Theoretical assessment of dose-rate effect in endovascular brachytherapy.
OBJECTIVE
Several prospective randomized clinical trials utilizing endovascular brachytherapy after coronary angioplasty have shown promising preliminary results. Numerous clinical trials have been initiated to evaluate different delivery systems and source types. In this study, the dose-rate effect is investigated using a biophysical model derived from linear-quadratic formalism.


METHODS
The dose-rate effect is quantified using the Dale's formulation, which is based on a linear-quadratic model. This model converts the total absorbed dose into the biological equivalent dose (BED) based on the dose rate, total dose, treatment duration, biological endpoint (alpha/beta ratio), and sublethal damage repair constant. The calculations are performed for two common source configurations used in current clinical trials (192Ir and 90Sr/Y).


RESULTS
At smaller radial distance, the dose rate is higher, hence BED increases due to the increase in the relative effectiveness per unit dose (RE) and absorbed dose for a given treatment duration. For 90Sr/Y source, a similar trend is observed; however, it is at a much greater magnitude. The RE for 192Ir is close to unity, which is equivalent to that of external beam irradiation.


CONCLUSIONS
Although current clinical trials in endovascular brachytherapy report similar absorbed dose, the biological effects may be different due to the extremely high gradient of dose rate near the sources, a variety of isotopes and delivery systems, and different dose prescriptions. If the theoretical predictions in this study are validated in clinical trials, the proposed model can be useful to compare different protocols, design new delivery systems and isotopes, and optimize how radiation is delivered.
Division of Radiation Oncology, Scripps Clinic, La Jolla, California 92037, USA. hbgiap@pol.net
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Giap
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Tripuraneni
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Teirstein
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Massullo
D055592:Biophysical Phenomena; D001703:Biophysics; D001808:Blood Vessels / Q000528:radiation effects*; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008962:Models, Theoretical; D011879:Radiotherapy Dosage; D013326:Strontium Radioisotopes / Q000627:therapeutic use; D013810:Therapeutic Equivalency
D007496:Iridium Radioisotopes; D013326:Strontium Radioisotopes