Boron Neutron Capture Therapy for Breast Cancer during Pregnancy: A Feasibility Study

Document Type : Original Paper


Physics Department, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran


Introduction: the present study aimed to evaluate the feasibility of boron neutron capture therapy (BNCT) for breast cancer (BC) incidence during pregnancy.
Material and Methods: Computational models of pregnant women at 3- and 6- month gestational ages were used with two different simulated tumors in their left breasts. The Monte Carlo simulation of tumor irradiation by thermal and epithermal output beams of in-hospital neutron irradiator was performed in five directions. The optimum treatment plans as a combination of the irradiation directions and output beams were then assessed using an optimization code.
Results: Based on the findings of the present study, the total irradiation time of ≤ 10 min was needed to deliver a prescribed dose of RX = 24.4 Gy-Eq to gross tumor volume (GTV) in a BNCT single fraction. The dosimetric properties and volume metrics of the optimized treatment plans were obtained and the dose-volume histogram (DVH)-based metrics, were compared to those from conventional radiotherapy. It has been shown that the dose to both target volume and organs at risk (OARs) were within clinically acceptable dose constraints throughout the course of a single- fraction BNCT. Moreover, the fetal dose (~4.8 mGy-Eq) was well below the threshold for secondary cancer incidence (10 mGy) in the first trimester of pregnancy, while for the second trimester of pregnancy, it was much higher (~35.5 mGy-Eq).
Conclusion: Regarding the DVH metrics for GTV, maternal OARs, and the fetus, the studied treatment modality was an appropriate alternative treatment, especially for BC incidence in the first trimester of pregnancy.


Main Subjects


    1. Amant F, Deckers S, Van Calsteren K, Loibl S, Halaska M, Brepoels L, et al. Breast cancer in pregnancy: recommendations of an international consensus meeting. European journal of cancer. 2010; 46(18):3158-68.
    2. Krishna I, Lindsay M. Breast cancer in pregnancy. Obstetrics and Gynecology Clinics. 2013; 40 (3):559-71
    3. Riet FG, Fayard F, Arriagada R, Santos MA, Bourgier C, Ferchiou M, et al. Preoperative radiotherapy in breast cancer patients: 32 years of follow-up. European Journal of Cancer. 2017; 76:45-51.
    4. Coles CE, Fourquet A, Poortmans P. Preoperative radiation therapy: The ‘new’targeted breast cancer treatment?. European Journal of Cancer. 2017; 78:116-7.
    5. Scotti V, Desideri I, Meattini I, Di Cataldo V, Cecchini S, Petrucci A, et al. Management of inflammatory breast cancer: focus on radiotherapy with an evidence-based approach. Cancer treatment reviews. 2013; 39(2):119-24.
    6. Pavlidis N, Pentheroudakis G. The pregnant mother with breast cancer: diagnostic and therapeutic management. Cancer treatment reviews. 2005; 31(6):439-47.
    7. Mirzaei D, Miri-Hakimabad H, Rafat-Motavalli L. Depth dose evaluation for prostate cancer treatment using boron neutron capture therapy. Journal of Radioanalytical and Nuclear Chemistry. 2014; 302 (3):1095-101.
    8. Weldy JB, Brenizer JS. Computational Dosimetry of BNCT for Breast Cancer Treatment. InCancer Neutron Capture Therapy. Springer, Boston, MA. 1996;501-9.
    9. Mundy DW, Harb W, Jevremovic T. Radiation binary targeted therapy for HER-2 positive breast cancers: assumptions, theoretical assessment and future directions. Physics in Medicine & Biology. 2006; 51(6):1377.
    10. Gonçalves-Carralves MLS, Jevremovic T. Numerical assessment of radiation binary targeted therapy for HER-2 positive breast cancers: advanced calculations and radiation dosimetry. Physics in medicine and biology. 2007; 52 (14):4245.
    11. Gadan MA, González SJ, Batalla M, Olivera MS, Policastro L, Sztejnberg ML. Application of BNCT to the treatment of HER2+ breast cancer recurrences: Research and developments in Argentina. Applied Radiation and Isotopes. 2015; 104:155-9. 
    12. Hoseinian-Azghadi E, Rafat-Motavalli L, Miri-Hakimabad H. Development of a 9-month pregnant hybrid phantom and its internal dosimetry for thyroid agents. Journal of radiation research. 2014; 55 (4):730-47.
    13. Motavalli LR, Hakimabad HM, Azghadi EH. Fetal and maternal dose assessment for diagnostic scans during pregnancy. Physics in Medicine & Biology. 2016; 61 (9):3596.
    14. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. Jama. 2015;314(10):1039-51. 
    15. Ancel PY, Goffinet F, Kuhn P, Langer B, Matis J, Hernandorena Xet al. Survival and morbidity of preterm children born at 22 through 34 weeks’ gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA pediatrics. 2015;169(3):230-8.
    16. Singletary SE. The new staging classification: Is it useful for clinicians. G. Bonadonna, et al.(Éds.), Texbook of Breast Cancer: A clinical guide to therapy. 2006; 67-80.
    17. Singletary SE, Greene FL. Revision of breast cancer staging: the 6th edition of the TNM Classification. InSeminars in surgical oncology. Hoboken: Wiley Subscription Services, Inc., A Wiley Company. 2003;21(1):53-9.
    18. Aljarrah A, Miller WR. Trends in the distribution of breast cancer over time in the southeast of Scotland and review of the literature. ecancermedicalscience. 2014;8.
    19. Sauerwein WA, Wittig A, Moss R, Nakagawa Y, editors. Neutron capture therapy: principles and applications. Springer Science & Business Media. 2012.
    20. Coderre JA, Makar MS, Micca PL, Nawrocky MM, Liu HB, Joel DD, et al. Derivations of relative biological effectiveness for the high-LET radiations produced during boron neutron capture irradiations of the 9L rat gliosarcoma in vitro and in vivo. International Journal of Radiation Oncology* Biology* Physics. 1993;27(5):1121-9.
    21. Rassow J, Sauerwein W, Wittig A, Bourhis‐Martin E, Hideghéty K, Moss R. Advantage and limitations of weighting factors and weighted dose quantities and their units in boron neutron capture therapy. Medical Physics. 2004;31(5):1128-34.
    22. Horiguchi H, Nakamura T, Kumada H, Yanagie H, Suzuki M, Sagawa H. Investigation of irradiation conditions for recurrent breast cancer in JRR-4. Applied Radiation and Isotopes. 2011;69(12):1882-4.
    23. Ke G, Sun Z, Shen F, Liu T, Li Y, Zhou Y. The study of physics and thermal characteristics for in-hospital neutron irradiator (IHNI). Applied Radiation and Isotopes. 2009;67(7-8): S234-7.
    24. Soppera N, Bossant M, Dupont E. JANIS 4: an improved version of NEA javabased nuclear data information system. Nuclear Data Sheets. 2014; 120 :294-6.
    25. Khan AJ, Stewart A, Dale R. The Radiobiology of Breast Radiotherapy. InShort Course Breast Radiotherapy. Springer, Cham. 2016; 39-52.
    26. Emami B. Tolerance of normal tissue to therapeutic radiation. Reports of radiotherapy and Oncology. 2013; 1 (1).
    27. Loibl S, Schmidt A, Gentilini O, Kaufman B, Kuhl C, Denkert C, et al. Breast cancer diagnosed during pregnancy: adapting recent advances in breast cancer care for pregnant patients. JAMA oncology. 2015;1(8):1145-53.
    28. Barnes DM, Newman LA. Pregnancy-associated breast cancer: a literature review. Surgical Clinics of North America. 2007; 87(2):417-30.





Volume 17, Issue 6
November and December 2020
Pages 401-409
  • Receive Date: 24 August 2019
  • Revise Date: 07 December 2019
  • Accept Date: 12 December 2019