Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
Phys Med Biol. 2022 Jun 2;67(11). doi: 10.1088/1361-6560/ac702c.
It has been postulated that the delivery of radiotherapy at ultra-high dose rates ('FLASH') reduces normal tissue toxicities by depleting them of oxygen. The fraction of normal tissue and cancer cells surviving radiotherapy depends on dose and oxygen levels in an exponential manner and even a very small fraction of tissue at low oxygen levels can determine radiotherapy response. To quantify the differential impact of FLASH radiotherapy on normal and tumour tissues, the spatial heterogeneity of oxygenation in tissue should thus be accounted for.The effect of FLASH on radiation-induced normal and tumour tissue cell killing was studied by simulating oxygen diffusion, metabolism, and radiolytic oxygen depletion (ROD) over domains with simulated capillary architectures. To study the impact of heterogeneity, two architectural models were used: (1) randomly distributed capillaries and (2) capillaries forming a regular square lattice array. The resulting oxygen partial pressure distribution histograms were used to simulate normal and tumour tissue cell survival using the linear quadratic model of cell survival, modified to incorporate oxygen-enhancement ratio effects. The ratio ('dose modifying factors') of conventional low-dose-rate dose and FLASH dose at iso-cell survival was computed and compared with empirical iso-toxicity dose ratios.Tumour cell survival was found to be increased by FLASH as compared to conventional radiotherapy, with a 0-1 order of magnitude increase for expected levels of tumour hypoxia, depending on the relative magnitudes of ROD and tissue oxygen metabolism. Interestingly, for the random capillary model, the impact of FLASH on well-oxygenated (normal) tissues was found to be much greater, with an estimated increase in cell survival by up to 10 orders of magnitude, even though reductions in mean tissue partial pressure were modest, less than ∼7 mmHg for the parameter values studied. The dose modifying factor for normal tissues was found to lie in the range 1.2-1.7 for a representative value of normal tissue oxygen metabolic rate, consistent with preclinical iso-toxicity results.The presence of very small nearly hypoxic regions in otherwise well-perfused normal tissues with high mean oxygen levels resulted in a greater proportional sparing of normal tissue than tumour cells during FLASH irradiation, possibly explaining empirical normal tissue sparing and iso-tumour control results.
已经有人假设,超高剂量率(FLASH)的放射治疗通过耗尽氧气来减少正常组织的毒性。正常组织和癌细胞在放射治疗中的存活率取决于剂量和氧气水平,呈指数关系,即使在低氧水平下只有一小部分组织也可以决定放射治疗的反应。为了量化 FLASH 放射治疗对正常组织和肿瘤组织的不同影响,因此应该考虑组织中氧合的空间异质性。通过模拟具有模拟毛细血管结构的域中的氧扩散、代谢和放射分解氧耗竭(ROD),研究了 FLASH 对辐射诱导的正常和肿瘤组织细胞杀伤的影响。为了研究异质性的影响,使用了两种结构模型:(1)随机分布的毛细血管和(2)形成规则正方形晶格阵列的毛细血管。使用线性二次细胞存活模型模拟氧分压分布直方图,对正常和肿瘤组织细胞存活进行模拟,该模型经过修改以纳入氧增强比效应。计算并比较了常规低剂量率剂量和 FLASH 剂量在等细胞存活时的剂量修正因子(剂量修正因子),并与经验等毒性剂量比进行了比较。与常规放射治疗相比,肿瘤细胞的存活被发现随着 FLASH 的增加而增加,取决于肿瘤缺氧的预期水平和 ROD 与组织氧代谢的相对大小,有 0-1 个数量级的增加。有趣的是,对于随机毛细血管模型,发现 FLASH 对充氧(正常)组织的影响要大得多,即使组织局部压力的平均降低幅度适中,对于研究的参数值,小于约 7mmHg,估计细胞存活增加高达 10 个数量级。对于代表正常组织氧代谢率的典型值,正常组织的剂量修正因子被发现介于 1.2-1.7 之间,与临床前等毒性结果一致。在具有高平均氧水平的其他灌注良好的正常组织中存在非常小的几乎缺氧区域,导致在 FLASH 照射期间正常组织比肿瘤细胞受到更大的比例保护,这可能解释了经验性的正常组织保护和等肿瘤控制结果。
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