R. Santoni
Particle beams in Radiation
Therapy: a new treatment
modality.
Università di Tor Vergata, Roma
(Università di Firenze)
New irradiation modalities
•Particle beams: Protons, Ions
•IMRT – Intensity modulated
Radiation Therapy
•Modifiers of the response
•Altered fractionation
•Radiation and concomitant
chemotherapy
Base of the skull tumor – Proton beam
treatment
•Almost no dose
beyond the target
Volume
•Conformation to
complex target
CLINICAL EVALUATION OF PROTONS.
CURRENTLY ACTIVE PROTOCOLS.
SKULL BASE SARCOMAS.
Favorable prognostic factors:
66 Gy
random
72 Gy
Unfavorable prognostic
factors:
72 Gy
random
79 Gy
CLINICAL EVALUATION OF PROTONS.
CLINICAL ACCOMPLISHMENTS.
SARCOMA OF THE SKULL BASE CERVICAL SPINE.
209
Skull base
45
Cervical spine
254 pts
PROTON TREATMENT.
5 year actuarial local control
Chondrosarcoma
94%
Chordoma
63%
CONVENTIONAL TREATMENT.
3 year local control rate
Chordoma + Chondrosarcoma
~35%
CLINICAL EVALUATION OF PROTONS.
CLINICAL ACCOMPLISHMENTS.
UVEAL MELANOMA - Proton treatment
70 CGE, 8-9 days
Sophisticated treatment planning
High positioning accuracy
(<= 1 mm)
5 year actuarial local tumor
control rate:
96%
5 year survival (1006 pts):
80%
Useful vision maintained in 40%
of patients.
Newer irradiation modalities – Patients per year
treatable with Protons in Italy - I
Category A – closeness to critical structures
Patients
Treatable with Protons
Expected/y. Number/year
%
Uveal
melanoma
200
200
100%
Meningioma
250
125
50%
Paraspinal T. 140
140
100%
Acoustic N. 40
10
25%
Chordomas
80
80
100%
Chondros.
40
40
100%
Optic Glioma 40
40
100%
Pituitary Ad. 750
150
20%
AVMs
130
130
100%
Newer irradiation modalities – Patients per year
treatable with Protons in Italy - II
Category B – low radiosensitivity
Patients
Treatable with Protons
Expected/y. Number/year
%
Prostate ca.
8800
Rectal ca.
4800
Salivary gl.
400
Cervix ca.
800
Retroperitoneum50
Pelvic rec.
300
2640
1440
200
400
50
150
30%
30%
50%
50%
100%
50%
Newer irradiation modalities – Patients per year
treatable with Protons in Italy - III
Category C – boost on a restricted volume
Patients
Expected/y.
Head&Neck
Biliary tract
Oesophagus
NSCLC
Thymomas
3000
2500
2000
19000
100
Treatable with Protons
Number/year
%
500
500
200
3000
20
15-20%
20%
10%
15-20%
20%
Newer irradiation modalities – Patients per year
treatable with Protons in Italy - IV
Category D – local evolution, unfavourable prognosis.
Patients
Treatable with Protons
Expected/y.
Number/year
%
Pancreatic ca.
Pelvic rec.
Pelvic rec.
post RT
Gliomas I-II
Single CNS
Metasatses
Retropertoneal
Met.
Head&neck rec.
Post RT
4500
500
900
250
20%
50%
250
900
250
450
100%
50%
1000
1000
100%
500
250
50%
50
50
100%
New irradiation modalities: Intensity-modulated
radiation therapy or Particle Beams?
Spreading passivo
Scanning system
The figures show an example for the
course of disease of a tumor patient
after carbon irradiations. It is quite
obvious that the tumor diagnosed at
the skull base (histological:
chordoma) before treatment (left)
has already decreased significantly
six weeks after beginning irradiation
with ion beams (right).
The PET method enables the
beam to be made visible within
the patient. For this purpose, the
X-ray-computer tomography is
overlaid with the display of the
activity distribution of the carbon
ions calculated on the basis of
the irradiation schedule (left).
The figure on the right shows
the activity distribution
measured during irradiation. A
comparison of both figures
shows how precise the
irradiation plan can be realised
by the new irradiation technique.
Per il futuro?
9Fasci monocromatici di alta energia
e con energia modulabile?
Yes!
9Fasci di particelle?
Yes!
9Agevole gestione delle immagini?
Yes!
9Sistemi di controllo e Robotizzazione?
Yes Yes Yes!
9Nuove applicazioni software
Yes Yes Yes!
CENT RAL
PROGETTO
PROTONI
CENTRO
ITALIA
Ipotesi di consorzio interistituzionale
e ipotesi di organi di gestione
PROTO N
PROSPETTO DE GL I ORGANI DI GESTIONE DEL PROGETTO E DEL
CENT RO PER TERAPIA CON PROTONI
I F ase - Realizzazione del
Pr ogetto
II Fase - F unzionamento del Centro per
ter apia con Protoni
Assemblea dei Soci
Assemblea dei Soci
Consiglio di
Amministrazione
Consiglio di
Amministrazione
Pr esidente del Consorzio
Pr esidente del Consorzio
Responsabile del
Pr ogetto
Direttor e del
Centr o
Segretar io
Amministrativo
Segretar io
Amministrativo
Consiglio Scientifico
Consiglio Scientifico
Revisori dei Conti
Revisori dei Conti
Staff di Pr ogetto
Dotazione organica del
Centr o
Looking forward to new results
and improvements – This is
the starting point and where we are now