Principles of therapy with fission neutrons and boron neutron capture therapy for radioresistant head-neck malignancies

Neutron therapy has proven to be clinically useful in cases of advanced, slow-growing radioresistant head and neck carcinoma. Therapeutic effects might be based on direct DNA damaging and thus immediate cell-killing, on the generation of free oxygen radicals and, among others, on the fact that heavy particle radiation is said to be less dependent on the presence of oxygen than gamma rays, i.e. on a lower oxygen enhancement ratio (OER). The smaller difference in reaction between oxygenated and nonoxygenated cells could entail advantages as well as disadvantages, depending on the characteristics of the tumor cell population and of the normal tissue. It is therefore essential to select patients and tumours with an expectedly high therapeutic gain factor. Fission neutrons for tumour therapy: As evaluated by several in vitro and in vivo studies (11/13) the biological efficiency (RBE) of the RENT (Reactor Neutron Therapy) beam in Munich seems to be among the highest of all clinically used neutron beams. For a single dose range between 2 and 8 Gy the RBE for chronic radiation damage is relatively small (2). Consequently, patients with recurrent or metastatic carcinomas of the head and neck are treated with a single dose of 200-250 cGy after previous surgery and/or combined radiochemotherapy. The main limitation of fission neutrons is the small penetration depth. Possibilities of clinical implementation of boron neutron capture therapy (BNCT) in otorhinolaryngology: In near surface tumours it is possible to administer high doses of 10boron not selectively, i.e. no selective tumour-seeking compound is needed. Animal experiments with intratumoural injection of 10boron glycine have shown a strong effect on tumour growth delay (18).(ABSTRACT TRUNCATED AT 250 WORDS)