<h3>Purpose/Objective(s)</h3> Historically, radiotherapy fractions for Glioblastoma (GBM) are delivered in equal doses over a given number of days, though this regimen has not changed in the past century and does not accommodate for the development of radioresistance. Using mathematical oncological simulations, we propose that ramping up dose can overcome radioresistance in patient-derived xenograft (PDX) GBM cells more sufficiently than the same dose delivered in equal fractions. <h3>Materials/Methods</h3> We generated a radiation-sensitive (JX14P) and -resistant (JX14P-RT) PDX GBM cell line by implanting primary tumors into the flank of athymic nude mice. To achieve radioresistance, we treated these mice with 6 fractions of 2 Gy of radiation over 14 days. In silico simulations utilizing the radiosensitivity parameters based on the linear-quadratic model and JX14P and JX14P-RT doubling time, suggested a total regimen of 16 Gy, with an average of 4 Gy/fx, delivered in fractions of 1 Gy, 3 Gy, 5 Gy, or 7 Gy (Ramp-Up, "RU") would result in a smaller surviving fraction than the equivalent total dose of 4 Gy, 4 Gy, 4 Gy, 4 Gy (Equal Dosing, "ED") in JX14P and JX14PRT. The equivalent opposite regimen of 7 Gy, 5 Gy, 3 Gy, and 1 Gy (Ramp-Down, "RD") was also investigated. 5000 cells were plated in DMEM-F12 media with B27 supplement and 20 ng/ml EGF and FGF and irradiated every three days. Viability was determined using CellTiterGlo, nine days after the final dose of radiation. This experiment was done in triplicates. Statistical analysis of viability between the different regimens was assessed using a two-way ANOVA with a multiple comparisons Tukey test. <h3>Results</h3> Our preliminary results indicate that delivering a total dose of 16 Gy, alternating radiation fractionations every three days of 1 Gy, 3 Gy, 5 Gy, or 7 Gy, enhances cytotoxicity in both radiation-sensitive and radiation-resistant PDX models when compared to no treatment and fractions of equal dose (4 Gy) delivered in the same manner (Cell line vs luminescence, <i>P</i><0.0001). <h3>Conclusion</h3> This data suggests RU and RD dosing is superior to ED in the radiosensitive cell lines ED (<i>P</i><0.0001). However, in the radioresistant cell lines, only RU was superior to ED (<i>P</i><0.0001). We are also exploring the effects of this novel treatment regimen in our radiation-sensitive and -resistant PDX GBM cell lines when co-cultured with different starting proportions. This is the first known experiment where two regimens with the same average dose per fraction and total dose results in vastly different cytotoxicity.
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