A comparative study of boost dose delivery techniques in breast cancer radiotherapy optimising efficacy and minimising toxicity

The present study aims to compare three techniques for delivering a boost absorbed dose: conventional reduced tangential (3D), volumetric modulated arc therapy (VMAT) and fields forward-planned technique boost (3DF). The study included 15 postoperative breast cancer patients who received a boost absorbed dose following breast-conserving surgery. The conformity index and homogeneity index were used to evaluate treatment outcomes, along with the average absorbed dose received by organs at risk (OAR). All the calculated dosimetric plans are carried out using Monaco Treatment Planning System (TPS). VMAT offers superior conformity, dose homogeneity and target coverage, it is associated with higher absorbed doses to OAR such as the heart and lung. In contrast, the 3D and 3DF techniques exhibit advantages in reducing absorbed doses to critical structures, potentially minimising the risk of cardiac and pulmonary complications. Each technique has its advantages and disadvantages. The choice of technique should be individualised, taking into account patient-specific factors and treatment goals and involves a multidisciplinary approach.

Using PRIMO to determine the initial beam parameters of Elekta Synergy linac for electron beam energies of 6, 9, 12, and 15 MeV

Background

The purpose of this research was to establish the primary electron beam characteristics for an Elekta Synergy linear accelerator. In this task, we take advantage of the PRIMO Monte Carlo software, where the model developed contains the majority of the component materials of the Linac.

Materials and methods

For all energies, the Elekta Linac electron mode and 14 × 14 cm2 applicator were chosen. To obtain percentage depth dose (PDD) curves, a homogeneous water phantom was voxelized in a 1 × 1 × 0.1 cm3 grid along the central axis. At the reference depth, the dose profile was recorded in 0.1 × 1 × 1 cm3 voxels. Iterative changes were made to the initial beams mean energy and full width at half maximum (FWHM) of energy in order to keep the conformity of the simulated and measured dose curves within. To confirm simulation results, the Gamma analysis was performed with acceptance criteria of 2 mm - 2%. From the validated calculation, the parameters of the PDD and profile curve (R100, R50, Rp, and field size) were collected.

Results

Initial mean energies of 7.3, 9.85, 12.9, and 15.7 MeV were obtained for nominal energies of 6, 9, 12, and 15, respectively. The PRIMO Monte Carlo model for Elekta Synergy was precisely validated.

Conclusions

PRIMO is an easy-to-use software program that can calculate dose distribution in water phantoms.

Impact of the anode tilt on photon emission spectrum and temperature rise in an x-ray tube

In radiology, the photon fluence and the energy spectrum generated from an x-ray tube may depend on the anode tilt angle. In this contribution, a Monte Carlo investigation is performed to quantify this effect by modeling an x-ray tube based on published data Bujila R.et al(2020Physica. Med.7544-54). The GATE simulation code is used for this purpose. The calculations have moreover confirmed this dependence; the tilt of the anode could be used to increase the photon fluence. The thermal analysis has shown that the hot spot size is dependent as well on the anode tilt angle. The thermal focus temperature (ΔT) decreases when the anode tilt angle increases. Finally, by moving the acquisition angle from 293°-337° to 248°-292° and changing the anode tilt angle from 8° to 28°, the photon fluence can be increased by 55%.

Experimental validation of a linac head Geant4 model under a grid computing environment

Background and purpose: This work aims to present the strategy to simulate a clinical linear accelerator based on the geometry provided by the manufacturer and summarize the corresponding experimental validation. Simulations were performed with the Geant4 Monte Carlo code under a grid computing environment. The objective of this contribution is reproducing therapeutic dose distributions in a water phantom with an accuracy less than 2%. Materials and methods: A Geant4 Monte Carlo model of an Elekta Synergy linear accelerator has been established, the simulations were launched in a large grid computing platform. Dose distributions are calculated for a 6 MV photon beam with treatment fields ranging from 5 × 5 cm2 to 20 × 20 cm 2 at a source - surface distance of 100 cm. Results: A high degree of agreement is achieved between the simulation results and the measured data, with dose differences of about 1.03% and 1.96% for the percentage depth dose curves and lateral dose profiles, respectively. This agreement is evaluated by the gamma index comparisons. Over 98% of the points for all simulations meet the restrictive acceptability criteria of 2%/2 mm. Conclusion: We have demonstrated the possibility to establish an accurate linac head Monte Carlo model for dose distribution simulations and quality assurance. Percentage depth dose curves and beam quality indices are in perfect agreement with the measured data with an accuracy of better than 2%.

Monte Carlo evaluation of particle interactions within the patient-dependent part of Elekta 6 MV photon beam applying IAEA phase space data

Background

This work aims to provide a simulated method to be used by designers of medical accelerators and in clinical centers to manage and minimize particles’ interaction in the patient-dependent part of a 6 MV X-Ray Beam generated by the Elekta linear accelerator system, based on the latest GATE software version 9.0 Monte Carlo simulation, IAEA phase space data, and the last version of “Slurm” computing cluster.

Materials and methods

The experimental results are obtained using the Elekta 6 MV accelerator. The simulation MC developed includes the majority of the patient-dependent segments, such as Multi-Leaf Collimator (MLC), Tongue and Groove T&G, Rounded leaf Part, including the Jaws (XY). This model is used, with a simulated Iba Blue Phantom 2 homogeneous water phantom with dimensions 480 × 480 × 410 mm³, positioned at a Source-to-Surface-Distance (SSD) of 100 cm, all of the interactions of the mega voltage 6 MV radiations in water are simulated. The IAEA phase space (PS) provided by the International Atomic Energy Agency database and cluster computing (Slurm HPC-MARWAN, CNRST, Morocco) are employed to reduce our simulation time.

Results

The results confirm that there are many interactions in all areas and the patient-dependent part’s internal structures. Thus, electrons and positrons participation appear in the generated field previously designed to be an X-ray beam. Besides, to validate our implementation geometry, the PDD’s and transverse profiles, at a depth ranging from 1.5 to 20 cm, for a field size of 10 × 10 cm², the beam quality such as D_10%, d_max (cm), d₈₀ (cm), TPR_(20/10), the two relative differences in dose were derived on σ_i and σ_i,max are calculated, respectively. Additionally, gamma index formalism for 2%/2 mm criteria is used. Once and for all, we typically take a good agreement between simulation MC GATE 9.0 and the experiment data with an error less than 2%/2 mm.

Conclusions

In the field of X-ray photons, a significant contribution of electrons and positrons has been found. This contribution could be enough to be essential or affect the delivered dose. A good agreement of 98% between this new approach of simulation MC GATE 9.0 software based on IAEA phase space and experimental dose distributions is observed regarding the validation tests used in this task.

Dosimetric study of Hounsfield number correction effect in areas influenced by contrast product in lungs case

BACKGROUND

The aim of the study was dosimetric effect quantification of exclusive computed tomography (CT) use with an intravenous (IV) contrast agent (CA ), on dose distribution of 3D-CRT treatment plans for lung cancer. Furthermore, dosimetric advantage investigation of manually contrast-enhanced region overriding, especially the heart.

MATERIALS AND METHODS

Ten patients with lung cancer were considered. For each patient two planning CT sets were initially taken with and without CA. Treatment planning were optimized based on CT scans without CA. All plans were copied and recomputed on scans with CA. In addition, scans with IV contrast were copied and density correction was performed for heart contrast enhanced. Same plans were copied and replaced to undo dose calculation errors that may be caused by CA. Eventually, dosimetric evaluations based on dose volume histograms (DVHs) of planning target volumes (PTV) and organs at-risk were studied and analyzed using the Wilcoxon's signed rank test.

RESULTS

There is no statistically significant difference in dose calculation for the PTV maximum, mean, minimum doses, spinal cord maximum doses and lung volumes that received 20 and 30 Gy, between planes calculated with and without contrast scans (p > 0.05) and also for contrast scan, with manual regions overriding.

CONCLUSIONS

Dose difference caused by the contrast agent is negligible and not significant. Therefore, there is no justification to perform two scans, and using an IV contrast enhanced scan for dose calculation is sufficient.

Implementation of a new virtual source model in Gate 9.0 package to simulate Elekta Synergy MLCi2 6 MV accelerator

Monte Carlo simulation is appreciated as an extraordinary technique to investigate particle physic processes in Radiation Therapy. This task offers a new Virtual Source Model (VSM) based on an innovative reconstruction method to extract energy and angular distribution from the Python phase space output data. Extensive comparisons of dose distributions are performed to evaluate VSM simulation precision. Four squared field configurations extending from 3 × 3 to 20 × 20 cm²are chosen for dose calculation to test field size and symmetry influences. To evaluate simulation accuracy, the beam quality parameters (such asD₁₀(%),d_max(cm),d₈₀(cm), andTPR(20/10)) also validation tests (gamma index formalism for 2%/2 mm criteria, Distance To Agreement DTA, and the estimator standard error (ϵ,ϵ_max)) are determined. Good agreement is achieved in terms of beam quality parameters and validation tests for each evaluated beam size, within a computation time of 58 hours and 17 hours on 20 nodes (presents 160 CPUs) of the full simulation and the VSM, respectively. This advanced VSM generated for the Elekta Synergy MLCi2 platform displays an uncomplicated approach. It is a great example of reconstructing different x-ray beams of various linac accelerators to facilitate its integration in cancer treatment.

PARP-1 deficiency blocks IL-5 expression through calpain-dependent degradation of STAT-6 in a murine asthma model

BACKGROUND

We recently showed that poly(ADP-ribose)polymerase-1 (PARP-1) may play a role in allergen (ovalbumin)-induced airway eosinophilia, potentially through a specific effect on IL-5 production. We also reported that while IL-5 replenishment promotes reversal of eosinophilia in lungs of PARP-1(-/-) mice, IL-4 or Immunoglobulin E replenishment do not, suggesting a potentially significant regulatory relationship between PARP-1 and IL-5.

OBJECTIVE

To explore the mechanism by which PARP-1 regulates IL-5 production and to determine how PARP-1 inhibition blocks allergen-induced eosinophilia.

METHODS

This study was conducted using a murine model of allergic airway inflammation and primary splenocytes.

RESULTS

PARP-1 knockout-associated reduction in IL-5 upon allergen exposure occurs at the mRNA level. Such an effect appears to take place after IL-4 receptor activation as PARP-1 inhibition exerted no effect on JAK1/JAK3 activation. Signal transducer and activator of transcription-6 (STAT-6) protein was severely downregulated in spleens of PARP-1(-/-) mice without any effect on mRNA levels, suggesting an effect on protein integrity rather than gene transcription. Interestingly, the degradation of STAT-6 in PARP-1(-/-) mice required allergen stimulation. Additionally, PARP-1 enzymatic activity appears to be required for STAT-6 integrity. The downregulation of STAT-6 coincided with mRNA and protein reduction of GATA-binding protein-3 and occupancy of its binding site on the IL-5 gene promoter. IL-4 was sufficient to induce STAT-6 downregulation in both PARP-1(-/-) mice and isolated splenocytes. Such degradation may be mediated by calpain, but not by proteasomes.

CONCLUSION

These results demonstrate a novel function of PARP-1 in regulating IL-5 expression during allergen-induced inflammation and explain the underlying mechanism by which PARP-1 inhibition results in IL-5 reduction.

Reciprocal regulation of iNOS and PARP-1 during allergen-induced eosinophilia

Inducible nitric oxide synthase (iNOS) inhibition was recently shown to exert no effect on allergen challenge in human asthma, raising serious concerns about the role of the protein in the disease. The present study investigated the role of iNOS in ovalbumin-induced eosinophilia from the perspective of its relationship with poly(ADP-ribose) polymerase-1 (PARP-1) and oxidative DNA damage. A mouse model of ovalbumin-induced eosinophilia was used to conduct the studies. iNOS-associated protein nitration and tissue damage were partially responsible for allergen-induced eosinophilia. iNOS expression was required for oxidative DNA damage and PARP-1 activation upon allergen challenge. PARP-1 was required for iNOS expression and protein nitration, and this requirement was connected to nuclear factor-kappaB. PARP-1 was an important substrate for iNOS-associated by-products after ovalbumin-challenge. PARP-1 nitration blocked its poly(ADP-ribosyl)ation activity. Interleukin-5 re-establishment in ovalbumin-exposed PARP-1(-/-) mice reversed eosinophilia and partial mucus production without a reversal of iNOS expression, concomitant protein nitration or associated DNA damage. The present results demonstrate a reciprocal relationship between inducible nitric oxide synthase and poly(ADP-ribose) polymerase-1 and suggest that expression of inducible nitric oxide synthase may be dispensable for eosinophilia after interleukin-5 production. Inducible nitric oxide synthase may be required for oxidative DNA damage and full manifestation of mucus production. Such dispensability may explain, in part, the reported ineffectiveness of inducible nitric oxide synthase inhibition in preventing allergen-induced inflammation in humans.

Post-allergen challenge inhibition of poly(ADP-ribose) polymerase harbors therapeutic potential for treatment of allergic airway inflammation

BACKGROUND

Identifying therapeutic drugs that block the release or effects of T-helper type 2 (Th2) cytokines after allergen exposure is an important goal for the treatment of allergic inflammatory diseases including asthma. We recently showed, using a murine model of allergic airway inflammation, that poly(ADP-ribose) polymerase (PARP) plays an important role in the pathogenesis of asthma-related lung inflammation. PARP inhibition, by single injection of a novel inhibitor, thieno[2,3-c]isoquinolin-5-one (TIQ-A), before ovalbumin (OVA) challenge, prevented airway eosinophilia in C57BL/6 mice with concomitant suppression of Th2 cytokine production and mucus secretion.

OBJECTIVE

To evaluate the efficacy of the drug when it is given after OVA challenge for its possible therapeutic potential.

METHODS

This study was conducted using a murine model of allergic airway inflammation.

RESULTS

A single injection of TIQ-A (6 mg/kg) one or 6 h post-allergen challenge conferred similar reduction in OVA challenge-induced eosinophilia. More significantly, post-allergen challenge administration of the drug exerted even better suppression on the production of IL-4, IL-5, IL-13, and IgE and prevented airway hyperresponsiveness to inhaled-methacholine. The significant decrease in IL-13 was accompanied by a complete absence of airways mucus production indicating a potential protection against allergen-induced airway remodelling.

CONCLUSION

The coincidence of the inflammation trigger and the time of drug administration appear to be important for the drug's more pronounced protection. The observed time window for efficacy, 1 or 6 h after allergen challenge may be of great clinical interest. These findings may provide a novel therapeutic strategy for the treatment of allergic airway inflammation, including asthma.

alpha(1,2)-fucosylation prevents sialyl Lewis x expression and E-selectin-mediated adhesion of fucosyltransferase VII-transfected cells

E-selectin is a cytokine-inducible, calcium-dependent endothelial cell adhesion molecule that plays a critical role in the leucocyte-endothelium interaction during inflammation and is thought to contribute to the metastatic dissemination of tumour cells. Like the other selectins, E-selectin binds to ligands carrying the tetrasaccharide sialyl-Lewis x (NeuAcalpha2,3Galbeta1,4[Fucalpha1, 3]GlcNAc)1 or its isomer sialyl-Lewis a (NeuAcalpha2, 3Galbeta1, 3[Fucalpha1,4]GlcNAc). We examined the effect of expressing the H-type alpha(1,2)-fucosyltransferase or the alpha(2, 6)-sialyltransferase on the synthesis of sialyl-Lewis x by alpha(1, 3)fucosyltransferase. We found that H-type alpha(1, 2)-fucosyltransferase but not alpha(2,6)-sialyltransferase, strongly inhibited sialyl-Lewis x expression and E-selectin adhesion. We assume that H-type alpha(1,2)-fucosyltransferase competes with the endogenous alpha(2,3)-sialyltransferase for the N-acetyllactosamine structures assigned to further serve as acceptors for alpha(1, 3)fucosyltransferase.

The formation of the oncofetal J28 glycotope involves core-2 beta6-N-acetylglucosaminyltransferase and alpha3/4-fucosyltransferase activities

The feto-acinar pancreatic protein or FAPP, the oncofetal glycoisoform of bile salt-dependent lipase (BSDL), is characterized by the presence of the J28 glycotope recognized by mAbJ28. This fucosylated epitope is carried out by the O-linked glycans of the C-terminal mucin-like region of BSDL. This glycotope is expressed by human tumoral pancreatic tissues and by human pancreatic tumoral cell lines such as SOJ-6 and BxPC-3 cells. However, it is not expressed by the normal human pancreatic tissues and by MiaPaCa-2 and Panc-1 cells. Due to the presence of many putative sites for O-glycosylation on FAPP and BSDL, the structure of the J28 glycotope cannot be attained by classical physical methods. In the first part of the present study, we have determined which glycosyltransferases were differently expressed in pancreatic tumoral cell lines compared to normal tissues, focusing in part on fucosyltransferases (Fuc-T) and core-2 beta6-N-acetylglucosaminyltransferase (Core2GlcNAc-T). Our data suggested that alpha2-Fuc-T activity was decreased in the four cell lines tested (SOJ-6, BxPC-3, MiaPaCa-2, and Panc-1). The alpha(1-3) and alpha(1-4) fucosylations were decreased in tumor cells that do not express the J28 glycotope whereas alpha4-Fuc-T and Core2GlcNAc-T activities were significantly increased in SOJ-6 cells which best expressed the J28 glycotope. Therefore, we wished to gain information about glycosyltransferases involved in the building of this structure by transfecting the cDNA encoding the mucin-like region of BSDL in CHO-K1 also expressing Core2GlcNAc-T and/or FUT3 and/or FUT7 activities. These CHO-K1 cells have been previously transfected with the cDNA encoding Core2GlcNAc-T and/or FUT3 and/or FUT7. Data indicated that the C-terminal peptide of BSDL (Cter) produced by those cells did not carry out the J28 glycotope unless Core2GlcNAc-T activity is present. Further transfection with FUT3 cDNA, increased the antibody recognition. Nevertheless, transfection with FUT3 or FUT7 alone did not generate the formation of the J28 glycotope on the C-terminal peptide. Furthermore, the Cter peptide produced by CHO-K1 cells expressing Core2GlcNAc-T was more reactive to the mAbJ28 after in vitro fucosylation with the recombinant soluble form of FUT3. These data suggested that the J28 glycotope encompasses structures initiated by Core2GlcNAc-T and further fucosylated by alpha3/4-Fuc-T such as FUT3, likely on GlcNAc residues.

Green fluorescent protein-based system for analysis of E-selectin-mediated adhesion

Numerous cell-based or cell-free systems for study of selectin adhesion use radiolabeled tracers. However, in addition to handling problems associated with the use of radioisotopes, these assays have difficulty relating a number of counts to a number of adherent cells. Here, we describe an assay that uses the natural fluorescence of the green fluorescent protein (GFP) to measure binding of cells to E-selectin. We elaborated an adhesion system composed of a cell monolayer expressing E-selectin ligand to which monodispersed fluorescent Chinese hamster ovary (CHO) cells expressing E-selectin are added. Due to GFP autofluorescence, adhered cells can be easily distinguished from cell monolayers by fluorescence microscopy, and adhesion can be measured by cytofluorometry. We applied this GFP-based adhesion assay to measure the adherence of a pancreatic tumor cell line and found that the binding parameters of these cells satisfy a number of E-selectin-specific criteria.

Functional reconstitution of membrane glycoproteins into lipid vesicles using lectin precipitation. Application to the VIP receptor

We studied the interaction of n-octyl-beta-d-glucopyranoside-solubilized VIP receptors (VIPR) with wheat germ agglutinin and found that the addition of the lectin to the detergent extract led to the formation of aggregates that could be pelleted by high speed centrifugation. Resuspension of the pellet in the presence of the competing trisaccharide, N,N', N"-triacetylchitotriose (TAC), dissociated the lectin from the complex without altering the precipitability of VIPR. The final pellet (referred to as TAC pellet) contained an average of 12% of total protein and 96% of total VIP binding activity with a typical rank order of potency for VIP-related peptides. Lipid analysis and electron microscopic examination indicated that the precipitated material was composed of lipid vesicles. VIPR molecules were shown to be integrally inserted in the liposomes because they could not be dissociated from the vesicles at pH 11 or with high salt concentration. By comparing the liposome-associated VIP binding activity in the presence and absence of detergent and by showing accessibility of VIPR to PNGase F, it was concluded that VIP binding sites were not simply trapped within the reconstituted vesicles but likely exposed at the external surface of the liposomes.

Glycosylation is the structural basis for changes in polymorphism and immunoreactivity of pituitary glycoprotein hormones

Glycoprotein hormones have long been known to display extensive polymorphism and changes in bioactivity according to the endocrine status of the patient. Structural analysis has shown that pituitary gonadotropins (lutropin and follitropin) and thyrotropin are synthesized and secreted as a panel of isoforms which differ in glycosylation, bioactivity and circulatory half-life. Ultrasensitive immunoassays could reveal that glycosylation of plasma hormones is structurally different from the pituitary stock so that the ratio of circulating glycoforms may vary according to the physiopathology of the pituitary axis. However, contradictory results between immunoassays have been often reported, suggesting that some plasma forms can escape recognition by monoclonal antibodies which have been raised to the pituitary or urinary antigen. When hormone levels do not correlate with clinical features, one can also suspect that inactive or hyperactive forms are being measured. At the molecular level, very limited information has been gained toward the expression of hormone epitopes as a function of carbohydrate structure. To address this issue, we have compared the recognition of pituitary and recombinant human thyrotropin by various polyclonal and monoclonal antibodies before and after neuraminidase treatment. Both, pituitary and recombinant thyrotropin bound to anti-alpha and anti-beta antibodies, demonstrating thereby that recombinant thyrotropin can be used to calibrate immunoassays. While removal of sialic acid did not alter the recognition of the recombinant hormone in various immunoassays, this treatment specifically abolished the binding of pituitary thyrotropin to anti-beta monoclonal antibodies. These findings show that immunoreactivity of circulating hormone glycoforms, which are often more sialylated than their pituitary counterparts, may very well account for variation depending on the antibodies used in the immunoassays.