Ytterbium-169 Based High Dose Rate Brachytherapy Alexander Bogdanov, Atommedcenter LLC Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 1
Why use Yb-169 based High Dose Rate micro sources A new approach to the cancer therapy, improving quality of therapy, minimizing radiation dose on healthy tissues and reducing risks of further complications q High Dose Rate (HDR) therapy of both surface and internal cancers q Therapy of head-neck cancers q Near critical organ localization therapy q Endovascular radiosurgery and to prevent rest enosis in stent operations Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 2
The Main Advantages of Yb-169 Micro-sources Radionuclide: Co-60 Cs-137 Ir-192 Yb-169 Tm-170 I-125 Pd-103 Average energy of photon emission 1250 ke. V 662 ke. V 380 ke. V 93 ke. V 84 ke. V 28 ke. V 21 ke. V Half-life 5, 3 years 30, 2 years 74 days 32 days 128 days 59, 4 days 17 days q Softer emission spectrum (63– 217 ke. V) compared with Ir-192 and Co-60 sources q They can be used for treatment of superficial cancers and internal cancers q They can be used with any apparatus for brachytherapy q Easy to handle q This sources can be used for endovascular radiosurgery and prevent restenosis in stent operations q Equivalent activity from 0. 5 to 15 Ci Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 3
Yb-169 Source Design Titanium capsule is housed in a steel capsule with a tail (cable and shaft) Before an irradiation titanium capsule contains of Ytterbium oxide powder (Yb 2 O 3), enriched by stabile isotope Yb-168 Yb 2 O 3 powder Tube capillary Bottom-globule The enrichment of Yb isotope ω(168 Yb) = 35. 8± 0. 3% Currently available techniques allows enrichment up to 90% This design allows using Yb-169 based HDR micro sources with any commercially available apparatuses for brachytherapy Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 4
Pre-clinical Trials of Yb-169 Based HDR Brachytherapy Positive biological effect of the source has been proved on tumors in animals Irradiation of rats with sarcoma М-1 by Yb-169 based HDR micro sources Dynamics of tumor volume change after irradiation with Yb-169 20 days after irradiation with Yb-169 no irradiation Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 5
Current Status of the Project Currently the project is under transition to the clinical trials On the previous project phases the following tasks has been completed: q Calculations and durability tests of the Yb-169 sources; q Reactor irradiation study of the construction materials used for manufacturing source body; q Experimental estimation of the absorbed doses in the tissue equivalent phantom; q Experimental study of the dose characteristics using water phantom; q Study of the medical and biological characteristics of the Yb-169 sources; q Recommendations on the medical use and radiation safety of the Yb-169 sources. Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 6
Market Potential Estimation Potential consumers: q. FSBI “N. N. Blokhin RCRC” RAMS” q. P. A. Herzen Moscow Cancer Research Institute q. Federal State Healthcare Institution Clinical Hospital No. 8 of FMBA of Russia, Obninsk, Kaluga Oblast q. Russian Scientific Center of Roentgenoradiology q. Federal State Healthcare Institution L. G. Sokolov Clinical Hospital No. 122 of FMBA of Russia, St. Petersburg Average cost of therapy is “ 1” The market size (Russia) is estimated at 500 HDR apparatuses (~3000 src/year) q. Medical Radialogical Research Center, Obninsk q. State Medical and Preventive Institution Chelyabinsk District Clinical Oncological Dispensary, Chelyabinsk Initial high investment in the building up radiation therapy complex will be later compensated by lower operational expenses compared to otherapy methods! Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 7
Market. Main Players The major players of the automated brachytherapy complexes market are the following: Companies Country Production for brachytherapy Varian Medical Systems USA Gamma. Medplus, Gamma. Medplus 3/24, Varisource, Gamma. Med 12 Eckert & Ziegler BEBIG Gmb. H Germany Multi. Source-HDR, Bebig Curietron LDR/MDR, Сurietron 192 Oris Nucletron (bought by Elekta in Sept. 2011) Sweden Selectron LDR, micro. Selectron LDR/MDR, micro. Selectron-HDR, micro. Selectron-PDR, Seed. Selectron, Selectron-HDR Buchler Germany GMBH JSC «NIITFA" Russia AGAT-VT q. Average price of the imported brachytherapy complexes in Russia is 30 -35 mil. rub. , while Russianmade complexes cost around 18 – 25 mil. rub q. Со-60 and Ir-192 are mainly used as radiation sources for brachytherapy Yb-169 until now is not used in clinical practice for brachytherapy Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 8
Cooperation. Partners JSC IRM, г. Yekaterinburg Cyclotron Co. , Ltd, Obninsk, Manufacturing a titanium capsule containing Yb-168 oxide üTitanium capsule irradiation inside a reactor üCoordination Medical Radialogical Research Center üCommercialization üStudy of the dosimetric, biological and medical characteristics of Yb-169 sources “Isotope Technologies”, Minsk üSource manufacture üTechnical tests Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 9
Proposal for cooperation with Varian q Ytterbium-169 (169 Yb) based HDR micro-sources for HDR q. Afterloader for HDR w/out 60 Co/192 Ir-conteiner, applicators and accessories (or Mick Radio-Nuclear Instruments) q. Results of pre-clinical trials q 3 D treatment planning system Russia Clinical trials USA Brachytherapy of breast, prostate cancer; head-neck localizations and other surface and internal cancers Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 10
Contacts: Alexander Bogdanov aabogdanov@atommedcenter. ru Tel. : +7 495 232 0345 Moscow, Russia, 115230 Warshavskoye sh, 46 Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 11
Приложения Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 12
Models and dimensions of Yb-169 based high-energy micro sources Overall dimensions, mm Power air cerma Equivalent Sources with Holder External Active core on distance 1 m, activity, Source model (Plug and Shaft) m. Gy/h Bq (Ci) D 1 L 1 D L* d* l* GYb 169 М 04. 210 0, 77 1, 9 х1010(0, 5) GYb 169 М 04. 410 1, 55 3, 7 х1010(1) GYb 169 М 04. 111 4, 64 1, 1 х1011(3) GYb 169 М 04. 211 1, 1± 0, 05 7, 73 1, 8 х1011(5) 5, 0+0, 1 1, 1± 0, 05 1000 -3000 0, 7 2, 1 GYb 169 М 04. 311 11, 59 2, 8 х1011(7. 5) GYb 169 М 04. 411 15, 45 3, 7 х1011(10) GYb 169 М 04. 610 23, 18 5, 6 х1011(15) GYb 169 М 05. 210 0, 77 1, 9 х1010(0, 5) GYb 169 М 05. 410 1, 55 3, 7 х1010(1) GYb 169 М 05. 111 4, 64 1, 1 х1011(3) GYb 169 М 05. 211 1, 1± 0, 05 7, 73 1, 8 х1011(5) 5, 0+0, 1 1, 1± 0, 05 1000 -3000 0, 7 2, 1 GYb 169 М 05. 311 11, 59 2, 8 х1011(7. 5) GYb 169 М 05. 411 15, 45 3, 7 х1011(10) GYb 169 М 05. 610 23, 18 5, 6 х1011(15) GYb 169 М 06. 210 0, 77 1, 9 х1010(0, 5) GYb 169 М 06. 410 1, 55 3, 7 х1010(1) GYb 169 М 06. 111 4, 64 1, 1 х1011(3) GYb 169 М 06. 211 1, 1± 0, 05 7, 73 1, 8 х1011(5) 5, 0+0, 1 1, 1± 0, 05 1000 -3000 0, 7 2, 1 GYb 169 М 06. 311 11, 59 2, 8 х1011(7. 5) GYb 169 М 06. 411 15, 45 3, 7 х1011(10) Research and GYb 169 М 06. 610 Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 23, 18 5, 6 х1011(15) 28 -29 September 2012, Saint-Petersburg 13
Energy spectrum (or distribution) of gamma quanta Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 14
The measurement of absorbed dose distribution in a mammary gland phantom using a tissue equivalent phantom Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 15
Three models of a steel construction depending on a holder design GYT 169 M 04 GYT 169 M 05 GYT 169 M 06 1. Titanium capsule 2. Cable 3. 169 Yb 4. Steel capsule 5. Plug 6. Shaft * Sizes for inquiries (are defined by the customer) Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 16
Relative Distribution of Yb-169 Dose in Living Tissues “Organ” of human phantom ovaries bowel lung (left) Absorbed dose rate, Gy/min 0, 00011± 0, 000013 0, 00019± 0, 0009 0, 009± 0, 0013 stomach / ventriclus 0, 00078± 0, 00010 liver 0, 0016± 0, 00020 thyroid gland 0, 0009± 0, 0001 rectum 0, 0005± 0, 0001 bone marrow 0, 0061± 0, 0033 esophagus 0, 012± 0, 010 bladder 0, 00005± 0, 0002 brain 0, 00039± 0, 0002 salivary glands 0, 0037± 0, 0023 Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 17
Dependence of relative tumor volume change ST on the time after irradiation Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 18
Photos of Yb-169 based HDR micro sources High energy micro source on basis of 169 Yb Operational wound at a cancer of a mammary gland with the subsequent Brachytherapy by radioisotope Steel capsule Shaft Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 19
Statistics of cancer Структура злокачественных новообразований мужского населения России Структура злокачественных новообразований женского населения России Research and Practical Conference “Accelerators and Radiation technologies for the Futures of Russia” 28 -29 September 2012, Saint-Petersburg 20
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