Collaboration Collaboration UMC St Radboud - RISOUMC St Radboud - RISO

André Minken

Highlights

Approach project team

Report/conclusions project team

Time frame CPAC

Indications and number(s) of patients

Advantages proton therapy

Proton dose distribution is highly conformal

Integral dose reduces by a factor of 2 to 3

No exit dose

Sharp penumbra (until ±17cm)

Protons are direct ionizing

initiatives in:Groningen, Maastricht,West-

Nederland

Proton Therapy Center – MD Anderson CC, Houston

Passive Scattering Ports

Pencil Beam Scanning Port

Large Field Fixed Eye Port

Experimental Port

Accelerator System

PTC-H3 Rotating Gantries1 Fixed Port1 Eye Port1 Experimental Port

Hitachi, Ltd.

M. Bues (MDACC)

Single room solution

initiatives in:Groningen, Maastricht,West-

Nederland

initiatives in:Groningen, Maastricht,West-

Nederland

Protons in

Eastern part

of the Netherlands

Contact CPAC RISO 2008

RISO internal discussion

Possibilities and pitfalls

State of the art proton therapy

Internal meeting RISO 2008

”RISO will not succeed on its own…”

Collaboration with academic partner in the Eastern part of the Netherlands

Second step: extension to other participants

Contact with UMC St.Radboud (june 2009): installation of project team

Project teamProton treatment in East of the Netherlands

Paul Bouma,RTO RISO, o.a. Head and neck oncologyJan Bussink, RTO UMCN, o.a. Pulmonary oncologyGeert Jansssens, RTO UMCN, o.a. Pediatric oncology Hans Kaanders, RTO UMCNKarin Muller, RTO RISO, o.a. GE oncology Henk Huizenga, head Med Phys UMCNMartina Kunze-Busch. Med Phys UMCNMartijn Kusters, Med Phys resident UMCNAndré Minken, head Med Phys RISORené Monshouwer, Med Phys UMCNRik Westendorp, Med Phys RISO

Agenda project team

Juli 3, 2009, NijmegenAgenda:kick-off meeting Huizenga, Monshouwer en Minkendiscussion on subjects and timeframe

September 28, 2009, Deventer, guest dr. M. Engelsman, head of

medical physics Francis H. Burr protoncentrum in Boston.

Agenda:Introduction (dr. A. Minken)

Radiotherapy planning of protons, (dr. M. Engelsman)

Dosimetrical aspects of protonplanning (dr. H. Huizenga)Indications (K. Muller)

December 4, 2009 NijmegenAgenda:Background protonaccelerators (dr. M. Kusters)Concept Dielectric Wall Accelerator (dr. R. Monshouwer)Overview of national timeframe (dr P. Bouma)Boston visit, highlights (dr G. Janssens)

Februari 12, 2010 protoncourse LeidenAgenda:All aspects of “conventional” protonfacilities

Februari 17, 2010 visit CPAC Deventer

Prof. R. Mackie, S. Guse en G. OliveiraAgenda:DWA-protonaccelerator: technical stepsProduct development: timeframe

Report: UMC St. Radboud - RISO in april 2010 

June 2010, Nijmegen, Regional meeting

September 2010, Nijmegen, National meeting

Conclusions report

• Feasible, critical evaluation of resources,

comparison with photon techniques

• Collaboration

• State of the art

• Indications

• Number of patients

• Scientific input: universities Nijmegen and Twente

State of the art techniques

Comparison with IMRT not 3D-CRT Pretreatment imaging on high level Set up and fixation Imaging on treatment machine IMPT (active scanning) Learn from experienced users

•Patching around OARs•Movement compensation•Fixations•Treatment planning techniques

Comparison with IMRT not 3D-CRTProton therapy, a small step ahead?

Source: Anthony J. Lomax et al. Radiotherapy and Oncology 51 (1999) 257-271

Pretreatment imaging on high levelTarget delineation Steenbakkers et al.

Radiother Oncol. 2005; 77:182-90

•PProtons: Reduced proximal and zero distal dose

•T

0

20

40

60

80

100

120

140

160

180

200

0 5 10 15 20 25 30Depth (cm)

Do

se

(%

)

Photon (10MV)

Proton SOBP (18cm)

IMPT (active scanning)

Passive scattering

Spot scanning

CPAC timeframe

fixed beam 120-150 MeV (2013)

+3 years gantry based systeem 200 MeV

“Signalement Gezondheidsraad” Proton treatmentIndications

Standard

Potential

Model based

Reduction of second malignancies

Signalement Proton treatmentPotential indications

Number of patients

• Region: Eastern part of the Netherlands patient population: 16% of the Netherlands

• Start with Fixed-beam 120-150 MeV

• End situation rotating 200 MeV beam

120 – 150MeV

200 MeV RCT’s

Standard 57 57 57

Potential 8 10 187

Model based 284 655 655

Second malignancies 101 117 117

450 839 1016

Number of Patients

•CPAC offers a potential chance for proton therapy in the eastern part of the Netherlands at reasonable costs

•Collaboration RISO & UMC St. Radboudo MSTo ARTIo Isala klinieken

•Scientific input universities Nijmegen and Twente

Conclusions

1010D

010C

100B

00A

SetupError

movement

Courtesy of M. Engelsman

A B C D

E F G H

Isodoses: 50%, 80%, 95% en 100%

Tumormovement

29

Depth

Do

se

Depth

Do

se

Raw Bragg Peak (RBP) Spread-Out Bragg Peak (SOBP)(poor rich man’s IMRT)

5 mm

30

Photon versus Proton

+ Less dose

+ Less dose

+ Skin sparing

0

20

40

60

80

100

120

140

160

180

200

0 5 10 15 20 25 30Depth (cm)

Do

se

(%

)

Photon (10MV)

Proton SOBP (18cm)