Marco Zaider

Cancer risks attributable to low doses of ionizing radiation: Assessing what we really know

High doses of ionizing radiation clearly produce deleterious consequences in humans, including, but not exclusively, cancer induction. At very low radiation doses the situation is much less clear, but the risks of low-dose radiation are of societal importance in relation to issues as varied as screening tests for cancer, the future of nuclear power, occupational radiation exposure, frequent-flyer risks, manned space exploration, and radiological terrorism. We review the difficulties involved in quantifying the risks of low-dose radiation and address two specific questions. First, what is the lowest dose of x- or γ-radiation for which good evidence exists of increased cancer risks in humans? The epidemiological data suggest that it is ≈10–50 mSv for an acute exposure and ≈50–100 mSv for a protracted exposure. Second, what is the most appropriate way to extrapolate such cancer risk estimates to still lower doses? Given that it is supported by experimentally grounded, quantifiable, biophysical arguments, a linear extrapolation of cancer risks from intermediate to very low doses currently appears to be the most appropriate methodology. This linearity assumption is not necessarily the most conservative approach, and it is likely that it will result in an underestimate of some radiation-induced cancer risks and an overestimate of others.

The Applications of Track Calculations to Radiobiology I. Monte Carlo Simulation of Proton Tracks

In the first of a series of papers on the application of track-structure calculations to radiobiology, a detailed Monte Carlo proton transport code in water vapor is described. In the code all important interaction types (elastic scattering, five levels of ionization, 12 types of excitation) are considered explicitly. All cross sections are based closely on experimental data. The proton energy range considered is 0.3-1.5 MeV since this is the range of available experimental ionization cross sections. Results are presented in terms of energy partitions, w values, stopping powers, and radial dose distributions, all showing agreement with the experiment.

DOSIMETRIC CONSIDERATIONS FOR CATHETER-BASED BETA AND GAMMA EMITTERS IN THE THERAPY OF NEOINTIMAL HYPERPLASIA IN HUMAN CORONARY ARTERIES

PURPOSE Recent data indicate that intraluminal irradiation of coronary arteries following balloon angioplasty reduces proliferation of smooth muscle cells, neointima formation, and restenosis. We present calculations for various isotopes and geometries in an attempt to identify suitable source designs for such treatments. METHODS AND MATERIALS Analytical calculations of dose distributions and dose rates are presented for 192Ir, 125I, 103Pd, 32P, and 90Sr for use in intracoronary irradiation. The effects of source geometry and positioning accuracy are studied. RESULTS Accurate source centering, high dose rate, well-defined treatment volume, and radiation safety are all of concern; 15-20 Gy are required to a length of 2-3 cm of vessel wall (2-4 mm diameter). Dose must be confined to the region of the angioplasty, with reduced doses to normal tissues. Beta emitters have radiation safety advantages, but may not have suitable ranges for treating large diameter vessels. Gamma emitters deliver larger doses to normal tissues and to staff. Low energy x-ray emitters such as 125I and 103Pd reduce these risks but are not available at high enough activities. The feasibility of injecting a radioactive liquid directly into the angioplasty balloon is also explored. CONCLUSIONS Accurate source centering is found to be of great importance. If this can be accomplished, then high energy beta emitters such as 90Sr would be ideal sources. Otherwise, gamma emitters such as 192Ir may be optimal. A liquid beta source would have optimal geometry and dose distribution, but available sources, such as 32P are unsafe for use with available balloon catheters.

On the stochastic treatment of fast chemical reactions.

A Monte Carlo code was developed to stimulate stochastically the fast reactions of radiolysis products in water. The results of these calculations show that treatments based on deterministic kinetic rate equations do not reproduce correctly the evolution in time of the number of species. Ad hoc initial distributions of species in spurs, of the type used in deterministic approaches, are compared with more realistic distributions obtained from Monte Carlo-generated particle tracks. The effects of using either type of distribution, stochastically or deterministically, are discussed.

Radiation Response Characteristics of Human Cells in Vitro

Improvements in tissue culture techniques and growth media have made it possible to culture a range of cells of human origin, both normal and malignant. The most recent addition to the list are endothelial cells from umbilical cord veins. Interesting results in radiosensitivity studies of these human cells have been obtained, some of which may have implications in radiation therapy. (i) Repair of potentially lethal damage (PLDR) has been observed in all cell lines investigated; cells of normal origin repair PLD at least as well as malignant cells, which makes clinical trials of PLDR inhibitors of doubtful usefulness. (ii) No apparent correlation can be made between the extent of PLDR and the traditional radioresponsiveness of a particular tumor type. Indeed, if anything, it could appear to have an inverse correlation since the most resistant tumor cells show the smallest amount of PLD repair. (iii) Dose-rate effects appear to be better predictors of radiosensitivity than PLDR capacity. (iv) Sublethal damage repair, manifest by a dose-rate effect, has also been observed in all human cell lines tested. Cells of normal tissue origin, including fibroblasts and endothelial cells, exhibit a dose-rate effect that is intermediate between that for cells from traditionally resistant tumors (melanoma and osteosarcoma) and cells from more sensitive tumors (neuroblastoma and breast).

The sequential irradiation of mammalian cells with x rays and charged particles of high LET

Chinese hamster V79 cells, synchronized in late-S phase, were irradiated with high-LET charged particles or X rays, or exposed sequentially to a single dose of charged particles followed by graded doses of X rays. The charged-particle irradiations consisted of deuterons (LET, 50 keV/microns) or 3He ions (96 or 160 keV/microns). The survival data obtained following the sequential irradiations show a synergistic effect compared with exposure to the low-LET radiation. An enhancement ratio is defined in order to quantify this effect. On the basis of this concept the present data show an enhanced interaction effect as the LET of the primary dose is increased or the size of this dose is increased. The data are also discussed in terms of a recent theoretical formulation which predicts synergism as a result of the interaction between the sublethal damage produced by the two radiations.

Impact of intraoperative edema during transperineal permanent prostate brachytherapy on computer-optimized and preimplant planning techniques.

The purpose of this study was to prospectively evaluate intraoperative prostatic edema during prostate brachytherapy with real-time ultrasound imaging and assess its impact upon the postimplant dosimetry of computer-optimized intraoperatively planned patients. Fifty consecutive patients with early-stage favorable risk adenocarcinoma of the prostate underwent transperineal ultrasound-guided I125 brachytherapy. Ultrasound volume studies of the prostate were performed immediately before and after placement of brachytherapy needles in the operating room. Twenty-five patients underwent intraoperative computer-optimized treatment planning using a genetic algorithm. Twenty-five patients underwent preimplant ultrasound studies for preimplant treatment planning. Postimplant dosimetry was performed on computed tomography scans obtained after the implant. Statistical analysis was performed taking into account patient age, preneedle volume, increase in intraoperative edema, use of hormonal therapy, type of isotope, number of needles or seeds used, and seed activity. For the intraoperatively planned patients, a median increase of 30% in intraoperative volume was found for the entire group. No correlation between the extent of intraoperative edema and %D90 (percentage of prescribed dose that covers 90% of the target volume) was found. None of the other analyzed variables correlated with %D90. Patients whose treatment was planned preoperatively experienced a median increase of 18.4% in target volume. A negative correlation between the amount of edema and the %D90 was found to be statistically significant (-0.55, P = 0.0047). All patients who underwent prostate brachytherapy experienced intraoperative prostatic edema. When planned intraoperatively, the amount of edema had no impact on the %D90. This may be because of the ability of intraoperative computer-optimized treatment planning to account for edema related to the procedure. Preplanned patients who encountered a greater degree of intraoperative edema had less %D90 target coverage.

On the Microdosimetric Definition of Quality Factors

A formulation of the concept of quality factor based on the microdosimetric quantity lineal energy, y, is described. Toward this end, functions--denoted Specific Quality Functions (SQF)--are defined such that (a) they can be determined directly from observation and (b) a number of them can be used toward setting, by consensus, the values of a microdosimetrically-based quality factor. The determination of SQFs is exemplified by correlating data on the yields of dicentric aberrations in human lymphocytes with measured and calculated microdosimetric distributions. The implications of this approach to problems of radiation protection are discussed.

Inactivation of Synchronized Mammalian Cells with Low-Energy X Rays: Results and Significance

Results for inactivation of hydroxyurea-synchronized V-79 cells by ultrasoft aluminum characteristic X rays of energy 1.5 keV are presented. Limiting RBEs at low doses, relative to 137Cs gamma rays, of 1.8 and 6.4 are, respectively, found for cells at the G1/S and late S stages of the cell cycle. The late-S data are analyzed in the light of previous experiments carried out under similar conditions, also designed to probe the effects of energy deposition in nanometer-sized sites, in which cells were irradiated with correlated pairs of ions. Within the framework of the theory of dual radiation action, the results for ultrasoft X rays and gamma rays can be deduced solely from track simulations and the results of the high-LET molecular ion experiment.

Dose-rate effects in normal and malignant cells of human origin*

Human cell lines derived from normal tissue and malignant tumours were irradiated in plateau phase under acute (81 Gy/h) or protracted (0.1-0.7 Gy/h) exposure to determine initial survival curve slopes, assess sublethal damage repair (SLDR) capability, and establish differences in survival due to SLDR over a range of dose rates. No correlation was found between clinical resistance of the tumor types and initial slope or survival at 2 Gy. Sublethal damage repair was assessed by comparing survival curves for acute and continuous irradiation. All cell lines showed significant SLDR, with the more clinically resistant tumour types demonstrating the best recovery rates. The survival data also demonstrated little difference in cell killing over the 0.1-0.7 Gy/h range. Using a modified linear-quadratic model with provisions for SLDR, it was found that for these cell lines the repair half-time was less than 1 h, with no significant change in the amount of recovery from sublethal damage at dose rates below 1 Gy/h.