A radiobiological model for the relative biological effectiveness of high-dose-rate 252Cf brachytherapy.

While there is significant clinical experience using both low- and high-dose-rate 252Cf brachytherapy, there are minimal data regarding values for the neutron relative biological effectiveness (RBE) with both modalities. The aim of this research was to derive a radiobiological model for 252Cf neutron RBE and to compare these results with neutron RBE values used clinically in Russia. The linear-quadratic (LQ) model was used as the basis to characterize cell survival after irradiation, with identical cell killing rates (S(N) = S(gamma)) between 252Cf neutrons and photons used for derivation of RBE. Using this equality, a relationship among neutron dose and LQ radiobiological parameter (i.e., alpha(N), beta(N), alpha(gamma), beta(gamma)) was obtained without the need to specify the photon dose. These results were used to derive the 252Cf neutron RBE, which was then compared with Russian neutron RBE values. The 252Cf neutron RBE was determined after incorporating the LQ radiobiological parameters obtained from cell survival studies with fast neutrons and teletherapy photons. For single-fraction high-dose-rate neutron doses of 0.5, 1.0, 1.5 and 2.0 Gy, the total biologically equivalent doses were 1.8, 3.4, 4.7 and 6.0 RBE Gy with 252Cf neutron RBE values of 3.2, 2.9, 2.7 and 2.5, respectively. Using clinical data for late-responding reactions from 252Cf, Russian investigators created an empirical model that predicted high-dose-rate 252Cf neutron RBE values ranging from 3.6 to 2.9 for similar doses and fractionation schemes and observed that 252Cf neutron RBE increases with the number of treatment fractions. Using these relationships, our results were in general concordance with high-dose-rate 252Cf RBE values obtained from Russian clinical experience.

Analysis of dose conformity and normal-tissue sparing using two different IMRT prescription methodologies for irregularly shaped CNS lesions irradiated with the Beak and 1-cm MIMiC collimators.

PURPOSE: To determine whether intensity modulated sequential tomotherapy using the NOMOS Beak provides superior dose conformity and organ sparing to the MIMiC "1-cm" mode, and if so, to identify a subset of patients most likely to benefit from Beak intensity modulated sequential tomotherapy. METHODS AND MATERIALS: Twelve patients with irregularly shaped central nervous system tumors were selected for intensity modulated radiation therapy planning. Two treatment plans, one using the Beak collimator and the other using the 1-cm MIMiC collimator, were generated for each patient with identical anatomic contouring, prescriptions, and optimization algorithms. The Beak attaches to the MIMiC collimator and truncates the 1-cm MIMiC mode beamlet size from 1.00 x 0.85 cm(2) to 1.00 x 0.39 cm(2) at isocenter. Conformity indexes were calculated for each lesion using two different prescription methodologies, and mean doses to critical structures were recorded. RESULTS: For the first prescription methodology using uniform prescribed isodose, mean conformity index was 2.19 (range, 1.33-3.90) for the Beak compared to 2.67 (range, 1.64-4.75) for the 1-cm mode (p = 0.0003). Mean doses to the brainstem, right orbit, and left optic nerve were significantly lower with the Beak than with the 1-cm mode (p = 0.0150, 0.0068, and 0.0284, respectively). For the second prescription methodology using uniform target volume coverage prescription, mean conformity index was 2.04 (range, 1.56-2.70) for the Beak compared to 2.73 (range, 1.70-8.58) for the 1-cm mode (p = 0.07). Mean doses to the brain, brainstem, optic chiasm, right optic nerve, left optic nerve, and left orbit were significantly lower with the Beak than with the 1-cm mode (p = <0.0001, <0.0026, <0.0016, <0.0076, <0.0007, and <0.046, respectively). CONCLUSION: Beak intensity modulated sequential tomotherapy is superior to the 1-cm MIMiC mode for irregularly shaped central nervous system tumors, because it provides better conformity and critical organ sparing. These differences may allow for safer dose escalation and retreatment, so the method presents an alternative to gamma knife stereotactic radiosurgery.

Treatment of in-stent restenosis for saphenous vein grafts using intravascular brachytherapy: regulatory challenges and clinical application.

Treatment of in-stent restenosis using intravascular brachytherapy (IVBT) has been demonstrated to be successful and has become the standard of care for native coronary artery disease. Based on the current Food and Drug Administration (FDA) indications for use and the clinical demand to increase the scope of this form of therapy to include saphenous vein grafts for the Beta-Cath System (Novoste Corporation, Norcross, Georgia), we set out to obtain institutional approval for off-label use. Identification of institutional regulatory bodies and related procedures for obtaining off-label device use was performed. Additionally, the IVBT written directive proscription and patient informed consent forms were revised to accurately administer radiation dose and to disclose the regulatory status of using IVBT for this anatomic site. While the specifics are outlined in this report, this process and the resources needed to obtain institutional approval for off-label use are indicative of that to be expected at similar institutions.