在EQDX形式体系背景下重新定义相对生物效应:对α粒子发射体治疗的意义。
Redefining Relative Biological Effectiveness in the Context of the EQDX Formalism: Implications for Alpha-Particle Emitter Therapy.
作者信息
Hobbs Robert F, Howell Roger W, Song Hong, Baechler Sébastien, Sgouros George
机构信息
a Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore Maryland.
出版信息
Radiat Res. 2013 Dec 30. doi: 10.1667/RR1343.1.
Alpha-particle radiopharmaceutical therapy (αRPT) is currently enjoying increasing attention as a viable alternative to chemotherapy for targeting of disseminated micrometastatic disease. In theory, αRPT can be personalized through pre-therapeutic imaging and dosimetry. However, in practice, given the particularities of α-particle emissions, a dosimetric methodology that accurately predicts the thresholds for organ toxicity has not been reported. This is in part due to the fact that the biological effects caused by α-particle radiation differ markedly from the effects caused by traditional external beam (photon or electron) radiation or β-particle emitting radiopharmaceuticals. The concept of relative biological effectiveness (RBE) is used to quantify the ratio of absorbed doses required to achieve a given biological response with alpha particles versus a reference radiation (typically a beta emitter or external beam radiation). However, as conventionally defined, the RBE varies as a function of absorbed dose and therefore a single RBE value is limited in its utility because it cannot be used to predict response over a wide range of absorbed doses. Therefore, efforts are underway to standardize bioeffect modeling for different fractionation schemes and dose rates for both nuclear medicine and external beam radiotherapy. Given the preponderant use of external beams of radiation compared to nuclear medicine in cancer therapy, the more clinically relevant quantity, the 2 Gy equieffective dose, EQD2(α/β), has recently been proposed by the ICRU. In concert with EQD2(α/β), we introduce a new, redefined RBE quantity, named RBE2(α/β), as the ratio of the two linear coefficients that characterize the α particle absorbed dose-response curve and the low-LET megavoltage photon 2 Gy fraction equieffective dose-response curve. The theoretical framework for the proposed new formalism is presented along with its application to experimental data obtained from irradiation of a breast cancer cell line. Radiobiological parameters are obtained using the linear quadratic model to fit cell survival data for MDA-MB-231 human breast cancer cells that were irradiated with either α particles or a single fraction of low-LET Cs γ rays. From these, the linear coefficient for both the biologically effective dose (BED) and the EQD2(α/β) response lines were derived for fractionated irradiation. The standard RBE calculation, using the traditional single fraction reference radiation, gave RBE values that ranged from 2.4 for a surviving fraction of 0.82-6.0 for a surviving fraction of 0.02, while the dose-independent RBE2(4.6) value was 4.5 for all surviving fraction values. Furthermore, bioeffect modeling with RBE2(α/β) and EQD2(α/β) demonstrated the capacity to predict the surviving fraction of cells irradiated with acute and fractionated low-LET radiation, α particles and chronic exponentially decreasing dose rates of low-LET radiation. RBE2(α/β) is independent of absorbed dose for α-particle emitters and it provides a more logical framework for data reporting and conversion to equieffective dose than the conventional dose-dependent definition of RBE. Moreover, it provides a much needed foundation for the ongoing development of an α-particle dosimetry paradigm and will facilitate the use of tolerance dose data available from external beam radiation therapy, thereby helping to develop αRPT as a single modality as well as for combination therapies.
α粒子放射药物治疗(αRPT)作为一种针对播散性微转移疾病的可行化疗替代方案,目前正受到越来越多的关注。理论上,αRPT可通过治疗前成像和剂量测定实现个体化。然而,在实际应用中,鉴于α粒子发射的特殊性,尚未有能准确预测器官毒性阈值的剂量测定方法被报道。部分原因在于,α粒子辐射所引发的生物学效应与传统外照射(光子或电子)辐射或发射β粒子的放射性药物所引发的效应显著不同。相对生物学效应(RBE)的概念用于量化用α粒子与参考辐射(通常为β发射体或外照射辐射)实现给定生物学反应所需吸收剂量的比值。然而,按照传统定义,RBE会随吸收剂量而变化,因此单一的RBE值在实用性上存在局限,因为它无法用于预测在广泛吸收剂量范围内的反应。所以,针对核医学和外照射放疗的不同分割方案和剂量率,正在努力实现生物效应建模的标准化。鉴于在癌症治疗中,外照射辐射相较于核医学的使用更为普遍,国际辐射单位与测量委员会(ICRU)最近提出了更具临床相关性的量——2 Gy等效剂量,EQD2(α/β)。与EQD2(α/β)相一致,我们引入了一个新的、重新定义的RBE量,命名为RBE2(α/β),作为表征α粒子吸收剂量 - 反应曲线和低LET兆伏级光子2 Gy分次等效剂量 - 反应曲线的两个线性系数的比值。本文介绍了所提出新形式体系的理论框架及其在从乳腺癌细胞系照射实验中获取的数据上的应用。使用线性二次模型拟合用α粒子或单次低LET Cs γ射线照射的MDA - MB - 231人乳腺癌细胞的存活数据,从而获得放射生物学参数。由此,得出了分次照射的生物学有效剂量(BED)和EQD2(α/β)反应线的线性系数。使用传统单分次参考辐射进行的标准RBE计算得出的RBE值范围为:存活分数为0.82时为2.4,存活分数为0.02时为6.0,而与剂量无关的RBE2(α/β)值对于所有存活分数值均为4.5。此外,用RBE2(α/β)和EQD2(α/β)进行的生物效应建模展示了预测用急性和分次低LET辐射、α粒子以及慢性指数递减低LET辐射剂量率照射的细胞存活分数的能力。对于α粒子发射体,RBE2(α/β)与吸收剂量无关,并且相较于传统的剂量依赖性RBE定义,它为数据报告和转换为等效剂量提供了更合理的框架。此外,它为正在发展的α粒子剂量测定范式提供了急需的基础,并将有助于利用外照射放疗可得的耐受剂量数据,从而有助于将αRPT发展为一种单一治疗方式以及联合治疗方式。