Radiotherapy in Society:

In modern society, cancer is considered to be a kind of death sentence. However, with new and improved cancer care, the survival rates are now skyrocketing, as well as simply the quality of lives of those living with cancer symptoms, due to palliative care. Despite the fact that cancer is still the leading cause of death within Canada and plagues societies across the world, radiation therapy remains incredibly important to moving on from this era. Since its creation, radiation therapy has earned a place amongst the most effective cancer treatment, and has greatly improved the lives of cancer patients overall. However, there is still a long way to go before radiation therapy cannot continue to be developed, making this an even more important issue.

New radiotherapies:

For many years, the focus of cancer research has been chemotherapy, or the nature of cancer cells themselves. However, with radiation and nuclear sciences rising in popularity, radiation therapy has once again returned to the forefront. Radiation has the potential to save nearly four million lives currently, and would continue to save up to one million lives per year. This not only shows the importance of radiation therapy, but also the blatant need of a reliable and effective cancer treatment. In addition, this could ensure the lengthened lifespans and reduction of symptoms of nearly four million people, continuing to prove the overall importance of this field of research.

Cancer Patients:

Often, when people think of cancer, they separate it from the patients, almost assuming they are dead already, their problems in the past. This comes with the stigma of cancer being a death sentence. However, the only reason for developing these therapies is for the patients themselves, including those currently suffering. Even if current radiotherapy cannot necessarily save every patient, it has shown itself time and time again to have the incredible ability to improve their lives through palliative care and help with symptoms. Thus, radiotherapy is worth developing and has the unmatched potential to improve the lives of millions of people across the globe.

Reproductive Cancer Patients:

Many different types of radiation therapy currently being developed centre around the growing prevalence of reproductive cancers, in both men and women. For example, Lutetium-177 was recently developed, and is solely used for these types of cancers. Reproductive cancers, in men and women, are very difficult to treat. Despite this, the creation and development of various radiation treatments throughout the years have increased lifespans, and decreased the overall difficulty of treatment. Even if radiation has potential in various different groups and types of cancer, these types of cancer are some that will likely see the largest decrease with the increase of radiation therapy creation and research.

Incurable Cancer Patients:

Currently, much of the cancer that patients are suffering from is currently deemed 'incurable'. However, this is only the case with the current treatments available. This is a growing issue in our society, and it is imperative that something is done to ensure that the lives of these patients are improved, either through a therapy that has the potential to provide a cure or through improved palliative care. The number of people with these dangerous forms of cancer is projected to decrease by over 100,000 people by 2026, assuming that radiotherapy continues to be developed. Overall, radiation therapy has the potential to improve if not save many lives, and it is incredibly important that it continues to be developed.

Overall, cancer is an issue that has been prevalent in Canada for decades, and likely will remain this way for decades to come. However, it is important to acknowledge the possibility of creating a better life for cancer patients, and contributing to the eradication of the disease itself through the future development of radiation therapy.

Testing the Data

To test the collected data, I used a t test (in order to compare current isotopes used with potential future isotopes). Before doing so, I picked three isotopes (polonium-210, francium-212, and bohrium-270) that were similar in properties to rhenium and bismuth, two existing isotopes used in glioma treatment. Firstly, a paired t test using polonium and rhenium showed that the likelihood of these data patterns being coincidental is quite low, sitting at five percent. These two isotopes proved to be fairly similar, though the half life of polonium is significantly longer. Secondly, francium came back even more similar through the t test, having a closer average half life and very close MeV levels. Bohrium scored closer to bismuth, but there were still barriers involving the MeV. Overall, francium had strikingly similar results to both bismuth and rhenium, polonium scoring fairly moderately.

Analyzing the Data

After determining that all three of the elements shown above (bohrium, francium, and polonium) had the potential in cancer treatment, it can be seen that others may be immediately applicable while others may require further scientific research. A clear example of this would be bohrium, which tested very similar to rhenium considering their close proximity on the periodic table, though did not match up in terms of MeV and halflife, two factors that would make the therapy both dangerous and impractical. However, it could be incredibly effective when used in combination with continued scientific efforts to uncover more about the later elements. Thus, francium and polonium could be the future of potential glioma treatment. On the whole, francium scored very high when placed with both bismuth and rhenium, meaning that it could have a future with radiation therapy. Overall, this could change the lives of many different cancer patients, and may even allow for the elongated lives of many.

Radiation Therapy Background:

Radiation therapy can be called many different things, including radiotherapy, irradiation, and x-ray therapy. However, each of these names refer to one thing: using radioactive particles to kill cancer cells or reduce symptoms. Generally speaking, it uses high energy particles and waves in order to destroy or shrink cancer cells. These include gamma rays, x-rays, protons, and electron beams, all of which are used in local treatment (directly at the site of the cancer). Aside from this style of irradiation, this type of therapy can be administered through the mouth or the vein, after which it concentrates at the tumor site, having as little of an impact on the rest of the body as possible. This is highly effective, and over half of all cancer patients receive some form of radiation therapy. It can also work with other types of treatment, including chemotherapy, though radiation does not normally reach every part of the body, meaning that it is seldom used when the cancer has spread to many different parts of the body.

Radiation can be used for a variety of different reasons, though all related to the physical tumor or cancer cells. It can be used to cure or shrink early stage cancer cells or tumors, which is one of the most widely known uses of this therapy. However, it can also be used to shrink a tumor before surgery, known as preoperative or neoadjuvant therapy, or after surgery to ensure that the tumor/cancer does not return, which is called adjuvant therapy. Radiation can also be used for palliative care, where it is used to treat symptoms of advanced cancer. Finally, it can be used to ensure that cancer does not come back, or after it does. Radiotherapy can be given in three ways, external radiation/external beam radiation, internal radiation, and systemic radiation.

EXTERNAL:

A machine directs high energy waves at tumor/cancer at a treatment center. This type of therapy is incredibly intense and therefore needs to be given over a long period of time (1-2 times per week). It does not have to follow specific guidelines at home (not radioactive).

INTERNAL:

This type of therapy is more commonly called brachytherapy. When a patient is given this therapy, a radioactive source is placed inside of the person near the tumor, which can stay, or be removed depending on the needs of the person. Special safety precautions are needed, the patient is considered to be ‘radioactive’.

SYSTEMIC RADIATION:

This form of radiation is when radioactive drugs are given by mouth or vein, based solely upon the needs of the specific patient receiving the treatment. After it is in the patient, it travels throughout the body to the various places that it may be needed. Precautions are also needed at home for this form of treatment, as the person can serve as a source of radiation for those around them.

More about radiation:

Radiation therapy can potentially increase risk of future cancer, though the risk of future cancer could also potentially be lowered, assuming that the radiation therapy is successful in curing the body of its cancer. However, there are still risks associated, specifically to vulnerable people (children, the elderly, and pregnant women, as well as anyone that could potentially be harmed more than the average person). Even so, if radiation and other treatments are given together, they are more effective, though side effects may be worse. This is due to the fact that radiation can slow/stop growth of the tumor by damaging its DNA. 

Radiation largely depends on a variety of different factors. These may include:

• the size of the tumor
• the tumor’s location in the body
• how close the tumor is to normal tissues that are sensitive to radiation
• your general health and medical history
• whether you will have other types of cancer treatment
• other factors, such as your age and other medical conditions

As mentioned above, there are different kinds of radiotherapy that may be administered to a patient depending upon their circumstances; each of them has different benefits, guidelines, and specifications. Firstly, internal therapy can be liquid or solid, being extremely beneficial to patients who need specific treatments. In addition, brachytherapy is a solid (can be seeds, ribbons, or capsules). Such treatments are often just used to treat symptoms, known as palliative treatments. there are many types of brachytherapy, such as:

• Interstitial - the radiation source is placed directly into tumor, used most often for head or neck cancer
• Intracavitary - placed inside a bodily cavity, mainly used for female reproductive cancer
• Intraluminal - placed inside a specialized applicator inside a bodily passage, often used for cancer of the esophagus or lung. It is often used in combination with external radiation therapy to give an extra boost of radiation (more serious cases)
• Plaque or surface - Small implant of the surface, often for eye or skin cancer

Internal radiation is sometimes called radiosurgery.

Despite the fact the availability of cancer treatments and radioactive medicine has skyrocketed due to research, many patients still lack the access to these life changing treatments, making current research and attempts to improve accessibility even more important. Ideally, radiation should target malignant tumors while not affecting the healthy cells. For such properties, alpha and beta emitting elements are desirable, while gamma radiation serves little to no purpose in this treatment.

Different Isotopes:

Due to the required diversity in irradiation (this treatment is not a one side fits all medication), there are many different isotopes of many different elements that may be used in order to obtain the desired outcomes. Additionally, there are many different isotopes currently being researched for use in cancer therapy. One such element is lutetium-177, which will likely be able to replace various forms of lesser, more ineffective therapies. This isotope uses beta radiation (high energy electron beams) and has shown a high success rate in clinical trials for reproductive cancers of various forms. It is able to keep radiation to a minimum of 2mm, greatly improving the ways in which this isotope may be used in the future. It can also be used for cancers of the nerve. Furthermore, various isotopes of radium (233 and others, called Xofigo) are currently undergoing clinical trials for use in bone cancer treatment as well as general palliative care. Aside from radium, strontium-89, samarium-153 and rhenium-186 can all be used for therapeutic treatment as well. Despite the fact that the success rate for such treatments is not perfect, many have saved the lives of patients. For example, iodine-131 is used for thyroid cancer (the most successful form of cancer treatment.

Potential Future Therapies:

There are many different types of revolutionary radiotherapy being developed. For example, radioimmunotherapy binds to antibodies near the cancer cell to help the body naturally fight cancer (white blood cells in combination with the radiation treatment allow for a greater possibility of the cancer being killed and the patient being unharmed on the whole). In addition, Radioactive iodine has been used to treat cancers, specifically of the thyroid for over 80 years, proving to be fairly safe, while still allowing the properties needed. Being that most of the body's iodine is stored in the thyroid, iodine remains incredibly useful, though more effective means of using this iodine for this cancer treatment are still under review, due to the usual health and safety issues involved in creating a new radiotherapy.  Despite the fact that this form of radiotherapy is already in existence, developing it further would both allow for a longer lifespan for cancer patients and a higher likelihood of getting over the disease. Hypothetically, scientists could link a radioisotope to a targeting molecule in a body to link to a target protein on a cancer cell, known as targeted alpha therapy (TAT). TAT among them, FDA has approved various radiotherapies, one of which can be used to treat non-Hodgkin lymphoma, a very difficult cancer to treat. Being that it does involve the immune system, lymphoma is one of the cancers for which targeted alpha therapy holds the most potential. If cancer spreads, TAT makes it easier to treat if it is developed, being that external beam therapy cannot work if there are small deposits throughout the body, as is the case with much recurring cancer (if radiation therapy is used and the cancer returns). If this experimental therapy is used, it would allow for “cold” (tumors that the immune system is unable to recognize) tumors to be recognized by the body, with dead protein and DNA from these cells spilling out into the bloodstream. Additionally, some types of radiotherapy combine liquid radiation and amino acids, so the therapy is better accepted by the body - particularly used for cancers of the kidney. This also provides another option to people with cancer in various parts of their body, as liquid radiation in combination with amino acids allow for a natural honing device, meaning that radiation is significantly less toxic to the other tissues.

Gliomas and Precision Radiotherapy:

In recent years,one of the areas that has benefited the most from the development of radiotherapy is the treatment of gliomas. These are a type of tumor in the brain originating in the glial cells (outer casing) rather than the other brain cells. However, more often than not, this type of tumor proves to be deadly. Gliomas impact 0.04% of Canadians yearly, a startlingly high number for such a deadly disease. However, recent advancements in radiotherapy have already made it so that people living with any form of brain tumor are much more likely to live for longer. Specifically, isotopes such as bismuth-212, boron-10 and gadolinium-157 have been undergoing clinical trials for use in radiation therapy in order to lengthen patients' lifespans. Overall, these trials have been incredibly successful and this field of research has immense potential.

Current radiation therapy:

Next possible radiation therapies (three possibilities):

	Half-life	Type of Radiation	Group	Amount of radiation (MeV)	Type of Cancer	Type of Radiotherapy
Polonium-210	140 days	alpha	chalcogens	5.38 MeV	Glioma	Systemic/TAT
Bohrium-270*	2.4 minutes	alpha (partially unknown)	transition metals	124 MeV	Glioma	Systemic/TAT
Francium-212	20 minutes	alpha and beta	alkali metals	1.2 MeV	Glioma	Systemic/TAT

*Bohrium cannot currently be used for therapy for a variety of reasons, all of which are discussed below. Its similarities to rhenium and other current irradiation isotopes are still vital to the future of radiation therapy, in combination with other research.

T Test Results

Rhenium and polonium

Group 1 (MeV) mean: 3.3

Group 2 (half life) mean: 71.9

​​​​​​Rhenium and francium 

Group 1 (MeV) mean: 1.2

Group 2 (half life) mean: 1.9

Rhenium and bohrium

Group 1 (MeV) mean: 62.6

Group 2 (half life) mean: 1.9

Bismuth and polonium

Group 1 (MeV) mean: 6.2

Group 2 (half life) mean: 1.9

Bismuth and francium

Group 1 (MeV) mean: 4.1

Group 2 (half life) mean: 0.02

Bismuth and bohrium

Group 1 (MeV) mean: 65.5

Group 2 (half life) mean: 0.0167

Polonium and Francium:

After running various tests on the data above, it was determined that these two of the three isotopes listed have potential for immediate development in radiation therapy, both for different reasons. Firstly, the polonium isotope listed above had properties that were incredibly similar to both the rhenium and bismuth isotope currently used to treat gliomas. The type (alpha) and amount (5-7) are nearly the same as the bismuth isotope listed. In addition, its placement on the periodic table ensures that it shares other properties, such as the behavior of the particles themselves. Thus, polonium-210 has a high potential relating to cystic gliomas and glioblastomas, due to its overall similarity to bismuth-213. Polonium is widely regarded as extremely toxic, which is only true due to its radioactivity. Thus, using emerging alpha therapy techniques, polonium has a high potential for treating glioblastomas, especially considering its compatibility with the human systems.

In addition to polonium, francium-212 has also shown potential for use in future radiation therapy. Similarly to polonium, it shows incredible similarity to bismuth, regardless of the fact that it is also incredibly toxic. Again, the only reason this isotope is considered toxic initially is due to its own radioactivity. Conversely, the radiation factor is present with francium, though there is also the question of reactivity. Due to the fact that francium is an alkali metal, it is incredibly reactive. However, if it could be bonded with something else (much as the radium in Xofigo is bonded), it may have immense potential in various types of cancer, including gliomas. Francium had the best results of the three tested isotopes, showing that it could have a large impact on radiation therapy if this theory is correct. In addition, it is similar in properties to other radiotherapy isotopes (including radium), making this even more likely to have a future in the field. As such, francium remains a possibility of an incredibly effective cancer treatment regardless of the issues surrounding it.

Bohrium:

Considering the fact that bohrium is a very radioactive element, including the fact that it is extremely unstable, the current isotopes that are known of bohrium would not be proper candidates for radiation therapy. Despite this, there is a scientific theory, known as the island of stability theory, that states that many transuranium (after uranium on the periodic table) elements likely have significantly more stable isotopes than the ones currently known to the scientific world, based upon trends in the periodic table. Being that bohrium fits the criteria that applies to elements theorized to be on the island of stability, future isotopes of bohrium have a high potential for radiation therapy. Assuming that other, more stable isotopes of bohrium would have similar properties to bohrium-270, it does have an especially high potential in certain cancers, including various forms of brain cancer (most notably, glioblastomas) due to its overall similarity to the element rhenium. Thus, bohrium may have the ability to revolutionize radiotherapy entirely, though this would likely occur in the distant future.

Overall, these three isotopes have the potential to change the way irradiation is viewed. Being that they could all positively impact brain cancer patients, they may also be able to support the creation of a more effective glioma treatment. Therefore, the isotopes listed above have the potential to change radiation therapy entirely, as well as the overall lives of these patients.

Current Research:

Despite the fact that existing radiotherapy has saved many lives, there is still a need for new and improved cancer therapy. Even with the advancements that can be seen throughout recent years, there is still relatively little knowledge on the disease itself, meaning that many will die, with even more suffering on a year to year basis. However, targeted alpha therapy trials and research are promising, and will likely have a significant impact on all of this. Thus, with current and emerging technologies, scientific research I'd an integral piece of the journey to help cancer patients.

New Isotopes:

There are currently a variety of different isotopes used in cancer therapy that have shown themselves to be quite effective. While this may be true, the fact that cancer is the leading cause of death in Canada serves to prove that there are new Isotopes needed. The therapies currently used have a fairly limited success rate, though, if they are used in combination with the emerging isotopes of irradiation, they could all be incredibly successful. It is important to note that while radiation therapy will likely never have a one hundred percent success rate, using new and improved therapies could bring the number a lot closer.

In Conclusion

In recent years, there has been much testing and searching for an appropriate radiotherapy, one that will be able to help, if not cure many patients. Some cancers remain to have a fairly high survival rate, though others continuously prove to be deadly. One of these such cancers is what are known as gliomas, or brain tumors. Being that these are so deadly, there has been much research on them and new technology has been able to emerge, including new isotopes and new forms of therapy entirely. With the isotopes and potential future research laid out within this project, it is likely that a more effective glioma treatment will emerge. Current isotopes of francium and polonium have immense potential for such research and use, and, in combination with scientific advancements, bohrium may also have a place in the future of glioma treatment. It was shown that francium had the highest potential when assuming that it could form a compound with something more stable, though polonium was also a clear candidate. Even bohrium, whose properties were impractical for a use such as this, had good results, and could potentially be used with the discovery of new isotopes (these would need to have a lower MeV and a higher half life) Overall, cancer research remains to be incredibly important, and a vital part of helping the patients who are suffering. 

How Radiation Therapy Is Used to Treat Cancer. (n.d.). American Cancer Society. https://www.cancer.org/cancer/managing-cancer/treatment-types/radiation/basics.html#:~:text=about%20radiation%20therapy-,What%20is%20radiation%20therapy%3F,destroy%20or%20damage%20cancer%20cells

Radiation Therapy for Cancer. (2019, January 8). Cancer.gov. https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy

The Institute of Cancer Research, London. (n.d.). Science Talk - The exciting potential of radioactive elements in cancer therapy. https://www.icr.ac.uk/blogs/science-talk/page-details/the-exciting-potential-of-radioactive-elements-in-cancer-treatment

Internal radiation therapy. Canadian Cancer Society. https://cancer.ca/en/treatments/treatment-types/radiation-therapy/internal-radiation-therapy#:~:text=Radioisotope%20therapy%2C%20sometimes%20called%20radiopharmaceutical,in%20a%20container%20like%20brachytherapy

Radiopharmaceuticals Emerging as New Cancer Therapy. (2020, October 26). Cancer.gov. https://www.cancer.gov/news-events/cancer-currents-blog/2020/radiopharmaceuticals-cancer-radiation-therapy

Radioisotope Therapy | The University of Kansas Cancer Center | Kansas City. (n.d.). https://www.kucancercenter.org/cancer/cancer-treatments/radioisotope-therapy#:~:text=Radiisotope%20therapy%20is%20a%20procedure,damage%20to%20surrounding%20healthy%20ces

Radioisotopes in Medicine - World Nuclear Association. (n.d.). https://world-nuclear.org/information-library/non-power-nuclear-applications/radioisotopes-r

search/radioisotopes-in-medicine

Radionuclide therapy. (n.d.). https://www.iaea.org/topics/radionuclide-therapy

Canadian Nuclear Association. (2021, January 21). Medical isotopes - Canadian Nuclear Association. https://cna.ca/nuclear-medicine/medical-isotopes/#:~:text=Isotopes%20that%20are%20commonly%20used,life%20of%20about%20110%20minutes.

Yttrium-90 Internal Radiation Therapy | UPMC Hillman Cancer Center. (n.d.). UPMC Hillman Cancer Center. https://hillman.upmc.com/cancer-care/surgical-oncology/koch-regional-cancer-therapy-center/treatments/yttrium-90

Thank you to the whole science fair team at North Trail!