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Introduction
Mailing Lists:
I have completed updating the mailing list. I thank everyone who
returned the forms to me.
Costs:
At PTCOG XIX, the Steering Committee decided that part of the registration
fee for PTCOG meetings would be used to help produce both Particles
and the abstracts of the PTCOG meetings. Only part of the costs
are covered in this way, so more financial help is needed from the
community. We are always happy to receive financial gifts
HCL is always
happy to receive financial gifts; all such gifts are deductible
as charitable contributions for federal income tax purposes. The
appropriate method is to send a check made out to the "Harvard
Cyclotron Laboratory". We thank Dr. Steven Goetsch for his
kind contribution.
Facility and
Patient Statistics: I continue to collect information about
all operating or proposed facilities. Please send me your information.
My most recent published summary of the world wide patient statistics
with detailed patient data through 1994 can be found in the following
reference. "Proton therapy in 1996." J. M. Sisterson,
CP392, Application of Accelerators in Research and Industry, eds.
J.L. Duggan and I.L. Morgan, AIP Press, New York (1997), p1261-4.
Particles on
the Internet: We have set up a home page for the Harvard Cyclotron
Laboratory on the Internet with links to recent issues of Particles.
Other proton
therapy links: (I did try all these URLs but I am sure this
list is not complete, so PLEASE send me your URL to include in the
next issue).
ARTICLES FOR PARTICLES
23
Address all
correspondence for the newsletter to:
Telephone:
(617) 495-2885 Articles for
the newsletter can be short but should NOT exceed two pages
in length. The best way to send an article is by computer.
If you mail or fax an article, remember that I scan them into
the computer so I need a good clean copy of any figures.
PTCOG and FUTURE
PTCOG MEETINGS
It is with regret that we accept Dr. Joe Castro’s resignation from the Steering Committee. We are pleased that Dr. Herman Suit has agreed to take his place on this committee. Steering Committee Members
The times and locations of the next PTCOG meetings are as follows:
The proceedings for the PTCOG XXVII meeting held in Chiba, Japan in November 1997 should be available soon.
SECOND ANNOUNCEMENT:
Heidelberg / Germany, September 14 - 16, 1998. Outline of the Preliminary Program
18:00 - 20:00
Welcome Reception Monday,
14th 9:00 -17:45
Sessions at the DKFZ, Heidelberg
Tuesday,
15th. 7:30 - 8:20
Steering Committee Meeting breakfast Wednesday,
16th 9:00 - 12:30
Sessions at the University Hospital, Heidelberg. DKFZ, The
University Hospital and the Renaissance Hotel are all in Heidelberg.
GSI, Darmstadt is about one hour away. Registration:
The registration form included in this mailing should be sent
to:
PD Dr. Dr. J¸rgen Debus Im Neuenheimer Feld 280 69120 Heidelberg Germany
Accommodation:
Participants are expected to make their own reservations
until August 10th 1998 at (please note space is limited):
Vangerwostr. 16 69115 Heidelberg Tel: + 49 6221 908-0 Fax + 49 6221 908 508 (Please
refer to the above meeting in order to obtain special rate
of about 200 DM) Information in other accommodations can be obtained by Heidelberg tourist service:
+ 49 6221 142223 / 24 +49 6221 167318
Registration
fee: The registration fee for the meeting has been set
at DM 350.--. DM 300 .-- if paid before August 15th
1998. (DM 300.-- for those registered before June 30th
1998) Please transfer
the fee to one of the following accounts with the code H
206
Landeszentralbank Heidelberg ( 672 000 00 ) 672 / 01900 Deutsche Bank Heidelberg ( 672 700 03 ) 01 / 57008 Dresdner Bank Heidelberg ( 672 800 51 ) 4 688 491
Abstracts:
Contributors are invited and strongly encouraged to submit an
abstract of their presentation
that will be published in the January 1999 issue of Particles.
The abstract should be about one half page in length, include
authors and affiliations. Abstracts will be collected at the
meeting or may be sent to Janet Sisterson by one of the means
listed earlier in this newsletter. THE BEST METHOD is by e-mail
to jsisterson@partners.org.
12-15 April 1999
EHTG - European Hadron Therapy Group ECHED - European Clinical Heavy Particle Dosimetry Group Date:
SEA POINT, CAPE TOWN SOUTH AFRICA Organisers:
National Accelerator Centre P O Box 72 7131 SOUTH AFRICA Contact:
Tel: +27-21-843-3820 Fax: +27-21-843-3382 e-mail: jones@nac.ac.za Latest Information: The meeting
will cover all aspects of neutron capture, fast neutron, proton
and heavy ion therapy including:
Cape Town is
regarded as one of the world’s most beautiful cities and
April is a very pleasant time of the year - the average maximum
temperature is 23°C/73°F and the average minimum temperature is
12°C/54°F. The Arthur’s Seat Hotel is conveniently located
in the suburb of Sea Point and is one block from the seafront.
Downtown is easily accessible as the hotel is on the main bus
and taxi routes and there is also a shuttle bus to the Waterfront
shopping, hospitality and entertainment complex. Cape Town is
easily reached from all major cities, either on South African
Airways or on other international carriers. Flights terminate
in Cape Town or Johannesburg, which is a 2-hour flight from Cape
Town. For information
on siteseeing and tours contact the nearest office of the South
African Tourism Board (SATOUR) or:
Talk Travel P O Box 6878 Roggebaai 8012 SOUTH AFRICA Tel: +27-21-797-1861 If you wish to receive further information please complete the form included in this mailing, and return it to the organisers. BEAM SCANNING
WORKSHOP
This Workshop
was arranged as a result of favourable responses received to the
proposal in PARTICLES No. 20 (July 1997) regarding the formation
of a beam scanning collaborative group and was attended by 26
participants. The proceedings were divided into several sessions
covering different topics. Each topic was introduced by different
speakers after which discussions took place. Apart from the main
agenda topics, Dr Y Futami of Chiba give a brief presentation
of the C-11 radioactive beam spot scanning system under development
at NIRS.
AGENDA INTRODUCTION
The main disadvantages
include: There are
several techniques which can be used for scanning. For lateral
beam spreading, circular scanning (wobbling) or linear scanning
can be done. In the latter case the beam can be scanned continuously
or in a discrete fashion (spot scanning). Another possibility
is to undertake the fastest scan in one-dimension (strip scanning)
and move the patient or the scanning magnet in the other dimension.
Depth variation is achieved by interposing degraders in the
beam (cyclotrons) or by changing the beam energy (synchrotrons). The aim of
beam scanning is to deliver a predetermined dose at any point
in the body. Special care must be taken as scanning (because
of high instantaneous dose rates) is potentially more dangerous
than passive beam modification systems. The beam position and
the dose delivered at each point must be accurately determined.
SUMMARY OF DISCUSSIONS
With polar
scanning (ie. with short SADs and therefore divergent beams)
these procedures are more difficult but can be done with proper
treatment planning. With short
SADs there is also an increase in the entrance dose (inverse
square law), but the impact of this effect is reduced when
multiple fields are used. FIELD SIZE
The length
of the other dimension depends on the scanning technique used.
At least 40 cm is desirable. he smallest
field is determined by the elemental beam size.
RANGE MODULATION
SPATIAL
RESOLUTION (s) AND PENCIL BEAM SIZE
s
approx =
3 mm. at and near edge of field. Within the
field, a broader beam could be contemplated, say s
= 6 mm or
even more. The sharper
resolution at the field edge can be achieved: with adjustable
pencil beam profiles; with a collimator; by phase space trimming;
or, to some extent, by a variable intensity near the field
edge. Changing
the spot size between layers to preserve spacing should be
considered, but this effect can be taken into account in the
treatment planning.
Up to 100:1
between layers. DOSE FIDELITY
BEAM SPACING
NO. OF
FIELDS PER FRACTION DELIVERED
TIME TO
DELIVER ONE FIELD / FRACTION
The more
important specification is the time to deliver one fraction.
Ideally, after patient set-up and localization, this should
take no more than from 5 to 10 minutes.
Patient
set-up is also more difficult as no field-defining lights
can be used for field shape and position confirmation. In
practice x-ray verification of position is almost always done. Typical
set-up accuracies which are needed are <0.2 mm (extremities),
1-2 mm (head and neck) and 5-10 mm (abdomen).
ORGAN AND PATIENT MOTION
Gating the
beam on and off at specific patient or organ positions can
be done.Up to now this has usually been related to the breathing
cycle. This requires real-time monitoring of the organ or
patient position by means of motion detectors and transducers.
Other motion
detector possibilities include the use of internal or external
fiducial markers or anatomical landmarks in conjunction with
x-radiography, ultrasound, neutron radiography or externally
applied magnetic fields. Patients
can also be required to hold their breath or the areas of
their bodies being irradiated can be compressed. Because
patient and organ motion usually takes place in a regular
and predictable fashion the extent of movement can be anticipated
and allowed for with reasonable accuracy. The capability
of repositioning from outside the treatment room is desirable
to allow adjustment for small changes in patient or target
position. SCANNING MAGNETS
Long throws
are possible with fixed beams but the throw is limited in
a gantry. It is desirable
to sweep the beam by 20 cm in 30-100 msecs.
SHAPE OF BEAM SPOT
A symmetrical
shape is ideal. Asymmetrical
spots do not pose problems if the spot spacing is close enough.
SAFETY
For safety
reasons, asymmetrical scanning is probably ideal ie. the scanning
magnet axes are offset from the treatment central axis. Verification
of the treatment pattern should take place as close to the
patient as possible. Redundant
checks of the beam position must be done, preferably with
different computers. eg. the position can be checked by feedback
of magnet current and of magnetic field strength. Great care
must be paid to restart procedures should interruption occur
during irradiation in order to reproduce the required dose
distribution.
BIOLOGICAL EFFECTS The RBE
depends on particle type, beam energy (depth), type of irradiated
tissue and the integral dose (the latter is a result of the
shape of the photon [reference] survival curves). At the dose
rates used in beam scanning there are no dose-rate effects. Long treatment
times are undesirable because they may approach the time scale
of repair mechanisms. With C-12
beams at GSI the RBE is changed for each irradiated elemental
volume. Although
the RBE for proton beams does increase as a function of increasing
depth (decreasing energy) this is not usually taken into account
with any form of beam delivery. A global
RBE (usually 1.10) is assumed, but recent measurements at
LLUMC, NAC and PSI done by the same group, using the same
biological system in similar beams gave RBEs of 1.05, 1.15
and 1.25 respectively.
TREATMENT PLANNING
Intensity
modulated beam delivery has been implemented at PSI only.
Intensity modulated plans have been developed, and intensity
modulated treatments are likely to be delivered in the near
future. A standard
elemental beam shape is assumed for planning purposes. How
often this shape should be checked is not clear (between fields,
every day, ?) A basic
problem is that all dose distribution measurements are made
in homogenous phantoms which do not reflect the situation
in a patient. Planning
optimization is usually done at present by iterative techniques.
At PSI, the treatment planning system produces a so-called
"steering file" which specifies the scanning parameters
for a particular field. For each spot the magnet currents,
beam energy/degrader thickness, couch position (if applicable),
RBE (if applicable) etc. are given). In principle
the RBE should be taken into account throughout the treated
volume.
DOSE CALIBRATION AND VERIFICATION
The 3-D
dose distribution must be verified. Different
detector systems can be used for simulations and for verification
during treatment. For simulation
the following detectors can be used: 1-D: diodes,
ionization chambers, TLDs, diamond detectors 2-D: "magic
cube", radiographic film, scintillation screens 3-D: GEL
(dose accuracy: 5%, spatial resolution: 1.5 mm
CCD cameras with scintillation screens (0.5% , 0.5 mm) During treatment
multiwire ionization chambers, radiographic film (not real-time)
and scintillation screens can be used. REQUIREMENTS FOR QUALITY ASSURANCE In order
to undertake quality assurance procedures knowledge of the
planned dose distributions are required. The dose
distributions must be checked with independent systems under
exactly the same conditions as pertain to the treatment. It
should be noted that for some detection systems this is not
possible (eg. radiochromic film requires higher doses, PET
requires beam interruptions for data acquisition). New dosimetry
protocols will have to be developed for scanned beams.
WORKING GROUPS
The subjects
to be addressed by the Working Groups, their Chairmen and
e-mail addresses are given below:
It is anticipated
that additional informal discussions among interested people
will take place at PTCOG XXIX (Heidelberg), while a second
workshop will be held next at PTCOG XXX (Cape Town) which
will give us more time to prepare the topics in more detail
than can be done in the short period since the last workshop
in Palm Springs. Those interested
in partaking in the activities of any of the above groups
should contact the respective Chairmen as soon as possible. Dan Jones,
Marco Schippers and Michael Goitein,
At the 28th
PTCOG meeting in Rancho Mirage, the Clinical Protocol Working
Group had it’s first session. The main objectives of this
working group are:
This first session
focused primarily on the status report of all currently existing
proton protocols. Several potential future trial designs in the
area of prostate cancer, CNS, sarcoma, and pediatric oncology.
The reaction of participants was positive and encouraging. All
relevant facts were summarized to the full PTCOG audience, on
the last meeting of the day. We plan to continue
the working group at the upcoming meeting in Heidelberg, as well
as future meetings, similar to other multi institutional and international
cooperative groups. Emphasis of
the upcoming Fall meeting in Heidelberg will be to discuss participation,
and future trials initiated by non U.S. institutions. In keeping with
PTCOG tradition, the clinical protocol working group is open to
everyone interested. We plan again, to present a summary to the
full PTCOG audience. Many of us are
unfamiliar with technical equipment, beam availability, patient
availability, etc., of the various institutions. These and other
variables are all factors influencing the choice of disease, site,
and design of new trials, as well as opportunities to participate.
Please consider a brief 5 - 8 min. presentation and outline of
these parameters of your facility at the session in Heidelberg.
Please keep in mind that this is not the forum to present any
clinical data, which should always be presented at the regular
clinical sessions. Eugen B.
Hug, M.D., Associate Professor,Radiation Medicine, Loma Linda
University Medical Center, Loma Linda California. Phone: (909)
824-4280, Fax: (909) 824-4083, E-mail: Ehug@dominion.llumc.edu.
The first Prolit
database was developed at LLUMC in the late 1980s; it was distributed
to PTCOG members and others interested in particle radiation therapy
via hard copy and diskettes. Prolit was discontinued in 1993,
when it became apparent that the data-collection process was too
labor-intensive and the mode of distribution limited. The current
incarnation of Prolit can be updated quickly, and should reach
a much larger audience via the Internet. The Prolit development
team anticipates refining the search engine and PubMed search
strategy based on user feedback. Please direct any comments to
Robert Kirby at rkirby@dominion.llumc.edu. Robert Kirby, Dept.
of Radiation Medicine, Loma Linda University Medical Center, 11234
Anderson Street, Loma Linda, CA 92354.
PTCOG Information/News/Reports: The following
reports and articles were received by July 1998.
The National Association for Proton Therapy (NAPT) announced on March 18, 1998 the launching of its new web site -- http://www.proton-therapy.org --to meet increasing demand for information on proton therapy for cancer treatment. The web
site focuses on the most frequently asked questions about
the benefits of proton beam technology in the treatment of
numerous cancer sites in the body -- including results of
a recent study on men with prostate cancer. The web site includes
sections on how protons work, proton facts, where to find
proton therapy treatment, treatment center floor plan, testimonials
from patients, and links to other proton therapy sites. The NAPT
is a non-profit organization providing education and awareness
for the public, professional and governmental communities.
Founded in 1990, it promotes the therapeutic benefits of proton
therapy for cancer treatment in the U.S. and broad. Internet users are encouraged to visit the site and ask questions of their own by contacting lenarzt@proton-therapy.org Contact:
Len Arzt, National Association for Proton Therapy, 7910
Woodmont Ave. #1303, Bethesda, MD 20814; 301-913-9360 .
Midwest
Proton Radiation Institute, Bloomington, In, USA update:
We have
completed development and testing of the eye treatment facility
and are now ready to treat patients, pending final approval
from IU's Machine Produced Radiation Safety Committee. The
testing process took somewhat longer than anticipated. The
first AMD patients are scheduled to be treated in mid-July.
These patients are participating in a clinical trial on choroidal
neovascular membrane in age-related macular degeneration.
Design work for the new facility has been centered on energy selection and beam transport from the Cyclotron to the treatment rooms. An architectural firm is working on a conceptual design for the building addition required for patient care, treatment planning and preparation, and staff support. Moira
Wedekind, Indiana University Cyclotron Facility, 2401 Milo
B Sampson Ln, Bloomington, IN 47408. News
from Moscow, Russia:
Patient treatment has been carried out at ITEP PTF in 1997. 3039 patients were irradiated by January 1, 1998. V.S.
Khoroshkov, Inst. for Theor. & Exper. Physics, B. Cheremushkinskaya
25, Moscow 117259, Russia. Heavy-Ion
Therapy at GSI, Darmstadt, Germany:
The follow
up of the two treated patients is very satisfying. In the
CT-images a reduced uptake of contrast drug is observed and
the T2 weighted MRI does not show any abnormality outside
the target area. Therefore, it can be concluded that the treated
volume coincides precisely with the target volume. This coincidence
was also measured online during the treatment using PET techniques.
Because
of the shut down period, the changes in the beam transport
system and the installation of the heavy new physics cave,
causing sedimentation problems to the building, a longer period
of test and realignment is expected before patient treatment
will be possible in order to obtain the same quality of performance
that was reached last time. At present
the results of these first treatments are implemented in the
control and safetxy system as well s in the treatment planning
procedures. Next patient treatments are in preparation for
late of August and early September. Then a maximum number
of ten patients will be treated with twenty fractions in twenty
consecutive days including weekends. On September
14 -16 the next PTCOG meeting will be held at Heidelberg combined
with the inauguration ceremonies for the GSI therapy. More information is available on the web on the GSI homepage: http://www.gsi.de Gerhard
Kraft, GSI, Planckstr. 1, Darmstadt D 64291, Germany. News
from NLHIAL (National Laboratory of Heavy Ion Accelerator, Lanzhou),
Lanzhou, P.R.China: HIRFL-CSR PROJECT IN LANZHOU
CSR, a new
accelerator planned at the Heavy Ion Research Facility in
Lanzhou (HIRFL), is a multipurpose Cooling Storage Ring system,
and consists of a main ring (CSRm) and an experimental ring
(CSRe). The existing HIRFL will be used as its injector system.
The heavy ion beams with energy range of 10-100MeV/u from
the HIRFL will be accumulated, cooled and accelerated to the
higher energy range of 100-400MeV/u in the main ring, and
then extracted fast to produce radioactive ion beams (RIBs)
or highly charged state heavy ions. After that, the secondary
beams (RIBs or highly charged ions) can be accepted by the
experimental ring for many internal target experiments with
cooling. Two electron
coolers located in the long straight sections of the CSRm
and CSRe respectively, will be used for beam accumulation,
compensating for the growth of beam emittance during internal
target experiment and providing high quality beams for special
experiments. The CSR
system intends to provide internal and external target beams
for many physics experiments. Two internal target in the long
straight sections of CSRm and CSRe will be used for nuclear
physics and highly charged atomic physics. Two external target
of CSRm will be used for cancer therapy studies and
the researches on the properties of nuclear matter under extreme
condition. The main
parameters of the CSR are listed in Table 1.The lattices of
the CSRm and CSRe are quite similar to each other. They consist
of four arc sections and two long straight sections. The doublet
and triplet quadruple are the essential options. Table 1.
Main parameters of the CSR
Circumference(m) 161.20 128.96 Average radius(m) 25.66 20.56 Max.energy(MeV/u) 900(12C6+) 400(12C6+) 400(238U72+) 250(238U90+) Bpmax/Bpmin(T-m) 10.64/1.25 6.44/0.64 Bmax/Bmin(T) 1.40/0.16 1.40/0.13 Ramping rate(T/s) ~10 ______________________________________________________________________ The combination
of multiturn injection and RF stacking will be used for the
CSRm to accumulate heavy ions up to 109-7 in a
short duration of about four seconds. During the accumulation,
both electron and stochastic cooling will be used for cooling
of beam phase space in order to increase the accumulation
ratio and efficiency. Table 2. is the accumulation parameters
of several typical ions. Table 2.
Parameters of accumulation in CSRm
Energy(MeV/U) 50 20 10 Current(pps) 3.1x1012 8.7x1010 8.5x109 Stacking cycle(ms) 30 20 20 Injection period(s) 4 4 4 Particles of accum. 2.4x109 1.5x108 2.1x107 --------------------------------------------------------------------------------------- For the
HIRFL-CSR plan, all optimising design and study are now in
progress. The total budget of the CSR is about 300 million
Chinese Yuan. The whole duration of it is intended to be seven
years, two years for design and five years for construction.
Zengquan Wei, IMP, CAS, Nanchang Road 363, Lanzhou 730000,
P.R.China
News from St Petersburg, Russia: Pulsed dose rate of high-energy proton beam as DNA structural damages modifier.
The slight
increasing of proton beam efficiency at regime I (RBEI:RBEII
@ 1,1 ¸
1,2) was established earlier in terms of lethality after total
irradiation (6,9 and 12 Gy) of rats, the loss of their body
weight, hematocrit, common protein level in plasma as well
as raising free aminoacids concentration in it (D. Karlin,
B. Konov, 1989). The size
or calculated volume of carcinoma metastases in lungs of locally
irradiated mice (10, 30 and 60 Gy) were more diminished at
regime I, then at II one Æ II : Æ I
@ 2 or VI:VII @
8, p=0,03). The intrinsic
viscosity [h ] of DNA, the yield of 3' OH-ends and malon aldehyde
(MA)-like ends after irradiation at doses 30-90 Gy were estimated
by means of magnetic ratator viscometer, liquid-spectrometer
"Picker-Nuclear", DEAE-chromatography, labeling
3'OH kit N67 (Amersham) and reaction DNA-MA-like end +NH-labelled
AdR* as well as NH-GdR* or NH-CdR* (TdR* for lack of NH-groups
was employed as a control). Statistical analysis of complete
data showed the significant increasing of 3'OH-and MA-like
ends/mkg DNA after irradiation could be demonstrated with
regime II only. Partial restoration of [h
] value for double strand DNA as well as for melted single
strand DNA both registered in time after exposure at regime
I. Therefore it is concluded from this study that capability
of irradiated DNA in solution to form the cross-links between
its damaged deoxyribose moiety of one strands and undamaged
base of another strand has depended just on the value of pulsed
dose rate parameter. The proposed appraisal of radiochemical
output of lethal structural damages of DNA like the cross-links
seems to be the fruitful approach for elucidation the nature
of radiobiological effects of fractionated high-energy particles.
A. Shoutko,
D. Karlin, B. Konov, N. Chatinina, M. Vasilyeva, L. Ekimova,
Central Research Institute of Roentgenology and Radiology,
Leningradskaja str. 70/4. Pesochnij-2, St.-Petersburg, Russia,
186646.
A very
compact Protontherapy facility based on an extensive use of
High Temperature Superconductors (HTS).
C. Bieth,
A. Laisne, Pantechnik 14 rue Alfred Kastler, 14000 Caen, France;
P. Mandrillon, Centre Antoine Lacassagne, 168 Avenue de la
lanterne, 6000 Nice, France; Dr Ponvert, Institut Curie, 26
Rue d'Ulm 75248 Paris Cedex 05, France.
Guest Commentary
by M. R. Raju
As a graduate
student in nuclear physics in India during the late 1950’s,
I was fascinated by and enjoyed reading about neutron capture
theory and Bragg peak therapy in the proceedings of the First
United Nations Conference on Peaceful Uses of Atomic Energy. I
had the good fortune to pursue a research career in this field
with the help of Prof. Gordon Brownell at the Massachusetts Institute
of Technology and Massachusetts General Hospital in Boston and
John Lawrence (brother of Ernest O. Lawrence) at the Radiation
Laboratory in Berkeley. I never expected
that I would have the privilege of being part of the continuing
development of particle therapy for more than three decades and
my last two publications were invited review papers. The first
in Radiation Research, "Particle therapy: Historical Developments
and Current Status" 145, 391-407 (1996) and the second in
Int. J. Rad. Biol., "Proton Radiobiology, Radiosurgery and
Radiotherapy", 67, 237-259 (1995). I am happy that I can
follow the progress in particle therapy through the Particles
newsletter, which is an excellent informal journal. Over the years,
I enjoyed my friendship with many of you, and I would like to
take this opportunity to express my deep appreciation. The purpose
of this letter is to keep you all informed of my new venture and
to seek your help and guidance, so that I can continue to interact
with those of you who are interested in my new project. Nearly
four years ago, I took voluntary retirement to spend most of my
time developing a rural cancer center which will serve a mostly
illiterate population in a rural area of Andhra Pradesh. The major
emphasis of this cancer center will be on cancer awareness, prevention,
early detection and treatment of the needy, who cannot afford
to travel to big cities or pay the treatment costs. The appropriate
technology needed, includes a Cobalt-60 treatment facility, a
good pathology laboratory and a surgical theatre. I am already
in the process of building the surgical theatre, butI seek your
help in finding resources to acquire a Cobalt-60 treatment facility. This rural cancer
center will be a small step in overcoming the gulf between sophisticated
medical research, where there is a lot of effort to develop new
ways of improving treatment, and the needs of most people in the
world, who can gain enormous benefits from relatively simple medical
measures. The "Mahatma Gandhi Memorial Medical Trust",
founded nearly 20 years ago by my wife and occupying nearly 15000
square feet of buildings located on a five acre site in a rural
area is making my work much easier. In the future, I would like
to invite radiation oncologists and medical physicists to visit
the Trust periodically to serve the poor, and personally experience
the living conditions of most people in the world. We have already
built a guest house our friends to stay in, when they come to
participate in the services of the Trust and its efforts. I have been
very fortunate to have the enthusiastic support of some of the
leading scientists and radiation oncologists from India. With
a grant from the Indian Atomic Energy Regulatory Board for Cancer
surveillance and the treatment of cervical cancer using intracavity
brachytherapy, we have been able to treat 16 patients and complete
a door-to-door survey of about 25000 families in this rural area.
We found that nearly 10% of the deaths were due to cancer and
that this percentage is increasing. We also found that most cervical
cancer patients are illiterate. Only about 10% of the population
seek qualified medical help, the rest are in the hands of quacks.
More than 80% of the cancer patients seek treatment at advanced
stages of the disease and this number is not increasing yet. Recently, I
was asked to be the Member Secretary for a District Cancer Control
Program, under the National Cancer Control Program which has support
from the World Health Organization. The major emphasis of this
program is on cancer awareness, prevention and early detection.
We are developing pamphlets in local language on cancer prevention
and early symptoms including self examination of the breast. Cervical,
oral and breast cancers together comprise nearly 75% of the cancer
problem in India. Cervical cancer among women and oral cancer
among men are the two most common cancers in India; both these
tumors are preventable and can be detected at even precancerous
stages. However, the incidence of breast cancer seems to be increasing.
With the help of local doctors in villages, we are conducting
cancer screening camps to detect early stages of cancer and then
we help these patients to get the necessary treatment in cancer
centers. Some medical
problems in India are due to illiteracy, but it still surprised
me to learn that nearly 75% of children drop out during elementary
school. Another pet project of mine is to develop preschools in
villages to benefit children of illiterate parents. In collaboration
with local people, we have established such a school in one village
and it is quite successful. My wife and I are now building a model
preschool in another village on a site that I inherited, and then
I hope to see such schools in as many villages as possible. I
am hoping that these preschools will reduce the drop out rate
during elementary schools, and the State Government seems to be
interested in partially funding such schools. If you are interested
in visiting us, please write to me. At this point I have neither
fax or electronic mail. Also, if you happen to be traveling in
India, you are welcome to come and visit us. My wish is that some
of the people working in the forefront of radiotherapy developments
will also take some time to address some of the basic problems,
such as those I have outlined here. M. R. Raju, Mahatma Memorial
Medical Trust, Bhimavaram (AP) 534202, India. Telephone +91 8816
231 67.
Proposed NEW FACILITIES for PROTON & ION BEAM THERAPY July 1998
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