Patent Application
20080300444
1. Field of the Invention
The present invention relates to an ophthalmic applicator for treating pterygium or glaucoma using 32P alone or in combination with 103Pd.
2. Description of the Related Art
A pterygium is a wedge-shaped fibrovascular growth of conjunctiva (the surface tissue of the white of the eye) that extends onto and invades the surface of the cornea. In addition to imparting a poor appearance, the growth of a pterygium can obscure vision if it encroaches on the pupil of the eye.
Although the causes of pterygium have remained unclear, hereditary predisposition, along with irritation with UV light, wind or dust are known to significantly contribute to the formation and progression of pterygium.
For the symptomatic therapy of small pterygium, ophthalmologists may recommend a trial of a decongestant, anti-inflammatory eye drops, or the like, but these medications are not a fundamental solution to pterygium.
In some cases, for example, where a pterygium is growing far enough onto the cornea to threaten the line of vision, surgical removal of the tissue may be recommended. Surgical removal is usually completed within 20-30 min after local anesthesia, and the patient should remain under the care of the ophthalmologist for about one month in order to ensure the subsidence of pain and a foreign body sensation caused by the operation.
Simple as it is, this surgery frequently entails the disadvantage of recurrence. Even when the surgical operation is successful, the recurrence rate is 30% on average, and as high as 70% in some cases.
Various techniques, such as conjunctival autograft transplantation, chemotherapy, etc., have been used to prevent the recurrence of pterygium post surgery. Like skin autografts, conjunctival autograft transplantation is a method in which a healthy conjunctival graft obtained from a patient is applied to a pterygium-excised site of the same patient. Chemotherapy involves the use of chemicals to prevent the recurrence of pterygium. However, these therapies are still unsatisfactory with regard to pterygium recurrence.
Recently, intensive attention has been paid to radiotherapy for preventing pterygium recurrence.
Since 1920, radiotherapy with radioisotopes has been medically used. In Korea, radiotherapy was first conducted by applying 131I to a hyperthyroidism patient when the Atomic Energy Act was established in March, 1959. Since then, with the great advances in nuclear medicine, radiotherapy has gradually progressed. Demands for radioisotopes that play a pivotal role in radiotherapy and for therapeutics using radioisotopes increase by 5% and 10% each year, respectively. 131I accounts for as much as 30% of the total demand for therapeutic radioisotopes. Currently, other isotopes including 90Y and 188Re are under development for use in radiotherapy. Supported by the Korean government's policy of spreading medical cyclotrons over the nation, the medical industry of Korea has become able to produce various therapeutic radioisotopes, such as 201TI, 123I, 67G, 111In, 57Co, 103Pd in amounts that ensure self-sufficiency. In addition, extensive research into the development of radioisotope therapeutics using β-radiation is now being conducted.
A radioisotope is a version of a chemical element that has an unstable nucleus and emits radiation during its decay into a stable form. Typically, radioisotopes emit three kinds of radiation: alpha radiation, beta radiation and gamma radiation. Elements emitting alpha radiation are highly toxic to the body, in addition to being somewhat difficult to obtain. [On the other hand, gamma radiation, due to its high energy content, can cause serious damage when absorbed by living cells.]
On thee other hand, gamma radiation, due to its high penetrative power, often is used in treatment of deep-seated tumor. But it can also cause serious damage when absorbed by normal tissue.
Beta radiation is weakly penetrative, but highly destructive, and thus radioisotopes emitting beta radiation are usually used in radiotherapy for superficial tumors because that can be focused on target lesions with little influence on other healthy parts.
Examples of radioisotopes emitting beta radiation useful in non-sealed therapy include 89Sr, 90Y, 188Re, 153Sm and 166Ho.
[Particularly, these radioisotopes decay to their respective stable forms in a short time due to their short half lives, so that they can be focused on target lesions with little influence on other healthy parts.]
Particularly, these radioisotopes decay to their respective stable forms in a short time due to their short half lives so that the radioisotopes can accumulate in target sites only during treatment, without leakage or damage to other sites. The products remaining after decay can be assimilated, degenerated and discharged from the body.
For the application of therapeutic radioisotopes to target lesions, proper account must be taken of many factors including emission properties, physical half life, radiochemical purity, attenuation properties of labeling with high specific radioactivity, ease of production, cost, and convenience of storage and use. In order to increase therapeutic efficiency, first of all, radioisotopes, which carry out therapeutic functions by carrying energy through particle emission, are required to be accumulated in the highest possible amounts in target lesions and in the lowest possible amounts in parts other than target lesions.
It has been confirmed that single-dose beta-irradiation (RT) after bare sclera surgery is a simple, effective, and safe treatment that reduces the risk of primary pterygium recurrence [Jurgenliemk-Schulz I M, Hartman L J, Roesink J M, Tersteeg R J, van Der Tweel I, Kal H B, Mourits M P, Wyrdeman HKInt J Radiat Oncol Biol Phys. Jul. 15, 2004;59(4):1138-47]. A pure beta-emitter of 90Sr has been almost exclusively used for this purpose. Particularly, high-energy beta radiation of 90Sr (maximum 2.27 MeV), which is usually used in the treatment of pterygium, can deliver therapeutic doses to the cornea within 1 mm from the applicator. However, 90Sr is an isotope that requires heavy radiochemical processing for its production from fission fragments. Furthermore, its long half-life (28.8 yrs) requires additional caution for the production, storage, and disposition thereof.
It is reported that possibility of failure for operation may be remarkably lowered by irradiating beta-radiation of 90Sr after having a operation for glaucoma. [J. F. Kirwan, S. C. Cousens, L. Venter, C. Cook, A. Stulting, P. Roux, and I. Murdoch, “Effect of b radiation on success of glaucoma drainage surgery in South Africa: randomized controlled trial,” BMJ. 333, 942-946 (2006)]
Leading to the present invention, intensive and thorough research into a radiation emitter that can replace an ophthalmic applicator using 90Sr, conducted by the present inventors, resulted in the finding that the pure-irradiation of 32P can be used as an alternative to 90Sr-irradiation and can deliver more effective therapeutic doses to lesions within a short time, and that the use of 32P in combination with 103Pd, which is a radioactive isotope emitting low-energy photons with a half-life similar to that of 32P, can provide a uniform dose distribution in the target and the sharp fall-off beyond the target.
Accordingly, the present invention has been made keeping in mind the above problems occurring in the prior art, and an object of the present invention is to provide an ophthalmic applicator for the treatment of pterygium or glaucoma using 32P alone or in combination with 103Pd.
In order to accomplish the object, the present invention provides an applicator for the treatment of pterygium or glaucoma, comprising a source volume for containing a radioisotope; and a filter volume for controlling a radiation dose and a radiation energy; and an encapsulator for encompassing the source volume and the filter volume, wherein the radioisotope is pure 32P or a combination of 32P and 103Pd.
The above and other objects, features and other advantages of the present invention will be more clearly understood from the following detailed description taken in conjunction with the accompanying drawings, in which:
A detailed description will be given of the present invention with reference to the drawings.
The present invention pertains to an ophthalmic applicator for the treatment of pterygium or glaucoma using 32P or a combination of 32P and 103Pd, which shows far more even dose distribution, leading to an improvement in therapeutic effect on pterygium or glaucoma, and can correctly irradiate radiation onto a lesion, with higher safety for the eye lens than a conventional one using 90Sr.
In accordance with an aspect of the present invention, the present invention provides an applicator for the treatment of pterygium or glaucoma, comprising a source volume for containing pure 32P therein; a filter volume for controlling a radiation dose and radiation energy; and an encapsulator for encompassing the source volume and the filter volume.
In the target irradiated with the radiation from 32P, the radiation dose of 32P is decreased in an exponential manner according to the depth. Doses of the 32P applicator decrease with depth more rapidly than those of the 90Sr applicator (Experimental Example 1 and
Such a rapid decrease might be advantageous in radiotherapy for pterygium or glaucoma in consideration of the fact that the eye surface is to be intensively irradiated while the eye lens, which is spaced slightly apart from the eye surface, should receive a minimum dose.
Featuring the intensive accumulation of radiation doses in the target lesion and a rapid decrease in energy and radiation dose before the eye lens, therefore, the ophthalmic applicator using 32P in accordance with the present invention is superior in medicinal terms to the conventional 90Sr applicator.
In accordance with another aspect thereof, the present invention provides an applicator for the treatment of pterygium or glaucoma, comprising a source volume for containing a combination of 32P and 103Pd therein; a filter volume for controlling a radiation dose and radiation energy; and an encapsulator for encompassing the source volume and the filter volume.
When an ophthalmic applicator employs a combination of 32P and 103Pd as a radiation source, the mixed radiation field lessens the stiff exponential decrease of the 32P doses, which may be amplified by a geometrical error such as a setup of an applicator to the target lesion, leading to large variations in the dose delivered to the sclera.
Due to comparable half-lives of the two isotopes (14.2 days for 32P vs. 16.9 days for 103Pd), the emission ratio of electrons and photons beta can be maintained constant during the treatment, thereby allowing the available irradiation time period to be calculated accurately.
In accordance with an embodiment of the present invention, the ophthalmic applicator using a mixed radiation field of 103 Pd and 32P may be structured to allow radiation emission in such a way that the 32P applicator is responsible for 80%˜90% of the total radiation dose while the 103Pd applicator is responsible for 10%˜20% of the total radiation dose, correspondingly. When the dose of 32P is outside of this range, the applicator does not confer the advantage of lessening the sharp decrease of the 32P doses, amplified by a geometrical error. When the dose of 103Pd is out of this range, an excessive radiation dose is delivered to the eye lens.
As long as it prevents the leakage of radioisotopes, any material may be used to construct the source volume therewith. Silver (Ag) may be a preferable material for the source volume.
In the ophthalmic applicator according to the present invention, the filter volume functions to control the radiation dose emitted from the radioisotope. That is, depending on the material and structure of the filter volume, the radiation dose delivered to the target lesion can be adjusted.
For the construction of the filter volume of the ophthalmic applicator according to the present invention, aluminum may be used as a material, as in a conventional one. as long as it prevents the leakage of radioisotopes, any material may be used to construct the source
volume therewith.
The encapsulator in the ophthalmic applicator of the present invention functions to prevent the leakage of the radioisotopes 32P and 103Pd and is also required to reduce the attenuation of the radiation dose delivered to the target lesion to the greatest extent possible and to be thin and firm. The applicator of the present invention may take a conventional form or a modified form, which can be readily designed by those skilled in the art.
A better understanding of the present invention may be obtained through the following examples which are set forth to illustrate, but are not to be construed as the limit of the present invention.
Monte Carlo simulations were performed for the design and dosimetry of the ophthalmic applicator according to the present invention.
Using the Monte Carlo program MCNP5 code, an ophthalmic applicator using 32P alone was designed and calculated for dosimetry as follows [Yang Kyun Park, Sung-Joon Ye, Il Han Kim, Won Ryang Wee, Mee Kum Kim, Hyon Soo Han, Kwang-Jae Son, and Ul Jae Park, “Potential use of P-32 ophthalmic applicator: Monte Carlo simulations for design and dosimetry”, pp. 1854-1858 Medical Physics, May 2008 Volume 35, Issue 5].
A 32P ophthalmic applicator was designed to have a size similar to that of a conventional 90Sr ophthalmic applicator. However, the design was focused on the structure and material of the encapsulator focus, with no filter volume imparted thereto, not only because 32P is smaller in maximum beta energy than 90Sr but also because the low-energy beta contribution of 32P to the total dose is not large, unlike that of 90Sr. The encapsulator was formed of a medical plastic material in order to ensure a sufficient encapsulation effect and minimum attenuation of the beta radiation and energy during delivery to a target lesion. The part to be brought into contact with a target lesion was designed to have a thickness of 0.5 mm. In order to calculate a dose distribution over depth in water, voxels having dimensions of 2.0 mm (width)×2.0 mm (length)×0.5 mm (thickness) were positioned according to depth, followed by the measurement of radiation doses at the depths. According to the Monte Carlo simulation, the transfer energy of beta radiation per unit of radioactivity (mCi or Bq) of each voxel was calculated per unit voxel weight to obtain a dose rate (cGy/s or Gy/s). From this, the radioactivity (mCi or Bq) necessary for a therapeutic dose or constant dose rate on a target lesion could be calculated.
Using the Monte Carlo code MCNP5, an ophthalmic applicator was designed and calculations for dosimetry were conducted therefor in the same manner as in Example 1, with the exception that 32P was used in combination with 103Pd instead of alone.
Calculations for the use of a 90Sr applicator for dosimetry were conducted using the Monte Carlo code MCNP5.
Calculations for the use of a 103Pd applicator were conducted for dosimetry using the Monte Carlo code MNCP5.
The calculation results of dosimetry obtained in Examples 1 and 2 and Comparative. Examples 1 and 2 are summarized in Table 1 below and graphed in
The dose distributions shown in Table 1 and
As seen in
Also, the dose of the ophthalmic applicator of Comparative Example 1 (b) decreases with depth to a lesser extent, resulting in the penetration of an excess dose into the eye lens and thus injury to the eye lens.
In order to compensate for geometrical errors which lead to large variations in the dose delivered to the sclera due to the exponential decrease of dose with depth, a mixed radiation field consisting of 85% 32P and 15% 103Pd was employed in the ophthalmic applicator of Example 2 (d), whose dose distribution agreed with that of Comparative Example 1 within a 5% difference at depths up to 1.25 mm. In this case, the dose decrease rate of Example 2 (d) was lower than the exponential decrease rate of Example 1, allowing an improvement in the accuracy of irradiation time calculation.
In Table 2 are summarized radioactivities required to deliver a therapeutic radiation dose of 25 Gy to the eye surface for various time periods
The ophthalmic applicator of Example 1 was found to require a radioactivity of 19.8 mCi for a treatment time of 1 hr, 1.98 mCi for a treatment time of 10 hrs, and 0.83 mCi for a treatment time of 24 hrs.
In the ophthalmic applicator of Example 2, the fractioned radioactivity was required to be 16.8 mCi+1.4×103 mCi for 1 hr, 1.68 mCi+140 mCi for 10 hrs, and 0.7 mCi+0.028 mCi for 24 hrs. These activities, required to deliver a therapeutic dose in a short time period, are producible in a pilot reactor.
As for the pure 103Pd applicator (Comparative Example 2), the radioactivity required to deliver 25 Gy was measured to be 9.3×103 mCi for 1 hr, 931 mCi for 10 hrs, and 388 mCi for 24 hrs. Thus, treatment with 103Pd only is not plausible due to the large radioactivities required and large doses to the lens. Further, the applicator using only 103Pd requires a longer dwelling time period than does the applicator using a mixed radiation field (Example 2), or is conducted in a fractioned treatment manner due to the required large radioactivity of 103Pd. In either case of Example 1 and Comparative Example 2, however, the dose delivered to the sclera and lens should be almost the same as planned because their half-lives are similar (14.2 days for 32P and 16.9 days for 103Pd). In other words, the contributions of beta radiation and X-ray to the total dose are almost constant during the treatment.
Ensuring the formation of more ideal dose distributions than do the conventional 90Sr ophthalmic applicators, as described hitherto, the ophthalmic applicator for the treatment of pterygium or glaucoma using 32P or a combination of 32P and 103Pd can promise both high therapeutic effects on pterygium or glaucoma and high safety effects on the eye lens. Further, 32P and 103Pd are easier to produce and treat than is 90Sr, thereby allowing the radiotherapy to be useful.
Although the preferred embodiments of the present invention have been disclosed for illustrative purposes, those skilled in the art will appreciate that various modifications, additions and substitutions are possible, without departing from the scope and spirit of the invention as disclosed in the accompanying claims.
| Number | Date | Country | Kind |
|---|---|---|---|
| 10-2007-0051570 | May 2007 | KR | national |
