A mechanism-guided approach for quantifying the biological effects of tumor hypoxia in particle therapy.

Guan, Fada; Stewart, Robert D; Carlson, David J · Int J Radiat Oncol Biol Phys · 2026

basic_science · Level V

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Abstract

To quantify how acute tumor hypoxia modifies the biological effectiveness of proton, helium, and carbon ions and to derive mechanistic hypoxia-compensation factors for representative spread-out Bragg peaks (SOBPs). The Monte Carlo Damage Simulation (MCDS) was used to generate DNA double-strand break (DSB) yields as functions of radiation quality q = (Z<sub>eff</sub>/β)<sup>2</sup> and oxygen level pO<sub>2</sub> (0.0001-100%). MCDS-derived DSB yields were integrated into Geant4 Monte Carlo simulations, and Repair-Misrepair-Fixation (RMF) model calculations were used to derive linear-quadratic radiosensitivity parameters. We distinguish hypoxic RBE (RBE<sub>H</sub>), which compares the biological effects of particles at reduced pO<sub>2</sub> with photons under normoxic conditions (<sup>137</sup>Cs γ-rays at pO<sub>2</sub> = 100%), from isoeffective RBE (RBE<sub>iso</sub>), which compares particles and photons at the same pO<sub>2</sub>. SOBP (10-15 cm depth) optimizations used either a uniform 2 Gy absorbed dose or a uniform RBE<sub>H</sub>-weighted dose (D<sub>RBE</sub> = 3.8 Gy) corresponding to 10% clonogenic survival in H460 cells; hypoxia reduction factors (HRFs) quantified the absorbed-dose compensation required to preserve this modeled endpoint. At pO<sub>2</sub> = 21%, at D<sub>RBE</sub> = 3.8 Gy, RBE<sub>H</sub> was 1.04-1.16 for protons, 1.23-1.67 for helium ions, and 1.84-3.55 for carbon ions. At pO<sub>2</sub> = 0.001%, RBE<sub>H</sub> decreased to 0.39-0.41, 0.50-0.70, and 0.87-2.28, respectively. Because RBE<sub>H</sub> uses the fixed photon reference at pO<sub>2</sub> = 100%, values below unity quantify the combined oxygen and radiation-quality penalty and do not indicate that particles are less effective than photons irradiating the same hypoxic tissue. At pO<sub>2</sub> = 0.001%, RBE<sub>iso</sub> remained >1 (protons 1.13-1.19; helium 1.46-2.03; carbon 2.54-6.63). The corresponding HRFs were 2.73-2.89, 2.42-2.53, and 1.57-2.07. Within the H460 single-fraction clonogenic-survival framework examined here, high-LET carbon ions are less sensitive to severe hypoxia than helium ions or protons and require smaller model-derived hypoxia-compensation factors.