John,
I'm not sure "treatment plan" is the right description -- this is experimental nuclear medicine - a clinical trial.
It doesn't seem strange to me -- the liver needs to be in the patient during the boron compound injection, so that the boron gets into the liver and into the cancer cells, and the excess may then be "washed away" from the rest of the (healthy) tissue, so that its not damaged during the neutron therapy ( the tumorcidal result is caused by the reaction 10B (n,a) 7Li; the path length of the alpha and lithium particles do not exceed 10 microns, about the diameter of the typical cell, thus cell killing is localized i.e. death of the cell where the reaction occurs.).
I'm not sure why they had to remove the liver -- certainly its easier to irradiate a small, portable object, than to direct a neutron beam at a specific part of the body.
But I'm sure that the latter would be the normal "treatment plan" once the technique is proven.
It may be related to the type of irradiation facility available at that research centre.... for instance, with glioblastoma (a deadly brain cancer), if you don't have the right kind of neutron beam, you have to remove a part of the skull, so that penetration is adequate without excessive irradiation of surface tissues and bone -- this is the approach the Japanese have been using with great success. But the trend now is to improve the beam quality at research facilities (a specific, epithermal energy range), so that surgery is not required.
I'm not sure I understand your second question, about "metastases in a necrosis condition while the normal tissues appear well preserved." This is the result you want - dead cancer cells and undamaged healthy cells ( I'm no expert on this, but I believe those dead cancer cells are "removed" by phagocytes....).
Some web sites on BNCT research and clinical programs :
http://www.bnct.net/
http://www.bnct.org/
http://web.chem.ucla.edu/~mfh/
http://www.vtt.fi/ket/ket1/bnct/bnctpro1.htm
http://ehs.lbl.gov/bnct/
http://www.cnea.gov.ar/bnct/eng.htm
http://www.jrc.nl/project/p1.html
http://web.mit.edu/afs/athena.mit.edu/org/n/ned/www/research/nukenews/960214bombard.html
http://www.rri.kyoto-u.ac.jp/BNCT/english/japanbnct.htm
http://users.unimi.it/~frixy/bnct/bnct_main.htm
http://omega.ujf.cas.cz/CFANR/k16.html
http://kelvin.seas.virginia.edu:8001/UVAR/bnct.html
http://www-cancer.med.ohio-state.edu/basic/programs/bnct.htm
http://scanner.hosp.utk.edu/radiology/research/BNCT/bnct.html
http://www.unsw.edu.au/clients/stgeorge/resproj.htm#bnct
Jaro
-----Original Message-----
From: Jacobus, John (OD/ORS) [mailto:jacobusj@ors.od.nih.gov]
Sent: Friday February 22, 2002 8:22 AM
To: Franta, Jaroslav; multiple (E-mail); Radsafe (E-mail)
Subject: RE: First neutron therapy procedure on the explanted human liver [FW]
Jaro,
Is it just me, but this seems like a bizarre treatment plan.
1. Inject patient with boron-labeled compound
2. Remove liver
3. Irradiate liver
4. Implant liver back into patient.
I also question the evaluation of success based on CT images to visualize
the "metastases in a necrosis condition while the normal tissues appear well
preserved." Of course, long term survival of the patient may not be the
outcome they were evaluating.
-- John
John Jacobus, MS
Certified Health Physicist
3050 Traymore Lane
Bowie, MD 20715-2024