Dr. Pierre Korysko

Abstract:

Background

The FLASH effect holds significant potential in improving radiotherapy treatment outcomes. Very high energy electrons (VHEEs) with energies in the range of 50-250 MeV can effectively target tumors deep in the body and can be accelerated to achieve ultra-high dose rates (UHDR), making them a promising modality for delivering FLASH radiotherapy in the clinic. However, apart from suitable VHEE sources, clinical translation requires accurate dosimetry, which is challenging due to the limitation of standard dosimeters under UHDR conditions. Water-equivalent and real-time plastic scintillation dosimeters (PSDs) may offer a viable solution. Purpose & Methods: In this study, a 4-channel PSD, consisting of polystyrene-based BCF12 and Medscint proprietary scintillators, polyvinyltoluene (PVT)-based EJ-212 and a blank plastic fiber channel for Cherenkov subtraction was exposed to the 200 MeV VHEE UHDR beam at the CLEAR CERN facility. The Hyperscint RP200 platform was used to assess linearity to dose pulses of up to 90 Gy and dose rates up to 4.6×10⁹Gy/s, and to investigate radiation damage and recovery after dose accumulation of 37.2 kGy. Results: While blank fiber response was linear across the entire dose range studied, light output saturated above 45 Gy/pulse for scintillators. Despite radiation damage, linearity was preserved, though it resulted in a decrease of scintillator and blank fiber light output of <1.87 %/kGy and a shift in spectra towards longer wavelengths. Short-term recovery (<100h) of these changes was observed and depended on rest duration and accumulated dose. After long-term rest (<172 days), light output recovery was partial, with 6-22% of residual permanent damage remaining, while spectral recovery was complete. Conclusions: We showed that PSDs are sensitive to radiation damage, but maintain dose linearity even after a total accumulated dose of 37.2 kGy, and exhibit significant response recovery. This work highlights the potential of PSDs for dosimetry in UHDR conditions.

Abstract:

Objective.To evaluate spatially fractionated radiation therapy (SFRT) for very-high-energy electrons (VHEEs) delivered with pencil beam scanning.Approach. Radiochromic film was irradiated at the CERN linear electron accelerator for research using 194 MeV electrons with a step-and-shoot technique, moving films within a water tank. Peak-to-valley dose ratios (PVDRs), depths of convergence (PVDR ⩽ 1.1), peak doses, and valley doses assessed SFRT dose distribution quality. A Monte Carlo (MC) model of the pencil beams was developed using TOPAS and applied to a five-beam VHEE SFRT treatment for a canine glioma patient, compared to a clinical 6 MV VMAT plan. The plans were evaluated based on dose-volume histograms, mean dose, and maximum dose to the planning target volume (PTV) and organs at risks (OARs).Main results. Experimental PVDR values were maximized at 15.5 ± 0.1 at 12 mm depth for 5 mm spot spacing. A DOC of 76.5, 70.7, and 56.6 mm was found for 5, 4, and 3 mm beamlet spacings, respectively. MC simulations and experiments showed good agreement, with maximum relative dose differences of 2% in percentage depth dose curves and less than 3% in beam profiles. Simulated PVDR values reached 180 ± 4, potentially achievable with reduced leakage dose. VHEE SFRT plans for the canine glioma patient showed a decrease in mean dose (>16%) to OARs while increasing the PTV mean dose by up to 15%. Lowering beam energy enhanced PTV dose homogeneity and reduced OAR maximum doses.Significance. The presented work demonstrates that pencil beam scanning SFRT with VHEEs could treat deep-seated tumors such as head and neck cancer or lung lesions, though small beam size and leakage dose may limit the achievable PVDR.

Abstract:

Objective.Spatially-fractionated radiotherapy (SFRT) delivered with a very-high-energy electron (VHEE) beam and a mini-GRID collimator was investigated to achieve synergistic normal tissue-sparing through spatial fractionation and the FLASH effect.Approach.A tungsten mini-GRID collimator for delivering VHEE SFRT was optimized using Monte Carlo (MC) simulations. Peak-to-valley dose ratios (PVDRs), depths of convergence (DoCs, PVDR ≤ 1.1), and peak and valley doses in a water phantom from a simulated 150 MeV VHEE source were evaluated. Collimator thickness, hole width, and septal width were varied to determine an optimal value for each parameter that maximized PVDR and DoC. The optimized collimator (20 mm thick rectangular prism with a 15 mm × 15 mm face with a 7 × 7 array of 0.5 mm holes separated by 1.1 mm septa) was 3D-printed and used for VHEE irradiations with the CERN linear electron accelerator for research beam. Open beam and mini-GRID irradiations were performed at 140, 175, and 200 MeV and dose was recorded with radiochromic films in a water tank. PVDR, central-axis (CAX) and valley dose rates and DoCs were evaluated.Main results.Films demonstrated peak and valley dose rates on the order of 100 s of MGy/s, which could promote FLASH-sparing effects. Across the three energies, PVDRs of 2-4 at 13 mm depth and DoCs between 39 and 47 mm were achieved. Open beam and mini-GRID MC simulations were run to replicate the film results at 200 MeV. For the mini-GRID irradiations, the film CAX dose was on average 15% higher, the film valley dose was 28% higher, and the film PVDR was 15% lower than calculated by MC.Significance.Ultimately, the PVDRs and DoCs were determined to be too low for a significant potential for SFRT tissue-sparing effects to be present, particularly at depth. Further beam delivery optimization and investigations of new means of spatial fractionation are warranted.