Current Status and Future Medical Perspectives at MedAustron U. Mock EBG MedAustron GmbH
Cancer treatment facility Ion beam therapy with protons and carbon ions Research facility Medical physics Radiobiology Experimental physics
Rettung Patienten Ground floor functional design Personaleingang (Medical, research) 90 m M. Benedikt ÖGRO, 20.11.2010 137 m 3
Medical treatment/research: Proton gantry (IR 4) Horizontal fix beam (IR 3) Horizontal and vertical fix beam (IR 2) Non clinical research: Horizontal fix beam (IR 1)
Technical Co-operation CERN, Geneva, Synchrotronconstruction CNAO, Milano, and INFN, Italy for the development of the beam application system CERN
Beam arrangements at the MedAustron Ion Beam facility
MedAustron: Gantry PSI Gantry 2 Weight: Diameter: 220 t 7,5 m
21.10.2013 PSI Gantry
HIT, Heidelberg MedAustron robotic patient positioning system
The robotic table
Project time schedule 2008 Start of the civil engineering pre-planning 2009 Submission of the documents for the mandatory Environmental Impact Assessment Study 2011 Start of building construction 2012 Start technical infrastructure installation 2013 Accelerator - Trial operation 2015 Start patient treatment (horizontal beam room) 12 12
Milestones at MedAustron 2014: technical trial operation End 2015: presumably first ambulant patient`s irradiation with protons at the horizontal beam End 2016: Presumably first patient`s treatment with carbon ions
Milestones at MedAustron Indications to ion beam therapy (at MedAustron)
Proton therapy Dose distribution Reduction of dose before the tumour Almost no dose after the tumour thereby: Dose normal tissue/organs at risk Reduction of dose to normal tissues Reduction of dose to organs at risk Optimal treatment for tumours in close proximity to radiosensitive organs like the optical nerve, spinal cord etc.
Carbon ions = higher biological effectiveness
Irradiation of the cranio-spinal axis in the treatment of medulloblastoma (most common pediatric brain tumour) Conventional radiotherapy (Photons): - Limited dose to inner organs Iontherapy (protons): No dose to inner organs Reduction of acute and late side effects
General treatment strategy: Protons Slightly higher biological effectiveness compared to photons (RBE: ~ 1,1) (simply) replacing photons by protons without changing fractionation and/or dose schedules will NOT improve local tumour control Reduction of treatment related side effects: e.g. paediatric tumours Improved local tumour control by dose escalation in the target region without exceeding tolerance doses of organs at risk
DEGRO-List of indications to proton therapy 2006 the Deutsche Gesellschaft für Radioonkologie (DEGRO) published a list of established indications to proton therapy http://www.dzkf.de/heft/2006_01-02/14.pdf
DEGRO list of indications Thoracic malignancies Lung cancer (NSCLC) Stage I and II (if the patient is medically inoperable/refuses surgery) Thoracic tumours which can not be treated by photons in a curative intent without exceeding the tolerance doses of critical organs at risk (e.g. spinal cord, lung) Example: selected patients with locally advanced lung cancer or pleural mesothelioma Retroperitoneal single metastasis in case of a locally controlled primary tumour Esophageal carcinoma (T3-4 or T1-2 tumours in medically inoperable patients), e.g. proton boost after combined radio-chemotherapy with photons). Breast carcinoma, if all regional lymph nodes have to be irradiated
DEGRO list of indications Abdominal tumours Liver cancer (hepatocellular carcinoma): curative treatment intention Carcinoma of the upper abdominal region which can not be treated curatively with photons without exceeding the tolerance doses of surrounding organs at risk like the liver, kidneys, spinal cord. Clinical examples: patients with cholangio-cellular carcinoma or selected cases of retroperitoneal sarcoma (multimodal treatment concept) Liver metastases of colorectal carcinoma, if surgery is not indicated Single retroperitoneal metastases in locally controlled primary tumours Para spinal sarcoma and carcinoma (curative treatment intention) Non-operable osteo- und chondrosarcoma of the axial skeleton Prostate carcinoma (e.g. proton boost therapy after conventionally fractionated photon therapy) or locally advanced prostate carcinoma Locally advanced gynaecological tumours (e.g. proton-boost after conventionally fractionated photon therapy, if a Brachytherapy boost can not be applied Inoperable rectal carcinoma or recurrences without prior irradiation (e.g. proton boost after conventional fractionated photon therapy within combined radio-chemotherapy concepts
DEGRO list of indications Tumours of the extremities Large soft tissue sarcoma of the extremities (after extremity preserving tumour resection) Head and Neck tumours Advanced tumours close to the scull base or paranasal sinus carcinoma Locally advanced head and neck tumours (e.g. proton-boost therapy after simultaneous radiochemotherapy with conventional photon irradiation Cerebral tumours Glioma Grad II/III in adults (e.g. within clinical studies aiming at a reduction of severe late toxicity) Meningioma of the scull base (e.g. proton-boost after conventional fractionated photon therapy) Pediatric malignancies
General treatment strategies: Carbon ions Higher biological effectiveness in comparison to protons/ photons Especially indicated in relatively radioresistant tumours Especially indicated in tumours which can only be treated with limited effectiveness by conventional irradiation techniques
Carbon ions Consolidated indications: Adenoid cystic carcinoma of the salivary glands Mucosal melanoma Chordoma of the scull base/spinal axis Soft tissue sarcoma (low- intermediate grading) without distant metastases, if the tumour is inoperable or only incomplete respectable Prospective indications : Sarcomas after definite R1-resection (and in children) Lung carcinoma, surgical inoperable Locally aggressive growing prostate carcinoma Local recurrences of adeno-carcinoma in the pelvic region (after already performed photon therapy) Locally advanced squamous carcinoma of the head and neck region High grade glioma (in children and adults) Gastrointestinal tumours (liver cancer, pancreatic carcinoma, carcinoma of the stomach etc.)
Intended operation Start of treatment end of 2015 Start in one treatment room = Horizontal fix beam with protons Continuous increase of patient numbers Treatment of almost all patients within clinical studies Operation concept Medicine/clinical research Medical treatment 5 days/week, 06:00 22:00 incl. QA Operation concept Non clinical research 22:00 6:00, and Saturday, Sunday, statutory holidays
Ion beam therapy facilities worldwide
Combined ion beam treatment facilities with protons and carbon ions worldwide HIBMC, Hyogo, Japan In operation since 2002 HIT Heidelberg, Germany 1. patient treatment: 15.11.2009 CNAO, Pavia, Italy 1. patient treatment Sept. 2011 Combined centres under construction: MedAustron, Wiener Neustadt, A ~ Start intended end of 2015
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