Proton Therapy

Hadrontherapy is a state-of-the-art medical cancer treatment providing methods for curing or controlling tumours using an external hadrons beam radiation facility.

What are HADRONS?

Hadrons are positively charged, high energy, subatomic particles that are precisely focused on cancerous tissue after being boosted in a medical-physics accelerator system: indirect ionizations break up the DNA chain of the target cancer cells, preventing the cell replication, reducing its dimensions and eliminating them, as detected in the majority of the observed clinical cases, the carcinoma itself.

Protontherapy and advantages for patients

Protontherapy falls within the medical discipline of Hadrontherapy and uses protons with an energy range between 60 to 250 MeV so that deep-seated tumours at up to 30 cm depth can be treated.

The chief advantage of protontherapy is the ability to more precisely localize the radiation dosage when compared with other types of external beam radiotherapy.

  • Since protons are heavy particles, they penetrate with minimal diffusion and they slow down relatively fast when entering biological tissue. Most of their energy is deposited, with little scatter, at the end of their path in the so called a Bragg peak region.
  • Since protons are charged particles, a proton "pencil" beam can be precisely guided towards any part of the tumour.

Bragg Peak

 

Conformal radiation therapy is in use to target the tumour as accurately as possible with the highest possible dose of radiation, minimizing the effect on healthy tissues.

Tissue selectivity is important when the tumour mass is seated close to vital organs that must not be irradiated by the beam. Ocular neoplasia, Head-And-Neck cancers and spinal cord tumours are eligible for protontherapy; this oncological treatment is well-established and gives significant advantages to patients affected by neoplasia to prostate, lungs and the gastro enteric tract.

 

 

 

Cancer Incidence Worldwide

According to GLOBOCAN 2008 Project, promoted by the International Agency for Research on Cancer (IARC), an estimated 12.7 million new cancer cases and 7.6 million cancer deaths occurred in 2008 worldwide (with 2.2 million new cancer cases in Europe).

Furthermore, the GLOBOCAN 2008 Project estimates that by 2030 there will be almost 21.4 million new cases diagnosed annually with over 13.2 million deaths occurring annually from cancer. (GLOBOCAN Cancer Research UK)

According to a detailed report supervised by Prof. R. Orecchia and distributed by Italian Association on Radiotherapy (AIRO), an estimated 2% of cancer patients are eligible for proton beam therapy and for an estimated 12% the potential therapeutic benefit is so great as to also justify the use of proton therapy, instead of conventional radiotherapy. [AIRO]

Proton Therapy Facilities in Operation

Today, worldwide, some proton therapy medical centres are already in operation. They are cyclotron-based or synchrotron-based facilities where protons are accelerated up to 70 MeV for ocular treatments; up to 150 MeV for head-neck tumours or for paediatric oncological treatment; over 150 MeV for deep-seated tumours.

All main proton therapy facilities in operation are listed below (PTCOG):


PT
Centers

Country

Max.
Clinical Energy

Beam
Delivery

Layout

Date

No.
of Treated Patients

Date
of TOT

LLUMC

Loma
Linda, CA., USA

250

3G;
1H

Synchrotron

1990

14000

Oct-09

PSI

Villigen,
CH

72

1H

Cyclotron

1984

5300

Dec-09

CPO

Orsay,
F

200

2H

Synchrocyclotron

1991

4811

Dec-09

NPTC

Boston,
MA, USA

235

2G;
1H

Cyclotron

2001

4270

oct-09

ITEP

Moscow,
RUS

250

1H

Synchrotron

1969

4162

Juil-09

CAL

Nice,
F

65

1H

Cyclotron

1991

3935

Dec-09

HIBMC

Hyogo,
Japan

230

2G;
1H

Synchrotron

2001

2382

Nov-09

CCO

Clatterbridge,
UK

62

1H

Cyclotron

1989

1923

Dec-09

FPTI

Jacksonville,
FL, USA

230

3G;
1H

Cyclotron

2006

1847

Dec-09

MD
ACC

Houston,
TX, USA

250

3G;
1H

Cyclotron

2006

1700

Dec-09

PMRC,
2

Tsukuba,
Japan

270

2G

Synchrotron

2001

1586

Dec-09

HZB
(HMI)

Berlin,
D

72

1H

Cyclotron

1998

1437

Dec-09

PNPI

St.
Petersburg, RUS

1000

1H

Synchrocyclotron

1975

1353

Dec-09

UCSF-CNL

CA,
USA

60

1H

Cyclotron

1994

1200

Dec-09

WPTC

Zibo,
China

230

2G;
1H

Cyclotron

2004

977

Dec-09

TSL
Svedberg

Uppsala,
S

200

1H

Cyclotron

1989

929

Dec-08

MPRI,
2

Bloomington,
IN, USA

200

2G;
1H

Cyclotron

2004

890

Dec-09

Shizuoka
CC

Shizuoka,
Japan

230

1G;
1H

Cyclotron

2003

852

Dec-09

NCC

Kashiwa,
Japan

235

2G;
1H

Cyclotron

1998

680

Dec-09

JINR,
2

Dubna,
RUS

200

1H

Cyclotron

1999

595

Dec-09

PSI

Villigen,
CH

250

1G

SC
cyclotron

1996

542

Dec-09

NCC

Ilsan,
Korea

230

2G;
1H

Cyclotron

2007

519

Dec-09

iThemba
LABS

Cape
Town, South Africa

200

1H

Cyclotron

1993

511

Dec-09

INFN-LNS

Catania,
IT

60

1H

SC
Cyclotron

2002

174

Mars-09

TRIUMF

Vancouver,
Canada

72

1H

Cyclotron

1995

145

Dec-09

RPTC

Münich,
D

250

4G;
1H

SC
cyclotron

2009

78

Dec-09

WERC

Wakasa,
Japan

200

1H;
1V

Synchrotron

2002

56

Dec-08

ProcurePTC

Oklahoma
C. OK, USA

230

1G;
1H

Cyclotron

2009

21

Dec-09











TOT

56875


It is evident that a greater number of oncological therapy facilities are required in order to deal with this constant increase of cancer incidence worldwide.

Total costs for cyclotron-based or synchrotron-based cancer therapy facilities are very high: indeed, the first centres were built in, or close to, research centres where particle accelerators were already used for different physics and biomedical purposes. The people skills and expertise that is available in these centres being used to advance the development of medical accelerator technology.

Nowadays, new protontherapy centres using the so called patient-oriented methods, exist or are being built in proximity to hospitals and medical facilities, but costs still remain high.

ADAM’s technology innovations

For these reasons, in 2008 ADAM SA started their R&D activities in collaboration with CERN, Geneva to produce innovative and compact, high frequency, linear accelerators in order to reduce these costs, allowing more protontherapy centres to be accessible to as many hospitals as possible.

LIGHT. xxxxxxtableau 5(Linac for Image Guided Hadron Therapy) developed by ADAM SA brings together the physics and medical requirements to ensure correct treatment of cancer tissues with proton beams, and importantly, it also brings innovations in concept, design and manufacturing to reduce production costs.

The main characteristic features are:

Precision: the system has an active longitudinal modulation along the beam propagation axis (beam energy can be electronically varied during therapy and therefore the treatment depth), rather than using a passive modulation system (where the cyclotrons fixed initial energy is degraded through the interposition of variable thickness energy absorbers between the accelerator and the patient, causing a quality loss of the beam). Moreover, the LIGHT system has a dynamic transversal modulation that allows a precise 3D treatment of the tumours (spot scanning)

Compact: the linear accelerator LIGHT, in substitution of a cyclotron or synchrotron, has compact dimensions, therefore reducing size and costs of the building construction.

230 MeV Synchrotron + Injector

Linear Accelerator (LIGHT + Injector)

30-230MeV LIGHT accelerator

Modularity: the linear accelerator LIGHT is conceived as an assembly of modular units. This specific feature offers to radiation therapy centres complete freedom of customizing, steering medical choices on a wide range of treatment energies. Moreover, LIGHT enables small hospitals the initial choice of a 70 MeV accelerator for eyes, head and neck treatment, without precluding the possibility to extend it to higher energies by means of a simple installation of additional units, without dismantling then re-installing a completely new system (as is needed for cyclotrons and synchrotrons).

Easy maintenance: modularity and compactness, associated with straightforward design principles, allow fast and low cost maintenance during the short shut-down periods of the system, giving the possibility to achieve an overall system availability of >95% required by critical medical installations in hospitals.

User friendly: proton beam linear accelerators are similar in use to the conventional X-Ray linear accelerators currently used for cancer treatment. This similarity offers to doctors and medical technicians a familiar approach to using LIGHT.