Welcome to the
for Particles 18
for PTCOG XXIV
Wide Patient Totals
New ICRU Report on Proton Dosimetry
Ion Therapy at GSI, Darmstadt, Germany: A progress
from St. Petersburg, Russia
from the Harvard Cyclotron Laboratory, USA
report: the Northeast Proton Therapy Center, at
Massachusetts General Hospital, Boston, MA USA
from the Triumf Proton Therapy Facility, Vancouver,
from the Centre de Protonthérapie dOrsay (CPO),
facility plans in Japan
version is currently missing the graphics that are on the original.
Please try using the MS
Word copy to save/print a paper copy locally.
- Mailing Lists
to keep the Particles mailing list up-to-date by sending me
address, telephone number, fax number and e-mail
additions/corrections. If you live in the UK, I NEED your
new phone numbers! Please try our GuestBook
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. 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 Professor Akine of Tsukuba for
his generous contribution which we have used to cover some
of the costs of producing this issue of Particles.
- Facility and
I am still
collecting information about all operating and proposed facilities,
regarding patient statistics, machine scheduling, and treatment
characteristics. Please send me up-to-date information.
on the Internet:
I am setting
up a Particles Home Page on World Wide Web. (It
is now here)I hope that it will be ready by the beginning
of 1996. At that time, you will be able to download the whole
newsletter, an article of interest, meeting information etc.
Sometime in 1996, I plan to have all back issues of Particles
and abstracts from selected PTCOG meetings on-line. Only the
PTCOG meeting abstracts that I circulated with Particles will
be available on WWW.
- E-mail address
FOR PARTICLES 18
for news for Particles 18 is May 31 1996, for the July 1996
issue. I will send reminders by fax or e-mail.
Address all correspondence
for the newsletter to:
Articles for the
newsletter can be short but should NOT exceed two pages in
length. I DO need a good clean copy of your article and figures
as I am using a scanner to get everything into the computer. If
you FAX me an article, please send a good copy by mail. The best
method, however, is to send the article as an ASCII file using e-mail
which I can down-load to my MAC.
Janet Sisterson Ph. D.
Harvard Cyclotron Laboratory Cambridge MA 02138
Telephone: (617) 495-2885
Fax: (617) 4958054
44 Oxford Street
THE PTCOG STEERING COMMITTEE
and Janet Sisterson
June and December
PTCOG is holding
an election for the Steering Committee which meets at each PTCOG
meeting and has the responsibility of guiding PTCOGs plans
and policies - which are always ratified at the subsequent PTCOG
business meeting. The steering committees meetings are open
and interested members are encouraged to attend and participate
in the committees deliberations.
The names of
all those nominated have been placed on a ballot and now we can
elect a Steering Committee. Please see the enclosed flyer for
details and the ballot that is to be returned to Janet Sisterson
by one of the ways listed in this issue of Particles.
If you have
questions about PTCOG, please contact the secretary of
Department of Radiation Oncology,
Loma Linda University Medical Center,
11234 Anderson Street,
Loma Linda CA 92354.
Telephone (909) 824-4378. Fax (909) 824-4083
The times and
locations of the next PTCOG meetings are as follows:-
PTCOG XXIV Detroit, Michigan, USA April 24-26 1996
PTCOG XXV PSI, Switzerland September 9-10 1996
PTCOG XXVI Boston Massachusetts USA Spring 1997
At the PTCOG
meeting in San Francisco in April 1995, two issues were raised
at the Steering Committee meeting:-
- Should PTCOG
meet once or twice a year.
- Should some
effort be made to coordinate PTCOG meetings with other meetings,
in particular EORTC (European Organization for Research and
Treatment of Cancer) in Europe.
discussion, it was decided that:-
- For the time
being we would still have TWO meetings a year, roughly
alternating between Europe and North America.
- Michael Goitein
should discuss the possibility of combining EORTC and PTCOG
meetings with the secretary of EORTC. This was done, and the
meeting at PSI in September 1996 will be a combined PTCOG and
encouraged to submit an abstract of their talk, which will be
published with the July 1996 issue of Particles.
be collected at the meeting or they can be sent directly to Janet
Sisterson by one of the methods listed above in articles
for Particles. THE VERY BEST WAY is by e-mail.
for accepting abstracts will be May 30 1996.
The space allocated
for each abstract is ONE HALF page; PLEASE try and keep to this
length. Each abstract must have a title and a list of authors
with addresses; graphs and line drawings are welcome.
& INTERNATIONAL PARTICLE THERAPY MEETING
Current status and future directions in particle
April 24-26, 1996.
Atheneum Hotel, Detroit, Michigan, USA.
will include papers on proton therapy, heavy ion therapy, external
beam neutron therapy and 252Cf neutron brachytherapy. The meeting
is also held in conjunction with the European Heavy Particle Therapy
Group and the European Clinical Heavy Particle Dosimetry Group
(ECHED). A NATO sponsored Advanced Research Workshop (ARW) will
be run in parallel with the International Particle Meeting. Further
information on submission of abstracts, registration and hotel
reservations will be mailed to all PTCOG members and others interested
in attending by the end of January 1996.
information will assist you in planning your trip to Detroit:
News: The following reports were received by December 1995.
A New ICRU
Report on Proton Dosimetry
L. Verhey, P. DeLuca, A. Wambersie, and G. Whitmore
Since its establishment
in 1928, the goal of the International Commission on Radiation
Units and Measurements (ICRU) has been to provide those involved
in the use of ionizing radiation with:
- a coherent
and practical set of quantities and units;
for methods of measuring these quantities;
of terms and concepts which are required for the exchange of
therapy, the need for uniformity is especially important when
new techniques or new types of beams are introduced. Therefore,
in 1989, the ICRU published Report 45 on Clinical Neutron
Dosimetry, Part I which is currently considered as a reference
in the neutron therapy centers worldwide.
Due to the excellent
clinical results reported from a number of proton facilities and
the resulting rapid development of proton beam therapy, the ICRU
appointed a Report Committee for proton dosimetry in 1991 with
the task to reach an agreement, and then to make recommendations
for determination of absorbed dose in a homogeneous phantom in
reference conditions, which could be universally accepted. The
composition of the Report Committee was as follows: L. Verhey
(Chair), H. Blattmann, P. DeLuca, D. W. Miller (Members), P. Andreo,
H. Bichsel, D.T.L. Jones and S. Vynckier (Consultants). H.H. Rossi
and A. Wambersie served as Sponsors from the Main Commission.
At its recent
meeting in Remscheid-Lennep (Germany) in September 1995, the ICRU
approved the Report entitled:-Clinical Proton Dosimetry,
Part I: Beam Production, Beam Delivery and Measurement of Absorbed
for using protons to treat cancer can be traced to a paper published
in 1946 by Robert Wilson (WILSON, 1946), who recognized that protons,
with their well-defined range and limited scattering potential,
could be an ideal radiation modality for improving physical dose
localization to a target. The earliest treatments of human disease
took place in 1954 at Berkeley, California at the 184 cyclotron
built by Ernest Lawrence (TOBIAS et al., 1955). Proton treatments
were also begun in Uppsala, Sweden in 1957 and at the Harvard
Cyclotron Laboratory in Cambridge, Massachusetts in 1961. Three
separate facilities in the Soviet Union have also treated significant
numbers of patients with protons beginning in 1968. To date, the
majority of proton treatments have been for patients with intracranial
arterial-venous malformations (AVMs), benign pituitary disease,
tumors of the eye, tumors near the base of skull or spinal cord
and tumors of the prostate. For most of these disease sites, adequate
dose localization with photon beams was judged to be difficult
or sometimes, impossible.
all proton treatment facilities were based on accelerators devoted
to research and converted later for medical treatments. In the
late 1980s, the first hospital-based facility for proton
treatments was designed at the Loma Linda University Medical Center
in California (SLATER et al., 1988). This facility uses a synchrotron
to accelerate protons to energies as high as 250 MeV which are
then guided into one of four treatment rooms. Three of these rooms
have gantry-mounted isocentric beam delivery systems, allowing
the delivery of protons to a fixed patient from arbitrary directions.
This facility began treating patients with protons in 1990.
by which protons interact with matter is primarily through electromagnetic
interactions with atomic electrons. Since protons are much more
massive than electrons, in a single interaction they lose only
a tiny fraction of their energy and are deflected by only small
angles. Therefore, for a given incident energy, the range of a
proton is well-determined to within an uncertainty which is small
compared to the range (approximately 1.5% per cm depth in water).
This produces an absorbed dose distribution which decreases rapidly
beyond the end of range. By modulating the energy of the incoming
protons, the absorbed dose can be spread out to cover the proximal
extent of the target from each beam direction. Thus, by careful
tailoring of the range of the beam at each point in a small number
of shaped beams, absorbed dose distributions in the patient can
be obtained which conform to the 3-dimensional shape of an irregular
target and which fall off rapidly outside the periphery of the
target, while remaining uniform within the target.
In the beginnings
of proton beam therapy, the lack of uniformity in dosimetric methods
used in different centers resulted in differences of up to 10%
in the dose delivered to the patient. These differences were due
in great part, but not entirely, to different numerical values
adopted for quantities such as w/e, stopping powers, etc. The
need for uniform standards thus became evident, resulting in two
separate protocols for the dosimetry of proton beams which were
developed and published by the AAPM in North America (AAPM, 1986)
and by the ECHED in Europe (VYNCKIER et al., 1991; VYNCKIER et
al., 1994). These protocols were in basic agreement as to the
use of ionization chambers, calibrated by national or international
standards laboratories in 60Co beams, to determine absorbed dose
to a phantom irradiated with proton beams. They were also in agreement
that universally available ionization chambers should be recommended
as the dosimeter of choice for the sake of uniformity, rather
than calorimeters or fluence measuring devices such as Faraday
cups. There was not, however, agreement on the values of the quantities
needed to convert a 60Co calibration factor to a proton calibration
factor. In particular, the recommended values of the electronic
mass stopping powers and the value of w/e, the average energy
required to form an ion pair in the gas of an ionization chamber,
for protons as a function of energy, is different in the two protocols.
Agreement on these values is critical for comparison of clinical
results between proton centers and also for comparison between
the results of patients treated with protons and x-rays.
A recent ICRU
Report (ICRU, 1993) has re-evaluated electronic stopping powers
for protons as a function of energy, including recently published
experimental results. This Report is now generally accepted as
the best compilation of stopping powers and is recommended for
use in proton dosimetry.
which directly or indirectly (through comparison with calorimetry)
measure w/e for proton energies commonly used in radiotherapy,
have recently become available. Reviews of these experimental
results led the present Report Committee to recommend a value
of 34.8 J C-1 (±2%) for w/e, somewhat different that the value
of 35.2 J C-1 (±4%) recommended previously in ICRU Report 31 (ICRU,
1979) which was based on measurements at very low proton energies.
to recommendations on the values of the parameters used to convert
from a 60Co calibration factor to a proton calibration factor,
the present Report makes recommendations (1) that standard, appropriately
sized thimble ionization chambers with walls of A-150 tissue equivalent
plastic or graphite be selected as the reference dosimeter, (2)
that the residual energy of the proton beam at the measurement
point in the phantom be used to select the appropriate electronic
mass stopping power, (3) that absorbed dose be measured in water
or water-like material and specified as absorbed dose to water
and (4) that calorimetry be used, where available, to confirm
the proton calibration factor of the reference chamber.
It is anticipated
that adoption of the recommendations of the present Report on
proton dosimetry will ensure an agreement on proton absorbed dose
to within ±2% between proton centers, and an accuracy which is
similar to that achievable with x-rays. Recent dosimetric intercomparisons
performed at Loma Linda University (Spring, 1995 involving 13
centers) and at NAC-Capetown (Autumn, 1995 involving 5 centers)
have shown that an agreement of about ±1% on the dose delivered
in reference conditions could be achieved if a common dosimetry
protocol such as the present ICRU protocol would be applied worldwide.
A new Report
Committee was appointed by the ICRU Main Commission at the Remsheid-Lennep
meeting which will soon begin the drafting of Part II of Clinical
Proton Dosimetry. This Report will deal with the influence of
patient shape and tissue heterogeneity on dose distribution and
the description of treatment planning considerations. Recommendations
on dose specification for reporting proton beam therapy and specification
of radiation quality in relation to microdosimetry and RBE of
proton beams will also be prepared.
American Association of Physicists in Medicine. Protocol for heavy
charged-particle therapy beam dosimetry, Report AAPM Report #16,
American Institute of Physics
Average Energy Required to Produce an Ion Pair, Report 31, International
Commission on Radiation Units and Measurements, Bethesda, MD.
Stopping powers for protons and alpha particles, Report 49,
International Commission on Radiation Units and Measurements,
R.N., Sweet W.H., Preston W.M. and Koehler A.M. (1962).
The Bragg peak of a proton beam in intracranial therapy
of tumors, Trans. Amer. Neurol. Assoc. 87, 216.
B., Leksell L., Rexed B., Sourander P., Mair W. and Andersson
B. (1958). The high-energy proton beam as a neurosurgical
tool, Nature 182, 1222.
J.M., Miller D.W. and Archambeau J.O. (1988). Development
of a hospital-based proton beam treatment center, Int.
J. Radiat. Onc. Biol. Phys. 14, 761.
C.A., Roberts J.E., Lawrence J.H., Low-Beer B.V.A., Anger
H.O., Born J.L., McCombs R. and Huggins C. (1955). Irradiation
hypophysectomy and related studies using 340 MeV deuterons,
Peaceful Uses of Atomic Energy 10, 95.
S., Bonnett D.E. and Jones D.T.L. (1991). Code of
practice for clinical proton dosimetry, Radiotherapy and
Oncology 20, 53.
S., Bonnett D.E. and Jones D.T.L. (1994). Supplement
to the code of practice for clinical proton dosimetry,
Radiotherapy and Oncology 32, 174-179.
R.R. (1946). Radiological use of fast protons,
Radiology 47, 487.
Therapy at GSI, Darmstadt, Germany: A progress report:
Since July 6
1995, carbon beams are delivered regularly in the new medical
cave for test of the new raster scan system and of the fast position
sensitive transmission counters. These counters measure the beam
intensity and the position independently in time intervals of
100 microseconds and compare it to the requested values. In the
tests, first and simple scan patterns have been recorded. In dosimetry
measurements, energy loss values in phantoms are compared to calculated
values based on CT numbers. In addition, calibration measurements
of different dosimeters are performed. In radiobiological experiments,
the reaction of the pig skin is compared between x and carbon
irradiation. In these experiments three fields at six minipigs
are exposed to different x-ray doses and compared to three carbon
fields. The RBE for the fractionated exposure (5 fractions in
five days) was calculated according to a biophysical model, and
carbon doses were chosen which are expected to result in the same
early response compared to the equivalent x ray doses.
each pig was irradiated in the same fractionation schedule in
the lung with a 4 x 4 cm field in order to measure the accuracy
of the repositioning and the dose calculations. Using a CT scanner
the irradiated filed can be detected two month after exposure.
For the first minipig pilot experiment in April excellent agreement
has been found between treatment planning and verification.
experiments the energy variation - 256 steps between 80 and 430
MeV/u has been tested. The variation of beam intensity and focusing
- 15 intensities and 7 beam diameters - will follow later. These
tests include an automatic beam tuning to the medical cave within
one pulse (2 sec). Difficulties are found for the lower energies
while the higher energies are not problematic. Finally, the construction
of the medical annex will be completed in the second week of December.
G. Kraft, GSI mbH, Planckstrasse 1, D-64291 Darmstadt, Germany.
St. Petersburg, Russia:
of the radiophotoluminescent (RPL) method application to clinical
In this report
we present the technique to measure of the depth dose fields,
based on RPL method. The principle of RPL process lies in the
fact that, there are some materials (silver-activated metaphosphat
glasses for instance), in which stable luminescent centers or
dose centers (DC) are produced under irradiation. The output information
is realised by UV light activation of DCs and by registration
of photon of luminescence. So that to allow the multiple dose
readout. The dose information can be rubbed off only after annealing
RPL glasses at the temperature 350 - 380 centigrade. Another feature
of the RPL-method is connected with the very low fading (less
than 1% per year).
of background centers (BC) in RPL glasses is the lower limit of
application of RPL method. The nature of BC is not very clear,
but it is known that the number of BC is independent on the dose
but only on the purity of the glass. Due to the development of
UV lasers techniques and working out of lownoise photomultipliers,
working in one electron regime and due to the progress in RPL
glasses production the counting method can be used in RPL technique
rather effectively and lower limit of measured doses can be decreased.
In 1988-1990 independently and practically simultaneously the
two devices were created. They are FGD-10 (Japan, TOSHIBA) and
KID RPL-2 (Russia, PNPI) to guarantee the lower level of measurements
from 0.003 sGr. The KID RPL-2 was checked on glasses, destined
to individual dosimetry of gamma-irradiation, developed in GOI,
St. Petersburg, Russia.
of KID RPL-2 device are presented below. The nitric laser is used
as the source of the UV light. The seven percent of intensity
of lasers pulse due to plane-parallel quartz plate, placed
under 45 degrees to laser beam, are deflected to the monitor PM,
working in linear regime. The amplitude of the signal from the
monitor PM is proportional to the intensity of the laser pulse
and simultaneously the monitor signal is used as the start for
the measurement of DC and BC. The photons of luminescence are
detected by the counting PM, working in the one electron regime,
in counting (CG) and background (BG) gates. Since the form of
background spectrum is constant from one glass to another, then
there is a possibility to recount the background from BG to CG
and to select the real dose. To avoid reloading and to provide
a possibility of dose measurements in wide range without rebuilding
the device, measurements are carried out not in one but in several
To measure of
the depth dose fields, used for irradiation of pathologic centers
of head during the biaxial rotation on the medical proton beam
of PNPIs 1 GeV synchrocyclotron, the special device was
constructed. It includes two-dimensional moving system (error
of coordinate determination is 0.2 mm), two PM, UV laser with
wavelength 337 nm and frequency 100 1/s. The RPL glass with geometrical
sizes 80 x 50 x 1 mm was prepared. Lasers beam was collimated
to the size x = 1 mm, y = 1 mm.
To check the
system, the RPL glass was irradiated by the doses 100 Gr, 10 Gr,
2 Gr at the medical beam of PNPIs synchrocyclotron (diameter
of the beam 6 mm).The measurements showed the right ratio between
brought doses (error 10%) and gave the diameter of the beam 6
To test the
homogeneity of glass properties, RPL plate was irradiated by dose
100R. The homogeneity of measured dose keeps with 6% error.
of glass in standard phantom of head at the PNPIs system
of proton stereotacsic therapy was the final test. Measured widths
at half of distribution height was x=6 mm and y=11 mm (the time
of one point measurement is about 30s). The form of the dose distribution
obtained by RPL method coincide to the measurements done by the
Results of our
measurements appear encouraging and well continue our experiments
in this field. D.L. Karlin, V.P. Koptev, I.V. Panteleev, S.M.
Mikirtichyants, G.V. Scherbakov, Central Scientific Research,
Institute of Roentgenology and Radiology, Gatchina, PNPI, St.
Petersburg 188350, Russia.
Cyclotron Laboratory, USA:
major project is installing an upstream everything
beam spreading system in the large-field radiotherapy room. If
the fixed absorber and modulator in a passive system are moved
upstream so that they become the effective proton source, the
lateral penumbra of the dose distribution is significantly improved,
particularly if the point of interest in the patient is shallow.
We already do this by switching to a single scattering system
but this is only an option for fairly small fields.
The new system
selects one of a set of lead/lexan sandwich modulators and uses
it along with lead and/or beryllium degraders selected from binary
sets. The whole thing acts as a first scatterer. The second scatterer
will be the usual compensated contoured variety. In the relatively
few cases (shallow fields) where this does not work due to overscattering
the same hardware can fall back to our present downstream
configuration or, for small fields, to single scattering. In sum,
we will be able to treat even large fields with the smallest possible
We are taking
advantage of the project to upgrade our beam diagnostics. Beam
range will be monitored by a multilayer Faraday cup mounted on
the beam shutter. A segmented ion chamber (IC), further downstream,
will perform a nondestructive flatness measurement which will,
using a PC-based system, activate steering magnets to center the
beam, which we currently do by hand. This has been tested with
a prototype chamber and centers the beam (which is pretty good
to start with) in the first two seconds of treatment.
We also plan
to use a central pad of the same IC as our beam monitor. This
will simplify the calibration function compared to our present
system which uses a large chamber that intercepts a large and
hard to predict fraction of the scattered beam. This procedure,
too, has been checked with the prototype IC. The entire system
uses many of the same techniques proposed for NPTC so that the
experience gained, and much of the actual hardware, will carry
over to that project. B. Gottschalk, Harvard Cyclotron Laboratory,
44 Oxford Street, Cambridge MA 02138.
Proton Therapy Center, at Massachusetts General Hospital,
Boston, MA USA:
ceremony for the Northeast Proton Therapy Center (NPTC) was
held at Massachusetts General Hospital (MGH) on September 14,
1995. The event began with a luncheon at noon for invited guests,
followed by a Scientific Symposium which featured Professor Allan
Cormack, a Nobel Laureate in Physics from Tufts University, Dr.
Zvi Fuks from Memorial Sloan-Kettering Hospital, New York City,
and Dr. James Slater from Loma Linda University Medical Center.
The groundbreaking reception was held under the Bulfinch tents
on the campus of MGH and included addresses by Samuel Thier, M.D.,
the President of MGH; Yves Jongen, President of IBA; Walter Bell,
Senior Vice President of Bechtel; Francis Mahoney, Ph.D. of the
NCI Radiation Research Program; Herman Suit, M.D., Chief of Radiation
Oncology at the MGH; and several other distinguished speakers
and guests. In the evening a dinner was held in honor of Dr. Suit.
The presence of many proton patients and friends of the ongoing
clinical program at the Harvard Cyclotron Laboratory made the
day a very memorable occasion.
The NPTC will have 44,000 gross square feet of space and will
be located on the MGH campus (see Figure 1. for artists concept
of the facade of the building as seen from a point near the MGH
main entrance). The facility will have two main floors: the lower
level will house all of the patient activities and the ground
floor will contain administrative offices,
and other administrative and physics support areas. The lower
level (shown in Figure 2.) will contain the cyclotron, three treatment
rooms, two with gantry capabilities and one fixed beam room having
an eye treatment station, a stereotactic radiosurgery station,
and an experimental/treatment station for large field irradiations.
Also on this level will be exam rooms, immobilization fabrication
and storage areas, mechanical, electrical and vacuum shops, and
space for a CT scanner and a simulator, both of which will be
installed in the future.
of the building began in September, 1995 and is progressing on
schedule and budget. To date, 48% of the entire construction bid
packages have been awarded and the total amount of the trade contract
awards remain under the Guaranteed Maximum Price contract amount.
The Bechtel Corporation is the lead firm and provides the project
management, radiation shielding, and construction management services.
Bechtel is teamed with Tsoi/Kobus and Associates, Architect; McNamara/Salvia,
Inc., Structural Engineer; McPhail Associates, Geotechnical Engineering;
and John Moriarty and Associates, Construction Contractor and
Preconstruction Services. The construction effort is expected
to last through December of 1996.
IBA, teamed with General Atomics, is furnishing the equipment
which includes the cyclotron, energy selection system, beam transport
systems, gantries and nozzles, patient positioning system, and
the control and safety systems. We are currently about one and
a half years into the approximately four year equipment procurement.
The cyclotron magnet has been fabricated and is currently being
field-mapped. Early indications are that the measured magnetic
field agrees very well with the three-dimensional TOSCA simulations
that were done during the design stage. The cyclotron RF cavities
have been delivered to IBA. It is expected that preliminary tests
with full energy beam will begin in the spring of 1996. All other
systems are in an advanced stage of design. The construction readiness
review for the cyclotron is scheduled for January 1996. Procurement
of some of the beamline elements has already begun. Work is ongoing
in the final design of the patient positioning system and the
beam delivery system. The equipment is on schedule to be delivered
during 1997 and early 1998 after the building is ready for occupation.
The project schedule targets the initiation of patient treatments
in the last quarter of 1998. The transition of the proton treatment
program from the Harvard Cyclotron to the Northeast Proton Therapy
Center will require several months and it is our plan to have
the transition completed by the end of 1998. Michael Goitein,
Alfred Smith, Jacob Flanz, Stanley Durlacher, Susan Woods, Chris
Tarpey The Northeast Proton Therapy Center, Massachusetts General
Hospital, Boston, MA 02114, USA.
the TRIUMF PROTON THERAPY FACILITY, Vancouver, Canada:
After two years
of development, we have finally commissioned the TRIUMF Proton
Facility for the irradiation of ocular melanoma. The first patient
was treated on 21 August and the tally for 1995 year end is five.
The therapy is a cooperative program amongst the British Columbia
Cancer Centre, the Eye Care Centre and TRIUMF. The Facility is
based on the TRIUMF Beamline 2C with an extraction energy of 70
MeV at a nominal current of 5 nA, which corresponds to an average
treatment time of 90 sec. The treatment planning is based on the
standard EYEPLAN as obtained from the Clatterbridge Cancer Centre.
A range modulator program was developed in-house to provide SOBP
dose uniformity to about 1%. The therapy RBE value of 1.2 was
taken from in vitro and in vivo radiobiological measurements performed
on the same dosimetry configuration as used in therapy. A dose
prescription of 50 proton grays (which corresponds to 60 cobalt
grays equivalent) in four daily fractions is used.
measurements indicate a slight increase of RBE with depth in the
order of about 2 - 3% per cm for the SOBPs of a 70 MeV beam.
Hence, it may be necessary to modify the range modulator designs
to provide a more uniform effective dose profile. For the treatment
of superiorly located tumors without eyelid retraction, MRI scans
were made to provide a better estimate of the eyelid and periorbital
tissue structures. Lastly, the beamline can deliver a beam of
120 MeV with a range of over 10 cm, we are examining the feasibility
of treating some relatively shallow-seated AVMs with a minor upgrading
of the eye facility. Roy Ma, Gabe Lam, BC Cancer Agency, 600
W 10th Avenue, Vancouver BC V5Z 4E6, and Proton Therapy Group
at TRIUMF, University of British Columbia, Vancouver, BC V6T 2A3,
the Centre de Protonthérapie dOrsay (CPO), France:
The CPO has
treated 673 patients in four years since the beginning of clinical
applications in 1991. Most of them are patients with uveal melanomas
(636), some angiomas (20) and intracranial targets (17), including
some pediatric cases, and we are preparing the first cases of
chordomas of the base of the skull. All of them are treated in
the first treatment room. A change in energy (73 to 200 MeV) ,
intensity (300 nA to 10 nA) and beam modifiers (collimators, scattering
foils, ...) is performed once a day, to move from ophthalmic to
intracranial conditions. The preliminary statistics on clinical
results of first 341 ophthalmic patients with follow-up from one
to four years are under evaluation, showing an actuarial survival
rate at one year of 99%, and 91% at two years. Local recurrences
were observed in 9 cases (5%). Complete results will be published
program is based on: the use of fiducial ball bearings implanted
in the skull, a treatment planning system developed in collaboration
with the Institut Curie, patient contention with masks, and the
same treatment chair used for the eye treatments. The number of
patients is increasing slowly but steadily. A clinical program
for stereotactic irradiations is under discussion for 1996.
Two PhD works
have been finished: on the implementation of our beam lines (C.
Nauraye) and on microdosimetric measurements at Orsay and Clatterbridge
in cooperation with a Birmingham team (V. Cosgrove). Two other
PhD thesis will be presented soon on the treatment planning system
(R. Belshi) and on the specific problem of inhomogeneities (R.
Oozeer). The annual technical report of 1994 has been devoted
to an internal communication of the activities of each sector,
as the beginning of a new Quality Assurance program. Dosimetric
intercomparisons have been done at Orsay with people from Uppsala
(J. Medin), and we participated in the comparisons at Loma Linda
(S. Delacroix) and Faure (R. Ferrand). A physicist from Berlin,
H. Fuchs, spent some months with us as part of the preparation
for the new medical room to be installed at their facility. Participants
of the Dynarad european project for conformal radiotherapy visited
the center during the meeting organized in Paris in 1995.
For the second
treatment room at CPO, preliminary specifications and drawings
have been done (Fig. 1) and shielding measurements have been performed
with the participation of K. Gall, from Boston. The results will
be submitted for publication soon.
Figure 1. Second
for the patient positionner could be based on industrial robotics
as is shown in Fig. 2.
A formal request
for proposals will be done in January 1996. At a first step, passive
scattering will be used to get fields of 25 cm diameter. If the
financial support is obtained, we plan to develop this room in
approximately one year (expected date: mid 1997). A third treatment
room is under study, including an isocentric gantry, for the mid
The staff of
the CPO includes today 26 positions (4 administrative, 2 MD, 3
medical physicists, 2 engineers, 12 technicians and 3 technologist).
The physicians and physicists of the partners participate in the
preparation and the treatment of their patients. Operating costs
are about 3 M$/year including salaries, electricity and machine
upgrade. The number of patients increased from 150 pat/year to
nearly 180 pat/year, and should evolve towards 300 pat/year in
the next 5 years. Comparative planning is performed against alternative
techniques (I125 plaques, conformational techniques including
stereotactic irradiations with photons,...) for different localisations.
Figure 2. Possible
design for a patient positioner
OUR NEW POSTAL ADDRESS, PHONE AND FAX NUMBERS: Tel. (33) (1) 188.8.131.52
/ Fax (33) (1) 69.07.55.00. We did not move the synchrocyclotron
!, so the visiting address is still: Building 101. Campus Universitaire.
Orsay. France. Ale Mazal, J.L. Habrand, L. Desjardins, P. Schlienger,
J.C. Rosenwald. Centre de Protonthérapie dOrsay./ BP 65
/ 91402 Orsay Cèdex. France.
plans in Japan:
Cancer Center has obtained funds for its plan to build a dedicated
proton therapy facility at its Kashiwa campus (about 30 km apart
from its Tokyo campus which is located at the central Tokyo).
Amount of money allocated to the project by Ministry of Health
and Welfare is about 8.3 billion yen (83 million dollars). They
will start building the facility next year. Details of the plan
are being formulated.
The Agency of
Science and Technology of the Japanese Government has decided
to help a couple of regional governments build dedicated proton
therapy facilities. They are negotiating with the Ministry of
Finance to get their plan funded. We should wait to see if the
plan is approved.
government of Hyogo (where the earthquake took place) is pursuing
its plan to build a medically dedicated heavy particle therapy
facility. Their initial plan includes both proton therapy and
heavy ion therapy, however, it is still possible that proton therapy
only will be chosen.
Tsukuba again failed to get funded for its plan to build a dedicated
proton therapy facility at the university campus. We are continuing
to work at the facility in National Laboratory for High-Energy
Physics. Yasuyuki Akine, M.D., Institute of Clinical Medicine,
University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305,
Ion Beams in
Tumor Therapy, U. Linz (ed.),
Chapman & Hall, London, 1995.
387 p., 150 figures (some in color), 61 tables.
ISBN-No. 3-8261-0063-8, ca. $100.
covers clinical and biological, physical and technical aspects
of proton and light ion beam therapy. It is an up-to-date and
comprehensive review of the field. Over 40 experts from the
US, Japan, South Africa and 7 European countries representing
all the relevant ion beam therapy facilities in the world have
contributed to it.
major sections of the book are:
I. Ion Beam
Therapy in Perspective. - 4 chapters.
II. Models and Preclinical Studies. - 6 chapters.
III. Clinical Results and Indications. - 8 chapters.
IV. Medical Accelerators and Beam Line Design. - 4 chapters.
V. Beam Preparation and Control. - 5 chapters.
VI. Patient Positioning and Treatment Planning. - 5 chapters.
VII. Individual Facilities. - 7 chapters.
NEW FACILITIES for PROTON & ION BEAM THERAPY
INSTITUTION PLACE TYPE 1ST COMMENTS
P.S.I Switzerland p 1996 200 MeV, var. energy, gantry,
Berlin Germany p 1996 72 MeV cyclotron; eye treatment beam
G.S.I Darmstadt Germany ion 1996 First Carbon beam in the medical cave
KVI Groningen The p 1997? plan:- 200 MeV accel.; 2 rms; 1
Netherlands gantry; 1 fix.
NPTC (Harvard) MA U.S.A. p 1998 at MGH; 235 MeV cyclotron; gantry; 4
NC Star NC U.S.A. p 1999? synchrotron; 70-300 MeV; 2 horiz; 1
Regensburg Germany p 1999? gantry;1 fixed beam; 1 eye beam.
Hyogo Japan ion 2000 protons & ion; 2 gantries; 1 horiz; 1
vert; 1 45 deg.
TERA Italy ion 2000? H- accel;60-250 MeV p; +BNCT; isotope
AUSTRON Austria ion ? protons and light ions.
Beijing China p ? 250 MeV synchrotron.
Brookhaven NY U.S.A p ? linear accelerator.
Clatterbridge England p ? upgrade using booster linear
ITEP Moscow Russia p ? 3 horiz.-1 fix beam, 2 gantry, 1
exp., H- accel.
Jülich (KFA) Germany p ? exp. beam line; plans for therapy.
Kashiwa Japan p ? no details yet; will start
construction in 1996.
Krakow Poland p ? 60 MeV proton beam.
Kyoto Japan p ? 250 MeV synchrotron; gantry; 1 fixed
Proton Development IL USA p ? 300 MeV protons;therapy & lithography
WIDE CHARGED PARTICLE PATIENT TOTALS
WHO WHERE WHAT DATE DATE RECENT DATE
FIRST LAST PATIENT OF
RX RX TOTAL TOTAL
Berkeley 184 CA. U.S.A. p 1954 1957 30
Berkeley CA. U.S.A. He 1957 1992 2054 June-91
Uppsala Sweden p 1957 1976 73
Harvard MA. U.S.A. p 1961 6626 Jan-96
Dubna Russia p 1967 1974 84
Moscow Russia p 1969 2877 May-95
Los Alamos NM. U.S.A. ¹- 1974 1982 230
St. Petersburg Russia p 1975 969 Dec-95
Berkeley CA. U.S.A. heavy ion 1975 1992 433 June-91
Chiba Japan p 1979 86 June-93
TRIUMF Canada ¹- 1979 1994 367 Dec-93
PSI (SIN) Switzerland ¹- 1980 1993 503
PMRC, Tsukuba Japan p 1983 462 July-95
PSI (SIN) Switzerland p 1984 1785 Dec-94
Dubna Russia p 1987 39 July-95
Uppsala Sweden p 1989 65 Spring-95
Clatterbridge England p 1989 656 Dec-95
Loma Linda CA. U.S.A p 1990 1262 April -95
Louvain-la-Neuve Belgium p 1991 21 Nov-93
Nice France p 1991 636 Nov-95
Orsay France p 1991 673 Nov-95
N.A.C. South Africa p 1993 106 Dec-95
IUCF IN USA p 1993 1 Dec-94
UCSF - CNN CA U.S.A p 1994 50 Oct-95
HIMAC, Chiba Japan heavy ion 1994 55 Aug-95
TRIUMF Canada p 1995 5 Dec-95
TOTAL 20148 all particles
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