PROGRESS IN HADRONTHERAPY Saverio Braccini TERA Foundation for Oncological Hadrontherapy IPRD06 - Siena - 01.10.06 - SB 1
Outline Introduction Radiation therapy with X rays and hadrontherapy Hadrontherapy today Proton-therapy therapy Carbon ion therapy New ideas for the future: Innovative cyclotrons CYCLINACs Laser plasma based accelerators Conclusions and outlook IPRD06 - Siena - 01.10.06 - SB 2
The basic concept of cancer radiation therapy Local control of the tumour Courtesy J.P. Jerard,, MD, Nice (France) IPRD06 - Siena - 01.10.06 - SB 3
A big step forward in particle physics and in Medical diagnostics Cancer radiation therapy due to the development of three fundamental tools M. S. Livingston and E. Lawrence with the 25 inches cyclotron Particle accelerators Particle detectors Computers Geiger-Müller counter built by E.Fermi and his group in Rome IPRD06 - Siena - 01.10.06 - SB 4
Radiotherapy with X-raysX IMRT - 9 different photon beams The limit is due to the dose given to the healthy tissues! Especially near organs at risk (OAR) Electron linacs to produce gamma rays (called X-rays X by medical doctors) 20'000 patients/year every 10 million inhabitants IPRD06 - Siena - 01.10.06 - SB 5
The basic principles of hadrontherapy Carbon ions 4800 MeV Protons 200 MeV 27 cm Beam of hadrons which slow down in matter Tumour target First idea: Bob Wilson, 1946 Bragg peak Better conformity of the dose to the target healthy tissue sparing Hadrons are charged Beam scanning for dose distribution Heavy ions (Carbon) Higher biological effectiveness IPRD06 - Siena - 01.10.06 - SB 6
Protons allow a better local control Tumour between the eyes IMRT - 9 X ray beams IPRD06 - Siena - 01.10.06 - SB 1 proton beam 7
Number of potential patients X-ray therapy every 10 million inhabitants: 20'000 000 pts/year Protontherapy 12% of X-ray X patients = 2'400 pts/year Therapy with Carbon ions for radio-resistant resistant tumour 3% of X-ray X patients = 600 pts/year Every 50 M inhabitants Proton-therapy therapy 4-5 centres Carbon ion therapy 1 centre TOTAL about 3'000 pts/year every 10 M IPRD06 - Siena - 01.10.06 - SB 8
The sites Up to present Proton-therapy: therapy: ~45 000 patients Carbon ion therapy ~2 2 200 patients IPRD06 - Siena - 01.10.06 - SB 9
Present and near future of hadrontherapy Proton-therapy therapy is booming! (for information see PTCOG, www.ptcog.com) Laboratory based centres: Orsay,, PSI, INFN-Catania Catania, Hospital based centres: 3 in USA, 4 in Japan and many under construction (USA, Japan, Germany, China, Korea, ) Companies offer turn-key centers (cost: 50-60 M Euro) Carbon ion therapy 2 hospital based centres in Japan Pilot project at GSI 2 hospital based centres under construction in Germany and Italy 2 projects approved (France and Austria) European network ENLIGHT IPRD06 - Siena - 01.10.06 - SB 10
The eye melanoma treatment at INFN-LNS in Catania LNS Supercoducting cyclotron 65 MeV protons 92 patients (oct( 2005) IPRD06 - Siena - 01.10.06 - SB 11
First hospital-based proton-therapy therapy centre, built in 1993 Deep seated tumours 160/sessions a day The Loma Linda University Medical Center IPRD06 - Siena - 01.10.06 - SB 12
Dose distribution Passive spreading Active scanning IPRD06 - Siena - 01.10.06 - SB 13
PROSCAN project at PSI SC cyclotron by ACCEL Experiment OPTIS Gantry 2 Gantry 1 Active scanning New SC 250 MeV proton cyclotron New proton gantry (Gantry2) IPRD06 - Siena - 01.10.06 - SB 14
SAMBA: an innovative detector for on-line monitoring 2 orthogonal strip ionization chambers Segmentation: strips 2 mm Very sensitive electronics (Quantum of charge 100 fc) Very thin: 50 um capton + 17 um copper foils Designed for the Gantry2 at PSI Beam tests with the Gantry1 at PSI Measurement of a square of dose Uniformity within 1 % Collaboration TERA-University and INFN Torino IPRD06 - Siena - 01.10.06 - SB 15
Carbon ion therapy in Europe 1998 - GSI pilot project (G. Kraft) 200 patients treated with carbon ions PET on-beam IPRD06 - Siena - 01.10.06 - SB 16
PET on-beam Simulated from TPS Direct control of the dose First attempts with proton beams Measured IPRD06 - Siena - 01.10.06 - SB 17
HIT University of Heidelberg MAN technology Project started in 2001 Architects Nickl & Partner, Munich and Heidelberg University Building Authority First patient treatment foreseen in 2007 IPRD06 - Siena - 01.10.06 - SB 18
CNAO on the Pavia site Investment: 75 M M Main source of funds: Italian Health Ministry Ground breaking: March 2005 Treatment of the first patient foreseen by the end of 2007 PIMMS/TERA IPRD06 - Siena - 01.10.06 - SB 19
CNAO January 21 st, 2006 June 1 st, 2006 Courtesy S. Rossi (CNAO Foundation) IPRD06 - Siena - 01.10.06 - SB 20
New accelerators for the future? Medium term Dual cyclotrons for protons and carbon ions Very compact SC proton synchrocyclotrons CYCLINAC = Cyclotron + LINAC Long term Laser plasma accelerators IPRD06 - Siena - 01.10.06 - SB 21
A dual cyclotron 250 MeV/u SC cyclotron H 2+ molecules 250 MeV proton beam for deep seated cancer treatment 250 MeV/u fully stripped C ions maximum penetration of 12 cm in water Project: INFN-LNS IPRD06 - Siena - 01.10.06 - SB 22
Very compact SC synchrocyclotrons 9.5 T SC magnet ~50 cm diameter for 250 MeV protons Innovative double scattering spreading technique based on scatterers made of low Z Z and high Z Z liquid materials Project MIT and Still River Systems Goal: One gantry-one room apparatus Very difficult project that could lead to a change of scale! IPRD06 - Siena - 01.10.06 - SB 23
The CYCLINAC: the new project of TERA Linear accelerator Cyclotron Hadron therapy CYCLINAC = CYClotron + LINAC Commercial cyclotron for the production of radioisotopes Linac to boost the beam energy for hadron-therapy Two main functions DIAGNOSTICS + THERAPY IPRD06 - Siena - 01.10.06 - SB 24
IDRA Radioisotope production Institute for Diagnostics and RA IDRA Institute for Diagnostics RAdiotherapy and RAdiotherapy 30 MeV 210 MeV Cyclinac Dose distribution Ex: PSI new gantry IPRD06 - Siena - 01.10.06 - SB 25
Dose [scaled utits] Bragg curves obtained by switching off klystrons 1 0.8 0.6 A unique feature! 0.4 5 Klystrons on 10 Klystrons on 15 Klystrons on 20 Klystrons on 0 Klystrons on 0.2 0 0 5 10 15 20 25 30 Depth [cm] Variation by dephasing last klystron IPRD06 - Siena - 01.10.06 - SB 26
The long term future: laser - plasma accelerators? ~ 10 13 protons measured Proton energy: 58 MeV (LLNL) The mechanism SIMULATION Laser: 50 fs,, 50 J (Petawatt( Petawatt!) I = 10 21 W/cm 2 >10 11 protons up to 300 MeV MANY YEARS OF WORK IPRD06 - Siena - 01.10.06 - SB 27
Suitable for protontherapy? Is the number of protons reproducible from pulse to pulse? Is it possible to control the intensity of the proton beam? Moreover the beam is neither monochromatic nor well collimated (with respect to standard accelerators) New ideas are needed, in particular for an ad hoc dose distribution system IPRD06 - Siena - 01.10.06 - SB 28
Hadrontherapy is becoming a clinical reality! Conclusions and Outlook Proton therapy is booming Carbon ion facilities are under construction or approved Still a lot of R&D is needed in the future Work is in progress IPRD06 - Siena - 01.10.06 - SB 29