1. March 2011 CERN, Geneva European Training Network for Particle Therapy Founded by the European Commission PARTNER

2. March 2011 2 Some facts about cancer and hadron therapy Treatment with hadrons is a promising treatment strategy with large future potential.  Cancer is the second most frequent cause of death in Western societies.  About 50% of patients with cancer undergo radiotherapy in the course of their treatment.  Not all cancers can be treated with a satisfying outcome.  Hadron therapy uses particle beams (i.e. mostly proton and carbon ions) to treat tumours located near critical organs and tumours that respond poorly to conventional radiation therapy.  Hadrons have advantageous dose distributions and increased biological effectiveness. Source: GSI

3. March 2011 3... to a clinical standard from pilot projects … Hadron therapy centers in Europe Source: EBG MedAustron

4. March 2011 4... training 24 young researchers For this we still need photos of the missing researchers! PARTNER is …

5. March 2011 5... a European Commission FP7 Initial Training Network (2008 – 2012) … working on a wide range of disciplines related to hadron therapy... a pan-European network... focussing on intensive and multi-disciplinary training... under the umbrella of together with other EC projects related to HT Enter Vision PARTNER is … TopicLocation Detectors and Accelerators applied in MedicineIFIC, Valencia Leadership CourseUNIS, Guildford Radiobiological Hands-on-trainingGSI, Darmstadt Hadrontherapy Today and Tomorrow and GRID technologiesCERN, Geneva RadiobiologyKI, Stockholm Treatment PlanningMedAustron, Wiener Neustadt and Vienna Clinical TrialsCNAO, Pavia Mathematical ModellingUNIS, Guildford ……

6. March 2011 PARTNER is …... a collaboration

7. March 2011 Clinical Studies and Epidemiology Investigating the clinical outcome of hadrontherapy for a wide range of cancer types tumour control overall survival quality of life Clinical Studies and Epidemiology Investigating the clinical outcome of hadrontherapy for a wide range of cancer types tumour control overall survival quality of life Simulations, Dosimetry and Treatment Planning Improving treatment planning Measurements of physical quantities Development and tuning of physics simulation codes Simulations, Dosimetry and Treatment Planning Improving treatment planning Measurements of physical quantities Development and tuning of physics simulation codes Image Guided Hadrontherapy and PET Prototype High-tech systems for optimizing patient treatment increasing the accuracy in localization of the tumour Image Guided Hadrontherapy and PET Prototype High-tech systems for optimizing patient treatment increasing the accuracy in localization of the tumour Information and Communications Technologies and Networking Common tools for promoting collaboration in research and treatment strategies in European hadrontherapy centres towards the creation of a prototype GRID test-bed for hadrontherapy Information and Communications Technologies and Networking Common tools for promoting collaboration in research and treatment strategies in European hadrontherapy centres towards the creation of a prototype GRID test-bed for hadrontherapy Novel Accelerator and Gantry Studies Design and development of new technologies for clinical requirements affordable cost reduced dimensions optimal performance Novel Accelerator and Gantry Studies Design and development of new technologies for clinical requirements affordable cost reduced dimensions optimal performance Radiobiology Experiments elucidating the underlying biological mechanisms of hadrontherapy to increase the treatment effectiveness while protecting healthy tissue Radiobiology Experiments elucidating the underlying biological mechanisms of hadrontherapy to increase the treatment effectiveness while protecting healthy tissue Research in the frame of PARTNER…

8. March 2011 8 Software platform for evaluating combined modality treatment plans The featurelet approach Deformable Registration algorithmThe image deformation field Image-Guided Hadron Therapy – Siemens Workflow of ‘treatment plan of the day’ adaptive strategy Online adaptive strategy to mitigate the effect of inter-fractional motion The deformation field applied to the delivered dose Valentina Zambrano Wenjing Chen Retrospective treatment planning study on prostate cancer cases rectum bladder prostate Region of interest (grey part) for similarity comparison Image Guided Hadrontherapy and PET Prototype

9. March 2011 Application of PET imaging in light ion therapy PET prototype for in-situ monitoring Brahme 2009 Development of innovative detector modules based on Multi-gap Resistive Plate Chambers (MRPC), using improved technologies over designs for High Energy Physics. Production of therapeutically useful positron emitter beams during carbon ion deceleration Selection of the optimal target material for 11 C beam production Marta Lazzeroni David Watts Brahme 2009 Image Guided Hadrontherapy and PET Prototype

10. March 2011 10 An interdisciplinary field that studies the biological effects of ionizing radiation, like: 1.Biophysical properties: LET and RBE We are assessing the relative biological effectiveness (RBE) for different ions for a range of LET values in different cell lines 2. Hypoxia and oxygen enhancement ratio (OER) Hypoxia causes resistance to low-LET radiation We are reproducing different hypoxic status by using specially designed chambers, and estimating the relative OER 3. Particle beams and cell cycle response We are trying to understand the molecular pathways leading to cell cycle alterations and identify the intracellular targets responsible for variation in radiosensitivity Radiobiology

11. March 2011 11 4. DNA damage and mechanisms of cell death We are investigating the different types of cell death (e.g. apoptosis, necrosis, mitotic catastrophe, autophagy and senescence), and chromosome aberrations 5. Combination with chemotherapy We are assessing the suitability of particle beam irradiation for combination with other therapeutic modalities such as chemotherapy (e.g. temozolomide) Binucleated with micronuclei Mono-nucleated with micronuclei Apoptotic, mitotic cells and cells with micronuclei Chitralekha Mohanty Katarzyna Zielinska-Chomej Thanks to... Walter Tinganelli Ming Chew Lara Barazzuol …Radiobiology

12. March 2011 : Objective: Participate in the conceptual design for the development of novel carbon ion gantry machine. To irradiate the tumor tissue from any direction with a carbon ion beam. Reduce size, weight and power consumption of the carbon ion gantry machine. Development of technical aspects of the Magnets to be used in the conceptual gantry design. Motivations The challenge Why Why is this an important subject? The magnets are the main elements which guide the ion beam into the gantry structure The magnets are the main elements which guide the ion beam into the gantry structure. Novel Accelerator and Gantry Studies

13. March 2011 Objective Development of a linear accelerator (linac) for a carbon ion cyclinac (CABOTO). Motivation… The challenge! Work description: - Performance optimization of CABOTO. - Tests of single-cell accelerating cavites to determine the highest reliable operational gradient for CABOTO. - Comparison between RF linacs and FFAGs for hadrontherapy To deliver a compact, dedicated accelerator, providing the best possible treatment modalities for hadrontherapy at the lowest cost. Machine dimensions could be reduced if high gradients could be achieved in the linac without compromising machine reliability. Cyclotron (injector) Linac (booster, beam energy modulation) Cyclinac Novel Concept Accelerators for Hadrontherapy and Gantry Studies

14. March 2011 … measurements for hadron therapy o Dosimetric o Microdosimetric o Nuclear fragmentation Objective: Improve treatment by … Simulation, Dosimetry and Treatment planning

15. March 2011 … treatment planning (TP) system support and benchmarking o Integration of measured data into TP systems o Development of Monte Carlo-based tools for TP o Validation and improvement of MC physics models … Adaptive Radiotherapy (ART) o Use of repeated cone beam CT for adaption of TP Objective: Improve treatment by … Bladder and rectum variation on different treatment days Simulation, Dosimetry and Treatment planning

16. March 2011 Subject: Development of clinical studies in diseases potentially treatable by hadrotherapy Role: Evaluate efficacy of hadrontherapy on patients with different tumor types treated in the European hadrontherapy facilities. Jeffrey Tuan, Anurita Srivastava Clincial Studies and Epidemiology

17. March 2011 No computing infrastructure connecting the emerging EU hadron therapy centres for: Situation Grid computing links distributed resources used in a multi- disciplinary virtual organisation. ETOILE (Lyon) HIT (Heidelberg) CNAO (Pavia) MedAustron (Wiener Neustadt) Prototype Cross-border patient referral Cancer Research IT for Hadrontherapy

18. March 2011 18 Coming soon... Should we mention PARTNER2?

19. March 2011 CERN, Geneva19 PARticle Training Network for European Radiotherapy http://cern.ch/partner This research project has been supported by a Marie Curie Early Initial Training Network Fellowship of the European Community's Seventh Framework Programme under contract number (PITN-GA-2008-215840-PARTNER). Coordination: CERN Manjit.Dosanjh@cern.chManjit.Dosanjh@cern.ch Thank you for your attention