Boron neutron capture therapy and Y-90 radioembolization are emerging therapeutic methods for uncontrolled brain cancers and hepatic cancers, respectively. These advanced radiation therapies are heavily relied on theranostic nuclear medicine imaging before the therapy for the eligibility of patients and the prescribed-dose simulation, as well as the post-therapy scanning for assessing the treatment efficacy. In Taiwan, the Taipei Veterans General Hospital is the only institute performing the BNCT and also the leading institute performing Y-90 radioembolization. In this article, we present our single institute experiences and associated theranostic nuclear medicine approaches for these therapies.
Boron Neutron Capture Therapy ; Brain Neoplasms ; Hospitals, General ; Humans ; Liver Neoplasms ; Nuclear Medicine ; Taiwan ; Theranostic Nanomedicine ; Treatment Outcome ; Veterans

This article presents and discusses some special problems about the dose calibration of high-energy elections for Linear Accelerator according to the practice of the authors. Thus the paper explain the issues of this work, and clarify the wrong understanding of real work for the aim of attaining the rules of quality assurance in radiotherapy by WHO.
Calibration ; Particle Accelerators ; Radiotherapy Dosage ; Radiotherapy, High-Energy ; instrumentation ; methods

PURPOSE: For the research of Boron Neutron Capture Therapy (BNCT), fast neutrons generated from the MC-50 cyclotron with maximum energy of 34.4 MeV in Korea Cancer Center Hospital were moderated by 70 cm paraffin and then the dose characteristics were investigated. Using these results, we hope to establish the protocol about dose measurement of epi-thermal neutron, to make a basis of dose characteristic of epi-thermal neutron emitted from nuclear reactor, and to find feasibility about accelerator-based BNCT. METHOD AND MATERIALS: For measuring the absorbed dose and dose distribution of fast neutron beams, we used Unidos 10005 (PTW, Germany) electrometer and IC-17 (Far West, USA), IC-18, EIC-1 ion chambers manufactured by A-150 plastic and used IC-17M ion chamber manufactured by magnesium for gamma dose. There chambers were flushed with tissue equivalent gas and argon gas and then the flow rate was 5 cc per minute. Using Monte Carlo N-Particle (MCNP) code, transport program in mixed field with neutron, photon, electron, two dimensional dose and energy fluence distribution was calculated and there results were compared with measured results. RESULTS: The absorbed dose of fast neutron beams was 6.47x10-3 cGy per 1 MU at the 4 cm depth of the water phantom, which is assumed to be effective depth for BNCT. The magnitude of gamma contamination intermingled with fast neutron beams was 65.2+/-0.9% at the same depth. In the dose distribution according to the depth of water, the neutron dose decreased linearly and the gamma dose decreased exponentially as the depth was deepened. The factor expressed energy level, D20/D10, of the total dose was 0.718. CONCLUSION: Through the direct measurement using the two ion chambers, which is made different wall materials, and computer calculation of isodose distribution using MCNP simulation method, we have found the dose characteristics of low fluence fast neutron beams. If the power supply and the target material, which generate high voltage and current, will be developed and gamma contamination was reduced by lead or bismuth, we think, it may be possible to accelerator-based BNCT.
Argon ; Bismuth ; Boron Neutron Capture Therapy* ; Boron* ; Cyclotrons ; Electric Power Supplies ; Fast Neutrons* ; Hope ; Korea ; Magnesium ; Neutrons ; Nuclear Reactors ; Paraffin ; Plastics ; Water

This study was performed to investigate the biological effects of boron neutron capture therapy (BNCT) on the testes and eyes in mice using HANARO Nuclear Reactor, Korea Atomic Energy Research Institute. BNCT relies on the high capacity of (10)B in capturing thermal neutrons. Sodium borocaptate (BSH, 75 ppm, iv) and boronophenylalanine (BPA, 750 ppm, ip) have been used as the boron delivery agents. Mice were irradiated with neutron (flux: 1.036739E +09, Fluence 9.600200E+12) by lying flat pose for 30 (10 Gy) or 100 min (33 Gy) with or without boron carrier treatment. In 45 days of irradiation, histopathological changes of the testes and eyes were examined. Thirty-three Gy neutron irradiation for 100 min induced testicular atrophy in which some of seminiferous tubules showed complete depletion of spermatogenic germ cells. Lens epithelial cells and lens fiber were swollen and showed granular changes in an exposure time dependent manner. However, boron carrier treatment had no significant effect on the lesions. These results suggest that the examination of histopathological changes of lens and testis can be used as "biological dosimeters" for gauging radiation responses and the HANARO Nuclear Reactor has sufficient capacities for the BNCT.
Animals ; Boranes/*pharmacology ; Borohydrides/*pharmacology ; Boron Neutron Capture Therapy/*methods ; Eye/pathology/*radiation effects ; Histocytochemistry ; Male ; Mice ; Mice, Inbred C57BL ; Neutrons ; Phenylalanine/*analogs&derivatives/pharmacology ; Seminiferous Tubules/pathology/*radiation effects ; Specific Pathogen-Free Organisms ; Sulfhydryl Compounds/*pharmacology

Two patients with stage three secondary lymphedema of the upper extremities underwent treatment for breast cancer, including surgery, chemotherapy, and radiotherapy. They were examined with computed tomography (CT) before and after extracorporeal shock wave therapy (ESWT). We used a manual tracing method using PiViewSTAR software to calculate the volume of the upper extremities. There was a decrease in the volume of the subcutaneous compartment measured by CT before and after ESWT. CT may be helpful in determining the treatment target area of ESWT and to monitor the effect of treatment by measuring the changes in volume before and after ESWT in patients with lymphedema. Therefore, CT may have good clinical potential for treatment and follow-up in the management of lymphedema.
Breast Neoplasms ; Drug Therapy ; High-Energy Shock Waves ; Humans ; Lymphedema* ; Radiotherapy ; Shock* ; Subcutaneous Tissue ; Upper Extremity

Hot spots and cold spots always appear in the matched region of electron-photon fields. The degree of this kind of dose heterogeneity depends on the physical characteristic of a treatment unit and the energy of electrons. In this paper, a set of dosimetric parameters have been measured on electron rays and x rays for the Elekta Precise treatment unit and the Elekta Synergy treatment unit, respectively. The hot spots and cold spots in the region of perpendicular electron-photon matching fields have been analysed quantitatively. The method to extend penumbra for photon beam profiles was proposed for improving the dose uniformity in the matched regions. And the dose profiles in the matched regions for different treatment units were compared. The results showed that there were stronger hot spots and cold spots for treatment unit with smaller penumbra for photon beams either under the condition of unmodified photon beam profile or the condition of modified photon beam profile.
Computer Simulation ; Electrons ; Head and Neck Neoplasms ; radiotherapy ; Humans ; Models, Theoretical ; Photons ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, High-Energy

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Combined Modality Therapy ; Humans ; Neoplasms ; drug therapy ; radiotherapy ; surgery ; Particle Accelerators ; Radiation Dosage ; Radiotherapy, High-Energy ; methods ; Salvage Therapy

OBJECTIVETo retrospectively investigate the difference in survival of pancreatic adenocarcinoma patients treated by radical surgery with or without adjuvant radiation therapy.

METHODSForty-four patients with pancreatic cancer underwent surgical resection with a curative intent, and were divided into two groups: surgery alone (n = 24) or surgery combined with postoperative external beam radiotherapy (EBRT) (n = 20). Survival as an endpoint was analyzed between the two groups.

RESULTSAll 44 patients completed their scheduled treatment. The median survival time of the patients treated with radical resection alone was 379 days versus 665 days for those treated with combined therapy. The 1-, 3-, 5-year survival rates of the patients treated with radical resection alone were 46.3%, 8.3%, 4.2% versus 65.2%, 20.2%, 14.1% for the patients treated with combined therapy, respectively, with a significant difference between the two groups (P = 0.017). The failures in local-regional relapse were significantly lower in the postoperative EBRT group than that in the surgery alone group (P < 0.05), while the additional postoperative radiation therapy did not increase the complication rate (P > 0.05).

CONCLUSIONPostoperative external beam radiation therapy can improve the survival in patients with pancreatic adenocarcinoma.

Adenocarcinoma ; pathology ; radiotherapy ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Pancreatectomy ; methods ; Pancreatic Neoplasms ; pathology ; radiotherapy ; surgery ; Postoperative Period ; Radiotherapy, Adjuvant ; Radiotherapy, High-Energy ; Retrospective Studies ; Survival Rate

OBJECTIVETo investigate the application value of extracorporeal shock wave to repair and reconstruct osseous tissue for the treatment of avascular necrosis of the femoral head (ANFH).

METHODSA total of 42 hips of 36 patients with ANFH were treated with extracorporeal shock waves included 29 males and 7 females,aged from 21 to 66 during March 2006 to March 2008. The course of disease was 6 months to 3 years (means 1.3 years). According to Ficat classification 8 hips were in stages I, 25 were in stage II, and 9 were in stage III. The energy density of ESWT was from 0.18 to 0.25 mJ/mm2. The treatment focusing points of avascular necrosis of the femoral on the surface projection were marked with X-ray fluoroscopy, and 1 to 2 points were selected for one treatment with 400 to 500 pulses in each point. Generally 3 to 5 treatments were performed, once per 7 days. The CR, CT or MRI and the hip Harris score were obtained to investigate the clinical effects of extracorporeal shock wave for repair and reconstruct osseous tissue framework and improve the hip function before treatment and at 3, 12 months after treatment.

RESULTSThe X-ray,CT or MR were performed of 42 hips,35 hips were treated successfully after extracorporeal shock wave therapy, cure occurred in 6 cases, marked effect in 13 cases, effectiveness in 16 cases and ineffectiveness in 7 case. After one years of followed-up, no relapse was found, the femoral head further collapse did not occur. The Harris hip score of stage I, II, III ere respectivey (90.1 +/- .4), (81.2 +/- .5), (66.9 +/- .6) at 3 months and (91.6 +/- .4), (91.1 +/- .5), (79.0 +/- .1) at 12 months after treatment. The scores after treatment were increased significantly than that of before treatment (P < 0.01).

CONCLUSIONExtracorporeal shock wave therapy has obviously therapeutic effect in the repairing and reconstructing osseous tissue and improve the hip Harris score and improve the hip function. It is a effect significantly, non-invasion, less complications, simple-accurate therapy method for ischemic necrosis of the femoral head.

Adult ; Aged ; Female ; Femur Head Necrosis ; diagnosis ; physiopathology ; radiotherapy ; therapy ; High-Energy Shock Waves ; Hip Joint ; physiopathology ; radiation effects ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

A thermal neutron beam facility utilizing a typical tangential beam port for Neutron Capture Therapy was installed at the HANARO, 30 MW multi-purpose research reactor. Mixed beams with different physical characteristics and relative biological effectiveness would be emitted from the BNCT irradiation facility, so a quantitative analysis of each component of the mixed beams should be performed to determine the accurate delivered dose. Thus, various techniques were applied including the use of activation foils, TLDs and ionization chambers. All the dose measurements were performed with the water phantom filled with distilled water. The results of the measurement were compared with MCNP4B calculation. The thermal neutron fluxes were 1.02E9 n/cm2 s and 6.07E8 n/cm2 s at 10 and 20 mm depth respectively, and the fast neutron dose rate was insignificant as 0.11 Gy/hr at 10 mm depth in water. The gamma-ray dose rate was 5.10 Gy/hr at 20 mm depth in water. Good agreement within 5%, has been obtained between the measured dose and the calculated dose using MCNP for neutron and gamma component and discrepancy with 14% for fast neutron flux. Considering the difficulty of neutron detection, the current study support the reliability of these results and confirmed the suitability of the thermal neutron beam as a dosimetric data for BNCT clinical trials.
Fast Neutrons ; Neutron Capture Therapy* ; Neutrons* ; Relative Biological Effectiveness ; Water