Teatment planning figures of merit in thermal and epithermal boron neutron capture therapy of brain tumours

Use of the CT images for BNCT calculation: development of BNCT treatment planning system and its applications to dose calculation for voxel phantoms

A BNCT (Boron Neutron Capture Therapy) treatment planning system (BTPS) was developed for BNCT study and treatment planning. Three kinds of CT images, VHP, PINNACLE and DICOM images, were employed to make voxel phantoms for BNCT patient treatment using the BTPS. The thermal neutron, fast neutron, gamma and boron doses are calculated and background, tissue, and tumour doses for idealised standard reactor neutron field (ISRNF) neutron beam were calculated by using BTPS and MCNP code. It was noted that the total computing times needed for BNCT analysis could be greatly reduced since the BTPS system provides a dose analysis tool and a lengthy MCNP input in a short time. It is, thus, expected that the BTPS can significantly contribute the BNCT study for the treatment of patients.

Computational assessment of improved cell-kill by gadolinium-supplemented boron neutron capture therapy

Potential improvement in neutron capture therapy (NCT) by utilizing both 157Gd and 10B is assessed considering two parameters calculated in transport models in MCNP4B, the dose to quiescent cells and the therapeutic ratio. Improved sterilization of quiescent or more generally non-uptaking cells is demonstrated with the addition of 157Gd to conventional 10B loading. The improved dose delivery to non-uptaking cells from concurrent administration of 157Gd and 10B is weighed against a second index, degradation in the therapeutic ratio resulting from the longer interaction lengths of the 157Gd capture products. Optimal concentrations of 157Gd are determined considering varying assumptions for boron uptake levels and selectivity. By analysing the dosimetry results of varying 157Gd concentrations applied concurrently with BPA-delivered boron in NCT, this work seeks to determine a balance between the high tumour-specific dose provided by BPA and the high dose to quiescent cells provided by potential gadolinium agents. Depending upon the assumptions for drug specificity, tumour size and fraction of quiescent cells, NCT with low levels of 157Gd (125 microg g(-1)) supplementing 10B loadings was shown to be superior to treatments applying 10B alone.

A method for fast evaluation of neutron spectra for BNCT based on in-phantom figure-of-merit calculation

In this paper a fast method to evaluate neutron spectra for brain BNCT is developed. The method is based on an algorithm to calculate dose distribution in the brain, for which a data matrix has been taken into account, containing weighted biological doses per position per incident energy and the incident neutron spectrum to be evaluated. To build the matrix, using the MCNP 4C code, nearly monoenergetic neutrons were transported into a head model. The doses were scored and an energy-dependent function to biologically weight the doses was used. To find the beam quality, dose distribution along the beam centerline was calculated. A neutron importance function for this therapy to bilaterally treat deep-seated tumors was constructed in terms of neutron energy. Neutrons in the energy range of a few tens of kilo-electron-volts were found to produce the best dose gain, defined as dose to tumor divided by maximum dose to healthy tissue. Various neutron spectra were evaluated through this method. An accelerator-based neutron source was found to be more reliable for this therapy in terms of therapeutic gain than reactors.

What is the best proton energy for accelerator-based BNCT using the 7Li(p,n)7Be reaction?

With a growing interest in the use of accelerator-based epithermal neutron sources for BNCT programs, in particular those based upon the 7Li(p,n)7Be reaction, there is a need to address the question of "what is the best proton energy to use?" This paper considers this question by using radiation transport calculations to investigate a range of proton energies from 2.15 to 3.5 MeV and a range of moderator sizes. This study has moved away completely from the use of empty therapy beam parameters and instead defines the beam quality and optimizes the moderator design using widely accepted in-phantom treatment planning figures of merit. It is concluded that up to a proton energy of about 2.8 MeV there is no observed variation in the achievable therapy beam quality, but a price is paid in terms of treatment time for not choosing the upper limit of this range. For higher proton energies, the beam quality falls, but with no improvement in treatment time for optimum configurations.

On the optimal energy of epithermal neutron beams for BNCT

The optimal neutron energy for the treatment of deep-seated tumours using boron neutron capture therapy is studied by analysing various figures of merit. In particular, analysis of the therapeutic gain as a function of the neutron energy indicates that, with the currently available 10B carriers, the most useful neutrons for the treatment of deep-seated tumours, in particular glioblastoma multiforme, are those with an energy of a few keV. Based on the results of the simulations, a method is presented which allows us to evaluate the quality of epithermal neutron beams of known energy spectrum, thus allowing us to compare different neutron-producing reactions and beam-shaping assembly configurations used for accelerator-based neutron sources.

Design for an accelerator-based orthogonal epithermal neutron beam for boron neutron capture therapy

This paper is concerned with the proposed Birmingham accelerator-based epithermal neutron beam for boron neutron capture therapy (BNCT). In particular, the option of producing a therapy beam at an orthogonal direction to the incoming protons is considered. Monte Carlo radiation transport simulations, both with and without a head phantom, have shown that an orthogonal beam geometry is not only acceptable but is indeed beneficial, in terms of a lower mean neutron energy and an enhanced therapeutic ratio for the same useful neutron fluence in the therapy beam. Typical treatment times for various beam options have been calculated, and range from 20 to 48 min with a 5 mA beam of 2.8 MeV protons, if the maximum photon-equivalent dose delivered to healthy tissue is to be 12.6 Gy Eq. The effects of proton beam diameter upon the therapy beam parameters have also been considered.

Toward a final design for the Birmingham boron neutron capture therapy neutron beam

This paper is concerned with the proposed Birmingham accelerator-based epithermal neutron beam for boron neutron capture therapy (BNCT). Details of the final moderator design, such as beam delimiter, shield, and beam exit surface shape are considered. Monte Carlo radiation transport simulations with a head and body phantom have shown that a simple flat moderator beam exit surface is preferable to the previously envisioned spherical design. Dose rates to individual body organs during treatment have been calculated using a standard MIRD phantom. We have shown that a simple polyethylene shield, doped with natural lithium, is sufficient to provide adequate protection to the rest of the body during head irradiations. The effect upon the head phantom dose distributions of the use of such a shield to delimit the therapy beam has been evaluated.

Boron neutron capture therapy for glioblastoma multiforme using p-boronophenylalanine and epithermal neutrons: trial design and early clinical results

A Phase I/II clinical trial of boron neutron capture therapy (BNCT) for glioblastoma multiforme is underway using the amino acid analog p-boronophenylalanine (BPA) and the epithermal neutron beam at the Brook-haven Medical Research Reactor. Biodistribution studies were carried out in 18 patients at the time of craniotomy using an i.v. infusion of BPA, solubilized as a fructose complex (BPA-F). There were no toxic effects related to the BPA-F administration at doses of 130, 170, 210, or 250 mg BPA/kg body weight. The tumor/ blood, brain/blood and scalp/blood boron concentration ratios were approximately 3.5:1, 1:1 and 1.5:1, respectively. Ten patients have received BNCT following 2-hr infusions of 250 mg BPA/kg body weight. The average boron concentration in the blood during the irradiation was 13.0 +/- 1.5 micrograms 10B/g. The prescribed maximum dose to normal brain (1 cm3 volume) was 10.5 photon-equivalent Gy (Gy-Eq). Estimated maximum and minimum doses (mean +/- sd, n = 10) to the tumor volume were 52.6 +/- 4.9 Gy-Eq (range: 64.4-47.6) and 25.2 +/- 4.2 Gy-Eq (range: 32.3-20.0), respectively). The estimated minimum dose to the target volume (tumor +2 cm margin) was 12.3 +/- 2.7 Gy-Eq (range: 16.2-7.8). There were no adverse effects on normal brain. The scalp showed mild erythema, followed by epilation in the 8 cm diameter field. Four patients developed recurrent tumor, apparently in the lower dose (deeper) regions of the target volume, at post-BNCT intervals of 7,5,3.5 and 3 months, respectively. The remaining patients have had less than 4 months of post-BNCT follow-up. BNCT, at this starting dose level, appears safe. Plans are underway to begin the dose escalation phase of this protocol.

Monte Carlo calculations of epithermal boron neutron capture therapy with heavy water

Much work over the past decade has centred upon the development of epithermal neutron beams for boron neutron capture therapy (BNCT) in an effort to increase thermal-neutron flux penetration and dose homogeneity throughout the brain. While heavy water has been used extensively to improve neutron penetration associated with thermal neutron beams, the effects of heavy water with epithermal neutron beams remain largely unexplored. Applying the Monte Carlo code MCNP to a heterogenous ellipsoidal skull/brain model, the effects of heavy-water replacement are studied for the JRC/ECN Petten HFR epithermal neutron beam. Thermal neutron flux and induced gamma depth dose distributions are calculated for 20% D2O replacement in comparison to standard brain and skull materials. Results are presented for both unilateral and bilateral irradiation. With bilateral irradiation, thermal-neutron flux homogeneity is substantially increased with 20% D2O replacement, thus improving the potential to give lethal doses to boron-10-loaded, disseminated cancer cells whilst avoiding local 'hot spots' to healthy tissue. Additionally, the induced gamma dose is reduced by up to 30%, substantially lowering the background dose to healthy tissue. With bilateral irradiation, 20% D2O replacement increases the therapeutic ratio from 2.25 to 2.75 for over 4 cm depth centred at the midline of the brain. These calculations use documented tumour and blood 10B concentrations for boronophenylalanine (BPA) in humans and recently documented neutron relative biological effectiveness (RBE) values.