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Purpose: Since June 2020, boron neutron capture therapy (BNCT) has been a health care service covered by health insurance in Japan to treat locally advanced or recurrent unresectable head and neck cancers. Therefore, we aimed to assess the clinical outcomes of BNCT as a health insurance treatment and explore its role among the standard treatment modalities for head and neck cancers. Materials and Methods: We retrospectively analyzed data from patients who were treated using BNCT at Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, between June 2020 and May 2022. We assessed objective response rates based on the Response Evaluation Criteria in Solid Tumors version 1.1, and adverse events based on the Common Terminology Criteria for Adverse Events, version 5.0. Additionally, we conducted a survival analysis and explored the factors that contributed to the treatment results. Results: Sixty‐nine patients (72 treatments) were included in the study, with a median observation period of 15 months. The objective response rate was 80.5%, and the 1‐year locoregional control, progression‐free survival, and overall survival rates were 57.1% (95% confidence interval [CI]: 43.9%–68.3%), 42.2% (95% CI: 30.1%–53.8%), and 75.4% (95% CI: 62.5%–84.5%), respectively. Locoregional control was significantly longer in patients with earlier TNM staging and no history of chemotherapy. Conclusions: BNCT may be an effective treatment option for locally advanced or recurrent unresectable head and neck cancers with no other definitive therapies. If definitive surgery or radiation therapy are not feasible, BNCT should be considered at early disease stages. [ABSTRACT FROM AUTHOR]

Background: The out‐of‐field radiation dose for boron neutron capture therapy (BNCT), which results from both neutrons and γ‐rays, has not been extensively evaluated. To safely perform BNCT, the neutron and γ‐ray distributions inside the treatment room and the whole‐body dose should be evaluated during commissioning. Although, certain previous studies have evaluated the whole‐body dose in the clinical research phase, no institution providing BNCT covered by health insurance has yet validated the neutron distribution inside the room and the whole‐body dose. Purpose: To validate the Monte Carlo model of the BNCT irradiation room extended for the whole‐body region and evaluate organ‐at‐risk (OAR) doses using the validated model with a human‐body phantom. Methods: First, thermal neutron distribution inside the entire treatment room was measured by placing Au samples on the walls of the treatment room. Second, neutron and gamma‐ray dose‐rate distributions inside a human‐body water phantom were measured. Both lying and sitting positions were considered. Bare Au, Au covered by Cd (Au+Cd), In, Al, and thermoluminescent dosimeters were arranged at 11 points corresponding to locations of the OARs inside the phantom. After the irradiation, γ‐ray peaks emitted from the samples were measured by a high‐purity germanium detector. The measured counts were converted to the reaction rate per unit charge of the sample. These measurements were compared with results of simulations performed with the Particle and Heavy Ion Transport code System (PHITS). A male adult mesh‐type reference computational phantom was used to evaluate OAR doses in the whole‐body region. The relative biological effectiveness (RBE)‐weighted doses and dose‐volume histograms (DVHs) for each OAR were evaluated. The median dose (D50%) and near‐maximum dose (D2%) were evaluated for 14 OARs in a 1‐h‐irradiation process. The evaluated RBE‐weighted doses were converted to equivalent doses in 2 Gy fractions. Results: Experimental results within 60 cm from the irradiation center agreed with simulation results within the error bars except at ±20, 30 cm, and those over 70 cm corresponded within one digit. The experimental results of reaction rates or γ‐ray dose rate for lying and sitting positions agreed well with the simulation results within the error bars at 8, 4, 11, 7 and 7, 4, 7, 6, 5, 6 out of 11 points, respectively, for Au, Au+Cd, In, Al, and TLD. Among the detectors, the discrepancies in reaction rates between experiment and simulation were most common for Au+Cd, but were observed randomly for measurement points (brain, lung, etc.). The experimental results of γ‐ray dose rates were systematically lower than simulation results at abdomen and waist regions for both positions. Extending the PHITS model to the whole‐body region resulted in higher doses for all OARs, especially 0.13 Gy‐eq increase for D50% of the left salivary gland. Conclusion: The PHITS model for clinical BNCT for the whole‐body region was validated, and the OAR doses were then evaluated. Clinicians and medical physicists should know that the out‐of‐field radiation increases the OAR dose in the whole‐body region. [ABSTRACT FROM AUTHOR]

Background: Evaluation of the boron dose is essential for boron neutron capture therapy (BNCT). Nevertheless, a direct evaluation method for the boron‐dose distribution has not yet been established in the clinical BNCT field. To date, even in quality assurance (QA) measurements, the boron dose has been indirectly evaluated from the thermal neutron flux measured using the activation method with gold foil or wire and an assumed boron concentration in the QA procedure. Recently, we successfully conducted optical imaging of the boron‐dose distribution using a cooled charge‐coupled device (CCD) camera and a boron‐added liquid scintillator at the E‐3 port facility of the Kyoto University Research Reactor (KUR), which supplies an almost pure thermal neutron beam with very low gamma‐ray contamination. However, in a clinical accelerator‐based BNCT facility, there is a concern that the boron‐dose distribution may not be accurately extracted because the unwanted luminescence intensity, which is irrelevant to the boron dose is expected to increase owing to the contamination of fast neutrons and gamma rays. Purpose: The purpose of this research was to study the validity of a newly proposed method using a boron‐added liquid scintillator and a cooled CCD camera to directly observe the boron‐dose distribution in a clinical accelerator‐based BNCT field. Method: A liquid scintillator phantom with 10B was prepared by filling a small quartz glass container with a commercial liquid scintillator and boron‐containing material (trimethyl borate); its natural boron concentration was 1 wt%. Luminescence images of the boron‐neutron capture reaction were obtained in a water tank at several different depths using a CCD camera. The contribution of background luminescence, mainly due to gamma rays, was removed by subtracting the luminescence images obtained using another sole liquid scintillator phantom (natural boron concentration of 0 wt%) at each corresponding depth, and a depth profile of the boron dose with several discrete points was obtained. The obtained depth profile was compared with that of calculated boron dose, and those of thermal neutron flux which were experimentally measured or calculated using a Monte Carlo code. Results: The depth profile evaluated from the subtracted images indicated reasonable agreement with the calculated boron‐dose profile and thermal neutron flux profiles, except for the shallow region. This discrepancy is thought to be due to the contribution of light reflected from the tank wall. The simulation results also demonstrated that the thermal neutron flux would be severely perturbed by the 10B‐containing phantom if a relatively larger container was used to evaluate a wide range of boron‐dose distributions in a single shot. This indicates a trade‐off between the luminescence intensity of the 10B‐added phantom and its perturbation effect on the thermal neutron flux. Conclusions: Although a partial discrepancy was observed, the validity of the newly proposed boron‐dose evaluation method using liquid‐scintillator phantoms with and without 10B was experimentally confirmed in the neutron field of an accelerator‐based clinical BNCT facility. However, this study has some limitations, including the trade‐off problem stated above. Therefore, further studies are required to address these limitations. [ABSTRACT FROM AUTHOR]

Background: The goal of the study was to evaluate the diagnostic ability of 18F-FBPA PET/CT for malignant tumors. Findings from 18F-FBPA and 18F-FDG PET/CT were compared with pathological diagnoses in patients with malignant tumors or benign lesions. Methods: A total of 82 patients (45 males, 37 females; median age, 63 years; age range, 20–89 years) with various types of malignant tumors or benign lesions, such as inflammation and granulomas, were examined by 18F-FDG and 18F-FBPA PET/CT. Tumor uptake of FDG or FBPA was quantified using the maximum standardized uptake value (SUVmax). The final diagnosis was confirmed by cytopathology or histopathological findings of the specimen after biopsy or surgery. A ROC curve was constructed from the SUVmax values of each PET image, and the area under the curve (AUC) and cutoff values were calculated. Results: The SUVmax for 18F-FDG PET/CT did not differ significantly for malignant tumors and benign lesions (10.9 ± 6.3 vs. 9.1 ± 2.7 P = 0.62), whereas SUVmax for 18F-FBPA PET/CT was significantly higher for malignant tumors (5.1 ± 3.0 vs. 2.9 ± 0.6, P < 0.001). The best SUVmax cutoffs for distinguishing malignant tumors from benign lesions were 11.16 for 18F-FDG PET/CT (sensitivity 0.909, specificity 0.390) and 3.24 for 18F-FBPA PET/CT (sensitivity 0.818, specificity 0.753). ROC analysis showed significantly different AUC values for 18F-FDG and 18F-FBPA PET/CT (0.547 vs. 0.834, p < 0.001). Conclusion: 18F-FBPA PET/CT showed superior diagnostic ability over 18F-FDG PET/CT in differential diagnosis of malignant tumors and benign lesions. The results of this study suggest that 18F-FBPA PET/CT diagnosis may reduce false-positive 18F-FDG PET/CT diagnoses. [ABSTRACT FROM AUTHOR]

The world's first accelerator based epithermal neutron source for clinical boron neutron capture therapy (BNCT) was designed, developed, and commissioned between 2008 and 2010 by Sumitomo Heavy Industries in collaboration with Kyoto University at the Kyoto University Institute for Integrated Radiation and Nuclear Science. The accelerator system is cyclotron-based and accelerates a proton up to an energy of approximately 30 MeV. The proton strikes a beryllium target, which produces fast neutrons that traverse a beam shaping assembly composed of a combination of lead, iron, aluminum, and calcium fluoride to reduce the neutron energy down to the epithermal range (∼10 keV) suitable for BNCT. The system is designed to produce an epithermal neutron flux of up to 1.4 × 10 9 n · cm − 2 · s − 1 (exiting from the moderator of a 12 cm diameter collimator) with a proton current of 1 mA. In 2017, the same type of accelerator was installed at the Kansai BNCT Medical Center and in March 2020 the system received medical device approval in Japan (Sumitomo Heavy Industries, NeuCure® BNCT system). Soon after, BNCT for unresectable, locally advanced, and recurrent carcinoma of the head and neck region was approved by the Japanese government for reimbursement covered by the national health insurance system. [ABSTRACT FROM AUTHOR]

Purpose: This study performed an automatic measurement of the off-axis beam-positioning accuracy at a single isocenter via the TrueBeam Developer mode and evaluated the beam-positioning accuracy considering the effect of couch rotational errors., Methods: TrueBeam STx and the Winston-Lutz test-dedicated phantom, with a 3 mm diameter steel ball, were used in this study. The phantom was placed on the treatment couch, and the Winston-Lutz test was performed at the isocenter for four gantry angles (0°, 90°, 180°, and 270°) using an electronic portal imaging device. The phantom offset positions were at distances of 0, 25, 50, 75, and 100 mm from the isocenter along the superior-inferior, anterior-posterior, and left-right directions. Seventeen patterns of multileaf collimator-shaped square fields of 10 × 10 mm 2 were created at the isocenter and off-axis positions for each gantry angle. The beam-positioning accuracy was evaluated with couch rotation along the yaw-axis (0°, ± 0.5°, and ± 1.0°)., Results: The mean beam-positioning errors at the isocenter and off-isocenter distances (from the isocenter to ±100 mm) were 0.46-0.60, 0.44-0.91, and 0.42-1.11 mm for the couch angles of 0°, ±0.5°, and ±1°, respectively. The beam-positioning errors increased as the distance from the isocenter and couch rotation increased., Conclusion: These findings suggest that the beam-positioning accuracy at the isocenter and off-isocenter positions can be evaluated quickly and automatically using the TrueBeam Developer mode. The proposed procedure is expected to contribute to an efficient evaluation of the beam-positioning accuracy at off-isocenter positions., (© 2022 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.)