Adam, Protontherapy Today

Protontherapy

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 (see left)

• Since protons are charged particles, a proton "pencil" beam can be precisely guided towards any part of the tumour.

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 chord 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

Click to open big size image 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.