Recently a powerful electron accelerator, 50 MeV race-track microtron, has been taken into clinical use. This gives the opportunity to treat patients with higher x-ray and electron energies than before. Furthermore, treatments can be performed were the entire fractional dose can be delivered in parts of a second. The relative biological effectiveness (RBE) of high energy photons (up to 50 MV) was studied in vitro and in vivo. Oxygen enhancement ratio (OER) of 50 MV photons and RBE of 50 MeV electrons were investigated in vitro. Single-fraction experiments, in vitro, using V-79 Chinese hamster fibroblasts showed an RBE for 50 MV x-rays of approximately 1.1 at surviving fraction 0.01, with reference to the response to 4 MV x- rays. No significant difference in OER could be demonstrated. Fractionation experiments were carried out to establish the RBE at the clinically relevant dose level, 2 Gy. The RBE calculated for the 2 Gy/fraction experiments was 1.17. The RBEs for 20 MV x-rays and 50 MeV electrons were equal to one. In order to investigate the validity of these results, the jejunal crypt microcolony assay in mice was used to determine the RBE of 50 MV x-rays. The RBE for 50 MV x-rays in this case was estimated to be 1.06 at crypt surviving fraction 0.1. Photonuclear processes are proposed as one possible explanation to the higher RBE for 50 MV x-rays. Several studies of biological response to ionizing radiation of high absorbed dose rates have been performed, often with conflicting results. With the aim of investigating whether a difference in effect between irradiation at high dose rates and at conventional dose rates could be verified, pulsed 50 MeV electrons from a clinical accelerator were used for experiments with ultra high dose rates (mean dose rate: 3.8 x 10^ Gy/s) in comparison to conventional (mean dose rate: 9.6 x 10"^ Gy/s). V-79 cells were irradiated in vitro under both oxic and anoxic conditions. No significant difference in relative biological effectiveness (RBE) or oxygen enhancement ratio (OER) was observed for ultra high dose rates compared to conventional dose rates. A central issue in clinical radiobiological research is the prediction of responses to different radiation qualities. The choice of cell survival and dose response model greatly influences the results. In this context the relationship between theory and model is emphasized. Generally, the interpretations of experimental data are dependent on the model. Cell survival models are systematized with respect to their relations to radiobiological theories of cell kill. The growing knowledge of biological, physical, and chemical mechanisms is reflected in the formulation of new models. This study shows that recent modelling has been more oriented towards the stochastic fluctuations connected to radiation energy deposition. This implies that the traditional cell survival models ought to be complemented by models of stochastic energy deposition processes at the intracellular level. / <p>S. 1-44: sammanfattning, s. 47-130: 5 uppsatser</p> / digitalisering@umu

Submitted by Claudinei Pracidelli (cpracide@ipen.br) on 2016-06-22T11:34:19Z No. of bitstreams: 0 / Made available in DSpace on 2016-06-22T11:34:19Z (GMT). No. of bitstreams: 0 / Tese (Doutorado em Tecnologia Nuclear) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

A modelagem em radiobiologia possibilita prever a eficácia de tratamentos radioterápicos, especificando protocolos e estratégias para se tratar pacientes com câncer. Muitos modelos matemáticos têm sido propostos para a avaliação da Probabilidade de Controle Tumoral (TCP). Nesta tese, inicialmente apresenta-se um estudo desenvolvido em colaboração com pesquisadores da Universidade de Alberta, no Canadá, em que são comparadas as TCP\'s obtidas através de simulações Monte Carlo e dos modelos Poissoniano, de Zaider-Minerbo (ZM) e de Dawson-Hillen (DH). Os resultados mostram que, para tumores de baixa proliferação celular, o uso do modelo Poissoniano para indicação de protocolos de tratamento é tão eficaz quanto o método Monte Carlo ou o uso de modelos mais sofisticados (ZM e DH). Na segunda parte da tese, propõe-se um teste estatístico, baseado em simulações Monte Carlo do modelo de TCP de DH, para se determinar a capacidade de previsão de erradicação de tumor (cura). Obtem-se a curva ROC do teste a partir das distribuições de probabilidade da fração de células tumorais remanescentes, nas condições de cura ou não-cura. Os resultados mostram que o método pode ser também aplicado a dados clínicos, sugerindo que a avaliação do tamanho do tumor no início da radioterapia permite a prognose do tratamento a curto prazo. Na terceira parte da tese, aborda-se o estudo da fração de sobrevivência (FS) de células tumorais em função da dose de radiação a que são submetidas. Na literatura, esta fração de sobrevivência tem sido formulada através do modelo Linear-Quadrático (LQ) e, mais recentemente, da estatística não-extensiva de Tsallis. Avalia-se o comportamento dessas duas formulações em termos dos ajustes da FS a dados experimentais da literatura (referentes a células cultivadas in vitro para vários tecidos tumorais) estendendo-se assim estudos prévios da literatura. Os parâmetros da FS para ambas formulações são obtidos e a qualidade dos ajustes da FS a dados experimentais é comparada utilizando-se o qui-quadrado reduzido. Os resultados mostram que, em geral, as duas formulações permitem bons ajustes das curvas de FS. Além deste estudo, utilizamos a estatística não-extensiva de Tsallis para obtenção da TCP de ZM em função da dose, expressando-a analiticamente em termos da função Gama (para um perfil de dose típico de radiação de feixe externo) e da função Hipergeométrica (para um perfil de dose típico de braquiterapia). Finalmente, as curvas das correspondentes TCP\'s são levantadas com o uso de dados experimentais e comparadas com a TCP\'s obtidas através do modelo LQ. / Radiobiological modeling allows one to predict the efficacy of radiotherapeutic treatments, specifying protocols and strategies to treat patients with cancer. Many mathematical models have been proposed to evaluate the Tumor Control Probability (TCP). In this thesis we first present a study in colaboration with researchers at the University of Alberta, Canada, in which we compare the TCPs obtained by Monte Carlo simulations and from the Poissonian, Zaider-Minerbo (ZM) and Dawson-Hillen (DH) models. Results show that, for low proliferation tumors, the use of the Poissonian model for indicating the treatment protocol is as effective as the Monte Carlo method or more sofisticated models (ZM and DH). in the second part of the thesis, we propose a statistical test based on Monte Carlo simulations of the DH TCP model to determine the prediction capacity of tumor eradication (cure). We obtain the ROC curve of the test from the probability distributions of the remaining tumor cells for conditions of cure and non-cure. Results show that the method can also be applied to clinical data suggesting that the evaluation of the tumor size at the beginning of the radiotherapy leads to a short-term prognosis of the treatment. In the third part of the thesis, we study the surviving fraction (FS) of tumor cells as function of the radiation dose to which they are subjected. In the literature, this surviving fraction has been formulated by the Linear-Quadratic (LQ) model and, more recently, from the Tsallis non-extensive statistics. We evaluate the behaviour of both formulations in terms of the FS fittings to experimental data in the literature (related to cells cultivated for several tumoral tissues) so that we extend previous studies in the literature. The FS parameters for both formulations are obtained and the quality of the FS fittings to experimental data is compared using the reduced chi-square. Results show that in general both formulations lead to very good FS-curve fittings. Furthermore, we use the Tsallis non-extensive statistics to obtain the ZM TCP as function of the dose, expressing it analitically in terms of the Gamma function (for a dose profile typical of external beam radiation) and the Hipergeometric function (for a dose profile typical of brachitherapy). Finally, the curves of the corresponding TCPs are plotted using experimental data and then compared with TCPs obtained from the LQ model.

Submitted by Claudinei Pracidelli (cpracide@ipen.br) on 2016-06-22T11:34:19Z No. of bitstreams: 0 / Made available in DSpace on 2016-06-22T11:34:19Z (GMT). No. of bitstreams: 0 / A Radioterapia em arco modulado volumétrico (VMAT) é uma das modalidades mais avançadas em teleterapia para o tratamento de câncer. Os diversos avanços tecnológicos, bem como a evolução das técnicas de tratamento tornaram o VMAT como uma das modalidades de estado da arte para o tratamento de alguns cânceres. Parte deste avanço é creditada à melhoria na acurácia e na prescrição de dose absorvida recomendada ao paciente ao longo dos anos. Este avanço permite que atualmente seja possível realizar os cálculos dosimétricos, por meio de sistemas de planejamento computadorizado, considerando as heterogeneidades dos pacientes, tais como: tecidos e órgãos com composições diferentes da água (meio de referência em radioterapia), contorno do paciente individualizado e o movimento dos tumores com a respiração. Tais avanços demandam o controle de qualidade destas ferramentas, com objetivo de assegurar que todo o processo de tratamento seja satisfatório e acurado. A comunidade dispõe poucos sistemas experimentais capazes de avaliar, considerando os níveis de incerteza, se os sistemas de planejamento computadorizados são aptos a considerar a movimentação dos alvos nos tratamentos com VMAT. Neste trabalho serão apresentados os resultados obtidos empregando um objeto simulador Fricke Xylenol Gel, com capacidade de mensurar as diferenças introduzidas pela movimentação, utilizando Imagem por Ressonância Magnética - MRI e comparando qualitativamente e quantitativamente os resultados. São discutidas as principais etapas de desenvolvimento deste objeto simulador, seus resultados experimentais, conclusões. / Tese (Doutorado em Tecnologia Nuclear) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Thesis (MSc (Radiography))--Cape Peninsula University of Technology, 2018 / Background: Breast cancer is one of the most commonly diagnosed among woman in South Africa, and a more resilient effort should be focused on treatment improvements. Worldwide, proton therapy is increasingly used as a radiation treatment alternative to photon therapy for breast cancer, mostly to decrease the risk for radiation-induced cardiovascular toxicity. This in vitro study aims to determine a better understanding of the radiosensitivity of both tumour and normal breast cell lines to clinical proton irradiation. In addition, we propose to investigate whether the increase in linear energy transfer (LET) towards the distal part of the proton beam results in an increase in relative biological effectiveness (RBE) for both cell lines. Methods: Malignant (MCF-7) and non-malignant (MCF-10A) breast cells were irradiated at different water equivalent depths in a 200 MeV proton beam at NRF iThemba LABS using a custom-made Perspex phantom: the entrance plateau, 3 points on the Bragg peak, the D80% and the D40%. A cytokinesis-block Micronucleus (CBMN) assay was performed and Micronuclei (MNi) were manually counted in binucleated cells (BNCs) using fluorescent microscopy. Reference dosimetry was carried out with a Markus chamber and irradiations were performed with a clinical proton beam generated at NRF iThemba LABS that was degraded to a R50 (half-value depths) range of 120 mm, with a field size of 10 cm x 10 cm and a 50 mm SOBP. The phantom could be adjusted to accommodate different perspex plates depending on the depth required within the proton beam. Cells were then exposed to 0.5, 1.0, 2.0, 3.0 and 4.0 Gy doses for each cell line independently and for each dose point. Results and Discussion: For the CBMN results, a program was developed on Matlab platform to calculate the 95% confidence ellipse on the co-variance parameters α and β. These values were determined by fitting the linear quadratic dose response curve to the average number of radiation induced MNi per 1000 BN cells. The ellipse region around a coordinate (the average MN frequency) for both MCF-7 and MCF-10A cells at the plateau region was defined by the mean estimate of the α-value and the β-value that were plotted on the X-axis and Y-axis respectively. The ratio of the two parameters, α/β, is a measure of the impact of fractionation to determine the biological effective dose. In fractionated proton therapy, the MCF10A cells will repair less between two fractions compared to the MCF7 cells. This is not an indication of therapeutic gain from a fractioned treatment protocol. For this reason, the hypofractionated stereotactic treatment protocols that can be applied with protons could be to the befit of the breast cancer patient. The above argument is based only on the radiosensitivity of the two cell lines exposed in the plateau region. Further analysis of the 95% confidence ellipse of both cell lines also showed a clear increase of the alpha value toward the distal portion of the beam and indicates an increase in energy transfer in this region. The gradual increase in α and β parameters with depth for protons for both cells is of clinical importance, since it implicates a non-homogeneous dose within the targeted area and an unwanted high dose behind the targeted area. Distal energy modulation could be investigated especially with larger breast tumours. RBE was calculated as the ratio of the dose at the different positions to the dose at the entrance plateau position (reference) to obtain an equal level of biological effect. A statistically significant difference in radiosensitivity could be observed between malignant and non-malignant cells at all positions (p<0.05). The variation in RBE was between 0.99 to 1.99 and 0.92 to 1.6 for the MCF-7 and MCF10A cell respectively. Conclusions: There is a variation in RBE along the depth-dose profile of a clinical proton beam. In addition, there is difference in radiosensitivity between the cancerous cells and the normal breast cells. While this study highlights a variation in sensitivity between cells it could be used by the modelling community to further develop biologically motivated treatment planning for proton therapy.

L’interaction des particules chargées avec la matière conduit à un dépôt d’énergie très localisé dans des traces de dimensions sub-micrométriques. Cette propriété unique rend ce type de rayonnement ionisant particulièrement intéressant pour disséquer les mécanismes moléculaires radio-induits suite à l’échelle de la cellule. L’utilisation de microfaisceaux de particules chargées offre en outre la capacité d’irradier sélectivement à l’échelle du micromètre avec une dose contrôlée jusqu’à la particule unique. Mon travail a porté sur des irradiations réalisées avec le microfaisceau de particules chargées de la plateforme AIFIRA (Applications Interdisciplinaires des Faisceaux d’Ions en Région Aquitaine) du CENBG. Ce microfaisceau délivre des protons et particules alpha et est dédié aux irradiations ciblées in vitro (cellules humains) et in vivo (C. elegans).En complément de l’intérêt qu’elles présentent pour des études expérimentales, les dépôts d’énergie et les interactions des particules chargées avec la matière peuvent être modélisés précisément tout au long de leur trajectoire en utilisant des codes de structures de traces basés sur des méthodes Monte Carlo. Ces outils de simulation permettent une caractérisation précise de la micro-dosimétrie des irradiations allant de la description détaillée des interactions physiques à l’échelle nanométrique jusqu’à la prédiction du nombre de dommages à l’ADN et leurs distributions dans l’espace.Au cours de ma thèse, j’ai développée des modèles micro-dosimétriques basés sur l’outil de modélisation Geant4-DNA dans deux cas. Le premier concerne la simulation de la distribution d’énergie déposée dans un noyau cellulaire et le calcul du nombre des différents types de dommages ADN (simple et double brin) aux échelles nanométrique et micrométrique, pour différents types et nombres de particules délivrées. Ces résultats sont confrontés à la mesure expérimentale de la cinétique de protéines de réparation de l’ADN marquées par GFP (Green Fluorescent Protein) dans des cellules humaines. Le second concerne la dosimétrie de l’irradiation d’un organisme multicellulaire dans le cadre d’études de l’instabilité génétique dans un organisme vivant au cours du développement (C. elegans). J’ai simulé la distribution de l’énergie déposée dans différents compartiments d’un modèle réaliste en 3D d’un embryon de C. elegans suite à des irradiations par protons. Enfin, et en parallèle de ces deux études, j’ai développé un protocole pour caractériser le microfaisceau d'AIFIRA à l’aide de détecteurs de traces fluorescent (FNTD) pour des irradiations par protons et par particules alpha. Ce type de détecteur permet en effet de visualiser les trajectoires des particules incidentes avec une résolution de l’ordre de 200 nm et d’examiner la qualité des irradiations cellulaires réalisées par le microfaisceau. / The interaction of charged particles with matter leads to a very localized energy deposits in sub-micrometric tracks. This unique property makes this type of ionizing radiation particularly interesting for deciphering the radiation-induced molecular mechanisms at the cell scale. Charged particle microbeams (CPMs) provide the ability to target a given cell compartment at the micrometer scale with a controlled dose down to single particle. My work focused on irradiations carried out with the CPM at the AIFIRA facility in the CENBG (Applications Interdisciplinaires des Faisceaux d’Ions en Région Aquitaine). This microbeam delivers protons and alpha particles and is dedicated to targeted irradiation in vitro (human cells) and in vivo (C. elegans).In addition to their interest for experimental studies, the energy deposits and the interactions of charged particles with matter can be modeled precisely along their trajectory using track structure codes based on Monte Carlo methods. These simulation tools allow a precise characterization of the micro-dosimetry of the irradations from the detailed description of the physical interactions at the nanoscale to the prediction of the number of DNA damage, their complexity and their distribution in space.During my thesis, I developed micro-dosimetric models based on the Geant4-DNA modeling toolkit in two cases. The first concerns the simulation of the energy distribution deposited in a cell nucleus and the calculation of the number of different types of DNA damage (single and double strand breaks) at the nanometric and micrometric scales, for different types and numbers of delivered particles. These simulations are compared with experimental measurements of the kinetics of GFP-labeled (Green Fluorescent Protein) DNA repair proteins in human cells. The second is the dosimetry of irradiation of a multicellular organism to study the genetic instability in a living organism during development (C. elegans). I simulated the distribution of the energy deposited in different compartments of a realistic 3D model of a C. elegans embryo following proton irradiations. Finally, and in parallel with these two studies, I developed a protocol to characterize the AIFIRA microbeam using fluorescent nuclear track detector (FNTD) for proton and alpha particle irradiations. This type of detector makes it possible to visualize in 3D the incident particle tracks with a resolution of about 200 nm and to examine the quality of the cellular irradiations carried out by the CPM.

Proton sources driven by high-power lasers are a promising addition to the portfolio of conventional proton accelerators. Regarding particle cancer therapy, where tumours are irradiated with protons or ions, the novel accelerator technology can be particularly beneficial for translational research - the research branch in which results of basic research are transferred to new approaches for the prevention, diagnosis and treatment of cancer. The overarching aim in the thesis at hand was a translational pilot study to irradiate tumours on mice’s ears with laser-accelerated protons while achieving the quality level of conventional proton accelerators. This is the only way to compare the radiobiological data of the novel accelerator technology with those of the established ones. To enable such experiments a predetermined dose distribution according to the radiobiological model’s requirements must be delivered to a sample volume. Ergo, the laser-driven protons have to be transported and shaped after their initial acceleration. Intense laser-driven proton pulses, inherently broadband and highly divergent, pose a challenge to established beamline concepts on the path to application-adapted irradiation field formation, particularly for 3D. This work demonstrates the successful implementation of a highly efficient and tuneable pulsed dual solenoid setup to generate a homogeneous (laterally and in depth) volumetric dose distribution using only a single dose pulse from the broad laser-driven proton spectrum. The experiments using the ALBUS-2S beamline were conducted at the titanium:sapphire high-power laser Draco PW at the Helmholtz-Zentrum Dresden–Rossendorf. The beamline and its model were characterised and verified via independent methods, leading to first experimental studies providing volumetrically homogeneous dose distributions to detector targets as well as tumour and normal tissue in proof-of-concept studies. To perform the mouse pilot study, a new solenoid with cooling capacities was designed, characterised and implemented in the course of this thesis. The combination of the new solenoid and an overall performance improvement of the laser-proton accelerator, enabled the successful conduction of the mouse model study. The results show that laser-accelerated protons induce a comparable tumour growth delay as protons from conventional accelerators. This outcome and the demonstration of the flawless interaction between laser-proton accelerator, beam transport, dosimetry and biology qualify the laser-based accelerator technology for complex studies in translational cancer research. Looking into the future, their unique extremely high intensity renders them of particular interest for the investigation into the ultra-high dose rate regime. There, the so-called FLASH effect shows fewer side effects in normal tissue while maintaining the same effect in the tumour when the target dose is administered in milliseconds rather than minutes, as currently common. The ALBUS-2S setup at Draco PW already provides all necessary conditions to realise irradiation times of around ten nanoseconds in preclinical studies. This significantly expands the parameter space for investigating the FLASH effect and is presented as a proof-of-concept in this thesis. / Protonenquellen, die von Hochleistungslasern getrieben werden, sind eine vielversprechende Ergänzung zu herkömmlichen Protonenbeschleunigern. Im Hinblick auf die Partikeltherapie von Krebserkrankungen, bei der Tumoren mit Protonen oder Ionen bestrahlt werden, kann die neuartige Beschleunigertechnologie vor allem der translationalen Forschung von Nutzen sein, in der die Ergebnisse der Grundlagenforschung in neue Ansätze zur Vorsorge, Diagnose und Behandlung von Krebserkrankungen übertragen werden. Übergeordnetes Ziel der vorliegenden Arbeit war eine translationale Pilotstudie zur Bestrahlung von Tumoren an Mäuseohren mit laserbeschleunigten Protonen bei gleichzeitiger Erfüllung des Qualitätsniveaus konventioneller Protonenbeschleuniger. Mit den Ergebnissen ist ein Vergleich der strahlenbiologischen Daten der neuen und der etablierten Beschleunigertechnologie möglich. Um dieses Experiment zu realisieren, muss eine vorher festgelegte Strahlendosis, die den Anforderungen des radiobiologischen Modells entspricht, an ein Probenvolumen abgegeben werden. Die lasergetriebenen Protonenpulse müssen dafür nach ihrer Beschleunigung transportiert und geformt werden. Intensive lasergetriebene Protonenpulse sind von Natur aus breitbandig und stark divergent. Sie stellen eine Herausforderung für etablierte Beamline-Konzepte auf dem Weg zu einer anwendungsangepassten Bestrahlungsfeldbildung dar, insbesondere bei einer räumlichen Anwendung. Diese Arbeit zeigt die erfolgreiche Implementierung eines hocheffizienten und abstimmbaren gepulsten Zwei-Solenoid-Aufbaus zur Erzeugung einer homogenen (lateral und in der Tiefe) volumetrischen Dosisverteilung mit einem einzigen Dosispuls aus dem breiten lasergetriebenen Protonenspektrum. Die Experimente an der ALBUS-2S3 Beamline wurden am Titan:Saphir-Hochleistungslaser Draco4 PW am Helmholtz-Zentrum Dresden– Rossendorf durchgeführt. Die Beamline und ihr Modell wurden experimentell charakterisiert und mit unabhängigen Methoden verifiziert. Es konnten erste experimentelle Studien durchgeführt werden, bei denen volumetrisch homogene Dosisverteilungen auf Detektorziele sowie Tumor- und Normalgewebe in Proof-of-Concept Studien appliziert wurden. Für die Durchführung der Maus-Pilotstudie wurde im Rahmen dieser Arbeit ein neuer kühlbarer Solenoid entworfen, charakterisiert und implementiert. Zusammen mit einer allgemeinen Leistungsverbesserung des Laser-Protonen Beschleunigers wurde die Pilotstudie erfolgreich abgeschlossen. Sie zeigt, dass laserbeschleunigte Protonen eine vergleichbare Verzögerung des Tumorwachstums bewirken wie Protonen aus konventionellen Beschleunigern. Dieses Ergebnis und der Nachweis des einwandfreien Zusammenspiels von Laser- Protonen-Beschleuniger, Strahltransport, Dosimetrie und Biologie qualifizieren die laserbasierte Beschleunigertechnologie für komplexe Studien in der translationalen Krebsforschung. Mit Blick auf die Zukunft sind sie aufgrund ihrer einzigartigen, extrem hohen Intensität besonders interessant für die Untersuchung im Bereich ultrahoher Dosisleistungen. Dort zeigt der so genannte FLASH-Effekt weniger Nebenwirkungen im gesunden Normalgewebe bei gleicher Wirkung im Tumor. Die Zieldosis wird dabei innerhalb von Millisekunden verabreicht und nicht, wie derzeit üblich, innerhalb von Minuten. Der ALBUS-2S-Aufbau bei Draco PW bietet bereits alle notwendigen Voraussetzungen, um in präklinischen Studien Bestrahlungszeiten von etwa zehn Nanosekunden zu realisieren. Dies erweitert den Parameterraum für die Untersuchung des FLASH-Effekts erheblich und wird in dieser Arbeit auch als Proof-of-Concept vorgestellt.

La radiothérapie occupe une place majeure dans l’arsenal thérapeutique des cancers.Malgré des progrès technologiques importants depuis près de vingt ans, des tissus sains au voisinage ou à distance de la tumeur cible continuent à être inévitablement irradiés à des niveaux de doses très différents. Ces doses sont à l’origine d’effets secondaires précoces (Œdème, radionécrose, Dysphagie, Cystite) ou tardifs (rectorragies, télangiectasie, effets carcinogènes, les pathologie cérébrovasculaires).Il est donc primordial de quantifier et de prévenir ces effets secondaires afin d'améliorer la qualité de vie des patients pendant et après leur traitement.La modélisation du risque d'événements iatrogènes radio-induits repose sur la connaissance précise de la distribution de doses au tissu sain d'intérêt ainsi que sur un modèle de risque capable d'intégrer un maximum d'informations sur le profil d'irradiation et des autres facteurs de risques non dosimétriques. L'objectif de ce travail de thèse a été de développer des méthodes de modélisation capables de répondre à des questions spécifiques aux deux aspects, dosimétriques et statistiques, intervenant dans la modélisation du risque de survenue d'événements iatrogènes radio-induits.Nous nous sommes intéressé dans un premier temps au développement d'un modèle de calcul permettant de déterminer avec précision la dose à distance due au rayonnements de diffusion et de fuite lors d'un traitement par radiothérapie externe et ce, pour différentes tailles des champs et à différentes distances de l'axe du faisceau. Ensuite, nous avons utilisé des méthodes d'analyse de données fonctionnelles pour développer un modèle de risque de toxicité rectales après irradiation de la loge prostatique. Le modèle proposé a montré des performances supérieures aux modèles de risque existants particulièrement pour décrire le risque de toxicités rectales de grade 3. Dans le contexte d'une régression de Cox flexible sur données réelles, nous avons proposé une application originale des méthodes de statistique fonctionnelle permettant d'améliorer les performances d'une modélisation via fonctions B-splines de la relation dose-effet entre la dose de radiation à la thyroïde.Nous avons également proposé dans le domaine de la radiobiologie une méthodes basée sur l’analyse en composantes principales multiniveau pour quantifier la part de la variabilité expérimentale dans la variabilité des courbes de fluorescence mesurées. / Radiotherapy plays a major role in the therapeutic arsenal against cancer. Despite significant advances in technology for nearly twenty years, healthy tissues near or away from the target tumor remain inevitably irradiated at very different levels of doses. These doses are at the origin of early side effects (edema, radiation necrosis, dysphagia, cystitis) or late (rectal bleeding, telangiectasia, carcinogenic, cerebrovascular diseases). It is therefore essential to quantify and prevent these side effects to improve the patient quality of life after their cancer treatment.The objective of this thesis was to propose modelling methods able to answer specific questions asked in both aspects, dosimetry and statistics, involved in the modeling risk of developing radiation-induced iatrogenic pathologies.Our purpose was firstly to assess the out-of-field dose component related to head scatter radiation in high-energy photon therapy beams and then derive a multisource model for this dose component. For measured doses under out-of-field conditions, the average local difference between the calculated and measured photon dose is 10%, including doses as low as 0.01% of the maximum dose on the beam axis. We secondly described a novel method to explore radiation dose-volume effects. Functional data analysis is used to investigate the information contained in differential dose-volume histograms. The method is applied to the normal tissue complication probability modeling of rectal bleeding for In the flexible Cox model context, we proposed a new dimension reduction technique based on a functional principal component analysis to estimate a dose-response relationship. A two-stage knots selection scheme was performed: a potential set of knots is chosen based on information from the rotated functional principal components and the final knots selection is then based on statistical model selection. Finally, a multilevel functional principal component analysis was applied to radiobiological data in order to quantify the experimental Variability for replicate measurements of fluorescence signals of telomere length.

Le cancer de l’ovaire est la première cause de décès par cancer gynécologique en France et il présente un fort taux de récidive justifiant la recherche de nouvelles thérapeutiques. Notre projet consiste à développer et à explorer sur des modèles expérimentaux précliniques de carcinose péritonéale de nouveaux agents thérapeutiques radiopharmaceutiques et des voies d’administration innovantes ciblant plus particulièrement la maladie résiduelle micro-métastatique présente après chirurgie de cytoréduction. Nous utilisons des anticorps monoclonaux internalisants spécifiques d’un récepteur membranaire surexprimé dans le cancer de l’ovaire et d’autres cancers gynécologiques, le récepteur de type 2 de l’hormone anti-müllerienne (AMHR2). Ces anticorps sont couplés à des radionucléides aux propriétés thérapeutiques : le Lutecium-177 (un émetteur de particules beta moins) et le Bismuth-213 (un émetteur de particules alpha) réalisant un traitement de radioimmunothérapie. Ils sont évalués après injection intrapéritonéale mais également en utilisant la technique RadioImmunoThérapie Intrapéritonéale Brève (BIP-RIT) consistant à instiller de fortes activités d’anticorps radiomarqués dans le péritoine avant d’en réaliser un rinçage abondant, à l’image de la chimiothérapie hyperthermique intrapéritonéale (CHIP). Sont étudiés sur différents modèles la biodistribution, la dosimétrie, la toxicité et l’efficacité thérapeutique des différentes combinaisons de radionucléides et de voies d’administration. La BIP-RIT présente un profil de biodistribution et de dosimétrie toujours favorable, quel que soit le radionucléide utilisé même si l’utilisation du Bismuth-213 apparait plus particulièrement adaptée à cette technique (bonne efficacité thérapeutique avec absence de toxicité). L’imagerie PET/CT de la biodistribution in-vivo de ces anticorps a été réalisée à l’aide de l’émetteur de positrons Zirconium-89 ouvrant la voie à une approche théragnostique du traitement des cancers gynécologiques AMHR2+ par (radio)immunothérapie. Les mécanismes d’action thérapeutique d’une version humanisée de l’anticorps anti-AMHR2 sont également étudiés. Ce travail ouvre des perspectives cliniques intéressantes dans la prise en charge du cancer de l’ovaire. / Ovarian cancer is the first cause of cancer death from gynaecologic malignancy in France and it has high rate of recurrence justifying the development of new therapeutic tools. Our project aims at developing new radiopharmaceuticals and innovative route of administration to target the small volume residual disease after complete cytoreductive surgery of peritoneal carcinomatosis on preclinical models. We use internalising monoclonal antibodies specific of the anti-müllerian hormone type 2 receptor (AMHR2), overexpressed in ovarian cancer and gynaecologic malignancies. Antibodies are radiolabelled with Lutecium-177, a beta minus emitter, and Bismuth-213, an alpha emitter, to perform radioimmunotherapy. Radiolabelled antibodies are injected intraperitoneally but also after Brief IntraPeritoneal RadioImmunoTherapy (BIP-RIT), a technique delivering high activities in the peritoneal cavity for a short time before washing, like Hyperthermic IntraPEritoneal Chemotherapy (HIPEC). We studied biodistribution, dosimetry, toxicity and therapeutic efficacy on various models and combinaison of radionuclides and route of administration. BIP-RIT appears to be always favourable in term of biodistribution and dosimetry (especially for the tumour-over-blood ratio) whatever the radionuclide used. Bismuth-213 is particularly adapted for radioimmunotherapy of small residual tumours, showing therapeutic efficacy with no toxicity. PET/CT imaging of radiolabelled antibodies with Zirconium-89 was performed and may be used as a theranostic tool for (radio)immunotherapy with anti-AMHR2 antibodies. The anti-tumour efficacy mechanisms of a humanized version of anti-AMHR2 antibody are also presented. This work may lead to realistic theranostic options in ovarian cancer in clinic.

Les microfaisceaux d’ions ont, au cours de ces dernières décennies, montré leur efficacité dansl’étude des effets des rayonnements ionisants sur le vivant notamment concernant les effets des faiblesdoses ou l’étude de l’effet de proximité. Le CENBG dispose depuis 2003 d’un dispositif permettant la micro-irradiation ciblée d’échantillons biologiques vivants. Les applications des microfaisceaux dans ce domainese sont récemment diversifiées et des études plus fines sur les mécanismes de réparation desdommages ADN radio-induits aux échelles cellulaire et multicellulaire sont devenues possibles via lesévolutions en imagerie par fluorescence et en biologie cellulaire. Ces approches ont nécessité une évolutionimportante de l'instrumentation de la ligne de micro-irradiation du CENBG qui a été entièrementredessinée et reconstruite dans un souci d’optimisation d’apport de nouvelles fonctionnalités. Les objectifsde mes travaux ont été i) la mise en service du dispositif, ii) la caractérisation des performances dusystème, iii) la mise en place de protocoles pour l’irradiation ciblée à dose contrôlée aux échelles cellulaireet multicellulaire, in vitro et in vivo, et le suivi en ligne des conséquences précoces de cette irradiation,iv) la modélisation des irradiations afin d’interpréter les observables biologiques au regard des donnéesphysiques calculées.Ces travaux ont permis i) de caractériser les performances du dispositif : une taille de faisceau d’environ2 μm sur cible et une précision de tir de ± 2 μm, de développer des systèmes de détection d’ions pour uncontrôle absolu de la dose délivrée, ii) d’induire des dommages ADN fortement localisés in vitro, et devisualiser en ligne le recrutement de protéines impliquées dans la réparation de ces dommages,iii) d’appliquer ces protocoles pour générer des dommages ADN in vivo au sein d’un organisme multicellulaireau stade embryonnaire, Caenorhabditis elegans.Ces résultats ouvrent la voie vers des expériences plus fines sur la ligne de micro-irradiation ciblée duCENBG pour étudier les effets de l’interaction des rayonnements ionisants avec le vivant, aux échellescellulaire et multicellulaire, in vitro et in vivo. / The main goal of radiobiology is to understand the effects of ionizing radiations on the living.These past decades, ion microbeams have shown to be important tools to study for example the effects oflow dose exposure, or the bystander effect. Since 2003, the CENBG has been equipped with a system toperform targeted micro-irradiation of living samples. Recently, microbeams applications on this subjecthave diversified and the study of DNA repair mechanisms at the cellular and multicellular scales, in vitroand in vivo, has become possible thanks to important evolutions of fluorescence imaging techniques andcellular biology. To take into account these new approaches, the CENBG micro-irradiation beamline hasbeen entirely redesigned and rebuilt to implement new features and to improve the existing ones. My PhDobjectives were i) commissioning the facility, ii) characterizing the system on track etch detectors, and onliving samples, iii) implementing protocols to perform targeted irradiations of living samples with a controlleddelivered dose, at the cellular and multicellular scales, and to visualize the early consequencesonline, iv) modelling these irradiations to explain the biological results using the calculated physical data.The work of these past years has allowed us i) to measure the performances of our system: a beam spotsize of about 2 μm and a targeting accuracy of ± 2 μm, and to develop ion detection systems for an absolutedelivered dose control, ii) to create highly localized radiation-induced DNA damages and to see onlinethe recruitment of DNA repair proteins, iii) to apply these protocols to generate radiation-induced DNAdamages in vivo inside a multicellular organism at the embryonic stage: Caenorhabditis elegans.These results have opened up many perspectives on the study of the interaction between ionizing radiationsand the living, at the cellular and multicellular scales, in vitro and in vivo.