Impacts of multiple-field irradiation and boron concentration on the treatment of boron neutron capture therapy for non-small cell lung cancer

Background: Boron neutron capture therapy (BNCT) is a radiotherapy that combines biological targeting and high linear energy transfer. A potential therapeutic approach for non-small cell lung cancer (NSCLC) is considered. However, dose in lung tumor is not homogeneous, and it will reduce the effect of BNCT treatment. In order to improve the dose distribution of BNCT, the multi-field irradiation strategy and its effects need to be explored. Materials and Methods: Common NSCLC model was defined in Chinese hybrid reference phantom and the boron concentration in skin and tumor varied from 6 to 18 ppm and from 30 to 65 ppm, respectively. Monte Carlo method for dose distribution calculation was used. Accelerator-based neutron source called “Neuboron source” was used and multi-field source irradiation plans were designed to optimize the dose distribution. Results: Under one-field irradiation, it was not feasible to perform BNCT, because the skin dose is unlikely to meet its dose limit. Under two- and three-field irradiation, the uniformity of tumor dose was improved and the maximum dose to organs at risk (OARs) decreased. If boron concentration in skin was between 6-18 ppm, BNCT was feasible with the boron concentration in tumor reaching about 57-60 ppm for two-field irradiation and 41-45 ppm for three-field irradiation, respectively. Conclusion: The multi-field irradiation plan could improve the dose distribution and the feasibility of BNCT for NSCLC. Theoretical distributions of Boron-10 were obtained to meet the treatable requirement of BNCT, which could provide a reference for NSCLC using BNCT in future multiple-field irradiation.