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Purpose: The aim of this study was to retrospectively observe and analyze the long-term treatment outcomes for a total of 952 esophageal cancer patients who were treated with (252)Cf neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT)., Methods and Materials: From November 2001 to March 2012, 952 patients with esophageal cancer underwent NBT in combination with EBRT. The patient numbers distributed over various cancer Stages I, IIA, IIB, III, and IVA were 9, 290, 51, 579, and 23, respectively. The total radiation dose to the reference point via NBT was 8-25 Gy-eq in three to five fractions with one fraction/week. The total dose via EBRT was 40-60 Gy delivered over a period of 5-6 weeks with normal fractionation., Results: The overall median survival time was 20.3 months. The 1-, 3-, and 5-year survival rates were 67.1%, 36.3%, and 26.6%, respectively. These results compare favorably with the results obtained from conventional high-dose rate in combination with EBRT. Although a majority of the patients (860 or 90.3%) developed Grades 1 and 2 esophagitis during treatment, the symptoms were effectively relieved after the application of antacid and surface anesthesia., Conclusions: The clinical data show that NBT in combination with EBRT produced favorable local control and long-term survival rates for patients with esophageal cancer and that the side effects are tolerable. As such, we conclude that this dual-modality method is an effective and safe way for treating esophageal cancer., (Published by Elsevier Inc.)

Aims and Background: Californium-252 (²⁵²Cf) neutron brachytherapy is a form of high linear energy transfer radiotherapy, which has proven effective when used in combination with external beam radiotherapy to treat intracavitary cancers of the cervix, colon/rectum and esophagus. No study has been reported for treatment of intracavitary cancers with neutron brachytherapy alone. The aim of the study was to observe and analyze the long-term curative effects and complications for early stage thoracic esophageal cancer patients treated with neutron brachytherapy alone., Methods: From December 2001 to August 2006, 16 patients of early stage squamous cell carcinoma underwent neutron brachytherapy. The total radiation dose to the reference point was 20-28 Gy-eq in 5 to 7 fractions with 4 Gy-eq/fraction. The 1-, 3-, and 5-year follow-up rates were 100%., Results: The 2-, 3-, 4-, and 5-year survival rates were 100%, 87.5%, 87.5%, and 75%, respectively. The early complication rates for grades 1 and 2 radiation esophagitis were 75% and 25%, respectively. The late complication rates for grades 0 and 1 (according to the RTOG/EORTC standard) were 87.5% and 12.5%, respectively. Barium esophagography after treatments confirmed that the complete response rate was 100%. Fourteen patients were confirmed by endoscopy to have either normal mucosa or inflammation change., Conclusions: Neutron brachytherapy alone was an effective and safe treatment for early stage esophageal squamous cell cancer.

A novel tissue-equivalent proportional counter (TEPC) based on a gas electron multiplier (GEM) for measuring H*(10) for neutrons was designed and constructed. The pulse height spectra (PHS) of two different neutron sources (a 252Cf source and a AmBe source) were measured using the new TEPC. The measurements were made with the TEPC filled with two different gases (10P gas and a propane-based tissue-equivalent gas) at various pressures. A computer simulation of the new TEPC, based on the Monte Carlo method, was performed to obtain the PHS for the two neutron sources. It is shown that the experimental results agree well with the simulation results for both 252Cf and AmBe neutron sources. Several outstanding problems are discussed and suggestions are made to make the GEM-based TEPC a practical neutron rem meter. The potential advantage of this novel neutron rem meter would be its low weight and compactness.

A new plate-like tissue equivalent proportional counter (TEPC) based on the gas electron multiplier (GEM) is being developed for use as a neutron rem meter. The advantage of a plate-like TEPC over a conventional spherical TEPC is that several of the plate-like TEPCs can be stacked together as one unit to increase sensitivity to neutrons. A GEM-based TEPC consists of four layers of materials in a series: the front cover made of polyethylene, the cathode made of A-150 plastic, the gas region containing 1/3 atm of P-10 and 1/3 atm of nitrogen and the anode made of a copper-coated printed circuit board. The dimensions of the TEPC are 10 cm x 10 cm x 1.8 cm. The computer simulation shows that the neutron response function of the TEPC closely resembles the response curve of H(10) for neutrons with energies between 0.25 eV and 10 MeV. The corresponding sensitivity for such a TEPC for a bare (252)Cf neutron source was calculated to be 5.0 cpm per microSv h(-1). This sensitivity can be increased many times by simply stacking several TEPCs together as one unit.

The existing dosimetry protocol that uses the concept of RBE for 252Cf brachytherapy contains large uncertainties. A new formula has been developed to correlate the biological effect (i.e. cell survival fraction) resulting from a mixed n + gamma radiation field with two physical quantities and two biological quantities. The formula is based on a pathway model evolved from that of the compound-dual-radiation-action (CDRA) theory, previously proposed by Rossi and Zaider. The new model employs the recently published data on radiation-induced DNA lesions. The new formula is capable of predicting quantitatively the synergistic effect caused by the interactions between neutron events and gamma ray events, and it is intended to be included into a new dosimetry protocol for future 252Cf brachytherapy.

Monte Carlo neutron transport calculations were performed to obtain the neutron response functions of a superheated drop detector (SDD-100) that is surrounded by polyethylene of various thicknesses. The calculational results suggest that a SDD-100 surrounded by 2.54 cm of polyethylene gives the best dose-equivalent response in a free neutron field. Results were confirmed by a sequence of experiments using various neutron sources. This polyethylene-moderated SDD-100 is ideal for use as an area neutron dose monitor.

An accelerator-based neutron irradiation facility (ANIF), which has been proposed for BNCT, is based on a 2.5-MeV proton beam bombarding a thick lithium target. Neutrons which are emitted from the lithium target are too energetic for BNCT and must be moderated. A calculational study, which was done previously on the moderator assembly for an ANIF, shows that, with an optimized moderator assembly, an ANIF can produce a neutron flux which has quality and intensity sufficient for BNCT. In order to verify our previous calculational study, a lithium target and a non-optimized moderator assembly (a cylindrical tank of D2O) have been constructed and tested at the Ohio State University Van de Graaff proton accelerator. The neutron spectrum was measured for neutrons emerging from the moderator assembly. The measured neutron spectrum agrees reasonably well with that obtained from Monte Carlo calculations, except for neutrons with energies above 100 keV. For those neutrons, the measured spectrum is lower by a factor of two than the calculated one. In addition to the neutron spectrum measurement, the boron-10 absorbed dose was measured on the axis of the neutron field in a 20 cm x 20 cm x 20 cm water phantom, and the result agrees quite well with that obtained from calculation. This experiment confirms that the calculated optimized moderator assembly, consisting of a 22.5-cm thick, 25-cm diameter cylinder of beryllia (BeO) surrounded by a 30-cm thick jacket of alumina (Al2O3), produces an epithermal neutron flux of 3.12 x 10(7) n/cm2-s per mA of protons. For an accelerator delivering 30 mA of 2.5-MeV protons, the irradiation time for a single-session treatment can be as short as 50 minutes. The calculated ratio of absorbed neutron dose to fluence for the optimized moderator assembly is 4.9 x 10(-11) cGy-cm2/n, which is equal to that of a 5-keV neutron beam. Our experimental measurements indicate that the ratio of absorbed neutron dose to fluence may in fact be lower (better) than calculated.

New technique is trending in spatially fractionated radiotherapy with protons to utilize the spot scanning together with a physical collimator to obtain minibeams. The primary goal of this study is to quantify ambient neutron dose equivalent (⁠|${H}^{\ast }(10)$|⁠) due to the secondary neutrons when physical collimator is used to achieve desired minibeams. The |${H}^{\ast }(10)$| per treatment proton dose (D) was assessed using Monte Carlo code TOPAS and measured using WENDI-II detector at different angles (135, 180, 225 and 270 degrees) and distances (11 cm, 58 and 105 cm) from the phantom for two cases: with and without physical collimation. Without collimation |$\frac{H^{\ast }(10)}{D}$| varied from 0.0013 to 0.242 mSv/Gy. With collimation |$\frac{H^{\ast }(10)}{D}$| varied from 0.017 to 3.23 mSv/Gy. Results show that the secondary neutron dose will increase tenfold when the physical collimator is used. Regardless, it will be low and comparable to the neutron dose produced by conventional passive-scattered proton beams. [ABSTRACT FROM AUTHOR]

Background: We conducted a retrospective analysis on 884 patients who were diagnosed with esophageal squamous cell carcinoma (ESCC) and treated with either the neutron brachytherapy in combination with external beam radiotherapy (NBT + EBRT) or 3-dimensional conformal radiation therapy (3D-CRT) to determine the differences in efficacy and morbidity between the two treatment groups.Methods: The 884 ESCC patients treated with either NBT + EBRT or 3D-CRT between 2002 and 2012 were retrospectively reviewed and analyzed. Multivariable Cox regression was used to compare oncologic outcomes of the two groups of patients in the context of other clinically relevant variables. The acute and chronic toxicities associated with the two groups were compared using Fisher exact and log-rank tests, respectively.Results: Among the 884 patients, 545 received NBT + EBRT and 339 received 3D-CRT (i.e. EBRT-only). The age range is 39-95 years (median 66). The follow-up time range is 3-145 months (median 32). The analysis shows that the NBT + EBRT group has higher overall survival rate and local control rate than that of the 3D-CRT group. The acute toxicity effects were acceptable for both groups of patients with the NBT + EBRT group showing higher rates of leukopenia and thrombocytopenia and the 3D-CRT group showing higher rates on fistula and massive bleeding.Conclusions: The patients treated with NBT + EBRT showed better oncologic outcomes than those treated with 3D-CRT. The toxicity effects were acceptable for both groups with the NBT + EBRT group showing higher rates on the acute effects and the 3D-CRT group showing higher rates on the late effects. [ABSTRACT FROM AUTHOR]

A new generation of medical grade 252Cf sources was developed in 2002 at the Oak Ridge National Laboratory. The combination of small size and large activity of 252Cf makes the new source suitable to be used with the conventional high-dose-rate remote afterload-ing system for interstitial brachy therapy. A recent in-water calibration experiment showed that the measured gamma dose rates near the new source are slightly greater than the neutron dose rates, contradicting the well established neutron-to-gamma dose ratio of approximately 2:1 at locations near a 252Cf brachytherapy source. Specifically, the MCNP-predicted gamma dose rate is a factor of two lower than the measured gamma dose rate at the distance of 1 cm, and the differences between the two results gradually diminish at distances farther away from the source. To resolve this discrepancy, we updated the source gamma spectrum by including in the ORIGEN-S data library the experimentally measured 252Cf prompt gamma spectrum as well as the true 252Cf spontaneous fission yield data to explicitly model delayed gamma emissions from fission products. We also investigated the bremsstrahlung X-rays produced by the beta particles emitted from fission product decays. The results show that the discrepancy of gamma dose rates is mainly caused by the omission of the bremsstrahlung X-rays in the MCNP runs. By including the bremsstrahlung X-rays, the MCNP results show that the gamma dose rates near a new 252Cf source agree well with the measured results and that the gamma dose rates are indeed greater than the neutron dose rates. [ABSTRACT FROM AUTHOR]