European Training Network for Particle Therapy

1. PARTNER European Training Network for Particle Therapy Founded by the European Commission

2. 2 Some facts about cancer and hadron therapy • Cancer is the second most frequent cause of death in • Western societies. • About 50% of patients with cancer undergo radiotherapy in the course of their treatment. • Not all cancers can be treated with a satisfying outcome. • Hadron therapy uses particle beams (i.e. mostly proton and carbon ions) to treat tumours located near critical organs and tumours that respond poorly to conventional radiation therapy. • Hadrons have advantageous dose distributions and increased biological effectiveness. Source: GSI Treatment with hadrons is a promising treatment strategy with large future potential.

3. 3 Hadron therapy centers in Europe from pilot projects … ... to a clinical standard Source: EBG MedAustron

4. 4 PARTNER is … ... training 24 young researchers For this we still need photos of the missing researchers!

5. 5 PARTNER is … ... a European Commission FP7 Initial Training Network (2008 – 2012) … working on a wide range of disciplines related to hadron therapy ... a pan-European network ... focussing on intensive and multi-disciplinary training ... under the umbrella of together with other EC projects related to HT Enter Vision

6. PARTNER is … ... a collaboration

7. Research in the frame of PARTNER… • Image Guided Hadrontherapy and PET Prototype • High-tech systems for • optimizing patient treatment • increasing the accuracy in localization of the tumour • Radiobiology • Experiments elucidating the underlying biological mechanisms of hadrontherapy • to increase the treatment effectiveness while protecting healthy tissue • Novel Accelerator and Gantry Studies • Design and development of new technologies for clinical requirements • affordable cost • reduced dimensions • optimal performance • Simulations, Dosimetry and Treatment Planning • Improving treatment planning • Measurements of physical quantities • Development and tuning of physics simulation codes • Clinical Studies and Epidemiology • Investigating the clinical outcome of hadrontherapy for a wide range of cancer types • tumour control • overall survival • quality of life • Information and Communications Technologies and Networking • Common tools for promoting collaboration in research and treatment strategies in European hadrontherapy centres • towards the creation of a prototype GRID test-bed for hadrontherapy

8. 8 bladder prostate rectum Retrospective treatment planning study on prostate cancer cases Region of interest (grey part) for similarity comparison Image Guided Hadrontherapy and PET Prototype Software platform for evaluating combined modality treatment plans The featurelet approach Deformable Registration algorithm The image deformation field The deformation field applied to the delivered dose Valentina Zambrano Image-Guided Hadron Therapy – Siemens Online adaptive strategy to mitigate the effect of inter-fractional motion Wenjing Chen Workflow of ‘treatment plan of the day’ adaptive strategy

9. Image Guided Hadrontherapy and PET Prototype Application of PET imaging in light ion therapy Production of therapeutically useful positron emitter beams during carbon ion deceleration Selection of the optimal target material for 11C beam production Brahme 2009 Marta Lazzeroni Brahme 2009 PET prototype for in-situ monitoring  Development of innovative detector modules based on Multi-gap Resistive Plate Chambers (MRPC), using improved technologies over designs for High Energy Physics. David Watts

10. 10 Radiobiology • An interdisciplinary field that studies the biological effects of ionizing radiation, like: • We are assessing the relative biological effectiveness (RBE) for different ions for a range of LET values in different cell lines Biophysical properties: LET and RBE • Hypoxia causes resistance to low-LET radiation • We are reproducing different hypoxic status by using specially designed chambers, and estimating the relative OER 2. Hypoxia and oxygen enhancement ratio (OER) • We are trying to understand the molecular pathways leading to cell cycle alterations and identify the intracellular targets responsible for variation in radiosensitivity 3. Particle beams and cell cycle response

11. 11 Binucleated with micronuclei Mono-nucleated with micronuclei …Radiobiology • We are investigating the different types of cell death (e.g. apoptosis, necrosis, mitotic catastrophe, autophagy and senescence), and chromosome aberrations 4. DNA damage and mechanisms of cell death Apoptotic, mitotic cells and cells with micronuclei • We are assessing the suitability of particle beam irradiation for combination with other therapeutic modalities such as chemotherapy (e.g. temozolomide) 5. Combination with chemotherapy Thanks to... Chitralekha Mohanty Katarzyna Zielinska-Chomej Ming Chew Lara Barazzuol Walter Tinganelli

12. Novel Accelerator and Gantry Studies Objective: Participate in the conceptual design for the development of novel carbon ion gantry machine. The challenge Motivations Development of technical aspects of the Magnets to be used in the conceptual gantry design. To irradiate the tumor tissue from any direction with a carbon ion beam. Reduce size, weight and power consumption of the carbon ion gantry machine. Why is this an important subject? The magnets are the main elements which guide the ion beam into the gantry structure.

13. Novel Concept Accelerators for Hadrontherapy and Gantry Studies Objective Development of a linear accelerator (linac) for a carbon ion cyclinac (CABOTO). Linac (booster, beam energy modulation) Cyclotron (injector) Cyclinac Motivation… To deliver a compact, dedicated accelerator, providing the best possible treatment modalities for hadrontherapy at the lowest cost. The challenge! Machine dimensions could be reduced if high gradients could be achieved in the linac without compromising machine reliability. • Work description: • Performance optimization of CABOTO. • Tests of single-cell accelerating cavites to determine the highest reliable operational gradient for CABOTO. • - Comparison between RF linacs and FFAGs for hadrontherapy

14. Simulation, Dosimetry and Treatment planning Objective: Improve treatment by … • … measurements • for hadron therapy • Dosimetric • Microdosimetric • Nuclear fragmentation

15. Simulation, Dosimetry and Treatment planning Objective: Improve treatment by … • … treatment planning (TP) system support and benchmarking • Integration of measured data into TP systems • Development of Monte Carlo-based tools for TP • Validation and improvement of MC physics models • … Adaptive Radiotherapy (ART) • Use of repeated cone beam CT for adaption of TP Bladder and rectum variation on different treatment days

16. Clincial Studies and Epidemiology • Subject: Development of clinical studies in diseases potentially treatable by hadrotherapy • Role: Evaluate efficacy of hadrontherapy on patients with different tumor types treated in the European hadrontherapy facilities. • Jeffrey Tuan, Anurita Srivastava

17. IT for Hadrontherapy Nocomputing infrastructure connecting the emerging EU hadron therapy centres for: Situation • Cross-border patient referral • Cancer Research HIT (Heidelberg) Prototype ETOILE (Lyon) Grid computing links distributed resources used in a multi-disciplinary virtual organisation.     CNAO (Pavia) MedAustron (Wiener Neustadt)

18. 18 Coming soon ...Should we mention PARTNER2?

19. 19 Thank you for your attention PARticle Training Network for European Radiotherapy http://cern.ch/partner This research project has been supported by a Marie Curie Early Initial Training Network Fellowship of the European Community's Seventh Framework Programme under contract number (PITN-GA-2008-215840-PARTNER). Coordination: CERN Manjit.Dosanjh@cern.ch