Abstract
Different therapies are adopted for the treatment of deep seated tumours in combination or as an alternative to surgical removal or chemotherapy: radiotherapy with photons (RT), particle therapy (PT) with protons or even heavier ions like 12C, are now available in clinical centres. In addition to these irradiation modalities, the use of Very High Energy Electron (VHEE) beams (100–200 MeV) has been suggested in the past, but the diffusion of that technique was delayed due to the needed space and budget, with respect to standard photon devices. These disadvantages were not paired by an increased therapeutic efficacy, at least when comparing to proton or carbon ion beams. In this contribution we investigate how recent developments in electron beam therapy could reshape the treatments of deep seated tumours. In this respect we carefully explored the application of VHEE beams to the prostate cancer, a well-known and studied example of deep seated tumour currently treated with high efficacy both using RT and PT. The VHEE Treatment Planning System was obtained by means of an accurate Monte Carlo (MC) simulation of the electrons interactions with the patient body. A simple model of the FLASH effect (healthy tissues sparing at ultra-high dose rates), has been introduced and the results have been compared with conventional RT. The study demonstrates that VHEE beams, even in absence of a significant FLASH effect and with a reduced energy range (70–130 MeV) with respect to implementations already explored in literature, could be a good alternative to standard RT, even in the framework of technological developments that are nowadays affordable.
Highlights
The treatment of deep seated tumours with external beam radiotherapy (EBRT) is an effective therapy either in alternative or in addition to surgical removal or chemotherapy
In the past, such energies were not considered suitable for the clinical practice due to cost, complexity and space encumbrance. Some of these issues can nowadays be addressed due to recent advances that allow to design compact accelerators matching the required energy with fields up to 50 MeV/m and with very high intensities [17,18,19]. In this manuscript we focused on the use of Very High Energy Electron (VHEE) beams, with a low number of fields and taking into account the FLASH effect potential
The tumour (PTV) coverage and the dose absorbed by the OARs have been compared with the results obtained in real Intensity Modulated Radiation Therapy (IMRT) cases, from patients treated at the Department of Radiotherapy, Policlinico Umberto I, “Sapienza” University of Rome, by means of Dose Volume Histograms (DVH)
Summary
The treatment of deep seated tumours with external beam radiotherapy (EBRT) is an effective therapy either in alternative or in addition to surgical removal or chemotherapy. In this paper we evaluate the potential of high energy electron beams according to the recent developments in the field of electrons acceleration and delivery, studying in detail the case of prostate cancer treatment. Stages of prostate cancer can be treated using Intensity Modulated Radiation Therapy (IMRT) [3,4,5,6]. One of the IMRT intrinsic limitations is related to how photons interact with the patient body. The absorbed dose peaks 1 or 2 cm (depending on the energy) after entering the patient body while, afterwards, it exponentially decreases along the beam direction.”
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