Oxygen Enhancement Ratio Research Articles

Benchmarking GATE/Geant4 for 16O ion beam therapy

Oxygen () ions are a potential alternative to carbon ions in ion beam therapy. Their enhanced linear energy transfer indicates a higher relative biological effectiveness and a reduced oxygen enhancement ratio. Due to the limited availability of ion beams, Monte Carlo (MC) transport codes are important research tools for investigating their potential. The purpose of this study was to validate GATE/Geant4 for ion beam therapy using experimental data from literature. Five hadron physics lists and two electromagnetic options were benchmarked against measured depth dose distributions (DDDs) and charge-changing cross sections. The simulated beam ranges deviated by less than 0.5% for all physics configurations and only a few points exceeded the gamma index criterion (2%/1 mm). However, the simulated partial charge-changing cross sections deviated considerably for some hadron physics configurations. Best agreement with the experimental values was obtained with the quantum molecular dynamics model (QMD), and we therefore suggest using this model in Geant4 to accurately describe the fragmentation of ion beams into lighter fragments ().

Oxygen Enhancement Ratio in Radiation-Induced Initial DSBs by an Optimized Flow Cytometry-based Gamma-H2AX Analysis in A549 Human Cancer Cells.

High-linear energy transfer (LET) heavy ions cause higher therapeutic effects than low-LET radiation due to lower dependency on oxygen concentration in tumor cell killing. The lethality after irradiation largely depends on DNA double-strand breaks (DSBs), however the detailed LET dependency for DSB induction under oxic and hypoxic conditions has not been reported. Therefore, we evaluated the oxygen enhancement ratio (OER) of heavy ion-induced DSB induction using a highly-optimized flow cytometry-based method of γ-H2AX detection. Non-small cell lung cancer (NSCLC) A549 cells were exposed to X-ray, carbon-ion and iron-ion radiations under oxic or hypoxic condition. As a DSB marker, the γ-H2AX signal was measured 1 h postirradiation and analyzed by flow cytometry. DSB slope values were calculated as DSB induction per Gy. Our method was able to detect high-LET radiation-induced DSBs even from clustered DNA damage sites. We also showed a decrease in OER value in an LET-dependent manner regardless of radiation type. In summary, we demonstrated a simple, quick and highly-optimized flow cytometry-based method of DSB analysis that detects DSBs induced by heavy-ion radiation for hypoxic and nonhypoxic cancer cells. Our study may provide a useful biological basis for heavy-ion radiotherapy.

Cell-line dependent effects of hypoxia prior to irradiation in squamous cell carcinoma lines

PurposeTo assess the impact of hypoxia exposure on cellular radiation sensitivity and survival of tumor cells with diverse intrinsic radiation sensitivity under normoxic conditions. Materials and methodsThree squamous cell carcinoma (SCC) cell lines, with pronounced differences in radiation sensitivity, were exposed to hypoxia prior, during or post irradiation. Cells were seeded in parallel for colony formation assay (CFA) and stained for γH2AX foci or processed for western blot analysis. ResultsHypoxia during irradiation led to increased cellular survival and reduced amount of residual γH2AX foci in all the cell lines with similar oxygen enhancement ratios (OER SKX: 2.31, FaDu: 2.44, UT-SCC5: 2.32), while post-irradiation hypoxia did not alter CFA nor residual γH2AX foci. Interestingly, prolonged exposure to hypoxia prior to irradiation resulted in differential outcome, assessed as Hypoxia modifying factor (HMF) namely radiosensitization (SKX HMF: 0.76), radioresistance (FaDu HMF: 1.54) and no effect (UT SCC-5 HMF: 1.1). Notably, radiosensitization was observed in the ATM-deficient SKX cell line while UT SCC-5 and to a lesser extent also FaDu cells showed radiation- and hypoxia-induced upregulation of ATM phosphorylation. Across all the cell lines Rad51 was downregulated whereas phosphor-DNA-PKcs was enhanced under hypoxia for FaDu and UTSCC-5 and was delayed in the SKX cell line. ConclusionWe herein report a key role of ATM in the cellular fitness of cells exposed to prolonged moderate hypoxia prior to irradiation. While DNA damage response post-irradiation seem to be mainly driven by non-homologous end joining repair pathway in these conditions, our data suggest an important role for ATM kinase in hypoxia-driven modification of radiation response.

OC-0242: The oxygen enhancement ratio for carbon ions is smaller than for photons in R3327-HI prostate tumors

OC-0242: The oxygen enhancement ratio for carbon ions is smaller than for photons in R3327-HI prostate tumors

Theoretical dosimetric evaluation of carbon and oxygen minibeam radiation therapy.

Charged particles have several advantages over x-ray radiations, both in terms of physics and radiobiology. The combination of these advantages with those of minibeam radiation therapy (MBRT) could help enhancing the therapeutic index for some cancers with poor prognosis. Among the different ions explored for therapy, carbon ions are considered to provide the optimum physical and biological characteristics. Oxygen could be advantageous due to a reduced oxygen enhancement ratio along with a still moderate biological entrance dose. The aforementioned reasons justified an in-depth evaluation of the dosimetric features of carbon and oxygen minibeam radiation therapy to establish the interest of further explorations of this avenue. The GATE/Geant4 6.2 Monte Carlo simulation platform was employed to simulate arrays of rectangular carbon and oxygen minibeams (600 μm × 2 cm) at a water phantom entrance. They were assumed to be generated by means of a magnetic focusing. The irradiations were performed with a 2-cm-long spread-out Bragg peak (SOBP) centered at 7-cm-depth. Several center-to-center (c-t-c) distances were considered. Peak and valley doses, as well as peak-to-valley dose ratio (PVDR) and the relative contribution of nuclear fragments and electromagnetic processes were assessed. In addition, the type and proportion of the secondary nuclear fragments were evaluated in both peak and valley regions. Carbon and oxygen MBRT lead to very similar dose distributions. No significant advantage of oxygen over carbon ions was observed from physical point of view. Favorable dosimetric features were observed for both ions. Thanks to the reduced lateral scattering, the standard shape of the depth dose curves (in the peaks) is maintained even for submillimetric beam sizes. When a narrow c-t-c is considered (910-980 μm), a (quasi) homogenization of the dose can be obtained at the target, while a spatial fractionation of the dose is maintained in the proximal normal tissues with low PVDR. In contrast when a larger c-t-c is used (3500 μm) extremely high PVDR (≥50) are obtained in normal tissues, corresponding to very low valley doses. This suggests that carbon and oxygen MBRT might lead to a significant reduction of normal tissue complication probability. The main participant to the valley doses are secondary nuclear products at all depths. Among them the highest yield in normal tissues corresponds to the lightest fragments, neutrons and protons. Heavier fragments are dominant in the valleys only at the target position, which might favor tumor control. The computed dose distributions suggest that a spatial fractionation of the dose combined to the use of submillimetric field sizes might allow profiting from the high efficiency of carbon and oxygen ions for the treatment of radioresistant tumors, while preserving normal tissues. Only biological experiments could confirm the shifting of the normal tissue complication probability curves. The authors' results support the further exploration of this avenue.

SC03.03 Carbon-Ion Therapy of Lung Cancer

SC03.03 Carbon-Ion Therapy of Lung Cancer

Adaptation of the microdosimetric kinetic model to hypoxia

Ion beams present a potential advantage in terms of treatment of lesions with hypoxic regions. In order to use this potential, it is important to accurately model the cell survival of oxic as well as hypoxic cells. In this work, an adaptation of the microdosimetric kinetic (MK) model making it possible to account for cell hypoxia is presented. The adaptation relies on the modification of damage quantity (double strand breaks and more complex lesions) due to the radiation. Model parameters such as domain size and nucleus size are then adapted through a fitting procedure. We applied this approach to two cell lines, HSG and V79 for helium, carbon and neon ions. A similar behaviour of the parameters was found for the two cell lines, namely a reduction of the domain size and an increase in the sensitive nuclear volume of hypoxic cells compared to those of oxic cells. In terms of oxygen enhancement ratio (OER), the experimental data behaviour can be reproduced, including dependence on particle type at the same linear energy transfer (LET). Errors on the cell survival prediction are of the same order of magnitude than for the original MK model. Our adaptation makes it possible to account for hypoxia without modelling the OER as a function of the LET of the particles, but directly accounting for hypoxic cell survival data.

Predicting the Influence of Microvascular Structure On Tumor Response to Radiotherapy

The purpose of this study is to investigate how theoretical predictions of tumor response to radiotherapy (RT) depend on the morphology and spatial representation of the microvascular network. A hybrid multiscale model, which couples a cellular automaton model of tumor growth with a model for oxygen transport from blood vessels, is used to predict the viable fraction of cells following one week of simulated RT. Both artificial and biologically derived three-dimensional (3-D) vessel networks of well vascularized tumors are considered and predictions compared with 2-D descriptions. For literature-derived values of the cellular oxygen consumption rate there is little difference in predicted viable fraction when 3-D network representations of biological or artificial vessel networks are employed. Different 2-D representations are shown to either over- or under-estimate viable fractions relative to the 3-D cases, with predictions based on point-wise descriptions shown to have greater sensitivity to vessel network morphology. The predicted RT response is relatively insensitive to the morphology of the microvessel network when 3-D representations are adopted, however, sensitivity is greater in certain 2-D representations. By using realistic 3-D vessel network geometries this study shows that real and artificial network descriptions and assumptions of spatially uniform oxygen distributions lead to similar RT response predictions in relatively small tissue volumes. This suggests that either a more detailed description of oxygen transport in the microvasculature is required or that the oxygen enhancement ratio used in the well known linear-quadratic RT response model is relatively insensitive to microvascular structure.

Extrapolation Ionization Chamber Dosimetry of Fluorescent X-Ray Energies from 4.5 to 19.6 keV.

Characteristic X rays of energies less than approximately 20 keV are of interest in radiobiology and radiation oncology. There is evidence that these low-energy photons produce higher relative biological effectiveness (RBE) and lower oxygen enhancement ratio (OER) relative to higher energies. Lower energy X rays also offer the advantage of healthy tissue sparing beyond the target treatment depth. Electronic brachytherapy systems that can deliver characteristic and bremsstrahlung X rays of varying energy are in clinical use as well as under development. We performed low-energy extrapolation ionization chamber dosimetry using two methods: 1. the exposure-to-dose method; and 2. the Burlin theory method combined with the extrapolation chamber method of Klevenhagen. We investigated fluorescent X rays emitted from seven metals: titanium (Ti, Z = 22); chromium (Cr, Z = 24); iron (Fe, Z = 26); cobalt (Co, Z = 27); copper (Cu, Z = 29); zinc (Zn, Z = 30); and molybdenum (Mo, Z = 42). X rays were produced by irradiation of the metals with a 55 kVp, 45 mA silver anode spectrum. The data obtained were air kerma rate (cGy/min), and radiation dose rate (cGy/min) in phosphate-buffered saline (PBS) solution and water. Air kerma rates ranged from 3.55 ± 0.10 to 14.36 ± 0.39 cGy/min. Dose rates ranged from 3.85 ± 0.10 to 16.96 ± 0.46 cGy/min in PBS and 3.59 ± 0.10 to 16.06 ± 0.43 cGy/min in water. Dose-rate energy dependence of both models was examined by taking a ratio of measured to Monte Carlo calculated dose rates. Dosimetry method 1 exhibited a linear relationship across all energies with a slope of 0.0127 keV(-1) and R(2) of 0.9276. Method 2 exhibited a linear relationship across all energies with a slope of 0.0467 keV(-1) and R(2) of 0.9933. Method 1 or 2 may be used as a relative dosimetry system to derive dose rates to water by using a second reference ion chamber with a NIST-traceable calibration for the molybdenum spectrum.

SU‐F‐J‐202: Secondary Radiation Measurements for Charged Particle Therapy Monitoring: Fragmentation of Therapeutic He, C and O Ion Beams Impinging On a PMMA Target

Purpose:In Charged Particle Therapy (CPT), besides protons, there has been recently a growing interest in 4He, 12C and 16O beams. The secondary radiation produced in the interaction of those beams with a patient could be potentially used for on‐line monitoring of range uncertainties in order to fully exploit the advantages of those light ions resulting from increased Radio Biological Effectiveness, reduced multiple scattering and Oxygen Enhancement Ratio. The study and precise characterization of secondary radiation (beta+, prompt gamma, charged fragments) is the cornerstone of any R&D activity aiming for online monitoring development and purpose of the analysis presented here.Methods:We present the measurements of the secondary radiation generated by He, C and O beams impinging on a beam stopping PMMA target. The data has been collected at the Heidelberg Ionbeam Therapy center (HIT), where several millions of collisions were recorded at different energies, relevant for therapeutical applications.Results:The experimental setup, as well as the analysis strategies will be reviewed. The detected particle fluxes as a function of the primary beam energy and the emission angle with respect to the beam direction will be presented and compared to the results of other available measurements. In addition, the energy spectra and emission shapes of charged secondary particles will be shown and discussed in the context of the primary beam range monitoring technique that is being developed by the ARPG collaboration, within the INSIDE project funded by the Italian research ministry. The implications for dose monitoring applications will be discussed, in the context of the current (or planned) state‐of‐ the‐art detector solutions.Conclusion:The characterization of the radiation produced by 12C, 4He and 16O beams fully supports the feasibility of on‐line range monitoring in the clinical practice of CPT by means of secondary particles detection.

WE-FG-BRA-03: Oxygen Interplay in Hypofractionated Radiotherapy: A Hidden Opportunity

Purpose: Local oxygen during a radiotherapy fraction has been shown to change over a full range of the oxygen enhancement ratio (OER) during the same time scale as the treatment fraction. Interplay with local oxygen is then likely a concern, especially for hypofractionation. Our experiments that show a strong role for metabolic dynamics suggesting one could manipulate this interplay for more efficacious treatments. Methods: Two published experiments are presented with the same human head and neck cancer cell line (UM-SCC-22B). One is a cell-specific in vitro prompt response to a 10 Gy dose of orthovotage radiation using fluorescence lifetime imaging (FLIM), benchmarked with a Seahorse assay. The other in vivo study uses autocorrelation analysis with blood oxygen level dependent magnetic resonance imaging (MRI-BOLD) on xenografts. In vivo results are verified with diffuse optics using spectra fitting and photoacoustic measurements. All these measurements are at high time resolution: sampling is one per minute. Results: Interplay happens when the radiosensitivity modulates at the same time scale as the radiation. These results show dynamics at these time scales. 1. The dominant time scale of the acute hypoxia in cell line xenografts is shown to be on the order of minutes to tens of minutes: similar to a metabolic oscillation known as the ‘glycolytic oscillator.’ 2. The radiation dose itself alters metabolism within minutes to tens of minutes also. Conclusion: These results vary with cell type. There is a possibility that special timing and dose levels could be used for radiation. Gating could be used for maximal oxygen during treatment. There is an analogy to the interplay discussions with tumor motion, except that an oxygen interplay could more likely be patient-specific at a more fundamental level.

Differential Superiority of Heavy Charged-Particle Irradiation to X-Rays: Studies on Biological Effectiveness and Side Effect Mechanisms in Multicellular Tumor and Normal Tissue Models.

This review is focused on the radiobiology of carbon ions compared to X-rays using multicellular models of tumors and normal mucosa. The first part summarizes basic radiobiological effects, as observed in cancer cells. The second, more clinically oriented part of the review, deals with radiation-induced cell migration and mucositis. Multicellular spheroids from V79 hamster cells were irradiated with X-rays or carbon ions under ambient or restricted oxygen supply conditions. Reliable oxygen enhancement ratios could be derived to be 2.9, 2.8, and 1.4 for irradiation with photons, 12C+6 in the plateau region, and 12C+6 in the Bragg peak, respectively. Similarly, a relative biological effectiveness of 4.3 and 2.1 for ambient pO2 and hypoxia was obtained, respectively. The high effectiveness of carbon ions was reflected by an enhanced accumulation of cells in G2/M and a dose-dependent massive induction of apoptosis. These data clearly show that heavy charged particles are more efficient in sterilizing tumor cells than conventional irradiation even under hypoxic conditions. Clinically relevant doses (3 Gy) of X-rays induced an increase in migratory activity of U87 but not of LN229 or HCT116 tumor cells. Such an increase in cell motility following irradiation in situ could be the source of recurrence. In contrast, carbon ion treatment was associated with a dose-dependent decrease in migration with all cell lines and under all conditions investigated. The radiation-induced loss of cell motility was correlated, in most cases, with corresponding changes in β1 integrin expression. The photon-induced increase in cell migration was paralleled by an elevated phosphorylation status of the epidermal growth factor receptor and AKT-ERK1/2 pathway. Such a hyperphosphorylation did not occur during 12C+6 irradiation under all conditions registered. Comparing the gene toxicity of X-rays with that of particles using the γH2AX technique in organotypic cultures of the oral mucosa, the superior effectiveness of heavy ions was confirmed by a twofold higher number of foci per nucleus. However, proinflammatory signs were similar for both treatment modalities, e.g., the activation of NFκB and the release of IL6 and IL8. The presence of peripheral blood mononuclear cell increased the radiation-induced release of the proinflammatory cytokines by factors of 2–3. Carbon ions are part of the cosmic radiation. Long-term exposure to such particles during extended space flights, as planned by international space agencies, may thus impose a medical and safety risk on the astronauts by a potential induction of mucositis. In summary, particle irradiation is superior to gamma-rays due to a higher radiobiological effectiveness, a reduced hypoxia-induced radioresistance, a multicellular radiosensitization, and the absence of a radiation-induced cell motility. However, the potential of inducing mucositis is similar for both radiation types.

237 - HIF-1α plays a key role in the response of HNSCC cancer stem cells to photon and carbon ion exposures

Purpose: Head and neck squamous cells carcinomas (HNSCC) have a poor prognosis due to escapement to anti-cancer therapies which leads to locoregional recurrences. The presence of cancer stem cells (CSCs), resistant to chemo- and radio-therapies, could explain these resistances and recurrences. Hadrontherapy has demonstrated favorable results for many cancers, since carbon ions induced more CSC’s cell death than photons. However, for the HNSCC tumor, local control remains low. CSCs are located in a hypoxic microenvironment and hypoxia is well-known for being able to induce the epithelial mesenchymal transition (EMT). The aim of this study is to investigate the response of CSCs to radiotherapy, compared with carbon ions under hypoxic conditions. Many signaling pathways involved in the resistance of CSCs and the invasion/migration process depend on the stabilization of HIF-1α. Reactive Oxygen Species (ROS), which are produced under hypoxia and in response to irradiation, play a key role in this stabilization. However, since few data are available, the mechanisms involving ROS production, HIF-1α stabilization as well as the invasion/migration process that follows, need to be clarified in HNSCC CSCs exposed to carbon or photon radiations in a hypoxic environment. Material and methods: Two HNSCC cells lines, SQ20B and FaDu, and their CSCs were grown in normoxic and hypoxic (1% O2) conditions. CSCs were isolated by flow cytometry cell sorting. Cell survival curves were performed in response to photon (250kV) and carbon ion (75MeV/n, GANIL, France) irradiations in order to define the Oxygen Enhancement Ratio (OER). The expression of HIF-1α was followed by Western-Blots. ROS were quantified with a CM-H2DCFDA dye and Migration/Invasion with Boyden chambers. Results: After photons, HNSCC cells and their CSCs appeared more resistant under hypoxia (OER>1.2) whereas the oxygen effects were cancelled after carbon ions (OER=1). Interestingly, the OER values and the expression of HIF-1α seemed to be linked. HIF-1α was weakly expressed after photon irradiation and fully inhibited after carbon ions. Additionally, under hypoxia, HIF-1α expression appeared earlier in CSCs than in the parental cell lines, confirming their adaptive properties to hypoxia. In CSCs, this expression was correlated with ROS levels. As a consequence, since HIF- 1α is known to promote EMT, under normoxia as well as hypoxia, the invasion/migration abilities of CSCs were more important than in non-CSCs. Finally, after carbon ions, either in normoxic or hypoxic conditions, invasion/migration processes were decreased compared with photons. Conclusion: HIF-1α plays a key role in the radioresistance of CSCs and in their invasiveness abilities. No expression of HIF-1α was found after carbon ion exposure suggesting that carbon ions could be a relevant therapeutic alternative to kill CSCs in their microenvironment.

Spatial Metrics of Tumour Vascular Organisation Predict Radiation Efficacy in a Computational Model.

Intratumoural heterogeneity is known to contribute to poor therapeutic response. Variations in oxygen tension in particular have been correlated with changes in radiation response in vitro and at the clinical scale with overall survival. Heterogeneity at the microscopic scale in tumour blood vessel architecture has been described, and is one source of the underlying variations in oxygen tension. We seek to determine whether histologic scale measures of the erratic distribution of blood vessels within a tumour can be used to predict differing radiation response. Using a two-dimensional hybrid cellular automaton model of tumour growth, we evaluate the effect of vessel distribution on cell survival outcomes of simulated radiation therapy. Using the standard equations for the oxygen enhancement ratio for cell survival probability under differing oxygen tensions, we calculate average radiation effect over a range of different vessel densities and organisations. We go on to quantify the vessel distribution heterogeneity and measure spatial organization using Ripley’s L function, a measure designed to detect deviations from complete spatial randomness. We find that under differing regimes of vessel density the correlation coefficient between the measure of spatial organization and radiation effect changes sign. This provides not only a useful way to understand the differences seen in radiation effect for tissues based on vessel architecture, but also an alternate explanation for the vessel normalization hypothesis.

Spot Scanning and Passive Scattering Proton Therapy: Relative Biological Effectiveness and Oxygen Enhancement Ratio in Cultured Cells

To determine the relative biological effectiveness (RBE), oxygen enhancement ratio (OER), and contribution of the indirect effect of spot scanning proton beams, passive scattering proton beams, or both in cultured cells in comparison with clinically used photons. The RBE of passive scattering proton beams at the center of the spread-out Bragg peak (SOBP) was determined from dose-survival curves in 4 cell lines using 6-MV X rays as controls. Survival of 2 cell lines after spot scanning and passive scattering proton irradiation was then compared. Biological effects at the distal end region of the SOBP were also investigated. The OER of passive scattering proton beams and 6 MX X rays were investigated in 2 cell lines. The RBE and OER values were estimated at a 10% cell survival level. The maximum degree of protection of radiation effects by dimethyl sulfoxide was determined to estimate the contribution of the indirect effect against DNA damage. All experiments comparing protons and X rays were made under the same biological conditions. The RBE values of passive scattering proton beams in the 4 cell lines examined were 1.01 to 1.22 (average, 1.14) and were almost identical to those of spot scanning beams. Biological effects increased at the distal end of the SOBP. In the 2 cell lines examined, the OER was 2.74 (95% confidence interval, 2.56-2.80) and 3.08 (2.84-3.11), respectively, for X rays, and 2.39 (2.38-2.43) and 2.72 (2.69-2.75), respectively, for protons (P<.05 for both cells between X rays and protons). The maximum degree of protection was significantly higher for X rays than for proton beams (P<.05). The RBE values of spot scanning and passive scattering proton beams were almost identical. The OER was lower for protons than for X rays. The lower contribution of the indirect effect may partly account for the lower OER of protons.

A mechanistic investigation of the oxygen fixation hypothesis and oxygen enhancement ratio

The presence of oxygen in tumours has substantial impact on treatment outcome; relative to anoxic regions, well-oxygenated cells respond better to radiotherapy by a factor 2.5–3. This increased radio-response is known as the oxygen enhancement ratio. The oxygen effect is most commonly explained by the oxygen fixation hypothesis, which postulates that radical-induced DNA damage can be permanently ‘fixed’ by molecular oxygen, rendering DNA damage irreparable. While this oxygen effect is important in both existing therapy and for future modalities such a radiation dose-painting, the majority of existing mathematical models for oxygen enhancement are empirical rather than based on the underlying physics and radiochemistry. Here we propose a model of oxygen-enhanced damage from physical first principles, investigating factors that might influence the cell kill. This is fitted to a range of experimental oxygen curves from literature and shown to describe them well, yielding a single robust term for oxygen interaction obtained. The model also reveals a small thermal dependency exists but that this is unlikely to be exploitable.

Kill-painting of hypoxic tumours in charged particle therapy

Solid tumours often present regions with severe oxygen deprivation (hypoxia), which are resistant to both chemotherapy and radiotherapy. Increased radiosensitivity as a function of the oxygen concentration is well described for X-rays. It has also been demonstrated that radioresistance in anoxia is reduced using high-LET radiation rather than conventional X-rays. However, the dependence of the oxygen enhancement ratio (OER) on radiation quality in the regions of intermediate oxygen concentrations, those normally found in tumours, had never been measured and biophysical models were based on extrapolations. Here we present a complete survival dataset of mammalian cells exposed to different ions in oxygen concentration ranging from normoxia (21%) to anoxia (0%). The data were used to generate a model of the dependence of the OER on oxygen concentration and particle energy. The model was implemented in the ion beam treatment planning system to prescribe uniform cell killing across volumes with heterogeneous radiosensitivity. The adaptive treatment plans have been validated in two different accelerator facilities, using a biological phantom where cells can be irradiated simultaneously at three different oxygen concentrations. We thus realized a hypoxia-adapted treatment plan, which will be used for painting by voxel of hypoxic tumours visualized by functional imaging.

Determination of the relative biological effectiveness and oxygen enhancement ratio for micronuclei formation using high-LET radiation in solid tumor cells: An in vitro and in vivo study

We determined the relative biological effectiveness (RBE) and oxygen enhancement ratio (OER) of micronuclei (MN) formation in clamped (hypoxic) and non-clamped (normoxic) solid tumors in mice legs following exposure to X-rays and heavy ions. Single-cell suspensions (aerobic) of non-irradiated tumors were prepared in parallel and used directly to determine the radiation response for aerobic cells. Squamous cell carcinoma (SCCVII) cells were transplanted into the right hind legs of syngeneic C3H/He male mice. Irradiation doses with either X-rays or heavy ions at a dose-averaged LET (linear energy transfer) of 14–192keV/μm were delivered to 5-mm diameter tumors and aerobic single-cells in sample-tubes. After irradiation, the tumors were excised and trypsinized to observe MN in single-cells. The single-cell suspensions were used for MN formation assays. The RBE values increased with increasing LET. The maximum RBE values for the three different oxygen conditions; hypoxic tumor, normoxic tumor, and aerobic cells, were 8.18, 5.30, and 3.76 at an LET of 192keV/μm, respectively. After X-irradiation, the OERh/n values (hypoxic tumor/normoxic tumor) were lower than the OERh/a (hypoxic tumor/aerobic cells), and were 1.73 and 2.58, respectively. We found that the OER for the in vivo studies were smaller in comparison to that for the in vitro studies. Both of the OER values at 192keV/μm were small in comparison to those of the X-ray irradiated samples. The OERh/n and OERh/a values at 192keV/μm were 1.12 and 1.19, respectively. Our results suggest that high LET radiation has a large biological effect even if a solid tumor includes substantial numbers of hypoxic cells. To conclude, we found that the RBE values under each oxygen state for non-MN fraction increased with increasing LET and that the OER values for both tumors in vivo and cells in vitro decreased with increasing LET.

SU‐E‐T‐770: Tumor Control in Ion Beam Radiotherapy with Different Ions in Presence of Hypoxia

Purpose:The reduced concentration of oxygen in cells (hypoxia) results in a lower cell death rate after irradiation that can lead to treatment failure. The effect can be expressed by the oxygen enhancement ratio (OER). So far, only few attempts to include OER in treatment planning for ion beam therapy were made, which are based on the dose averaged LET estimates and do not distinguish among ion species and fractionation schemes. To overcome these limitations, we implemented a new OER model and used it to estimate tumor control in clinical cases.Methods:The model, based on the microdosimetric kinetic model, was benchmarked with in‐vitro data from different ions irradiation. It was included in the simulation of treatments of a set of clinical cases (glioblastoma) using p, Li, He, C and O ion beams. Tumor Control Probability (TCP) was estimated as a function of oxygen partial pressure, dose per fraction and primary ion type.Results:The modelized OER was found to be strongly dependent on both LET and ion type, and showed a decreasing OER for increasing dose per fraction with a slope that depends on the LET and ion type, in good agreement with the experimental data. In the clinical cases studied, an increase in TCP by increasing ion charge and dose per fraction (more than 30% variation from p to O for moderate hypoxia) was found. Higher OER decrease rates as function of dose per fraction were found for lighter ions (up to 20% varying from 2 to 8 Gy(RBE)).Conclusions:A novel modeling of the OER that explicitly includes the dependence on ion type and dose per fraction was implemented. The model was exploited to evaluate the impact of hypoxia in ion beam radiotherapy, facilitating the identification of the treatment condition optimality, including fractionation scheme and ion type.

Radiation biophysical aspects of charged particles: From the nanoscale to therapy

Charged particle applications for radiotherapy are motivated by their specific advantages in terms of dose delivery and biological effect. These advantages have to a large extent originated from the peculiarities of ion beam energy deposition patterns in the medium on a microscopic, down to a nanoscopic scale. A large amount of research was conducted in this direction, especially in the last two decades, profiting also from the parallel investigations going on in radiation protection for space exploration. The main biophysical aspects of charged particles, which are relevant to hadrontherapy are shortly reviewed in the present contribution, namely focusing on relative biological effectiveness (RBE), oxygen enhancement ratio (OER) and combination with radiosensitizers. A summary of present major research direction on both microscopic and macroscopic assessment of the specific mechanism of radiation damage will be given, as well as several open challenges for a better understanding of the whole process, which still limit the full exploitation of ion beams for radiotherapy.