Microdosimetric relative biological effectiveness of therapeutic proton beams

When compared to photon beams, particle beams have distinct spatial distributions on the energy depositions in both the macroscopic and microscopic volumes. In a macroscopic volume, the absorbed dose distribution shows a rapid increase near the particle range, that is, Bragg peak, as particle penetrates deep inside the tissue. In a microscopic volume, individual particle deposits its energy along the particle track by producing localized ionizations through the formation of clusters. These highly localized clusters can induce complex types of deoxyribonucleic acid (DNA) damage which are more difficult to repair and lead to higher relative biological effectiveness (RBE) as compared to photons. To describe the biological actions, biophysical models on a microscopic level have been developed. In this review, microdosimetric approaches are discussed for the determination of RBE at different depths in a patient under particle therapy. These approaches apply the microdosimetric lineal energy spectra obtained from measurements or calculations. Methods to determine these spectra will be focused on the tissue equivalent proportional counter and the Monte Carlo program. Combining the lineal energy spectrum and the biological model, RBE can be determined. Three biological models are presented. A simplified model applies the dose-mean lineal energy and the measured RBE (linear energy transfer) data. A more detailed model makes use of the full lineal energy spectrum and the biological weighting function spectrum. A comprehensive model calculates the spectrum-averaged yields of DNA damages caused by all primary and secondary particles of a particle beam. Results of these models are presented for proton beams.