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Medical requirements for FFAG as proton beam sources

FFAG 2007, April 12-17, 2007 Grenoble. Medical requirements for FFAG as proton beam sources. Jacques BALOSSO, MD, PhD Radiation oncologiste UJF / INSERM / ETOILE. Plan. Why to use protons in radiotherapy ? What kind of tumors are presently treated by protons ?

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Medical requirements for FFAG as proton beam sources

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  1. FFAG 2007, April 12-17, 2007 Grenoble Medical requirements for FFAG as proton beam sources Jacques BALOSSO, MD, PhD Radiation oncologiste UJF / INSERM / ETOILE

  2. Plan • Why to use protons in radiotherapy ? • What kind of tumors are presently treated by protons ? • What kind of tumors would be treated by widely available proton beams? • Requirement for a medical proton source • Prospective for a radiotherapy of the future

  3. Why to use protons in radiotherapy ? • What kind of tumors are presently treated by protons ? • What kind of tumors would be treated by widely available proton beams? • Requirement for a medical proton source • Prospective for a radiotherapy of the future

  4. The protons Bragg peak The 200 MeV Bragg peak of the CPO (Orsay, France)

  5. The protons Spread Out Bragg Peak (SOBP) The inside structure of the proton SOBP

  6. Comparison of the « efficient » dose according to the depth for photons, a proton SOPB and a carbon ion SOBP. (GSI, Darmstadt, Germany)

  7. PSI Villigen

  8. PSI Villigen

  9. PSI Villigen

  10. PSI Villigen

  11. Comparison of the « efficient » dose according to the depth for photons, a proton SOPB and a carbon ion SOBP. (GSI, Darmstadt, Germany)

  12. X-Rays Protons Carbone RBE  1 RBE >> 1 Neutrons

  13. Protons and Carbon ions are not offering the same advantages • Protons are representing a crude and important ballistic improvement for any type of radiotherapy… providing they are affordable ! • Carbones are an innovative kind of radiations with particular radiobiological properties suitable for certain indications only.

  14. Indication for a fractionated radiotherapy of RBE  1 Indication for particle therapy having an RBE >> 1 Survival

  15. Consequently … • Protons indications are not limited • Protons can, with the time, replace X-Rays • Carbon ions should have a definitive and limited number of indications • These indications are a number of therapeutic spots present in different groups of tumors.

  16. Why to use protons in radiotherapy ? • What kind of tumors are presently treated by protons ? • What kind of tumors would be treated by widely available proton beams? • Requirement for a medical proton source • Prospective for a radiotherapy of the future

  17. Indications for protontherapy in Loma Linda (1) • Brain and spinal cord • Isolated brain metastases • Pituitary adenomas • Arteriovenous malformations (AVMs) • Base of skull • Meningiomas • Acoustic neuromas • Chordomas and chondrosarcomas • Eye • Uveal melanomas In red: indications treated in France

  18. Indications for protontherapy in Loma Linda (2) Head and neck • Nasopharynx • Oropharynx (locally advanced) • Chest and abdomen • Medically inoperable non-small-cell lung cancer • Chordomas and chondrosarcomas • Pelvis • Prostate • Chordomas and chondrosarcomas • Tumors in children • Brain • Orbital and ocular tumors • Sarcomas of the base of skull and spine

  19. Uvea melanoma treated by protons

  20. Chondrosarcoma of the skull base

  21. Chordoma

  22. Meningioma

  23. Why to use protons in radiotherapy ? • What kind of tumors are presently treated by protons ? • What kind of tumors would be treated by widely available proton beams? • Requirement for a medical proton source • Prospective for a radiotherapy of the future

  24. Indications for protontherapy in Loma Linda (1) • Brain and spinal cord • Isolated brain metastases +++ • Pituitary adenomas • Arteriovenous malformations (AVMs) • Base of skull • Meningiomas • Acoustic neuromas • Chordomas and chondrosarcomas • Eye • Uveal melanomas In red: indications treated in France

  25. Indications for protontherapy in Loma Linda (2) Head and neck • Nasopharynx +++ • Oropharynx (locally advanced) • Chest and abdomen • Medically inoperable non-small-cell lung cancer +++ • Chordomas and chondrosarcomas • Pelvis • Prostate +++ • Chordomas and chondrosarcomas • Tumors in children • Brain • Orbital and ocular tumors • Sarcomas of the base of skull and spine

  26. Why to use protons in radiotherapy ? • What kind of tumors are presently treated by protons ? • What kind of tumors would be treated by widely available proton beams? • Requirement for a medical proton source • Prospective for a radiotherapy of the future

  27. Technical requirements • Depth: 2 to 30 cm in water • Size: at least 10 x 10 cm up to 20 x 20 • Dose rate: at least one Gy / min / liter • Precision of size & position: 1 mm • Precision of the dose: +/- 2 to 3% • Operability: > 97% • Session time: < 30 min • Beam control: active +++ (rapid change of energy ??) better than passive

  28. Exemple of a single proton beam

  29. Exemple of the set-up with a gantry

  30. Why to use protons in radiotherapy ? • What kind of tumors are presently treated by protons ? • What kind of tumors would be treated by widely available proton beams? • Requirement for a medical proton source • Prospective for a radiotherapy of the future

  31. Toward the future of radiotherapy • 100% hadrontherapy: • with 95% proton • and 5% light-ions (carbon…) • High precision and small volume of early diagnozed tumors • Few sessions of >> « 2 Gy » • Fast shot RT to reduce immobilization and to favor precision of moving target treatment (lung, lever, prostate…) • About 5000 treatments / 106 inhabitants per year in 20 years

  32. Open questions • What type of machine for the generalized availability of protons ? • What are the radiobiological characteristic of very high dose rates ? • What could be the organization and the economical conditions of very short but highly sophisticated treatments ? • Could FFAG be an answer?

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