Clinical Results of Carbon Ion Radiotherapy: The Heidelberg Experience
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1 Clinical Results of Carbon Ion Radiotherapy: The Heidelberg Experience Stephanie E. Combs, MD Department of Radiation Oncology University of Heidelberg, Germany
2 Carbon ion RT at GSI Active beam delivery (raster scan technique) Online beam verification with PET Biologic plan optimization Treatment planning software TRiP Physical treatment planning and dosimetry Preclinical reseach (cell and animal experiments) Clinical research Cooperation: GSI (Kraft and Co-workers) Research Center Rossendorf (Enghardt and Co-workers) DKFZ, Div. of Physics in Medicine (Schlegel, Jäkel, Karger and Co-workers) DKFZ, Div. of Radiation Oncology (Huber and Co-workers) University of Heidelberg and HIT (Debus and Co-workers)
3 Patient setup and treatment at GSI PET-camera X-ray system Beam line
4 3D Active beam scanning at GSI: Principle of raster scanning
5 Intensity Controlled Raster Scanning with heavy charged particles: Clinical Experience: Protons: PSI, CH: > 350 patients Carbon-ions: GSI, D: 407patients Clinical Feasibility Verification film irradiated with C-12 in 1996
6 Carbon Ion Radiotherapy at GSI n= Chondrosarcoma Chordoma ACC Re-Irradiation Prostate other 205
7 Introduction Chordomas orininate from embryonal remnants of the notochord 1-4% of all malignant bone tumors 35% localized in the skull base region Chondrosarcomas 10% of all malignant bone tumors 5-12% localized in the head-and-neck region Central role of proton RT for the treatment of chordomas and chondrosarcomas of the skull base
8 Carbon ion RT in skull base chondrosarcomas Clinical Phase I/II trial Intensity-modulated carbon ion RT Active beam delivery Biological plan optimization Stereotactic target point localization Total dose 60 CGE, fractionation 7 x 3.0 CGE BED 75 CGE (75-96 CGE)
9 Immobilization for Precision Radiotherapy
10 Patient positioning and stereotactic definition of treatment volume contrast-enhanced CT and MRI scans image fusion target delineation y z x
11 Patients characteristics n=54 chondorsarcoma patients treated between 1998 and 2005 median age 46 years (6-74) m:w = 1:1 macroscopic tumor in all patients WHO-Classification (G1-3, EMC, mesenchymal) G1 23 (42.6%) G2 12 (22.2%) G1/2 5 (9.3%) well diff. 14 (25.9%) Myxoid 7 Mesenchymal 1
12 Carbon ion radiotherapy for skull base chondrosarcomas - 54 patients analyzed - GD = 60 Gy E, 7 x 3Gy E/week Schulz-Ertner et al. IJROBP, 2007
13 Carbon ion radiotherapy for skull base chondrosarcomas Local Control Overall Survival 96.2% and 3 and 4 years 5-years OS 98.2% 2 recurrences (mesenchymaler histology): n=1 in-field n=1 field border Schulz-Ertner et al. IJROBP, 2007
14 Particle therapy for chondrosarcomas Author, year n RT dose LC Rosenberg, Prot. (+ Phot) % / 5y Hug, Protons /25 / 5y Weber, Protons % / 3y Castro, He 65 78% / 5y Noel, Prot + Phot 67 85% / 3y Schulz-Ertner, C12 60* 89% / 4y *FX 75 CGE
15 Prior to C12: rt. hemianopsia 60 GyE PR 12 months hemianopsia 20 months moderate improvement
16 Carbon ion RT in skull base chordoma prospective phase I/II trial ( ) , n=96 with macroscopic tumor Total dose CGE, weekly fractionation 7 x 3.0 CGE (a/ß=2 Gy) corresponding to BED of CGE Intensity-modulated carbon ion RT, active beam delivery Biologic plan optimization Prospective clinical phase I/II trial: 43 patients, 53 further patients Median FU 31 months Regular FU with MRI scan
17 Carbon ion radiotherapy for skull base chordomas Overall Survival 88.5% / 5 years Local Control Dose-response relationship > 60 Gy E 60Gy E 70% / 5 years Schulz-Ertner et al. IJROBP, 2007
18 Chordoma of the Skull Base patient with intended left lateral gaze Before RT: diplopia 6 Months after RT resolution of diplopia
19 Motivation: Dose Response Relationship Radiotherapy of Skull Base Chordomas C-Ions Protons FSRT conventional RT [Schulz-Ertner, IJROBP 2007]
20 Carbon ion Radiotherapy at GSI - Clinical feasibility and safety was shown - excellent local control rates for chordomas/chondrosarcomas of the skull base with low toxicity - superior results for photon treatment for adenoidcystic carcinomas (boost treatment) - currently study on prostate cancer (boost treatment) - further studies on carbon ion RT required - for skull base chordomas and chondrosarcomas, randomized trials comparing proton and carbon ion RT are needed
21 PTCOG 48: September 21 st September 25 th, 2009
22 Meeting homepage Contact Information - meeting venue - progamme updates - hotel and travel - sightseeing and entertainment Local organizing committee Send us and ! ptcog.2009@med.uni-heidelberg.de
23 PTCOG 48: September 21 st September 25 th, 2009
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