24 September 2008 ENLIGHT, ESF Workshop-Oxford European Network for Light Ion Therapy ENLIGHT Manjit Dosanjh ENLIGHT Coordinator & CERN

24 September 2008 ENLIGHT, ESF Workshop-Oxford Hadron therapy history … Today 51,000 patients (44,000 protons, 2900 carbon ions). …in ,000 patients since the beginning (18,300 protons) 1954Berkeley First patient

24 September 2008 ENLIGHT, ESF Workshop-Oxford Numbers of potential patients From studies in Austria, France, Germany and Italy X-ray therapy every 10 million inhabitants 20,000 pts/year Proton therapy 12% of X-ray patients 2,400 pts/year Therapy with Carbon ions for radio-resistant tumour 3% of X-ray patients 600 pts/year TOTAL for hadron therapy for 10 M 3,000 pts/year

24 September 2008 ENLIGHT, ESF Workshop-Oxford PIMMS at CERN in CERN–TERA–MedAustron Collaboration for optimized medical synchrotron CERN–TERA–MedAustron Collaboration for optimized medical synchrotron and protons linacs for carbon ions p p C C p RF cavity Resonance sextupole Betatron core Injection septum Electrostatic septum Extraction septum Sextupole horiz. chromaticity Sextupole vert. chromaticity Sextupole vert. chromaticity Sextupole horiz. chromaticity Circumference C = m Tune horizontal Q x = 1.67 Tune vertical Q z = MeV/u synchrotron 16 Bending Magnets 3 extraction systems: betatron core 1/3 resonance RF knock-out

24 September 2008 ENLIGHT, ESF Workshop-Oxford Why collaborate? Hadrontherapy to improve cancer treatment & outcome Very complex in all aspects of undertaking, therefore –Create common multidisciplinary platform –Share knowledge –Share best practices –Harmonise data –Provide training, education –Identify challenges –  innovate

24 September 2008 ENLIGHT, ESF Workshop-Oxford ENLIGHT challenges A heterogeneous group - different disciplines plus networking How to balance between basic research and the clinical needs? Many partners. How to give space to each and make progress with the main objectives? How to strike a balance between agenda of the single centres and the common ENLIGHT goals? Can we show ion therapy is more effective? Will practice validate the theory?

24 September 2008 ENLIGHT, ESF Workshop-Oxford ENLIGHT++ ingredients Clinical Studies Radiobiology Treatment planning for Intensity Modulated Particle Therapy Adaptive ion therapy and treating of moving organs Novel in-beam PET systems Feasibility study for innovative gantry designs Information and Communication Technologies for Hadron therapy –………..Future acclerator designs?? + networking

24 September 2008 ENLIGHT, ESF Workshop-Oxford What happened? ENLIGHT was established in 2002 ENLIGHT was composed of: Centres in Heidelberg, Lyon, and Pavia, CERN, EORTC, ESTRO, GSI, Karolinska, MedAustron, TERA, Czech Rep, Spain Main achievements: Creation of a European Hadrontherapy Community Common multidisciplinary platform with a shared vision Catalysed the transition from research to the clinical environment, 5 centres approved in Europe Served as a vehicle for education and dissemination

24 September 2008 ENLIGHT, ESF Workshop-Oxford European situation in 2008 The first two dual Carbon/proton centres in Heidelberg and Pavia are foreseen to start operation in 2008/9…..The first two dual Carbon/proton centres in Heidelberg and Pavia are foreseen to start operation in 2008/9….. Approved: Marburg (Germany), Etoile (France), MedAustron (Austria) and ARCHADE (France)Approved: Marburg (Germany), Etoile (France), MedAustron (Austria) and ARCHADE (France) Sweden, Belgium, Netherlands, Spain, UK ………Sweden, Belgium, Netherlands, Spain, UK ……… Clear desire for continuing the network focusing on new and on un- completed research topics and helping new initiatives….

24 September 2008 ENLIGHT, ESF Workshop-Oxford From ENLIGHT… to ENLIGHT++ In 2006 ENLIGHT++: + one “plus” for more hadrons (specifically protons), ++ the second “plus” refers to more Countries (17 countries, with >60 Institutions) ENLIGHT++ goes beyond being a network: Main Objective: Being more INCLUSIVE and becoming a RESEARCH network

24 September 2008 ENLIGHT, ESF Workshop-Oxford ENLIGHT 2008 European Commission funding project (Framework programme 7) Training 25 young researchers million euro project Research in optimizing 8.5 million euro project

25 researcher positions 21 PhDs and 4 Post-doc Positions posted: Will start 1st October 2008 PARTNER

Infrastructure project (8.5M Euros) 3 Pillars:Transnational access, Research and Networking Start at the beginning of 2009 ULICE

24 September 2008 ENLIGHT, ESF Workshop-Oxford Manjit Dosanjh HEALTH : Novel imaging systems for in vivo monitoring and quality control during tumour ion beam therapy. Single stage application. Collaborative project (small or medium-scale focused research project) The focus should be to develop novel imaging instruments, methods and tools for monitoring, in vivo and preferably in real time, the 3-dimensional distribution of the radiation dose effectively delivered within the patient during ion beam therapy of cancer. The ions should be protons or heavier ions. The system should typically be able to quantify the radiation dose delivered, to determine the agreement between the planned target volume and the actually irradiated volume, and for decreasing localisation uncertainties between planned and effective positions (e.g. of tissues or organs), and between planned and effective dose distribution during irradiation. It should aim at improving quality assurance, increasing target site (tumour) to normal tissue dose ratio and better sparing normal tissue.

24 September 2008 ENLIGHT, ESF Workshop-Oxford In-beam PET allows for a control of tumour irradiations by means of ion beams an in-vivo measurement of the ion range the validation of the physical model of the treatment planning the evaluation of the whole physical process of the treatment from planning to the dose application deviations between planned and actually applied dose distributions 1. What do we have? In-beam PET Advantages

24 September 2008 ENLIGHT, ESF Workshop-Oxford PET is not applicable to - real time monitoring: ▪ too slow ▪ T 1/2 ( 15 O) = 2 min, T 1/2 ( 11 C) = 20 min ▪ dose specific activity: ~ Bq cm -3 Gy -1 - quantitative imaging, precise dose quantification, feedback to treatment planning and to IGRT ▪ limited angle artefacts ▪ degradation of activity distributions by the metabolism ▪ degradation of activity distributions by moving organs ▪ inaccurate prediction of activity distributions from treatment planning due to unknown nuclear reaction cross sections 2. What do we have? In-beam PET Disadvantages and open problems

24 September 2008 ENLIGHT, ESF Workshop-Oxford 3. What do we need? Aim of this FP7-project - Development and proof of principle new solutions for ▪ non-invasive, real-time, in-vivo monitoring ▪ quantitative imaging ▪ precise dose quantification ▪ feedback to treatment planning ▪ real-time feedback to IGRT for moving organs - Preserve the leading European position in the field

24 September 2008 ENLIGHT, ESF Workshop-Oxford ENLIGHT Meeting Novel Imaging Systems WP1: Time-of-flight in-beam PET (F. Sauli, M. Rafecas) WP2: In-beam single particle tomography (W. Enghardt, D. Dauvergne) WP3: PT in-vivo dosimetry and moving target volumes (K. Parodi, G. Baroni) WP4: The combination of in-vivo dosimetry, treatment planning, and clinical relevance (D. Georg, B. Jones) WP5: Monte Carlo Simulation of in-vivo dosimetry (I. Buvat?, G. Battistoni)

24 September 2008 ENLIGHT, ESF Workshop-Oxford ENLIGHT Meeting Novel Imaging Systems WP1: Time-of-flight in-beam PET (TERA, INFN, IFIC/CSIC, IN2P3, OncoRay, CERN, PoliAnnecy, Oxford) WP2: In-beam single particle tomography (TERA, IBA, ICX, IFIC/CSIC, In2P3,Etoile,OncoRay) WP3: PT in-vivo dosimetry and moving target volumes (GSI, HIT, Oncoray, PoliMilano, Oxford, IBA, Etoile, IFIC/CSIC, INFN,TERA, Siemens?, Marburg?) WP4: The combination of in-vivo dosimetry, treatment planning, and clinical relevance (BHTC, MUVienna, Oxford, INFN, Siemens, Etoile, Marburg) WP5: Monte Carlo Simulation of in-vivo dosimetry (CERN, INFN, Ciemat, IFIC, PoliAnnecy, HIT, OncoRay, IN2P3, Etoile, IBA)

24 September 2008 ENLIGHT, ESF Workshop-Oxford Manjit Dosanjh TERA INFN IFIC/CSIC IN2P3 OncoRay CERN PoliAnnecy Oxford IBA ICX Etoile GSI HIT PoliMilano Siemens Marburg BHTC MUVienna Ciemat TERA/CNAO/PoliMilano/UBern INFN IFIC-CSIC/Ciemat IN2P3/CEA? OncoRay CERN Oxford IBA ICX Etoile/ PoliAnnecy/Archade? GSI HIT/Marburg Siemens BHTC MUVienna FIRST LISTSECOND LIST

24 September 2008 ENLIGHT, ESF Workshop-Oxford Conclusions ENLIGHT++ continues to catalyse Common interdisciplinary environment Creation of maximum possible uniformity Inter-facilities uniformity and comparison Ease of exchange of information. Harmonization of data…………..

24 September 2008 ENLIGHT, ESF Workshop-Oxford Outlook Particle therapy will cover the full spectrum of radiotherapeutical indications One particle therapy facility for 10 million inhabitants Treatments will be fully accepted by the health insurance systems