title: Neutron activation of patients following boron neutron capture therapy of brain tumors at the high flux reactor (HFR) Petten (EORTC Trials 11961 and 11011).
abstract: OBJECTIVE
  At the High Flux Reactor (HFR), Petten, The Netherlands, EORTC clinical trials of Boron Neutron Capture Therapy (BNCT) have been in progress since 1997. BNCT involves the irradiation of cancer patients by a beam of neutrons, with an energy range of predominantly 1 eV to 10 keV. The patient is infused with a tumor-seeking, (10)B-loaded compound prior to irradiation. Neutron capture in the (10)B atoms results in a high local radiation dose to the tumor cells, whilst sparing the healthy tissue. Neutron capture, however, also occurs in other atoms naturally present in tissue, sometimes resulting in radionuclides that will be present after treatment. The patient is therefore, following BNCT, radioactive. The importance of this induced activity with respect to the absorbed dose in the patient as well as to the radiation exposure of the staff has been investigated.
  
  
  METHODS
  As a standard radiation protection procedure, the ambient dose equivalent rate was measured on all patients following BNCT using a dose ratemeter. Furthermore, some of the patients underwent measurements using a gamma-ray spectrometer to identify which elements and confirm which isotopes are activated.
  
  
  RESULTS
  Peak levels, i.e., at contact and directly after irradiation, are of the order of 40-60 muSv/h, falling to < 10 muSv/h 30-50 min after treatment. The average ambient dose equivalent in the first 2 h at a distance of 2 m from the patient is in the order of 2.5 muSv. The ambient dose equivalent rate in 2 m distance from the patient's head at the earliest time of leaving the reactor center (20 min after the end of treatment) is far less than 1 muSv/h. The main radioisotopes were identified as (38)Cl, (49)Ca, and (24)Na. Furthermore, in two patients, the isotopes (198)Au and (116m)In were also present. The initial activity is predominantly due to (49)Ca, whilst the remaining activity is predominantly due to (24)Na.
  
  
  CONCLUSIONS
  The absorbed dose resulting from the activated isotopes in the irradiated volume is in the order of < 1% of the prescribed dose and therefore does not add a significant contribution to the absorbed dose in the target volume. In other parts of the patient's body, the absorbed dose by induced activity is magnitudes smaller and can be neglected. The levels of radiation received by staff members and non-radiation workers (i.e., accompanying persons) are well below the recommended limits.
authors.affiliation: Strahlenklinik, University Hospital Essen, Essen, Germany. andrea.wittig@uni-essen.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Wittig
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Moss
authors.forename: Finn
authors.initials: F
authors.lastname: Stecher-Rasmussen
authors.forename: Klaas
authors.initials: K
authors.lastname: Appelman
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rassow
authors.forename: Antoanetta
authors.initials: A
authors.lastname: Roca
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Sauerwein
mesh_terms: D001822:Body Burden; D016754:Boron Neutron Capture Therapy; D001932:Brain Neoplasms / Q000532:radiotherapy*; D004781:Environmental Exposure / Q000032:analysis*; D005858:Germany; D006801:Humans; D018499:Linear Energy Transfer; D009502:Neutrons; D009688:Nuclear Reactors; D011829:Radiation Dosage; D011834:Radiation Monitoring / Q000379:methods*; D011835:Radiation Protection / Q000379:methods*; D011868:Radioisotopes / Q000032:analysis*; D012062:Relative Biological Effectiveness; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
chemical_list: D011868:Radioisotopes