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Basic Press Information Contact MedAustron EBG MedAustron GmbH Marie Curie-Strasse 5 A-2700 Wiener Neustadt Austria T +43 2622 26 100-0 e-mail: office@medaustron.at Internet: www.medaustron.at Press contact: Petra Wurzer Tel. +43 664 808 78 111 e-mail: petra.wurzer@medaustron.at Basic Press Information MedAustron February 2017

MedAustron in Wiener Neustadt, Austria, is one of the world s most cutting-edge centers for cancer treatment and research. It started treating patients in Dezember 2016. MedAustron uses an innovative form of radiation therapy, namely ion beam therapy. Patients get irradiated with charged particles protons or carbon ions. This form of therapy is optimal for treating tumors close to radiation sensitive organs. Side effects can be reduced significantly. What is ion beam therapy? Ion beam therapy or particle therapy is based on the special physical properties of ions. When charged particles enter human tissue, they emit energy. The slower they get, the higher their biological effectiveness, which reaches its peak just before they stop ( Bragg Peak ). This principle is used in ion beam therapy. Through exact calculations, the maximum radiation dose can be focused precisely on the area of the tumor. The hereby-released energy damages the DNA of the cancer cell irreparably, while mostly sparing the healthy tissue. Thus, the biological effectiveness of carbon ions is higher than that of protons. This means that even radio-resistant tumors can be effectively treated with carbon ions. Particle therapy is used especially for tumors resistant to conventional irradiation, or for tumors in delicate anatomical structures. Worldwide, more than 150,000 patients have been treated with particle therapy. Through in-house research, MedAustron aims to further support the development of ion beam therapy. Working together with colleagues from conventional radiotherapy and other centers for particle therapy, the objective is to even better define which patients benefit most from a treatment with protons or carbon ions. Indications for proton or carbon ion therapy can be tumors of the skull base, head and neck tumors, brain tumors, sarcoma or ENT tumors. Furthermore, also tumor diseases of the lung, pancreas, liver or pelvic area can be treated using charged particles. Ion beam therapy is often indicated for pediatric tumors in particular. Basic Press Information MedAustron February 2017 2

Technology at MedAustron To generate different types of charged particles for treatment and research, a synchrotron-based facility is necessary. A synchrotron is a form of circular accelerator. In cooperation with CERN, the synchrotron at MedAustron was developed. The particles protons or carbon ions are generated by three ion sources. Carbon dioxide CO 2 or hydrogen gas H 2 is heated to extremely high temperatures, creating a plasma. Using electric fields, positively charged ions can now be separated from the negatively charged electrons. In a linear accelerator, the ions are then pre-accelerated to approximately 12% of the speed of light. After this pre-acceleration, the particles are injected into the synchrotron with a circumference of 80 meters. In this circular accelerator, the particles are held in place within a very slim vacuum tube by strong magnetic fields. The acceleration itself only takes place in a very short section of the synchrotron. With each turn, the particles are further accelerated until they reach their final velocity of approximately two thirds of the speed of light. For clinical use, energies ranging from 60 to 250 MeV for protons and from 120 to 400 MeV/u for carbon ions are possible at the MedAustron facility. For non-clinical research, the proton energies can reach up to 800 MeV. The energy of the particles corresponds to their penetration depth, which can reach up to 30 centimeters. Four irradiation rooms are available for use at MedAustron. Three are intended for medical use and one is solely designed for non-clinical research. All rooms are equipped with identical medical technology to allow the direct comparison and application of the results drawn from research for patient treatment. Two medical treatment rooms have a horizontal fixed beam in place, one of them additionally offers a vertical fixed beam. One medical irradiation room provides a so called gantry a bogie of 220 tons that enables irradiation from random angles with a beam precision of 0.3 mm. Treatment Process for Patients MedAustron is an outpatient clinic offering ambulant treatments with daily irradiation sessions over a period of several weeks. The duration of the individual patients therapy varies, the average being four weeks. A crucial factor for the treatment is the exact positioning of the patient. For that purpose, MedAustron has installed a worldwide unique positioning system: a ceiling-mounted Basic Press Information MedAustron February 2017 3

robotic system, with industrial robots custom-built for medical use. This system makes it possible to position the patients with an accuracy of half a millimeter, and ensures that the patient stays in this position during the whole treatment. Hence, the precise irradiation of the tumor can be guaranteed. Immediately before each treatment fraction, a so called imaging ring system (IRS) is used to verify the correct position of the patient. The IRS is mounted on the patient table and comprises an X-ray tube and a detector. The components can be moved and rotated independently. The IRS provides three-dimensional imaging of the tumor position. Employees at MedAustron 160 employees from 18 different nations are currently working at MedAustron. About 50 of them previously worked for MedAustron at the European Organization for Nuclear Research CERN. At full operation, MedAustron will provide jobs for 180 employees. Typical job profiles at MedAustron include physicists, technicians of various disciplines, radiation oncologists, medical physicists and radiology technologists. Cooperations with Austrian and international medical universitites and clinics provide the medical staff with thorough education and training. Management DI Alfred Zens, MBA CEO Prof. Dr. med. Eugen B. Hug - CMO Basic Press Information MedAustron February 2017 4

Research at MedAustron Besides the treatment of patients in clinical trials, the MedAustron accelerator facility offers the opportunity to perform non-clinical research. A special feature of the center is that it provides a separate research room for irradiating with protons and carbon ions. On the one hand, areas of research close to the medical application are addressed, i.e. translational research. This includes basic investigations on physical and biological interactions between the available radiation qualities and tissue in the framework of the two study groups on Medical Radiation Physics and Radiation Biology. On the other hand, the particle beam can generally be used for scientific projects in radiation physics, for example to determine cross sections of primary particles interacting with different target objects. In co-operation with the Medical University of Vienna and the Vienna University of Technology, three professorships were established in the years of 2014 and 2015. Two of them, namely Medical Radiation Physics and OncoTechnology and Applied and Translational Radiobiology (ATRAB) have been installed at the Medical University of Vienna. The third professorship on Radiation Physics belongs to the Institute of Atomic and Subatomic Physics of the Vienna University of Technology. Besides these three keyuser groups, visiting researchers can apply for external projects. Such proposals can be submitted in co-operation with the three mentioned key-user groups, or as thoroughly independent external projects providing that free capacities are assured. Basic Press Information MedAustron February 2017 5

Financing of MedAustron MedAustron has been realized with the support of the Republic of Austria, the Government of Lower Austria, and the City Government of Wiener Neustadt. MedAustron is in direct property of the Government of Lower Austria. The investment costs for the construction of the center were in the range of 200 million Euros. Republic of Austria 41 million Euros investment held of the building costs for non-clinical research and inseparably mutually used units. 5.5 million Euros per year research grants for at least the next 14 years. Federal State of Lower Austria The center for ion beam therapy and research is built and operated by the EBG MedAustron GmbH whilst being 100% in direct property of the Federal State of Lower Austria. The Federal State of Lower Austria assumes liability for 200 million Euros. 3.7 million Euros investment for the building costs for non-clinical research and inseparably common used units. 32 million Euros as equity surrogate (uncommitted capital reserves). City Government of Wiener Neustadt The City Government of Wiener Neustadt provided the premises in the size of 3.2 ha. 1.9 million Euros participation in the building costs for non-clinical research and inseparably mutually used units. Basic Press Information MedAustron February 2017 6

MedAustron in numbers 200,000 kilometers per second is the velocity of the particles used for irradiation 200 million Euros were the investment costs for the center. 5 centers worldwide offer particle therapy with protons and carbon ions at the moment 1,000 different components of 200 suppliers from over 20 different countries were installed in the accelerator. 18 nations are the home countries of the MedAustron employees. 306 jobs are generated additionally through MedAustron each year on average. 457 million Euros of regional economic effects can be achieved through MedAustron for Lower Austria. 32,200 m² is the size of the property on which the MedAustron facility is built. 12,000 kilowatts is MedAustron s total power input. 200 kilometers of power cables were installed. 10.000.000.000.000 = 10 13 protons are necessary for a single patient treatment (approx.). Basic Press Information MedAustron February 2017 7