Pulsed brachytherapy as a substitute for continuous low dose rate: An in vitro study with human carcinoma cells

Abstract

Purpose : Pulsed dose rate (PDR) brachytherapy as a substitute for continuous low dose rate (CLDR) has the potential to be a useful option in brachytherapy. However, the frequency and duration of pulses that will produce results practically equivalent to CLDR is still an open and important question. This study was designed to compare the survival of human tumor cells, cultured in vitro, and exposed to continuous or pulsed irradiation where the pulse frequency was varied. Methods and Materials : Three different human carcinoma cells, derived from cervical and breast cancers, were exposed to CLDR gamma rays, or to pulsed irradiations with the same overall dose rate. Pulsed regimens used were 3.8 min every hour, 7.6 min every 2 h, 11.4 min every 3 h, 15.2 min every 4 h, 22.8 min every 6 h, and 45.6 min every 12 h. For each comparison between CLDR and PDR, the overall dose and the overall time were the same. Experimental design was such that significant differences in biological effectiveness, if present, would be detected. Results : For the cell lines investigated, hourly pulses resulted in cell survival indistinguishable from CLDR. However, as the pulse interval was increased, cell survival progressively decreased compared with CLDR, and the pulsed regimes were no longer equivalent to continuous low dose rate. Conclusion : This study provides some evidence to support the suggestion that a 10-min pulse, repeated every 1 to 2 h, would be functionally equivalent to a continuous low dose rate irradiation, at least in terms of early responding endpoints. Longer intervals between pulses might result in loss of equivalence in some cases.