Week 2 Radiobiology Flashcards

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1
Q

Radiobiology

A

the study of the action of ionizing radiation on living things

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2
Q

Bergonie and Tribondeau, 1906

A

any cells that are immature, undifferentiated and actively dividing (i.e., stomach mucosa, basal layer of skin, stem cells) are more radiosensitive
Cells that are mature, differentiated and not actively dividing (i.e., neurons) are more radioresistant

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3
Q

Types of ionizing radiation

Electromagnetic

A

X-rays
produced in an electrical device that accelerates electron to high energy and abruptly stops them in a target (tungsten or gold)
Gamma rays
Emitted by radioactive isotopes

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4
Q

Types of ionizing radiation

Particulate

A
Electrons
Protons
α-particles
Neutrons
Heavy charged particles
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5
Q

Absorption of x-rays

Directly Ionization

A

Disrupt the atomic structure, producing chemical and biologic changes
α particles, protons
electrons, β-, β+
High LET radiation

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6
Q

Absorption of x-rays

Indirect ionization

A

Give up energy to charged particles, which are able to produce damage.
Neutrons
EM Radiation
Interact with other atoms or molecules to produce free radicals

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7
Q

Mitosis

A

process of cell division that results in two genetically identical daughter cells developing from a single parent cell.

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8
Q

Cell cycle

A

There are 4 phases of mitosis:
M Phase, in which cells divide in 2
most radiosensitive
G1Phase (gap one), in which cells prepare for DNA replication
S Phase, in which DNA doubles by replication
G2Phase (gap two), in which cells prepare for mitosis

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9
Q

Undifferentiated cells

A

are precursor or stem cells and have less specialized functions. Their major role is to reproduce to replace themselves and to provide cells which mature into more differentiated cells.
Examples: bone marrow cells, intestinal crypt cells and basal cells of the skin

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10
Q

The more specialized a cells function is, the more differentiated it is

A

examples are the major organ cells, muscle and neurons

Highly differentiated cell usually have less reproductive activity than undifferentiated cells

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11
Q

radiosensitivity

A
The most radio-sensitive cells are those which:
have a high division rate
have a high metabolic rate
are of a non-specialized type
are well nourished
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12
Q

Single Target-Single Hit

A

Only one target in the cell associated with cell death and a singal hit on this target is adequate to inactivate the target (viruses and some bacteria)

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13
Q

Multiple-Target Single Hit

A

Multiple targets per cell, a single hit of any of these targets is required for cell death. Not all targets are hit, some of them are killed, while others are damaged by low doses (sublethal damage) Cells with SLD may repair themselves during interfractional periods
This is valid for mammalian cells

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14
Q

Linear energy transfer (LET)

A

LET → loss of energy per unit tract length
A function of the charge and velocity of the ionizing radiation
increases as the charge on the ionizing radiation increases and its velocity decreases

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15
Q

Relative biological effectiveness (RBE)

A

The RBE is the ratio of the 250 kV X-ray dose that produces a specific biological effect to the test dose of any radiation that produces the same effect. The RBE is related to the LET.

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16
Q

High LET (pariculate)

A

deposits more energy per unit length, more destructive
than same dose of external beam rad.
Alpha particles are slow and positively charged
Beta particle fast and negatively charged
LET alpha>LET beta

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17
Q

RBE-Radiobiologic Effect

A

RBE=250 kV x-ray dose required for a specific effect/Tested dose of any radiation required for a specific event

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18
Q

Cell survival curves

A

Relationship between dose and proportion of cells that survive

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19
Q

Linear Quadratic Model

A
Respones at low levels of radiation are linear, while higher doses are quadratic
No threshold (although may be inaccurate at 7Gy+)
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20
Q

Extrapolation number (n)

A

Determinated by extrapolating the linear of the curve back until it intersects the y-axis (#of critical targets in the cell)

21
Q

D(0) dose:

A

D37 dose, reduces surviving fraction (SF) by 63%

22
Q

D(q) dose:

A

Quasithreshold dose: measure of width of the shoulder region. also a measure of the cells ability to repair sublethal damage

23
Q

Oxygen Enhancement Ratio (OER)

A

Radiosensitizer
Oxygen must be present during the radiation exposure for sensitization to occur
As the availability of oxygen decreases, cell response also decreases and the survival curve shifts to the right because Dq and Do increase

OER = Radiation dose under hypoxic/anoxic conditions
Radiation dose under oxic conditions to produce the same biological effect

24
Q

BED

A

Biological Effective Dose Model
Derived from LQ equation for cell survival
Used to calculate treatment regimes that are equally effective biologically
Use with caution for extrapolation to normal tissue limits

25
Q

Conventional

A

1.8 – 2.2Gy /fx & 5 fx per week

26
Q

Hyperfractionation

A

More than 1 fraction a day
1.2 – 1.3Gy/fx
Dose increased ~ 20% to allow for increased repair at lower dose/fx

27
Q

Accelerated Fractionation

A

For rapidly growing tumors

Treat 6-7 days a week, same dose/fx as conventional

28
Q

Accelerated Hyperfractionation

A

CHART: Acute side effects are a problem
1.5Gy/fx three times a day, 7 days per week
Patients are done with treatment before the acute side effects start

29
Q

Hypofractionation

A

Palliative

30Gy/10fx; 20Gy/5fx; 8Gy/1fx

30
Q

5 R’s of radiobiology

A

Fractioned radiotherapy is founded on five main features:
Repopulation
Increases the number of tumor cells to be destroyed → against treatment
Increases the number of normal tissue cells following irradiation → in favor of treatment
Repair
The application of radiotherapy in fractionated doses allows normal tissues time to repair
If an optimal interval is left between fractions (6–12 h), normal tissue cells responding late to radiation have the capacity for faster repair than tumor cells.
The repair of SLD in spinal cord is much slower than that in other normal tissues. Thus, the interfraction interval should be at least 8 h in spinal cord irradiation.
Redistribution (= reassortment)
Cells in resistant phases of the cell cycle may progress into a sensitive phase during the next dose fraction.
Reoxygenation
Oxygen is required for the indirect effect to occur, therefore hypoxic cells are 2-3 times more radioresistant
Radiosensitivity
involves multiple components
Radiosensitivity may be affected by environmental conditions.
radiosensitivity is directly proportional to mitosis and inversely proportional to differentiation.

31
Q

Brainstem

A

TD 5/5 of 50Gy to entire brainstem and 60Gy to 1/3 of the brainstem

QUANTEC
Entire brainstem can tolerate 54Gy with a < 5% risk of brainstem necrosis or neurological toxicity.
Small volumes (1-10 cc) can tolerate up to 59 Gy while a point (< 1 cc) may receive up to 64Gy.

32
Q

Spinal cord

A

Max dose of 50 Gy to spinal cord <0.2% risk of myelopathy

Paralysis, sensory, deficits, pain, and bowel/bladder incontinence

33
Q

Chiasm & Optic Nerves

A
Infrequent
Rapid painless visual loss
Whole organ dose of 50Gy has a  < 1% risk of blindness
< max 55Gy = rare
Max 55 -60 Gy = 3 – 7% risk
> 60Gy risk greatly increases
34
Q

retina

A

Recommendation of max dose < 50Gy

Retinopathy- results in loss of vision

35
Q

cochlea

A

Hearing loss
High frequency more common
Recommended mean ≤ 45Gy
Cisplatin-based chemotherapy can have an additional adverse effect on hearing loss

36
Q

parotid

A

Xerostomia
Sparing 1 parotid (mean < 20Gy) reduces incidence of grade 4 xerostomia
Or both means < 25Gy

37
Q

mandible

A

Osteoradionecrosis

Recommended point dose dmax of ≤70Gy

38
Q

Pharyngeal Constrictors

A

Dysphagia & aspiration

Recommended mean dose of < 60Gy when possible

39
Q

larynx

A

Vocal dysfunction & laryngeal edema

Mean <44Gy <20% Edema

40
Q

Brachial plexus

A

Pain, paresthesias or motor deficits of the upper extremity
Muscular atrophy and edema may develop
Late effect
5-20 years post radiation
Max dose of 60Gy has < 5% risk of nerve damage after 5 years

41
Q

lung

A

Seen in lung, breast & mediastinal lymphatics
V20 is the most useful parameter for predicting the risk of radiation pneumonitis
V20 <30%, <20% risk
Mean 20Gy, <20% risk

42
Q

esophagus

A

Acute esophagitis
During radiotherapy
Mean < 34Gy

43
Q

heart

A

Clinical pericarditis & long-term cardiac mortality
Breast & Hodgkin’s Lymphoma
V25 < 10% has a <1% probability of cardiac mortality at 15 years after radiotherapy

44
Q

liver

A

Radiation-induced liver disease typically occurs between 2 weeks and 3 months after radiotherapy
Mean 30-32Gy, <5% risk,

45
Q

kidney

A

Renal dysfunction

bilateral mean <15-18m, V20 <32%

46
Q

stomach

A

Dyspepsia & ulceration

D100 <45Gy

47
Q

Small bowel

A

Individual loops V15 <120cc

Peritoneal Cavity V45 <195cc

48
Q

rectum

A

High doses are most important in determining risk of toxicity
V50 <50%
V70 <20%

49
Q

bladder

A

<65