Advances in RT technologies: opportunities and

Advances in RT Technologies
Opportunities and Challenges
C-M Charlie Ma, Ph.D.
Department of Radiation Oncology
FCCC, Philadelphia, PA 19111
Advanced RT Systems
The Top Grade LA45 System
Revived Technology – Scanditronix MM50
Beam scanning, double-focused MLC
Applications of LA45+PET/MR
Radiotherapy
Drug study
PET Imaging
Radio-dynamic Therapy
RT and Direct Dose Validation
O(γ , n)15O （ +β, T1/2 = 122.2 秒）；
12
C(γ , n)11C （ +β, T1/2 = 20.4 分）；
14
N(γ , n)13N （ +β, T1/2 = 10.5 分）。
16
50MV photon beam incident on a 30cm x 30cm x 30cm PMMA phantom C5O2H8)n
RT and Direct Dose Validation
疗效预测
Upper: RT plan views，Lower: PET images after 45MV/2Gy
White arrows – low dose or hypoxia，red arrows – high dose in healthy tissues?
PET
3D projection
15O-H O
2
Axial
Images
Sagittal
coronal
Water irradiated by LA45, degas 20sec，I.V. injection of 1.0mCi,
immediately PET imaging, arrows show tumor
30 min after 18F-FDG ( 0.062mCi) injection, arrows show tumor
PET Imaging with New Tracers
15O-H O脑血流灌注图像，brain
2
18F-FDG脑代谢图像,
perfusion imaging with 15O-H2O
brain perfusion imaging with 18F-FDG
PET Imaging with Irradiated Drug
Doxorubicin Hydrochloride
阿霉素 3mg，45MeV, 30Gy
cardiac toxicities
未经照射
30Gy照射
1. After 45MeV/30Gy，the spectrum of
Doxorubicin Hydrochloride shows no changes
2. After I.V. injection of irradiated Doxorubicin
Hydrochloride (with 11C和15O) PET images
showing drug concentration in the heart
Fluorescent
PET Imaging with Irradiated Drug
帕米膦酸二钠（博宁）, Pamidronate
Disodium (Bonin) 10mg，50MeV, 30Gy
Bonin is used to relieve pain of
metastatic bone tumor – PET shows
Bonin distribution in bones
Aredia (Pamidronate Disodium)
PET Imaging with Irradiated Drug
头孢哌酮钠(CEFOPERAZONE SODIUM)
High concentrations shown in
areas of infections but not in
normal tissues.
Radio-Dynamic Therapy (RDT)
High-Energy Photons + Photosensitizers
 Photosensitizers as targeting/sensitizing agents
10-20 times high concentration in tumor than in normal tissue
 High-energy electrons generate Cerenkov light
blue (Cerenkov) light is more effective than red (laser) light
 RDT enhances immune response
RDT can be combined with surgery and RT to provide systemic tx
Porphyrin and Cancer
Pathology shows cancer cells
10-20 times higher concentration
of porphyrin in cancer cells
Mitochondria
<20nm
1O
2
PET Images Rabbits
(H&N, 1 week interval)
control (3Gy)
治
疗
前
治
疗
后
RDT (3Gy)
PET/CT Images (1 month interval)
Liver mets treated with RDT
Before RDT
After RDT
Before RDT
After RDT
Lung cancer with metastasis of lymph nodes
Before RDT
After RDT
Lung cancer with metastasis of lymph nodes
18F-FDG PET Imaging
Before treatment
After treatment
Arrows point liver
18F-FDG PET Imaging
before RDT
4 days after RDT
esophageal squamous cell carcinoma
Effect of Radio-Dynamic Therapy (RDT)
Before RDT
4 days after RDT
Lung cancer, multiple bone mets
Effect of Radio-Dynamic Therapy (RDT)
Before RDT
After RDT
Right lung mets in mandible and mediastinum, right hydrotherax disappeared after RDT
Effect of Radio-Dynamic Therapy (RDT)
Before RDT
After RDT
Colon cancer, multiple mets
结肠癌，伴肠系膜、后腹膜、纵膈、锁骨上多出淋巴结转移，左侧髂骨转移
Applications of RDT
 Potentially suitable for cancers of all stages (mets)
combination with surgery, RT and chemotherapy
 Could be great for brain tumors (GBM) and mets
 Potential for other applications
Severe infections, atheromatous plaques and leukemia
(>300 patients treated in Yiren with up to 28 months follow-up)
Acknowledgments
Top Grade and Yiren Hospital
for technical and clinical materials

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