Development of Optical Fiber Based Measurement System for the Verification of Entrance Dose Map in Pencil Beam Scanning Proton Beam.

This study describes the development of a beam monitoring system for the verification of entrance dose map in pencil beam scanning (PBS) proton therapy based on fiber optic radiation sensors (FORS) and the validation of this system through a feasibility study. The beam monitoring system consisted of 128 optical fibers optically coupled to photo-multiplier tubes. The performance of the beam monitoring system based on FORS was verified by comparing 2D dose maps of square-shaped fields of various sizes, which were obtained using conventional dosimeters such as MatriXX and EBT3 film, with those measured using FORS. The resulting full-width at half maximum and penumbra were compared for PBS proton beams, with a ≤2% difference between each value, indicating that measurements using the conventional dosimetric tool corresponded to measurements based on FORS. For irregularly-shaped fields, a comparison based on the gamma index between 2D dose maps obtained using MatriXX and EBT3 film and the 2D dose map measured by the FORS showed passing rates of 96.9 ± 1.3% and 96.2 ± 1.9%, respectively, confirming that FORS-based measurements for PBS proton therapy agreed well with those measured using the conventional dosimetric tools. These results demonstrate that the developed beam monitoring system based on FORS is good candidate for monitoring the entrance dose map in PBS proton therapy.

Radiobiological characterization of proton beam at the National Cancer Center in Korea.

Estimation of the relative biological effectiveness (RBE) of the proton beam at the National Cancer Center Proton Therapy Center in Korea (NCCPTC) is required clinically for the treatment of cancer. The proton beam was fixed at 190 MeV with 6 cm a spread out Bragg peaks (SOBP) for which corresponds to most frequent clinical condition. The RBE was estimated from the survival of human salivary gland (HSG) cells using the traditional colonogenic and MTT assays. The HSG cells were also irradiated in a cell-stack chamber and monitored for survival to identify whether the characteristic depth-dependent survival pattern was observed. The RBE of the NCCPTC was estimated to be 1.024 +/- 0.007 and 1.049 +/- 0.028 at the middle of SOBP using colonogenic and MTT assays, respectively. Further analysis of the biological response of proton exposure revealed no difference compared to conventional X-ray treatment in western blot, and FACS analysis. The proton beam of the NCCPTC also exhibited the characteristic depth-dependent survival pattern. The estimated RBE value of NCCPTC was slightly smaller than generic RBE value of 1.1 for protons of the majority of centers. Due to the recommendation of a generic RBE of 1.1 for protons, a representative RBE value of 1.1 was assigned for clinical application for proton beams at the NCCPTC.

Tumor-associated carbonic anhydrases are linked to metastases in primary cervical cancer.

PURPOSE: Carbonic anhydrase IX (CA9) has emerged as an important surrogate marker for hypoxia in solid tumors. CA12 shares a role with CA9 in acidification of micromilieu but it is less strictly regulated by hypoxia than CA9. In this study, we investigated expression of CA9 and CA12 mRNA in primary cervical cancer. We also examined whether CA9 expression can be an indicator of reoxygenation of tumor by measuring its mRNA expression during fractionated radiotherapy. METHODS: Tumor tissues were obtained from 59 patients with uterine cervical cancer who underwent radiotherapy, and a second biopsy was taken after patients had received either 10 or 20 Gy of radiation. The follow-up period ranged from 2.4 to 75 months (median=23 months). The ratio of CA9 and beta-actin mRNA expression was determined both pre- and during radiation treatment by RT-PCR. RESULTS: CA9 and CA12 mRNA expression was detected in 62.7 and 88.1% of tumors (i.e. patients), respectively, and co-expression was observed in 61% of patients. Multivariate analysis revealed that CA9 expression was the most significant factor associated with metastasis-free survival (P=0.008, hazard ratio 34.8), whereas CA12 mRNA expression was linked to a lower risk of metastasis (P=0.007, hazard ratio of 0.07). Tumor CA9 expression was not altered following either 10 or 20 Gy of radiotherapy. CONCLUSION: The strong correlation between CA9 expression and metastasis suggests that CA9 expression might be an important indicator for identifying patients who require more aggressive systemic therapy.

A dual-energy technique for enhanced localization accuracy in intracavitary brachytherapy.

The orthogonal imaging method is commonly used for source localization in brachytherapy. In some cases, however, difficulty is encountered in determining the dummy sources because of the presence of either contrast materials or bony structures. We here offer a novel method for source localization utilizing a dual-energy, radiographic technique. In this approach, two sets of orthogonal radiographic images (anterior-posterior and lateral views) are obtained using two different x-ray energies. Image processing (i.e., subtraction between two image sets) is carried out to enhance the source image. In a study performed using a laboratory developed pelvic phantom, it was demonstrated that the dual-energy method could significantly enhance the image quality of the dummy sources, and improve the achievable precision and relative accuracy in localization of source positions. When directly combined with digital imaging modalities, the dual-energy method can be a useful technique to improve the accuracy in brachytherapy source localization from planar radiographs.

Development of a novel proton dosimetry system using an array of fiber-optic Cerenkov radiation sensors.

This study describes the development and evaluation of a new dosimetric system for proton therapy using an array of fiber-optic Cerenkov radiation sensors (AFCRS). The AFCRS was superior to a conventional, multi-layer ion chamber (MLIC) system in real-time data acquisition and cost effectiveness.

Dominant-negative Rac increases both inherent and ionizing radiation-induced cell migration in C6 rat glioma cells.

Rho-like GTPases, including Cdc42, Rac1 and RhoA, regulate distinct actin cytoskeleton changes required for cell adhesion, migration and invasion. In the present study, we examined the role of Rac signaling in inherent migration, as well as radiation-induced migration, of rat glioma cells. Stable overexpression of dominant-negative Rac1N17 in a C6 rat glioma cell line (C6-RacN17) promoted cell migration, and ionizing radiation further increased this migration. Migration was accompanied by decreased expression of the focal adhesion molecules FAK and paxillin. Focal contacts and actin stress fibers were also reduced in C6-RacN17 cells. Downstream effectors of Rac include JNK and p38 MAP kinases. Irradiation transiently activated p38, JNK and ERK1/2 MAP kinases in C6-RacN17 cells, while p38 and JNK were constitutively activated in C6 control cells. Blocking JNK activity with JNK inhibitor SP600125 inhibited migration, suggesting that the JNK pathway may regulate radiation-induced, as well as inherent, migration of C6-RacN17 cells. Additionally, the radiation-induced migration increase was also inhibited by SB203580, a specific inhibitor of p38 MAP kinase. However, PD98059, a MEK kinase 1 inhibitor, failed to influence migration. This is the first evidence that suppression of Rac signaling may be involved in invasion or metastasis of glioma cells before and/or after radiotherapy. These data further suggest that radiotherapy for malignant glioma needs to be used with caution because of the potential for therapy-induced cell migration or invasion and that pharmacological inhibition of cell migration and invasion through targeting the Rac signaling pathway may represent a new approach for improving the therapeutic efficacy of radiotherapy for malignant glioma.

Ionizing radiation induces astrocyte gliosis through microglia activation.

The aim of this study was to investigate the role of microglia in radiation-induced astrocyte gliosis. We found that a single dose of 15 Gy radiation to a whole rat brain increased immunostaining of glial fibrillary acidic protein in astrocytes 6 h later, and even more so 24 h later, indicating the initiation of gliosis. While irradiation of cultured rat astrocytes had little effect, irradiation of microglia-astrocyte mixed-cultures displayed altered astrocyte phenotype into more processed, which is another characteristic of gliosis. Experiments using microglia-conditioned media indicated this astrocyte change was due to factors released from irradiated microglia. Irradiation of cultured mouse microglial cells induced a dose-dependent increase in mRNA levels for cyclooxygenase-2 (COX-2), interleukin (IL)-1beta, IL-6, IL-18, tumor necrosis factor-alpha and interferon-gamma-inducible protein-10, which are usually associated with microglia activation. Consistent with these findings, irradiation of microglia activated NF-kappaB, a transcription factor that regulates microglial activation. Addition of prostaglandin E2 (PGE2: a metabolic product of the COX-2 enzyme) to primary cultured rat astrocytes resulted in phenotypic changes similar to those observed in mixed-culture experiments. Therefore, it appears that PGE(2) released from irradiated microglia is a key mediator of irradiation-induced gliosis or astrocyte phenotype change. These data suggest that radiation-induced microglial activation and resultant production of PGE2 seems to be associated with an underlying cause of inflammatory complications associated with radiation therapy for malignant gliomas.

LY294002 inhibits interferon-gamma-stimulated inducible nitric oxide synthase expression in BV2 microglial cells.

The current study examined the potential involvement of phosphatidylinositol 3 phosphate kinase (PI3K) in interferon-gamma (IFN-gamma)-stimulated nitric oxide (NO) generation in BV2 murine microglial cells. We found that LY294002, a PI3K inhibitor, markedly reduced IFN-gamma-induced morphological changes, NO production, and cell death. The inhibitory effect of LY294002 on NO generation may be mediated through specific inhibition of signal transducer and activator-1 (STAT1) and NF-kappaB, which are activated by IFN-gamma. Induction of the mRNA for IFN-gamma-mediated interferon response factor (IRF-1) and inducible protein-10 (IP-10) was not significantly affected by LY294002, indicating that suppression of PI3K may not be sufficient for downregulation of these genes. Although it remains unclear how PI3K signaling is involved in IFN-gamma-mediated inflammatory reactions in the brain, our findings provide some insight into the inflammatory mechanisms of IFN-gamma in the brain and suggest that regulators of the PI3K pathway may act as anti-inflammatory agents in microglia.