Approaches for Stereotactic Radiosurgery (SRS)/Stereotactic Radiotherapy (SRT) in brain metastases using different radiotherapy modalities (Feasibility study).

BACKGROUND: SRS and SRT are precise treatments for brain metastases, delivering high doses while minimizing doses to nearby organs. Modern linear accelerators enable the precise delivery of SRS/SRT using different modalities like three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and Rapid Arc (RA). OBJECTIVE: This study aims to compare dosimetric differences and evaluate the effectiveness of 3DCRT, IMRT, and Rapid Arc techniques in SRS/SRT for brain metastases. METHODS: 10 patients with brain metastases, 3 patients assigned for SRT, and 7 patients for SRS. For each patient, 3 treatment plans were generated using the Eclipse treatment planning system using different treatment modalities. RESULTS: No statistically significant differences were observed among the three techniques in the homogeneity index (HI), maximum D2%, and minimum D98% doses for the target, with a p > 0.05. The RA demonstrated a better conformity index of 1.14±0.25 than both IMRT 1.21±0.26 and 3DCRT 1.37±0.31. 3DCRT and IMRT had lower Gradient Index values compared to RA, suggesting that they achieved a better dose gradient than RA. The mean treatment time decreased by 26.2% and 10.3% for 3DCRT and RA, respectively, compared to IMRT. In organs at risk, 3DCRT had lower maximum doses than IMRT and RA, but some differences were not statistically significant. However, in the brain stem and brain tissues, RA exhibited lower maximum doses compared to IMRT and 3DCRT. Additionally, RA and IMRT had lower V15Gy, V12Gy, and V9Gy values compared to 3DCRT. CONCLUSION: While 3D-CRT delivered lower doses to organs at risk, RA and IMRT provided better conformity and target coverage. RA effectively controlled the maximum dose and irradiated volume of normal brain tissue. Overall, these findings indicate that 3DCRT, RA, and IMRT are suitable for treating brain metastases in SRS/SRT due to their improved dose conformity and target coverage while minimizing dose to healthy tissues.

Exposure to radioactive rocks from the Egyptian eastern desert attenuates the efficiency of the immune organs and induces apoptosis of blood lymphocytes in rat model.

Exposure to ionizing radiation emitted from natural sources induces many health hazards. The response to ionizing radiation involves a number of mediators including inflammatory cytokines and free radicals which mediate immunosuppression. The present study aimed to monitor the impact of exposure to natural radioactive rocks from the Egyptian eastern desert on the primary immune organs. Therefore, three experimental groups (15 rats per group) were used: group I included the control non-irradiated rats; group II included rats that were exposed for 28 consecutive days to natural radioactive rocks from the Egyptian eastern desert (IR/R group); and group III (positive control group) included rats that were exposed to high dose of γ-rays (4 Gy/14 days for 28 days) (IR/γR group). We found that rats of both the IR/R and IR/γR groups exhibited pathological alterations in the architecture of the primary immune organs (bone marrow and thymus). Additionally, the levels of C-reactive protein (CRP), proinflammatory cytokines (IL-1ß, IL-6 and TNF-α), and reactive oxygen species (ROS) were significantly increased in the IR/R and IR/γR groups compared to the control group. Furthermore, rats from the IR/R and IR/γR groups exhibited significant increase in the activity of caspase-3 and caspase-9 and subsequently exhibited a significant increase in the apoptosis of PBMCs compared with the control group. Most importantly, apoptosis induction in the PBMCs was associated with increased expression of cyclin B1 and decreased expression of cyclin D1 and survivin compared with the control non-irradiated group. Taken together, our data demonstrated that consecutive exposure to natural radioactive rocks from the Egyptian eastern desert could dampen the immune response through damaging the architectures of the immune system and mediating serious health problems to the population inhabiting this region.