The needs of hadrontherapy in spain
Download
1 / 40

THE NEEDS OF HADRONTHERAPY IN SPAIN - PowerPoint PPT Presentation


  • 69 Views
  • Uploaded on

THE NEEDS OF HADRONTHERAPY IN SPAIN. Ignacio Petschen Verdaguer IFIMED 2009. HADRONTHERAPY. Therapeutic Window: Favorable. tumor control. toxicity. 90%. PROBABILITY. 5%. DOSE OF RADIATION. H Cárdenas courtesy. HADRONTHERAPY. Therapeutic Window: Unfavorable. tumor control. toxicity.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' THE NEEDS OF HADRONTHERAPY IN SPAIN' - kalona


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
The needs of hadrontherapy in spain
THE NEEDS OF HADRONTHERAPY IN SPAIN

Ignacio Petschen Verdaguer

IFIMED 2009


Therapeutic window favorable

HADRONTHERAPY

Therapeutic Window: Favorable

tumor control

toxicity

90%

PROBABILITY

5%

DOSE OF RADIATION

H Cárdenas courtesy


HADRONTHERAPY

Therapeutic Window: Unfavorable

tumor control

toxicity

90%

PROBABILITY

50%

DOSE OF RADIATION

H Cárdenas courtesy


HADRONTHERAPY

Therapeutic Window: Effect

of reducing Volume of Normal Tissue

tumor control

toxicity

90%

V1

V2

PROBABILITY

50%

V2 < V1

5%

DOSE OF RADIATION

H Cárdenas courtesy



AK Lee courtesy

MD Anderson CC


AK Lee courtesy

MD Anderson CC




Hadrotherapy rbe
HADROTHERAPY: RBE

PROTONS:

Between 0,9 y 1,3 (average: 1,1)

“plateau”: 0,9-1

“Bragg peak”: 1,2-1,3

CARBON IONS:

Between 2 and 3

An increase of apoptosis induction, mainly at Bragg peak level, has been

shown, for protons and ions.



Hadrontherapy carbon ions
HADRONTHERAPY: CARBON IONS

- Reduction in the OER.

- Lesser influence of repair phenomena.

- Reduction of the differences in RS related to

cell cycle position.


Hadrontherapy carbon ions1
HADRONTHERAPY: CARBON IONS

Malignant tumors:

-Well differenciated

-Slowly growing

-Hypoxic (RR)

-Slowly cell cycle redistribution

-repair-proficient tumors


Hadrontherapy image
HADRONTHERAPY: IMAGE

Only possible if modern image techniques are available



Hadrontherapy image1
HADRONTHERAPY: IMAGE

Ling et al. IJROBP, 47: 551 (2000)


Hadrontherapy conformality
HADRONTHERAPY: CONFORMALITY

Ling et al. IJROBP, 47: 551 (2000)


Hadrontherapy
HADRONTHERAPY

  • POTENTIALS:

  • High conformal dose distribution

  • Higher target dose

  • Steepest dose gradients between PTVs and PRVs

  • Reduction of patient integral dose

  • Increase RBE (ions)

AIMS:

-Tumor dose intensification (Increase of tumor control)

-Low doses to the ORs and non involved tissue (less toxicity)

-Higher survival rates

-Better outcome in patients with RR-tumors (ions)

-Reduction of RT-fractions (less treatment days)


Hadrontherapy the tera project
HADRONTHERAPYTHE TERA PROJECT

  • POTENTIAL INDICATIONS FOR PROTONTHERAPY

  • Category A:

  • Closenesstohighlycriticalstructures

  • - Onlywaytoadminister a radical dosewithoutproducing

  • serioussideeffects


Hadrontherapy the tera project1
HADRONTHERAPYTHE TERA PROJECT

  • POTENTIAL INDICATIONS FOR PROTONTHERAPY

  • Tumoursbelongingcategory A:

  • Uveal melanoma

  • Base of skullchordoma and chondrosarcoma

  • Spinal and paraspinaltumours

  • Parasellarmeningioma

  • Opticalnerve glioma

  • Acousticnerveschwanoma


Hadrontherapy protons uveal melanoma results
HADRONTHERAPY: PROTONSUVEALMELANOMA: RESULTS

CENTER 5 y. local control 5 y. ocular retention

MGH 96% 84%

PSI 94,8%· 86%·

CP Niza 89% 88%

CP Orsay 97% 92%

Berlin 95,5%·· 87,5··

PC Clatterbridge 96,5% 90,6%

Useful vision in > 50% · 10 years ··3 years


Hadrontherapy protons base skull chordomas and chondrosa results
HADRONTHERAPY: PROTONS BASE SKULL CHORDOMAS AND CHONDROSA. RESULTS

CHORDOMASCHONDROSA.

CENTER 5 y. local control 5 y. local control

MGH 73 % 99 %

CPULL 59 % 75 %

CP Orsay 71 % 85 %


Hadrontherapy the tera project2
HADRONTHERAPYTHE TERA PROJECT

  • POTENTIAL INDICATIONS FOR PROTONTHERAPY

  • Category B :

  • Prevalently local evolution

  • - LowRadiosensitivity


Hadrontherapy the tera project3
HADRONTHERAPYTHE TERA PROJECT

  • POTENTIAL INDICATIONS FOR PROTONTHERAPY

  • Tumoursbelongingtocategory B :

  • Prostaticadenocarcinoma

  • Retroperitoneal sarcoma

  • Salivaryglandtumours

  • Uterinecervixcancer (IIB bulkyor IIIB)

  • Undiff. tumours of thethyroidgland


Hadrontherapy the tera project4
HADRONTHERAPYTHE TERA PROJECT

  • POTENTIAL INDICATIONS FOR PROTONTHERAPY

  • Category C :

  • Protons as “boost” in a restrictedvolume

  • -Irradiationvolumewith a large safety margin

  • - Selectionbasedontheinitial response tophotonirradiation


Hadrontherapy the tera project5
HADRONTHERAPYTHE TERA PROJECT

  • POTENTIAL INDICATIONS FOR PROTONTHERAPY

  • Tumoursbelongingtocategory C :

  • Head and neckcancer

  • Low grade glioma

  • Malignantthymoma

  • Biliarytracttumours

  • Somelungtumours (NSCLC)

  • Oesophagustumours

  • Somepediatrictumours (CNS, sarcoma)


Hadrontherapy the tera project6
HADRONTHERAPYTHE TERA PROJECT

  • POTENTIAL INDICATIONS FOR PROTONTHERAPY

  • Category D :

  • Tu. withlocallyadvancedconditions and unfavourable prognosis

  • -Expectingsurvivalwith heavy symptomatology

  • - Paliationwithphotonsoftenunsatisfactory


Hadrontherapy the tera project7
HADRONTHERAPYTHE TERA PROJECT

  • POTENTIAL INDICATIONS FOR PROTONTHERAPY

  • Tumorsbelongingtocategory D :

  • Pancreascancer

  • High grade glioma

  • Paraaorticmetastaticadenopathies

  • Pelvicrecurrences in previouslytreatedareas

  • Rhinopharingealrecurrences in previouslyirradiatedareas

  • isolatedbrainmetastasis


Hadrontherapy protons patients calculation
HADRONTHERAPY: PROTONS PATIENTS CALCULATION

  • According to an Italian epidemiological study (reduction to ¾ = 45/60).

  • Patients with elective indications for protontherapy (cat.A)

  • TUMOR TYPES: RT pat/y %prot Pat prot/y

  • Uveal melanoma . 232 100% 232

  • -Chordomas 35 100% 35

  • -Chondrosarcomas (head,trunk) 68 100% 68

  • -Meningiomas base of the skull 188 50% 94

  • Naso-etmoidal/paranasal tumors 105 100% 105

  • CNS Schwanoma 225 15% 34

  • Hypophysis adenoma 562 10% 56

  • Pediatric solid tumors 727 15% 109

  • TOTAL 2.142 34% 733

Krengly and Orecchia. Radiother Oncol, 73, S21-23 (2004)-modif-


Rt protons patientscalculation
RT-PROTONS: PATIENTSCALCULATION

  • AccordingtoanItalianepidemiologicalstudy (reductionto ¾ = 45/60).

  • Patientstobeincluded in clinicaltrials (cat B)

  • TUMOR TYPES: RT pat/y %Prot Pat prot/y

  • -Brain gliomas 1.950 20% 390

  • -Prostate carcinoma 16.750 25% 4.188

  • -Pancreatic carcinoma 6.788 20% 1.357

  • -NSCLC 23.250 5% 1.162

  • -Biliarytracttumors 3.225 10% 322

  • -Bladder carcinoma 12.713 10% 1.271

  • -Head and Necktumors 5.085 15% 763

  • -Brain gliomas 1.950 20% 390

  • -Esophageal carcinoma 2.130 5% 106

  • Undiff. thyroidcancer 75 50% 37

  • Uterinecervixcancer 2.243 20% 448

  • Hepaticcancer 10.005 10% 1.000

  • -Pelvicrecurrence >375 50% >190

  • TOTAL >86.539 13% >11.624


Hadrontherapy c ions patients calculation
HADRONTHERAPY: C-IONS PATIENTS CALCULATION

  • According to an Italian epidemiological study (reduction to ¾ = 45/60).

  • Patients elegible for C-ions therapy

  • TUMOR TYPES: RT pat/y %prot Pat prot/y

  • Salivary glands tumours 465 50% 232

  • -ENT mucosal melanoma 23 100% 23

  • -Bone sarcoma 390 10% 39

  • Soft tissue sarcoma 1.020 10% 102

  • NSC Lung cancer 23.250 5% 1.162

  • Hepatocelular carcinoma 3.750 10% 37

  • Prostata carcinoma 16.748 5% 837

  • TOTAL 45.646 5,5% 2.432

Krengly and Orecchia. Radiother Oncol, 73, S21-23 (2004)-modif-


Hadrontherapy patientscalculation
HADRONTHERAPY: PATIENTSCALCULATION

POTENTIAL RECRUITMENT FOR HADRONTHERAPY

IN FRANCE

“ One-daysurvey” in 5 radiationtherapydepartments:

InstitutionsNr pat./dayNrpot. H-indications/dayAnnualrecruit.

Besançon 115 13 130

Lyon Bérard 152 13 130

Pierre Benite 100 26 260

Dijon 83 11 110

Grenoble 82 14 140

Total 532 77 (14,5%) 770

RT treatments/year: 160.000

Potentialindicationsforhadrontherapy: 23.000

Baron et al. Radiother Oncol, 73, S 15-17 (2004)-modif-


Hadronontherapy patients calculation
HADRONONTHERAPY: PATIENTS CALCULATION

POTENTIAL RECRUITMENT FOR HADRONTHERAPY

IN AUSTRIA

“Nationwidesurvey” in 12 austrianradiationtherapydepartments.

Accordingtothecriteriafrom 5 EuropeanUniversityHospitalsinvolved in hadronprojects (Heidelberg, Milan, Lyon, Vienna and Innsbruck)

Inhabitants Austria: 8.000.000

New cancerpatients/year: 36.500

RT-treatments/year: 15.141

Potentialindicationsforhadrontherapy/year: 2.044 (13,5% RT)

Mayer et al. Radiother Oncol, 73, S 24-28 (2004)-modif-


Hadronontherapy patients calculation1
HADRONONTHERAPY: PATIENTS CALCULATION

CONCLUSIONS ACCORDING EXPERTGROUP FROM

ITALY, GERMANY, FRANCE AND AUSTRIA (% RTpatients

who need HT):

Main indications for protons 1%

Indications for protons which require clinical trials 12%

Indications for C-ions which require clinical trials 3%

Amaldi and Kraft. Rep Prog Phis, 10, 478-85 (2005)


Hadrontherapy patients calculation
HADRONTHERAPY: PATIENTS CALCULATION

Cancer incidence rate in Spain 385

Annual cancer incidence in Spain 173.250

Nr of cancer patients elegible for RT in Spain (50%) 86.625

Nr of cancer patients undergoing RT in Spain (43%) 74.500

Nr of RT patients elegible for PT in Spain (13%) 9.750

Nr of RT patients elegible for C-ions in Spain (3%) 2.250


Hadrontherapy patients calculation1
HADRONTHERAPY: PATIENTS CALCULATION

Averagetime per fraction: 20’ (3 fr/h)

Double shift : 2x7h: 14h/day

Nr of patients/day for PTU: 42 fr/day

5 days/week: 250 treatment days/year

Output for PTU: 10.500 fr/year


Hadrontherapy patients calculation2
HADRONTHERAPY: PATIENTS CALCULATION

Average Nr fractions/patient (for protons): 12·

Average Nr fractions/patient (for C-ions): 8·

Nr patients/year treated /PTU (for protons) 875

Nr patients/year treated /PTU (for C-ions) 1.300

Nr PTU needed in Spain 11-12

Nr C-ionsTU needed in Spain 2

·Krengly and Orecchia. Radiother Oncol, 73, S21-23 (2004)


Hadrontherapy protons some conclusions
HADRONTHERAPY: PROTONSSOME CONCLUSIONS

  • Advantages due mainly to excellent dose distribution.

  • -Main indications in recognized tumor types and locations (> 10%).

  • -Need to have at least one protonterapy center in Spain: Valencia

  • -Need to perform fase II y III trials comparing protons with photons.

  • -Further increase of protontherapy facilities to cover the spanish needs.


THANK YOU FOR YOUR ATENTION

Delaney courtesy


ad