title: Combination of boron neutron capture therapy and external beam radiotherapy for brain tumors.
abstract: OBJECTIVE
  Boron neutron capture therapy (BNCT) has been used clinically as a single modality treatment for high-grade gliomas and melanomas metastatic to the brain. The purpose of the present study was to determine whether its efficacy could be enhanced by an X-ray boost administered after BNCT. Two brain tumor models were used, the F98 glioma as a model for primary brain tumors and the MRA 27 human melanoma as a model for metastatic brain tumors.
  
  
  METHODS
  For biodistribution studies, either 10(5) F98 glioma cells were implanted stereotactically into the brains of syngeneic Fischer rats or 10(6) MRA 27 melanoma cells were implanted intracerebrally into National Institutes of Health (NIH)-rnu nude rats. Biodistribution studies were performed 11-13 days after implantation of the F98 glioma and 20-24 days after implantation of the MRA 27 melanoma. Animals bearing the F98 glioma received a combination of two boron-containing drugs, sodium borocaptate at a dose of 30 mg/kg and boron phenylalanine (BPA) at a dose of 250 mg/kg. MRA 27 melanoma-bearing rats received BPA (500 mg/kg) containing an equivalent amount of 10B (27 mg B/kg). The drugs were administered by either intracarotid or i.v. injection.
  
  
  RESULTS
  The tumor boron concentration after intracarotid injection was approximately 50% greater in the F98 glioma and MRA 27 melanoma after intracarotid injection (20.8 and 36.8 microg/g, respectively) compared with i.v. injection (11.2 and 19.5 microg/g, respectively). BNCT was carried out at the Brookhaven National Laboratory Medical Research Reactor approximately 14 days after tumor implantation of either the F98 glioma or the MRA 27 melanoma. Approximately 7-10 days after BNCT, subsets of animals were irradiated with 6-MV photons, produced by a linear accelerator at a total dose of 15 Gy, delivered in 5-Gy daily fractions. F98 glioma-bearing rats that received intracarotid or i.v. sodium borocaptate plus BPA, followed 2.5 h later by BNCT and 7-10 days later by X-rays, had similar mean survival times (61 days and 53 days, respectively, p = 0.25), and the non X-irradiated, BNCT-treated animals had a mean survival time of 52 and 40 days, respectively, for intracarotid vs. i.v. injection; the latter was equivalent to that of the irradiated animals. The corresponding survival time for MRA 27 melanoma-bearing rats that received intracarotid or i.v. BPA, followed by BNCT and then X-irradiation, was 75 and 82 days, respectively (p = 0.5), 54 days without X-irradiation (p = 0.0002), 37 days for X-irradiation alone, and 24 days for untreated controls. In contrast to the data obtained with the F98 glioma, MRA 27 melanoma-bearing rats that received i.v. BPA, followed by BNCT, had a highly significant difference in mean survival time compared with the irradiated controls (54 vs. 37 days, p = 0.008).
  
  
  CONCLUSIONS
  Our data are the first to suggest that a significant therapeutic gain may be obtained when BNCT is combined with an X-ray boost. Additional experimental studies are required to determine the optimal combination of X-radiation and neutron doses and whether it is more advantageous to administer the photon boost before or after BNCT.
authors.affiliation: Department of Pathology, Ohio State University, Columbus, OH 43210, USA. barth.1@osu.edu
authors.forename: Rolf F
authors.initials: RF
authors.lastname: Barth
authors.forename: John C
authors.initials: JC
authors.lastname: Grecula
authors.forename: Weilan
authors.initials: W
authors.lastname: Yang
authors.forename: Joan H
authors.initials: JH
authors.lastname: Rotaru
authors.forename: Marta
authors.initials: M
authors.lastname: Nawrocky
authors.forename: Nilendu
authors.initials: N
authors.lastname: Gupta
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Albertson
authors.forename: Amy K
authors.initials: AK
authors.lastname: Ferketich
authors.forename: Melvin L
authors.initials: ML
authors.lastname: Moeschberger
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Coderre
authors.forename: Einar K
authors.initials: EK
authors.lastname: Rofstad
mesh_terms: D000818:Animals; D001894:Borohydrides / Q000627:therapeutic use; D001896:Boron Compounds / Q000627:therapeutic use*; D016754:Boron Neutron Capture Therapy; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D045744:Cell Line, Tumor; D005910:Glioma / Q000532:radiotherapy*; D006801:Humans; D008545:Melanoma / Q000532:radiotherapy* / Q000556:secondary; D011879:Radiotherapy Dosage; D051381:Rats; D011916:Rats, Inbred F344; D011923:Rats, Nude; D013438:Sulfhydryl Compounds / Q000627:therapeutic use
chemical_list: D001894:Borohydrides; D001896:Boron Compounds; D013438:Sulfhydryl Compounds; C014651:mercaptoundecahydrododecaborate