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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. PTCOG 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 "Massachusetts General Hospital" and sent to
Janet Sisterson at the address given below. We thank the
organizers of PTCOG XXVII, Chiba, Japan for their generous contribution
over and above the designated amount normally due to PTCOG for the
support of Particles. Facility and
Patient Statistics: I continue to collect information about
all operating or proposed facilities. Please send me your information.
A 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.
A new summary with patient data through 1997, "World wide proton
therapy experience in 1997" is accepted for publication in
the proceedings of the 1998 International Conference on the Application
of Accelerators in Research and Industry. The publication date is
expected to be April 1999. Particles on
the Internet: The URL for the Harvard Cyclotron Laboratory is:-
This contains links
to recent issues of Particles. Other proton
therapy links: ARTICLES FOR PARTICLES
24 May 30 1999 is
the deadline for news for Particles 24, the July 1999 issue. I will
send reminders by fax or e-mail. Please note that
I have moved from the Harvard Cyclotron Laboratory to the Northeast
Proton Therapy Center at Massachusetts General Hospital. Address
all correspondence for the newsletter to: Janet Sisterson
Ph.D. Telephone: (617) 724-1942 Northeast Proton
Therapy Center Fax: (617) 724-9532 Massachusetts General
Hospital E-mail: jsisterson@partners.org Boston MA 02114
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. PLEASE,
when you send me a file by computer GIVE IT AN UNIQUE TITLE
that will indicate to me the source of the article. You have no
idea how many files I have on my computer that are called ptles23.doc
or something similar!! PTCOG and FUTURE
PTCOG MEETINGS
The PTCOG e-mail address is PTCOG@radonc.mgh.harvard.edu Steering Committee Members
The times and locations of the next PTCOG meetings are as follows:-
COMBINED MEETING - PTCOG XXX / EHTG / ECHED 12-15 April 1999
PTCOG Proton Therapy Co-Operative Group EHTG European Hadron Therapy Group ECHED European Clinical Heavy Particle Dosimetry Group Date: 12-15 APRIL 1999 Venue: MÖVENPICK ARTHUR'S SEAT HOTEL SEA POINT, CAPE TOWN SOUTH AFRICA Organisers: Medical Radiation Group Contact: National Accelerator Centre Dr. Dan Jones P O Box 72 Tel: +27-21-843-3820 Faure Fax: +27-21-843-3382 7131 SOUTH AFRICA e-mail: jones@nac.ac.za Latest Information: http://www.medrad.nac.ac.za/events.htm. Full information with registration information was mailed in December to all those on the Particles mailing list as of October 1998. If you did not get the documentation, or require additional copies please contact Dan Jones by one of the means given above. ************ ERRATUM ************ KRUGER NATIONAL PARK TOURS
Regrettably GM Taylor Tours can no longer offer the tour to the Kruger National Park as specified in the mailed PTCOGXXX/EHTG/ECHED Meeting announcement. Talk Travel (the official travel agent for the Meeting) can however, offer a wide selection of Kruger National Park (and other) tours. Please contact Carol at Talk Travel, the correct phone and fax numbers are below.: Tel: +27-21-797-1861 Fax: +27-21-797-7810 e-mail: CarolJ.talk@galileo.sa.co.za NB. The fax number for Talk Travel in the mailed announcement was incorrect. ************************* Program: The meeting will cover all aspects of neutron capture, fast neutron, proton and heavy ion therapy. Eros Pedroni, who will chair the focus session on "patient motion and positioning", asks for your help in organizing this session. See his announcement below. 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. Announcement: FOCUS SESSION ON "PATIENT MOTION AND POSITIONING" Dear colleagues, I received the task to organize and chair this session and I need therefore your help. We should try to put together our present knowledge on these important topics. Here are just a few examples of possible contributions to the session:
Organ motion is probably one of the most important obstacles to precision radiotherapy in general. I expect therefore a strong interest in this topic and numerous contributions. Anyone coming to the next PTCOG meeting and willing to give a presentation for this session, is invited to announce his contribution either to me (pedroni@psi.ch) or to the local organizing committee. E. Pedroni, PSI, Switzerland.
FIRST ANNOUNCEMENT: PTCOG XXXI Bloomington, IN USA October 11 - 13, 1999 Venue: Indiana University Campus Indiana Memorial Union Bloomington, IN Organizers: Indiana University Cyclotron Facility (IUCF) 2401 Milo B. Sampson Ln. Bloomington, IN 47408 Contact: Dr. Susan B. Klein Tel: (812) 856-4405 Fax: (812) 855-6645 e-mail: sklein@iucf.indiana.edu Latest Information: http://www.iucf.indiana.edu Agenda:
Bloomington, Indiana is the heart of mid-western United States. The Indiana University campus has been rated as one of the five most beautiful campuses in the United States by Thomas A. Gaines in his book, The Campus as a Work of Art. IU Bloomington, is applauded internationally for its musical arts program. The IU School of Music, one of the world's top-ranked music schools, offers more than 1,000 performances each year. October is by far the most pleasant time of the year. Temperatures generally remain around 13C/60o F until late in the month, and this part of the country is renowned for its beautiful autumn colors. Bloomington is an hour's drive south of Indianapolis, where the airport is located. Hotel accommodations will be available at the conference site, and also at other locations within Bloomington. Nothing is beyond walking distance, if you have comfortable shoes and sufficient time, but motorized transportation will be available. Detailed information will be announced in the next Particles Newsletter, and located on the "latest information" web site noted above.
PROLIT: Culling The Heavy-Particle Radiation Therapy Literature
I am repeating this article from Particles 22, so that the many people who have asked me about a bibliography can have a better answer than the one I have been giving. Prolit, a database of Medline abstracts related to particle radiation therapy, is now available on the Loma Linda Proton Treatment Center Web pages (http://proton.llu.edu). The database provides access to over 5000 particle therapy abstracts, enabling physicians, patients, and researchers to begin their search for information in one convenient site on the Web. A full description of Prolit is available on the Web site. The database will be updated regularly. 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. Borje Larsson 1931 – 1998 There is a picture of Borje in the paper version of Particles With sadness we have to record the death of Borje Larsson last November. There can hardly be a member of the particle therapy community whose life was not in some way touched by him. We have all listened to him as, over the years, he publicly articulated his always broad vision of the possibilities for exploiting what was known, and gaining new knowledge. In his sweeping surveys of whatever topic he was asked to speak about, he was never less than enthusiastic; the time allocated to him was never enough. Our community will be a duller one in his absence. Borje was a pioneer. The proton therapy program which he, with others, initiated in Uppsala was the first systematic investigation of the use of protons for cancer therapy. His doctoral dissertation of 1962, aptly subtitled "a biophysical study," describes a series of investigations which were comprehensive in their coverage of physical, radiobiological and clinical issues. Borje had a broad vision. Rarely could one discuss something with him without his introducing new issues of relevance or having him allude to experiences in widely dispersed fields which might have some bearing on the problem at hand. His own work covered several fields and employed many technologies. He saw the future as though it were just around the corner. Years and, indeed, decades before they were generally appreciated, he saw synergies between disparate areas of knowledge. Borje had humor. He was rarely without a smile on his face. He saw the lighter side of the issues he dealt with; even, perhaps especially, those he cared most about. On a 1983 visit to the Harvard Cyclotron Laboratory, Borje gave a lecture during which he stepped before the audience, whipped out his electronic flash camera, and proceeded to take three photos of the audience to make a sort of panorama. He made some remark about now being able to say who attended his lecture. Such whimsy was typical of him. Borje was deeply curious. To take a walk outdoors with him was to enter into a continuum of speculation about the world around one. What was the name of that flower and in what climates could it flourish? What could explain the detailed knowledge implicit in the migratory behavior of that bird? What was the chemistry behind the fallen leaves below the maples which bordered the path? No problem was too small or too exotic to fail to elicit his attention and wonderment. Borje was an internationalist. Besides holding Professorships in two countries, and participating in scientific conferences on probably all continents, he enthusiastically supported programs in the then Soviet Union and in Thailand. These programs were important in supporting the work and development of established and upcoming scientists in those countries. Amongst several positions and honors, Borje was President of the International Society for Neutron Capture Therapy, organized their 7th International Symposium and received their first Hatanaka award; and, in recognition, amongst other things, of his role in developing the original gamma knife, he received the first Fabrikant award from the International Stereotactic Radiosurgery Society. Borje was ingenious. As an example, he conceived and began the development of a so-called Compact Cell Culture Disc (CCCD). This is a specially prepared CD with a large number of "micropits" into which single cells can be deposited – for example, by a fast cell sorter – and then rapidly and automatically individually analyzed for their clonogenic or other characteristics. He thought this device could add a new dimension to what can be learned from the traditional cell-visualization techniques of pathology. Borje was enthusiastic. He had a particular way of pronouncing the word "fascinating" - and it was never far from his lips. His excitement about his work and, even more, the work of others, was clearly evident and it was infectious. His energy and optimism could raise the mood of even the most exhausted companion. Borje was a most generous and warm-hearted man. He thought well about everybody; he looked for the good in all. In going to Zurich to head the Institute for Medical Radiobiology he had the most generous of motivations: to support, encourage and help the investigators there, young and old, to achieve their highest potential. This he did with the utmost selflessness. And, when the University of Zurich elected to change the Institute's direction, he accepted this decision with noteworthy good grace and provided his successor with his fullest support. Borje was a courageous truth-seeker. In the 1980's he proposed a series of popular books in natural science. Together with Sven Kullander he wrote "Mikrokosmos" and, more recently, "Out of Sight." Mikrokosmos and its authors were criticized severely and very publicly for the non-alarmist position they took on the after-effects of the Chernobyl accident. Borje never yielded to this criticism and was unfailingly honest and clear about the issues and what he felt to be the status of scientific knowledge in this matter. Borje was a family man. He and his wife, Inga-Lis, met and married during their student days. Their harmony was evident for all to see. With his son, Jonas, his daughter, Anneka, and his eight grandchildren, he was blessed with a close and sustaining family life. Borje was an enormous friend to many of us. We miss him. Michael
Goitein
PTCOG Information/News/Reports: The following reports and articles were received by January 1999.
Status Report: Heavy Ion Therapy at GSI, Darmstadt, Germany: After a machine shut down of six months, two therapy blocks of 4 weeks each were available from August 12 to September 12 and from October 23 to November 23. In each therapy block 9 patients have been treated, suffering from chordomas, chondrosarcomas and adenocystic carcinomas. Half of the patients received all fractions with carbon beam only, the other half had a carbon boost of at least 5 fractions combined with precision photon treatment. The tumors were mostly located in the base of the skull. One patient having a chordoma in the pelvic region was treated also. Target volumes up to 300 ccm were dissected into range layers of 2 mm thickness resulting in up to 120 isoenergy slices and up to 20,000 treatment pixels. Major problems at the beginning of each patient treatment period resulted from the many changes in the accelerator system and the beam line reconstruction. It took always a few days to obtain a stable beam having less than 1mm dislocation at the target point for all 250 energies between 88 and 430 MeV/u and the different intensity steps and beam diameters. When the stability conditions were fulfilled the irradiation could be performed without major problems over the complete time course. For the second patient treatment period there were only a few hours of interruption mainly caused by defects in the oldest part of the accelerator system, the Alvarez tanks. In such cases of longer interruptions the patients were released from their fixation mask and realigned after the problems were fixed. The treatment started at the same pixel at the same range layer and lateral position as it was stopped before. The intensity and the spatial limits for each pixel were very narrow: in lateral position an error of 50 % of the half width and +/- 50 % in calculated intensity were allowed for a single pixel. Only a few interrupts occurred during irradiation mostly because of intensity fluctuations rather than because of lateral errors. The total agreement between planning volume and irradiated volume could be also tested using the positron emitting nuclides mainly 11C and 10 C. The decay of these isotopes was monitored online by means of a PET camera. The comparison of planning contours and PET reconstruction were very useful and agreement within 2-3 mm was found which is the spatial resolution of the PET camera. However in some cases the PET image was influenced by biological effects as for instance the fast wash out of C isotopes from soft tissue. For bones these wash out effects were not observed. This yields a biology weighted PET image depending on time after irradiation. Another difference was found in measured and planned particle ranges when „mixed" tissues are traversed by the beam: Volume elements consisting of bones and soft tissues showed Hounsfield numbers that represent an average of both tissues but do not reflect the local tissue density that is responsible for the energy loss of the beam, because range correction are based on CT images. Therefore calibration-experiments with fresh animal tissues have been carried out and animal experiments are in preparation. During treatment these inaccuracies of the range correction were not expected to cause problems, because entrance channels were selected in such a way that possible range overshoots would not be directed towards critical organs. For treatment planning the Voxelplan program was used in combination with TRIP that takes into account particle fragmentation as well as local variations in RBE. The physical dose distribution (absorbed dose) could be verified in phantom irradiations and the distal fall off by PET analysis. For the RBE verifications the response of tumors and healthy tissue has to be waited for. Up to now no effects in the patients treated with carbon alone have been observed. Analysis of the first two patients treated in December last year yielded an unexpected fast tumor regression although these patients received a boost of 5 fractions with carbon ions only. As a general conclusion it can be stated that the treatment of the first twenty patients with the intensity controlled rasterscan system went extremely well concerning the reliability of the accelerator, the precision of the dose distribution and online PET verification and also in the interplay of the four institutions at Darmstadt, Heidelberg and Dresden. This success supports the desire for a dedicated therapy machine, where carbon beam for treatment is available every day through out the year. A proposal of a heavy ion treatment facility to be installed at Heidelberg has been completed and handed over to the minister for science and technology at an inauguration ceremony of the Heavy Ion Therapy at GSI at September 16 that was held in the connection with PTCOG meeting at Heidelberg. (This proposal written in English is available on request.) For the next year, three patient treatment periods are scheduled between February and end of September. Gerhard Kraft, GSI, Planckstr. 1, Darmstadt D 64291, Germany. An Update from IUCF, Bloomington, Indiana: INTRODUCTION: In 1996, a consortium of physicians and scientists throughout the Midwest collaborated to form the Midwest Proton Radiation Institute (MPRI) consortium. MPRI is an independent radiation therapy center which will be operated as a regional facility in association with physicians and scientists at a number of radiation oncology practices within a 300-mile radius of the institute. MPRI will be operated by one or more existing organizations which already operate radiation oncology facilities. The medical facility will purchase proton beam from the Indiana University Cyclotron Facility (IUCF). IUCF has two operational accelerators suitable for proton therapy: a 210 MeV cyclotron, and a 240 MeV synchrotron. The cyclotron is currently available and the synchrotron could be available for expansion. FACILITY DESCRIPTION: A conceptual design for the proton therapy facility has been completed which utilizes the existing cyclotrons and their experimental facilities space, as well as much of the existing beam line equipment and services. The Main Cyclotron, which can deliver over one micro-amp of protons at 210 MeV, will be operated as a fixed energy machine at its maximum energy. The main beam line from the cyclotron will be reconfigured for fast switching between the treatment rooms and the other research activities, and equipped with a new control system. In addition to the eye-line there are four new rooms planned, each with their own energy selection system: a fixed horizontal beam line, two gantries and a research/radiation effects room. An adjoining clinical facility will be constructed to house treatment planning, patient care and staff support facilities. A schematic layout of the MPRI facility is shown in Figure 1. Missing Picture CURRENT STATUS: MPRI has been granted one million dollars through a VA/HUD economic development initiative. The past year has been occupied with developing the clinical specifications and with the conceptual design of the facility to meet these specifications. The preliminary beam line design for beam transport and energy selection from the Cyclotron to the proposed treatment rooms was reviewed on December 4, 1998. Decommissioning of the cyclotron's nuclear physics experimental areas has begun, with the intention of keeping the eye-line operational as long as possible during the facility renovation. Planning is underway for upgrades to the accelerator systems to insure their long-term reliability. PATIENT TREATMENT: The first AMD patient was treated at the Indiana University Cyclotron Facility on July 27, 1998. We have since treated a total of eight patients for a clinical trial evaluating proton therapy for the choroidal neovascular membrane in age-related macular degeneration. This study is being carried out in collaboration with the Department of Ophthalmology at the IU Medical School, the IU School of Optometry, and radiation oncologists from Methodist and IU Hospitals. The clinical trial is designed to be a randomized, double-blinded, controlled trial of patients who have been recently diagnosed with AMD and who are not candidates for conventional laser coagulation therapy. The treatment consists of a total dose of 16 Gy delivered in two equal fractions on consecutive days. The patient accrual rate has been steady, but not as high as the physicians expected. ACKNOWLEDGMENTS: We have benefited from advice and assistance from many physicists and radiation oncologists in refining our plans. In particular, we acknowledge and thank members of the Harvard Cyclotron Facility, Loma Linda University Medical Center and the Northeast Proton Therapy Center. We have greatly benefited from advice from Dr. A. Mazal, C.P.O. and Dr. A. Thornton, M.G.H. Finally, we owe a great debt to the various members of our consortium and technical advisory boards who have given us much excellent counsel. G. P. Berg, C. Bloch, J. M. Cameron, S. B. Klein, M. K. Wedekind, Indiana University Cyclotron Facility, 2401 Milo B Sampson Ln, Bloomington, Indiana 47408.
The first treatment periods at the Berlin Eye Treatment Facility: As reported earlier, the Berlin Eye Treatment Facility at the Hahn-Meitner Institute (HMI) started patient treatments in June 1998. Besides the experimental physics work at the accelerator department, patient treatments are now scheduled during one week per month. After seven therapy periods, 30 patients have been treated up to December 1998. The following eye diseases were treated:
Patient's ages varied from 10 to 85 years. Fractionation schedules of 60 CGE and 20 CGE delivered in 4 fractions on 4 days were applied for melanoma and hemangioma patients, respectively. The patients are prepared and treated in a close collaboration between ophthalmologists and radiation oncologists from university hospitals in Berlin and Essen where the patients are being prepared for the proton therapy (Ta clip surgery). For all treatment planning, EYEPLAN was used. Eye modeling and tumor localisation was assisted in most cases with CT and high-resolution MRT data. Treatment times could be reduced due to the new technical features of the HMI eye treatment beam line (X-ray image intensifiers, image processing of X-ray pictures and data link to the treatment chair). For the 2nd to 4th irradiations, a patient treatment generally took not longer than 12 minutes including patient preparation and positioning procedure. A follow-up of the first patient after 4 month revealed first signs for an overall tumor regression, no side effects and an increased visual acuity compared to the last measurements before the treatment in June. Juergen Heese, Hahn-Meitner-Institut Berlin GmbH, Abt. Ionenstrahltechniken/Augentumortherapie, Glienicker Str. 100, D-14109 Berlin, Germany.
PSI Spot Scanning Gantry: Review of the first beam periods for patient treatments: After a first human patient treatment in November 1996, two beam periods of five months each allowed for the irradiation of 19 more patients in 1997/98. The treated lesions were located within the brain, retroperitoneum, sacral area, shoulder and orbita, target volumes varied between 30 and 3900 cc. Histologies were selected gliomas, meningiomas, sarcomas, chordomas and chondrosarcomas of the skullbase, chordomas of the sacrum, and two selected metastases. Out of 20 treatments, four were boost treatments or planned photon-proton combinations. Four patients received palliative therapy, though this will not be a main program in the future. All treatments were well tolerated, medically as well as with respect to the logistics of the new therapy installation. None of the patients with brain tumors required steroid medication. During the short follow up period, no tumor progression was seen or reported. One patient suffers from grade 2 reaction of the rectal mucosa, in an area where the tumor was directly attached to the rectal wall. All other patients are free from treatment related toxicity. Proton radiation therapy with spot scanning protons on the PSI gantry has been successful in two beam periods. Longer follow up time, increasing experience and improved logistics will be basis for further patient treatments within defined programs and protocols in close collaboration with the Swiss Proton Users Group and referring centers and doctors. G. Goitein, L. Wisser, A. Lomax, E. Pedroni, Team Radiation Medicine, Division of Radiation Medicine, Paul Scherrer Institute, CH - 5232 Villigen PSI. First patient treatment at the National Cancer Center, Kashiwa, Japan: The year of 1998 is commemorative for the National Cancer Center (NCC), JAPAN. The Project of Proton Treatment Facility of NCC, Kashiwa started in April 1996, when the building construction and machine manufacturing initiated. These construction and manufacturing completed in March 1997. Adjustments and tests of all the equipments have begun from April 1997. In November 1997, we had the pleasure to show our new facility to the participants of PTCOG XXVII meeting held at the National Institute of Radiological Sciences (NIRS), Chiba. In February 1998, first proton beam was extracted from the cyclotron, and in March, beam tests have been started at gantry #2. Biological experiments to determine RBE were performed, in collaboration with NIRS, in May and June. After that, we have improved some hardwares and softwares of our proton therapy system until October. On November 24, 1998, first proton beam irradiation to a human was carried out. The first patient is a male with carcinoma of the maxillary sinus. We had made a 2 beams treatment planning for the patient at gantry #2. The system for patient set-up with real-time digital radiography worked very well. It is planned in our initial protocol for the head & neck malignancies to treat 2.5 GyE x 26 fr., total of 65 GyE by proton therapy alone. Takashi Ogino, M.D., Div. of Radiation Oncology,National Cancer Center Hospital East 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, JAPAN
Proposed NEW FACILITIES for PROTON & ION BEAM THERAPY January 1999
WORLD WIDE CHARGED PARTICLE PATIENT TOTALS January 1999
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