Californium-252Isotope for 21 st Century Radiotherapy

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3. High Technology - Vol. 29

Californium-252 Isotope for 21 st Century Radiotherapy

edited by

Jacek G. Wierzbicki Associate Professor, Wayne State University, Detroit, Michigan, U.S.A.

Springer Science+Business Media, BV

Proceedings of the NATD Advanced Research Workshop on Californium-252. Isotope for 21 st Century Radiotherapy Detroit, U.S.A. ApriI24-27,1996

A C.I.P. Catalogue record for this book is available from the Library of Congress.

ISBN 978-94-010-6433-0 ISBN 978-94-011-5766-7 (eBook) DOI 10.1007/978-94-011-5766-7

Printed on acid-free paper

AII Rights Reserved © 1997 Springer Science+Business Media Dordrecht Originally published by Kluwer Academic Publishers in 1997

Softcover reprint of the hardcover 1 st edition 1997

No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photo­copying, recording or by any information storage and retrieval system, without written permission from the copyright owner.

Yosh Maruyama MD (1930 - 1995)

Dedication

This book is dedicated to the late Yosh Maruyama, M.D. ­pioneer of neutron brachytherapy, his wife Fudeko and his childrenWarren, Nancy, Miriam and Karen.

PrefaceJ.G. Wierzbicki

TABLE OF CONTENTS

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Acknowledgments xvii

List of Contributors XIX

Yosh Maruyama - Father of Neutron BrachytherapyJ. Feola 1

I. Production and Physical Properties of Californium Sources

Californium-252 Production and Neutron Source FabricationJ.B. Knauer and R.C. Martin 7

Physics and Dosimetry of Clinical 2S2Cf SourcesJ.G. Wierzbicki, M.J. Rivard and W. Roberts. . . . . . . . . . . . . . . . . . . . . . . . . .. 25

II. Brachytherapy of Gynaecological Tumors

The Relationship of Cf-252 and Ra-226 Radiation Doses and the Reoxygenationand Regression of Cervix Uteri Tumor. Part I: Clinical Experimental StudyT. Tacev, A. Vacek, B. Prokes, O. Rasovskti, B. Ptackova, V. Strnad andV. Krystof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 57

The Relationship of Cf-252 and Ra-226 Radiation Doses and the Reoxygenationand Regression of Cervix Uteri Tumor. Part II: Preliminary Results in AdvancedCervical CarcinomaT. Tacev, B. Ptackova, A. Vacek, O. Rasovska, B. Prokes, V. Strnad andV. Krystof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 77

Californium-252 and Hypoxyradiotherapy in Treatment of Advanced Carcinomaof the Cervix UteriT. Tacev, B. Ptackova, A. Vacek, O. Rasovskti and V. Strnad 83

Results of Mixed Radiation Therapy of Endometrial Cancer using NeutronGamma-TherapyL.I. Guseva, L.I. Krikunova and V.P. Rykova 99

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Preoperative Intracavitary Neutron Therapy Carcinoma of Endometrial andCervixL.A Marjina, M.I. Nechushkin and V. V. Serova 105

The Results of Treatment of Patients with Endometrial Cancer and CarcinomaCervix using Califomium-252 HDRL.A Marjina, V.N. Kiseleva, M.I. Nechushkin, V.N. Chekhonadsky andG.P. Elisyutin 115

Clinical Experience of Neutron Brachytherapy for Patients with CervixCarcinomaAS. Pavlov, K.N. Kostromina, M.A. Fadeyeva and AL Bocharov 131

III. Brachytherapy of Head and Neck Tumors

Radiation Injuries of Oral Cavity and Oropharynx after Interstitial NeutronBrachytherapy and Gamma-TherapyV.S. Medvedev, B.M. Vtyurin, V./. Plichko and I.A. Gulidov 137

Brachytherapy with Califomium-252 for Head and Neck TumorsB.M. Vtyurin, V.S. Medvedev, V.I. Plichko, V.N. Ivanov, L.F. Ivanova,S.A. Maximov 145

Immunoendocrine Homeostasis State in Patients with Cancer of the BuccalMucosa after Interstitial Therapy with Califomium-252N.P. Savina, V.S. Medvedev and L.I. Ljasko 159

IV. Brachytherapy of Rectal Tumors and Sarcomas

Intracavitary Neutron Therapy for Malignant Rectal Tumors using High Cf-252SourcesV. O. Sidorchenkov, O.N. Denisenko, V.N. Ivanov and VA Kozlov . . . . . . . . . . . . 179

Preoperative Radiotherapy in the Treatment of Rectal CarcinomaA. Bumeckis, E. Stratilatovas, V. Atkocius, Z. Sinkevicius and R. Bausys 199

Califomium-252 in the Treatment of Soft Tissue SarcomaJ. Fontanesi, M. Zalupski, P. Chuba, J.G. Wierzbicki, M.J. Rivard and J. Ryan . .. 203

V. Dosimetry, Radiobiology and Treatment Planning of MixedNeutron-Photon Radiation

Treatment Planning for Interstitial and Intracavitary Cf-252 NeutronBrachytherapyA. Miller, E. Atkocine, M. Kersuliene and V. Atkocius 211

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Dosimetry and Treatment Planning in High Dose Rate Cf-252 BrachytherapyO.N. Denisenko, V.N. Ivanov, V.A Kozlov, V.O. Sidorchenkov, A.A. Omarov,I.M. Chernichenko and V.N. Chekhonadsky 221

To the Problem on Selection of the Target in Brachytherapy with Cf-252V.N. Ivanov, B.M. Vtyurin, L.F. Ivanova, V.S. Medvedev and AA. Omarov 233

Factors Influencing the Efficiency of Cf-252 Brachytherapy: Clinical andTechnological AspectsV.N. Ivanov, B.M. Vtyurin, L.F. Ivanova and T. V. Popova 243

Biological Effects of Gamma-Neutron Radiation Cf-252 or Fission Neutronfrom the BR-IO Reactor on Tumor and Normal Cells and TissuesAG. Konoplyannikov 257

Cf-252 Brachytherapy in Cervical Cancer: Monte Carlo Studies of the Effect ofTissue HeterogeneityA Ralston and B.I. Allen 263

VI. Source Design and Delivery

Automatic Afterloading Device for Neutron Brachytherapy (ANET-BA)G. Elisyutin 273

Small Accelerators - An Alternative Source of Neutrons for Brachytherapyi.F. Crawford and S. Teichmann 283

The IEC as a Complementary Neutron Source to Cf-252G.H. Miley 287

Subject Index 299

Preface

Californium-252 was first identified in the debris of a thermonuclear testexplosion in 1952 by Glenn Seaborg and his collaborators. For this discovery, Dr.Seaborg was awarded the Nobel prize in chemistry. Cf-252 decays with a half life of 2.65emitting neutrons and photons which deposit dose in a ratio of2:1. One gram ofCf-252emits 2.3 x 1012 neutrons per second making it an especially compact source ofneutrons.These desirable properties led to a sustained effort to produce and recover macroscopicquantities of Cf-252. In 1958, a National Transplutonium Element Production Programwas undertaken in the United States to produce large quantities of Cf-252 for research,industry and medicine. Today, there are only two reactors in the world capable ofproducing useful quantities of Cf-252: Oak Ridge National Laboratory in Oak Ridge,Tennessee, U.S.A. and the Research Institute for Atomic Reactors in Dmitrovgrad, Russia.

There are many applications of Cf-252. The spectrum of emitted neutrons andphotons is almost the same as that produced by a nuclear reactor, however, the dimensionsof a source are minimal. Therefore, Cf-252 sources with strengths of 50-1 00 milligramsare used as starters for nuclear reactors. Another important application of Californiumsources is neutron radiography used to detect cracks in ship engines. It is also used forexplosives detection by airport security. The most spectacular use of Cf-252, however, isin brachytherapy for cancer patients. Brachytherapy is radiation therapy of malignanttumors accomplished by placing radioactive sources inside or adjacent to the tumors.Radiation Oncology has exhausted nearly every option to more succesfully treat so-calledradioresistant tumors by means ofphoton brachytherapy (radium, cesium, iridium, iodine,etc.) and, therefore, new types of radiation should be studiecl to improve the curability ofcancer.

The NATO Advanced Research Workshop: Californium-252 Isotope for 21stCentury Radiotherapy was held in Detroit on April 24-28, 1996.* Supported by NATO,the undersigned workshop director was able to invite experts from all centers that have anactive californium brachytherapy program or are considering implementation of it in thenear future.

* This was the third workshop on Cf-252 brachytherapy. Workshops in 1985 and 1990were not really international due to poorfinancial support. Leading clinical centers fromRussia, Lithuania, Poland and Chechoslovakia were either under-represented or notrepresented at all.

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Institutions represented at the workshop:

Russian Academy ofMedical Sciences, Oncological Research Center, Moscow, Russia.Specialization: Treatment of gynecological and breast cancer since 1980, dosimetry andradiobiology.

National Technology Physics and Automation Research Institute, Moscow, Russia.Specialization: Californium source delivery systems since 1970.

Russian Academy ofMedical Sciences, Medical Radiological Research Center, Obninsk,Russia.Specialization: Treatment of head and neck and oral cavity tumors since 1970, dosimetryand radiobiology.

Lithuanian Society for Radiation Therapy, Vilnius, Lithuania.Specialization: Treatment of gynecological and rectal tumors since 1989.

Masaryk Memorial Cancer Institute, Bemo, Czech RepublicSpecialization: Treatment ofgynecological tumors since 1985.

Wayne State University, Detroit, Michigan, U.S.A.Specialization: Treatment of soft tissue sarcomas and oral cavity tumors since 1976,dosimetry and radiobiology.

Center ofOncology, Krakow, Poland.Specialization: Neutron beam therapy since 1978, dosimetry and radiobiology. Interest inimplementation ofCf-252 brachytherapy.

Radiation Physics Department, Umea, Sweden.Serious interest in implementation of Cf-252 brachytherapy.

Oak Ridge National Laboratory, Oak Ridge, Tennessee, U.S.A.Producer ofCalifornium-252.

National Cancer Institute, Chiang Mai, Thailand.Specialization: Cf-252 source has been purchased and clinical trials of gynecologicaltumors will begin soon.

Varian Oncology Systems, Palo Alto, California, U.S.A.Specialization: Source delivery system - design and production underway.

Other participants:St. George Cancer Institute, Australia.University of Illinois, Urbana, Illinois, U.S.A.Armed Forces Radiobiology Research Institute, Bethesda, Maryland, U.S.A.

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C.H.R. Orleans Service d'Oncologie, Orleans, LA, France.European Society for Therapeutical Radiology and Oncology, Brussels, Belgium.

The presentations were arranged in the following focus sessions:Brachytherapy of Head and Neck, Oral Cavity, Breast and Soft Tissue Tumors (6presentations),Brachytherapy ofGynecological and Rectal Tumors (6 presentations),Radiobiology and Dosimetry ofRadiation from Cf-252 (10 presentations),Source Production, Storage, Delivery Techniques and Alternative Sources (5presentations),Cf-252 Source for High Dose Rate Interstitial Brachytherapy (2 presentations).

Findings of the round table discussion at the end of the workshop

Californium brachytherapy is practiced at the following radiotherapy centers:

Wayne State University, Detroit, MI, U.S.A. (12 sources, 12 micrograms each),Lithuanian Oncology Center, Vilnius, Lithuania (3 sources: 2 x 300 and 1 x 250micrograms),Russian Academy of Medical Sciences, Moscow, Russia ( 2 x 300 and x 500micrograms),Russian Academy ofMedical Sciences, Obninsk, Russia (many low activity sources).Masaryk Memorial Cancer Institute, Berno, Czech Republic (many low activity sources,on-going reconstruction ofthe Californium facility able to handle up to 200 micrograms),University of Chiang Mai, Thailand (one source of200 micrograms).

The following radiation oncology facilities expressed serious interest inimplementation of californium brachytherapy programs:

Umea University, Umea, SwedenUniversity de Louvain-La-Neuve, BelgiumHacettepe University, Ankara, TurkeyCenter ofOncology, Krakow, PolandJean-Philippe Pignol, Strasbourg, France

The prerequisite for californium brachytherapy is the availability of sources.Russian and Lithuanian Centers have been supplied by the Research Institute for AtomicReactors in Dmitrovgrad, Russia. Political and structural changes in the former SovietUnion create difficulties in obtaining new sources. It was noted that NATO ARW and itsinternational participation may be a convincing argument for Medical Care authorities inthose countries to fmance the californium supply for radiation therapy. Workshoporganizers promised to send a letter of support if requested.

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Important collaboration between Wayne State University, ORNL and VarianOncology Systems was presented at the special session. The goal of the collaboration ofthe source user, producer and medical equipment manufacturer is to design and producea high strength miniature source with a remote delivery system to make implants short andsafe for personnel.

Conclusion

The NATO ARW was the fIrst meeting of all californium brachytherapyresearchers and clinicians. The workshop initiated international, East-West collaborationin the fIght against cancer by means of Cf-252 - a transplutonium isotope which is aproduct of nuclear industry. This meeting was one of the steps towards turning nucleartechnology from production of materials of nuclear destruction into production of lifesaving isotopes serving all ofhumanity.

Jacek G. Wierzbicki, Ph.D.Workshop Director

Acknowledgments

As the undersigned Editor and Workshop Director, I wish to thankall of the individuals and organizations that helped to make theseproceedings very productive and successful.

The generous grant from NATO made it possible to invite all of thescientists actively pursuing research in californium brachytherapy.

The Gershenson Radiation Oncology Center (ROC) of the KarmanosCancer Institute was the host institution for the Workshop. I am grateful forthe financial support offered by the ROC and for the dedication of its staff.A special thanks to:

Cay Bernock, Hilda Grayson and Dolores Windom. Your work ishighly appreciated.

Mark Rivard and David Waid, graduate students of Wayne StateUniversity's Medical Physics Program for helping to organize the workshopand edit the proceedings. Both showed leadership skills and as theiracademic advisor I am proud of their performance.

Lastly, I am grateful for receiving significant support and assistanceat every stage of the workshop organization and proceedings preparationfrom my wife, Grazyna, and our children Grazyna, Przemek, Danusia andKinga.

Thank you all,

Jacek G. Wierzbicki, Ph.D.

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List of contributors:

Dr. A.S. PavlovRussian Medical Academy ofPost-Graduate Training7, 2nd Botkinskij ProMoscow 125284, Russia

Dr. V.O. SidorchenkovMedical Radiological ResearchCenter Russian Academy ofMedical Sciences,Obninsk, Ka1uga Region 249020, Russia fax 095956-1440

Dr. N. DenisenkoMedical Radiological ResearchCenter Russian Academy ofMedical Sciences,Obninsk, Kaluga Region 249020, Russia fax 095956-1440

N.P. SavinaMedical Radiological ResearchCenter Russian Academy ofMedical Sciences,Obninsk, Kaluga Region 249020, Russia fax 095956-1440

Dr.L.I. GusevaMedical Radiological ResearchCenter Russian Academy ofMedical Sciences,Obninsk, Kaluga Region 249020, Russia fax 095956-1440

Prof. B.M. VtiurinMedical Radiological ResearchCenter Russian Academy ofMedical Sciences,Obninsk, Kaluga Region 249020, Russia fax 095 956-1440

Dr. V.N. IvanovMedical Radiological Research Center Russian Academy ofMedical Sciences,Obninsk, Kaluga Region 249020, Russia fax 095 956-1440

Prof. A.G. KonopliannikovMedical Radiological Research Center Russian Academy ofMedical SciencesObninsk, Kaluga Region 249020, Russia fax 095956-1440

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Dr. Lia A. MarjinaRussian Academy ofMed. SciencesOncological Research CenterKashirakoye 24, Moscow 115478Russia

Dr. G.P. ElisijutinNat.Techn. Physics and Automatation Res lost.Varshavskoje 46Moscow 115230 Russia

Dr. Victor MiedviedievMedical Radiological ResearchCenter Russian Academy ofMedical Sciences,Obninsk, Kaluga Region 249020, Russia fax 095956-1440

Dr. Arvydas BurneckisLithuanian Society for RadiationTherapyP.O. Box 15792010 Vilnius Lithuania

Dr Albertas MillerLithuanian Society for RadiationTherapyP.O. Box 15792010 Vilnius Lithuania

Dr. Taco TacevMasaryk Memorial Cancer Inst.Zluty Kopec 7, 653 56 BmoCzech Republic

Dr. John F. CrawfordThe Paul Scherrer InstituteCH-5232 Villigen PSI, SwitzerlandENGLAND-rep

Dr. Barry AllenSt. George Cancer Care CentreKagarah, NSWAustralia

Dr Jose FeolaUniv. OfKentuckyLexington, KY 40523USA

Dr Jim FontanesiWayne State UniversityDetroit MI 48201USA

Dr Jacek WierzbickiWayne State UniversityDetroit MI 48201USA

Dr. George H. MileyUniv of IllinoisUrbana 1161801USA

lB. KnauerOak Ridge National LaboratoryP.O. Box 2008 MS-6384Oak Ridge TN 37831-6384USA

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