R. Santoni. Particle beams in Radiation Therapy: a new treatment modality. Università di Tor Vergata, Roma (Università di Firenze)

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1 R. Santoni Particle beams in Radiation Therapy: a new treatment modality. Università di Tor Vergata, Roma (Università di Firenze)

2 New irradiation modalities Particle beams: Protons, Ions IMRT Intensity modulated Radiation Therapy Modifiers of the response Altered fractionation Radiation and concomitant chemotherapy

5 Base of the skull tumor Proton beam treatment Almost no dose beyond the target Volume Conformation to complex target

6 CLINICAL EVALUATION OF PROTONS. CURRENTLY ACTIVE PROTOCOLS. SKULL BASE SARCOMAS. Favorable prognostic factors: random 66 Gy 72 Gy Unfavorable prognostic factors: random 72 Gy 79 Gy

7 CLINICAL EVALUATION OF PROTONS. CLINICAL ACCOMPLISHMENTS. SARCOMA OF THE SKULL BASE - CERVICAL SPINE. 254 pts 209 Skull base 45 Cervical spine PROTON TREATMENT. 5 year actuarial local control Chondrosarcoma 94% Chordoma 63% CONVENTIONAL TREATMENT. 3 year local control rate Chordoma + Chondrosarcoma ~35%

8 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.

9 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 % Meningioma % Paraspinal T % Acoustic N % Chordomas % Chondros % Optic Glioma % Pituitary Ad % AVMs %

10 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 % Rectal ca % Salivary gl % Cervix ca % Retroperitoneum % Pelvic rec %

11 Newer irradiation modalities Patients per year treatable with Protons in Italy - III Category C boost on a restricted volume Patients Treatable with Protons Expected/y. Number/year % Head&Neck % Biliary tract % Oesophagus % NSCLC % Thymomas %

12 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 %

13 New irradiation modalities: Intensity-modulated radiation therapy or Particle Beams?

14 Spreading passivo

15 Scanning system

The figure on the right shows the activity distribution measured during irradiation.

16 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. 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).

17 Per il futuro? Fasci monocromatici di alta energia e con energia modulabile? Yes! Fasci di particelle? Agevole gestione delle immagini? Yes! Yes! Sistemi di controllo e Robotizzazione? Yes Yes Yes! Nuove applicazioni software Yes Yes Yes!

18 CENTRAL PROTON PROGETTO PROTONI CENTRO ITALIA Ipotesi di consorzio interistituzionale e ipotesi di organi di gestione PROSPETTO DEGLI ORGANI DI GESTIONE DEL PROGETTO E DEL CENTRO 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 C onsiglio di Amministrazione C onsiglio di Amministrazione Pr esidente del Consorzio Pr esidente del Consorzio Responsabile del Progetto Direttor e del Centro Segretar io Amministrativo Segretar io Amministrativo Consiglio Scientifico Consiglio Scientifico Revisori dei Conti Revisori dei Conti Staff di Pr ogetto Dotazione organica del Centro

19 Looking forward to new results and improvements This is the starting point and where we are now

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