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Collaboration UMC St Radboud - RISO André Minken.

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Presentation on theme: "Collaboration UMC St Radboud - RISO André Minken."— Presentation transcript:

1 Collaboration UMC St Radboud - RISO André Minken

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

3 Advantages proton therapy  Proton dose distribution is highly conformal  Integral dose reduces by a factor of 2 to 3  No exit dose  Sharp penumbra (until ±17cm)‏  Protons are direct ionizing ‏

4 initiatives in: Groningen, Maastricht, West-Nederland

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

6 Single room solution

7 initiatives in: Groningen, Maastricht, West-Nederland

8 Protons in Eastern part of the Netherlands

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

10 Internal meeting RISO 2008 ”RISO will not succeed on its own…”  Collaboration with academic partner in the Eastern part of the Netherlands  Second step: extension to other participants  Contact with UMC St.Radboud (june 2009): installation of project team

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

12 Agenda project team Juli 3, 2009, Nijmegen Agenda: kick-off meeting Huizenga, Monshouwer en Minken discussion on subjects and timeframe September 28, 2009, Deventer, guest dr. M. Engelsman, head of medical physics Francis H. Burr protoncentrum in Boston. Agenda: Introduction (dr. A. Minken)‏ Radiotherapy planning of protons, (dr. M. Engelsman)‏ Dosimetrical aspects of protonplanning (dr. H. Huizenga)‏ Indications (K. Muller)‏

13 December 4, 2009 Nijmegen Agenda: Background protonaccelerators (dr. M. Kusters)‏ Concept Dielectric Wall Accelerator (dr. R. Monshouwer)‏ Overview of national timeframe (dr P. Bouma)‏ Boston visit, highlights (dr G. Janssens)‏ Februari 12, 2010 protoncourse Leiden Agenda: All aspects of “conventional” protonfacilities Februari 17, 2010 visit CPAC Deventer Prof. R. Mackie, S. Guse en G. Oliveira Agenda: DWA-protonaccelerator: technical steps Product development: timeframe

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

15 Conclusions report • Feasible, critical evaluation of resources, comparison with photon techniques • Collaboration • State of the art • Indications • Number of patients • Scientific input: universities Nijmegen and Twente

16 State of the art techniques  Comparison with IMRT not 3D-CRT  Pretreatment imaging on high level  Set up and fixation  Imaging on treatment machine  IMPT (active scanning)‏  Learn from experienced users • Patching around OARs • Movement compensation • Fixations • Treatment planning techniques

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

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

19 IMPT (active scanning)‏ Passive scattering Spot scanning

20 CPAC timeframe  fixed beam MeV (2013)‏  +3 years gantry based systeem 200 MeV

21 “Signalement Gezondheidsraad” Proton treatment Indications  Standard  Potential  Model based  Reduction of second malignancies

22 Signalement Proton treatment Potential indications

23 Number of patients • Region: Eastern part of the Netherlands patient population: 16% of the Netherlands • Start with Fixed-beam MeV • End situation rotating 200 MeV beam

24 120 – 150 MeV 200 MeV RCT’s Standard57 Potential Model based Second malignancies Number of Patients

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



28 10 D 0 C 0B 00A Setup Error move ment Courtesy of M. Engelsman Isodoses: 50%, 80%, 95% en 100% Tumormovement

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

30 30 Photon versus Proton + Less dose + Skin sparing



33 4 groepen indicaties • Standaard indicaties • Potentiële indicaties • Op modellen-gebaseerde indicaties • Verkleining van het risico op secundaire tumoren Rapport GR

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