Tumours are characterised by unorganised vasculature, which often results in hypoxic regions. Hypoxia is a common cause for photon radiotherapy (RT) treatment failure, as hypoxic cells require up to 2-3 times higher doses compared to well-oxygenated cells for the same effect in terms of cell kill. The increase in dose that would be required to treat the tumours of cancer patients is limited by the radiation sensitivity of surrounding normal tissues. Using carbon ions instead of photons, the radiation dose can be conformed to the tumour to a much higher degree, resulting in an improved sparing of normal tissues. In addition, carbon ions have a much higher radiobiological effectiveness near the end of their range, which is positioned in the tumour. Also, the radiation modes of action leading to cell death when carbon ions interact with living tissues, are less sensitive to the oxygen status compared with the action modes of photons. The focus of this thesis lies in the development of models for the computation of the cell surviving fraction and tumour control probability (TCP) in hypoxic tumours after photon and carbon ion RT. The impact of fractionation was evaluated with regard to possible spatial changes in oxygenation, both for stereotactic body RT and for carbon ion RT. The feasibility of a method to determine and deliver the optimal photon dose for achieving a high TCP according to spatial variations in radiation sensitivity was evaluated in a treatment planning study. The radiobiological models were finally used for the theoretical quantification of the gain in using carbon ions instead of photons. The results show that there are great possibilities to increase the number of positive outcomes of radiation treatment of tumours if the key influential factors are taken into account, such as level and distribution of hypoxia, radiation quality and choice of fractionation schedule. / <p>At the time of the doctoral defence the following papers were unpublished and had a status as follows; Paper 3: Manuscript; Paper 4: Epubl ahead of print; Paper 5: Manuscript</p>

In radiotherapy, a quantity asked for by clinics when calculating a treatment plan, along withdose, is linear energy transfer. Linear energy transfer is defined as the absorbed energy intissue per particle track length and has been shown to increase with relative biologicaleffectiveness untill the overkilling effect. In this master thesis the dose averaged linear energytransfer from proton and carbon ion beams was simulated using the FLUKA multi purposeMonte Carlo code. The simulated distributions have been compared to algorithms fromRaySearch Laboratories AB in order to investigate the agreement between the computationmethods. For the proton computation algorithm improvements to the current scoring algorithmwere also implemented. A first version of the linear energy transfer validation code was alsoconstructed. Scoring of linear energy transfer in the RaySearch algorithm was done with theproton Monte Carlo dose engine and the carbon pencil beam dose engine. The results indicatedthat the dose averaged linear energy transfer from RaySearch Laboratories agreed well for lowenergies for both proton and carbon beams. For higher energies shape differences were notedwhen using both a small and large field size. The protons, the RaySearch algorithm initiallyoverestimates the linear energy transfer which could result from fluence differences in FLUKAcompared to the RaySearch algorithm. For carbon ions, the difference could stem from someloss of information in the tables used to calculate the linear energy transfer in the RaySearchalgorithm. From validation γ-tests the proton linear energy transfer passed for (3%/3mm) and(1%/1mm) with no voxels out of tolerance. γ-tests for the carbon linear energy transfer passedwith no voxels out of tolerance for (5%/5mm) and a fail rate of 2.92% for (3%/3mm).

Activated Carbon was produced from strong cation-exchange resins, sulphonated styrene divinylbenzene copolymers originally in H+ form, by means of carbonization and steam activation in an electrical furnace. One macroporous resin produced by BAYER Chemicals Inc., Lewatit MonoPlus SP 112 H, was used in the research. Products of carbonization and activation were characterized by using BET, Mercury Porosimetry, Helium Pycnometry and SEM techniques. The effect of carbonization time and temperature on the BET surface areas of the resins were also investigated. Two sets of carbonization experiments (Set 1 and 2) were performed in which time and temperature were varied in order to study their effects on the BET surface areas of the products. In activation experiments (Set 3), carbonized ion-exchangers (600 oC, 1 hr) were activated with steam at 900&deg / C, changing the time of activation and the steam flow rate. The temperatures of the water bath used for steam generation were selected as 60&deg / C, 80&deg / C and 90&deg / C. The pore structures of activated carbons were determined by proper techniques. The volume and area of macropores in the pore diameter range of 8180-50 nm were determined by mercury intrusion porosimetry. Mesopore (in the range of 50-2 nm) areas and volumes were determined by N2 gas adsorption technique at -195.6oC, BET surface areas of the samples were also determined, in the relative pressure range of 0.05 to 0.02, by the same technique. The pore volume and the area of the micropores with diameters less than 2 nm were determined by CO2 adsorption measurements at 0oC by the application of Dubinin Radushkevich equation. In the experiments of Sets 1 and 2, the BET surface area results of the six different carbonization times ranging from 0.5 to 3 hours gave almost the same value with a maximum deviation of 5% from the average showing almost no effect on the areas of the products. In the experiments of Set 3 , the sample activated at 800&deg / C for 6 hrs had the highest BET area, 2130 m2/g, and the one activated at 800&deg / C for 1 hr had the lowest BET area 636 m2/g. N2 adsorption/ desorption isotherms showed no distinct hysteresis indicating a cylindrical geometry of the pores. Adsorption isotherms further indicated that the pores are both highly microporous and mesoporous. N2 (BET) and CO2 (D-R) surface areas of the samples were in the range of 636-2130m2/g and 853-1858 m2/g, respectively. Surface areas of the samples consisted of about 8-53% mesopores and 47-92% micropores.

京都大学 / 新制・課程博士 / 博士(工学) / 甲第23883号 / 工博第4970号 / 新制||工||1776(附属図書館) / 京都大学大学院工学研究科機械理工学専攻 / (主査)教授 蓮尾 昌裕, 教授 鈴木 基史, 教授 江利口 浩二 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

Multi-ion radiotherapy has been suggested as a new way to treat cancer, combining the radiological advantages of lighter and heavier ions in a single treatment to improve plan robustness and increase LETd in the target. To succeed, multi-ion radiotherapy requires a treatment planning system capable of computing dose for and optimising multi-ion treatment plans. In this project, prototypical multi-ion radiotherapy treatment planning support has been implemented in the RayStation treatment planning system. The existing dose engine for helium and carbon ion beams has been extended to support protons, oxygen and neon ions, and support has been added for dose computation and plan optimisation for any combination of these ion species. The implemented functionality has been evaluated in two phantom cases and a patient case. Multi-ion treatment plans have been shown to outperform carbon ion treatment plans in terms of simultaneously providing plan robustness, uniform RBE-weighted dose and high LETd. In the patient case, the multi-ion plan displayed significant improvements in the ability to "paint" high LETd in the target. Clinical studies are required to determine to what extent this new modality increases treatment quality in practice.

La radiothérapie externe est un traitement anticancéreux locorégional efficace et curatif. Néanmoins, il y a toujours des malades qui meurent de tumeurs locales non-contrôlées. Les nouvelles techniques en radiothérapie visent toujours à trouver un moyen d'augmenter la dose à la tumeur tout en réduisant au minimum la dose aux tissus sains adjacents. Une des dernières techniques innovantes est l'hadronthérapie par ions carbone. Ces dix dernières années ont vu augmenter le nombre de nouveaux centres d hadronthérapie dans le monde avec des faisceaux d'ions carbone, forts des résultats promettant des projets pilotes Berkeley (USA), Chiba (Japon) et Darmstadt (Allemagne). Les avantages théoriques des ions carbone sont: une meilleure balistique et une meilleure efficacité dans la destruction des cellules tumorales. Ainsi cette technique a le potentiel d'augmenter le contrôle des tumeurs, particulièrement pour celles inopérables et radiorésistantes. Les effets biologiques varient le long de la trajectoire des ions de haut TEL (Transfert d'´Énergie Linéique) comme les ions carbone. Ainsi des modèles radiobiologiques sont nécessaires pour quantifier les effets biologiques. Il existe plusieurs modèles radiobiologiques qui reposent sur des approches et des approximations théoriques différentes. Ces modèles ont été développés au sein de chacune des institutions où se déroulaient les projets pilotes. Au stade actuel des connaissances, il semble peu probable d'atteindre une rapide convergence des résultats produits par ces différents modèles. Parmi les modèles radiobiologiques utilisés en clinique, il y a le Local Effect Model (LEM), développé en Allemagne et implémenté dans les systèmes de planification de traitement certifiés CE, le modèle de la National Institute of Radiological Science (NIRS), employé dans les centres japonais d'hadronthérapie possédant un système d'irradiation passif, et le Microdosimetric Kinetic Model (MKM) employé dans les centres japonais d'hadronthérapie possédant un système d'irradiation actif en mode pencil beam scanning / External beam radiotherapy (EBRT) is a therapy technique aiming at treating locoregional tumors with high efficiency. However, many tumors remain uncontrolled. Newest EBRT techniques always aim at increasing the dose to the tumor while sparing the surrounding healthy tissues. Carbon-ion beam therapy is one of these promising techniques. The number of clinical centres offering carbon-ion beam radiotherapy has been increasing over the world for the last decade. This keen interest spread after very promising results from pilot projects at Berkeley (USA), Chiba (Japan) and Darmstadt (Germany). The theoretical advantages of carbon-ionsare better spatial selectivity in dose deposition and better efficiency in cell killing. They have thus the potential to increase the control of tumors, particularly for unresectable radioresistant tumors. In high linear-energy-transfer (LET) radiations, such as carbon-ion beams, biological effects vary along the ion track, hence, to quantify them, specific radiobiological models are needed. There exist several radiobiological models based on very different theoretical approaches and approximations. They were created and improved in each of the pilot institutions. At the current state of knowledge, no convergence between the model results seems to be possible in the very near future. Clinically employed radiobiological models are the Local Effect Model (LEM) developed in Germany and implemented in CE-certified treatment planning systems, the National Institute of Radiological Science (NIRS) model employed in Japanese centres with passive beam delivery systems and the microdosimetric kinetic model (MKM) in Japanese centres with active scanning beam delivery systems

Les carcinomes épidermoïdes de la tête et du cou sont souvent de mauvais pronostic, en raison de leur résistance aux traitements suivie de récidives loco-régionales, voire de métastases. Ce travail s'est focalisé sur le rôle des cellules souches cancéreuses (CSC) dans la radiorésistance d'un modèle cellulaire de cancer du larynx, SQ20B, ainsi que sur leur ciblage thérapeutique en association avec la radiothérapie photonique ou par ions carbone. Une sous-population a été isolée à partir de la lignée SQ20B par tris cellulaires successifs selon 3 critères spécifiques des CSC de tumeurs ORL : exclusion du Hoechst 33342, expression de CD44 et activité élevée de l'aldéhyde déshydrogénase (ALDH). Les cellules SQ20B/SP/CD44 high/ALDHhigh présentent bien les caractéristiques de CSC (tumorisphères, tumorigénèse, radiorésistance). La résistance des CSC aux 2 types d'irradiation, par rapport aux cellules « non souche » SQ20B/SP/CD44low/ALDHlow, implique une diminution de la mort par apoptose, une augmentation des capacités prolifératives ainsi qu'une surexpression de la voie de l'autorenouvellement Bmi1. L'effet radiosensibilisant de 3 molécules ciblant les CSC a été démontré : la mort apoptotique induite par l'UCN-01 en inhibant l'arrêt en phase G2/M ; les capacités prolifératives ciblées par l'acide trans-rétinoïque (ATRA) induisant la différenciation ; et la voie de l'autorenouvellement Bmi-1 inhibée par l'artésunate. Seule ou associées (UCN-01 + ATRA), elles agissent en synergie avec une irradiation par photons ou ions carbone. Des études pré-clinique, puis clinique, devraient confirmer l'intérêt du ciblage des CSC dans le contrôle de l'échappement de ces cancers radiorésistants / Head and neck squamous cell carcinomas (HNSCC) have a poor prognosis, due to their resistance to standard treatments. In most cases, locoregional recurrence or metastases occur. This study has focused on the role of cancer stem cells (CSC) in the radioresistance of the SQ20B HNSCC cell line and their therapeutic targeting in association with photon or carbon ions irradiation. A subpopulation of SQ20B-CSC has been isolated by cell sorting based on 3 specific characteristics of HNSCC-CSC : Hoechst 33342 exclusion, CD44 expression and high aldehyde dehydrogenase activity (ALDH). SQ20B/SP/CD44high/ALDHhigh cells show the CSC characteristics (in vitro and in vivo tumorigenesis, high radioresistance). The response of CSC to both types of irradiation was compared to the non-“stem cells” SQ20B/SP/CD44low sub-population. The observed radioresistance involves a decrease in apoptotic cell death, an increase in proliferative capacities and an overexpression of the Bmi1 self-renewing signaling pathway. The radiosensitizing effects of 3 molecules targeting the CSC has been demonstrated : an induction of apoptotic cell death by the inhibition of the G2/M phase arrest after a treatment with UCN01 ; an inhibition of proliferative capacities using the all-trans-retinoic acid (ATRA) which induce their differentiation ; and an inhibition of Bmi1 by artesunate. These treatments, alone or in combination (UCN01+ATRA) have a synergistic effect with photon or carbon ion irradiation to overcome CSC radioresistance. Preclinical and clinical studies should confirm the benefit of targeting CSC and improve the control of tumor escape in patients with radioresistant HNSCC cancers