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Estimation of linear energy transfer distribution for broad-beam carbon-ion radiotherapy at the National Institute of Radiological Sciences, Japan

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 Publication date 2017
  fields Physics
and research's language is English




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Carbon-ion radiotherapy (CIRT) is generally evaluated with the dose weighted by relative biological effectiveness (RBE), while the radiation quality varying in the body of each patient is ignored for lack of such distribution. In this study, we attempted to develop a method to estimate linear energy transfer (LET) for a treatment planning system that only handled physical and RBE-weighted doses. The LET taken from a database of clinical broad beams was related to the RBE per energy with two polyline fitting functions for spread-out Bragg peak (SOBP) and for entrance depths, which would be selected by RBE threshold per energy per modulation. The LET estimation was consistent with the original calculation typically within a few keV/{mu}m except for the overkill at the distal end of SOBP. The CIRT treatments can thus be related to the knowledge obtained in radiobiology experiments that used LET to represent radiation quality.



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In carbon-ion radiotherapy, single-beam delivery each day in alternate directions has been commonly practiced for operational efficiency, taking advantage of the Bragg peak and the relative biological effectiveness (RBE) for uniform dose conformation to a tumor. The treatment plans are usually evaluated with total RBE-weighted dose, which is however deficient in relevance to the biological effect in the linear-quadratic model due to its quadratic-dose term, or the dose-fractionation effect. In this study, we reformulate the extrapolated response dose (ERD), or synonymously BED, which normalizes the dose-fractionation and cell-repopulation effects as well as the RBE of treating radiation, based on inactivation of a single model cell system and a typical treating radiation in carbon-ion RT. The ERD distribution virtually represents the biological effect of the treatment regardless of radiation modality or fractionation scheme. We applied the ERD formulation to simplistic model treatments and to a preclinical survey for hypofractionation based on an actual prostate-cancer treatment of carbon-ion radiotherapy. The proposed formulation was demonstrated to be practical and to offer theoretical implications. In the prostate-cancer case, the ERD distribution was very similar to the RBE-weighted-dose distribution of the actual treatment in 12 fractions. With hypofractionation, while the RBE-weighted-dose distribution varied significantly, the ERD distribution was nearly invariant, implying that the carbon-ion radiotherapy would be insensitive to fractionation. However, treatment evaluation with simplistic biological dose is intrinsically limited and must be complemented in practice somehow by clinical experiences and biology experiments.
item[Purpose] A recent study revealed that polyethylene (PE) would cause extra carbon-ion attenuation per range shift by 0.45%/cm due to compositional differences in nuclear interactions. The present study aims to assess the influence of PE range compensators on tumor dose in carbon-ion radiotherapy. item[Methods] Carbon-ion radiation was modeled to be composed of primary carbon ions and secondary particles, for each of which the dose and the relative biological effectiveness (RBE) were estimated at a tumor depth in the middle of spread-out Bragg peak. Assuming exponential behavior for attenuation and yield of these components with depth, the PE effect on dose was calculated for clinical carbon-ion beams and was partly tested by experiment. The two-component model was integrated into a treatment-planning system and the PE effect was estimated in two clinical cases. item[Results] The attenuation per range shift by PE was 0.1%--0.3%/cm in dose and 0.2%--0.4%/cm in RBE-weighted dose, depending on energy and range-modulation width. This translates into reduction of RBE-weighted dose by up to 3% in extreme cases. In the treatment-planning study, however, the effect on RBE-weighted dose to tumor was typically within 1% reduction. item[Conclusions] The extra attenuation of primary carbon ions in PE was partly compensated by increased secondary particles for tumor dose. In practical situations, the PE range compensators would normally cause only marginal errors as compared to intrinsic uncertainties in treatment planning, patient setup, beam delivery, and clinical response.
Purpose: Beam range control is the essence of radiotherapy with heavy charged particles. In conventional broad-beam delivery, fine range adjustment is achieved by insertion of range shifting and compensating materials. In dosimetry, solid phantoms are often used for convenience. These materials should ideally be equivalent to water. In this study, we evaluated dosimetric water equivalence of four common plastics, HDPE, PMMA, PET, and POM. Methods: Using the Bethe formula for energy loss, the Gottschalk formula for multiple scattering, and the Sihver formula for nuclear interactions, we calculated the effective densities of the plastics for these interactions. We experimentally measured variation of the Bragg peak of carbon-ion beams by insertion of HDPE, PMMA, and POM, which were compared with analytical model calculations. Results: The theoretical calculation resulted in slightly reduced multiple scattering and severely increased nuclear interactions for HDPE, compared to water and the other plastics. The increase in attenuation of carbon ions for 20-cm range shift was experimentally measured to be 8.9% for HDPE, 2.5% for PMMA, and 0.0% for POM while PET was theoretically estimated to be in between PMMA and POM. The agreement between the measurements and the calculations was about 1% or better. Conclusions: For carbon-ion beams, POM was dosimetrically indistinguishable from water and the best of the plastics examined in this study. The poorest was HDPE, which would reduce the Bragg peak by 0.45% per 1-cm range shift, although with marginal superiority for reduced multiple scattering. Between the two clear plastics, PET would be superior to PMMA in dosimetric water equivalence.
Proton and carbon ion therapy is an emerging technique used for the treatment of solid cancers. The monitoring of the dose delivered during such treatments and the on-line knowledge of the Bragg peak position is still a matter of research. A possible technique exploits the collinear $511 kiloelectronvolt$ photons produced by positrons annihilation from $beta^+$ emitters created by the beam. This paper reports rate measurements of the $511 kiloelectronvolt$ photons emitted after the interactions of a $80 megaelectronvolt / u$ fully stripped carbon ion beam at the Laboratori Nazionali del Sud (LNS) of INFN, with a Poly-methyl methacrylate target. The time evolution of the $beta^+$ rate was parametrized and the dominance of $^{11}C$ emitters over the other species ($^{13}N$, $^{15}O$, $^{14}O$) was observed, measuring the fraction of carbon ions activating $beta^+$ emitters $A_0=(10.3pm0.7)cdot10^{-3}$. The average depth in the PMMA of the positron annihilation from $beta^+$ emitters was also measured, $D_{beta^+}=5.3pm1.1 millimeter$, to be compared to the expected Bragg peak depth $D_{Bragg}=11.0pm 0.5 millimeter$ obtained from simulations.
Purpose: Retinoblastoma (RB) is the most common eye tumor in childhood and can be treated external radiotherapy. The purpose of this work is to evaluate the adequacy of Monte Carlo simulations and the accuracy of a commercial treatment planning system by means of experimental measurements. Dose measurements in water were performed using a dedicated collimator. Methods: A 6MV Varian Clinac 2100 C/D and a dedicated collimator are used for RB treatment. The collimator conforms a D-shaped off-axis field whose irradiated area can be either 5.2 or 3.1cm$^2$. Depth dose distributions and lateral profiles were measured and compared with Monte Carlo simulations run with PENELOPE and with calculations performed with the analytical anisotropic algorithm (AAA) using the gamma test. Results: PENELOPE simulations agree well with the experimental data with discrepancies in the dose profiles less than 3mm of distance-to-agreement and 3% of dose. Discrepancies between the results of AAA and the experimental data reach 3mm and 6%. The agreement in the penumbra region between AAA and the experiment is noticeably worse than that between the latter and PENELOPE. The percentage of voxels passing the gamma test when comparing PENELOPE (AAA) and the experiment is on average 99% (93%) assuming a 3mm distance-to-agreement and a discrepancy of 3% of dose. Conclusions: Although the discrepancies between AAA and experimental results are noticeable, it is possible to consider this algorithm for routine treatment planning of RB patients, provided the limitations of the algorithm are known and taken into account by the medical physicist. Monte Carlo simulation is essential for knowing these limitations. Monte Carlo simulation is required for optimizing the treatment technique and the dedicated collimator.
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