xHypoxia and repopulation of tumour clonogens are two important determinants of treatment outcome in radiotherapy. In general clinical evidence indicates that loco-regional control may be reduced with long overall treatment times and for tumours with low pre-treatment levels of oxygen. Experimental studies with normobaric carbogen and oxygen showed a two-fold enhancement of the efficacy of radiation in a mouse tumour model when combining oxygen with treatment acceleration. It was then demonstrated that substituting carbogen for oxygen and adding high-dose nicotinamide (NAM) further increased the effect. These findings became the basis for a multi-factorial approach designed to overcome the radioprotective effect of tumour repopulation and that of perfusion–limited and diffusion–limited hypoxia. The strategy, named ARCON, combines Accelerated Radiotherapy with CarbOgen and Nicotinamide. Experimental evaluation of ARCON The therapeutic potential of carbogen combined with NAM (CON) focusing on treatment schedules that use clinically relevant radiation and drug dose levels was evaluated in tumour and normal tissue animal models. Some of the conditions under which ARCON gives the largest degree of tumour radiosensitization and therapeutic benefit were identified. Specifically, NAM-dose level, pharmacokinetics and scheduling, and the effect of NAM on repair processes in vivo were also investigated. The results showed that in conventional and accelerated radiotherapy, carbogen and CON are effective and relatively non-toxic tumour sensitizers. They also demonstrated that tumour sensitization with CON was independent of time of NAM administration but that it was drug dose dependent. Some degree of normal tissue sensitization was observed but even relative to mouse skin a significant therapeutic gain was achieved. The mechanism of action for NAM sensitization originally proposed was that of repair inhibition. In the in vivo mouse models tested, namely skin and kidney, NAM did not alter the rate nor the magnitude of repair of radiation induced damage. Clinical evaluation of ARCON In the early 90s, various centres, particularly in the UK, Sweden, Holland and Switzerland, undertook clinical trials of ARCON. The protocols were designed based on detailed considerations of the rodent and human radiation and pharmacokinetic studies. This document also discusses the findings of a phase II non-randomized trial in advanced bladder cancer of accelerated radiotherapy combined with carbogen alone and ARCON. The aim of the study was to establish the feasibility of administering carbogen and NAM to patients and to determine the extent of early and late normal tissue damage. Historical comparisons suggested no overt increase in normal tissue radiosensitivity and the data indicate that ARCON could achieve a therapeutic gain in advanced bladder cancer.

Orientador: Marco Antônio Rodrigues Fernandes / Resumo: O sucesso da radioterapia está intimamente ligado à razão terapêutica que representa o quociente entre a quantidade de tecido tumoral irradiado e o volume de tecido sadio atingido. A Probabilidade de Complicação em Tecidos Normais (NTCP) e a Probabilidade de Controle do Tumor (TCP) são parâmetros fornecidos por Sistemas de Planejamentos de Tratamentos (TPS) computadorizados, usados na rotina da radioterapia que auxiliam na interpretação da qualidade do tratamento. Neste trabalho são analisados os planejamentos de radioterapia de 03 pacientes portadores de câncer de próstata. Os planejamentos dos tratamentos foram realizados no TPS XiO, simulando as técnicas de radioterapia por intensidade modulada de feixe (IMRT) e radioterapia tridimensional conformada (3D-CRT). A dose de radiação preconizada para o volume de tratamento planejado (PTV) foi de 7.600 cGy, as simulações foram realizadas para um arranjo de 6 campos de radiação com feixes de raios X de megavoltagem e energia de 10 MV. Os volumes prostáticos variaram entre 107 cm3 e 143 cm3. A dose de cobertura D98% do PTV variou de 6.940 cGy a 7.570 cGy com IMRT e de 6.410 cGy a 7.250 cGy com 3D-CRT. Os valores obtidos para o TCP ficaram entre 73,5% a 81,1% com IMRT e entre 70,6% a 75,9% com 3D-CRT. Considerando os valores de NTCP para o reto e a bexiga, os maiores valores encontrados foram 6,9% para o reto e 6,1% para a bexiga, ambos planejados com a técnica de 3D-CRT. Para os casos analisados, os resultados mostram que a técnic... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The success of radiotherapy is closely related to the therapeutic ratio which represents the ratio of the amount of irradiated tumor tissue to the volume of healthy tissue achieved. Normal Tissue Complication Probability (NTCP) and Tumor Control Probability (TCP) are parameters provided by computerized treatment planning systems (TPS), used in radiotherapy routine and also allow the interpretation of treatment quality. The aim of this work is analyze the planning of 03 cases of patients submitted to prostate cancer radiotherapy. The treatment plans were performed in TPS XiO, simulating the techniques of beam intensity modulated radiotherapy (IMRT) and tree-dimensional conformal radiation therapy (3D-CRT). The recommended radiation dose for the planned treatment volume (PTV) was 7600 cGy, the simulations were performed for an arrangement of 6 radiation fields with megavoltage X-ray beams and 10 MV energy. Prostatic volumes ranged from 107cm3 to 143cm3 . The D98% PTV coverage dose ranged from 6,940 cGy to 7,570 cGy with IMRT and from 6,410 cGy to 7,250 cGy with 3D-CRT. The values obtained for TCP were between 73.5% to 81.1% with IMRT and between 70.6% to 75.9% with 3D-CRT. Considering the NTCP values for the rectum and bladder, the highest values found were 6.9% for the rectum and 6.1% for the bladder, both planned using the 3D-CRT technique. For the analyzed cases, the results show that the IMRT technique presents better NTCP and TCP values than the 3D-CRT technique. These par... (Complete abstract click electronic access below) / Mestre