RESUMEN
PURPOSE: In clinical brachytherapy, there is a tendency to replace continuous low-dose-rate (LDR) irradiation by either single-dose or fractionated high-dose-rate (HDR) irradiation. In this study, the equivalence of LDR treatments and fractionated HDR (2 fractions/day) or pulsed-dose-rate (PDR, 4 fractions/day) schedules in terms of tumor cure was investigated in an experimental tumor model. METHODS AND MATERIALS: Tumors (rat rhabdomyosarcoma R1M) were grown s.c. in the flank of rats and implanted with 4 catheters guided by a template. All interstitial radiation treatment (IRT) schedules were given in the same geometry. HDR was given using an (192)Ir single-stepping source. To investigate small fraction sizes, part of the fractionated HDR and PDR schedules were applied after an external irradiation (ERT) top-up dose. The endpoint was the probability of tumor control at 150 days after treatment. Cell survival was estimated by excision assay. RESULTS: Although there was no fractionation effect for fractionated HDR given in 1 or 2 fractions per day, TCD(50)-values were substantially lower than that for LDR. A PDR schedule with an interfraction interval of 3 h (4 fractions/day), however, was equivalent to LDR. The combination of ERT and IRT resulted in a remarkably increased tumor control probability in all top-up regimens, but no difference was found between 2 or 4 fractions/day. Catheter implantation alone decreased the TCD(50) for single-dose ERT already by 17.4 Gy. Cell viability assessed at 24 h after treatment demonstrated an increased effectiveness of interstitial treatment, but, after 10 Gy ERT followed by 10 Gy IRT (24-h interval), it was not less than that calculated for the combined effect of these treatments given separately. CONCLUSION: In full fractionation schedules employing large fractions and long intervals, the sparing effect of sublethal damage repair may be significantly counteracted by reoxygenation. During 3-h intervals, however, repair may be largely completed with only partial reoxygenation causing PDR schedules to be less effective than fractionated HDR, and equivalent to LDR. Brachytherapy with clinically sized fractions after a large external top-up dose showed a remarkable increase in tumor control rate with no effect of fractionation (up to 4 fractions/day), which could not be fully explained by differences in dose distribution or in the cell viability assessed after treatment. This suggests a longer lasting effect on cell survival or radiosensitivity associated with catheter implantation shortly after the top-up dose.
Asunto(s)
Braquiterapia/métodos , Fraccionamiento de la Dosis de Radiación , Rabdomiosarcoma/radioterapia , Animales , Supervivencia Celular , Relación Dosis-Respuesta en la Radiación , Femenino , Modelos Logísticos , Modelos Animales , Trasplante de Neoplasias , Radiobiología , Ratas , Factores de TiempoRESUMEN
PURPOSE: To evaluate the potential effects of tumor hypoxia induced by afterloading catheter implantation on the effectiveness of brachytherapy in a rat tumor model. METHODS AND MATERIALS: Afterloading catheters (4) were implanted in subcutaneously growing R1M rhabdomyosarcoma in female Wag/Rij rats. A MicroSelectron (Nucletron) was used for interstitial high-dose-rate irradiation ((192)Ir). Tumor oxygenation, perfusion, and cell survival were assessed by pO(2) histography (Eppendorf), Tc-99m injection, and excision assay, respectively. RESULTS: Tumor perfusion was markedly reduced at 1 h after catheter implantation (33.9 +/- 6.0% (SEM, n = 9) of control) and partly recovered after 5 h (61.5 +/- 12.2%). At 24 h, the perfusion level reached control values (100.6 +/- 25.7%), but was highly variable with some of the tumors showing hardly any recovery at all. Tumor oxygenation showed a similar pattern, but with less recovery. Median pO(2) readings were 13.5, 1.2, and 5.3 mm Hg before and at 1 and 24 h after implantation, respectively (7 tumors). The percentages of pO(2) readings
Asunto(s)
Braquiterapia , Hipoxia de la Célula/fisiología , Consumo de Oxígeno/fisiología , Animales , Artefactos , Braquiterapia/instrumentación , Cateterismo/efectos adversos , Hipoxia de la Célula/efectos de la radiación , Supervivencia Celular/efectos de la radiación , Femenino , Consumo de Oxígeno/efectos de la radiación , Presión Parcial , Radiobiología , Ratas , Flujo Sanguíneo Regional/efectos de la radiación , Rabdomiosarcoma/irrigación sanguínea , Rabdomiosarcoma/fisiopatología , Rabdomiosarcoma/radioterapia , Factores de Tiempo , Células Tumorales Cultivadas/efectos de la radiaciónRESUMEN
Animal tumour experiments have been performed to elucidate the interactions between interstitial hyperthermia (IHT) and interstitial radiotherapy (IRT), and to obtain information about the most effective sequence of these treatment modalities. Experimental tumours, transplanted in the flank of Wag/Rij rats, were treated with IHT for 0.5 h at 44 degrees C, and with IRT using low dose-rate (LDR) iridium-192 sources. Both tumour cure probability and the fraction of clonogenic cells in vitro after different IHT and IRT treatments in vivo, were used as endpoints. The sequence of a short (0.5 h) IHT treatment followed by an extended LDR-IRT treatment lasting up to 10 days appeared to be very effective, and resulted in a significant thermal enhancement ratio of 1.34 at the 50% tumour cure probability level. A not significantly increased thermal enhancement of 1.06 was found when the same IHT treatment followed IRT. The level of clonogenic cell survival after IHT alone is high (0.24 +/- 0.08) compared with that after an IRT dose of 20 Gy (0.017 +/- 0.004). Clonogenic cell repopulation started 2-4 days after the in vivo treatment irrespective of the type of treatment. The in vivo combination of IHT and LDR-IRT resulted in lower surviving fractions compared with IRT alone, regardless of the time interval between the end of treatment and in vitro clonogenic assay. IHT followed by LDR-IRT appeared to be the most effective treatment in terms of tumour cure. The in vivo/in vitro studies indicated that the effect of hyperthermia is mainly attributed to radiosensitization, possibly by partial inhibition of sublethal damage repair processes during the subsequent irradiation. The hyperthermia-induced cytotoxicity was of minor importance as estimated from the surviving clonogenic fraction.
Asunto(s)
Braquiterapia/métodos , Hipertermia Inducida/métodos , Rabdomiosarcoma/radioterapia , Rabdomiosarcoma/terapia , Animales , Supervivencia Celular/efectos de la radiación , Terapia Combinada , Femenino , Tolerancia a Radiación , Dosificación Radioterapéutica , Ratas , Rabdomiosarcoma/patología , Temperatura , Factores de Tiempo , Ensayo de Tumor de Célula MadreRESUMEN
A 27 MHz capacitive-coupling interstitial hyperthermia system has been developed. It uses thin flexible applicators which can easily be inserted in standard brachytherapy catheters. The system can be operated in two different configurations. In the external ground return configuration tissue is heated by currents passing from the catheters to external ground returns; in the balanced configuration, by currents passing between applicators with a phase difference of 180 degrees. The purpose of this study was to find out which configuration is preferable, in terms of temperature homogeneity and clinical usefulness. Model calculations show that, due to the high impedance associated with capacitive coupling, the applicators can be represented as current sources, in contrast to local current field electrodes which are voltage sources. SAR measurements in muscle-equivalent phantoms illustrate that homogeneous heating patterns along the catheters can be expected in both configurations in regular as well as in irregular implants. Using the external ground return configuration the power of each applicator can be controlled individually. Calculations and measurements show that cross-talk cannot be avoided completely in this configuration, but that it can be minimized by using applicators operating in phase.
Asunto(s)
Braquiterapia/instrumentación , Hipertermia Inducida/instrumentación , Neoplasias/terapia , Terapia Combinada , Humanos , Neoplasias/radioterapiaRESUMEN
The influence of ageing on the metabolism of antipyrine by different forms of cytochrome P-450 was studied in vitro, by measuring the formation of antipyrine metabolites by microsomes isolated from untreated rats, which were grouped into 5 different ages. Km, Vmax and Vmax/Km values were determined for the metabolites: 3-hydroxymethylantipyrine (HMA), norantipyrine (NORA) and 4-hydroxyantipyrine (OHA). Km values for all metabolites ranged from 2.0 to 5.0 mM and Vmax values from 1.84 to 3.66 nmol/min per mg. The Vmax/Km ratios varied from 0.65 to 1.73 microliters/min per mg. With respect to the Km values, a decrease for HMA from 12 to 24 months, no change for OHA and an increase for NORA from 3 to 30 months, was observed. The Vmax values showed an increase for HMA from 3 to 24 months, a decrease for OHA from 12 to 30 months and no change for NORA. The absolute Vmax/Km ratios for all metabolites showed no significant changes during ageing. However, regarding the relative Vmax/Km ratios, an increase for HMA from 3 to 24 months, a decrease for OHA from 12 to 35 months and also a decrease for NORA from 3 to 24 months, was observed. It is concluded that ageing influenced the Km, Vmax and Km/Vmax ratio of the different P-450 isoenzymes involved in antipyrine metabolism, in different ways. However, the age-related changes are modest (10-100%), especially for the Vmax/Km ratio.