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Ahmed M, Bicher S, Combs SE, Lindner R, Raulefs S, Schmid TE, Spasova S, Stolz J, Wilkens JJ, Winter J, Bartzsch S. In Vivo Microbeam Radiation Therapy at a Conventional Small Animal Irradiator. Cancers (Basel) 2024; 16:581. [PMID: 38339332 PMCID: PMC11154279 DOI: 10.3390/cancers16030581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
Microbeam radiation therapy (MRT) is a still pre-clinical form of spatially fractionated radiotherapy, which uses an array of micrometer-wide, planar beams of X-ray radiation. The dose modulation in MRT has proven effective in the treatment of tumors while being well tolerated by normal tissue. Research on understanding the underlying biological mechanisms mostly requires large third-generation synchrotrons. In this study, we aimed to develop a preclinical treatment environment that would allow MRT independent of synchrotrons. We built a compact microbeam setup for pre-clinical experiments within a small animal irradiator and present in vivo MRT application, including treatment planning, dosimetry, and animal positioning. The brain of an immobilized mouse was treated with MRT, excised, and immunohistochemically stained against γH2AX for DNA double-strand breaks. We developed a comprehensive treatment planning system by adjusting an existing dose calculation algorithm to our setup and attaching it to the open-source software 3D-Slicer. Predicted doses in treatment planning agreed within 10% with film dosimetry readings. We demonstrated the feasibility of MRT exposures in vivo at a compact source and showed that the microbeam pattern is observable in histological sections of a mouse brain. The platform developed in this study will be used for pre-clinical research of MRT.
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Affiliation(s)
- Mabroor Ahmed
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
- Department of Physics, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany
| | - Sandra Bicher
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
| | - Stephanie Elisabeth Combs
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
| | - Rainer Lindner
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
| | - Susanne Raulefs
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
| | - Thomas E. Schmid
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
| | - Suzana Spasova
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
- Department of Physics, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany
| | - Jessica Stolz
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
| | - Jan Jakob Wilkens
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Department of Physics, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany
| | - Johanna Winter
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
- Department of Physics, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany
- Heinz Maier-Leibnitz Zentrum (MLZ), 85748 Garching, Germany
| | - Stefan Bartzsch
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.A.); (S.B.); (S.E.C.); (S.R.); (T.E.S.); (S.S.); (J.S.); (J.J.W.); (J.W.)
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Institute of Radiation Medicine, 85764 Neuherberg, Germany;
- Heinz Maier-Leibnitz Zentrum (MLZ), 85748 Garching, Germany
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Lu Q, Yan W, Zhu A, Tubin S, Mourad WF, Yang J. Combining spatially fractionated radiation therapy (SFRT) and immunotherapy opens new rays of hope for enhancing therapeutic ratio. Clin Transl Radiat Oncol 2024; 44:100691. [PMID: 38033759 PMCID: PMC10684810 DOI: 10.1016/j.ctro.2023.100691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/04/2023] [Accepted: 10/15/2023] [Indexed: 12/02/2023] Open
Abstract
Spatially Fractionated Radiation Therapy (SFRT) is a form of radiotherapy that delivers a single large dose of radiation within the target volume in a heterogeneous pattern with regions of peak dosage and regions of under dosage. SFRT types can be defined by how the heterogeneous pattern of radiation is obtained. Immune checkpoint inhibitors (ICIs) have been approved for various malignant tumors and are widely used to treat patients with metastatic cancer. The efficacy of ICI monotherapy is limited due to the "cold" tumor microenvironment. Fractionated radiotherapy can achieve higher doses per fraction to the target tumor, and induce immune activation (immodulate tumor immunogenicity and microenvironment). Therefore, coupling ICI therapy and fractionated radiation therapy could significantly improve the outcome of metastatic cancer. This review focuses on both preclinical and clinical studies that use a combination of radiotherapy and ICI therapy in cancer.
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Affiliation(s)
- Qiuxia Lu
- Foshan Fosun Chancheng Hospital, P.R. China
- Junxin Precision Oncology Group, P.R. China
| | - Weisi Yan
- Baptist Health System, Lexington, KY, United States
- Junxin Precision Oncology Group, P.R. China
| | - Alan Zhu
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, United States
| | - Slavisa Tubin
- Albert Einstein Collage of Medicine New York, Center for Ion Therapy, Medaustron, Austria
| | - Waleed F. Mourad
- Department of Radiation Medicine Markey Cancer Center, University of Kentucky - College of Medicine, United States
| | - Jun Yang
- Foshan Fosun Chancheng Hospital, P.R. China
- Junxin Precision Oncology Group, P.R. China
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El Gamal I, Dessureault J, McEwen MR. A novel calorimeter for synchrotron produced monochromatic x-ray beams. Med Phys 2023; 50:6543-6553. [PMID: 37287315 DOI: 10.1002/mp.16526] [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: 11/08/2022] [Revised: 03/12/2023] [Accepted: 05/05/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Electron synchrotrons produce x-ray beams with dose rates orders of magnitude greater than conventional x-ray tubes and with beam sizes on the order of a few millimeters. These characteristics put severe challenges on current dosimeters to accurately realize absorbed dose or air kerma. PURPOSE This work seeks to investigate the suitability of a novel aluminum-based calorimeter to determine absorbed dose to water with an uncertainty significantly smaller than currently possible with conventional detectors. A lower uncertainty in the determination of absolute dose rate would impact both therapeutic applications of synchrotron-produced x-ray beams and research investigations. METHODS A vacuum-based calorimeter prototype with an aluminum core was built, matching the beam profile of the 140 keV monochromatic x-ray beam, produced by the Canadian Light Source Biomedical Imaging and Therapy beamline. The choice of material and overall calorimeter design was optimized using FEM thermal modeling software while Monte Carlo radiation transport simulations were used to model the impact of interactions of the radiation beam with the detector components. RESULTS Corrections for both the thermal conduction and radiation transport effects were of the order of 3% and the simplicity of the geometry, combined with the monochromatic nature of the incident x-ray beam, meant that the uncertainty in each correction was ≤0.5%. The calorimeter performance was found to be repeatable over multiple irradiations of 1 Gy at the ± 0.6% level, and no systematic dependence on environmental effects or total dose was observed. CONCLUSION The combined standard uncertainty in the determination of absorbed dose to aluminum was estimated to be 0.8%, indicating that absorbed dose to water, the ultimate quantity of interest, could be determined with an uncertainty on the order of 1%. This value is an improvement over current techniques used for synchrotron dosimetry and comparable with the state-of-the art for conventional kV x-ray dosimetry.
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Affiliation(s)
- Islam El Gamal
- Metrology Research Centre, National Research Council Canada, Ottawa, Ontario, Canada
- Department of Physics, Carleton University, Ottawa, Ontario, Canada
| | - Jean Dessureault
- Metrology Research Centre, National Research Council Canada, Ottawa, Ontario, Canada
| | - Malcolm R McEwen
- Metrology Research Centre, National Research Council Canada, Ottawa, Ontario, Canada
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Stengl C, Arbes E, Thai LYJ, Echner G, Vedelago J, Jansen J, Jäkel O, Seco J. Development and characterization of a versatile mini-beam collimator for pre-clinical photon beam irradiation. Med Phys 2023; 50:5222-5237. [PMID: 37145971 DOI: 10.1002/mp.16432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Interest in spatial fractionation radiotherapy has exponentially increased over the last decade as a significant reduction of healthy tissue toxicity was observed by mini-beam irradiation. Published studies, however, mostly use rigid mini-beam collimators dedicated to their exact experimental arrangement such that changing the setup or testing new mini-beam collimator configurations becomes challenging and expensive. PURPOSE In this work, a versatile, low-cost mini-beam collimator was designed and manufactured for pre-clinical applications with X-ray beams. The mini-beam collimator enables variability of the full width at half maximum (FWHM), the center-to-center distance (ctc), the peak-to-valley dose ratio (PVDR), and the source-to-collimator distance (SCD). METHODS The mini-beam collimator is an in-house development, which was constructed of 10 × 40 mm2 tungsten or brass plates. These metal plates were combined with 3D-printed plastic plates that can be stacked together in the desired order. A standard X-ray source was used for the dosimetric characterization of four different configurations of the collimator, including a combination of plastic plates of 0.5, 1, or 2 mm width, assembled with 1 or 2 mm thick metal plates. Irradiations were done at three different SCDs for characterizing the performance of the collimator. For the SCDs closer to the radiation source, the plastic plates were 3D-printed with a dedicated angle to compensate for the X-ray beam divergence, making it possible to study ultra-high dose rates of around 40 Gy/s. All dosimetric quantifications were performed using EBT-XD films. Additionally, in vitro studies with H460 cells were carried out. RESULTS Characteristic mini-beam dose distributions were obtained with the developed collimator using a conventional X-ray source. With the exchangeable 3D-printed plates, FWHM and ctc from 0.52 to 2.11 mm, and from 1.77 to 4.61 mm were achieved, with uncertainties ranging from 0.01% to 8.98%, respectively. The FWHM and ctc obtained with the EBT-XD films are in agreement with the design of each mini-beam collimator configuration. For dose rates in the order of several Gy/min, the highest PVDR of 10.09 ± 1.08 was achieved with a collimator configuration of 0.5 mm thick plastic plates and 2 mm thick metal plates. Exchanging the tungsten plates with the lower-density metal brass reduced the PVDR by approximately 50%. Also, increasing the dose rate to ultra-high dose rates was feasible with the mini-beam collimator, where a PVDR of 24.26 ± 2.10 was achieved. Finally, it was possible to deliver and quantify mini-beam dose distribution patterns in vitro. CONCLUSIONS With the developed collimator, we achieved various mini-beam dose distributions that can be adjusted according to the needs of the user in regards to FWHM, ctc, PVDR and SCD, while accounting for beam divergence. Therefore, the designed mini-beam collimator may enable low-cost and versatile pre-clinical research on mini-beam irradiation.
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Affiliation(s)
- Christina Stengl
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Eric Arbes
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department for Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Long-Yang Jan Thai
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department for Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Gernot Echner
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - José Vedelago
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Jeannette Jansen
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Oliver Jäkel
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
| | - Joao Seco
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department for Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
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Mentzel F, Paino J, Barnes M, Cameron M, Corde S, Engels E, Kröninger K, Lerch M, Nackenhorst O, Rosenfeld A, Tehei M, Tsoi AC, Vogel S, Weingarten J, Hagenbuchner M, Guatelli S. Accurate and Fast Deep Learning Dose Prediction for a Preclinical Microbeam Radiation Therapy Study Using Low-Statistics Monte Carlo Simulations. Cancers (Basel) 2023; 15:cancers15072137. [PMID: 37046798 PMCID: PMC10093595 DOI: 10.3390/cancers15072137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023] Open
Abstract
Microbeam radiation therapy (MRT) utilizes coplanar synchrotron radiation beamlets and is a proposed treatment approach for several tumor diagnoses that currently have poor clinical treatment outcomes, such as gliosarcomas. Monte Carlo (MC) simulations are one of the most used methods at the Imaging and Medical Beamline, Australian Synchrotron to calculate the dose in MRT preclinical studies. The steep dose gradients associated with the 50μm-wide coplanar beamlets present a significant challenge for precise MC simulation of the dose deposition of an MRT irradiation treatment field in a short time frame. The long computation times inhibit the ability to perform dose optimization in treatment planning or apply online image-adaptive radiotherapy techniques to MRT. Much research has been conducted on fast dose estimation methods for clinically available treatments. However, such methods, including GPU Monte Carlo implementations and machine learning (ML) models, are unavailable for novel and emerging cancer radiotherapy options such as MRT. In this work, the successful application of a fast and accurate ML dose prediction model for a preclinical MRT rodent study is presented for the first time. The ML model predicts the peak doses in the path of the microbeams and the valley doses between them, delivered to the tumor target in rat patients. A CT imaging dataset is used to generate digital phantoms for each patient. Augmented variations of the digital phantoms are used to simulate with Geant4 the energy depositions of an MRT beam inside the phantoms with 15% (high-noise) and 2% (low-noise) statistical uncertainty. The high-noise MC simulation data are used to train the ML model to predict the energy depositions in the digital phantoms. The low-noise MC simulations data are used to test the predictive power of the ML model. The predictions of the ML model show an agreement within 3% with low-noise MC simulations for at least 77.6% of all predicted voxels (at least 95.9% of voxels containing tumor) in the case of the valley dose prediction and for at least 93.9% of all predicted voxels (100.0% of voxels containing tumor) in the case of the peak dose prediction. The successful use of high-noise MC simulations for the training, which are much faster to produce, accelerates the production of the training data of the ML model and encourages transfer of the ML model to different treatment modalities for other future applications in novel radiation cancer therapies.
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Affiliation(s)
- Florian Mentzel
- Department of Physics, TU Dortmund University, D-44227 Dortmund, Germany
| | - Jason Paino
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Micah Barnes
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Imaging and Medical Beamline, Australian Synchrotron, ANSTO, Clayton, VIC 3168, Australia
- Peter MacCallum Cancer Center, Physical Sciences, Melbourne, VIC 3000, Australia
| | - Matthew Cameron
- Imaging and Medical Beamline, Australian Synchrotron, ANSTO, Clayton, VIC 3168, Australia
| | - Stéphanie Corde
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
- Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Elette Engels
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Imaging and Medical Beamline, Australian Synchrotron, ANSTO, Clayton, VIC 3168, Australia
- Peter MacCallum Cancer Center, Physical Sciences, Melbourne, VIC 3000, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Kevin Kröninger
- Department of Physics, TU Dortmund University, D-44227 Dortmund, Germany
| | - Michael Lerch
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Olaf Nackenhorst
- Department of Physics, TU Dortmund University, D-44227 Dortmund, Germany
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Moeava Tehei
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Ah Chung Tsoi
- School of Computing and Information Technology, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Sarah Vogel
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Jens Weingarten
- Department of Physics, TU Dortmund University, D-44227 Dortmund, Germany
| | - Markus Hagenbuchner
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
- School of Computing and Information Technology, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Susanna Guatelli
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
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Zhang W, Li W, Lin Y, Wang F, Chen RC, Gao H. TVL1-IMPT: Optimization of Peak-to-Valley Dose Ratio Via Joint Total-Variation and L1 Dose Regularization for Spatially Fractionated Pencil-Beam-Scanning Proton Therapy. Int J Radiat Oncol Biol Phys 2023; 115:768-778. [PMID: 36155212 PMCID: PMC10155885 DOI: 10.1016/j.ijrobp.2022.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/18/2022] [Accepted: 09/08/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Proton minibeam radiation therapy (pMBRT) is a novel proton modality of spatially fractionated RT. pMBRT can reduce the radiation damage to normal tissues via biological dose sparing of high peak-to-valley dose ratio (PVDR). This work will develop a new spatially fractionated IMPT treatment planning method for pMBRT that jointly optimizes the plan quality and maximizes the PVDR. METHODS The new optimization method simultaneously maximizes the normal-tissue PVDR and optimizes the dose distribution at tumor targets and organs at risk. The PVDR maximization is through the joint total variation (TV) and L1 regularization with respect to the normal-tissue dose. That is, the beam-eye view projects dose slices of several depths for each beam angle; the TV of dose is maximized, corresponding to the PVDR maximization; and the L1 of dose is minimized, corresponding to the minimization of the organs-at-risk dose and maximization of survival fraction (SF). RESULTS The new IMPT method with TV and L1 regularization was validated in comparison with the conventional IMPT method for pMBRT in several clinical cases. The results show that TVL1 provided larger PVDR and SF than the conventional IMPT method for biological sparing of normal tissues, with preserved plan quality in terms of physical dose distribution. CONCLUSIONS A new spatially fractionated IMPT treatment planning method was developed for pMBRT that can optimize and improve normal-tissue PVDR and SF by incorporating TV and L1 dose regularization with properly chosen regularization parameters into IMPT.
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Affiliation(s)
- Weijie Zhang
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Wangyao Li
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Yuting Lin
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Fen Wang
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Hao Gao
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas.
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7
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Baiocco G, Bartzsch S, Conte V, Friedrich T, Jakob B, Tartas A, Villagrasa C, Prise KM. A matter of space: how the spatial heterogeneity in energy deposition determines the biological outcome of radiation exposure. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2022; 61:545-559. [PMID: 36220965 PMCID: PMC9630194 DOI: 10.1007/s00411-022-00989-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/03/2022] [Indexed: 05/10/2023]
Abstract
The outcome of the exposure of living organisms to ionizing radiation is determined by the distribution of the associated energy deposition at different spatial scales. Radiation proceeds through ionizations and excitations of hit molecules with an ~ nm spacing. Approaches such as nanodosimetry/microdosimetry and Monte Carlo track-structure simulations have been successfully adopted to investigate radiation quality effects: they allow to explore correlations between the spatial clustering of such energy depositions at the scales of DNA or chromosome domains and their biological consequences at the cellular level. Physical features alone, however, are not enough to assess the entity and complexity of radiation-induced DNA damage: this latter is the result of an interplay between radiation track structure and the spatial architecture of chromatin, and further depends on the chromatin dynamic response, affecting the activation and efficiency of the repair machinery. The heterogeneity of radiation energy depositions at the single-cell level affects the trade-off between cell inactivation and induction of viable mutations and hence influences radiation-induced carcinogenesis. In radiation therapy, where the goal is cancer cell inactivation, the delivery of a homogenous dose to the tumour has been the traditional approach in clinical practice. However, evidence is accumulating that introducing heterogeneity with spatially fractionated beams (mini- and microbeam therapy) can lead to significant advantages, particularly in sparing normal tissues. Such findings cannot be explained in merely physical terms, and their interpretation requires considering the scales at play in the underlying biological mechanisms, suggesting a systemic response to radiation.
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Affiliation(s)
- Giorgio Baiocco
- Radiation Biophysics and Radiobiology Group, Physics Department, University of Pavia, Pavia, Italy.
| | - Stefan Bartzsch
- Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany
| | - Valeria Conte
- Istituto Nazionale Di Fisica Nucleare INFN, Laboratori Nazionali Di Legnaro, Legnaro, Italy
| | - Thomas Friedrich
- Department of Biophysics, GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
| | - Burkhard Jakob
- Department of Biophysics, GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
| | - Adrianna Tartas
- Biomedical Physics Division, Institute of Experimental Physics, University of Warsaw, Warsaw, Poland
| | - Carmen Villagrasa
- IRSN, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
| | - Kevin M Prise
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
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8
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McAuley GA, Lim CJ, Teran AV, Slater JD, Wroe AJ. Monte Carlo evaluation of high-gradient magnetically focused planar proton minibeams in a passive nozzle. Phys Med Biol 2022; 67. [PMID: 35421853 DOI: 10.1088/1361-6560/ac678b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/14/2022] [Indexed: 11/12/2022]
Abstract
Objective. To investigate the potential of using a single quadrupole magnet with a high magnetic field gradient to create planar minibeams suitable for clinical applications of proton minibeam radiation therapy.Approach. We performed Monte Carlo simulations involving single quadrupole Halbach cylinders in a passively scattered nozzle in clinical use for proton therapy. Pencil beams produced by the nozzle of 10-15 mm initial diameters and particle range of ∼10-20 cm in water were focused by magnets with field gradients of 225-350 T m-1and cylinder lengths of 80-110 mm to produce very narrow elongated (planar) beamlets. The corresponding dose distributions were scored in a water phantom. Composite minibeam dose distributions composed from three beamlets were created by laterally shifting copies of the single beamlet distribution to either side of a central beamlet. Modulated beamlets (with 18-30 mm nominal central SOBP) and corresponding composite dose distributions were created in a similar manner. Collimated minibeams were also compared with beams focused using one magnet/particle range combination.Main results. The focusing magnets produced planar beamlets with minimum lateral FWHM of ∼1.1-1.6 mm. Dose distributions composed from three unmodulated beamlets showed a high degree of proximal spatial fractionation and a homogeneous target dose. Maximal peak-to-valley dose ratios (PVDR) for the unmodulated beams ranged from 32 to 324, and composite modulated beam showed maximal PVDR ranging from 32 to 102 and SOBPs with good target dose coverage.Significance.Advantages of the high-gradient magnets include the ability to focus beams with phase space parameters that reflect beams in operation today, and post-waist particle divergence allowing larger beamlet separations and thus larger PVDR. Our results suggest that high gradient quadrupole magnets could be useful to focus beams of moderate emittance in clinical proton therapy.
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Affiliation(s)
- Grant A McAuley
- Department of Radiation Medicine, Loma Linda University, Loma Linda CA, United States of America
| | - Crystal J Lim
- School of Medicine, Loma Linda University, Loma Linda, CA United States of America
| | - Anthony V Teran
- Department of Radiation Medicine, Loma Linda University, Loma Linda CA, United States of America.,Orange County CyberKnife and Radiation Oncology Center, Fountain Valley, CA, United States of America
| | - Jerry D Slater
- Department of Radiation Medicine, Loma Linda University, Loma Linda CA, United States of America
| | - Andrew J Wroe
- School of Medicine, Loma Linda University, Loma Linda, CA United States of America.,Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, United States of America.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
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9
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Kundapur V, Mayer M, Auer RN, Alexander A, Weibe S, Pushie MJ, Cranmer-Sargison G. Is Mini Beam Ready for Human Trials? Results of Randomized Study of Treating De-Novo Brain Tumors in Canines Using Linear Accelerator Generated Mini Beams. Radiat Res 2022; 198:162-171. [PMID: 35536992 DOI: 10.1667/rade-21-00093.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
The main challenge in treating malignant brain neoplasms lies in eradicating the tumor while minimizing treatment-related damage. Conventional radiation treatments are associated with considerable side effects. Synchrotron generated micro-beam radiation (SMBRT) has shown to preserve brain architecture while killing tumor cells, however physical characteristics and limited facility access restrict its use. We have created a new clinical device which produces mini beams on a linear accelerator, to provide a new type of treatment called mini-beam radiation therapy (MBRT). The objective of this study is to compare the treatment outcomes of linear accelerator based MBRT versus standard radiation treatment (SRT), to evaluate the tumor response and the treatment-related changes in the normal brain with respect to each treatment type. Pet dogs with de-novo brain tumors were accrued for treatment. Dogs were randomized between standard fractionated stereotactic (9 Gy in 3 fractions) radiation treatment vs. a single fraction of MBRT (26 Gy mean dose). Dogs were monitored after treatment for clinical assessment and imaging. When the dogs were euthanized, a veterinary pathologist assessed the radiation changes and tumor response. We accrued 16 dogs, 8 dogs in each treatment arm. In the MBRT arm, 71% dogs achieved complete pathological remission. The radiation-related changes were all confined to the target region. Structural damage was not observed in the beam path outside of the target region. In contrast, none of the dogs in control group achieved remission and the treatment related damage was more extensive. Therapeutic superiority was observed with MBRT, including both tumor control and the normal structural preservation. The MBRT findings are suggestive of an immune related mechanism which is absent in standard treatment. These findings together with the widespread availability of clinical linear accelerators make MBRT a promising research topic to explore further treatment and clinical trial opportunities.
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Affiliation(s)
- V Kundapur
- Radiation Oncology, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - M Mayer
- Veterinary Radiation Oncology, Department of Small Animal clinical Sciences, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - R N Auer
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - A Alexander
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - S Weibe
- Department of Clinical Imaging, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - M J Pushie
- Department of Surgery, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - G Cranmer-Sargison
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
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10
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Jin JY. Prospect of radiotherapy technology development in the era of immunotherapy. JOURNAL OF THE NATIONAL CANCER CENTER 2022. [DOI: 10.1016/j.jncc.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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11
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Fukunaga H, Yokoya A, Prise KM. A Brief Overview of Radiation-Induced Effects on Spermatogenesis and Oncofertility. Cancers (Basel) 2022; 14:cancers14030805. [PMID: 35159072 PMCID: PMC8834293 DOI: 10.3390/cancers14030805] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Spermatogenesis is one of the most important processes for the propagation of life; however, the testes’ ability to form sperm via this differentiation process is highly radiosensitive and easily impacted by exposure to environmental, occupational, or therapeutic radiation. Furthermore, the possibility that radiation effects on the gonads can be passed on from generation to generation should not be overlooked. This review focuses on the radiation-induced effects on spermatogenesis and the transgenerational effects. We also explore the potential of novel radiobiological approaches to improve male fertility preservation during radiotherapy. Abstract The genotoxicity of radiation on germ cells may be passed on to the next generation, thus its elucidation is not only a scientific issue but also an ethical, legal, and social issue in modern society. In this article, we briefly overview the effects of radiation on spermatogenesis and its associated genotoxicity, including the latest findings in the field of radiobiology. The potential role of transgenerational effects is still poorly understood, and further research in this area is desirable. Furthermore, from the perspective of oncofertility, we discuss the historical background and clinical importance of preserving male fertility during radiation treatment and the potential of microbeam radiotherapy. We hope that this review will contribute to stimulating further discussions and investigations for therapies for pediatric and adolescent/young adult patients.
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Affiliation(s)
- Hisanori Fukunaga
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
- Correspondence:
| | - Akinari Yokoya
- Institute for Quantum Life Science, National Institutes for Quantum Science and Technology, Ibaraki 319-1106, Japan;
- Graduate School of Science and Engineering, Ibaraki University, Ibaraki 310-8512, Japan
| | - Kevin M. Prise
- Patrick G Johnstone Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, UK;
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12
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Abstract
AbstractSpatially fractionated radiation therapy (SFRT) challenges some of the classical dogmas in conventional radiotherapy. The highly modulated spatial dose distributions in SFRT have been shown to lead, both in early clinical trials and in small animal experiments, to a significant increase in normal tissue dose tolerances. Tumour control effectiveness is maintained or even enhanced in some configurations as compared with conventional radiotherapy. SFRT seems to activate distinct radiobiological mechanisms, which have been postulated to involve bystander effects, microvascular alterations and/or immunomodulation. Currently, it is unclear which is the dosimetric parameter which correlates the most with both tumour control and normal tissue sparing in SFRT. Additional biological experiments aiming at parametrizing the relationship between the irradiation parameters (beam width, spacing, peak-to-valley dose ratio, peak and valley doses) and the radiobiology are needed. A sound knowledge of the interrelation between the physical parameters in SFRT and the biological response would expand its clinical use, with a higher level of homogenisation in the realisation of clinical trials. This manuscript reviews the state of the art of this promising therapeutic modality, the current radiobiological knowledge and elaborates on future perspectives.
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13
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Bazyar S, O’Brien ET, Benefield T, Roberts VR, Kumar RJ, Gupta GP, Zhou O, Lee YZ. Immune-Mediated Effects of Microplanar Radiotherapy with a Small Animal Irradiator. Cancers (Basel) 2021; 14:155. [PMID: 35008319 PMCID: PMC8750301 DOI: 10.3390/cancers14010155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 12/30/2022] Open
Abstract
Spatially fractionated radiotherapy has been shown to have effects on the immune system that differ from conventional radiotherapy (CRT). We compared several aspects of the immune response to CRT relative to a model of spatially fractionated radiotherapy (RT), termed microplanar radiotherapy (MRT). MRT delivers hundreds of grays of radiation in submillimeter beams (peak), separated by non-radiated volumes (valley). We have developed a preclinical method to apply MRT by a commercial small animal irradiator. Using a B16-F10 murine melanoma model, we first evaluated the in vitro and in vivo effect of MRT, which demonstrated significant treatment superiority relative to CRT. Interestingly, we observed insignificant treatment responses when MRT was applied to Rag-/- and CD8-depleted mice. An immuno-histological analysis showed that MRT recruited cytotoxic lymphocytes (CD8), while suppressing the number of regulatory T cells (Tregs). Using RT-qPCR, we observed that, compared to CRT, MRT, up to the dose that we applied, significantly increased and did not saturate CXCL9 expression, a cytokine that plays a crucial role in the attraction of activated T cells. Finally, MRT combined with anti-CTLA-4 ablated the tumor in half of the cases, and induced prolonged systemic antitumor immunity.
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Affiliation(s)
- Soha Bazyar
- Department of Radiation Oncology, University of Maryland, Maryland, MD 21201, USA;
| | - Edward Timothy O’Brien
- Department of Physics and Astronomy, The University of North Carolina, Chapel Hill, NC 27514, USA;
| | - Thad Benefield
- Department of Radiology, The University of North Carolina, Chapel Hill, NC 27514, USA;
| | | | - Rashmi J. Kumar
- Medical Scientist Training Program, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA;
| | - Gaorav P. Gupta
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA;
| | - Otto Zhou
- Department of Applied Physics Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA;
| | - Yueh Z. Lee
- Department of Radiology, The University of North Carolina, Chapel Hill, NC 27514, USA;
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
- Biomedical Research Imaging Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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14
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Eley JG, Haga CW, Keller A, Lazenby EM, Raver C, Rusek A, Dilmanian FA, Krishnan S, Waddell J. Heavy Ion Minibeam Therapy: Side Effects in Normal Brain. Cancers (Basel) 2021; 13:cancers13246207. [PMID: 34944825 PMCID: PMC8699126 DOI: 10.3390/cancers13246207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this work was to investigate whether minibeam therapy with heavy ions might offer improvements of the therapeutic ratio for the treatment of human brain cancers. To assess neurotoxicity, we irradiated normal juvenile rats using 120 MeV lithium-7 ions at an absorbed integral dose of 20 Gy. Beams were configured either as a solid parallel circular beam or as an array of planar parallel minibeams having 300-micron width and 1-mm center-to-center spacing within a circular array. We followed animals for 6 months after treatment and utilized behavioral testing and immunohistochemical studies to investigate the resulting cognitive impairment and chronic pathologic changes. We found both solid-beam therapy and minibeam therapy to result in cognitive impairment compared with sham controls, with no apparent reduction in neurotoxicity using heavy ion minibeams instead of solid beams under the conditions of this study.
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Affiliation(s)
- John G. Eley
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA;
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Correspondence:
| | - Catherine W. Haga
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Asaf Keller
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.K.); (C.R.)
| | - Ellis M. Lazenby
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA;
| | - Charles Raver
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.K.); (C.R.)
| | - Adam Rusek
- Brookhaven National Laboratory, Upton, NY 11973, USA;
- NASA Space Radiation Laboratory, Upton, NY 11973, USA
| | - Farrokh Avraham Dilmanian
- Health Sciences Center, Departments of Radiation Oncology, Radiology, and Neurology, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Sunil Krishnan
- Mayo Clinic Cancer Center, Department of Radiation Oncology, Jacksonville, FL 32224, USA;
| | - Jaylyn Waddell
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
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15
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Laissue JA, Barré S, Bartzsch S, Blattmann H, Bouchet AM, Djonov VG, Haberthür D, Hlushchuk R, Kaser-Hotz B, Laissue PP, LeDuc G, Reding SO, Serduc R. Tolerance of Normal Rabbit Facial Bones and Teeth to Synchrotron X-Ray Microbeam Irradiation. Radiat Res 2021; 197:233-241. [PMID: 34755190 DOI: 10.1667/rade-21-00032.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/30/2021] [Indexed: 11/03/2022]
Abstract
Microbeam radiation therapy, an alternative radiosurgical treatment under preclinical investigation, aims to safely treat muzzle tumors in pet animals. This will require data on the largely unknown radiation toxicity of microbeam arrays for bones and teeth. To this end, the muzzle of six young adult New Zealand rabbits was irradiated by a lateral array of microplanar beamlets with peak entrance doses of 200, 330 or 500 Gy. The muzzles were examined 431 days postirradiation by computed microtomographic imaging (micro-CT) ex vivo, and extensive histopathology. The boundaries of the radiation field were identified histologically by microbeam tracks in cartilage and other tissues. There was no radionecrosis of facial bones in any rabbit. Conversely, normal incisor teeth exposed to peak entrance doses of 330 Gy or 500 Gy developed marked caries-like damage, whereas the incisors of the two rabbits exposed to 200 Gy remained unscathed. A single, unidirectional array of microbeams with a peak entrance dose ≤200 Gy (valley dose14 Gy) did not damage normal bone, teeth and soft tissues of the muzzle of normal rabbits longer than one year after irradiation. Because of that, Microbeam radiation therapy of muzzle tumors in pet animals is unlikely to cause sizeable damage to normal teeth, bone and soft tissues, if a single array as used here delivers a limited entrance dose of 200 Gy and a valley dose of ≤14 Gy.
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Affiliation(s)
- Jean Albert Laissue
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, CH -3012 Bern, Switzerland
| | - Sébastien Barré
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, CH -3012 Bern, Switzerland
| | - Stefan Bartzsch
- Department of Radiation Oncology, Klinikum rechts der Isar - TU Munich, Germany
| | - Hans Blattmann
- Niederwiesstrasse 13C, CH-5417 Untersiggenthal, Switzerland
| | - Audrey M Bouchet
- INSERM UA8, "Radiations : Défense, Santé, Environnement," 69008 Lyon, France
| | | | - David Haberthür
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, CH -3012 Bern, Switzerland
| | - Ruslan Hlushchuk
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, CH -3012 Bern, Switzerland
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16
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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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17
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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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18
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A Brief Overview of the Preclinical and Clinical Radiobiology of Microbeam Radiotherapy. Clin Oncol (R Coll Radiol) 2021; 33:705-712. [PMID: 34454806 DOI: 10.1016/j.clon.2021.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022]
Abstract
Microbeam radiotherapy (MRT) is the delivery of spatially fractionated beams that have the potential to offer significant improvements in the therapeutic ratio due to the delivery of micron-sized high dose and dose rate beams. They build on longstanding clinical experience of GRID radiotherapy and more recently lattice-based approaches. Here we briefly overview the preclinical evidence for MRT efficacy and highlight the challenges for bringing this to clinical utility. The biological mechanisms underpinning MRT efficacy are still unclear, but involve vascular, bystander, stem cell and potentially immune responses. There is probably significant overlap in the mechanisms underpinning MRT responses and FLASH radiotherapy that needs to be further defined.
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19
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The role of the spatially fractionated radiation therapy in the management of advanced bulky tumors. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2021. [DOI: 10.2478/pjmpe-2021-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Spatially fractionated radiation therapy (SFRT) refers to the delivery of a single large dose of radiation within the target volume in a heterogeneous pattern using either a custom GRID block, multileaf collimators, and virtual methods such as helical tomotherapy or synchrotron-based microbeams. The potential impact of this technique on the regression of bulky deep-seated tumors that do not respond well to conventional radiotherapy has been remarkable. To date, a large number of patients have been treated using the SFRT techniques. However, there are yet many technical and medical challenges that have limited their routine use to a handful of clinics, most commonly for palliative intent. There is also a poor understanding of the biological mechanisms underlying the clinical efficacy of this approach. In this article, the methods of SFRT delivery together with its potential biological mechanisms are presented. Furthermore, technical challenges and clinical achievements along with the radiobiological models used to evaluate the efficacy and safety of SFRT are highlighted.
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20
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Laissue JA. Elke Bräuer-Krisch: dedication, creativity and generosity: May 17, 1961-September 10, 2018. Int J Radiat Biol 2021; 98:280-287. [PMID: 34129423 DOI: 10.1080/09553002.2021.1941385] [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] [Indexed: 10/21/2022]
Abstract
PURPOSE This extraordinary woman worked her professional way from a radiation protection engineer to become the successful principal investigator of a prestigious international European project for a new radiation therapy (ERC Synergy grant, HORIZON 2020). The evaluation of the submitted proposal was very positive. The panel proposed that it be funded. Elke tragically passed away a few days before this conclusion of the panel. The present account describes her gradual career development; it includes many episodes that Elke personally chronicled in her curriculum of 2017. METHODS An internet literature search was performed using Google Scholar and other sources to assist in the writing of this narrative review and account. CONCLUSIONS In parallel to the development of the new Biomedical Beamline ID17 at the European Synchrotron Radiation Facility in Grenoble in the late nineties, Elke focused her interest and her personal and professional priorities on MRT, particularly on its clinical goals. She outlined her main objectives in several documents: (1) develop a new paradigm of cancer care by broadening the foundation for MRT. (2) Filling the gaps in basic biological knowledge about the mechanisms of MRT effects on normal and neoplastic tissues. (3) Broaden the preclinical level of evidence for the low normal organ toxicity of MRT versus standard X-ray irradiations; preclinical experiments involved the application of MRT to animal tumor patients, to animals of larger size than laboratory rodents, using larger radiation field sizes, and irradiating in a real-time scenario comparable to the one planned for human patients. (4) To foster the specific purpose of radiosurgical MRT of tumor patients at the ESRF that required development of new, specific state of the art modalities and tools for treatment planning, dosimetry, dose calculation, patient positioning and, of particular importance, redundant levels of patient safety. Just as she was about to take responsibility as principal investigator for a prestigious international European project on a new radiation therapy, death called Elke in.
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Affiliation(s)
- Jean A Laissue
- Institute of Pathology, University of Bern, Bern, Switzerland
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21
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Steel H, Brüningk SC, Box C, Oelfke U, Bartzsch SH. Quantification of Differential Response of Tumour and Normal Cells to Microbeam Radiation in the Absence of FLASH Effects. Cancers (Basel) 2021; 13:3238. [PMID: 34209502 PMCID: PMC8268803 DOI: 10.3390/cancers13133238] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/11/2021] [Accepted: 06/24/2021] [Indexed: 12/12/2022] Open
Abstract
Microbeam radiotherapy (MRT) is a preclinical method of delivering spatially-fractionated radiotherapy aiming to improve the therapeutic window between normal tissue complication and tumour control. Previously, MRT was limited to ultra-high dose rate synchrotron facilities. The aim of this study was to investigate in vitro effects of MRT on tumour and normal cells at conventional dose rates produced by a bench-top X-ray source. Two normal and two tumour cell lines were exposed to homogeneous broad beam (BB) radiation, MRT, or were separately irradiated with peak or valley doses before being mixed. Clonogenic survival was assessed and compared to BB-estimated surviving fractions calculated by the linear-quadratic (LQ)-model. All cell lines showed similar BB sensitivity. BB LQ-model predictions exceeded the survival of cell lines following MRT or mixed beam irradiation. This effect was stronger in tumour compared to normal cell lines. Dose mixing experiments could reproduce MRT survival. We observed a differential response of tumour and normal cells to spatially fractionated irradiations in vitro, indicating increased tumour cell sensitivity. Importantly, this was observed at dose rates precluding the presence of FLASH effects. The LQ-model did not predict cell survival when the cell population received split irradiation doses, indicating that factors other than local dose influenced survival after irradiation.
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Affiliation(s)
- Harriet Steel
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK; (C.B.); (U.O.)
| | - Sarah C. Brüningk
- Machine Learning & Computational Biology, Department of Biosystems Science and Engineering, ETH Zurich, 4058 Basel, Switzerland;
- Swiss Institute for Bioinformatics (SIB), 1015 Lausanne, Switzerland
| | - Carol Box
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK; (C.B.); (U.O.)
| | - Uwe Oelfke
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK; (C.B.); (U.O.)
| | - Stefan H. Bartzsch
- Department of Radiation Oncology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany;
- Helmholtz Centre Munich, Institute for Radiation Medicine, Ingolstädter Landstraße 1, 85764 Munich, Germany
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22
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Sabatasso S, Fernandez-Palomo C, Hlushchuk R, Fazzari J, Tschanz S, Pellicioli P, Krisch M, Laissue JA, Djonov V. Transient and Efficient Vascular Permeability Window for Adjuvant Drug Delivery Triggered by Microbeam Radiation. Cancers (Basel) 2021; 13:cancers13092103. [PMID: 33925455 PMCID: PMC8123803 DOI: 10.3390/cancers13092103] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Microbeam Radiation Therapy (MRT) induces a transient vascular permeability window, which offers a novel drug-delivery system for the preferential accumulation of therapeutic compounds in tumors. MRT is a preclinical cancer treatment modality that spatially fractionates synchrotron X-rays into micrometer-wide planar microbeams which can induce transient vascular permeability, especially in the immature tumor vessels, without compromising vascular perfusion. Here, we characterized this phenomenon using Chicken Chorioallantoic Membrane (CAM) and demonstrated its therapeutic potential in human glioblastoma xenografts in mice. METHODS the developing CAM was exposed to planar-microbeams of 75 Gy peak dose with Synchrotron X-rays. Similarly, mice harboring human glioblastoma xenografts were exposed to peak microbeam doses of 150 Gy, followed by treatment with Cisplatin. Tumor progression was documented by Magnetic Resonance Imaging (MRI) and caliper measurements. RESULTS CAM exposed to MRT exhibited vascular permeability, beginning 15 min post-irradiation, reaching its peak from 45 min to 2 h, and ending by 4 h. We have deemed this period the "permeability window". Morphological analysis showed partially fragmented endothelial walls as the cause of the increased transport of FITC-Dextran into the surrounding tissue and the extravasation of 100 nm microspheres (representing the upper range of nanoparticles). In the human glioblastoma xenografts, MRI measurements showed that the combined treatment dramatically reduced the tumor size by 2.75-fold and 5.25-fold, respectively, compared to MRT or Cisplatin alone. CONCLUSIONS MRT provides a novel mechanism for drug delivery by increasing vascular transpermeability while preserving vessel integrity. This permeability window increases the therapeutic index of currently available chemotherapeutics and could be combined with other therapeutic agents such as Nanoparticles/Antibodies/etc.
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Affiliation(s)
- Sara Sabatasso
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
| | - Cristian Fernandez-Palomo
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
| | - Ruslan Hlushchuk
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
| | - Stefan Tschanz
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
| | - Paolo Pellicioli
- Biomedical Beamline ID17, European Synchrotron Radiation Facility, 38043 Grenoble, France; (P.P.); (M.K.)
| | - Michael Krisch
- Biomedical Beamline ID17, European Synchrotron Radiation Facility, 38043 Grenoble, France; (P.P.); (M.K.)
| | - Jean A. Laissue
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (S.S.); (C.F.-P.); (R.H.); (J.F.); (S.T.); (J.A.L.)
- Correspondence: ; Tel.: +41-31-631-84-32
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23
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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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24
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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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25
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Forrester HB, Lobachevsky PN, Stevenson AW, Hall CJ, Martin OA, Sprung CN. Abscopal Gene Expression in Response to Synchrotron Radiation Indicates a Role for Immunological and DNA Damage Response Genes. Radiat Res 2021; 194:678-687. [PMID: 32991732 DOI: 10.1667/rade-19-00014.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 08/24/2020] [Indexed: 11/03/2022]
Abstract
Abscopal effects are an important aspect of targeted radiation therapy due to their implication in normal tissue toxicity from chronic inflammatory responses and mutagenesis. Gene expression can be used to determine abscopal effects at the molecular level. Synchrotron microbeam radiation therapy utilizing high-intensity X rays collimated into planar microbeams is a promising cancer treatment due to its reported ability to ablate tumors with less damage to normal tissues compared to conventional broadbeam radiation therapy techniques. The low scatter of synchrotron radiation enables microbeams to be delivered to tissue effectively, and is also advantageous for out-of-field studies because there is minimal interference from scatter. Mouse legs were irradiated at a dose rate of 49 Gy/s and skin samples in the out-of-field areas were collected. The out-of-field skin showed an increase in Tnf expression and a decrease in Mdm2 expression, genes associated with inflammation and DNA damage. These expression effects from microbeam exposure were similar to those found with broadbeam exposure. In immune-deficient Ccl2 knockout mice, we identified a different gene expression profile which showed an early increase in Mdm2, Tgfb1, Tnf and Ccl22 expression in out-of-field skin that was not observed in the immune-proficient mice. Our results suggest that the innate immune system is involved in out-of-field tissue responses and alterations in the immune response may not eliminate abscopal effects, but could change them.
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Affiliation(s)
- Helen B Forrester
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Australia.,Monash University, Clayton, Australia.,School of Science, RMIT University, Melbourne, Australia
| | - Pavel N Lobachevsky
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Advanced Analytical Technologies, Melbourne, Australia
| | - Andrew W Stevenson
- Australian Synchrotron, ANSTO, Clayton, Australia.,CSIRO Manufacturing, Clayton, Australia
| | | | - Olga A Martin
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Carl N Sprung
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Australia.,Monash University, Clayton, Australia
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26
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Pellicioli P, Donzelli M, Davis JA, Estève F, Hugtenburg R, Guatelli S, Petasecca M, Lerch MLF, Bräuer-Krisch E, Krisch M. Study of the X-ray radiation interaction with a multislit collimator for the creation of microbeams in radiation therapy. JOURNAL OF SYNCHROTRON RADIATION 2021; 28:392-403. [PMID: 33650550 DOI: 10.1107/s1600577520016811] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
Microbeam radiation therapy (MRT) is a developing radiotherapy, based on the use of beams only a few tens of micrometres wide, generated by synchrotron X-ray sources. The spatial fractionation of the homogeneous beam into an array of microbeams is possible using a multislit collimator (MSC), i.e. a machined metal block with regular apertures. Dosimetry in MRT is challenging and previous works still show differences between calculated and experimental dose profiles of 10-30%, which are not acceptable for a clinical implementation of treatment. The interaction of the X-rays with the MSC may contribute to the observed discrepancies; the present study therefore investigates the dose contribution due to radiation interaction with the MSC inner walls and radiation leakage of the MSC. Dose distributions inside a water-equivalent phantom were evaluated for different field sizes and three typical spectra used for MRT studies at the European Synchrotron Biomedical beamline ID17. Film dosimetry was utilized to determine the contribution of radiation interaction with the MSC inner walls; Monte Carlo simulations were implemented to calculate the radiation leakage contribution. Both factors turned out to be relevant for the dose deposition, especially for small fields. Photons interacting with the MSC walls may bring up to 16% more dose in the valley regions, between the microbeams. Depending on the chosen spectrum, the radiation leakage close to the phantom surface can contribute up to 50% of the valley dose for a 5 mm × 5 mm field. The current study underlines that a detailed characterization of the MSC must be performed systematically and accurate MRT dosimetry protocols must include the contribution of radiation leakage and radiation interaction with the MSC in order to avoid significant errors in the dose evaluation at the micrometric scale.
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Affiliation(s)
- P Pellicioli
- ID17 Biomedical Beamline, ESRF - The European Synchrotron, 71 avenue des Martyrs, Grenoble, France
| | - M Donzelli
- ID17 Biomedical Beamline, ESRF - The European Synchrotron, 71 avenue des Martyrs, Grenoble, France
| | - J A Davis
- School of Physics, University of Wollongong, Wollongong, Australia
| | - F Estève
- STROBE - Synchrotron Radiation for Biomedicine, Grenoble, France
| | - R Hugtenburg
- Swansea University Medical School, Singleton Park, Swansea, United Kingdom
| | - S Guatelli
- School of Physics, University of Wollongong, Wollongong, Australia
| | - M Petasecca
- School of Physics, University of Wollongong, Wollongong, Australia
| | - M L F Lerch
- School of Physics, University of Wollongong, Wollongong, Australia
| | - E Bräuer-Krisch
- ID17 Biomedical Beamline, ESRF - The European Synchrotron, 71 avenue des Martyrs, Grenoble, France
| | - M Krisch
- ID17 Biomedical Beamline, ESRF - The European Synchrotron, 71 avenue des Martyrs, Grenoble, France
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27
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Schültke E, Fiedler S, Menk RH, Jaekel F, Dreossi D, Casarin K, Tromba G, Bartzsch S, Kriesen S, Hildebrandt G, Arfelli F. Perspectives for microbeam irradiation at the SYRMEP beamline. JOURNAL OF SYNCHROTRON RADIATION 2021; 28:410-418. [PMID: 33650552 PMCID: PMC7941286 DOI: 10.1107/s1600577521000400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/12/2021] [Indexed: 05/10/2023]
Abstract
It has been shown previously both in vitro and in vivo that microbeam irradiation (MBI) can control malignant tumour cells more effectively than the clinically established concepts of broad beam irradiation. With the aim to extend the international capacity for microbeam research, the first MBI experiment at the biomedical beamline SYRMEP of the Italian synchrotron facility ELETTRA has been conducted. Using a multislit collimator produced by the company TECOMET, arrays of quasi-parallel microbeams were successfully generated with a beam width of 50 µm and a centre-to-centre distance of 400 µm. Murine melanoma cell cultures were irradiated with a target dose of approximately 65 Gy at a mean photon energy of ∼30 keV with a dose rate of 70 Gy s-1 and a peak-to-valley dose of ∼123. This work demonstrated a melanoma cell reduction of approximately 80% after MBI. It is suggested that, while a high energy is essential to achieve high dose rates in order to deposit high treatment doses in a short time in a deep-seated target, for in vitro studies and for the treatment of superficial tumours a spectrum in the lower energy range might be equally suitable or even advantageous.
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Affiliation(s)
- Elisabeth Schültke
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059 Rostock, Germany
| | - Stefan Fiedler
- European Molecular Biology Laboratory, Notkestrasse 85, 22607 Hamburg, Germany
| | - Ralf Hendrik Menk
- Elettra-Sincrotrone Trieste, Strada Statale 14, Trieste 34149, Italy
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Trieste Section, Istituto Nazionale Fisica Nucleare (INFN), Trieste, Italy
| | - Felix Jaekel
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059 Rostock, Germany
| | - Diego Dreossi
- Elettra-Sincrotrone Trieste, Strada Statale 14, Trieste 34149, Italy
| | - Katia Casarin
- Elettra-Sincrotrone Trieste, Strada Statale 14, Trieste 34149, Italy
| | - Giuliana Tromba
- Elettra-Sincrotrone Trieste, Strada Statale 14, Trieste 34149, Italy
| | - Stefan Bartzsch
- Department of Radiooncology, Technical University Munich, Munich, Germany
- Institute for Innovative Radiotherapy, Helmholtz-Zentrum Munich (HMGU), Munich, Germany
| | - Stephan Kriesen
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059 Rostock, Germany
| | - Guido Hildebrandt
- Department of Radiooncology, Rostock University Medical Center, Südring 75, 18059 Rostock, Germany
| | - Fulvia Arfelli
- Trieste Section, Istituto Nazionale Fisica Nucleare (INFN), Trieste, Italy
- Department of Physics, University of Trieste, Trieste, Italy
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28
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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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29
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Treibel F, Nguyen M, Ahmed M, Dombrowsky A, Wilkens JJ, Combs SE, Schmid TE, Bartzsch S. Establishment of Microbeam Radiation Therapy at a Small-Animal Irradiator. Int J Radiat Oncol Biol Phys 2021; 109:626-636. [PMID: 33038461 DOI: 10.1016/j.ijrobp.2020.09.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/03/2020] [Accepted: 09/21/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Microbeam radiation therapy is a preclinical concept in radiation oncology. It spares normal tissue more effectively than conventional radiation therapy at equal tumor control. The radiation field consists of peak regions with doses of several hundred gray, whereas doses between the peaks (valleys) are below the tissue tolerance level. Widths and distances of the beams are in the submillimeter range for microbeam radiation therapy. A similar alternative concept with beam widths and distances in the millimeter range is presented by minibeam radiation therapy. Although both methods were developed at large synchrotron facilities, compact alternative sources have been proposed recently. METHODS AND MATERIALS A small-animal irradiator was fitted with a special 3-layered collimator that is used for preclinical research and produces microbeams of flexible width of up to 100 μm. Film dosimetry provided measurements of the dose distributions and was compared with Monte Carlo dose predictions. Moreover, the micronucleus assay in Chinese hamster CHO-K1 cells was used as a biological dosimeter. The focal spot size and beam emission angle of the x-ray tube were modified to optimize peak dose rate, peak-to-valley dose ratio (PVDR), beam shape, and field homogeneity. An equivalent collimator with slit widths of up to 500 μm produced minibeams and allowed for comparison of microbeam and minibeam field characteristics. RESULTS The setup achieved peak entrance dose rates of 8 Gy/min and PVDRs >30 for microbeams. Agreement between Monte Carlo simulations and film dosimetry is generally better for larger beam widths; qualitative measurements validated Monte Carlo predicted results. A smaller focal spot enhances PVDRs and reduces beam penumbras but substantially reduces the dose rate. A reduction of the beam emission angle improves the PVDR, beam penumbras, and dose rate without impairing field homogeneity. Minibeams showed similar field characteristics compared with microbeams at the same ratio of beam width and distance but had better agreement with simulations. CONCLUSION The developed setup is already in use for in vitro experiments and soon for in vivo irradiations. Deviations between Monte Carlo simulations and film dosimetry are attributed to scattering at the collimator surface and manufacturing inaccuracies and are a matter of ongoing research.
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Affiliation(s)
- Franziska Treibel
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany; Physics Department, Technical University of Munich, Garching, Germany
| | - Mai Nguyen
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany
| | - Mabroor Ahmed
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany; Physics Department, Technical University of Munich, Garching, Germany
| | - Annique Dombrowsky
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany
| | - Jan J Wilkens
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Physics Department, Technical University of Munich, Garching, Germany
| | - Stephanie E Combs
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany
| | - Thomas E Schmid
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany
| | - Stefan Bartzsch
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany.
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30
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Zabihzadeh M, Rabiei A, Shahbazian H, Razmjoo S. Investigating the Dosimetric Characteristics of Microbeam Radiation Treatment. JOURNAL OF MEDICAL SIGNALS & SENSORS 2021; 11:45-51. [PMID: 34026590 PMCID: PMC8043115 DOI: 10.4103/jmss.jmss_12_19] [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: 06/29/2019] [Revised: 07/05/2020] [Accepted: 07/11/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND High-radiation therapeutic gain could be achieved by the modern technique of microbeam radiation treatment (MRT). The aim of this study was to investigate the dosimetric properties of MRT. METHODS The EGSnrc Monte Carlo (MC) code system was used to transport photons and electrons in MRT. The mono-energetic beams (1 cm × 1 cm array) of 50, 100, and 150 keV and the spectrum photon beam (European Synchrotron Radiation Facility [ESRF]) were modeled to transport through multislit collimators with the aperture's widths of 25 and 50 μm and the center-to-center (c-t-c) distance between two adjacent microbeams (MBs) of 200 μm. The calculated phase spaces at the upper surface of water phantom (1 cm × 1 cm) were implemented in DOSXYZnrc code to calculate the percentage depth dose (PDD), the dose profile curves (in depths of 0-1, 1-2, and 3-4 cm), and the peak-to-valley dose ratios (PVDRs). RESULTS The PDD, dose profile curves, and PVDRs were calculated for different effective parameters. The more flatness of lateral dose profile was obtained for the ESRF spectrum MB. With constant c-t-c distance, an increase in the MB size increased the peak and valley dose; simultaneously, the PVDR was larger for the 25 μm MB (33.5) compared to 50 μm MB (21.9) beam, due to the decreased scattering photons followed to the lower overlapping of the adjacent MBs. An increase in the depth decreased the PVDRs (i.e., 54.9 in depth of 0-1 cm). CONCLUSION Our MC model of MRT successfully calculated the effect of dosimetric parameters including photon's energy, beam width, and depth to estimate the dose distribution.
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Affiliation(s)
- Mansour Zabihzadeh
- Cancer Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Clinical Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Atefeh Rabiei
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hojattollah Shahbazian
- Department of Clinical Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sasan Razmjoo
- Department of Clinical Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Simiele EA, Breitkreutz DY, Capaldi DPI, Liu W, Bush KK, Skinner LB. Precision radiotherapy using monochromatic inverse Compton x-ray sources. Med Phys 2020; 48:366-375. [PMID: 33107049 DOI: 10.1002/mp.14552] [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: 06/15/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The dosimetric properties of inverse Compton (IC) x-ray sources were investigated to determine their utility for stereotactic radiation therapy. METHODS Monte Carlo simulations were performed using the egs brachy user code of EGSnrc. Nominal IC source x-ray energies of 80 and 150 keV were considered in this work. Depth-dose and lateral dose profiles in water were calculated, as was dose enhancement in the bone. Further simulations were performed for brain and spine treatment sites. The impact of gold nanoparticle doping was also investigated for the brain treatment site. Analogous dose calculations were performed in a clinical treatment planning system using a clinical 6 MV photon beam model and were compared to the Monte Carlo simulations. RESULTS Both 80 and 150 keV IC beams were observed to have sharp 80-20 penumbra (i.e., < 0.1 mm) with broad low-dose tails in water. For reference, the calculated penumbra for the 6 MV clinical beam was 3 mm. Maximum dose enhancement factors in bone of 3.1, 1.4, and 1.1 were observed for the 80, 150 keV, and clinical 6 MV beams, respectively. The plan quality for the single brain metastasis case was similar between the IC beams and the 6 MV beam without gold nanoparticles. As the concentration of gold within the target increased, the V12 Gy to the normal brain tissue and D max within the target volume significantly decreased and the conformity significantly improved, which resulted in superior plan quality over the clinical 6 MV beam plan. In the spine cases, the sharp penumbra and enhanced dose to bone of the IC beams produced superior plan quality (i.e., better conformity, normal tissue sparing, and spinal cord sparing) as compared to the clinical 6 MV beam plans. CONCLUSIONS The findings from this work indicate that inverse Compton x-ray sources are well suited for stereotactic radiotherapy treatments due to their sharp penumbra and dose enhancement around high atomic number materials. Future work includes investigating the properties of intensity-modulated inverse Compton x-ray sources to improve the homogeneity within the target tissue.
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Affiliation(s)
- Eric A Simiele
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Dylan Y Breitkreutz
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Dante P I Capaldi
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Wu Liu
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Karl K Bush
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Lawrie B Skinner
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
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Blood-Brain Barrier Modulation to Improve Glioma Drug Delivery. Pharmaceutics 2020; 12:pharmaceutics12111085. [PMID: 33198244 PMCID: PMC7697580 DOI: 10.3390/pharmaceutics12111085] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023] Open
Abstract
The blood-brain barrier (BBB) is formed by brain microvascular endothelial cells that are sealed by tight junctions, making it a significant obstacle for most brain therapeutics. The poor BBB penetration of newly developed therapeutics has therefore played a major role in limiting their clinical success. A particularly challenging therapeutic target is glioma, which is the most frequently occurring malignant brain tumor. Thus, to enhance therapeutic uptake in tumors, researchers have been developing strategies to modulate BBB permeability. However, most conventional BBB opening strategies are difficult to apply in the clinical setting due to their broad, non-specific modulation of the BBB, which can result in damage to normal brain tissue. In this review, we have summarized strategies that could potentially be used to selectively and efficiently modulate the tumor BBB for more effective glioma treatment.
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Complete Remission of Mouse Melanoma after Temporally Fractionated Microbeam Radiotherapy. Cancers (Basel) 2020; 12:cancers12092656. [PMID: 32957691 PMCID: PMC7563854 DOI: 10.3390/cancers12092656] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Synchrotron Microbeam Radiotherapy (MRT) significantly improves local tumour control with minimal normal tissue toxicity. MRT delivers orthovoltage X-rays at an ultra-high "FLASH" dose rate in spatially fractionated beams, typically only few tens of micrometres wide. One of the biggest challenges in translating MRT to the clinic is its use of high peak doses, of around 300-600 Gy, which can currently only be delivered by synchrotron facilities. Therefore, in an effort to improve the translation of MRT to the clinic, this work studied whether the temporal fractionation of traditional MRT into several sessions with lower, more clinically feasible, peak doses could still maintain local tumour control. METHODS Two groups of twelve C57Bl/6J female mice harbouring B16-F10 melanomas in their ears were treated with microbeams of 50 µm in width spaced by 200 µm from their centres. The treatment modality was either (i) a single MRT session of 401.23 Gy peak dose (7.40 Gy valley dose, i.e., dose between beams), or (ii) three MRT sessions of 133.41 Gy peak dose (2.46 Gy valley dose) delivered over 3 days in different anatomical planes, which intersected at 45 degrees. The mean dose rate was 12,750 Gy/s, with exposure times between 34.2 and 11.4 ms, respectively. RESULTS Temporally fractionated MRT ablated 50% of B16-F10 mouse melanomas, preventing organ metastases and local tumour recurrence for 18 months. In the rest of the animals, the median survival increased by 2.5-fold in comparison to the single MRT session and by 4.1-fold with respect to untreated mice. CONCLUSIONS Temporally fractionating MRT with lower peak doses not only maintained tumour control, but also increased the efficacy of this technique. These results demonstrate that the solution to making MRT more clinically feasible is to irradiate with several fractions of intersecting arrays with lower peak doses. This provides alternatives to synchrotron sources where future microbeam radiotherapy could be delivered with less intense radiation sources.
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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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Lamirault C, Doyère V, Juchaux M, Pouzoulet F, Labiod D, Dendale R, Patriarca A, Nauraye C, Le Dudal M, Jouvion G, Hardy D, Massioui NE, Prezado Y. Short and long-term evaluation of the impact of proton minibeam radiation therapy on motor, emotional and cognitive functions. Sci Rep 2020; 10:13511. [PMID: 32782370 PMCID: PMC7419511 DOI: 10.1038/s41598-020-70371-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/15/2020] [Indexed: 12/23/2022] Open
Abstract
Radiotherapy (RT) is one of the most frequently used methods for cancer treatment. Despite remarkable advancements in RT techniquesthe treatment of radioresistant tumours (i.e. high-grade gliomas) is not yet satisfactory. Finding novel approaches less damaging for normal tissues is of utmost importance. This would make it possible to increase the dose applied to tumours, resulting in an improvement in the cure rate. Along this line, proton minibeam radiation therapy (pMBRT) is a novel strategy that allows the spatial modulation of the dose, leading to minimal damage to brain structures compared to a high dose (25 Gy in one fraction) of standard proton therapy (PT). The aim of the present study was to evaluate whether pMBRT also preserves important cerebral functions. Comprehensive longitudinal behavioural studies were performed in irradiated (peak dose of 57 Gy in one fraction) and control rats to evaluate the impact of pMBRT on motor function (motor coordination, muscular tonus, and locomotor activity), emotional function (anxiety, fear, motivation, and impulsivity), and cognitive function (learning, memory, temporal processing, and decision making). The evaluations, which were conducted over a period of 10 months, showed no significant motor or emotional dysfunction in pMBRT-irradiated rats compared with control animals. Concerning cognitive functions, similar performance was observed between the groups, although some slight learning delays might be present in some of the tests in the long term after irradiation. This study shows the minimal impact of pMBRT on the normal brain at the functional level.
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Affiliation(s)
- Charlotte Lamirault
- Translational Research Department, Experimental Radiotherapy Platform, Institut Curie, PSL Research University, Orsay, France
| | - Valérie Doyère
- Université Paris-Saclay, CNRS, Institut des Neurosciences Paris-Saclay, 91190, Gif-sur-Yvette, France
| | - Marjorie Juchaux
- Laboratoire de Physique des 2 Infinis Irène Joliot-Curie (IJCLab-UMR 9012), CNRS/Université Paris-Saclay/Université de Paris, Campus Universitaire, Orsay, France
| | - Frederic Pouzoulet
- Translational Research Department, Experimental Radiotherapy Platform, Institut Curie, PSL Research University, Orsay, France
| | - Dalila Labiod
- Translational Research Department, Experimental Radiotherapy Platform, Institut Curie, PSL Research University, Orsay, France
| | - Remi Dendale
- Radiation Oncology Department, Centre de Protonthérapie d'Orsay, 101, Institut Curie, PSL Research University, 91898, Orsay, France
| | - Annalisa Patriarca
- Radiation Oncology Department, Centre de Protonthérapie d'Orsay, 101, Institut Curie, PSL Research University, 91898, Orsay, France
| | - Catherine Nauraye
- Radiation Oncology Department, Centre de Protonthérapie d'Orsay, 101, Institut Curie, PSL Research University, 91898, Orsay, France
| | - Marine Le Dudal
- Institut Pasteur, Neuropathologie Expérimentale, 75015, Paris, France
- Ecole Nationale Vétérinaire d'Alfort, Biopôle, Unité d'Histologie, d'Embryologie et d'Anatomie Pathologique, Université Paris-Est, Maisons-Alfort, France
| | - Grégory Jouvion
- Institut Pasteur, Neuropathologie Expérimentale, 75015, Paris, France
- Physiopathologie des Maladies Génétiques d'Expression Pédiatrique, Assistance Publique des Hôpitaux de Paris, Hôpital Armand-Trousseau, UF de Génétique Moléculaire, Sorbonne Université, INSERM, Paris, France
| | - David Hardy
- Institut Pasteur, Neuropathologie Expérimentale, 75015, Paris, France
| | - Nicole El Massioui
- Université Paris-Saclay, CNRS, Institut des Neurosciences Paris-Saclay, 91190, Gif-sur-Yvette, France
| | - Yolanda Prezado
- Institut Curie, Inserm U 1021-CNRS UMR 3347, University Paris Saclay, PSL Research University, Bat 110, Campus d'Orsay, Orsay, France.
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Eley JG, Chadha AS, Quini C, Vichaya EG, Zhang C, Davis J, Sahoo N, Waddell J, Leiser D, Dilmanian FA, Krishnan S. Pilot study of neurologic toxicity in mice after proton minibeam therapy. Sci Rep 2020; 10:11368. [PMID: 32647361 PMCID: PMC7347840 DOI: 10.1038/s41598-020-68015-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/24/2020] [Indexed: 01/03/2023] Open
Abstract
Proton minibeams (MBs) comprised of parallel planar beamlets were evaluated for their ability to spare healthy brain compared to proton broad beams (BBs). Juvenile mice were given partial brain irradiation of 10 or 30 Gy integral dose using 100 MeV protons configured either as BBs or arrays of 0.3-mm planar MBs spaced 1.0 mm apart on center. Neurologic toxicity was evaluated during an 8-month surveillance: no overt constitutional or neurologic dysfunction was noted for any study animals. Less acute epilation was observed in MB than BB mice. Persistent chronic inflammation was noted along the entire BB path in BB mice whereas inflammation was confined to just within the MB peak regions in MB mice. The potential neurologic sparing, possibly via reduced volume of chronic inflammation, offers a compelling rationale for clinical advancement of this proton technique.
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Affiliation(s)
- John G Eley
- Department of Radiation Oncology, Vanderbilt University School of Medicine, 2220 Pierce Avenue, Preston Research Building B1003, Nashville, TN, 37232, USA.
| | - Awalpreet S Chadha
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Caio Quini
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Elisabeth G Vichaya
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Cancan Zhang
- Department of Radiation Oncology, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201, USA
| | - James Davis
- Department of Pathology, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Narayan Sahoo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Jaylyn Waddell
- Department of Pediatrics, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201, USA
| | - Dominic Leiser
- Department of Radiation Oncology, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201, USA
| | - F Avraham Dilmanian
- Departments of Radiology, Neurology, and Radiation Oncology, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Florida, 4500 San Pablo Road S., Jacksonville, FL, 32224, USA.
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Hombrink G, Wilkens JJ, Combs SE, Bartzsch S. Simulation and measurement of microbeam dose distribution in lung tissue. Phys Med 2020; 75:77-82. [PMID: 32559648 DOI: 10.1016/j.ejmp.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/01/2020] [Indexed: 11/26/2022] Open
Abstract
Microbeam radiation therapy (MRT), a so far preclinical method in radiation oncology, modulates treatment doses on a micrometre scale. MRT uses treatment fields with a few ten micrometre wide high dose regions (peaks) separated by a few hundred micrometre wide low dose regions (valleys) and was shown to spare tissue much more effectively than conventional radiation therapy at similar tumour control rates. While preclinical research focused primarily on tumours of the central nervous system, recently also lung tumours have been suggested as a potential target for MRT. This study investigates the effect of the lung microstructure, comprising air cavities of a few hundred micrometre diameter, on the microbeam dose distribution in lung. In Monte Carlo simulations different models of heterogeneous lung tissue are compared with pure water and homogeneous air-water mixtures. Experimentally, microbeam dose distributions in porous foam material with cavity sizes similar to the size of lung alveoli were measured with film dosimetry at the European Synchrotron Radiation Facility (ESRF) in Grenoble, France. Simulations and experiments show that the microstructure of the lung has a huge impact on the local doses in the microbeam fields. Locally, material inhomogeneities may change the dose by a factor of 1.7, and also average peak and valley doses substantially differ from those in homogeneous material. Our results imply that accurate dose prediction for MRT in lung requires adequate models of the lung microstructure. Even if only average peak and valley doses are of interest, the assumption of a simple homogeneous air-water mixture is not sufficient. Since anatomic information on a micrometre scale are unavailable for clinical treatment planning, alternative methods and models have to be developed.
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Affiliation(s)
- Gerrit Hombrink
- University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Physics Department, Technical University of Munich, Garching, Germany; Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
| | - Jan J Wilkens
- University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Physics Department, Technical University of Munich, Garching, Germany
| | - Stephanie E Combs
- University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
| | - Stefan Bartzsch
- University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany; Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
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The Tissue-Sparing Effect of Spatially Fractionated X-rays for Maintaining Spermatogenesis: A Radiobiological Approach for the Preservation of Male Fertility after Radiotherapy. J Clin Med 2020; 9:jcm9041089. [PMID: 32290436 PMCID: PMC7231089 DOI: 10.3390/jcm9041089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/07/2020] [Accepted: 04/10/2020] [Indexed: 01/15/2023] Open
Abstract
Radiotherapy can result in temporary or permanent gonadal toxicity in male cancer patients despite the high precision and accuracy of modern radiation treatment techniques. Previous radiobiological studies have shown an effective tissue-sparing response in various tissue types and species following exposure to spatially fractionated radiation. In the present study, we used an ex vivo mouse testicular tissue culture model and a conventional X-ray irradiation device to evaluate the tissue-sparing effect (TSE) of spatially fractionated X-rays for the protection of male fertility from radiotherapy-related adverse effects. We revealed a significant TSE for maintaining spermatogenesis in the ex vivo testes model following spatially fractionated X-ray irradiation. Moreover, we experimentally propose a possible mechanism by which the migration of spermatogonial cells, from the non-irradiated areas to the irradiated ones, in irradiated testicular tissue, is essential for the TSE and maintaining spermatogenesis. Therefore, our findings demonstrate that the control of TSE following spatially fractionated X-rays in the testes has a considerable potential for clinical application. Interdisciplinary research will be essential for further expanding the applicability of this method as an approach for the preservation of male fertility during or after radiotherapy.
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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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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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41
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Mazal A, Prezado Y, Ares C, de Marzi L, Patriarca A, Miralbell R, Favaudon V. FLASH and minibeams in radiation therapy: the effect of microstructures on time and space and their potential application to protontherapy. Br J Radiol 2020; 93:20190807. [PMID: 32003574 PMCID: PMC7066940 DOI: 10.1259/bjr.20190807] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
After years of lethargy, studies on two non-conventional microstructures in time and space of the beams used in radiation therapy are enjoying a huge revival. The first effect called “FLASH” is based on very high dose-rate irradiation (pulse amplitude ≥106 Gy/s), short beam-on times (≤100 ms) and large single doses (≥10 Gy) as experimental parameters established so far to give biological and potential clinical effects. The second effect relies on the use of arrays of minibeams (e.g., 0.5–1 mm, spaced 1–3.5 mm). Both approaches have been shown to protect healthy tissues as an endpoint that must be clearly specified and could be combined with each other (e.g., minibeams under FLASH conditions). FLASH depends on the presence of oxygen and could proceed from the chemistry of peroxyradicals and a reduced incidence on DNA and membrane damage. Minibeams action could be based on abscopal effects, cell signalling and/or migration of cells between “valleys and hills” present in the non-uniform irradiation field as well as faster repair of vascular damage. Both effects are expected to maintain intact the tumour control probability and might even preserve antitumoural immunological reactions. FLASH in vivo experiments involving Zebrafish, mice, pig and cats have been done with electron beams, while minibeams are an intermediate approach between X-GRID and synchrotron X-ray microbeams radiation. Both have an excellent rationale to converge and be applied with proton beams, combining focusing properties and high dose rates in the beam path of pencil beams, and the inherent advantage of a controlled limited range. A first treatment with electron FLASH (cutaneous lymphoma) has recently been achieved, but clinical trials have neither been presented for FLASH with protons, nor under the minibeam conditions. Better understanding of physical, chemical and biological mechanisms of both effects is essential to optimize the technical developments and devise clinical trials.
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Affiliation(s)
| | - Yolanda Prezado
- IMNC, University Paris-Sud and Paris-Saclay, CNRS/IN2P3, Orsay, France
| | - Carme Ares
- Centro de Protonterapia Quironsalud, Madrid, Spain
| | - Ludovic de Marzi
- Institut Curie, Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay 91898, France.,Institut Curie, Inserm U 1021-CNRS UMR 3347, Paris-Saclay and PSL Research Universities, Orsay, France
| | - Annalisa Patriarca
- Institut Curie, Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay 91898, France
| | | | - Vincent Favaudon
- Institut Curie, Inserm U 1021-CNRS UMR 3347, Paris-Saclay and PSL Research Universities, Orsay, France
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42
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Bartzsch S, Corde S, Crosbie JC, Day L, Donzelli M, Krisch M, Lerch M, Pellicioli P, Smyth LML, Tehei M. Technical advances in x-ray microbeam radiation therapy. Phys Med Biol 2020; 65:02TR01. [PMID: 31694009 DOI: 10.1088/1361-6560/ab5507] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In the last 25 years microbeam radiation therapy (MRT) has emerged as a promising alternative to conventional radiation therapy at large, third generation synchrotrons. In MRT, a multi-slit collimator modulates a kilovoltage x-ray beam on a micrometer scale, creating peak dose areas with unconventionally high doses of several hundred Grays separated by low dose valley regions, where the dose remains well below the tissue tolerance level. Pre-clinical evidence demonstrates that such beam geometries lead to substantially reduced damage to normal tissue at equal tumour control rates and hence drastically increase the therapeutic window. Although the mechanisms behind MRT are still to be elucidated, previous studies indicate that immune response, tumour microenvironment, and the microvasculature may play a crucial role. Beyond tumour therapy, MRT has also been suggested as a microsurgical tool in neurological disorders and as a primer for drug delivery. The physical properties of MRT demand innovative medical physics and engineering solutions for safe treatment delivery. This article reviews technical developments in MRT and discusses existing solutions for dosimetric validation, reliable treatment planning and safety. Instrumentation at synchrotron facilities, including beam production, collimators and patient positioning systems, is also discussed. Specific solutions reviewed in this article include: dosimetry techniques that can cope with high spatial resolution, low photon energies and extremely high dose rates of up to 15 000 Gy s-1, dose calculation algorithms-apart from pure Monte Carlo Simulations-to overcome the challenge of small voxel sizes and a wide dynamic dose-range, and the use of dose-enhancing nanoparticles to combat the limited penetrability of a kilovoltage energy spectrum. Finally, concepts for alternative compact microbeam sources are presented, such as inverse Compton scattering set-ups and carbon nanotube x-ray tubes, that may facilitate the transfer of MRT into a hospital-based clinical environment. Intensive research in recent years has resulted in practical solutions to most of the technical challenges in MRT. Treatment planning, dosimetry and patient safety systems at synchrotrons have matured to a point that first veterinary and clinical studies in MRT are within reach. Should these studies confirm the promising results of pre-clinical studies, the authors are confident that MRT will become an effective new radiotherapy option for certain patients.
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Affiliation(s)
- Stefan Bartzsch
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany. Helmholtz Centre Munich, Institute for Radiation Medicine, Munich, Germany
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43
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Dilmanian FA, Venkatesulu BP, Sahoo N, Wu X, Nassimi JR, Herchko S, Lu J, Dwarakanath BS, Eley JG, Krishnan S. Proton minibeams-a springboard for physics, biology and clinical creativity. Br J Radiol 2020; 93:20190332. [PMID: 31944824 DOI: 10.1259/bjr.20190332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Proton minibeam therapy (PMBT) is a form of spatially fractionated radiotherapy wherein broad beam radiation is replaced with segmented minibeams-either parallel, planar minibeam arrays generated by a multislit collimator or scanned pencil beams that converge laterally at depth to create a uniform dose layer at the tumor. By doing so, the spatial pattern of entrance dose is considerably modified while still maintaining tumor dose and efficacy. Recent studies using computational modeling, phantom experiments, in vitro and in vivo preclinical models, and early clinical feasibility assessments suggest that unique physical and biological attributes of PMBT can be exploited for future clinical benefit. We outline some of the guiding principle of PMBT in this concise overview of this emerging area of preclinical and clinical research inquiry.
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Affiliation(s)
- F Avraham Dilmanian
- Departments of Radiology, Health Sciences Center and Cancer Center, Stony Brook University, Stony Brook, NY, USA.,Departments of Radiation Oncology, Health Sciences Center and Cancer Center, Stony Brook University, Stony Brook, NY, USA.,Departments of Neurology, Health Sciences Center and Cancer Center, Stony Brook University, Stony Brook, NY, USA.,Departments of Psychiatry, Health Sciences Center and Cancer Center, Stony Brook University, Stony Brook, NY, USA
| | - Bhanu P Venkatesulu
- Department of Experimental Radiation Oncology, Health Sciences Center and Cancer Center, Stony Brook University, Stony Brook, NY, USA
| | - Narayan Sahoo
- Departments of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiaodong Wu
- Biophysics Research Institute of America, Miami, FL, USA.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Jessica R Nassimi
- Departments of Radiology, Health Sciences Center and Cancer Center, Stony Brook University, Stony Brook, NY, USA
| | - Steven Herchko
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Jiade Lu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | | | - John G Eley
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
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44
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Yan W, Khan MK, Wu X, Simone CB, Fan J, Gressen E, Zhang X, Limoli CL, Bahig H, Tubin S, Mourad WF. Spatially fractionated radiation therapy: History, present and the future. Clin Transl Radiat Oncol 2020; 20:30-38. [PMID: 31768424 PMCID: PMC6872856 DOI: 10.1016/j.ctro.2019.10.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Weisi Yan
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mohammad K. Khan
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | - Charles B. Simone
- New York Proton Center, Department of Radiation Oncology, New York, NY, USA
| | - Jiajin Fan
- Radiation Oncology, Inova Schar Cancer Institute, Inova Health System, USA
| | - Eric Gressen
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Xin Zhang
- Boston University School of Medicine, Boston, MA, USA
| | - Charles L. Limoli
- Department of Radiation Oncology, University of California, Ivine 92697-2695, USA
| | - Houda Bahig
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Slavisa Tubin
- KABEG Klinikum Klagenfurt, Institute of Radiation Oncology, Feschnigstraße 11, 9020 Klagenfurt am Wörthersee, Austria
| | - Waleed F. Mourad
- Department of Radiation Medicine, Markey Cancer Center, University of Kentucky – College of Medicine, USA
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45
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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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46
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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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47
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Fukunaga H, Kaminaga K, Sato T, Butterworth KT, Watanabe R, Usami N, Ogawa T, Yokoya A, Prise KM. High-precision microbeam radiotherapy reveals testicular tissue-sparing effects for male fertility preservation. Sci Rep 2019; 9:12618. [PMID: 31575926 PMCID: PMC6773706 DOI: 10.1038/s41598-019-48772-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/05/2019] [Indexed: 12/24/2022] Open
Abstract
Microbeam radiotherapy (MRT) is based on a spatial fractionation of synchrotron X-ray microbeams at the microscale level. Although the tissue-sparing effect (TSE) in response to non-uniform radiation fields was recognized more than one century ago, the TSE of MRT in the testes and its clinical importance for preventing male fertility remain to be determined. In this study, using the combination of MRT techniques and a unique ex vivo testes organ culture, we show, for the first time, the MRT-mediated TSE for the preservation of spermatogenesis. Furthermore, our high-precision microbeam analysis revealed that the survival and potential migration steps of the non-irradiated germ stem cells in the irradiated testes tissue would be needed for the effective TSE for spermatogenesis. Our findings indicated the distribution of dose irradiated in the testes at the microscale level is of clinical importance for delivering high doses of radiation to the tumor, while still preserving male fertility.
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Affiliation(s)
- Hisanori Fukunaga
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK.,Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Kiichi Kaminaga
- Institute for Quantum Life Science, National Institutes for Quantum and Radiological Science and Technology, 2-4 Shirakata-Shirane, Tokai, Ibaraki, 319-1195, Japan
| | - Takuya Sato
- Institute of Molecular Medicine and Life Science, Yokohama City University Association of Medical Science, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Karl T Butterworth
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK
| | - Ritsuko Watanabe
- Institute for Quantum Life Science, National Institutes for Quantum and Radiological Science and Technology, 2-4 Shirakata-Shirane, Tokai, Ibaraki, 319-1195, Japan
| | - Noriko Usami
- Institute of Materials Structure Science, High Energy Accelerator Research Organization, 1-1 Oho, Tsukuba, Ibaraki, 305-0801, Japan
| | - Takehiko Ogawa
- Institute of Molecular Medicine and Life Science, Yokohama City University Association of Medical Science, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Akinari Yokoya
- Institute for Quantum Life Science, National Institutes for Quantum and Radiological Science and Technology, 2-4 Shirakata-Shirane, Tokai, Ibaraki, 319-1195, Japan.
| | - Kevin M Prise
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK.
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48
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Film dosimetry studies for patient specific quality assurance in microbeam radiation therapy. Phys Med 2019; 65:227-237. [DOI: 10.1016/j.ejmp.2019.09.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/02/2019] [Accepted: 09/05/2019] [Indexed: 11/21/2022] Open
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49
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Eling L, Bouchet A, Nemoz C, Djonov V, Balosso J, Laissue J, Bräuer-Krisch E, Adam JF, Serduc R. Ultra high dose rate Synchrotron Microbeam Radiation Therapy. Preclinical evidence in view of a clinical transfer. Radiother Oncol 2019; 139:56-61. [PMID: 31307824 DOI: 10.1016/j.radonc.2019.06.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022]
Abstract
This paper reviews the current state of the art of an emerging form of radiosurgery dedicated to brain tumour treatment and which operates at very high dose rate (kGy·s-1). Microbeam Radiation Therapy uses synchrotron-generated X-rays which triggered normal tissue sparing partially mediated by FLASH effect.
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Affiliation(s)
- Laura Eling
- Inserm UA7, Synchrotron Radiation for Biomedical Research (STROBE), Université Grenoble Alpes - ID17, Installation Européenne du Rayonnement Synchrotron (ESRF) CS 40220, Grenoble Cedex 9, France
| | - Audrey Bouchet
- Inserm UA7, Synchrotron Radiation for Biomedical Research (STROBE), Université Grenoble Alpes - ID17, Installation Européenne du Rayonnement Synchrotron (ESRF) CS 40220, Grenoble Cedex 9, France
| | | | | | | | | | | | - Jean Francois Adam
- Inserm UA7, Synchrotron Radiation for Biomedical Research (STROBE), Université Grenoble Alpes - ID17, Installation Européenne du Rayonnement Synchrotron (ESRF) CS 40220, Grenoble Cedex 9, France
| | - Raphael Serduc
- Inserm UA7, Synchrotron Radiation for Biomedical Research (STROBE), Université Grenoble Alpes - ID17, Installation Européenne du Rayonnement Synchrotron (ESRF) CS 40220, Grenoble Cedex 9, France.
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50
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Novel treatment planning approaches to enhance the therapeutic ratio: targeting the molecular mechanisms of radiation therapy. Clin Transl Oncol 2019; 22:447-456. [PMID: 31254253 DOI: 10.1007/s12094-019-02165-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/16/2019] [Indexed: 12/16/2022]
Abstract
Radiation acts not only through cell death but has also angiogenic, immunomodulatory and bystander effects. The realization of its systemic implications has led to extensive research on the combination of radiotherapy with systemic treatments, including immunotherapy and antiangiogenic agents. Parameters such as dose, fractionation and sequencing of treatments are key determinants of the outcome. However, recent high-quality research indicates that these are not the only radiation therapy parameters that influence its systemic effect. To effectively integrate systemic agents with radiation therapy, these new aspects of radiation therapy planning will have to be taken into consideration in future clinical trials. Our aim is to review these new treatment planning parameters that can influence the balance between contradicting effects of radiation therapy so as to enhance the therapeutic ratio.
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