Retrospective analysis of treatment-positioning accuracy and dose error in boron neutron capture therapy using a sitting-position treatment system for head and neck cancer.

The neutron beam in boron neutron capture therapy (BNCT) exhibits poor directionality and significantly decreasing neutron flux with increasing distance. Therefore, the treatment site must be close to the irradiation aperture. Some patients with head and neck cancer may benefit from a sitting-position setup. The study aim was to evaluate the treatment-positioning accuracy and dose error in sitting patients receiving BNCT. Thirty-two patients with head and neck cancer who underwent sitting-position BNCT at Southern Tohoku BNCT Research Center were included in the study. Horizontal (ΔX) and vertical (ΔY) errors were defined as the displacement between the treatment planning system (TPS) digital reconstructed radiograph and the pre-treatment X-ray image. Using in-house software, image matching was performed. The beam-axial directional (ΔZ) error was compared with the parameters entered into the TPS and the actual pre-treatment measured values. The translational-position error was reflected in the TPS's patient coordinate system with respect to the reference plan. Re-dose calculations were performed to evaluate the effect of positional error on tumor and normal-tissue doses. The [ΔX, ΔY, ΔZ] DRR-CR mean ± 1SD were - 0.40 ± 2.0, 0.30 ± 2.3, and - 1.4 ± 1.5 mm, respectively. The Dmean and D98% tumor-dose errors were 1.22 % ± 1.44 % and 0.99 % ± 1.63 %, respectively. The D2% pharyngeal and oral mucosal-dose errors were 0.98 % ± 1.91 % and 1.21 % ± 1.78 %, respectively. The tumor- and normal-tissue dose errors were typically < 5 %. High-precision treatment was feasible in sitting-positioned BNCT.

Correction: Sato et al. Safety of Boron Neutron Capture Therapy with Borofalan(10B) and Its Efficacy on Recurrent Head and Neck Cancer: Real-World Outcomes from Nationwide Post-Marketing Surveillance. Cancers 2024, 16, 869.

The authors wish to make the following corrections to this paper [...].

Evaluation of calculation accuracy and computation time in a commercial treatment planning system for accelerator-based boron neutron capture therapy.

This study aims to evaluate the feasibility of using a commercially available boron neutron capture therapy (BNCT) dose calculation program (NeuCure® Dose Engine) in terms of calculation accuracy and computation time. Treatment planning was simulated under the following calculation parameters: 1.5-5.0 mm grid sizes and 1-10% statistical uncertainties. The calculated monitor units (MUs) and computation times were evaluated. The MUs calculated on grid sizes larger than 2 mm were overestimated by 2% compared with the result of 1.5 mm grid. We established the two-step method for the routine administration of BNCT: multiple calculations involved in beam optimization should be done at a 5 mm grid and a 10% statistical uncertainty (the shortest computation time: 10.3 ± 2.1 min) in the first-step, and final dose calculations should be performed at a 2 mm grid and a 10% statistical uncertainty (satisfied clinical accuracy: 6.9 ± 0.3 h) in the second-step.

Assessment of environmental impacts from authorized discharges of tritiated water from the Fukushima site to coastal and offshore regions.

In August 2023, the long-planned discharging of radioactive wastewater from the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) started after the confirmation of its feasibility and safety. As this water contains elevated amounts of tritium even after being diluted, a lot of resources have been invested in the monitoring of the Fukushima coastal region where the discharge outlet is located. We compare the first 3H surface activity concentrations from these measurements (up to the end of November 2023) with the available background values to evaluate a possible impact of the long-term discharging on humans and environmental levels of the radionuclide of interest in the same or nearby area. From our results, we can conclude that the joint effect of horizontal and vertical mixing has been significant enough to reduce tritium concentrations at the monitored locations in the region close to the FDNPP port two days after the end of the respective phase of the discharging beyond the detection limit of the applied analytical methods (∼0.3 Bq L-1) which is by five orders of magnitude lower than safety limit for drinking water set by the World Health Organization (WHO). Moreover, the distant correlation analysis showed that tritium concentrations at stations located further than 1.4 km were very close to pre-discharge levels (∼0.4 Bq L-1). We also estimated that the 3H activity concentration in the offshore Fukushima region would be elevated by 0.01 Bq L-1 at maximum over a year of continuous discharging, which is in concordance with the already published modeling papers and much less than the impact of the FDNPP accident in 2011.

A simple prediction model for the risk of boron neutron capture therapy-induced nausea and vomiting in head and neck cancer.

BACKGROUND AND PURPOSE: Head and neck cancer patients undergoing boron neutron capture therapy (BNCT) often experience BNCT-induced nausea and vomiting (BINV). This study aimed to construct a BINV risk prediction model. MATERIALS AND METHODS: In this retrospective study, 237 patients were randomly divided into a training and test cohort. In the training cohort, a univariate analysis was performed to identify factors associated with BINV. Multivariate analysis was used to identify factors and calculate coefficients for the model. The Hosmer-Lemeshow test was used to assess the goodness of fit, and receiver operating characteristic curves were plotted to evaluate the accuracy of the model. For both the training and test cohort, the predictive model was used to generate the scores and calculate the sensitivity and specificity. RESULTS: The incidence of nausea and vomiting was 50% and 18%, respectively. Female sex, younger age, non-squamous cell carcinoma, no prior chemotherapy, and beam entry from the face/lateral region were associated with the occurrence of BINV. The prediction model showed a good fit (P = 0.96) and performance (area under the curve = 0.75). The sensitivity and specificity were 83% and45 % for the training cohort (n = 193) and 86% and 59% for the test cohort (n = 44), respectively. CONCLUSION: We developed a simple model that predicts BINV. This will enable appropriate care to be implemented based on increased risk to prevent its occurrence.

Review of the sources and behaviors of plutonium isotopes in the atmosphere and ocean.

Plutonium, as well as fission products such as 137Cs, had been released into the earth environment in 1945 after the first atmospheric nuclear explosion of plutonium bomb in the desert of New Mexico (USA, July 16) and later over Nagasaki (August 9), followed then by many other explosions. Thus, plutonium cycling in the atmosphere and ocean has become a major public concern as a result of the radiological and chemical toxicity of plutonium. However, plutonium isotopes and 137Cs are important transient tracers of biogeochemical and physical processes in the environment, respectively. In this review, we show that both physical and chemical approaches are needed to comprehensively understand the behaviors of plutonium in the atmosphere and ocean. In the atmosphere, plutonium and 137Cs attach with aerosols; thus, plutonium moves according to physical and chemical processes in connection with aerosols; however, since plutonium is a chemically reactive element, its behavior in an aqueous environment is more complicated, because biogeochemical regulatory factors, in addition to geophysical regulatory factors, must be considered. Meanwhile, 137Cs is chemically inert in aqueous environments. Therefore, the biogeochemical characteristics of plutonium can be elucidated through a comparison with those of 137Cs, which show conservative properties and moves according to physical processes. Finally, we suggest that monitoring of both plutonium and 137Cs can help elucidate geophysical and biogeochemical changes from climate changes.

Efficacy and safety of boron neutron capture therapy for Hypopharyngeal/Laryngeal cancer patients with previous head and neck irradiation.

BACKGROUND AND PURPOSE: Patients with hypopharyngeal cancer (HPC)/laryngeal cancer (LCA) with a history of head and neck irradiation are often difficult to treat with conventional radiotherapy. This study aimed to clarify the efficacy and safety of boron neutron capture therapy (BNCT) for HPC/LCA. MATERIALS AND METHODS: In this retrospective study, HPC/LCA with local lesions were analyzed, including both recurrent cases after treatment and second primary cases. The primary endpoints were tumor response and incidence of adverse events (AEs) after BNCT. The secondary endpoints were local control (LC), progression-free survival (PFS), and overall survival (OS). Evaluation of tumor response was terminated when any additional treatment was administered, and only survival data were collected. RESULTS: The analysis included 25 and 11 cases of HPC and LCA, respectively. All had a history of head and neck irradiation, and median dose of prior radiotherapy was 70 Gy. The complete response (CR) rate was 72%, overall response rate was 84%, and the 1-year LC and PFS were 63.1% and 53.7%, respectively. The median survival time was 15.5 months, and the 2-year OS was 79.8%. Of the 27 patients with CR, 11 cases recurred at a median of 6.0 months. The acute G3 AEs were oral mucositis (6%), pharyngeal mucositis (3%), and soft tissue infection (3%). Acutely, there were no G4-5 AEs, except hyperamylasemia, and in the late phase, there were no G3 or higher AEs. CONCLUSION: BNCT can be achieve good tumor response while preserving the larynx without severe AEs.

Chemical implication of the partition coefficient of 137Cs between the suspended and dissolved phases in natural water.

After the Fukushima Daiichi nuclear power plant accident, the terrestrial environment became severely contaminated with radiocesium. Consequently, the river and lake water in the Fukushima area exhibited high radiocesium levels, which declined subsequently. The partition coefficient of 137Cs between the suspended sediment (SS) and dissolved phases, Kd, was introduced to better understand the dynamic behavior of 137Cs in different systems. However, the Kd values in river water, ranging from 2 × 104 to 7 × 106 L kg-1, showed large spatiotemporal variability. Therefore, the factors controlling the 137Cs partition coefficient in natural water systems should be identified. Herein, we introduce a chemical model to explain the variability in 137Cs Kd in natural water systems. The chemical model includes the complexation of Cs+ with mineral and organic binding sites in SS, metal exchange reactions, and the presence of colloidal species. The application of the chemical model to natural water systems revealed that Cs+ is strongly associated with binding sites in SS, and a major chemical interaction between 137Cs and the binding sites in SS is the isotope exchange reaction between stable Cs and 137Cs, rather than metal exchange reactions with other metal ions such as potassium ions. To explain the effect of the SS concentration on Kd, the presence of colloidal 137Cs passing through a filter is significant as the dominant dissolved species of 137Cs in river water. These results suggest that a better understanding of stable Cs dissolved in natural water is important for discerning the geochemical and ecological behaviors of 137Cs in natural water.

Effects on local atmospheric environment of volcanic ash from Sakurajima volcano, inferred from atmospheric deposition of Potassium-40 at Kagoshima City, Japan.

In this study, we statistically demonstrated that an anomalous high of 40K fallout in the atmospheric fallout in Kagoshima City is caused by heavy ashfall associated with eruptions of Sakurajima volcano. Sakurajima is one of the most active volcanoes in Japan, and its repeated explosive eruptions cause large amounts of ash to fall on Kagoshima City. The fallout of crust-derived natural radionuclides, 40K, 212Pb, and 214Bi, from the atmosphere in Kagoshima City showed a significant correlation with the number of eruptions of Sakurajima volcano and the amount of ashfall in Kagoshima City. In contrast, no significant correlation was found between 40K and 7Be fallout. The 40K fallout indicates that almost all of the atmospheric fallout in Kagoshima City is composed of volcanic ash particles. The contribution from mineral and sea salt particles other than volcanic ash is minimal. The mass balance of the observed 40K fallout, ashfall, and atmospheric fallout yield indicates that there is a significant amount of volcanic ash deposition that is not accounted for as ashfall. In most cases, the ash deposition observed as ashfall is only 30-70 wt% of the total deposition collected as atmospheric fallout samples, and the remaining portion is fine-grained and behaves as suspended volcanic ash particles, which significantly impact the atmospheric environment.

Clinical Results and Prognostic Factors in Boron Neutron Capture Therapy for Recurrent Squamous Cell Carcinoma of the Head and Neck Under the Japan National Health Insurance System: A Retrospective Study of the Initial 47 Patients.

PURPOSE: Recurrent head and neck cancer presents a therapeutic challenge because of cumulative toxicity from initial radiation therapy, limiting reirradiation options. Boron neutron capture therapy (BNCT) offers a promising alternative, selectively delivering a radical dose to tumors while sparing adjacent normal tissue. This study investigates the initial clinical outcomes and prognostic factors associated with BNCT for recurrent squamous cell carcinoma of the head and neck. METHODS AND MATERIALS: This retrospective analysis investigated the initial 47 patients treated with BNCT between May 2020 and February 2021 in Japan. All patients had received radiation therapy with a median dose of 70 Gy (range, 44-176) before BNCT. Median tumor size was 11 cm3 (range, 1-117 cm3), with 23% of tumors larger than 30 cm3, and 87% of patients had prior systemic therapy. The most common prescribed dose to the pharyngeal mucosa was 15 Gy-Eq (36%), followed by 18 Gy-Eq (34%). The minimum dose given to tumor was 27.4 Gy-Eq (range, 13.3-45.2). In 23 patients, 18F-fluoro-borono-phenylalanine positron emission tomography was performed within 1 week before BNCT, and the tumor-to-blood 10B ratio was 3.5 (range, 2.0-8.7). RESULTS: Efficacy analysis revealed a 51% complete response rate and a 74% overall response rate. Disease-free survival rates at 1 and 2 years were 34.6% and 26.6%, respectively. Overall survival rates at 1 and 2 years were 86.1% and 66.5%, respectively. Multivariate analysis revealed that, among the patient characteristics, whether the lesion was mucosal had a significant effect on achieving complete response. CONCLUSIONS: This study provided valuable insights into the early integration of BNCT into routine clinical practice, highlighting its efficacy and safety. Technical improvements are needed to ensure precise dose administration. Ongoing prospective studies, such as the phase II REBIVAL study, will further elucidate the role of BNCT in recurrent head and neck cancer.

Safety of Boron Neutron Capture Therapy with Borofalan(10B) and Its Efficacy on Recurrent Head and Neck Cancer: Real-World Outcomes from Nationwide Post-Marketing Surveillance.

BACKGROUND: This study was conducted to evaluate the real-world safety and efficacy of boron neutron capture therapy (BNCT) with borofalan(10B) in Japanese patients with locally advanced or locally recurrent head and neck cancer (LA/LR-HNC). METHODS: This prospective, multicenter observational study was initiated in Japan in May 2020 and enrolled all patients who received borofalan(10B) as directed by regulatory authorities. Patient enrollment continued until at least 150 patients were enrolled, and adverse events attributable to drugs, treatment devices, and BNCT were evaluated. The patients with LA/LR-HNC were systematically evaluated to determine efficacy. RESULTS: The 162 patients enrolled included 144 patients with squamous cell carcinoma of the head and neck (SCCHN), 17 patients with non-SCCHN (NSCCHN), and one patient with glioblastoma. Treatment-related adverse events (TRAEs) were hyperamylasemia (84.0%), stomatitis (51.2%), sialoadenitis (50.6%), and alopecia (49.4%) as acute TRAEs, and dysphagia (4.5%), thirst (2.6%), and skin disorder (1.9%) as more common late TRAEs. In patients with LA/LR-HNC, the overall response rate (ORR) was 72.3%, with a complete response (CR) in 63 (46.0%) of 137 patients with SCCHN. Among 17 NSCCHN patients, the ORR was 64.7%, with eight cases (47.1%) of CR. One- and two-year OS rates in patients with recurrent SCCHN were 78.8% and 60.7%, respectively. CONCLUSIONS: This post-marketing surveillance confirmed the safety and efficacy of BNCT with borofalan(10B) in patients with LA/LR-HNC in a real-world setting.

Temporal changes of 137Cs concentrations in the Far Eastern Seas: partitioning of 137Cs between overlying waters and sediments.

Deep-ocean sediments, similarly to seawater, are important reservoirs of 137Cs, an anthropogenic radionuclide with a relatively long half-live found in the Earth system. To better understand the geochemical behaviour of 137Cs in the ocean, we examined the temporal changes of 137Cs activity concentrations in the overlying waters and in sediments from the Far Eastern Seas (Sea of Japan, SOJ, and Okhotsk Sea, OS) during the period of 1998-2021. The 137Cs activity levels showed exponential changes during the observed period. The decay-corrected change rates of 137Cs in deep waters of SOJ exhibited a slow increase, while 137Cs levels in seawater and sediment in OS decreased gradually. This reflects a topographical difference, as SOJ is a semi-closed sea, whereas OS receives continuously inflow of subarctic waters. It was confirmed that 137Cs released after the Fukushima Dai-ichi Nuclear Power Plant accident was rapidly transported into the deep waters of the SOJ. To elucidate the transfer processes of 137Cs from seawater to sediment, we discussed the temporal changes of the partition coefficients (Kd) of 137Cs between the overlying water and the surface sediment. In shallow areas (< 1500 m water depth), Kd values were almost constant within the sampling periods, although the temporal changes in the Kd values occurred in deeper waters (> 2500 m depth). The Kd values increased with increasing depth, which may reflect a pressure effect as a possible mechanism. These findings suggest that chemical processes may be important factors controlling the transport of 137Cs between seawater and sediment, although more complicated phenomena occurred in deep waters and sediments of the SOJ (> 3000 m depth).

Dose Rate Effect on Cell Survival in BNCT.

The output constancy of the accelerator used for boron neutron capture therapy (BNCT) is essential to ensuring anti-tumor efficacy and safety. BNCT as currently practiced requires a wide variety of beam quality assessments to ensure that RBE dose errors are maintained within 5%. However, the necessity of maintaining a constant beam dose rate has not been fully discussed. We therefore clarified the effect of different physical dose rates of the accelerator BNCT on biological effects. SAS and A172 cells exposed to 10B-boronophenylalanine were irradiated using a neutron beam (normal operating current, 100 µA) at the Aomori Quantum Science Center. Thermal neutron flux was attenuated to 50.0 ± 0.96% under 50 µA irradiation compared to that under 100 µA irradiation. Cells were given physical doses of 1.67 and 3.36 Gy at 30 and 60 mC, respectively, and survival was significantly increased after 50 µA irradiation for both cell types (p = 0.0052 for SAS; p = 0.046 for A172, for 60 mC). Differences in accelerator BNCT beam dose rates have non-negligible effects on biological effects. Dose rate fluctuations and differences should not be easily permitted to obtain consistent biological effects.

Characterization and clinical utility of different collimator shapes in accelerator-based BNCT systems for head and neck cancer.

NeuCure® is the only accelerator-based boron neutron capture therapy (BNCT) system in the world with pharmaceutical approval. Until now, only flat collimators (FCs) on the patient side have been installed. However, in some cases of head and neck cancer patients, positioning the patient close enough to the collimator when using FCs was difficult. Thus, there are concerns about the prolongation of the irradiation time and overdose to normal tissues. To address these issues, a collimator with a convex-extended section on the patient side (extended collimators [ECs]) was developed, and its pharmaceutical approval was obtained in February 2022. This study evaluated the physical characterization and usefulness of each collimator using a simple geometry water phantom model and human model. In the water phantom model, the thermal neutron fluxes at 2 cm depth on the central axis were 5.13 × 108, 6.79 × 108, 1.02 × 109, and 1.17 × 109n/cm2/s for FC(120), FC(150), EC50(120), and EC100(120), respectively, when the distance from the irradiation aperture was kept constant at 18 cm. With ECs, the relative off-axis thermal neutron flux decreased steeply. In the hypopharyngeal cancer human model, the tumor dose changes were within <2%, but the maximum oral mucosa doses were 7.79, 8.51, 6.76, and 4.57 Gy-Eq, respectively. The irradiation times were 54.3, 41.3, 29.2, and 24.8 min, respectively. In cases where positioning the patient close to the collimator is difficult, the use of ECs may reduce the dose to normal tissues and shorten the irradiation time.

Initiatives Toward Clinical Boron Neutron Capture Therapy in Japan.

Boron neutron capture therapy (BNCT) has been performed at nuclear research reactors for many years. The development of accelerators for BNCT resulted in a paradigm shift from research to real clinical applications. In Japan, BNCT was approved as a clinical therapy covered by the National Health Insurance in 2020. In this article, the status of BNCT in Japan is briefly introduced.

RGD Peptide-Conjugated Dodecaborate with the Ga-DOTA Complex: A Preliminary Study for the Development of Theranostic Agents for Boron Neutron Capture Therapy and Its Companion Diagnostics.

A boron neutron capture therapy (BNCT) system, using boron-10-introduced agents coupled with companion diagnostics, is anticipated as a promising cancer theranostic. Thus, this study aimed to synthesize and evaluate a probe closo-dodecaborate-(Ga-DOTA)-c(RGDfK) (16) [Ga = gallium, DOTA =1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid, and c(RGDfK) = cyclo(arginine-glycine-aspartate-d-phenylalanine-lysine] containing closo-dodecaborate ([B12H12]2-) as a boron cluster, a [67Ga]Ga-DOTA derivative for nuclear medicine imaging, and an RGD peptide for tumor targeting. Moreover, we prepared a radioiodinated probe [125I]17 in which I-125 is introduced into a closo-dodecaborate moiety of 16. [67Ga]16 and [125I]17 showed high stability and high uptake in cancer cells in vitro. Biodistribution experiments in tumor-bearing mice revealed similar biodistribution patterns between [67Ga]16 and [125I]17, such as a high uptake in the tumor and a low uptake in other non-target tissues. Meanwhile, [125I]17 exhibited higher accumulation in most tissues, including the tumor, than [67Ga]16, probably because of higher albumin binding. The higher the [125I]17 accumulation in the tumor, the more desirable it is for BNCT, with the possibility that the iodo-closo-dodecaborate site may work as an albumin binder.

Dosimetric effects of the ipsilateral shoulder position variations in the sitting-positioned boron neutron capture therapy for lower neck tumor.

We aimed to evaluate dosimetric effects of ipsilateral shoulder position variations (ISPVs) in sitting-positioned boron neutron capture therapy (BNCT) for lower neck tumor. The ISPVs were simulated using deformed shoulder images that can simulate arbitrary shape. The dose-volume parameters for the tumor in the rotated shoulder plans considerably varied compared with that for the mucosa. Even in a small number of cases, these differences were clearly observed among patients. The ISPVs in lower neck BNCT have great dosimetric effects.

Ten years of investigations of Fukushima radionuclides in the environment: A review on process studies in environmental compartments.

In March 2011, severe nuclear accident happened at the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) after the gigantic earthquake and following huge tsunami wave. A lot of investigations to assess environmental and radiological impacts of released radionuclides have been conducted by domestic and international organizations. Environmental radioactivity research related to the FDNPP accident has spread widely over different scientific fields due to specific features of the accident, and specifically its impact on the marine environment. The present paper summarizes major lessons learned from the environmental investigations of the FDNPP accident. Environmental radioactivity studies have typical interdisciplinary character; especially physics and chemistry are fundamental as a base of process studies in the environment. In this sight, we review chemical aspects regarding FDNPP-derived radiocesium transfer within and between compartments (atmosphere, ocean and land). We also discuss future trends in investigations of behavior of anthropogenic radionuclides in the environment, important not only for a better understanding of impacts of the FDNPP accident on the environment, but also for improving our general knowledge of the total environment in the Anthropocene era and its protection for the future.

Determining a methodology of dosimetric quality assurance for commercially available accelerator-based boron neutron capture therapy system.

The irradiation field of boron neutron capture therapy (BNCT) consists of multiple dose components including thermal, epithermal and fast neutron, and gamma. The objective of this work was to establish a methodology of dosimetric quality assurance (QA), using the most standard and reliable measurement methods, and to determine tolerance level for each QA measurement for a commercially available accelerator-based BNCT system. In order to establish a system of dosimetric QA suitable for BNCT, the following steps were taken. First, standard measurement points based on tissue-administered doses in BNCT for brain tumors were defined, and clinical tolerances of dosimetric QA measurements were derived from the contribution to total tissue relative biological effectiveness factor-weighted dose for each dose component. Next, a QA program was proposed based on TG-142 and TG-198, and confirmed that it could be assessed whether constancy of each dose component was assured within the limits of tolerances or not by measurements of the proposed QA program. Finally, the validity of the BNCT QA program as an evaluation system was confirmed in a demonstration experiment for long-term measurement over 1 year. These results offer an easy, reliable QA method that is clinically applicable with dosimetric validity for the mixed irradiation field of accelerator-based BNCT.