DESCRIPTION
Glioblastoma multiforme (GBM) accounts for approximately 80% of all adult malignant gliomas and continues to be one of the most intractable brain tumors. Despite aggressive surgery, radiotherapy, and chemotherapy, the median survival time is approximately 12 months or less. Only a few individuals achieve long-term, disease-free survival. Boron neutron capture therapy (BNCT) has been investigated as an alternative therapy for GBM. BNCT combines radiotherapy and chemotherapy after surgical debulking.
BNCT has two major components. The first component is the selective incorporation of boron-10 into cancer cells after infusion of a stable, nonradioactive isotope of boron. The second component of irradiation with low energy neutrons produced by a nuclear reactor then follows. These neutrons are readily captured by the boron-10 nuclei in a neutron capture reaction. Upon capture, the boron-10 nuclei disintegrate, producing the high linear energy transfer particles alpha (He) and lithium (Li), accompanied by approximately 2.4 million electron volts (MeV) of energy. He and Li particles only travel a distance of one diameter of a tumor cell; the ionizing energy and cell killing take place in the vicinity of the boron-containing cells with little or no damage to the surrounding normal tissues. Thus, tumor destruction during BNCT depends on the selective accumulation of a sufficient dose of boron atoms in cancer cells with little or no accumulation in normal cells. Tumor destruction during BNCT also depends on the use of nuclear reactors with the capability of delivering high fluxes of thermal neutrons at depths sufficient to reach all parts of the tumor.
POLICY
Boron neutron capture therapy for the treatment of glioblastoma multiforme is considered investigational.
ADDITIONAL INFORMATION
Published scientific evidence in the form of well-designed studies in peer-reviewed journals regarding the clinical utility of boron neutron capture therapy for the treatment of glioblastoma multiforme is lacking. Standardized protocols for the use of neutron capture therapy are not available. There is insufficient evidence to permit conclusion whether the use of boron neutron capture therapy improves net health outcomes.
SOURCES
Barth, R. F., Corderre, J. A., Vicente, M. G., & Blue, T. E. (2005). Boron neutron capture therapy of cancer: current status and future prospects. Clinical Cancer Research, 11 (11), 3987-4002. Abstract retrieved September 29, 2008 from PubMed database.
Barth, R. F., Soloway, A. H., Goodman, J. H., Gahbauer, R. A., Gupta, N., Blue, T. E., et al. (1999). Boron neutron capture therapy of brain tumors: an emerging therapeutic modality. Neurosurgery, 44 (3), 433-450. Abstract retrieved July 23, 2001 from PubMed database.
Chadha, M., Capala, J., Coderre, J. A., Elowitz, E. H., Iwai, J., Joel, D. D., et al. (1998). Boron neutron-capture therapy (BNCT) for glioblastoma multiforme (GBM) using the epithermal neutron beam at the Brookhaven National Laboratory. International Journal of Radiation Oncology, Biology, Physics, 40 (4), 829-834. Abstract retrieved July 25, 2001 from PubMed database.
Chanana, A. D., Capala, J., Chadha, M., Coderre, J. A., Diaz, A. Z., Eloqitz, E. H., et al. (1999). Boron neutron capture therapy for glioblastoma multiforme: interim results from the phase I/II dose-escalation studies. Neurosurgery, 44 (6), 1182-1193.
Coderre, J. A., & Morris, G. M. (1999). The radiation biology of boron neutron capture therapy. Radiation Research, 151 (1), 1-18.
Diaz, A. Z., Coderre, J.A., Chanana, A. D., & Ma, R. (2000). Boron neutron capture therapy for malignant gliomas. Annals of Medicine, 32 (1), 81-85. Abstract retrieved July 19, 2001 from PubMed database.
Gahbauer, R., Gupta, N., Blue, T., Goodman, J., Barth, R., Grecula, J., et al. (1998). Boron neutron capture therapy: principles and potential. Recent Results in Cancer Research, 150, 183-209.
Goodman, J. H., Yang, W., Barth, R. F., Gao, Z., Boesel, C. P., Straubus, A. E., et al. (2000). Boron neutron capture therapy of brain tumors: biodistribution, pharmacokinetics, and radiation dosimetry sodium borocaptate in patients with gliomas. Neurosurgery, 47 (3), 608-621. Abstract retrieved July 19, 2001 from PubMed database.
Hideghety, K., Sauerwein, W., Haselsberger, K., Grouchulla, F., Fankhauser, H., Moss, R., et al. (1999). Postoperative treatment of glioblastoma with BNCT at the petten irradiation facility (EORTC protocol 11,961). Strahlentherapie und Onkologie, 175 Suppl 2, 111-114. Abstract retrieved July 19, 2001 from PubMed database.
Kageji, G., Nagahiro, S., Kitzmura, K., Nakagawa, Y., Hatanaka, H., Haritz, D., et al. (2001). Optimal timing of neutron irradiation for boron neutron capture therapy after intravenous infusion of sodium barocaptate in patients with glioblastoma. International Journal of Radiation Oncology, Biology, Physics, 51 (1), 120-130. Abstract retrieved July 19, 2001 from PubMed database.
Lee, C. L., Zhou, X. L., Kudchadker, R. J., Harmon, F., & Harker, Y. D. (2000). A Monte Carlo dosimetry-based evaluation of the 7Li (p, n) 7Be reaction near threshold for accelerator boron neutron capture therapy. Medical Physics, 27 (1), 192-202.
Nakagawa, Y., & Hatanaka, H. (1997). Boron neutron capture therapy. (1997). Clinical brain tumor studies. Journal of Neuro-oncology, 33 (1-2), 105-115. Abstract retrieved July 25, 2001 from PubMed database.
Sauerwein, W., Moss, R., Rassow, J., Stecher-Rasmussen, F., Hideghety, K., Wolbers, J. G., et al. (1999). Organisation and management of the first clinical trial of BNCT in Europe (EORTC protocol 11961). EORTC BNCT study group. Strahlentherapie und Onkologie, 175 Suppl 2, 108-111. Abstract retrieved July 19, 2001 from PubMed database.
Soloway, A. H., Barth, R. F., Gahbauer, R. A., Blue, T. E., & Goodman, J. H. (1997). The rationale and requirements for the development of boron neutron capture therapy of brain tumors. Journal of Neuro-oncology, 33 (1-2), 9-18. Abstract retrieved July 23, 2001 from PubMed database.
Takagaki, M., Oda, Y., Miyatake, S., Kikuchi, H., Kobayashi, T., Sakurai, Y., et al. (1997). Boron neutron capture therapy: preliminary study of BNCT with sodium borocaptate (Na2B12H11SH) on glioblastoma. Journal of Neuro-oncology, 35 (2), 177-185. Abstract retrieved April 14, 2003 from PubMed database.
ORIGINAL EFFECTIVE DATE: 2/1/2002
MOST RECENT REVIEW DATE: 11/13/2008
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