title: The effect of high-dose-rate brachytherapy dwell sequence on cell survival.
abstract: OBJECTIVE
  During a high-dose-rate (HDR) brachytherapy treatment, as the source steps through different dwell positions, the dose rate at any fixed point within the implant varies, because the distance between the point and the source continually changes. The instantaneous dose rate may vary by a factor of 100 or more, in a complex dwell position sequence. Two different points which receive the same total dose may have received that dose with a very different sequence of dose rates. Any effects due to the complex changes in dose rate, including the sequence of dose delivery, are ignored. We investigated the possible effects of the sequence in which dose is delivered at two different dose rates, representative of dose rates that occur during an HDR treatment.
  
  
  METHODS
  The target consisted of a tube containing a 1.0 cm(3) suspension of V-79 Chinese hamster cells. Two fixed source dwell positions near and far from the target, representing high and intermediate dose rates, were considered. The experiments compared the survival of V-79 cells exposed to an irradiation sequence consisting of either an HDR component followed by an intermediate-dose-rate component (H-I arm), or the reverse (I-H arm). In either case, the total dose and the dose ratio were the same, only the order in which the high- or intermediate-dose-rate components of the dose were delivered was changed.
  
  
  RESULTS
  When the intermediate-dose-rate component was given before the HDR component, there was increased survival. All data pairs from three experiments showed greater survival for the I-H arm than the H-I arm by amounts ranging from 4% to 24%. Simple linear-quadratic models such as the Lea-Catchside model, which is invariant to time reversal of irradiation sequence, do not predict these results.
  
  
  CONCLUSIONS
  These results suggest that targets receiving the same total dose of radiation during an HDR implant may not experience the same biological effect. This may be related to induced radioresistance or sublethal damage repair.
authors.affiliation: Department of Radiation Oncology, Medical College of Virginia at Virginia Commonwealth University, Richmond, VA 23298, USA. marnfield@hsc.vcu.edu
authors.forename: Mark R
authors.initials: MR
authors.lastname: Arnfield
authors.forename: Peck Sun
authors.initials: PS
authors.lastname: Lin
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Manning
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Arthur
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kavanagh
authors.forename: Robert D
authors.initials: RD
authors.lastname: Zwicker
authors.forename: Rupert K
authors.initials: RK
authors.lastname: Schmidt-Ullrich
mesh_terms: D000818:Animals; D001918:Brachytherapy / Q000379:methods*; D002470:Cell Survival / Q000502:physiology / Q000528:radiation effects*; D002478:Cells, Cultured; D006224:Cricetinae; D003412:Cricetulus / Q000502:physiology; D011836:Radiation Tolerance; D011879:Radiotherapy Dosage