Clinical benefits: fixed beam line vs gantry? PD Dr. Alexandra Jensen, MSc mingham-Why-send-tourists-there.html.

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Presentation transcript:

Clinical benefits: fixed beam line vs gantry? PD Dr. Alexandra Jensen, MSc mingham-Why-send-tourists-there.html

Particle Therapy - Rationale according to Hermann Holthusen, 1933

Particle Therapy: SOBP b90b c/mriProton1.jpg.aspx

Particle Treatment Delivery Systems

Passive scattering: Range modulation berlin.de/media/media/angebote/pt/strahlentherapie/infos/modulatorrad_freig estellt.jpg

Urie et al, PMB 1984 Passive Beam Shaping m?c=186&id=438

inhomogeneity compensation field collimation  range modulators (slide: Prof. O Jäkel) Passive Beam Shaping

Dose conformation only at distal end High dose region SOBP has a fixed extension Only measured depth doses needed No detailled biological modelling needed (slide: Prof. O Jäkel) Passive Beam Shaping

Active scanning techniques (Dept of Radiation Oncology, Heidelberg)

Intensity-controlled raster- scanning (Dept of Radiation Oncology, Heidelberg)

Intensity-controlled raster- scanning

Particle Therapy: fixed beam vs gantry beam application – passive beam application – active beam application spot scanning raster scanning IMPT fixed beam line – horizontal – oblique

Cozzi et al, Strahlenther Onkol Gy 54 Gy 50 Gy passive scatter spot scanningpassive scatter

Cozzi et al, Strahlenther Onkol 2006

Particle Therapy: fixed beam vs gantry scanning techniques vs passive beam application: – higher plan conformality – even in presence of gantry Cozzi et al, Strahlenther Onkol 2006

Jäkel et al, PMB 2000 Particle Therapy: fixed beam vs gantry Gantry at 65° and 300°horizontal beam line

Jäkel et al, PMB 2000 Particle Therapy: fixed beam vs gantry raster-scanning technique no IMPT improved conformality improved sparing of critical structures fixed oblique beam as lower cost alternative?

Kosaki et al, Radiat Oncol 2012 Particle Therapy: fixed beam vs gantry IMRTprotons, fixed beamprotons, gatry IMPT

Cao et al, Cancers 2015 IMPT, 2 horizontal beams Particle Therapy: fixed beam vs gantry IMPT, 3 beams, gantry

Cao et al, Cancers 2015 Particle Therapy: fixed beam vs gantry

Suzuki et al, Med Phys 2011 Particle Therapy: fixed beam vs gantry

Suzuki et al, Med Phys 2011 Particle Therapy: fixed beam vs gantry

N=4332 cases feasibility of gantry-less treatment? Yan et al, IJROBP 2015 FixedBend: +/- 20° Move: >+/-20° passive scattering head&neck44%70%100% torso99%100% scanning99%100%

Miralbell et al, IJROBP D photonsIMRT photonsprotons Particle Therapy: fixed beam vs gantry

Dr. Nikoghosyan/ Dept Radiation Oncology Heidelberg

Uhl et al, Cancer J 2014 Particle Therapy: fixed beam vs gantry

SiteCountryStartParticleGantry Fixed horizontalOblique MoscowRussia1969p1 St PetersburgRussia1975p1 ClatterbridgeUK1989p1 Loma LindaUS1990p31 NiceFrance1991p1 OrsayFrance1991p11 iThembaSouth Africa1993p1 San FranciscoUS1994p1 VancouverCanada1995p1 BerlinGermany1998p1 DubnaRussia1999p1 HIBMCJapan2001p/C111 CataniaItaly2002p1 ShizupkaJapan2003p31 WanjieChina2004p21 WanzonChina2006C1 JacksonvilleUS2006p31 IlsanSouth Korea2007p21 OklahomaUS2009p111 GunmaJapan2010C31 ChicagoUS2010p112 HamptonUS2010p41 KrakowPoland2011p1 St LouisUS2013p1 YokohamaJapan2015C41 Jacksonville/ Ackermann CentreUS2015p1

SiteCountryStartParticleScanningGantry Fixed horizontalOblique PSISwitzerland1984ps21 ChibaJapan1994Cs11 KashiwaJapan1998ps2 TsukubaJapan2001ps2 BostonUS2001ps21 BloomingtonUS2004ps21 HoustonUS2006ps31 KoriyamaJapan2008ps21 MunichGermany2009ps41 HeidelbergGermany2009p/Cs12 PhaldelphiaUS2010ps41 IbusukiJapan2011ps3 FukuiJapan2011ps21 PaviaItaly2011p/Cs31 PragueCzech Republik2012ps31 New JerseyUS2012ps4 EssenGermany2013ps41 NagoyaJapan2013ps21 SeattleUS2013ps4 ShanghaiChina2014p/Cs3 DresdenGermany2014ps1 TrentoItaly2014ps21 KnoxvilleUS2014ps3 San DiegoUS2014ps32 ShewportUS2014ps1 MarburgGermany2015p/Cs31 UppsalaSweden2015ps21 TaipeiTaiwan2015ps41 IrvingUS2015ps21 MemphisUS2015ps21

Particle Therapy: fixed beam vs gantry dosimetric advantages of scanning techniques theoretical advantages of gantry arrangements gantry-less treatment reproducible with – positioning strategies in majority of cases (cave: robustness, positioning accuracy) – fixed oblique beam in the absence of clinical data...

Particle Therapy: fixed beam vs gantry ?

Thank you! herbst.de/cms/h/heidelberg/schoene-orte-a-z/heidelberg/dei- alte-bruecke-im-nebel-31.html mittelalterlichen-Bern-geniessen.html