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Dose estimation after a mixed field exposure: Radium-223 and intensity modulated radiotherapy.

Isabella Bastiani1, Stephen J McMahon2, Philip Turner3

  • 1Centre for Health Effects of Radiological and Chemical Agents, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, London UB8 3PH, United Kingdom of Great Britain and Northern Ireland.

Nuclear Medicine and Biology
|December 30, 2021
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Summary
This summary is machine-generated.

This study estimates radiation doses in metastatic castration resistant prostate cancer patients treated with radium-223 dichloride and intensity modulated radiotherapy. New methods provide insights into systemic radiation risks from novel radiopharmaceuticals.

Keywords:
BiodosimetryChromosome exchangesProstate cancerRadium-223Targeted alpha-particle therapy

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Area of Science:

  • Nuclear Medicine
  • Radiation Oncology
  • Medical Physics

Background:

  • Radium-223 dichloride ([223Ra]RaCl2) improves survival in metastatic castration resistant prostate cancer (mCRPC).
  • Patients on the ADRRAD trial receive combined radium-223 and intensity modulated radiotherapy (IMRT).
  • Accurate absorbed dose estimation is crucial for understanding systemic radiation risks, especially for novel radiopharmaceuticals like radium-223.

Purpose of the Study:

  • To quantify chromosome aberrations in peripheral blood lymphocytes of mCRPC patients undergoing combined radium-223 and IMRT.
  • To estimate absorbed blood dose from both radium-223 and IMRT using standard and novel dosimetry models.
  • To evaluate the M-FISHLET approach for assessing mixed-field radiation exposure.

Main Methods:

  • 24-Colour karyotyping was used to analyze chromosome aberrations in patient lymphocytes.
  • Dicentric equivalent frequencies informed standard absorbed dose models.
  • A novel M-FISHLET method was developed to estimate the radium-223 to IMRT dose ratio based on damage complexity.

Main Results:

  • Total IMRT doses ranged from 1.167 ± 0.092 to 2.148 ± 0.096 Gy.
  • Estimated radium-223 absorbed blood doses varied from 0.024 ± 0.027 to 0.665 ± 0.080 Gy, depending on the model.
  • Significant dose variance was attributed to inter-model differences rather than inter-patient variability.

Conclusions:

  • The developed models offer initial estimations of cumulative doses from radium-223 and IMRT.
  • These estimations aid in understanding patient-specific radiation doses.
  • Further evaluation of the M-FISHLET method is needed for assessing non-targeted radium-223 exposure.