Preliminary dosimetric study on feasibility of multi-beam boron neutron capture therapy in patients with diffuse intrinsic pontine glioma without craniotomy

Lee, Jia-Cheng; Chen, Yiwei; Hsu, F.Y.; Chou, Fong‐In; Yen, Sang‐Hue; Wu, Yuan‐Hung

doi:10.1371/journal.pone.0180461

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…BNCT has recently gained attention in salvage treatment for recurrent head, neck, and brain tumors. 12 , 13 In Japan, BNCT has been approved as a standard treatment modality and has been included in the national health insurance since May 2020. More and more BNCT specialist hospitals were built and are constantly leading development both in the number of patients treated and in basic research studies.…”

Section: Discussionmentioning

confidence: 99%

Prevention and early management of carotid blowout syndrome for patients receiving head and neck salvage boron neutron capture therapy (BNCT)

Lan

Chang

Wang

et al. 2021

Journal of Dental Sciences

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Background/purpose The incidence rate of oral and pharyngeal cancers in Taiwan has increased gradually over the past few decades. The standard treatment strategy for oral and pharyngeal cancers includes surgery or radiotherapy, with concurrent chemotherapy in certain types of tumors. Unfortunately, in-field recurrence is sometimes inexorable. Furthermore, re-irradiation of the recurrence site may cause severe complications due to the tolerance of normal tissue to radiation therapy. One fatal complication is carotid blowout syndrome (CBS). Boron neutron capture therapy (BNCT) is a new modality of radiation therapy, which is also mentioned as targeted radiotherapy. It is a feasible treatment that has the potential to spare normal tissue from being damaged by irradiation while simultaneously treating the primary tumor. In this presentation, we will share our experience with BNCT in treating recurrent head and neck cancers, as well as the prevention and management of CBS. Materials and methods We evaluated 4 patients with head and neck cancers treated by BNCT in Taiwan. All patients had undergone surgery previously and had received postoperative concurrent chemoradiotherapy. Results The 4 patients in this study were diagnosed with head and neck malignancies. The median follow-up period after the first course of BNCT was 15.1 months. After BNCT, 2 patients developed impending CBS, and 1 of them died. The remaining 3 patients survived until the last date of follow-up. Conclusion Pre-BNCT carotid artery evaluation through computed tomography angiography and early intervention if necessary is crucial when treating patients with recurrent head and neck cancers by BNCT.

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Section: Discussionmentioning

confidence: 99%

Prevention and early management of carotid blowout syndrome for patients receiving head and neck salvage boron neutron capture therapy (BNCT)

Lan

Chang

Wang

et al. 2021

Journal of Dental Sciences

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“…Also, in this study of single-field radiation, the greatest tumor depth modeled was 8 cm. For tumors at depths greater than the AD, better dose distribution may be achieved with multi-field BNCT [21]. Finally, the effects of positioning errors on multifield cases were not evaluated.…”

Section: Discussionmentioning

confidence: 99%

The Dosimetric Impact of Shifts in Patient Positioning during Boron Neutron Capture Therapy for Brain Tumors

Lee

Chen

Chuang

et al. 2018

BioMed Research International

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Unlike conventional photon radiotherapy, sophisticated patient positioning tools are not available for boron neutron capture therapy (BNCT). Thus, BNCT remains vulnerable to setup errors and intra-fractional patient motion. The aim of this study was to estimate the impact of deviations in positioning on the dose administered by BNCT for brain tumors at the Tsing Hua open-pool reactor (THOR). For these studies, a simulated head model was generated based on computed tomography (CT) images of a patient with a brain tumor. A cylindrical brain tumor 3 cm in diameter and 5 cm in length was modeled at distances of 6.5 cm and 2.5 cm from the posterior scalp of this head model (T6.5 cm and T2.5 cm, respectively). Radiation doses associated with positioning errors were evaluated for each distance, including left and right shifts, superior and inferior shifts, shifts from the central axis of the beam aperture, and outward shifts from the surface of the beam aperture. Rotational and tilting effects were also evaluated. The dose prescription was 20 Gray-equivalent (Gy-Eq) to 80 % of the tumor. The treatment planning system, NCTPlan, was used to perform dose calculations. The average decreases in mean tumor dose for T6.5 cm for the 1 cm, 2 cm, and 3 cm lateral shifts composed by left, right, superior, and inferior sides, were approximately 1 %, 6 %, and 11 %, respectively, compared to the dose administered to the initial tumor position. The decreases in mean tumor dose for T6.5 cm were approximately 5 %, 11 %, and 15 % for the 1 cm, 2 cm, and 3 cm outward shifts, respectively. For a superficial tumor at T2.5cm, no significant decrease in average mean tumor dose was observed following lateral shifts of 1 cm. Rotational and tilting up to 15° did not result in significant difference to the tumor dose. Dose differences to the normal tissues as a result of the shifts in positioning were also minimal. Taken together, these data demonstrate that the mean dose administered to tumors at greater depths is potentially more vulnerable to deviations in positioning, and greater shift distances resulted in reduced mean tumor doses at the THOR. Moreover, these data provide an estimation of dose differences that are caused by setup error or intra-fractional motion during BNCT, and these may facilitate more accurate predictions of actual patient dose in future treatments.

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“…However, the issue of non-uniform dose distribution within tumors has consistently posed a challenge in the context of BNCT (Yu et al 2017). Multi-field neutron beams have the potential to enhance the dose distribution to large tumors (Fujimoto et al 2015, Lee et al 2017, which is similar to the principle of three-dimensional conformal radiotherapy (3D CRT). However, neutron beams are difficult to achieve intensity modulation within a single field considering its forward angle and field size.…”

Section: Introductionmentioning

confidence: 99%

Combined BNCT-CIRT treatment planning for glioblastoma using the effect-based optimization

Han,

Geng,

Altieri

et al. 2023

Phys. Med. Biol.

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Objective: Boron neutron capture therapy (BNCT) and carbon ion radiotherapy (CIRT) are emerging treatment modalities for glioblastoma. In this study, we investigated the methodology and feasibility to combine BNCT and CIRT treatments. The combined treatment plan illustrated how the synergistic utilization of BNCT’s biological targeting and CIRT’s intensity modulation capabilities could lead to optimized treatment outcomes.Approach: The Monte Carlo toolkit, TOPAS, was employed to calculate the dose distribution for BNCT, while matRad was utilized for the optimization of CIRT. The biological effect-based approach, instead of the dose-based approach, was adopted to develop the combined BNCT-CIRT treatment plans for six patients diagnosed with glioblastoma, considering the different radiosensitivity and fraction. Five optional combined treatment plans with specific BNCT effect proportions for each patient were evaluated to identify the optimal treatment that minimizes damage on normal tissue.Main results: Individual BNCT exhibits a significant effect gradient along with the beam direction in the large tumor, while combined BNCT-CIRT treatments can achieve uniform effect delivery within the CTV through the effect filling with reversed gradient by the CIRT part. In addition, the increasing BNCT effect proportion in combined treatments can reduce damage in the normal brain tissue near the CTV. Besides, the combined treatments effectively minimize damage to the skin compared to individual BNCT treatments.Significance: The initial endeavor to combine BNCT and CIRT treatment plans is achieved by the effect-based optimization. The observed advantages of the combined treatment suggest its potential applicability for tumors characterized by pleomorphic, infiltrative, radioresistant and voluminous features.

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Preliminary dosimetric study on feasibility of multi-beam boron neutron capture therapy in patients with diffuse intrinsic pontine glioma without craniotomy

Cited by 5 publications

References 19 publications

Prevention and early management of carotid blowout syndrome for patients receiving head and neck salvage boron neutron capture therapy (BNCT)

Prevention and early management of carotid blowout syndrome for patients receiving head and neck salvage boron neutron capture therapy (BNCT)

The Dosimetric Impact of Shifts in Patient Positioning during Boron Neutron Capture Therapy for Brain Tumors

Combined BNCT-CIRT treatment planning for glioblastoma using the effect-based optimization

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