartzsch S, Achterhold K, Combs SE, Schmid TE, Wilkens JJ, Pfeiffer F. Technical and dosimetric realization of in vivo x-ray microbeam irradiations at the Munich Compact Light Source. Med Phys 2020; 47:5183-5193. [PMID: 32757280 DOI: 10.1002/mp.14433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/15/2020] [Accepted: 07/20/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE X-ray microbeam radiation therapy is a preclinical concept for tumor treatment promising tissue sparing and enhanced tumor control. With its spatially separated, periodic micrometer-sized pattern, this method requires a high dose rate and a collimated beam typically available at large synchrotron radiation facilities. To treat small animals with microbeams in a laboratory-sized environment, we developed a dedicated irradiation system at the Munich Compact Light Source (MuCLS). METHODS A specially made beam collimation optic allows to increase x-ray fluence rate at the position of the target. Monte Carlo simulations and measurements were conducted for accurate microbeam dosimetry. The dose during irradiation is determined by a calibrated flux monitoring system. Moreover, a positioning system including mouse monitoring was built. RESULTS We successfully commissioned the in vivo microbeam irradiation system for an exemplary xenograft tumor model in the mouse ear. By beam collimation, a dose rate of up to 5.3 Gy/min at 25 keV was achieved. Microbeam irradiations using a tungsten collimator with 50 μm slit size and 350 μm center-to-center spacing were performed at a mean dose rate of 0.6 Gy/min showing a high peak-to-valley dose ratio of about 200 in the mouse ear. The maximum circular field size of 3.5 mm in diameter can be enlarged using field patching. CONCLUSIONS This study shows that we can perform in vivo microbeam experiments at the MuCLS with a dedicated dosimetry and positioning system to advance this promising radiation therapy method at commercially available compact microbeam sources. Peak doses of up to 100 Gy per treatment seem feasible considering a recent upgrade for higher photon flux. The system can be adapted for tumor treatment in different animal models, for example, in the hind leg.
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Affiliation(s)
- Karin Burger
- Department of Radiation Oncology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.,Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, 85748, Germany
| | - Theresa Urban
- Department of Radiation Oncology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.,Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, 85748, Germany
| | - Annique C Dombrowsky
- Department of Radiation Oncology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.,Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, 85764, Germany
| | - Martin Dierolf
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, 85748, Germany
| | - Benedikt Günther
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, 85748, Germany
| | - Stefan Bartzsch
- Department of Radiation Oncology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.,Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, 85764, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, 85748, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.,Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, 85764, Germany
| | - Thomas E Schmid
- Department of Radiation Oncology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.,Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, 85764, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.,Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, 85748, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, 85748, Germany.,Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, München, 81675, Germany
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21
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Dombrowsky AC, Burger K, Porth AK, Stein M, Dierolf M, Günther B, Achterhold K, Gleich B, Feuchtinger A, Bartzsch S, Beyreuther E, Combs SE, Pfeiffer F, Wilkens JJ, Schmid TE. A proof of principle experiment for microbeam radiation therapy at the Munich compact light source. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2020; 59:111-120. [PMID: 31655869 DOI: 10.1007/s00411-019-00816-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
Microbeam radiation therapy (MRT), a preclinical form of spatially fractionated radiotherapy, uses an array of microbeams of hard synchrotron X-ray radiation. Recently, compact synchrotron X-ray sources got more attention as they provide essential prerequisites for the translation of MRT into clinics while overcoming the limited access to synchrotron facilities. At the Munich compact light source (MuCLS), one of these novel compact X-ray facilities, a proof of principle experiment was conducted applying MRT to a xenograft tumor mouse model. First, subcutaneous tumors derived from the established squamous carcinoma cell line FaDu were irradiated at a conventional X-ray tube using broadbeam geometry to determine a suitable dose range for the tumor growth delay. For irradiations at the MuCLS, FaDu tumors were irradiated with broadbeam and microbeam irradiation at integral doses of either 3 Gy or 5 Gy and tumor growth delay was measured. Microbeams had a width of 50 µm and a center-to-center distance of 350 µm with peak doses of either 21 Gy or 35 Gy. A dose rate of up to 5 Gy/min was delivered to the tumor. Both doses and modalities delayed the tumor growth compared to a sham-irradiated tumor. The irradiated area and microbeam pattern were verified by staining of the DNA double-strand break marker γH2AX. This study demonstrates for the first time that MRT can be successfully performed in vivo at compact inverse Compton sources.
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Affiliation(s)
- Annique C Dombrowsky
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Karin Burger
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Ann-Kristin Porth
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Marlon Stein
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Martin Dierolf
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Benedikt Günther
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Bernhard Gleich
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Annette Feuchtinger
- Research Unit Analytical Pathology, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
| | - Stefan Bartzsch
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Elke Beyreuther
- Helmholtz-Zentrum Dresden-Rossendorf, 01328, Dresden, Germany
- OncoRay, National Center for Radiation Research in Oncology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01328, Dresden, Germany
| | - Stephanie E Combs
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
- German Consortium for Translational Cancer Research, Deutsches Konsortium für Translationale Krebsforschung (dktk), Technical University Munich, 81675, Munich, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiobiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, 85748, Garching, Germany
| | - Thomas E Schmid
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, 85764, Neuherberg, Germany.
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany.
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22
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Fernandez-Palomo C, Fazzari J, Trappetti V, Smyth L, Janka H, Laissue J, Djonov V. Animal Models in Microbeam Radiation Therapy: A Scoping Review. Cancers (Basel) 2020; 12:cancers12030527. [PMID: 32106397 PMCID: PMC7139755 DOI: 10.3390/cancers12030527] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Microbeam Radiation Therapy (MRT) is an innovative approach in radiation oncology where a collimator subdivides the homogeneous radiation field into an array of co-planar, high-dose beams which are tens of micrometres wide and separated by a few hundred micrometres. OBJECTIVE This scoping review was conducted to map the available evidence and provide a comprehensive overview of the similarities, differences, and outcomes of all experiments that have employed animal models in MRT. METHODS We considered articles that employed animal models for the purpose of studying the effects of MRT. We searched in seven databases for published and unpublished literature. Two independent reviewers screened citations for inclusion. Data extraction was done by three reviewers. RESULTS After screening 5688 citations and 159 full-text papers, 95 articles were included, of which 72 were experimental articles. Here we present the animal models and pre-clinical radiation parameters employed in the existing MRT literature according to their use in cancer treatment, non-neoplastic diseases, or normal tissue studies. CONCLUSIONS The study of MRT is concentrated in brain-related diseases performed mostly in rat models. An appropriate comparison between MRT and conventional radiotherapy (instead of synchrotron broad beam) is needed. Recommendations are provided for future studies involving MRT.
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Affiliation(s)
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
| | - Verdiana Trappetti
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
| | - Lloyd Smyth
- Department of Obstetrics & Gynaecology, University of Melbourne, 3057 Parkville, Australia;
| | - Heidrun Janka
- Medical Library, University Library Bern, University of Bern, 3012 Bern, Switzerland;
| | - Jean Laissue
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (C.F.-P.); (J.F.); (V.T.); (J.L.)
- Correspondence: ; Tel.: +41-31-631-8432
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23
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Targeting Specific Sites in Biological Systems with Synchrotron X-Ray Microbeams for Radiobiological Studies at the Photon Factory. QUANTUM BEAM SCIENCE 2020. [DOI: 10.3390/qubs4010002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
X-ray microbeams have been used to explore radiobiological effects induced by targeting a specific site in living systems. Synchrotron radiation from the Photon Factory, Japan, with high brilliance and highly parallel directionality is a source suitable for delivering a particular beam size or shape, which can be changed according to target morphology by using a simple metal slit system (beam size from 5 μm to several millimeters). Studies have examined the non-targeted effects, called bystander cellular responses, which are thought to be fundamental mechanisms of low-dose or low-dose-rate effects in practical radiation risk research. Narrow microbeams several tens of micrometers or less in their size targeted both the cell nucleus and the cytoplasm. Our method combined with live-cell imaging techniques has challenged the traditional radiobiological dogma that DNA damage is the only major cause of radiation-induced genetic alterations and is gradually revealing the role of organelles, such as mitochondria, in these biological effects. Furthermore, three-dimensionally cultured cell systems have been used as microbeam targets to mimic organs. Combining the spatial fractionation of X-ray microbeams and a unique ex vivo testes organ culture technique revealed that the tissue-sparing effect was induced in response to the non-uniform radiation fields. Spatially fractionated X-ray beams may be a promising tool in clinical radiation therapy.
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24
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Dipuglia A, Cameron M, Davis JA, Cornelius IM, Stevenson AW, Rosenfeld AB, Petasecca M, Corde S, Guatelli S, Lerch MLF. Validation of a Monte Carlo simulation for Microbeam Radiation Therapy on the Imaging and Medical Beamline at the Australian Synchrotron. Sci Rep 2019; 9:17696. [PMID: 31776395 PMCID: PMC6881291 DOI: 10.1038/s41598-019-53991-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 11/05/2019] [Indexed: 01/05/2023] Open
Abstract
Microbeam Radiation Therapy (MRT) is an emerging cancer treatment modality characterised by the use of high-intensity synchrotron-generated x-rays, spatially fractionated by a multi-slit collimator (MSC), to ablate target tumours. The implementation of an accurate treatment planning system, coupled with simulation tools that allow for independent verification of calculated dose distributions are required to ensure optimal treatment outcomes via reliable dose delivery. In this article we present data from the first Geant4 Monte Carlo radiation transport model of the Imaging and Medical Beamline at the Australian Synchrotron. We have developed the model for use as an independent verification tool for experiments in one of three MRT delivery rooms and therefore compare simulation results with equivalent experimental data. The normalised x-ray spectra produced by the Geant4 model and a previously validated analytical model, SPEC, showed very good agreement using wiggler magnetic field strengths of 2 and 3 T. However, the validity of absolute photon flux at the plane of the Phase Space File (PSF) for a fixed number of simulated electrons was unable to be established. This work shows a possible limitation of the G4SynchrotronRadiation process to model synchrotron radiation when using a variable magnetic field. To account for this limitation, experimentally derived normalisation factors for each wiggler field strength determined under reference conditions were implemented. Experimentally measured broadbeam and microbeam dose distributions within a Gammex RMI457 Solid Water® phantom were compared to simulated distributions generated by the Geant4 model. Simulated and measured broadbeam dose distributions agreed within 3% for all investigated configurations and measured depths. Agreement between the simulated and measured microbeam dose distributions agreed within 5% for all investigated configurations and measured depths.
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Affiliation(s)
- Andrew Dipuglia
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Matthew Cameron
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Jeremy A Davis
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Iwan M Cornelius
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Andrew W Stevenson
- CSIRO, Clayton, 3168, Australia
- Imaging and Medical Beamline, ANSTO/Australian Synchrotron, Melbourne, 3168, Australia
| | - Anatoly B Rosenfeld
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Marco Petasecca
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Stéphanie Corde
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
- Department of Radiation Oncology, Prince of Wales Hospital, Randwick, 2031, Australia
| | - Susanna Guatelli
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia
| | - Michael L F Lerch
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, 2522, Australia.
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25
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De Marzi L, Nauraye C, Lansonneur P, Pouzoulet F, Patriarca A, Schneider T, Guardiola C, Mammar H, Dendale R, Prezado Y. Spatial fractionation of the dose in proton therapy: Proton minibeam radiation therapy. Cancer Radiother 2019; 23:677-681. [DOI: 10.1016/j.canrad.2019.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
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26
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Sammer M, Teiluf K, Girst S, Greubel C, Reindl J, Ilicic K, Walsh DWM, Aichler M, Walch A, Combs SE, Wilkens JJ, Dollinger G, Schmid TE. Beam size limit for pencil minibeam radiotherapy determined from side effects in an in-vivo mouse ear model. PLoS One 2019; 14:e0221454. [PMID: 31483811 PMCID: PMC6726230 DOI: 10.1371/journal.pone.0221454] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 08/06/2019] [Indexed: 11/29/2022] Open
Abstract
Side effects caused by radiation are a limiting factor to the amount of dose that can be applied to a tumor volume. A novel method to reduce side effects in radiotherapy is the use of spatial fractionation, in which a pattern of sub-millimeter beams (minibeams) is applied to spare healthy tissue. In order to determine the skin reactions in dependence of single beam sizes, which are relevant for spatially fractionated radiotherapy approaches, single pencil beams of submillimeter to 6 millimeter size were applied in BALB/c mice ears at a Small Animal Radiation Research Platform (SARRP) with a plateau dose of 60 Gy. Radiation toxicities in the ears were observed for 25 days after irradiation. Severe radiation responses were found for beams ≥ 3 mm diameter. The larger the beam diameter the stronger the observed reactions. No ear swelling and barely reddening or desquamation were found for the smallest beam sizes (0.5 and 1 mm). The findings were confirmed by histological sections. Submillimeter beams are preferred in minibeam therapy to obtain optimized tissue sparing. The gradual increase of radiation toxicity with beam size shows that also larger beams are capable of healthy tissue sparing in spatial fractionation.
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Affiliation(s)
- Matthias Sammer
- Institut für Angewandte Physik und Messtechnik (LRT2), Universität der Bundeswehr München, Neubiberg, Germany
- * E-mail:
| | - Katharina Teiluf
- Department of Radiation Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Institut für innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany
- Deutches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Stefanie Girst
- Institut für Angewandte Physik und Messtechnik (LRT2), Universität der Bundeswehr München, Neubiberg, Germany
| | - Christoph Greubel
- Institut für Angewandte Physik und Messtechnik (LRT2), Universität der Bundeswehr München, Neubiberg, Germany
| | - Judith Reindl
- Institut für Angewandte Physik und Messtechnik (LRT2), Universität der Bundeswehr München, Neubiberg, Germany
| | - Katarina Ilicic
- Department of Radiation Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Institut für innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany
- Deutches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Dietrich W. M. Walsh
- Institut für Angewandte Physik und Messtechnik (LRT2), Universität der Bundeswehr München, Neubiberg, Germany
- Department of Radiation Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Michaela Aichler
- Research Unit Analytical Pathology, Helmholtz Zentrum München, German Research Center for Environmental Health, Oberschleißheim, Germany
| | - Axel Walch
- Research Unit Analytical Pathology, Helmholtz Zentrum München, German Research Center for Environmental Health, Oberschleißheim, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Institut für innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany
- Deutches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Jan J. Wilkens
- Department of Radiation Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Institut für innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany
| | - Günther Dollinger
- Institut für Angewandte Physik und Messtechnik (LRT2), Universität der Bundeswehr München, Neubiberg, Germany
| | - Thomas E. Schmid
- Department of Radiation Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Institut für innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany
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27
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Lad J, Rusin A, Seymour C, Mothersill C. An investigation into neutron-induced bystander effects: How low can you go? ENVIRONMENTAL RESEARCH 2019; 175:84-99. [PMID: 31108356 DOI: 10.1016/j.envres.2019.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 06/09/2023]
Abstract
Neutron radiation is very harmful to both individual organisms and the environment. A n understanding of all aspects of both direct and indirect effects of radiation is necessary to accurately assess the risk of neutron radiation exposure. This review seeks to review current evidence in the literature for radiation-induced bystander effects and related effects attributable to neutron radiation. It also attempts to determine if the suggested evidence in the literature is sufficient to justify claims that neutron-based radiation can cause radiation-induced bystander effects. Lastly, the present paper suggests potential directions for future research concerning neutron radiation-induced bystander effects. Data was collected from studies investigating radiation-induced bystander effects and was used to mathematically generate pooled datasets and putative trends; this was done to potentially elucidate both the appearance of a conventional trend for radiation-induced bystander effects in studies using different types of radiation. Furthermore, literature review was used to compare studies utilizing similar tissue models to determine if neutron effects follow similar trends as those produced by electromagnetic radiation. We conclude that the current understanding of neutron-attributable radiation-induced bystander effects is incomplete. Various factors such as high gamma contamination during the irradiations, unestablished thresholds for gamma effects, different cell lines, energies, and different dose rates affected our ability to confirm a relationship between neutron irradiation and RIBE, particularly in low-dose regions below 100 mGy. It was determined through meta-analysis of the data that effects attributable to neutrons do seem to exist at higher doses, while gamma effects seem likely predominant at lower dose regions. Therefore, whether neutrons can induce bystander effects at lower doses remains unclear. Further research is required to confirm these findings and various recommendations are made to assist in this effort. With these recommendations, we hope that research conducted in the future will be better equipped to explore the indirect effects of neutron radiation as they pertain to biological and ecological phenomena.
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Affiliation(s)
- Jigar Lad
- Department of Physics and Astronomy, McMaster University, Hamilton, Canada.
| | - Andrej Rusin
- Department of Biology, McMaster University, Hamilton, Canada
| | - Colin Seymour
- Department of Biology, McMaster University, Hamilton, Canada
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28
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Schneider T, Patriarca A, Prezado Y. Improving the dose distributions in minibeam radiation therapy: Helium ions vs protons. Med Phys 2019; 46:3640-3648. [DOI: 10.1002/mp.13646] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/27/2019] [Accepted: 05/27/2019] [Indexed: 01/26/2023] Open
Affiliation(s)
- Tim Schneider
- IMNC‐UMR 8165 CNRS Paris 7 and Paris 11 Universities 15 rue Georges Clemenceau Orsay Cedex 91405France
| | - Annalisa Patriarca
- Institut Curie PSL Research University Centre de protonthrapie d’Orsay Campus universitaire btiment 101 Orsay 91898France
| | - Yolanda Prezado
- IMNC‐UMR 8165 CNRS Paris 7 and Paris 11 Universities 15 rue Georges Clemenceau Orsay Cedex 91405France
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29
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Dilmanian FA, Krishnan S, McLaughlin WE, Lukaniec B, Baker JT, Ailawadi S, Hirsch KN, Cattell RF, Roy R, Helfer J, Kruger K, Spuhler K, He Y, Tailor R, Vassantachart A, Heaney DC, Zanzonico P, Gobbert MK, Graf JS, Nassimi JR, Fatemi NN, Schweitzer ME, Bangiyev L, Eley JG. Merging Orthovoltage X-Ray Minibeams spare the proximal tissues while producing a solid beam at the target. Sci Rep 2019; 9:1198. [PMID: 30718607 PMCID: PMC6362296 DOI: 10.1038/s41598-018-37733-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/07/2018] [Indexed: 02/07/2023] Open
Abstract
Conventional radiation therapy of brain tumors often produces cognitive deficits, particularly in children. We investigated the potential efficacy of merging Orthovoltage X-ray Minibeams (OXM). It segments the beam into an array of parallel, thin (~0.3 mm), planar beams, called minibeams, which are known from synchrotron x-ray experiments to spare tissues. Furthermore, the slight divergence of the OXM array make the individual minibeams gradually broaden, thus merging with their neighbors at a given tissue depth to produce a solid beam. In this way the proximal tissues, including the cerebral cortex, can be spared. Here we present experimental results with radiochromic films to characterize the method's dosimetry. Furthermore, we present our Monte Carlo simulation results for physical absorbed dose, and a first-order biologic model to predict tissue tolerance. In particular, a 220-kVp orthovoltage beam provides a 5-fold sharper lateral penumbra than a 6-MV x-ray beam. The method can be implemented in arc-scan, which may include volumetric-modulated arc therapy (VMAT). Finally, OXM's low beam energy makes it ideal for tumor-dose enhancement with contrast agents such as iodine or gold nanoparticles, and its low cost, portability, and small room-shielding requirements make it ideal for use in the low-and-middle-income countries.
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Affiliation(s)
- F Avraham Dilmanian
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA.
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA.
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA.
- Department of Psychiatry, Stony Brook University Hospital, Stony Brook, NY, 11794, USA.
- Department of Biomedical Engineering, Stony Brook University Hospital, Stony Brook, NY, 11794, USA.
- Stony Brook Cancer Center, Stony Brook University Hospital, Stony Brook, NY, 11794, USA.
| | - Sunil Krishnan
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | | | | | - Jameson T Baker
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
- Department of Radiation Medicine, Northwell Health Medical Center, Northwell, NY, USA
| | - Sandeep Ailawadi
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Kara N Hirsch
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Renee F Cattell
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
- Department of Biomedical Engineering, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Rahul Roy
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Joel Helfer
- Precision X-ray Inc., North Branford, CT, 06471, USA
| | - Kurt Kruger
- Precision X-ray Inc., North Branford, CT, 06471, USA
| | - Karl Spuhler
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Yulun He
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ramesh Tailor
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Dakota C Heaney
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Pat Zanzonico
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthias K Gobbert
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, MD, 21250, USA
| | - Jonathan S Graf
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, MD, 21250, USA
| | - Jessica R Nassimi
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Nasrin N Fatemi
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
- Department of Radiology, City of Hope, Duarte, CA, 91010, USA
| | - Mark E Schweitzer
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Lev Bangiyev
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - John G Eley
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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Mukherjee S, Chakraborty A. Radiation-induced bystander phenomenon: insight and implications in radiotherapy. Int J Radiat Biol 2019; 95:243-263. [PMID: 30496010 DOI: 10.1080/09553002.2019.1547440] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Sharmi Mukherjee
- Stress biology Lab, UGC-DAE Consortium for Scientific Research, Kolkata Centre, Kolkata, West Bengal, India
| | - Anindita Chakraborty
- Stress biology Lab, UGC-DAE Consortium for Scientific Research, Kolkata Centre, Kolkata, West Bengal, India
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Prezado Y, Jouvion G, Patriarca A, Nauraye C, Guardiola C, Juchaux M, Lamirault C, Labiod D, Jourdain L, Sebrie C, Dendale R, Gonzalez W, Pouzoulet F. Proton minibeam radiation therapy widens the therapeutic index for high-grade gliomas. Sci Rep 2018; 8:16479. [PMID: 30405188 PMCID: PMC6220274 DOI: 10.1038/s41598-018-34796-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/26/2018] [Indexed: 12/15/2022] Open
Abstract
Proton minibeam radiation therapy (pMBRT) is a novel strategy which has already shown a remarkable reduction in neurotoxicity as to compared with standard proton therapy. Here we report on the first evaluation of tumor control effectiveness in glioma bearing rats with highly spatially modulated proton beams. Whole brains (excluding the olfactory bulb) of Fischer 344 rats were irradiated. Four groups of animals were considered: a control group (RG2 tumor bearing rats), a second group of RG2 tumor-bearing rats and a third group of normal rats that received pMBRT (70 Gy peak dose in one fraction) with very heterogeneous dose distributions, and a control group of normal rats. The tumor-bearing and normal animals were followed-up for 6 months and one year, respectively. pMBRT leads to a significant tumor control and tumor eradication in 22% of the cases. No substantial brain damage which confirms the widening of the therapeutic window for high-grade gliomas offered by pMBRT. Additionally, the fact that large areas of the brain can be irradiated with pMBRT without significant side effects, would allow facing the infiltrative nature of gliomas.
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Affiliation(s)
- Yolanda Prezado
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France.
| | - Gregory Jouvion
- Institut Pasteur, Neuropathologie Expérimentale, Institut Pasteur, 28 Rue du Docteur Roux, 75015, Paris, France
| | - Annalisa Patriarca
- Institut Curie, PSL Research University, Radiation Oncology Department, Centre de Protonthérapie d'Orsay, 101, F-91898, Orsay, France
| | - Catherine Nauraye
- Institut Curie, PSL Research University, Radiation Oncology Department, Centre de Protonthérapie d'Orsay, 101, F-91898, Orsay, France
| | - Consuelo Guardiola
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Marjorie Juchaux
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Charlotte Lamirault
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Dalila Labiod
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
- Paris Sud University, Paris -Saclay University, 91405, Orsay, France
| | - Laurene Jourdain
- IR4M, UMR8081, Université Paris Sud, CNRS, Université Paris-Saclay, 91405, Orsay, France
| | - Catherine Sebrie
- IR4M, UMR8081, Université Paris Sud, CNRS, Université Paris-Saclay, 91405, Orsay, France
| | - Remi Dendale
- Institut Curie, PSL Research University, Radiation Oncology Department, Centre de Protonthérapie d'Orsay, 101, F-91898, Orsay, France
| | - Wilfredo Gonzalez
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Frederic Pouzoulet
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
- Paris Sud University, Paris -Saclay University, 91405, Orsay, France
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De Marzi L, Patriarca A, Nauraye C, Hierso E, Dendale R, Guardiola C, Prezado Y. Implementation of planar proton minibeam radiation therapy using a pencil beam scanning system: A proof of concept study. Med Phys 2018; 45:5305-5316. [PMID: 30311639 DOI: 10.1002/mp.13209] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/26/2018] [Accepted: 09/02/2018] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Proton minibeam radiation therapy (pMBRT) is an innovative approach that combines the advantages of minibeam radiation therapy with the more precise ballistics of protons to further reduce the side effects of radiation. One of the main challenges of this approach is the generation of very narrow proton pencil beams with an adequate dose-rate to treat patients within a reasonable treatment time (several minutes) in existing clinical facilities. The aim of this study was to demonstrate the feasibility of implementing pMBRT by combining the pencil beam scanning (PBS) technique with the use of multislit collimators. This proof of concept study of pMBRT with a clinical system is intended to guide upcoming biological experiments. METHODS Monte Carlo simulations (TOPAS v3.1.p2) were used to design a suitable multislit collimator to implement planar pMBRT for conventional pencil beam scanning settings. Dose distributions (depth-dose curves, lateral profiles, Peak-to-Valley Dose Ratio (PVDR) and dose-rates) for different proton beam energies were assessed by means of Monte Carlo simulations and experimental measurements in a water tank using commercial ionization chambers and a new p-type silicon diode, the IBA RAZOR. An analytical intensity-modulated dose calculation algorithm designed to optimize the weight of individual Bragg peaks composing the field was also developed and validated. RESULTS Proton minibeams were then obtained using a brass multislit collimator with five slits measuring 2 cm × 400 μm in width with a center-to-center distance of 4 mm. The measured and calculated dose distributions (depth-dose curves and lateral profiles) showed a good agreement. Spread-out Bragg peaks (SOBP) and homogeneous dose distributions around the target were obtained by means of intensity modulation of Bragg peaks, while maintaining spatial fractionation at shallow depths. Mean dose-rates of 0.12 and 0.09 Gy/s were obtained for one iso-energy layer and a SOBP conditions in the presence of multislit collimator. CONCLUSIONS This study demonstrates the feasibility of implementing pMBRT on a PBS system. It also confirms the reliability of RAZOR detector for pMBRT dosimetry. This newly developed experimental methodology will support the design of future preclinical research with pMBRT.
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Affiliation(s)
- Ludovic De Marzi
- Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay, 91898, France
| | - Annalisa Patriarca
- Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay, 91898, France
| | - Catherine Nauraye
- Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay, 91898, France
| | - Eric Hierso
- Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay, 91898, France
| | - Rémi Dendale
- Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay, 91898, France
| | - Consuelo Guardiola
- IMNC-UMR 8165, CNRS, Paris 7 and Paris 11 Universities, 15 rue Georges Clemenceau, Orsay Cedex, 91405, France
| | - Yolanda Prezado
- IMNC-UMR 8165, CNRS, Paris 7 and Paris 11 Universities, 15 rue Georges Clemenceau, Orsay Cedex, 91405, France
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Peng V, Suchowerska N, Esteves ADS, Rogers L, Claridge Mackonis E, Toohey J, McKenzie DR. Models for the bystander effect in gradient radiation fields: Range and signalling type. J Theor Biol 2018; 455:16-25. [DOI: 10.1016/j.jtbi.2018.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 06/14/2018] [Accepted: 06/30/2018] [Indexed: 11/17/2022]
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Esplen NM, Chergui L, Johnstone CD, Bazalova-Carter M. Monte Carlo optimization of a microbeam collimator design for use on the small animal radiation research platform (SARRP). ACTA ACUST UNITED AC 2018; 63:175004. [DOI: 10.1088/1361-6560/aad7e2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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35
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Prezado Y, Dos Santos M, Gonzalez W, Jouvion G, Guardiola C, Heinrich S, Labiod D, Juchaux M, Jourdain L, Sebrie C, Pouzoulet F. Transfer of Minibeam Radiation Therapy into a cost-effective equipment for radiobiological studies: a proof of concept. Sci Rep 2017; 7:17295. [PMID: 29229965 PMCID: PMC5725561 DOI: 10.1038/s41598-017-17543-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/23/2017] [Indexed: 01/13/2023] Open
Abstract
Minibeam radiation therapy (MBRT) is an innovative synchrotron radiotherapy technique able to shift the normal tissue complication probability curves to significantly higher doses. However, its exploration was hindered due to the limited and expensive beamtime at synchrotrons. The aim of this work was to develop a cost-effective equipment to perform systematic radiobiological studies in view of MBRT. Tumor control for various tumor entities will be addressable as well as studies to unravel the distinct biological mechanisms involved in normal and tumor tissues responses when applying MBRT. With that aim, a series of modifications of a small animal irradiator were performed to make it suitable for MBRT experiments. In addition, the brains of two groups of rats were irradiated. Half of the animals received a standard irradiation, the other half, MBRT. The animals were followed-up for 6.5 months. Substantial brain damage was observed in the group receiving standard RT, in contrast to the MBRT group, where no significant lesions were observed. This work proves the feasibility of the transfer of MBRT outside synchrotron sources towards a small animal irradiator.
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Affiliation(s)
- Y Prezado
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France.
| | - M Dos Santos
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - W Gonzalez
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - G Jouvion
- Histopathologie Humaine et Modèles Animaux, Institut Pasteur, 28 Rue du Docteur Roux, 75015, Paris, France
| | - C Guardiola
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - S Heinrich
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
- Paris Sud University, Paris -Saclay University, 91405, Orsay, France
| | - D Labiod
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
- Paris Sud University, Paris -Saclay University, 91405, Orsay, France
| | - M Juchaux
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - L Jourdain
- Imagerie par Résonance Magnétique Médicale et Multi-modalités (IR4M-UMR8081), Université Paris Sud, 91405, Orsay, France
| | - C Sebrie
- Imagerie par Résonance Magnétique Médicale et Multi-modalités (IR4M-UMR8081), Université Paris Sud, 91405, Orsay, France
| | - F Pouzoulet
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
- Paris Sud University, Paris -Saclay University, 91405, Orsay, France
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Meyer J, Stewart RD, Smith D, Eagle J, Lee E, Cao N, Ford E, Hashemian R, Schuemann J, Saini J, Marsh S, Emery R, Dorman E, Schwartz J, Sandison G. Biological and dosimetric characterisation of spatially fractionated proton minibeams. Phys Med Biol 2017; 62:9260-9281. [PMID: 29053105 DOI: 10.1088/1361-6560/aa950c] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The biological effectiveness of proton beams varies with depth, spot size and lateral distance from the beam central axis. The aim of this work is to incorporate proton relative biological effectiveness (RBE) and equivalent uniform dose (EUD) considerations into comparisons of broad beam and highly modulated proton minibeams. A Monte Carlo model of a small animal proton beamline is presented. Dose and variable RBE is calculated on a per-voxel basis for a range of energies (30-109 MeV). For an open beam, the RBE values at the beam entrance ranged from 1.02-1.04, at the Bragg peak (BP) from 1.3 to 1.6, and at the distal end of the BP from 1.4 to 2.0. For a 50 MeV proton beam, a minibeam collimator designed to produce uniform dose at the depth of the BP peak, had minimal impact on the open beam RBE values at depth. RBE changes were observed near the surface when the collimator was placed flush with the irradiated object, due to a higher neutron contribution derived from proton interactions with the collimator. For proton minibeams, the relative mean RBE weighted entrance dose (RWD) was ~25% lower than the physical mean dose. A strong dependency of the EUD with fraction size was observed. For 20 Gy fractions, the EUD varied widely depending on the radiosensitivity of the cells. For radiosensitive cells, the difference was up to ~50% in mean dose and ~40% in mean RWD and the EUD trended towards the valley dose rather than the mean dose. For comparative studies of uniform dose with spatially fractionated proton minibeams, EUD derived from a per-voxel RWD distribution is recommended for biological assessments of reproductive cell survival and related endpoints.
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Affiliation(s)
- Juergen Meyer
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA 98195, United States of America
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Bazyar S, Inscoe CR, O’Brian ET, Zhou O, Lee YZ. Minibeam radiotherapy with small animal irradiators; in vitro and in vivo feasibility studies. ACTA ACUST UNITED AC 2017; 62:8924-8942. [DOI: 10.1088/1361-6560/aa926b] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Prezado Y, Jouvion G, Hardy D, Patriarca A, Nauraye C, Bergs J, González W, Guardiola C, Juchaux M, Labiod D, Dendale R, Jourdain L, Sebrie C, Pouzoulet F. Proton minibeam radiation therapy spares normal rat brain: Long-Term Clinical, Radiological and Histopathological Analysis. Sci Rep 2017; 7:14403. [PMID: 29089533 PMCID: PMC5663851 DOI: 10.1038/s41598-017-14786-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022] Open
Abstract
Proton minibeam radiation therapy (pMBRT) is a novel strategy for minimizing normal tissue damage resulting from radiotherapy treatments. This strategy partners the inherent advantages of protons for radiotherapy with the gain in normal tissue preservation observed upon irradiation with narrow, spatially fractionated beams. In this study, whole brains (excluding the olfactory bulb) of Fischer 344 rats (n = 16) were irradiated at the Orsay Proton Therapy Center. Half of the animals received standard proton irradiation, while the other half were irradiated with pMBRT at the same average dose (25 Gy in one fraction). The animals were followed-up for 6 months. A magnetic resonance imaging (MRI) study using a 7-T small-animal MRI scanner was performed along with a histological analysis. Rats treated with conventional proton irradiation exhibited severe moist desquamation, permanent epilation and substantial brain damage. In contrast, rats in the pMBRT group exhibited no skin damage, reversible epilation and significantly reduced brain damage; some brain damage was observed in only one out of the eight irradiated rats. These results demonstrate that pMBRT leads to an increase in normal tissue resistance. This net gain in normal tissue sparing can lead to the efficient treatment of very radio-resistant tumours, which are currently mostly treated palliatively.
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Affiliation(s)
- Yolanda Prezado
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS); Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France.
| | - Gregory Jouvion
- Institut Pasteur, Histopathologie Humaine et Modèles Animaux, Institut Pasteur, 28 Rue du Docteur Roux, 75015, Paris, France
| | - David Hardy
- Institut Pasteur, Histopathologie Humaine et Modèles Animaux, Institut Pasteur, 28 Rue du Docteur Roux, 75015, Paris, France
| | - Annalisa Patriarca
- Institut Curie - Centre de Protonthérapie d'Orsay, Campus Universitaire, Bât. 101, Orsay, 91898, France
| | - Catherine Nauraye
- Institut Curie - Centre de Protonthérapie d'Orsay, Campus Universitaire, Bât. 101, Orsay, 91898, France
| | - Judith Bergs
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS); Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Wilfredo González
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS); Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Consuelo Guardiola
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS); Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Marjorie Juchaux
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS); Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Dalila Labiod
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
- Paris Sud University, Paris -Saclay University, 91405, Orsay, France
| | - Remi Dendale
- Institut Curie - Centre de Protonthérapie d'Orsay, Campus Universitaire, Bât. 101, Orsay, 91898, France
| | - Laurène Jourdain
- Imagerie par Résonance Magnétique Médicale et Multi-modalités (IR4M-UMR8081), Université Paris Sud, 91405, Orsay, France
| | - Catherine Sebrie
- Imagerie par Résonance Magnétique Médicale et Multi-modalités (IR4M-UMR8081), Université Paris Sud, 91405, Orsay, France
| | - Frederic Pouzoulet
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
- Paris Sud University, Paris -Saclay University, 91405, Orsay, France
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Sammer M, Greubel C, Girst S, Dollinger G. Optimization of beam arrangements in proton minibeam radiotherapy by cell survival simulations. Med Phys 2017; 44:6096-6104. [PMID: 28880369 DOI: 10.1002/mp.12566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Proton minibeam radiotherapy using submillimeter beam dimensions allows to enhance tissue sparing in the entrance channel by spatial fractionation additionally to advantageous proton depth dose distribution. In the entrance channel, spatial fractionation leads to reduced side effects compared to conventional proton therapy. The submillimeter sized beams widen with depth due to small angle scattering and enable therefore, in contrary to x-ray microbeam radiation therapy (MRT), the homogeneous irradiation of a tumor. Proton minibeams can either be applied as planar minibeams or pencil shaped with an additional possibility to vary between a quadratic and a hexagonal arrangement for pencil minibeams. The purpose of this work is to deduce interbeam distances to achieve a homogeneous dose distribution for different tumor depths and tumor thicknesses. Furthermore, we aim for a better understanding of the sparing effect on the basis of surviving cells calculated by the linear-quadratic model. METHODS Two-dimensional dose distributions are calculated for proton minibeams of different shapes and arrangements. For a tumor in 10-15 cm depth, treatment plans are calculated with initial beam size of σ0 = 0.2 mm in a water phantom. Proton minibeam depth dose distributions are finally converted into cell survival using a linear-quadratic model. RESULTS Inter proton beam distances are maximized under the constraint of dose homogeneity in the tumor for tumor depths ranging from 4 to 15 cm and thickness ranging from 0.5 to 10 cm. Cell survival calculations for a 5 cm thick tumor covered by 10 cm healthy tissue show less cell death by up to 85%, especially in the superficial layers, while keeping the cell death in the tumor as in conventional therapy. In the entrance channel, the pencil minibeams result in higher cell survival in comparison to the planar minibeams while all proton minibeam irradiations show higher cell survival than conventional broadbeam irradiation. CONCLUSION The deduced constraints for interbeam distances simplify treatment planning for proton minibeam radiotherapy applications in future studies. The cell survival results indicate that proton minibeam radiotherapy reduces side effects but keeps tumor control as in conventional proton therapy. It makes proton minibeam, especially pencil minibeam radiotherapy a potentially attractive new approach for radiation therapy.
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Bazyar S, Inscoe CR, Benefield T, Zhang L, Lu J, Zhou O, Lee YZ. Neurocognitive sparing of desktop microbeam irradiation. Radiat Oncol 2017; 12:127. [PMID: 28800740 PMCID: PMC5554005 DOI: 10.1186/s13014-017-0864-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 08/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Normal tissue toxicity is the dose-limiting side effect of radiotherapy. Spatial fractionation irradiation techniques, like microbeam radiotherapy (MRT), have shown promising results in sparing the normal brain tissue. Most MRT studies have been conducted at synchrotron facilities. With the aim to make this promising treatment more available, we have built the first desktop image-guided MRT device based on carbon nanotube x-ray technology. In the current study, our purpose was to evaluate the effects of MRT on the rodent normal brain tissue using our device and compare it with the effect of the integrated equivalent homogenous dose. METHODS Twenty-four, 8-week-old male C57BL/6 J mice were randomly assigned to three groups: MRT, broad-beam (BB) and sham. The hippocampal region was irradiated with two parallel microbeams in the MRT group (beam width = 300 μm, center-to-center = 900 μm, 160 kVp). The BB group received the equivalent integral dose in the same area of their brain. Rotarod, marble burying and open-field activity tests were done pre- and every month post-irradiation up until 8 months to evaluate the cognitive changes and potential irradiation side effects on normal brain tissue. The open-field activity test was substituted by Barnes maze test at 8th month. A multilevel model, random coefficients approach was used to evaluate the longitudinal and temporal differences among treatment groups. RESULTS We found significant differences between BB group as compared to the microbeam-treated and sham mice in the number of buried marble and duration of the locomotion around the open-field arena than shams. Barnes maze revealed that BB mice had a lower capacity for spatial learning than MRT and shams. Mice in the BB group tend to gain weight at the slower pace than shams. No meaningful differences were found between MRT and sham up until 8-month follow-up using our measurements. CONCLUSIONS Applying MRT with our newly developed prototype compact CNT-based image-guided MRT system utilizing the current irradiation protocol can better preserve the integrity of normal brain tissue. Consequently, it enables applying higher irradiation dose that promises better tumor control. Further studies are required to evaluate the full extent effects of this novel modality.
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Affiliation(s)
- Soha Bazyar
- Department of Biomedical Engineering, The University of North Carolina at Chapel Hill, 350 Chapman Hall, 4Chapel Hill, NC, 27599, USA.
| | - Christina R Inscoe
- Department of Applied Physics Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Physics and Astronomy, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Thad Benefield
- Biomedical Research Imaging Center, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Lei Zhang
- Department of Applied Physics Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Jianping Lu
- Department of Applied Physics Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, USA.,Biomedical Research Imaging Center, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Otto Zhou
- Department of Applied Physics Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, USA.,Biomedical Research Imaging Center, The University of North Carolina at Chapel Hill, Chapel Hill, USA.,Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Yueh Z Lee
- Department of Biomedical Engineering, The University of North Carolina at Chapel Hill, 350 Chapman Hall, 4Chapel Hill, NC, 27599, USA. .,Department of Physics and Astronomy, The University of North Carolina at Chapel Hill, Chapel Hill, USA. .,Biomedical Research Imaging Center, The University of North Carolina at Chapel Hill, Chapel Hill, USA. .,Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, USA. .,Department of Radiology, The University of North Carolina at Chapel Hill, CB#7510, Chapel Hill, NC, 27599, USA.
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41
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Zeinali-Rafsanjani B, Mosleh-Shirazi MA, Haghighatafshar M, Jalli R, Saeedi-Moghadam M. Assessment of the dose distribution of Minibeam radiotherapy for lung tumors in an anthropomorphic phantom: A feasibility study. Technol Health Care 2017; 25:683-692. [DOI: 10.3233/thc-170818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Banafsheh Zeinali-Rafsanjani
- Nuclear Medicine and Molecular Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Amin Mosleh-Shirazi
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Radiotherapy and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Haghighatafshar
- Nuclear Medicine and Molecular Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jalli
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Saeedi-Moghadam
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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42
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Peng V, Suchowerska N, Rogers L, Claridge Mackonis E, Oakes S, McKenzie DR. Grid therapy using high definition multileaf collimators: realizing benefits of the bystander effect. Acta Oncol 2017; 56:1048-1059. [PMID: 28303745 DOI: 10.1080/0284186x.2017.1299939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In microbeam radiotherapy (MRT), parallel arrays of high-intensity synchrotron x-ray beams achieve normal tissue sparing without compromising tumor control. Grid-therapy using clinical linacs has spatial modulation on a larger scale and achieves promising results for palliative treatments of bulky tumors. The availability of high definition multileaf collimators (HDMLCs) with 2.5 mm leaves provides an opportunity for grid-therapy to more closely approach MRT. However, challenges to the wider implementation of grid-therapy remain because spatial modulation of the target volume runs counter to current radiotherapy practice and mechanisms for the beneficial effects of MRT are not fully understood. Without more knowledge of cell dose responses, a quantitative basis for planning treatments is difficult. The aim of this study is to determine if therapeutic benefits of MRT can be achieved using a linac with HDMLCs and if so, to develop a predictive model to support treatment planning. MATERIAL AND METHODS HD120-MLCs of a Varian Novalis TXTM were used to generate grid patterns of 2.5 and 5.0 mm spacing, which were characterized dosimetrically using GafchromicTM EBT3 film. Clonogenic survival of normal (HUVEC) and cancer (NCI-H460, HCC-1954) cell lines following irradiation under the grid and open fields using a 6 MV photon beam were compared in-vitro for the same average dose. RESULTS AND CONCLUSIONS Relative to an open field, survival of normal cells in a 2.5 mm striped field was the same, while the survival of both cancer cell lines was significantly lower. A mathematical model was developed to incorporate dose gradients of the spatial modulation into the standard linear quadratic model. Our new bystander extended LQ model assumes spatial gradients drive the diffusion of soluble factors that influence survival through bystander effects, successfully predicting the experimental results that show an increased therapeutic ratio. Our results challenge conventional radiotherapy practice and propose that additional gain can be realized by prescribing spatially modulated treatments to harness the bystander effect.
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Affiliation(s)
- Valery Peng
- School of Physics, University of Sydney, Camperdown, NSW, Australia
| | - Natalka Suchowerska
- School of Physics, University of Sydney, Camperdown, NSW, Australia
- Department of Radiation Oncology, Chris O’Brien Lifehouse, VectorLAB, Camperdown, NSW, Australia
| | - Linda Rogers
- School of Physics, University of Sydney, Camperdown, NSW, Australia
- Department of Radiation Oncology, Chris O’Brien Lifehouse, VectorLAB, Camperdown, NSW, Australia
| | | | - Samantha Oakes
- The Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - David R. McKenzie
- School of Physics, University of Sydney, Camperdown, NSW, Australia
- Department of Radiation Oncology, Chris O’Brien Lifehouse, VectorLAB, Camperdown, NSW, Australia
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43
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Nolan MW, Gieger TL, Karakashian AA, Nikolova-Karakashian MN, Posner LP, Roback DM, Rivera JN, Chang S. Outcomes of Spatially Fractionated Radiotherapy (GRID) for Bulky Soft Tissue Sarcomas in a Large Animal Model. Technol Cancer Res Treat 2017; 16:357-365. [PMID: 28168937 PMCID: PMC5616052 DOI: 10.1177/1533034617690980] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/07/2016] [Accepted: 01/03/2017] [Indexed: 11/27/2022] Open
Abstract
GRID directs alternating regions of high- and low-dose radiation at tumors. A large animal model mimicking the geometries of human treatments is needed to complement existing rodent systems (eg, microbeam) and clarify the physical and biological attributes of GRID. A pilot study was undertaken in pet dogs with spontaneous soft tissue sarcomas to characterize responses to GRID. Subjects were treated with either 20 Gy (3 dogs) or 25 Gy (3 dogs), delivered using 6 MV X-rays and a commercial GRID collimator. Acute toxicity and tumor responses were assessed 2, 4, and 6 weeks later. Acute Radiation Therapy Oncology Group grade I skin toxicity was observed in 3 of the 6 dogs; none experienced a measurable response, per Response Evaluation Criteria in Solid Tumors. Serum vascular endothelial growth factor, tumor necrosis factor α, and secretory sphingomyelinase were assayed at baseline, 1, 4, 24, and 48 hours after treatment. There was a trend toward platelet-corrected serum vascular endothelial growth factor concentration being lower 1 and 48 hours after GRID than at baseline. There was a significant decrease in secretory sphingomyelinase activity 48 hours after 25 Gy GRID ( P = .03). Serum tumor necrosis factor α was quantified measurable at baseline in 4 of the 6 dogs and decreased in each of those subjects at all post-GRID time points. The new information generated by this study includes the observation that high-dose, single fraction application of GRID does not induce measurable reduction in volume of canine soft tissue sarcomas. In contrast to previously published data, these data suggest that GRID may be associated with at least short-term reduction in serum concentration of vascular endothelial growth factor and serum activity of secretory sphingomyelinase. Because GRID can be applied safely, and these tumors can be subsequently surgically resected as part of routine veterinary care, pet dogs with sarcomas are an appealing model for studying the radiobiologic responses to spatially fractionated radiotherapy.
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Affiliation(s)
- Michael W. Nolan
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
| | - Tracy L. Gieger
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
| | | | | | - Lysa P. Posner
- Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Donald M. Roback
- Department of Radiation Oncology, Rex Cancer Center, Raleigh, NC, USA
| | - Judith N. Rivera
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Sha Chang
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, NC, USA
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, NC, USA
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44
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Poole CM, Day LRJ, Rogers PAW, Crosbie JC. Synchrotron microbeam radiotherapy in a commercially available treatment planning system. Biomed Phys Eng Express 2017. [DOI: 10.1088/2057-1976/aa5f1a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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45
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Optimizing dose enhancement with Ta 2O 5 nanoparticles for synchrotron microbeam activated radiation therapy. Phys Med 2016; 32:1852-1861. [PMID: 27866898 DOI: 10.1016/j.ejmp.2016.10.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 11/22/2022] Open
Abstract
Microbeam Radiation Therapy (MRT) exploits tumour selectivity and normal tissue sparing with spatially fractionated kilovoltage X-ray microbeams through the dose volume effect. Experimental measurements with Ta2O5 nanoparticles (NPs) in 9L gliosarcoma treated with MRT at the Australian Synchrotron, increased the treatment efficiency. Ta2O5 NPs were observed to form shells around cell nuclei which may be the reason for their efficiency in MRT. In this article, our experimental observation of NP shell formation is the basis of a Geant4 radiation transport study to characterise dose enhancement by Ta2O5 NPs in MRT. Our study showed that NP shells enhance the physical dose depending microbeam energy and their location relative to a single microbeam. For monochromatic microbeam energies below ∼70keV, NP shells show highly localised dose enhancement due to the short range of associated secondary electrons. Low microbeam energies indicate better targeted treatment by allowing higher microbeam doses to be administered to tumours and better exploit the spatial fractionation related selectivity observed with MRT. For microbeam energies above ∼100keV, NP shells extend the physical dose enhancement due to longer-range secondary electrons. Again, with NPs selectively internalised, the local effectiveness of MRT is expected to increase in the tumour. Dose enhancement produced by the shell aggregate varied more significantly in the cell population, depending on its location, when compared to a homogeneous NP distribution. These combined simulation and experimental data provide first evidence for optimising MRT through the incorporation of newly observed Ta2O5 NP distributions within 9L cancer cells.
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46
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Peucelle C, Martínez-Rovira I, Prezado Y. Spatial fractionation of the dose using neon and heavier ions: A Monte Carlo study. Med Phys 2016; 42:5928-36. [PMID: 26429267 DOI: 10.1118/1.4930960] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE This work explores a new radiation therapy approach which might trigger a renewed use of neon and heavier ions to treat cancers. These ions were shown to be extremely efficient in radioresistant tumor killing. Unfortunately, the efficient region also extends into the normal tissue in front of the tumor. The strategy the authors propose is to profit from the well-established sparing effect of thin spatially fractionated beams, so that the impact on normal tissues might be minimized while a high tumor control is achieved. The main goal of this work is to provide a proof of concept of this new approach. With that aim, a dosimetric study was carried out as a first step to evaluate the interest of further explorations of this avenue. METHODS The gate/geant4 v.6.1 Monte Carlo simulation platform was employed to simulate arrays of rectangular minibeams (700 μm × 2 cm) of four ions (Ne, Si, Ar, and Fe). The irradiations were performed with a 2 cm-long spread-out Bragg peak centered at 7 cm-depth. Dose distributions in a water phantom were scored considering two minibeams center-to-center distances: 1400 and 3500 μm. Peak and valley doses, peak-to-valley dose ratios (PVDRs), beam penumbras, and relative contribution of nuclear fragments and electromagnetic processes were assessed as figures of merit. In addition, the type and proportion of the secondary nuclear fragments were evaluated in both peak and valley regions. RESULTS Extremely high PVDR values (>100) and low valley doses were obtained. The higher the atomic number (Z) of the primary ion is, the lower the valleys and the narrower the penumbras. Although the yield of secondary nuclear products increases with Z, the actual dose being deposited by the secondary nuclear fragments in the valleys starts to be the dominant contribution at deeper points, helping in the sparing of proximal normal tissues. Additionally, a wider center-to-center distance leads to a minimized contribution of heavier secondary fragments in valleys. CONCLUSIONS The computed dose distributions suggest that a spatial fractionation of the dose combined to the use of submillimetric field sizes might allow profiting from the high efficiency of neon and heavier ions for the treatment of radioresistant tumors, while preserving normal tissues. The authors' results support the further exploration of this avenue. Next steps include the realization of biological experiment to confirm the shifting of normal tissue complication probability curves.
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Affiliation(s)
- C Peucelle
- IMNC-UMR 8165, CNRS Paris 7 and Paris 11 Universities, 15 rue Georges Clemenceau, Orsay Cedex 91406, France
| | - I Martínez-Rovira
- IMNC-UMR 8165, CNRS Paris 7 and Paris 11 Universities, 15 rue Georges Clemenceau, Orsay Cedex 91406, France
| | - Y Prezado
- IMNC-UMR 8165, CNRS Paris 7 and Paris 11 Universities, 15 rue Georges Clemenceau, Orsay Cedex 91406, France
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Dilmanian FA, Eley JG, Rusek A, Krishnan S. Charged Particle Therapy with Mini-Segmented Beams. Front Oncol 2015; 5:269. [PMID: 26649281 PMCID: PMC4664668 DOI: 10.3389/fonc.2015.00269] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023] Open
Abstract
One of the fundamental attributes of proton therapy and carbon ion therapy is the ability of these charged particles to spare tissue distal to the targeted tumor. This significantly reduces normal tissue toxicity and has the potential to translate to a wider therapeutic index. Although, in general, particle therapy also reduces dose to the proximal tissues, particularly in the vicinity of the target, dose to the skin and to other very superficial tissues tends to be higher than that of megavoltage x-rays. The methods presented here, namely, “interleaved carbon minibeams” and “radiosurgery with arrays of proton and light ion minibeams,” both utilize beams segmented into arrays of parallel “minibeams” of about 0.3 mm incident-beam size. These minibeam arrays spare tissues, as demonstrated by synchrotron x-ray experiments. An additional feature of particle minibeams is their gradual broadening due to multiple Coulomb scattering as they penetrate tissues. In the case of interleaved carbon minibeams, which do not broaden much, two arrays of planar carbon minibeams that remain parallel at target depth, are aimed at the target from 90° angles and made to “interleave” at the target to produce a solid radiation field within the target. As a result, the surrounding tissues are exposed only to individual carbon minibeam arrays and are therefore spared. The method was used in four-directional geometry at the NASA Space Radiation Laboratory to ablate a 6.5-mm target in a rabbit brain at a single exposure with 40 Gy physical absorbed dose. Contrast-enhanced magnetic resonance imaging and histology 6-month later showed very focal target necrosis with nearly no damage to the surrounding brain. As for minibeams of protons and light ions, for which the minibeam broadening is substantial, measurements at MD Anderson Cancer Center in Houston, TX, USA; and Monte Carlo simulations showed that the broadening minibeams will merge with their neighbors at a certain tissue depth to produce a solid beam to treat the target. The resulting sparing of proximal normal tissue allows radiosurgical ablative treatments with smaller impact on the skin and shallow tissues. This report describes these two methods and discusses their potential clinical applications.
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Affiliation(s)
- F Avraham Dilmanian
- Department of Radiation Oncology, Health Sciences Center, Stony Brook University , Stony Brook, NY , USA ; Department of Neurology, Health Sciences Center, Stony Brook University , Stony Brook, NY , USA ; Department of Radiology, Health Sciences Center, Stony Brook University , Stony Brook, NY , USA
| | - John G Eley
- Department of Radiation Oncology, School of Medicine, University of Maryland , Baltimore, MD , USA
| | - Adam Rusek
- Brookhaven National Laboratory , Upton, NY , USA ; NASA Space Radiation Laboratory , Upton, NY , USA
| | - Sunil Krishnan
- Department of Radiation Oncology, MD Anderson Cancer Center , Houston, TX , USA
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48
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Gagliardi FM, Cornelius I, Blencowe A, Franich RD, Geso M. High resolution 3D imaging of synchrotron generated microbeams. Med Phys 2015; 42:6973-86. [DOI: 10.1118/1.4935410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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49
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Hong Z, Zenkoh J, Le B, Gerelchuluun A, Suzuki K, Moritake T, Washio M, Urakawa J, Tsuboi K. Generation of low-flux X-ray micro-planar beams and their biological effect on a murine subcutaneous tumor model. JOURNAL OF RADIATION RESEARCH 2015; 56:768-776. [PMID: 26141370 PMCID: PMC4577006 DOI: 10.1093/jrr/rrv037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/20/2015] [Accepted: 06/07/2015] [Indexed: 06/04/2023]
Abstract
We generated low-flux X-ray micro-planar beams (MPBs) using a laboratory-scale industrial X-ray generator (60 kV/20 mA) with custom-made collimators with three different peak/pitch widths (50/200 μm, 100/400 μm, 50/400 μm). To evaluate normal skin reactions, the thighs of C3H/HeN mice were exposed to 100 and 200 Gy MPBs in comparison with broad beams (20, 30, 40, 50, 60 Gy). Antitumor effects of MPBs were evaluated in C3H/HeN mice with subcutaneous tumors (SCCVII). After the tumors were irradiated with 100 and 200 Gy MPBs and 20 and 30 Gy broad beams, the tumor sizes were measured and survival analyses were performed. In addition, the tumors were excised and immunohistochemically examined to detect γ-H2AX, ki67 and CD34. It was shown that antitumor effects of 200 Gy MPBs at 50/200 μm and 100/400 μm were significantly greater than those of 20 Gy broad beams, and were comparable with 30 Gy broad beams. γ-H2AX-positive cells demonstrated clear stripe-patterns after MPB irradiation; the pattern gradually faded and intermixed over 24 h. The chronological changes in ki67 positivity did not differ between MPBs and broad beams, whereas the CD34-positive area decreased significantly more in MPBs than in broad beams. In addition, it was shown that skin injury after MPB irradiation was significantly milder when compared with broad-beam irradiation at equivalent doses for achieving the same tumor control effect. Bystander effect and tumor vessel injury may be the mechanism contributing to the efficacy of MPBs.
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Affiliation(s)
- Zhengshan Hong
- Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Junko Zenkoh
- Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Biao Le
- Ningbo M&J Biotechnologies Co. Ltd, 299 GuangHua Road, Building C6, Suite 1, High-tech Zone, Ningbo City, China
| | - Ariungerel Gerelchuluun
- Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kenshi Suzuki
- Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Takashi Moritake
- Department of Radiological Health Science, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan
| | - Masakazu Washio
- Research Institute for Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo 169-8555, Japan
| | - Junji Urakawa
- High Energy Accelerator Research Organization, 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - Koji Tsuboi
- Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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50
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Microradiosurgical cortical transections generated by synchrotron radiation. Phys Med 2015; 31:642-6. [DOI: 10.1016/j.ejmp.2015.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/15/2015] [Accepted: 05/13/2015] [Indexed: 11/22/2022] Open
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