To validate that altering radiotherapy dose rate through either changing pulse repetition frequency or instantaneous dose rate does not have an effect on cell survival, two human carcinoma and a hamster lung cell line were irradiated with various beam settings. Varian TrueBeam linac with a flattening filter free mode of operation was used for all experiments. The results obtained indicate that either method of changing dose rate has no effect on cell survival in the three cell lines studied. Filtered and filter free modes were also compared in treatments with protracted dose delivery which significantly increases overall treatment time. Cell survival indicated no difference between filter and filter free beam delivery in any of the protraction schemes. An increase in survival was seen in both modes upon protracting dose delivery to 15, 30 or 60 min rather than delivering acutely. Further, analysis of induced DNA double-strand breaks via the γH2AX assay showed no difference between filtered and unfiltered beams. The following study suggests that increasing dose rate is an acceptable manner of decreasing radiotherapy treatment time that does not have any detrimental effects on in vitro cell eradication.

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Summary Low pH and hypoxia are a common feature of many solid tumours. This study examined the effect of these two conditions on the cytotoxic properties of the bifunctional agent RB 6145, the prodrug of RSU 1069. The effect of acidic pH on RB 6145 toxicity was examined in six human tumour (Coleman, 1988), much effort has been directed at finding ways to specifically target such cells in tumours. The use of hypoxic cell radiosensitisers such as the 2-nitroimidazole, misonidazole, has provided some therapeutic gain, though neurotoxicity limited its dose and thus its effectiveness. (Dische, 1985;Overgaard et al., 1989). RSU 1069 [x-(1-aziridinomethyl)-2-nitro-lH-imidazole-1-ethanol] was one of the newer generation nitroimidazoles developed by Adams et al. (1984a,b), and one which exhibited two functions: radiosensitisation due to the electron affinic properties of the molecule and alkylation by the aziridine moiety. It was very efficient both as a radiosensitiser and as a chemosensitiser, but also produced severe gastrointestinal toxicity (Horwich et al., 1986). RB 6145 [a-([(2-bromoethyl)-aminoJmethyl)-2-nitro-JH-imidazole-1-ethanol hydrobromide] was developed as an analogue (see Figure 1) and prodrug of RSU 1069 (Jenkins et al., 1990). It retained most of the radiosensitisation and bioreductive cytotoxicity of RSU 1069 but had much lower toxicity (Cole et al., 1990(Cole et al., , 1991(Cole et al., , 1992Bremner, 1993), and is currently awaiting clinical evaluation.The pharmacokinetics of RB 6145 and its metabolites have been carefully examined in mice (Binger and Workman, 1991). The major metabolites were shown to be RSU 1069 (the pharmacologically active aziridine ring metabolite) and an oxazolidinone metabolite, with much lower levels of at least two other analogues, RSU 1137 and RSU 1111 (see Figure 1)

Dose rate and presence of a flattening filter showed no effect on cell survival, however, survival was significantly affected when dose delivery time was protracted to that typical of conformal field therapy. Volumetric arc based gated SBRT may be beneficial for tumor cell kill, though the gating window and duty cycle have to be balanced against the effect of dose delivery protraction. Research Support (Varian Medical Systems).

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