Download 1. Why proton beams in tumour radiation treatment

Protontherapy at INFN-LNS
C.Agodi
Laboratori Nazionali del Sud - Catania
LEA-COLLIGA – IPN Orsay November 14-16 2011
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
LNS
Why clinical hadron beam?
Higher precision and greater biological effectiveness of the applied dose
Depth dependence of the deposited dose for different radiation
Because of the Bragg
peak, protons dose
distribution is “inverted”
with respect to the
almost exponential
behaviour produced by
a beam of high energy
photons. The surface
dose is low when
compared to the dose
absorbed in the region
of the peak, at variance
with what happens with
photons and electrons.
Why clinical proton beam?
• penetration depth is well-defined and adjustable
• most energy at end-of -range
• protons travel in straight lines
• dose to normal tissue minimised
• no dose beyond target
PROTONS PERMIT TO DELIVER AN HIGH DOSE TO
THE TUMOUR SPARING THE SOURRONDING TISSUES
Intensity Modulateted Radiation Therapy vs PROTONS
Between the eyes
Abdomen
Brain
PT faces a fast growing demand!
45,000
40,000 patients
45
40,000
40
35,000
35
30,000
30
25,000
22 PT centers
25
20,000
20
15,000
15
PT center under operation
10,000
10
5,000
0
1950
1990 - The Loma Linda
University Medical
Centre in California
heralded the age of
“dedicated” medical
accelerators with
commissioned its
proton therapy facility
with a 250 MeV
Synchroton
5
1960
1970
1980
1990
2000
0
2010
• 1954 - C.Tobias and J.Lowrence: first therapeutic exposure of human patients to hadron beams at
the Radiation Laboratory of California, Berkeley
• 1957 – Protons treatments : University of Uppsala, Sweden
• 1961 – Massachusetts General Hospital-Harvard Cyclotron Laboratory ,USA
• 1967 – Dubna, 1969 Moscow, 1975 St Petersbourg in Russia
•1979 – Chiba, 1983 Tsukuba in Japa
•1984 – PSI-Villigen in Switzerland
LNS
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
INFN & Hadrotherapy
• In 90’ years INFN supported TERA in R&D project.
• INFN, in collaboration with University of Catania, realized in
its laboratory (Lab. Naz. Del Sud) the first Italian
protontherapy facility.
• INFN has UNIQUE capability in Italy in accelerators
development.
• Considering its particular features, INFN was involved in
CNAO to guarantee the necessary expertise.
• In 2005 INFN was encharged by Health Minister to produce
a document about protontherapy in our country.
In Catania we developed a
facility
(named CATANA)
for the treatment of ocular
tumours with 62 AMeV proton
beams
LNS
Superconducting
Cyclotron is the
unique machine in in
Italy and South
Europe used for
protontherapy
Treatment of the
choroidal and iris
melanoma
In Italy about 300 new
cases for year
LNS Accelerator Layout
Ocular Protontherapy
Unique Italian Facility
CATANA
CATANA proton therapy beam line (until June 2004)
CATANA proton therapy beam line (new location)
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
CATANA proton therapy beam line
Ligth
field
Laser
Modulator &
Range shifter
Monitor
chambers
Scattering
system
Lateral dose distribution in a clinical proton beam
120
100
Relative dose
95 %
80
60
50 %
40
20 %
20
0
-20
-15
-10
-5
0
5
10
15
20
Distance from central axis (mm)
Lateral penumbra :
d 80%20%
Field ratio :
H 
90% field size
50% field size
Flatness :
  25mm   0.90
  25mm   20mm
w95% :
Simmetry ( Area ratio ) :
Tolleranze
 1.50mm
ABS (a  b)  200%
ab
P  Pmin
RT %  max
100%
Pmax  Pmin
Sr 
 3%
 3%
Depth dose distribution – Energy modulation
Generation of the Spread Out Bragg Peak (SOBP)
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
Dosimetric commissioning: absolute & relative dosimetry
Absolute Dosimetry: Energy Released in Water (Gray)
Relative Dosimetry: Three dimensional dose distribution
measurements

Considering the high gradient dose, conformation and
small fields often used the detectors have to be kindly
characterized in terms of spatial resolution, energy or
fluence dependence to be used in protontherapy.
Relative and Absolute Dosimetry are
fundamental for:
Customizing of TPS
Monitor Unit Calculation
Quality Control
Dosimetric commissioning: absolute & relative dosimetry
ICRU 59 AND TRS 398 IAEA
RECOMMENDATION

“ FOR MEASUREMENTS OF DEPTH-DOSE
DISTRIBUTION IN PROTON BEAMS
THE USE OF PLANE-PARALLEL CHAMBERS IS
RECOMMENDED”

Parallel plate MARKUS PTW is the golden
standard for depth dose measurements
GEANT4 Simulation
Monte Carlo Simulation of the entire beam line using GEANT4:
Improvement of our beam line and dosimetry
Give a general purpose tool for the design of new hadrontherapy beam line
Validation of the treatment system software
GEANT4 simulation
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
A typical treatment
 The Surgical Phase
 The Treatment Planning Phase
 The Verification Phase
 The Treatment Phase
Two orthogonal X-Rays tubes for the visualization of the clips
NEW X-RAY SYSTEM FOR PATIENTS POSITIONING
Lay-out of the axial X-Ray
flat panel with its moving
system
Hamamatsu XRay axial flat
panel
[email protected]
26
Treatment Planning System Phase
EYEPLAN
Originally developed by Michael Goitein and Tom
Miller (Massachussetts General Hospital), is now
maintained by Martin Sheen (Clatterbridge Center
for Oncology) and Charle Perrett (PSI)
Fixation Point Choice
This point is chosen in order to spare the organs at risk,
and to maintain the best polar angle.
Fixation Point
Isocenter
Fixation
Light
q
f
q Polar Angle
f Azimuthal Angle
Treatment Planning System Output
Isodoses curves for different planes
Treatment Phase
At the end of patient positioning phase the radiotherapist
draws the eye’s contour on a dedicated monitor in order to
monitoring in any moment the eye’s position during the
treatment.
TREATMENT MODALITIES
Dose: 15.0 CGE per day
Treatment Time: 45-60 sec.
Total Dose: 60 CGE
Fractions: 4
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Clinical results
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
Patient Distribution by Pathologies
Uveal Melanoma
164 patients
Conjunctival Melanoma
4 patients
Conjunctival
rhabdomyosarcoma
1 patient
Eyelid Carcinoma
and metastases
2 patient
Conjunctival MALT-NHL
1 patient
Conjunctival Papilloma
2 patient
TOTAL PATIENTS 174
Patient Distribution by Origin Region
10
1
2
Total
number of
patients :
230
3
2
18
3
29
7
1
10
18
Since feb
2002
70
Patient Distribution by Sex
Women
Men
51%
49%
The patients’age ranges between 14yrs and 81yrs
(the mean age is 48 yrs)
PATIENTS FOLLOW-UP
(March 2002 – November 2008)
PatientsTotal Number
(April 2009)
174
Patients with Follow up
138
TUMORAL THICKNESS
ECOGRAPHIC
REFLECTIVITY
Reduced
Stable
70 % Increased
24 % Stable
77 %
18 %
Increased
2 % Not evaluable
5%
Not evaluable
2%
SURVAIVAL RESULTS
PatientsTotal Number
(April 2009)
174
Dead patients
4
Metastatis
3
Other
1
Eye retention rate
95 %
TOTAL SURVIVAL
98 %
LOCAL CONTROL
95 %
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
CATANA Spin-off: Some Important Milestones
In 2002, the First Italian Protontherapy Facility Funded by INFN
and Catania University started in Catania at INFN-Laboratori
Nazionali del Sud
Sicilian Region has approved to realize an HadronTherapy Center
in Catania, for protons and heavy charge particles. It has to be
realized as “Scientific collaboration between Region, INFN and
University of Catania also open to private contributions”
What is in progress?
•
•
•
•
Proton computed tomography (PCT)
Carbon beams for therapy…
Lithium beams for therapy?
…….
Remarks
• Knowledge gained from basic research influenced the choices
of ion, energy, beam delivery system and treatment schedule.
• Moreover radiotherapy shall be developed only on the basis of
research conducted according to the highest standard of
scientific inquiry and using the most advanced method
available.