RESUMEN
PURPOSE: LIAC® and NOVAC are two mobile linear accelerators dedicated to intraoperative radiation therapy (IORT), generating electron beams in the energy range of 3-12 MeV. Due to high dose-per-pulse (up to 70 mGy per pulse), in 2003 the Italian National Institute of Health (ISS) stated that "for the measure of dose to water in reference conditions, ionization chambers cannot be employed and no published dosimetry protocol can be used". As a consequence, ferrous sulphate (or, alternatively alanine) dosimetry was recommended. Based on a retrospective multi-center survey, a comparison with ferrous sulphate dosimetry is now used to validate the parallel-plate ionization chambers for reference dosimetry of NOVAC and LIAC. METHODS: The IAEA TRS-398 dosimetry protocol was applied except for the reference irradiation setup and the determination of the ion-recombination correction factor ks . Moreover the depth of maximum dose (R100 ) instead of zref as measurement depth was chosen by the majority of centers, thus implying a renormalization of the beam-quality correction factor kQ,Qo , based on water-air stopping power ratios. Regarding the ks determination, a previously published method, independent of ferrous sulphate dosimetry, was adopted. All the centers participating in this study had used both ferrous sulphate dosimeters and ionization chambers in water phantoms for dosimetry under reference conditions. RESULTS: The mean percentage difference between ionization chambers and ferrous sulphate dosimetry was -0.5% with a dispersion of 3.9% (2σ). Moreover, the uncertainty analysis allowed the agreement between ionization chambers and ferrous sulphate dosimetry to be verified. These results did not show any significant dependence on electron energy, thus indirectly confirming kQ,Qo renormalization. The results from the centers using zref as the measurement depth were similar to the other data, but further focused studies could aim at investigating possible dependences of the dose differences on the chosen reference depth. CONCLUSION: The present study confirms that parallel-plate ionization chambers can properly and accurately substitute ferrous sulphate detectors in reference dosimetry of LIAC and NOVAC mobile linear accelerators. Therefore, we hope that the most commonly used protocols for reference dosimetry in external-beam radiotherapy will be updated in order to provide guidance in the calibration of electron beams from linear accelerators dedicated to IORT, so that users may benefit from specific, authoritative and up-to-date recommendations.
Asunto(s)
Electrones , Aceleradores de Partículas , Radiometría/instrumentación , Radiometría/normas , Radioterapia/instrumentación , Compuestos Ferrosos , Periodo Intraoperatorio , Estándares de ReferenciaRESUMEN
Tp53 is frequently mutated or inactivated in glioblastomas. Due to the impairment of p53 activity, glioblastomas show a high degree of radioresistance. In an attempt to convert the radioresistant phenotype to a more radiosensitive one, we evaluated the efficacy of the combination of Adp53 gene transfer and X-ray irradiation. The combination of Adp53, at low multiplicity in order to mimic the low in vivo efficiency of virus-mediated gene delivery, with X-ray irradiation resulted in a marked decrease of glioblastoms cell survival. Interestingly, Adp53 was able to induce low dose (<2Gy) hypersensitivity. The data suggest the possibility for the development of new therapeutic strategies.
Asunto(s)
Neoplasias Encefálicas/genética , Técnicas de Transferencia de Gen , Genes p53 , Glioblastoma/genética , Tolerancia a Radiación , Adenoviridae , Neoplasias Encefálicas/patología , Supervivencia Celular , Terapia Genética , Glioblastoma/patología , Humanos , Fenotipo , Células Tumorales Cultivadas , Terapia por Rayos XRESUMEN
PURPOSE: Positron emission tomography is the most advanced scintigraphic imaging technology and can be employed in the planning of radiation therapy (RT). The aim of this study was to evaluate the possible role of fused images (anatomical CT and functional FDG-PET), acquired with a dedicated PET/CT scanner, in delineating gross tumour volume (GTV) and clinical target volume (CTV) in selected patients and thus in facilitating RT planning. METHODS: Twenty-eight patients were examined, 24 with lung cancer (17 non-small cell and seven small cell) and four with non-Hodgkin's lymphoma in the head and neck region. All patients underwent a whole-body PET scan after a CT scan. The CT images provided morphological volumetric information, and in a second step, the corresponding PET images were overlaid to define the effective target volume. The images were exported off-line via an internal network to an RT simulator. RESULTS: Three patient were excluded from the study owing to change in the disease stage subsequent to the PET/CT study. Among the remaining 25 patients, PET significantly altered the GTV or CTV in 11 (44%) . In five of these 11 cases there was a reduction in GTV or CTV, while in six there was an increase in GTV or CTV. CONCLUSION: FDG-PET is a highly sensitive imaging modality that offers better visualisation of local and locoregional tumour extension. This study confirmed that co-registration of CT data and FDG-PET images may lead to significant modifications of RT planning and patient management.