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Collaboration UMC St Radboud - RISO

André Minken. Collaboration UMC St Radboud - RISO. 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

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Collaboration UMC St Radboud - RISO

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  1. André Minken Collaboration UMC St Radboud - RISO

  2. Highlights • Approach project team • Report/conclusions project team • Time frame CPAC • Indications and number(s) of patients

  3. 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 • ‏

  4. initiatives in: Groningen, Maastricht, West-Nederland

  5. Proton Therapy Center – MD Anderson CC, Houston Pencil Beam Scanning Port PTC-H 3 Rotating Gantries 1 Fixed Port 1 Eye Port 1 Experimental Port Passive Scattering Ports Experimental Port Accelerator System Hitachi, Ltd. M. Bues (MDACC)‏ Large Field Fixed Eye Port

  6. Single room solution

  7. initiatives in: Groningen, Maastricht, West-Nederland

  8. initiatives in: Groningen, Maastricht, West-Nederland Protons in Eastern part of the Netherlands

  9. Contact CPAC RISO 2008 • RISO internal discussion • Possibilities and pitfalls • State of the art proton therapy

  10. 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

  11. Project team Proton treatment in East of the Netherlands Paul Bouma,RTO RISO, o.a. Head and neck oncology Jan Bussink, RTO UMCN, o.a. Pulmonary oncology Geert Jansssens, RTO UMCN, o.a. Pediatric oncology Hans Kaanders, RTO UMCN Karin Muller, RTO RISO, o.a. GE oncology Henk Huizenga, head Med Phys UMCN Martina Kunze-Busch. Med Phys UMCN Martijn Kusters, Med Phys resident UMCN André Minken, head Med Phys RISO René Monshouwer, Med Phys UMCN Rik Westendorp, Med Phys RISO

  12. Agenda project team Juli 3, 2009, Nijmegen Agenda: kick-off meeting Huizenga, Monshouwer en Minken discussion 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)‏

  13. December 4, 2009 Nijmegen Agenda: 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 Leiden Agenda: All aspects of “conventional” protonfacilities Februari 17, 2010 visit CPAC Deventer Prof. R. Mackie, S. Guse en G. Oliveira Agenda: DWA-protonaccelerator: technical steps Product development: timeframe

  14. Report: UMC St. Radboud - RISO in april 2010 June 2010, Nijmegen, Regional meeting September 2010, Nijmegen, National meeting

  15. 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

  16. 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

  17. Comparison with IMRT not 3D-CRTProton therapy, a small step ahead? Source: Anthony J. Lomax et al. Radiotherapy and Oncology 51 (1999) 257-271

  18. Pretreatment imaging on high level Target delineation Steenbakkers et al. Radiother Oncol. 2005; 77:182-90 • PProtons: Reduced proximal and zero distal dose • T

  19. IMPT (active scanning)‏ Passive scattering Spot scanning

  20. CPAC timeframe fixed beam 120-150 MeV (2013)‏ +3 years gantry based systeem 200 MeV

  21. “Signalement Gezondheidsraad” Proton treatmentIndications • Standard • Potential • Model based • Reduction of second malignancies

  22. Signalement Proton treatmentPotential indications

  23. 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

  24. 120 – 150 MeV 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

  25. Conclusions • CPAC offers a potential chance for proton therapy in the eastern part of the Netherlands at reasonable costs • Collaboration RISO & UMC St. Radboud • MST • ARTI • Isala klinieken • Scientific input universities Nijmegen and Twente

  26. movement Setup Error A 0 0 B 0 10 C 10 0 D 10 10 Tumormovement Isodoses: 50%, 80%, 95% en 100% Courtesy of M. Engelsman

  27. 5 mm Raw Bragg Peak (RBP)‏ Spread-Out Bragg Peak (SOBP)‏ (poor rich man’s IMRT)‏ Dose Dose Depth Depth 29

  28. + Less dose + Skin sparing + Less dose Photon versus Proton 30

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