Transcript PAMELA

BASROC/CONFORM
OPEN DAY 2009
At STFC Cockroft Institute Daresbury
2.
Bleddyn Jones
University of Oxford
1. Gray Institute for Radiation Oncology & Biology
21 Century School Particle Therapy Cancer Research
Institute, Oxford Physics.
CANCER…..the threat to humanity



40% risk during lifetime…might even increase
with global warming (thermodynamics)
Surgery, Radiotherapy, Chemotherapy can all be
risky and permanently injurious……..no cause
for complacency.
R/T 12% of NHS cancer budget; its provision
regarded as inadequate internationally
Which form of technology would you like used to
treat your cancer?
Development of Cancer Radiotherapy



Most current radiotherapy
uses High energy X-ray
beams from linear
accelerators or ‘linacs’
These X-ray beams pass
through entire thickness
of body
Versatile: 3600 rotations, +
imaging capabilities
Modern Linac
Pristine
Bragg
Peaks of
Selected
Energies at
FHBPTC
Courtesy of
H. Kooy, Ph.D.
Carbon Ion Beam Profile
Bragg
peak
RBE 5-7
Plateau
RBE 1.1
 20-30
times effect in
peak c.f.
plateau
Peak is spread /
scanned &
diluted, so RBE
is intermediate
and varies with
position in a
patient.
X-Rays or
Protons/Ions
80
60
150
40
50
0
150
0
Orbital Rhabdomyosarcoma
X-Rays
Protons
Courtesy T. Yock, N. Tarbell, J. Adams
International Scene






Japan: formed National Institute of Radiation
Sciences 1957.
1986 Decision to have C ion therapy
Commenced 1996
Japan Government Science Policy Review 20062010 noted favourable results and need for
science to contribute directly to health of
population.
Emphasis on cancers that are difficult to treat
and for a kinder form of radiotherapy
Japan will soon have 10 facilities, all protons + 3
C ions. Tariff of ~ $ 30,000 per course allowed.
Countries who used national Physics
labs/projects to start Particle Therapy






Germany ……GSI….. Heidelberg University
Hospital Synchrotron built close to German
Cancer Research Institute
France…Orsay University Protons; GANIL
(Caen) will host new IBA 400 MeV C cyclotron
Switzerland: large expansion at PSI (Villigen);
development of spot scanning techniques.
Austria…..will use novel CERN cyclolinac
system
Italy ….Pavia, synchrotron system
Stanford/USA ..plans for new high tech
accelerator for C ions; twenty proton centres
planned in USA.
We chose the wrong particle ….the neutron
Physical Dose
Neutrons
would not
be chosen
today,
we need
the Bragg
Peaks
Kidney Cancer : Stage I, TIa N0 M0
National Institute of Radiological Sciences,
Chiba, Japan carbon ions, 80GyE / 16fr.
/4wks
治療前
Can
radical
surgery be
avoided?
1 year
3 years
4 years
Better cancer screening
might create extra need to
use physics solutions
5 years
Cancer of the oesophagus treated to 72 Gy hardly any lung exposure in Japan:
British
plan 54 Gy only
Protons
two beams
British X-rays
three beams
Medulloblastoma in a child
X-rays
100
60
Proton particles
10
The only working model in UK (funded by NHS doctor
working during his holiday)
High LET optimum dose per fraction using
calculus method
Even for protons,
treatments might
be accelerated;
Germany 19#
Japan 16, 10, 4,
1#
Cost Model for
Radiotherapy
Following from Jones & Dale
Inputs:
Int J Radiat Oncol Biol &
Physics 1998
Cell sensitivity:
(dose + dose
squared)
Cell number
Proliferation rate
DNA Repair
Dose to N Tissue
[z]
Dose to tumour [d]
d=g z
g is degree of
sparing
Cost of achieving
low g (reciprocal)
Cost per fraction
Cost of failure to
cure
Cost of toxicity
Fixed costs
Poisson statistics
Japanese Progress in Fractionation






1 treatment only for small lung cancer
4 treatments for prostate cancer
Most treatments in 12 -16 treatments over 4
weeks
Cost applied regardless of fractionation
Germany 19 fractions in 19 days at GSI
Protons in USA 4-8 (eye); to 38 fractions
prostate/skull base.
Expected and achievable benefits





Reduce fear of cancer treatment,
improved patient experience
Dose increase to cancer : 1% increase in
cancer control per unit increase in dose
…..i.e. 15 Gy extra 15% extra control
Dose reduction to organs e.g. lung, brain,
eye, spine, bowel, bone: leading to
reduced or absence of many side effects
Chemotherapy better tolerated
Better quality of life, ability to contribute
to society etc.
UK Position



Member of PARTNER, ULICE & ENVISION
EU FP7 grants……totalling ~24 M Euro
Occupying a peripheral role…data collection,
instrumentation, leadership skills, modelling.
PAMELA – could transform our position to be
leader in terms of new technology, clinical
efficiency, clinical policies/research, and
opportunity for comprehensive radiobiology
programme under our own guidance.
EMMA
RingWE4PBI01
See Smith:
PAMELA
Particle Accelerator for
MEdicaL Applications



Clinical Requirements
PAMELA – status
Summary
Electrons – at
relativistic velocities
approaching speed of
light
Protons, helium to
carbon range of ions
– at non-relativistic
velocities
Main Clinical Requirements
Treatment
Plan
should be
determined
by
clinical
need
not
limited
by
Accelerator
Technology
Injector systems
Gantry/delivery
systems
Double-helix coil - smart way of creating
a cosine-theta magnet
RF
System
Choices
cyclotron
Proton Therapy
1 ring
NSFFAG
OR
Ring 1
NSFFAG
Carbon Therapy
Proton Therapy
1ring
ring2
NSFFAG
Carbon Therapy
Next steps
1.
2.
3.
4.
5.
Complete the proton ring design
Develop the carbon ring
Develop beam transport & gantry
Seek component prototype funding
• Main ring magnets,
RF, Kickers,
Carbon RFQ
Seek machine funding
• UK Demonstrator for CPT
Primary Liver cancer


Primary liver
cancer treated by
carbon ions
5 year follow up in
cured patient
malignant melanoma
15 months
after RT
Some PAMELA work on
radiobiology of




Dose rate (and so dose duration)
Ion species
Throughput
Dose painting …new features
N
C
+
Gantries



Heidelberg has huge 300+ ton
gantry…… First in world
French seeking to use cryogenic s/c
magnet to halve the weight
CONFORM system magnets within
gantries offers best long term
solution to gantry manufacture at
lower tonnage, footprint and cost
21 Century School
Particle Therapy Cancer Research Institute, Oxford
Since January 2009 our aims are to promote:



Education (Public, Professions and Policy
Makers)
Research [Physics, Biology and Medicine]
Investment [NHS, Research Councils, Cancer
Charities and Public]
Advanced Technology Ion Treatment Facility in
UK and elsewhere - including third world with
cost optimisation.