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Background and purposes: Carbon ion radiotherapy (CIRT) with raster scanning technology is a promising treatment for lung cancer and thoracic malignancies. Determining normal tissue tolerance of organs at risk is of utmost importance for the success of CIRT. Here we report the relative biological effectiveness (RBE) of CIRT as a function of dose and fractionation for development of pulmonary fibrosis using well established fibrosis index (FI) model. Materials and Methods: Dose series of fractionated clinical quality CIRT versus conventional photon irradiation to the whole thorax were compared in C57BL6 mice. Quantitative assessment of pulmonary fibrosis was performed by applying the FI to computed tomography (CT) data acquired 24-weeks post irradiation. RBE was calculated as the ratio of photon to CIRT dose required for the same level of FI. Further RBE predictions were performed using the derived equation from high-linear energy transfer biologically effective dose (high-LET BED) model. Results: The averaged lung fibrosis RBE of 5-fraction CIRT schedule was determined as 2.75 ± 0.55. The RBE estimate at the half maximum effective dose (RBEED50) was estimated at 2.82 for clinically relevant fractional sizes of 1-6 Gy. At the same dose range, an RBE value of 2.81 ± 0.40 was predicted by the high-LET BED model. The converted biologically effective dose (BED) of CIRT for induction of half maximum FI (BEDED50) was identified to be 58.12 Gy3.95. In accordance, an estimated RBE of 2.88 was obtained at the BEDED50 level. The LQ model radiosensitivity parameters for 5-fraction was obtained as αH = 0.3030 ± 0.0037 Gy-1 and βH = 0.0056 ± 0.0007 Gy-2. Conclusion: This is the first report of RBE estimation for CIRT with the endpoint of pulmonary fibrosis in-vivo. We proposed in present study a novel way to mathematically modeling RBE by integrating RBEmax and α/βL based on conventional high-LET BED conception. This model well predicted RBE in the clinically relevant dose range but is sensitive to the uncertainties of α/β estimates from the reference photon irradiation (α/βL). These findings will assist to eliminate current uncertainties in prediction of CIRT induced normal tissue complications and builds a solid foundation for development of more accurate in-vivo data driven RBE estimates.

Original publication




Journal article


Clin Transl Radiat Oncol

Publication Date





25 - 32


BED, biologically effective dose, Biologically effective dose (BED), CPFE, combined pulmonary fibrosis and emphysema syndrome, CT, computed tomography, Carbon ion radiotherapy (CIRT), FI, fibrosis index, Fractionation, HU, Hounsfield unit, High-linear energy transfer (high-LET), LET, linear energy transfer, LQ model, linear quadratic model, Lung fibrosis, NSCLC, non-small cell lung cancer, Normal tissue response, PMMA, Polymethylmethacrylat, RBE, relative biological effectiveness, RILF, Radiation-induced lung fibrosis, RP, radiation pneumonitis, Relative biological effectiveness (RBE), SBRT or SABR, hypofractionated stereotactic body or ablative radiation therapy, V5, volume of lung receiving ≥5 Gy (RBE), α/β, alpha/beta ratio