Boron Neutron Capture Therapy

In Chapter 16 of Intermediate Physics for Medicine and Biology, Russ Hobbie and I discuss boron neutron capture therapy.

Boron neutron capture therapy (BNCT) is based on a nuclear reaction which occurs when the stable isotope ¹⁰B is irradiated with neutrons, leading to the nuclear reaction (in the notation of Chap. 17)

Both the alpha particle and lithium are heavily ionizing and travel only about one cell diameter. BNCT has been tried since the 1950s; success requires boron-containing drugs that accumulate in the tumor. The field has been reviewed by Barth (2003).

The citation is to an article by Rolf Barth of Ohio State University.

Barth, RF (2003) A Critical Assessment of Boron Neutron Capture Therapy: An Overview. Journal of Neuro-Oncology, Volume 62, Pages 1–5.

The abstract of this seventeen-year-old review states

Boron neutron capture therapy (BNCT) is based on the nuclear reaction that occurs when boron-10 is irradiated with neutrons of the appropriate energy to produce high-energy alpha particles and recoiling lithium-7 nuclei. BNCT has been used clinically to treat patients with high-grade gliomas, and a much smaller number with primary and metastatic melanoma. The purpose of this special issue of the Journal of Neuro-Oncology is to provide a critical and realistic assessment of various aspects of basic and clinical BNCT research in order to better understand its present status and future potential. Topics that are covered include neutron sources, tumor-targeted boron delivery agents, brain tumor models to assess therapeutic efficacy, computational dosimetry and treatment planning, results of clinical trails in the United States, Japan and Europe, pharmacokinetic studies of sodium borocaptate and boronophenylalanine (BPA), positron emission tomography imaging of BPA for treatment planning, and finally an overview of the challenges and problems that must be faced if BNCT is to become a useful treatment modality for brain tumors. Clinical studies have demonstrated the safety of BNCT. The next challenge is an unequivocal demonstration of therapeutic efficacy in one or more of the clinical trails that either are in progress or are planned over the next few years.

I was wondering what’s happening in this field lately, so I searched the Physics World website and found a fascinating and recent article by Tami Freeman.

Boron neutron capture therapy (BNCT), a technique that deposits highly targeted radiation into tumour cells, was first investigated as a cancer treatment back in the 1950s. But the field remains small, with only 1700 to 1800 patients treated to date worldwide. This may be about to change.

“The field of BNCT seems to be progressing rapidly at the moment,” said Stuart Green, director of medical physics at University Hospital Birmingham. “The big difference compared with five or ten years ago is that the commercial interest from a variety of companies is strong now and this is driving the field…”

Speaking at the Medical Physics & Engineering Conference (MPEC), Green updated on the status of BNCT programmes worldwide, noting that clinical experience is continually increasing. The US Food and Drug Administration has now approved two boron drugs for clinical use. But by far the majority of treatments, over 1150 to date, have taken place in Japan, initially using the Kyoto University Reactor in the early 2000s, and more recently using three Sumitomo accelerator systems in Kyoto, Fukushima and Osaka.

“Very importantly, earlier this year we had the first ever medical device approval for BNCT, for treatment in Japan of recurrent head-and-neck cancer,” said Green. “This is a significant marker for the entire field….”

“For the first time, there’s a substantial and sustained effort in the commercial sector to drive this field forward,” Green concluded. “We should keep an eye on BNCT over the next few years, there’s a lot happening, and hopefully our community can play a key role.”

Why the renewed interest in this technique? First, the original clinical applications of BNCT used neutrons from a nuclear reactor. Now accelerator-based neutron sources are available that can be installed in a hospital. Second, researchers are working hard on boron-containing drugs. Currently, boronophenylalanine and sodium borocaptate are the most common drugs used clinically. Improving the delivery of these drugs, or designing entirely new drugs, could increase the usefulness of BNCT. 

We live in exciting times.

Boron Neutron Capture Therapy Animation. 

https://www.youtube.com/watch?v=cQrbfBiQpfk