Breast cancer: imaging and radiotherapy with synchrotron radiation

The breast cancer is the most common cancer in woman worldwide. In this scenario, two aspects are very important: the early diagnosis and the efficacy of the care. The gold standard for the screening of breast cancer is the two-view mammography and the standard care includes surgery, usually coupled with chemotherapy or radiotherapy with 6-MV X-ray tangential beams from a linear accelerator. The problem of superimposition of tissue along the direction of the beam, which can make difficult the task of lesion detection in mammography, has led to the development of 3D techniques – such as Digital Breast Tomosynthesis (DBT) and Breast Computed Tomography (BCT) – which resolve the breast anatomy also in the longitudinal direction. In addition, in the last decades the use of phase-contrast (PhC) imaging techniques (which permit to detect the phase-shift of the X-ray beam in tissue) produced improvements in the detection of breast cancer. As regards adjuvant radiotherapy of breast cancer, an effective treatment has to guarantee the maximum sparing to the healty tissues, in particular to the skin. For this purpose, new techniques – such as IMRT, helical tomotherapy, VMAT – are under clinical investigation. Moreover, new kilovoltage rotational radiotherapy techniques with X-ray beam from orthovoltage X-ray tube as well as linear accelerator have been proposed. In this work, we investigated the use of the synchrotron radiation (SR) for both low-dose phase-contrast breast computed tomography (PhC-BCT) and breast rotational radiotherapy, via Monte Carlo simulations and measurements. Experiments were conducted at three different synchrotron radiation facilities: ELETTRA (Trieste, Italy), ESRF (Granoble, France), Australian Synchrotron (Melbourne, Australia). Phase contrast mammography on a cohort of patients was pioneered at ELETTRA in the last decade, showing the advantage of propagation based PhC imaging in producing higher conspicuity of breast masses; the ongoing projects at ELETTRA aim at devising a setup and a protocol for future computed tomography (CT) scans of the breast. The first part of the work, carried out in the framework of the SYRMA-CT/3D projects funded by INFN (National Institute for Nuclear Physics, Italy), showed the dosimetry measurements as well as the first imaging test of PhC-BCT at ELETTRA, carried out at 38 keV or lower energies. New dose metrics were introduced to take into account the partial breast irradiation envisaged for the exam; in addition, we carried out a characterization of dosimeters (TLD GR-200A and radiochromic film XR-QA2) to be employed for beam and phantom dosimetry. Finally, we showed the results of the first imaging test with a breast tissue specimen.In the second part of this PhD work, we demonstrated the feasibility of rotational breast radiotherapy with synchrotron radiation laying the foundations for the study of a new image-guided radiotherapy technique for breast cancer. This technique employs the same setup used for BCT but uses higher energies (60–120 keV) and higher intensity SR beams. The use of such low photon energies (with respect to megavoltage photon energies used in conventional radiotherapy) would provide a higher dose-enhancement when a radiosensitizing (e.g. gold nanoparticles) is used for breast radiotherapy. Possible applications of this technique could be the treatment of the small lesion and hypo-fractionated radiotherapy.