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Prezado Y, Grams M, Jouglar E, Martínez-Rovira I, Ortiz R, Seco J, Chang S. Spatially fractionated radiation therapy: a critical review on current status of clinical and preclinical studies and knowledge gaps. Phys Med Biol 2024; 69:10TR02. [PMID: 38648789 DOI: 10.1088/1361-6560/ad4192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/22/2024] [Indexed: 04/25/2024]
Abstract
Spatially fractionated radiation therapy (SFRT) is a therapeutic approach with the potential to disrupt the classical paradigms of conventional radiation therapy. The high spatial dose modulation in SFRT activates distinct radiobiological mechanisms which lead to a remarkable increase in normal tissue tolerances. Several decades of clinical use and numerous preclinical experiments suggest that SFRT has the potential to increase the therapeutic index, especially in bulky and radioresistant tumors. To unleash the full potential of SFRT a deeper understanding of the underlying biology and its relationship with the complex dosimetry of SFRT is needed. This review provides a critical analysis of the field, discussing not only the main clinical and preclinical findings but also analyzing the main knowledge gaps in a holistic way.
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Affiliation(s)
- Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, F-91400, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, F-91400, Orsay, France
- New Approaches in Radiotherapy Lab, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Instituto de investigación Sanitaria de Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, A Coruña, E-15706, Spain
- Oportunius Program, Galician Agency of Innovation (GAIN), Xunta de Galicia, Santiago de Compostela, A Coruña, Spain
| | - Michael Grams
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America
| | - Emmanuel Jouglar
- Institut Curie, PSL Research University, Department of Radiation Oncology, F-75005, Paris and Orsay Protontherapy Center, F-91400, Orsay, France
| | - Immaculada Martínez-Rovira
- Physics Department, Universitat Auto`noma de Barcelona, E-08193, Cerdanyola del Valle`s (Barcelona), Spain
| | - Ramon Ortiz
- University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero Street, San Francisco, CA 94143, United States of America
| | - Joao Seco
- Division of Biomedical physics in Radiation Oncology, DKFZ-German Cancer Research Center, Heidelberg, Germany
- Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Sha Chang
- Dept of Radiation Oncology and Department of Biomedical Engineering, University of North Carolina School of Medicine, United States of America
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolin State University, United States of America
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Stengl C, Muñoz ID, Arbes E, Rauth E, Christensen JB, Vedelago J, Runz A, Jäkel O, Seco J. Dosimetric study for breathing-induced motion effects in an abdominal pancreas phantom for carbon ion mini-beam radiotherapy. Med Phys 2024. [PMID: 38631000 DOI: 10.1002/mp.17077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Particle mini-beam therapy exhibits promise in sparing healthy tissue through spatial fractionation, particularly notable for heavy ions, further enhancing the already favorable differential biological effectiveness at both target and entrance regions. However, breathing-induced organ motion affects particle mini-beam irradiation schemes since the organ displacements exceed the mini-beam structure dimensions, decreasing the advantages of spatial fractionation. PURPOSE In this study, the impact of breathing-induced organ motion on the dose distribution was examined at the target and organs at risk(OARs) during carbon ion mini-beam irradiation for pancreatic cancer. METHODS As a first step, the carbon ion mini-beam pattern was characterized with Monte Carlo simulations. To analyze the impact of breathing-induced organ motion on the dose distribution of a virtual pancreas tumor as target and related OARs, the anthropomorphic Pancreas Phantom for Ion beam Therapy (PPIeT) was irradiated with carbon ions. A mini-beam collimator was used to deliver a spatially fractionated dose distribution. During irradiation, varying breathing motion amplitudes were induced, ranging from 5 to 15 mm. Post-irradiation, the 2D dose pattern was analyzed, focusing on the full width at half maximum (FWHM), center-to-center distance (ctc), and the peak-to-valley dose ratio (PVDR). RESULTS The mini-beam pattern was visible within OARs, while in the virtual pancreas tumor a more homogeneous dose distribution was achieved. Applied motion affected the mini-beam pattern within the kidney, one of the OARs, reducing the PVDR from 3.78 ± $\pm$ 0.12 to 1.478 ± $\pm$ 0.070 for the 15 mm motion amplitude. In the immobile OARs including the spine and the skin at the back, the PVDR did not change within 3.4% comparing reference and motion conditions. CONCLUSIONS This study provides an initial understanding of how breathing-induced organ motion affects spatial fractionation during carbon ion irradiation, using an anthropomorphic phantom. A decrease in the PVDR was observed in the right kidney when breathing-induced motion was applied, potentially increasing the risk of damage to OARs. Therefore, further studies are needed to explore the clinical viability of mini-beam radiotherapy with carbon ions when irradiating abdominal regions.
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Affiliation(s)
- Christina Stengl
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
- 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
| | - Iván D Muñoz
- 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
- Department for Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Eric Arbes
- Department for Physics and Astronomy, Heidelberg University, Heidelberg, Germany
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Evelyn Rauth
- Department for Physics and Astronomy, Heidelberg University, Heidelberg, Germany
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jeppe B Christensen
- Department of Radiation Safety and Security, Paul Scherrer Institute (PSI), Villigen, Switzerland
| | - 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
- Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
| | - Armin Runz
- 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
| | - 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), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
| | - Joao Seco
- Department for Physics and Astronomy, Heidelberg University, Heidelberg, Germany
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Loap P, Giorgi M, Vu-Bezin J, Kirov K, Sampai JM, Prezado Y, Kirova Y. Dosimetric feasibility study ("proof of concept") of refractory ventricular tachycardia radioablation using proton minibeams. Cancer Radiother 2024; 28:195-201. [PMID: 38599941 DOI: 10.1016/j.canrad.2024.02.002] [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: 12/20/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Preclinical data demonstrated that the use of proton minibeam radiotherapy reduces the risk of toxicity in healthy tissue. Ventricular tachycardia radioablation is an area under clinical investigation in proton beam therapy. We sought to simulate a ventricular tachycardia radioablation with proton minibeams and to demonstrate that it was possible to obtain a homogeneous coverage of an arrhythmogenic cardiac zone with this technique. MATERIAL AND METHODS An arrhythmogenic target volume was defined on the simulation CT scan of a patient, localized in the lateral wall of the left ventricle. A dose of 25Gy was planned to be delivered by proton minibeam radiotherapy, simulated using a Monte Carlo code (TOPAS v.3.7) with a collimator of 19 0.4 mm-wide slits spaced 3mm apart. The main objective of the study was to obtain a plan ensuring at least 93% of the prescription dose in 93% of the planning target volume without exceeding 110% of the prescribed dose in the planning target volume. RESULTS The average dose in the planning treatment volume in proton minibeam radiotherapy was 25.12Gy. The percentage of the planning target volume receiving 93% (V93%), 110% (V110%), and 95% (V95%) of the prescribed dose was 94.25%, 0%, and 92.6% respectively. The lateral penumbra was 6.6mm. The mean value of the peak-to-valley-dose ratio in the planning target volume was 1.06. The mean heart dose was 2.54Gy versus 5.95Gy with stereotactic photon beam irradiation. CONCLUSION This proof-of-concept study shows that proton minibeam radiotherapy can achieve a homogeneous coverage of an arrhythmogenic cardiac zone, reducing the dose at the normal tissues. This technique, ensuring could theoretically reduce the risk of late pulmonary and breast fibrosis, as well as cardiac toxicity as seen in previous biological studies in proton minibeam radiotherapy.
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Affiliation(s)
- P Loap
- Department of Radiation Oncology, institut Curie, Paris, France
| | - M Giorgi
- Signalisation radiobiologie et cancer, Inserm U1021, CNRS UMR3347, Institut Curie, université PSL, 91400 Orsay, France; Laboratório de Instrumentação e Física Experimental de Partículas (LIP), Lisboa, Portugal; Departamento de Física, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - J Vu-Bezin
- Department of Radiation Oncology, institut Curie, Paris, France
| | - K Kirov
- Department of Anesthesia and Reanimation, institut Curie, Paris, France
| | - J M Sampai
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), Lisboa, Portugal; Departamento de Física, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Y Prezado
- Signalisation radiobiologie et cancer, Inserm U1021, CNRS UMR3347, Institut Curie, université PSL, 91400 Orsay, France
| | - Y Kirova
- Department of Radiation Oncology, institut Curie, Paris, France; Université Versailles, Saint-Quentin, France.
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Clements N, Esplen N, Bateman J, Robertson C, Dosanjh M, Korysko P, Farabolini W, Corsini R, Bazalova-Carter M. Mini-GRID radiotherapy on the CLEAR very-high-energy electron beamline: collimator optimization, film dosimetry, and Monte Carlo simulations. Phys Med Biol 2024; 69:055003. [PMID: 38295408 DOI: 10.1088/1361-6560/ad247d] [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: 08/10/2023] [Accepted: 01/31/2024] [Indexed: 02/02/2024]
Abstract
Objective.Spatially-fractionated radiotherapy (SFRT) delivered with a very-high-energy electron (VHEE) beam and a mini-GRID collimator was investigated to achieve synergistic normal tissue-sparing through spatial fractionation and the FLASH effect.Approach.A tungsten mini-GRID collimator for delivering VHEE SFRT was optimized using Monte Carlo (MC) simulations. Peak-to-valley dose ratios (PVDRs), depths of convergence (DoCs, PVDR ≤ 1.1), and peak and valley doses in a water phantom from a simulated 150 MeV VHEE source were evaluated. Collimator thickness, hole width, and septal width were varied to determine an optimal value for each parameter that maximized PVDR and DoC. The optimized collimator (20 mm thick rectangular prism with a 15 mm × 15 mm face with a 7 × 7 array of 0.5 mm holes separated by 1.1 mm septa) was 3D-printed and used for VHEE irradiations with the CERN linear electron accelerator for research beam. Open beam and mini-GRID irradiations were performed at 140, 175, and 200 MeV and dose was recorded with radiochromic films in a water tank. PVDR, central-axis (CAX) and valley dose rates and DoCs were evaluated.Main results.Films demonstrated peak and valley dose rates on the order of 100 s of MGy/s, which could promote FLASH-sparing effects. Across the three energies, PVDRs of 2-4 at 13 mm depth and DoCs between 39 and 47 mm were achieved. Open beam and mini-GRID MC simulations were run to replicate the film results at 200 MeV. For the mini-GRID irradiations, the film CAX dose was on average 15% higher, the film valley dose was 28% higher, and the film PVDR was 15% lower than calculated by MC.Significance.Ultimately, the PVDRs and DoCs were determined to be too low for a significant potential for SFRT tissue-sparing effects to be present, particularly at depth. Further beam delivery optimization and investigations of new means of spatial fractionation are warranted.
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Affiliation(s)
- Nathan Clements
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
| | - Nolan Esplen
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
| | - Joseph Bateman
- Department of Physics, University of Oxford, Oxford, United Kingdom
| | | | - Manjit Dosanjh
- Department of Physics, University of Oxford, Oxford, United Kingdom
- CERN, Geneva, Switzerland
| | - Pierre Korysko
- Department of Physics, University of Oxford, Oxford, United Kingdom
- CERN, Geneva, Switzerland
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Clements N, Esplen N, Bazalova-Carter M. A feasibility study of ultra-high dose rate mini-GRID therapy using very-high-energy electron beams for a simulated pediatric brain case. Phys Med 2023; 112:102637. [PMID: 37454482 DOI: 10.1016/j.ejmp.2023.102637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/09/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
Ultra-high dose rate (UHDR, >40 Gy/s), spatially-fractionated minibeam GRID (mini-GRID) therapy using very-high-energy electrons (VHEE) was investigated using Monte Carlo simulations. Multi-directional VHEE treatments with and without mini-GRID-fractionation were compared to a clinical 6 MV volumetric modulated arc therapy (VMAT) plan for a pediatric glioblastoma patient using dose-volume histograms, volume-averaged dose rates in critical patient structures, and planning target volume D98s. Peak-to-valley dose ratios (PVDRs) and dose rates in organs at risk (OARs) were evaluated due to their relevance for normal-tissue sparing in FLASH and spatially-fractionated techniques. Depths of convergence, defined where the PVDR is first ≤1.1, and depths at which dose rates fall below the UHDR threshold were also evaluated. In a water phantom, the VHEE mini-GRID treatments presented a surface (5 mm depth) PVDR of (51±2) and a depth of convergence of 42 mm at 150 MeV and a surface PVDR of (33±1) with a depth of convergence of 57 mm at 250 MeV. For a pediatric GBM case, VHEE treatments without mini-GRID-fractionation produced 25% and 22% lower volume-averaged doses to OARs compared to the 6 MV VMAT plan and 8/9 and 9/9 of the patient structures were exposed to volume-averaged dose rates >40 Gy/s for the 150 MeV and 250 MeV plans, respectively. The 150 MeV and 250 MeV mini-GRID treatments produced 17% and 38% higher volume-averaged doses to OARs and 3/9 patient structures had volume-averaged dose rates above 40 Gy/s. VHEE mini-GRID plans produced many comparable dose metrics to the clinical VMAT plan, encouraging further optimization.
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Affiliation(s)
- Nathan Clements
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada.
| | - Nolan Esplen
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, 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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Tubin S, Vozenin M, Prezado Y, Durante M, Prise K, Lara P, Greco C, Massaccesi M, Guha C, Wu X, Mohiuddin M, Vestergaard A, Bassler N, Gupta S, Stock M, Timmerman R. Novel unconventional radiotherapy techniques: Current status and future perspectives - Report from the 2nd international radiation oncology online seminar. Clin Transl Radiat Oncol 2023; 40:100605. [PMID: 36910025 PMCID: PMC9996385 DOI: 10.1016/j.ctro.2023.100605] [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: 12/14/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023] Open
Abstract
•Improvement of therapeutic ratio by novel unconventional radiotherapy approaches.•Immunomodulation using high-dose spatially fractionated radiotherapy.•Boosting radiation anti-tumor effects by adding an immune-mediated cell killing.
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Affiliation(s)
- S. Tubin
- Medaustron Center for Ion Therapy, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
- Corresponding author.
| | - M.C. Vozenin
- Radiation Oncology Laboratory, Radiation Oncology Service, Oncology Department, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Y. Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay 91400, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay 91400, France
| | - M. Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, Darmstadt 64291, Germany
- Technsiche Universität Darmstadt, Institute for Condensed Matter Physics, Darmstadt, Germany
| | - K.M. Prise
- Patrick G Johnston Centre for Cancer Research Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom
| | - P.C. Lara
- Canarian Comprehensive Cancer Center, San Roque University Hospital & Fernando Pessoa Canarias University, C/Dolores de la Rocha 9, Las Palmas GC 35001, Spain
| | - C. Greco
- Department of Radiation Oncology Champalimaud Foundation, Av. Brasilia, Lisbon 1400-038, Portugal
| | - M. Massaccesi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - C. Guha
- Montefiore Medical Center Radiation Oncology, 111 E 210th St, New York, NY, United States
| | - X. Wu
- Executive Medical Physics Associates, 19470 NE 22nd Road, Miami, FL 33179, United States
| | - M.M. Mohiuddin
- Northwestern Medicine Cancer Center Warrenville and Northwestern Medicine Proton Center, 4455 Weaver Pkwy, Warrenville, IL 60555, United States
| | - A. Vestergaard
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - N. Bassler
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - S. Gupta
- The Loop Immuno-Oncology Laboratory, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - M. Stock
- Medaustron Center for Ion Therapy, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
- Karl Landsteiner University of Health Sciences, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
| | - R. Timmerman
- Department of Radiation Oncology, University of Texas, Southwestern Medical Center, Inwood Road Dallas, TX 2280, United States
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Schneider T, Malaise D, Pouzoulet F, Prezado Y. Orthovoltage X-ray Minibeam Radiation Therapy for the Treatment of Ocular Tumours-An In Silico Evaluation. Cancers (Basel) 2023; 15:cancers15030679. [PMID: 36765637 PMCID: PMC9913874 DOI: 10.3390/cancers15030679] [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: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
(1) Background: Radiotherapeutic treatments of ocular tumors are often challenging because of nearby radiosensitive structures and the high doses required to treat radioresistant cancers such as uveal melanomas. Although increased local control rates can be obtained with advanced techniques such as proton therapy and stereotactic radiosurgery, these modalities are not always accessible to patients (due to high costs or low availability) and side effects in structures such as the lens, eyelids or anterior chamber remain an issue. Minibeam radiation therapy (MBRT) could represent a promising alternative in this regard. MBRT is an innovative new treatment approach where the irradiation field is composed of multiple sub-millimetric beamlets, spaced apart by a few millimetres. This creates a so-called spatial fractionation of the dose which, in small animal experiments, has been shown to increase normal tissue sparing while simultaneously providing high tumour control rates. Moreover, MBRT with orthovoltage X-rays could be easily implemented in widely available and comparably inexpensive irradiation platforms. (2) Methods: Monte Carlo simulations were performed using the TOPAS toolkit to evaluate orthovoltage X-ray MBRT as a potential alternative for treating ocular tumours. Dose distributions were simulated in CT images of a human head, considering six different irradiation configurations. (3) Results: The mean, peak and valley doses were assessed in a generic target region and in different organs at risk. The obtained doses were comparable to those reported in previous X-ray MBRT animal studies where good normal tissue sparing and tumour control (rat glioma models) were found. (4) Conclusions: A proof-of-concept study for the application of orthovoltage X-ray MBRT to ocular tumours was performed. The simulation results encourage the realisation of dedicated animal studies considering minibeam irradiations of the eye to specifically assess ocular and orbital toxicities as well as tumour response. If proven successful, orthovoltage X-ray minibeams could become a cost-effective treatment alternative, in particular for developing countries.
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Affiliation(s)
- Tim Schneider
- Institut Curie, Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
- Correspondence:
| | - Denis Malaise
- Department of Ophthalmology, Institut Curie, 75005 Paris, France
- LITO, INSERM U1288, Institut Curie, PSL University, 91898 Orsay, France
| | - Frédéric Pouzoulet
- LITO, INSERM U1288, Institut Curie, PSL University, 91898 Orsay, France
- Département de Recherche Translationnelle, CurieCoreTech-Experimental Radiotherapy (RadeXp), Institut Curie, PSL University, 91400 Orsay, France
| | - Yolanda Prezado
- Institut Curie, Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
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Clements N, Bazalova-Carter M, Esplen N. Monte Carlo optimization of a GRID collimator for preclinical megavoltage ultra-high dose rate spatially-fractionated radiation therapy. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac8c1a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/23/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Objective. A 2-dimensional pre-clinical SFRT (GRID) collimator was designed for use on the ultra-high dose rate (UHDR) 10 MV ARIEL beamline at TRIUMF. TOPAS Monte Carlo simulations were used to determine optimal collimator geometry with respect to various dosimetric quantities. Approach. The GRID-averaged peak-to-valley dose ratio (PVDR) and mean dose rate of the peaks were investigated with the intent of maximizing both values in a given design. The effects of collimator thickness, focus position, septal width, and hole width on these metrics were found by testing a range of values for each parameter on a cylindrical GRID collimator. For each tested collimator geometry, photon beams with energies of 10, 5, and 1 MV were transported through the collimator and dose rates were calculated at various depths in a water phantom located 1.0 cm from the collimator exit. Main results. In our optimization, hole width proved to be the only collimator parameter which increased both PVDR and peak dose rates. From the optimization results, it was determined that our optimized design would be one which achieves the maximum dose rate for a PVDR
≥
5
at 10 MV. Ultimately, this was achieved using a collimator with a thickness of 75 mm, 0.8 mm septal and hole widths, and a focus position matched to the beam divergence. This optimized collimator maintained the PVDR of 5 in the phantom between water depths of 0–10 cm at 10 MV and had a mean peak dose rate of
3.06
±
0.02
Gy
s
−
1
at 0–1 cm depth. Significance. We have investigated the impact of various GRID-collimator design parameters on the dose rate and spatial fractionation of 10, 5, and 1 MV photon beams. The optimized collimator design for the 10 MV ultra-high dose rate photon beam could become a useful tool for radiobiology studies synergizing the effects of ultra-high dose rate (FLASH) delivery and spatial fractionation.
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10
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Schneider T, Fernandez-Palomo C, Bertho A, Fazzari J, Iturri L, Martin OA, Trappetti V, Djonov V, Prezado Y. Combining FLASH and spatially fractionated radiation therapy: The best of both worlds. Radiother Oncol 2022; 175:169-177. [PMID: 35952978 DOI: 10.1016/j.radonc.2022.08.004] [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: 04/14/2022] [Revised: 07/23/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022]
Abstract
FLASH radiotherapy (FLASH-RT) and spatially fractionated radiation therapy (SFRT) are two new therapeutical strategies that use non-standard dose delivery methods to reduce normal tissue toxicity and increase the therapeutic index. Although likely based on different mechanisms, both FLASH-RT and SFRT have shown to elicit radiobiological effects that significantly differ from those induced by conventional radiotherapy. With the therapeutic potential having been established separately for each technique, the combination of FLASH-RT and SFRT could therefore represent a winning alliance. In this review, we discuss the state of the art, advantages and current limitations, potential synergies, and where a combination of these two techniques could be implemented today or in the near future.
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Affiliation(s)
- Tim Schneider
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | | | - Annaïg Bertho
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Lorea Iturri
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Olga A Martin
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland; Division of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; University of Melbourne, Parkville, VIC 3010, Australia
| | - Verdiana Trappetti
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France.
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11
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Fernandez-Palomo C, Chang S, Prezado Y. Should Peak Dose Be Used to Prescribe Spatially Fractionated Radiation Therapy?-A Review of Preclinical Studies. Cancers (Basel) 2022; 14:cancers14153625. [PMID: 35892895 PMCID: PMC9330631 DOI: 10.3390/cancers14153625] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/04/2022] Open
Abstract
Spatially fractionated radiotherapy (SFRT) is characterized by the coexistence of multiple hot and cold dose subregions throughout the treatment volume. In preclinical studies using single-fraction treatment, SFRT can achieve a significantly higher therapeutic index than conventional radiotherapy (RT). Published clinical studies of SFRT followed by RT have reported promising results for bulky tumors. Several clinical trials are currently underway to further explore the clinical benefits of SFRT. However, we lack the important understanding of the correlation between dosimetric parameters and treatment response that we have in RT. In this work, we reviewed and analyzed this important correlation from previous preclinical SFRT studies. We reviewed studies prior to 2022 that treated animal-bearing tumors with minibeam radiotherapy (MBRT) or microbeam radiotherapy (MRT). Eighteen studies met our selection criteria. Increased lifespan (ILS) relative to control was used as the treatment response. The preclinical SFRT dosimetric parameters analyzed were peak dose, valley dose, average dose, beam width, and beam spacing. We found that valley dose was the dosimetric parameter with the strongest correlation with ILS (p-value < 0.01). For studies using MRT, average dose and peak dose were also significantly correlated with ILS (p-value < 0.05). This first comprehensive review of preclinical SFRT studies shows that the valley dose (rather than the peak dose) correlates best with treatment outcome (ILS).
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Affiliation(s)
| | - Sha Chang
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7512, USA
- Correspondence:
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France;
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
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12
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Barnes MJ, Paino J, Day LR, Butler D, Häusermann D, Pelliccia D, Crosbie JC. SyncMRT: a solution to image-guided synchrotron radiotherapy for quality assurance and pre-clinical trials. JOURNAL OF SYNCHROTRON RADIATION 2022; 29:1074-1084. [PMID: 35787575 PMCID: PMC9255576 DOI: 10.1107/s1600577522004829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
In this work, a new image guidance system and protocols for delivering image-guided radiotherapy (IGRT) on the Imaging and Medical Beamline (IMBL) at the ANSTO Australian Synchrotron are introduced. The image guidance methods used and the resulting accuracy of tumour alignment in in vivo experiments are often under-reported. Image guidance tasks are often complex, time-consuming and prone to errors. If unchecked, they may result in potential mis-treatments. We introduce SyncMRT, a software package that provides a simple, image guidance tool-kit for aligning samples to the synchrotron beam. We have demonstrated sub-millimetre alignment using SyncMRT and the small-animal irradiation platform (the DynamicMRT system) on the IMBL. SyncMRT has become the standard for carrying out IGRT treatments on the IMBL and has been used in all pre-clinical radiotherapy experiments since 2017. Further, we introduce two quality assurance (QA) protocols to synchrotron radiotherapy on the IMBL: the Winston-Lutz test and hidden target test. It is shown that the presented QA tests are appropriate for picking up geometrical setup errors and assessing the end-to-end accuracy of the image guidance process. Together, these tools make image guidance easier and provide a mechanism for reporting the geometric accuracy of synchrotron-based IGRT treatments. Importantly, this work is scalable to other delivery systems, and is in continual development to support the upcoming veterinary radiotherapy trials on the IMBL.
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Affiliation(s)
- M. J. Barnes
- ANSTO Australian Synchrotron, Kulin Nation, Clayton, Victoria, Australia
- Peter MacCallum Cancer Centre, Kulin Nation, Melbourne, Victoria, Australia
- School of Science, RMIT Univeristy, Kulin Nation, Melbourne, Victoria, Australia
- Illawarra Health and Medical Research Institute, Dharawal Nation, Wollongong, New South Wales, Australia
| | - J. Paino
- Illawarra Health and Medical Research Institute, Dharawal Nation, Wollongong, New South Wales, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Dharawal Nation, Wollongong, New South Wales, Australia
| | - L. R. Day
- School of Science, RMIT Univeristy, Kulin Nation, Melbourne, Victoria, Australia
| | - D. Butler
- Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), Kulin Nation, Yallambie, Victoria, Australia
| | - D. Häusermann
- ANSTO Australian Synchrotron, Kulin Nation, Clayton, Victoria, Australia
| | - D. Pelliccia
- Instruments and Data Tools, Kulin Nation, Melbourne, Victoria, Australia
| | - J. C. Crosbie
- School of Science, RMIT Univeristy, Kulin Nation, Melbourne, Victoria, Australia
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13
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Technical aspects of proton minibeam radiation therapy: Minibeam generation and delivery. Phys Med 2022; 100:64-71. [PMID: 35750002 DOI: 10.1016/j.ejmp.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Proton minibeam radiation therapy (pMBRT) is a novel therapeutic strategy that combines the normal tissue sparing of sub-millimetric, spatially fractionated beams with the improved ballistics of protons. This may allow a safe dose escalation in the tumour and has already proven to provide a remarkable increase of the therapeutic index for high-grade gliomas in animal experiments. One of the main challenges in pMBRT concerns the generation of minibeams and the implementation in a clinical environment. This article reviews the different approaches for generating minibeams, using mechanical collimators and focussing magnets, and discusses the technical aspects of the implementation and delivery of pMBRT.
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14
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Wei Z, Liu Y, Li B, Li J, Lu S, Xing X, Liu K, Wang F, Zhang H. Rare-earth based materials: an effective toolbox for brain imaging, therapy, monitoring and neuromodulation. LIGHT, SCIENCE & APPLICATIONS 2022; 11:175. [PMID: 35688804 PMCID: PMC9187711 DOI: 10.1038/s41377-022-00864-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
Brain diseases, including tumors and neurodegenerative disorders, are among the most serious health problems. Non-invasively high-resolution imaging methods are required to gain anatomical structures and information of the brain. In addition, efficient diagnosis technology is also needed to treat brain disease. Rare-earth based materials possess unique optical properties, superior magnetism, and high X-ray absorption abilities, enabling high-resolution imaging of the brain through magnetic resonance imaging, computed tomography imaging, and fluorescence imaging technologies. In addition, rare-earth based materials can be used to detect, treat, and regulate of brain diseases through fine modulation of their structures and functions. Importantly, rare-earth based materials coupled with biomolecules such as antibodies, peptides, and drugs can overcome the blood-brain barrier and be used for targeted treatment. Herein, this review highlights the rational design and application of rare-earth based materials in brain imaging, therapy, monitoring, and neuromodulation. Furthermore, the development prospect of rare-earth based materials is briefly introduced.
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Affiliation(s)
- Zheng Wei
- State Key Laboratory of Rare Earth Resource Utilization, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei, 230026, China
| | - Yawei Liu
- State Key Laboratory of Rare Earth Resource Utilization, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
| | - Bo Li
- State Key Laboratory of Rare Earth Resource Utilization, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
| | - Jingjing Li
- State Key Laboratory of Rare Earth Resource Utilization, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
| | - Shuang Lu
- State Key Laboratory of Rare Earth Resource Utilization, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China.
| | - Xiwen Xing
- Department of Biotechnology, College of Life Science and Technology, Jinan University, Guangzhou, 510632, China.
| | - Kai Liu
- State Key Laboratory of Rare Earth Resource Utilization, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei, 230026, China
- Department of Chemistry, Tsinghua University, Beijing, 100084, China
| | - Fan Wang
- State Key Laboratory of Rare Earth Resource Utilization, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China.
| | - Hongjie Zhang
- State Key Laboratory of Rare Earth Resource Utilization, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei, 230026, China
- Department of Chemistry, Tsinghua University, Beijing, 100084, China
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15
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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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16
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Moghaddasi L, Reid P, Bezak E, Marcu LG. Radiobiological and Treatment-Related Aspects of Spatially Fractionated Radiotherapy. Int J Mol Sci 2022; 23:3366. [PMID: 35328787 PMCID: PMC8954016 DOI: 10.3390/ijms23063366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
The continuously evolving field of radiotherapy aims to devise and implement techniques that allow for greater tumour control and better sparing of critical organs. Investigations into the complexity of tumour radiobiology confirmed the high heterogeneity of tumours as being responsible for the often poor treatment outcome. Hypoxic subvolumes, a subpopulation of cancer stem cells, as well as the inherent or acquired radioresistance define tumour aggressiveness and metastatic potential, which remain a therapeutic challenge. Non-conventional irradiation techniques, such as spatially fractionated radiotherapy, have been developed to tackle some of these challenges and to offer a high therapeutic index when treating radioresistant tumours. The goal of this article was to highlight the current knowledge on the molecular and radiobiological mechanisms behind spatially fractionated radiotherapy and to present the up-to-date preclinical and clinical evidence towards the therapeutic potential of this technique involving both photon and proton beams.
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Affiliation(s)
- Leyla Moghaddasi
- Department of Medical Physics, Austin Health, Ballarat, VIC 3350, Australia;
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5001, Australia;
| | - Paul Reid
- Radiation Health, Environment Protection Authority, Adelaide, SA 5000, Australia;
| | - Eva Bezak
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5001, Australia;
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
| | - Loredana G. Marcu
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
- Faculty of Informatics and Science, University of Oradea, 1 Universitatii Str., 410087 Oradea, Romania
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17
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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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18
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Bertho A, Iturri L, Prezado Y. Radiation-induced immune response in novel radiotherapy approaches FLASH and spatially fractionated radiotherapies. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2022; 376:37-68. [PMID: 36997269 DOI: 10.1016/bs.ircmb.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The last several years have revealed increasing evidence of the immunomodulatory role of radiation therapy. Radiotherapy reshapes the tumoral microenvironment can shift the balance toward a more immunostimulatory or immunosuppressive microenvironment. The immune response to radiation therapy appears to depend on the irradiation configuration (dose, particle, fractionation) and delivery modes (dose rate, spatial distributions). Although an optimal irradiation configuration (dose, temporal fractionation, spatial dose distribution, etc.) has not yet been determined, temporal schemes employing high doses per fraction appear to favor radiation-induced immune response through immunogenic cell death. Through the release of damage-associated molecular patterns and the sensing of double-stranded DNA and RNA breaks, immunogenic cell death activates the innate and adaptive immune response, leading to tumor infiltration by effector T cells and the abscopal effect. Novel radiotherapy approaches such as FLASH and spatially fractionated radiotherapies (SFRT) strongly modulate the dose delivery method. FLASH-RT and SFRT have the potential to trigger the immune system effectively while preserving healthy surrounding tissues. This manuscript reviews the current state of knowledge on the immunomodulation effects of these two new radiotherapy techniques in the tumor, healthy immune cells and non-targeted regions, as well as their therapeutic potential in combination with immunotherapy.
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19
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Davis J, Dipuglia A, Cameron M, Paino J, Cullen A, Guatelli S, Petasecca M, Rosenfeld A, Lerch M. Evaluation of silicon strip detectors in transmission mode for online beam monitoring in microbeam radiation therapy at the Australian Synchrotron. JOURNAL OF SYNCHROTRON RADIATION 2022; 29:125-137. [PMID: 34985430 PMCID: PMC8733993 DOI: 10.1107/s1600577521011140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/24/2021] [Indexed: 06/14/2023]
Abstract
Successful transition of synchrotron-based microbeam radiation therapy (MRT) from pre-clinical animal studies to human trials is dependent upon ensuring that there are sufficient and adequate measures in place for quality assurance purposes. Transmission detectors provide researchers and clinicians with a real-time quality assurance and beam-monitoring instrument to ensure safe and accurate dose delivery. In this work, the effect of transmission detectors of different thicknesses (10 and 375 µm) upon the photon energy spectra and dose deposition of spatially fractionated synchrotron radiation is quantified experimentally and by means of a dedicated Geant4 simulation study. The simulation and experimental results confirm that the presence of the 375 µm thick transmission detector results in an approximately 1-6% decrease in broad-beam and microbeam peak dose. The capability to account for the reduction in dose and change to the peak-to-valley dose ratio justifies the use of transmission detectors as thick as 375 µm in MRT provided that treatment planning systems are able to account for their presence. The simulation and experimental results confirm that the presence of the 10 µm thick transmission detector shows a negligible impact (<0.5%) on the photon energy spectra, dose delivery and microbeam structure for both broad-beam and microbeam cases. Whilst the use of 375 µm thick detectors would certainly be appropriate, based upon the idea of best practice the authors recommend that 10 µm thick transmission detectors of this sort be utilized as a real-time quality assurance and beam-monitoring tool during MRT.
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Affiliation(s)
- Jeremy Davis
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Andrew Dipuglia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Matthew Cameron
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jason Paino
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ashley Cullen
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Susanna Guatelli
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marco Petasecca
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michael Lerch
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
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20
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Proton Minibeam Radiation Therapy and Arc Therapy: Proof of Concept of a Winning Alliance. Cancers (Basel) 2021; 14:cancers14010116. [PMID: 35008280 PMCID: PMC8749801 DOI: 10.3390/cancers14010116] [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: 11/25/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Normal tissue’s morbidity continues to limit the increase in the therapeutic index in radiation therapy. This study explores the potential advantages of combining proton arc therapy and proton minibeam radiation therapy, which have already individually shown a significant normal tissue’s sparing. This alliance aims to integrate the benefits of those techniques in a single approach. Abstract (1) Background: Proton Arc Therapy and Proton Minibeam Radiation Therapy are two novel therapeutic approaches with the potential to lower the normal tissue complication probability, widening the therapeutic window for radioresistant tumors. While the benefits of both modalities have been individually evaluated, their combination and its potential advantages are being assessed in this proof-of-concept study for the first time. (2) Methods: Monte Carlo simulations were employed to evaluate the dose and LET distributions in brain tumor irradiations. (3) Results: a net reduction in the dose to normal tissues (up to 90%), and the preservation of the spatial fractionation of the dose were achieved for all configurations evaluated. Additionally, Proton Minibeam Arc Therapy (pMBAT) reduces the volumes exposed to high-dose and high-LET values at expense of increased low-dose and intermediate-LET values. (4) Conclusions: pMBAT enhances the individual benefits of proton minibeams while keeping those of conventional proton arc therapy. These results might facilitate the path towards patients’ treatments since lower peak doses in normal tissues would be needed than in the case of a single array of proton minibeams.
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21
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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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22
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Ahmad MY, Yue H, Tegafaw T, Liu S, Ho SL, Lee GH, Nam SW, Chang Y. Functionalized Lanthanide Oxide Nanoparticles for Tumor Targeting, Medical Imaging, and Therapy. Pharmaceutics 2021; 13:1890. [PMID: 34834305 PMCID: PMC8624040 DOI: 10.3390/pharmaceutics13111890] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 12/17/2022] Open
Abstract
Recent progress in functionalized lanthanide oxide (Ln2O3) nanoparticles for tumor targeting, medical imaging, and therapy is reviewed. Among the medical imaging techniques, magnetic resonance imaging (MRI) is an important noninvasive imaging tool for tumor diagnosis due to its high spatial resolution and excellent imaging contrast, especially when contrast agents are used. However, commercially available low-molecular-weight MRI contrast agents exhibit several shortcomings, such as nonspecificity for the tissue of interest and rapid excretion in vivo. Recently, nanoparticle-based MRI contrast agents have become a hot research topic in biomedical imaging due to their high performance, easy surface functionalization, and low toxicity. Among them, functionalized Ln2O3 nanoparticles are applicable as MRI contrast agents for tumor-targeting and nontumor-targeting imaging and image-guided tumor therapy. Primarily, Gd2O3 nanoparticles have been intensively investigated as tumor-targeting T1 MRI contrast agents. T2 MRI is also possible due to the appreciable paramagnetic moments of Ln2O3 nanoparticles (Ln = Dy, Ho, and Tb) at room temperature arising from the nonzero orbital motion of 4f electrons. In addition, Ln2O3 nanoparticles are eligible as X-ray computed tomography contrast agents because of their high X-ray attenuation power. Since nanoparticle toxicity is of great concern, recent toxicity studies on Ln2O3 nanoparticles are also discussed.
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Affiliation(s)
- Mohammad Yaseen Ahmad
- Department of Chemistry, College of Natural Sciences, Kyungpook National University, Taegu 41566, Korea; (M.Y.A.); (H.Y.); (T.T.); (S.L.); (S.L.H.)
| | - Huan Yue
- Department of Chemistry, College of Natural Sciences, Kyungpook National University, Taegu 41566, Korea; (M.Y.A.); (H.Y.); (T.T.); (S.L.); (S.L.H.)
| | - Tirusew Tegafaw
- Department of Chemistry, College of Natural Sciences, Kyungpook National University, Taegu 41566, Korea; (M.Y.A.); (H.Y.); (T.T.); (S.L.); (S.L.H.)
| | - Shuwen Liu
- Department of Chemistry, College of Natural Sciences, Kyungpook National University, Taegu 41566, Korea; (M.Y.A.); (H.Y.); (T.T.); (S.L.); (S.L.H.)
| | - Son Long Ho
- Department of Chemistry, College of Natural Sciences, Kyungpook National University, Taegu 41566, Korea; (M.Y.A.); (H.Y.); (T.T.); (S.L.); (S.L.H.)
| | - Gang Ho Lee
- Department of Chemistry, College of Natural Sciences, Kyungpook National University, Taegu 41566, Korea; (M.Y.A.); (H.Y.); (T.T.); (S.L.); (S.L.H.)
| | - Sung-Wook Nam
- Department of Molecular Medicine, School of Medicine, Kyungpook National University, Taegu 41405, Korea;
| | - Yongmin Chang
- Department of Molecular Medicine, School of Medicine, Kyungpook National University, Taegu 41405, Korea;
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23
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Mayerhofer M, Bergmaier A, Datzmann G, Hagn H, Helm R, Mitteneder J, Schubert R, Picardi L, Nenzi P, Ronsivalle C, Wirth HF, Dollinger G. Concept and performance evaluation of two 3 GHz buncher units optimizing the dose rate of a novel preclinical proton minibeam irradiation facility. PLoS One 2021; 16:e0258477. [PMID: 34634079 PMCID: PMC8504737 DOI: 10.1371/journal.pone.0258477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
To demonstrate the large potential of proton minibeam radiotherapy (pMBRT) as a new method to treat tumor diseases, a preclinical proton minibeam radiation facility was designed. It is based on a tandem Van-de-Graaff accelerator providing a 16 MeV proton beam and a 3 GHz linac post-accelerator (designs: AVO-ADAM S.A, Geneva, Switzerland and ENEA, Frascati, Italy). To enhance the transmission of the tandem beam through the post-accelerator by a factor of 3, two drift tube buncher units were designed and constructed: A brazed 5-gap structure (adapted SCDTL tank of the TOP-IMPLART project (ENEA)) and a non-brazed low budget 4-gap structure. Both are made of copper. The performance of the two differently manufactured units was evaluated using a 16 MeV tandem accelerator beam and a Q3D magnetic spectrograph. Both buncher units achieve the required summed voltage amplitude of 42 kV and amplitude stability at a power feed of less than 800 W.
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Affiliation(s)
- Michael Mayerhofer
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
- * E-mail:
| | - Andreas Bergmaier
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | - Gerd Datzmann
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | - Hermann Hagn
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | - Ricardo Helm
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | - Johannes Mitteneder
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | - Ralf Schubert
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
| | | | | | | | - Hans-Friedrich Wirth
- Ludwig-Maximilians-Universität München, Fakultät für Physik, München, Bavaria, Germany
| | - Günther Dollinger
- Universität der Bundeswehr München, Institut für Angewandte Physik und Messtechnik (LRT2), Neubiberg, Bavaria, Germany
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24
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Romano M, Bravin A, Mittone A, Eckhardt A, Barbone GE, Sancey L, Dinkel J, Bartzsch S, Ricke J, Alunni-Fabbroni M, Hirner-Eppeneder H, Karpov D, Giannini C, Bunk O, Bouchet A, Ruf V, Giese A, Coan P. A Multi-Scale and Multi-Technique Approach for the Characterization of the Effects of Spatially Fractionated X-ray Radiation Therapies in a Preclinical Model. Cancers (Basel) 2021; 13:cancers13194953. [PMID: 34638437 PMCID: PMC8507698 DOI: 10.3390/cancers13194953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study is to use a multi-technique approach to detect the effects of spatially fractionated X-ray Microbeam (MRT) and Minibeam Radiation Therapy (MB) and to compare them to seamless Broad Beam (BB) irradiation. Healthy- and Glioblastoma (GBM)-bearing male Fischer rats were irradiated in-vivo on the right brain hemisphere with MRT, MB and BB delivering three different doses for each irradiation geometry. Brains were analyzed post mortem by multi-scale X-ray Phase Contrast Imaging-Computed Tomography (XPCI-CT), histology, immunohistochemistry, X-ray Fluorescence (XRF), Small- and Wide-Angle X-ray Scattering (SAXS/WAXS). XPCI-CT discriminates with high sensitivity the effects of MRT, MB and BB irradiations on both healthy and GBM-bearing brains producing a first-time 3D visualization and morphological analysis of the radio-induced lesions, MRT and MB induced tissue ablations, the presence of hyperdense deposits within specific areas of the brain and tumor evolution or regression with respect to the evaluation made few days post-irradiation with an in-vivo magnetic resonance imaging session. Histology, immunohistochemistry, SAXS/WAXS and XRF allowed identification and classification of these deposits as hydroxyapatite crystals with the coexistence of Ca, P and Fe mineralization, and the multi-technique approach enabled the realization, for the first time, of the map of the differential radiosensitivity of the different brain areas treated with MRT and MB. 3D XPCI-CT datasets enabled also the quantification of tumor volumes and Ca/Fe deposits and their full-organ visualization. The multi-scale and multi-technique approach enabled a detailed visualization and classification in 3D of the radio-induced effects on brain tissues bringing new essential information towards the clinical implementation of the MRT and MB radiation therapy techniques.
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Affiliation(s)
- Mariele Romano
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität, Am Coulombwall 1, München, 85748 Garching, Germany; (M.R.); (A.E.); (G.E.B.)
| | - Alberto Bravin
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38000 Grenoble, France; (A.B.); (A.M.); (D.K.)
- Department of Physics, Faculty of Physics, University of Milano-Bicocca, 20126 Milan, Italy
| | - Alberto Mittone
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38000 Grenoble, France; (A.B.); (A.M.); (D.K.)
- CELLS-ALBA Synchrotron, 08290 Cerdanyola del Valles, Spain
| | - Alicia Eckhardt
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität, Am Coulombwall 1, München, 85748 Garching, Germany; (M.R.); (A.E.); (G.E.B.)
| | - Giacomo E. Barbone
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität, Am Coulombwall 1, München, 85748 Garching, Germany; (M.R.); (A.E.); (G.E.B.)
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (J.D.); (J.R.); (M.A.-F.); (H.H.-E.)
| | - Lucie Sancey
- Centre de Recherche UGA/INSERM U1209/CNRS UMR5309, Institute for Advanced Biosciences, 38700 La Tronche, France;
| | - Julien Dinkel
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (J.D.); (J.R.); (M.A.-F.); (H.H.-E.)
| | - Stefan Bartzsch
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany;
- Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (J.D.); (J.R.); (M.A.-F.); (H.H.-E.)
| | - Marianna Alunni-Fabbroni
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (J.D.); (J.R.); (M.A.-F.); (H.H.-E.)
| | - Heidrun Hirner-Eppeneder
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (J.D.); (J.R.); (M.A.-F.); (H.H.-E.)
| | - Dmitry Karpov
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38000 Grenoble, France; (A.B.); (A.M.); (D.K.)
- Swiss Light Source, Paul Scherrer Institute, 5232 Villigen, Switzerland;
| | - Cinzia Giannini
- Institute of Crystallography, National Research Council, 70126 Bari, Italy;
| | - Oliver Bunk
- Swiss Light Source, Paul Scherrer Institute, 5232 Villigen, Switzerland;
| | - Audrey Bouchet
- Inserm U1296 Unit “Radiation: Defense, Health Environment”, 69008 Lyon, France;
| | - Viktoria Ruf
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (V.R.); (A.G.)
| | - Armin Giese
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (V.R.); (A.G.)
| | - Paola Coan
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität, Am Coulombwall 1, München, 85748 Garching, Germany; (M.R.); (A.E.); (G.E.B.)
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, 81377 Munich, Germany; (J.D.); (J.R.); (M.A.-F.); (H.H.-E.)
- Correspondence:
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25
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Montay-Gruel P, Corde S, Laissue JA, Bazalova-Carter M. FLASH radiotherapy with photon beams. Med Phys 2021; 49:2055-2067. [PMID: 34519042 DOI: 10.1002/mp.15222] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/12/2021] [Accepted: 08/30/2021] [Indexed: 12/16/2022] Open
Abstract
Ultra-high-dose rate "FLASH" radiotherapy (FLASH-RT) has been shown to drastically reduce normal tissue toxicities while being as efficacious as conventional dose rate radiotherapy to treat tumors. A large number of preclinical studies describing this so-called FLASH effect have led to the clinical translation of FLASH-RT using ultra-high-dose rate electron and proton beams. Although the vast majority of radiation therapy treatments are delivered using X-rays, few preclinical data using ultra-high-dose rate X-ray irradiation have been published. This review focuses on different methods that can be used to generate ultra-high-dose rate X-rays and their beam characteristics along with their effect on the biological tissues and the perspectives for the development of FLASH-RT with X-rays.
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Affiliation(s)
- Pierre Montay-Gruel
- Department of Radiation Oncology, University of California, Irvine, California, USA.,Department of Radiotherapy, Iridium Network, Antwerp, Belgium
| | - Stéphanie Corde
- Department of Radiation Oncology, Prince of Wales Hospital, Randwick, NSW, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Jean A Laissue
- Institute of Pathology, University of Bern, Bern, Switzerland
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26
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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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27
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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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28
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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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29
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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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Esplen N, Mendonca MS, Bazalova-Carter M. Physics and biology of ultrahigh dose-rate (FLASH) radiotherapy: a topical review. Phys Med Biol 2020; 65:23TR03. [PMID: 32721941 DOI: 10.1088/1361-6560/abaa28] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ultrahigh dose-rate radiotherapy (RT), or 'FLASH' therapy, has gained significant momentum following various in vivo studies published since 2014 which have demonstrated a reduction in normal tissue toxicity and similar tumor control for FLASH-RT when compared with conventional dose-rate RT. Subsequent studies have sought to investigate the potential for FLASH normal tissue protection and the literature has been since been inundated with publications on FLASH therapies. Today, FLASH-RT is considered by some as having the potential to 'revolutionize radiotherapy'. FLASH-RT is considered by some as having the potential to 'revolutionize radiotherapy'. The goal of this review article is to present the current state of this intriguing RT technique and to review existing publications on FLASH-RT in terms of its physical and biological aspects. In the physics section, the current landscape of ultrahigh dose-rate radiation delivery and dosimetry is presented. Specifically, electron, photon and proton radiation sources capable of delivering ultrahigh dose-rates along with their beam delivery parameters are thoroughly discussed. Additionally, the benefits and drawbacks of radiation detectors suitable for dosimetry in FLASH-RT are presented. The biology section comprises a summary of pioneering in vitro ultrahigh dose-rate studies performed in the 1960s and early 1970s and continues with a summary of the recent literature investigating normal and tumor tissue responses in electron, photon and proton beams. The section is concluded with possible mechanistic explanations of the FLASH normal-tissue protection effect (FLASH effect). Finally, challenges associated with clinical translation of FLASH-RT and its future prospects are critically discussed; specifically, proposed treatment machines and publications on treatment planning for FLASH-RT are reviewed.
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Affiliation(s)
- Nolan Esplen
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
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Buckley JG, Dowling JA, Sidhom M, Liney GP, Rai R, Metcalfe PE, Holloway LC, Keall PJ. Pelvic organ motion and dosimetric implications during horizontal patient rotation for prostate radiation therapy. Med Phys 2020; 48:397-413. [PMID: 33151543 DOI: 10.1002/mp.14579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Gantry-free radiation therapy systems utilizing patient rotation would be simpler and more cost effective than the conventional gantry-based systems. Such a system could enable the expansion of radiation therapy to meet global demand and reduce capital costs. Recent advances in adaptive radiation therapy could potentially be applied to correct for gravitational deformation during horizontal patient rotation. This study aims to quantify the pelvic organ motion and the dosimetric implications of horizontal rotation for prostate intensity-modulated radiation therapy (IMRT) treatments. METHODS Eight human participants who previously received prostate radiation therapy were imaged in a clinical magnetic resonance imaging (MRI) scanner using a bespoke patient rotation system (PRS). The patients were imaged every 45 degrees during a full roll rotation (0-360 degrees). Whole pelvic bone, prostate, rectum, and bladder motion were compared to the supine position using dice similarity coefficient (DSC) and mean absolute surface distance (MASD). Prostate centroid motion was compared in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) direction prior to and following pelvic bone-guided rigid registration. Seven-field prostate IMRT treatment plans were generated for each patient rotation angles under three adaption scenarios: No plan adaption, rigid planning target volume (PTV)-guided alignment to the prostate, and plan re-optimization. Prostate, rectum, and bladder doses were compared for each adaption scenario. RESULTS Pelvic bone motion within the PRS of up to 53 mm relative to the supine position was observed for some participants. Internal organ motion was greatest at the 180-degree PRS couch angle (prone), with prostate centroid motion range < 2 mm LR, 0 mm to 14 mm SI, and -11 mm to 4 mm AP. Rotation with no adaption of the treatment plan resulted in an underdose to the PTV -- in some instances up to 75% (D95%: 78 ± 0.3 Gy at supine to 20 ± 15.0 Gy at the 225-degree PRS couch angle). Bladder dose was reduced during the rotation by up to 98% (V60 Gy: 15.0 ± 9.4% supine to 0.3 ± 0.5% at the 225-degree PRS couch angle). In some instances, the rectum dose increased during rotation (V60Gy: 20.0 ± 4.5% supine to 25.0 ± 15.0% at the 135-degree PRS couch angle). Rigid PTV-guided alignment resulted in PTV coverage which, though statistically lower (P < 0.05 for all D95% values), was within 1 Gy of the supine plans. Plan re-optimization resulted in a statistically equivalent PTV coverage compared to the supine plans (P > 0.05 for all D95% metrics and all within ±0.4 Gy). For both rigid PTV-guided alignment and plan re-optimization, rectum dose volume metrics were reduced compared to the supine position between the 90- and 225-degree PRS couch angles (P < 0.05). Bladder dose volume metrics were not impacted by rotation. CONCLUSION Pelvic bone and internal organ motion are present during patient rotation. Rigid PTV-guided alignment to the prostate will be a requirement if prostate IMRT is to be safely delivered using patient rotation. Plan re-optimization for each PRS couch angle to account for anatomical deformations further improves the PTV coverage.
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Affiliation(s)
- J G Buckley
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - J A Dowling
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- CSIRO Australian eHealth Research Centre, Herston, QLD, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - M Sidhom
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Liverpool and Macarthur Cancer Therapy Centre, Sydney, NSW, Australia
| | - G P Liney
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Liverpool and Macarthur Cancer Therapy Centre, Sydney, NSW, Australia
| | - R Rai
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Liverpool and Macarthur Cancer Therapy Centre, Sydney, NSW, Australia
| | - P E Metcalfe
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - L C Holloway
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Liverpool and Macarthur Cancer Therapy Centre, Sydney, NSW, Australia
- Institute of Medical Physics, University of Sydney, Sydney, NSW, Australia
| | - P J Keall
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- ACRF Image-X Institute, School of Health Sciences, University of Sydney, Sydney, Australia
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External beam radiation therapy with kilovoltage x-rays. Phys Med 2020; 79:103-112. [PMID: 33221545 DOI: 10.1016/j.ejmp.2020.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/03/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022] Open
Abstract
Kilovoltage (kV) x-rays are most commonly used for diagnostic imaging due to their sensitivity to tissue composition. In radiation therapy (RT), due to their fast attenuation, kV x-rays are typically only used for superficial irradiation of skin cancer and for intra-operative RT (IORT). Recently, however, a number of kV RT techniques have emerged. In this review article, we provide a brief overview of the use of kV x-rays for RT. Various kV x-ray source technologies suitable for RT, such as conventional x-ray tubes as well as novel x-ray sources, are first described. This x-ray source section is then followed by a section on their implementation in terms of clinical, veterinary and preclinical applications. Specifically, IORT, superficial RT and dose enhancement with iodine and gold nanoparticles, as well as microbeam RT and FLASH RT are discussed in this context. Then, a number of kV x-ray RT applications in modeling and proof-of-principle stages, such as breast external beam RT with rotational sources, kilovoltage arc therapy and the BriXS Compton pulsed x-ray sources, are reviewed. Finally, some clinical and economic considerations for the development of kV RT techniques are discussed.
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Toward personalized synchrotron microbeam radiation therapy. Sci Rep 2020; 10:8833. [PMID: 32483249 PMCID: PMC7264143 DOI: 10.1038/s41598-020-65729-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/08/2020] [Indexed: 12/12/2022] Open
Abstract
Synchrotron facilities produce ultra-high dose rate X-rays that can be used for selective cancer treatment when combined with micron-sized beams. Synchrotron microbeam radiation therapy (MRT) has been shown to inhibit cancer growth in small animals, whilst preserving healthy tissue function. However, the underlying mechanisms that produce successful MRT outcomes are not well understood, either in vitro or in vivo. This study provides new insights into the relationships between dosimetry, radiation transport simulations, in vitro cell response, and pre-clinical brain cancer survival using intracerebral gliosarcoma (9LGS) bearing rats. As part of this ground-breaking research, a new image-guided MRT technique was implemented for accurate tumor targeting combined with a pioneering assessment of tumor dose-coverage; an essential parameter for clinical radiotherapy. Based on the results of our study, we can now (for the first time) present clear and reproducible relationships between the in vitro cell response, tumor dose-volume coverage and survival post MRT irradiation of an aggressive and radioresistant brain cancer in a rodent model. Our innovative and interdisciplinary approach is illustrated by the results of the first long-term MRT pre-clinical trial in Australia. Implementing personalized synchrotron MRT for brain cancer treatment will advance this international research effort towards clinical trials.
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Charyyev S, Artz M, Szalkowski G, Chang C, Stanforth A, Lin L, Zhang R, Wang CC. Optimization of hexagonal‐pattern minibeams for spatially fractionated radiotherapy using proton beam scanning. Med Phys 2020; 47:3485-3495. [DOI: 10.1002/mp.14192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Serdar Charyyev
- Medical Physics Program Georgia Institute of Technology Atlanta GA 30332 USA
- Department of Radiation Oncology Emory University Atlanta GA 30322 USA
| | - Mark Artz
- UF Health Proton Therapy Institute Jacksonville FL 32206 USA
| | - Gregory Szalkowski
- Medical Physics Program Georgia Institute of Technology Atlanta GA 30332 USA
- Department of Radiation Oncology University of North Carolina Chapel Hill NC 27514 USA
| | - Chih‐Wei Chang
- Department of Radiation Oncology Emory University Atlanta GA 30322 USA
| | | | - Liyong Lin
- Department of Radiation Oncology Emory University Atlanta GA 30322 USA
| | - Rongxiao Zhang
- Department of Radiation Oncology Dartmouth College Hanover NH 03755 USA
| | - C.‐K. Chris Wang
- Medical Physics Program Georgia Institute of Technology Atlanta GA 30332 USA
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Lansonneur P, Mammar H, Nauraye C, Patriarca A, Hierso E, Dendale R, Prezado Y, De Marzi L. First proton minibeam radiation therapy treatment plan evaluation. Sci Rep 2020; 10:7025. [PMID: 32341427 PMCID: PMC7184593 DOI: 10.1038/s41598-020-63975-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/08/2020] [Indexed: 11/09/2022] Open
Abstract
Proton minibeam radiation therapy (pMBRT) is a novel dose delivery method based on spatial dose fractionation. pMBRT has been shown to be promising in terms of reduced side effects and superior tumour control in high-grade glioma-bearing rats compared to standard irradiation. These findings, together with the recent optimized implementation of pMBRT in a clinical pencil beam scanning system, have triggered reflection on the possible application to patient treatments. In this context, the present study was designed to conduct a first theoretical investigation of the clinical potential of this technique. For this purpose, a dedicated dose engine was developed and used to evaluate two clinically relevant patient treatment plans (high-grade glioma and meningioma). Treatment plans were compared with standard proton therapy plans assessed by means of a commercial treatment planning system (ECLIPSE-Varian Medical systems) and Monte Carlo simulations. A multislit brass collimator consisting of 0.4 mm wide slits separated by a centre-to-centre distance of 4 or 6 mm was placed between the nozzle and the patient to shape the planar minibeams. For each plan, spread-out Bragg peaks and homogeneous dose distributions (±7% dose variations) can be obtained in target volumes. The Peak-to-Valley Dose Ratios (PVDR) were evaluated between 9.2 and 12.8 at a depth of 20 mm for meningioma and glioma, respectively. Dose volume histograms (DVHs) for target volumes and organs at risk were quantitatively compared, resulting in a slightly better target homogeneity with standard PT than with pMBRT plans, but similar DVHs for deep-seated organs-at-risk and lower average dose for shallow organs. The proposed delivery method evaluated in this work opens the way to an effective treatment for radioresistant tumours and will support the design of future clinical research.
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Affiliation(s)
- P Lansonneur
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France
| | - H Mammar
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France
| | - C Nauraye
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France
| | - A Patriarca
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France
| | - E Hierso
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France
| | - R Dendale
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France
| | - Y Prezado
- Institut Curie, PSL Research University, University Paris Saclay, Inserm U 1021-CNRS UMR 3347, 91898, Orsay, France
| | - L De Marzi
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France. .,Institut Curie, PSL Research University, University Paris Saclay, Inserm U 1021-CNRS UMR 3347, 91898, Orsay, France.
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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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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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39
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Dos Santos M, Delorme R, Salmon R, Prezado Y. Minibeam radiation therapy: A micro- and nano-dosimetry Monte Carlo study. Med Phys 2020; 47:1379-1390. [PMID: 31900944 DOI: 10.1002/mp.14009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/12/2019] [Accepted: 12/22/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Minibeam radiation therapy (MBRT) is an innovative strategy based on a distinct dose delivery method that is administered using a series of narrow (submillimetric) parallel beams. To shed light on the biological effects of MBRT irradiation, we explored the micro- and nanodosimetric characteristics of three promising MBRT modalities (photon, electron, and proton) using Monte Carlo (MC) calculations. METHODS Irradiation with proton (100 MeV), electron (300 MeV), and photon (effective energy of 69 keV) minibeams were simulated using Geant4 MC code and the Geant4-DNA extension, which allows the simulation of energy transfer points with nanometric accuracy. As the target of the simulations, cells containing spherical nuclei with or without a detailed description of the DNA (deoxyribonucleic acid) geometry were placed at different depths in peak and valley regions in a water phantom. The energy deposition and number of events in the cell nuclei were recorded in the microdosimetry study, and the number of DNA breaks and their complexity were determined in the nanodosimetric study, where a multi-scale simulation approach was used for the latter. For DNA damage assessment, an adapted DBSCAN clustering algorithm was used. To compare the photon MBRT (xMBRT), electron MBRT (eMBRT), and proton MBRT (pMBRT) approaches, we considered the treatment of a brain tumor located at a depth of 75 mm. RESULTS Both mean energy deposition at micrometric scale and DNA damage in the "valley" cell nuclei were very low as compared with these parameters in the peak region at all depths for xMBRT and at depths of 0 to 30 mm and 0 to 50 mm for eMBRT and pMBRT, respectively. Only the charged minibeams were favorable for tumor control by producing similar effects in peak and valley cells after 70 mm. At the micrometer scale, the energy deposited per event pointed to a potential advantage of proton beams for tumor control, as more aggressive events could be expected at the end of their tracks. At the nanometer scale, all three MBRT modalities produced direct clustered DNA breaks, although the majority of damage (>93%) was composed of isolated single strand breaks. The pMBRT led to a significant increase in the proportion of clustered single strand breaks and double-strand breaks at the end of its range as compared to the entrance (7% at 75 mm vs 3% at 10 mm) in contrast to eMBRT and xMBRT. In the latter cases, the proportions of complex breaks remained constant, irrespective of the depth and region (peak or valley). CONCLUSIONS Enhanced normal tissue sparing can be expected with these three MBRT techniques. Among the three modalities, pMBRT offers an additional gain for radioresistant tumors, as it resulted in a higher number of complex DNA damage clusters in the tumor region. These results can aid understanding of the biological mechanisms of MBRT.
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Affiliation(s)
- M Dos Santos
- Department of Radiobiology and regenerative medicine (SERAMED), Laboratory of Radiobiology of Accidental exposures (LRAcc), IRSN, F-92260, Fontenay-aux-Roses, France
| | - R Delorme
- Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), CNRS, Univ Paris-Sud, Université Paris-Saclay, F-91400, Orsay, France.,Université de Paris, IMNC, F-91400, Orsay, France
| | - R Salmon
- Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), CNRS, Univ Paris-Sud, Université Paris-Saclay, F-91400, Orsay, France.,Université de Paris, IMNC, F-91400, Orsay, France
| | - Y Prezado
- Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), CNRS, Univ Paris-Sud, Université Paris-Saclay, F-91400, Orsay, France.,Université de Paris, IMNC, F-91400, Orsay, France
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40
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Minibeam radiation therapy at a conventional irradiator: Dose-calculation engine and first tumor-bearing animals irradiation. Phys Med 2020; 69:256-261. [PMID: 31918378 DOI: 10.1016/j.ejmp.2019.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Minibeam radiation therapy (MBRT) is a novel therapeutic strategy, whose exploration was hindered due to its restriction to large synchrotrons. Our recent implementation of MBRT in a wide-spread small animal irradiator offers the possibility of performing systematic radiobiological studies. The aim of this research was to develop a set of dosimetric tools to reliably guide biological experiments in the irradiator. METHODS A Monte Carlo (Geant4)-based dose calculation engine was developed. It was then benchmarked against a series of dosimetric measurements performed with gafchromic films. Two voxelized rat phantoms (ROBY, computer tomography) were used to evaluate the treatment plan of F98 tumor-bearing rats. The response of a group of 7 animals receiving a unilateral irradiation of 58 Gy was compared to a group of non-irradiated controls. RESULTS The good agreement between calculations and the experimental data allowed the validation of the dose-calculation engine. The latter was first used to compare the dose distributions in computer tomography images of a rat's head and in a digital model of a rat's head (ROBY), obtaining a good general agreement. Finally, with respect to the in vivo experiment, the increase of mean survival time of the treated group with respect to the controls was modest but statistically significant. CONCLUSIONS The developed dosimetric tools were used to reliably guide the first MBRT treatments of intracranial glioma-bearing rats outside synchrotrons. The significant tumor response obtained with respect to the non-irradiated controls, despite the heterogenous dose coverage of the target, might indicate the participation of non-targeted effects.
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41
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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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42
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First experimental measurement of the effect of cardio‐synchronous brain motion on the dose distribution during microbeam radiation therapy. Med Phys 2019; 47:213-222. [DOI: 10.1002/mp.13899] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/16/2019] [Accepted: 10/21/2019] [Indexed: 01/03/2023] Open
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43
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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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44
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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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45
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Schneider T, Patriarca A, Prezado Y. Improving the dose distributions in minibeam radiation therapy: Helium ions vs protons. Med Phys 2019; 46:3640-3648. [DOI: 10.1002/mp.13646] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/27/2019] [Accepted: 05/27/2019] [Indexed: 01/26/2023] Open
Affiliation(s)
- Tim Schneider
- IMNC‐UMR 8165 CNRS Paris 7 and Paris 11 Universities 15 rue Georges Clemenceau Orsay Cedex 91405France
| | - Annalisa Patriarca
- Institut Curie PSL Research University Centre de protonthrapie d’Orsay Campus universitaire btiment 101 Orsay 91898France
| | - Yolanda Prezado
- IMNC‐UMR 8165 CNRS Paris 7 and Paris 11 Universities 15 rue Georges Clemenceau Orsay Cedex 91405France
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46
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Donzelli M, Oelfke U, Bräuer-Krisch E. Introducing the concept of spiral microbeam radiation therapy (spiralMRT). Phys Med Biol 2019; 64:065005. [PMID: 30650386 DOI: 10.1088/1361-6560/aaff23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
MOTIVATION With interlaced microbeam radiation therapy (MRT) a first kilovoltage radiotherapy (RT) concept combining spatially fractionated entrance beams and homogeneous dose distribution at the target exists. However, this technique suffers from its high sensitivity to positioning errors of the target relative to the radiation source. With spiral microbeam radiation therapy (spiralMRT), this publication introduces a new irradiation geometry, offering similar spatial fractionation properties as interlaced MRT, while being less vulnerable to target positioning uncertainties. METHODS The dose distributions achievable with spiralMRT in a simplified human head geometry were calculated with Monte Carlo simulations based on Geant4 and the dependence of the result on the microbeam pitch, total field size, and photon energy were analysed. A comparison with interlaced MRT and conventional megavoltage tomotherapy was carried out. RESULTS SpiralMRT can deliver homogeneous dose distributions, while using spatially fractionated entrance beams. The valley dose of spiralMRT entrance beams is by up to 40% lower than the corresponding tomotherapy dose, thus indicating a better normal tissue sparing. The optimum photon energy is found to be around [Formula: see text]. CONCLUSIONS SpiralMRT is a promising approach to delivering homogeneous dose distributions with spatially fractionated entrance beams, possibly decreasing normal tissue side effects in hypofractionated RT.
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Affiliation(s)
- Mattia Donzelli
- European Synchrotron Radiation Facility, Biomedical beamline ID17, Grenoble, France. Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom. Author to whom any correspondence should be addressed
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47
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Meyer J, Eley J, Schmid TE, Combs SE, Dendale R, Prezado Y. Spatially fractionated proton minibeams. Br J Radiol 2019; 92:20180466. [PMID: 30359081 PMCID: PMC6541186 DOI: 10.1259/bjr.20180466] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 12/26/2022] Open
Abstract
Extraordinary normal tissue response to highly spatially fractionated X-ray beams has been explored for over 25 years. More recently, alternative radiation sources have been developed and utilized with the aim to evoke comparable effects. These include protons, which lend themselves well for this endeavour due to their physical depth dose characteristics as well as corresponding variable biological effectiveness. This paper addresses the motivation for using protons to generate spatially fractionated beams and reviews the technological implementations and experimental results to date. This includes simulation and feasibility studies, collimation and beam characteristics, dosimetry and biological considerations as well as the results of in vivo and in vitro studies. Experimental results are emerging indicating an extraordinary normal tissue sparing effect analogous to what has been observed for synchrotron generated X-ray microbeams. The potential for translational research and feasibility of spatially modulated proton beams in clinical settings is discussed.
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Affiliation(s)
- Juergen Meyer
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - John Eley
- Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, MD, USA
| | | | | | - Remi Dendale
- Institut Curie, Centre de Protonthérapie d’Orsay, Orsay, France
| | - Yolanda Prezado
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique, Universités Paris 11 and Paris 7, Campus d'Orsay, Orsay, France
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48
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Prezado Y, Jouvion G, Patriarca A, Nauraye C, Guardiola C, Juchaux M, Lamirault C, Labiod D, Jourdain L, Sebrie C, Dendale R, Gonzalez W, Pouzoulet F. Proton minibeam radiation therapy widens the therapeutic index for high-grade gliomas. Sci Rep 2018; 8:16479. [PMID: 30405188 PMCID: PMC6220274 DOI: 10.1038/s41598-018-34796-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/26/2018] [Indexed: 12/15/2022] Open
Abstract
Proton minibeam radiation therapy (pMBRT) is a novel strategy which has already shown a remarkable reduction in neurotoxicity as to compared with standard proton therapy. Here we report on the first evaluation of tumor control effectiveness in glioma bearing rats with highly spatially modulated proton beams. Whole brains (excluding the olfactory bulb) of Fischer 344 rats were irradiated. Four groups of animals were considered: a control group (RG2 tumor bearing rats), a second group of RG2 tumor-bearing rats and a third group of normal rats that received pMBRT (70 Gy peak dose in one fraction) with very heterogeneous dose distributions, and a control group of normal rats. The tumor-bearing and normal animals were followed-up for 6 months and one year, respectively. pMBRT leads to a significant tumor control and tumor eradication in 22% of the cases. No substantial brain damage which confirms the widening of the therapeutic window for high-grade gliomas offered by pMBRT. Additionally, the fact that large areas of the brain can be irradiated with pMBRT without significant side effects, would allow facing the infiltrative nature of gliomas.
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Affiliation(s)
- Yolanda Prezado
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France.
| | - Gregory Jouvion
- Institut Pasteur, Neuropathologie Expérimentale, Institut Pasteur, 28 Rue du Docteur Roux, 75015, Paris, France
| | - Annalisa Patriarca
- Institut Curie, PSL Research University, Radiation Oncology Department, Centre de Protonthérapie d'Orsay, 101, F-91898, Orsay, France
| | - Catherine Nauraye
- Institut Curie, PSL Research University, Radiation Oncology Department, Centre de Protonthérapie d'Orsay, 101, F-91898, Orsay, France
| | - Consuelo Guardiola
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Marjorie Juchaux
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Charlotte Lamirault
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Dalila Labiod
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
- Paris Sud University, Paris -Saclay University, 91405, Orsay, France
| | - Laurene Jourdain
- IR4M, UMR8081, Université Paris Sud, CNRS, Université Paris-Saclay, 91405, Orsay, France
| | - Catherine Sebrie
- IR4M, UMR8081, Université Paris Sud, CNRS, Université Paris-Saclay, 91405, Orsay, France
| | - Remi Dendale
- Institut Curie, PSL Research University, Radiation Oncology Department, Centre de Protonthérapie d'Orsay, 101, F-91898, Orsay, France
| | - Wilfredo Gonzalez
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Frederic Pouzoulet
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
- Paris Sud University, Paris -Saclay University, 91405, Orsay, France
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Guardiola C, Prezado Y, Roulin C, Bergs JW. Effect of X-ray minibeam radiation therapy on clonogenic survival of glioma cells. Clin Transl Radiat Oncol 2018; 13:7-13. [PMID: 30211325 PMCID: PMC6134191 DOI: 10.1016/j.ctro.2018.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/26/2018] [Accepted: 07/31/2018] [Indexed: 01/02/2023] Open
Abstract
The goal is to compare, in vitro, the efficiency of minibeam radiotherapy (MBRT) and standard RT in inducing clonogenic cell death in glioma cell lines. With this aim, we report on the first in vitro study performed in an X-ray Small Animal Radiation Research Platform (SARRP) modified for minibeam irradiations. F98 rat and U87 human glioma cells were irradiated with either an array of minibeams (MB) or with conventional homogeneous beams (broad beam, BB). A specially designed multislit collimator was used to generate the minibeams with a with of a center-to-center distance of 1465 (±10) μm, and a PVDR value of 12.4 (±2.3) measured at 1 cm depth in a water phantom. Cells were either replated for clonogenic assay directly (immediate plating, IP) or 24 h after irradiation (delayed plating, DP) to assess the effect of potentially lethal damage repair (PLDR) on cell survival. Our hypothesis is that with MBRT, a similar level of clonogenic cell death can be reached compared to standard RT, when using equal mean radiation doses. To prove this, we performed dose escalations to determine the minimum integrated dose needed to reach a similar level of clonogenic cell death for both treatments. We show that this minimum dose can vary per cell line: in F98 cells a dose of 19 Gy was needed to obtain similar levels of clonogenic survival, whereas in U87 cells there was still a slightly increased survival with MB compared to BB 19 Gy treatment. The results suggest also an impairment of DNA damage repair in F98 cells as there is no difference in clonogenic cell survival between immediately and delayed plated cells for each dose and irradiation mode. For U87 cells, a small IP-DP effect was observed in the case of BB irradiation up to a dose of 17 Gy. However, at 19 Gy BB, as well as for the complete dose range of MB irradiation, U87 cells did not show a difference in clonogenic survival between IP and DP. We therefore speculate that MBRT might influence PLDR. The current results show that X-ray MBRT is a promising method for treatment of gliomas: future preclinical and clinical studies should aim at reaching a minimum radiation (valley) dose for effective eradication of gliomas with increased sparing of normal tissues compared to standard RT.
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Affiliation(s)
- Consuelo Guardiola
- IMNC-UMR 8165, CNRS Paris-Saclay University, 15 rue Georges Clemenceau, 91406 Orsay cedex, France
| | - Yolanda Prezado
- IMNC-UMR 8165, CNRS Paris-Saclay University, 15 rue Georges Clemenceau, 91406 Orsay cedex, France
| | - Christophe Roulin
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
| | - Judith W.J. Bergs
- IMNC-UMR 8165, CNRS Paris-Saclay University, 15 rue Georges Clemenceau, 91406 Orsay cedex, France
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50
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De Marzi L, Patriarca A, Nauraye C, Hierso E, Dendale R, Guardiola C, Prezado Y. Implementation of planar proton minibeam radiation therapy using a pencil beam scanning system: A proof of concept study. Med Phys 2018; 45:5305-5316. [PMID: 30311639 DOI: 10.1002/mp.13209] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/26/2018] [Accepted: 09/02/2018] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Proton minibeam radiation therapy (pMBRT) is an innovative approach that combines the advantages of minibeam radiation therapy with the more precise ballistics of protons to further reduce the side effects of radiation. One of the main challenges of this approach is the generation of very narrow proton pencil beams with an adequate dose-rate to treat patients within a reasonable treatment time (several minutes) in existing clinical facilities. The aim of this study was to demonstrate the feasibility of implementing pMBRT by combining the pencil beam scanning (PBS) technique with the use of multislit collimators. This proof of concept study of pMBRT with a clinical system is intended to guide upcoming biological experiments. METHODS Monte Carlo simulations (TOPAS v3.1.p2) were used to design a suitable multislit collimator to implement planar pMBRT for conventional pencil beam scanning settings. Dose distributions (depth-dose curves, lateral profiles, Peak-to-Valley Dose Ratio (PVDR) and dose-rates) for different proton beam energies were assessed by means of Monte Carlo simulations and experimental measurements in a water tank using commercial ionization chambers and a new p-type silicon diode, the IBA RAZOR. An analytical intensity-modulated dose calculation algorithm designed to optimize the weight of individual Bragg peaks composing the field was also developed and validated. RESULTS Proton minibeams were then obtained using a brass multislit collimator with five slits measuring 2 cm × 400 μm in width with a center-to-center distance of 4 mm. The measured and calculated dose distributions (depth-dose curves and lateral profiles) showed a good agreement. Spread-out Bragg peaks (SOBP) and homogeneous dose distributions around the target were obtained by means of intensity modulation of Bragg peaks, while maintaining spatial fractionation at shallow depths. Mean dose-rates of 0.12 and 0.09 Gy/s were obtained for one iso-energy layer and a SOBP conditions in the presence of multislit collimator. CONCLUSIONS This study demonstrates the feasibility of implementing pMBRT on a PBS system. It also confirms the reliability of RAZOR detector for pMBRT dosimetry. This newly developed experimental methodology will support the design of future preclinical research with pMBRT.
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Affiliation(s)
- Ludovic De Marzi
- Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay, 91898, France
| | - Annalisa Patriarca
- Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay, 91898, France
| | - Catherine Nauraye
- Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay, 91898, France
| | - Eric Hierso
- Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay, 91898, France
| | - Rémi Dendale
- Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay, 91898, France
| | - Consuelo Guardiola
- IMNC-UMR 8165, CNRS, Paris 7 and Paris 11 Universities, 15 rue Georges Clemenceau, Orsay Cedex, 91405, France
| | - Yolanda Prezado
- IMNC-UMR 8165, CNRS, Paris 7 and Paris 11 Universities, 15 rue Georges Clemenceau, Orsay Cedex, 91405, France
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