Modified Screen Printed and Carbon Paste Ion Selective Electrodes
Carbon Ion Radiotherapy at NIRS -...
Transcript of Carbon Ion Radiotherapy at NIRS -...
Carbon Ion Radiotherapy at NIRS
Rationale, Technique, Results and Future…
Tadashi KAMADA, MD
Research Center for Charged Particle Therapy National Institute of Radiological Sciences
Chiba, JAPAN
ESTRO Teaching Course on Proton and Ions March 25-29
Uppsala, Sweden
Rationale Carbon ion beam has a definite range and the Bragg peak. In addition to this physical selectivity, ionization is enormous at the Bragg peak, while remains low at the plateau, showing biological advantages such as cell cycle independent effect.
Therefore, carbon beam could be a potentially curable armament for radio-resistant tumors with minimal normal tissue injury.
“Four Rs” in Radiobiology
From E. Hall : Radiobiology for the Radiologist
1920~1930s in Paris
Repair Redistribution Reoxygenation Repopulation
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5 Fractions 0
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Carbon 74 keV/ m m
Single fraction
5 Fractions
γ-ray Carbon
5 fractions
Ando et al. unpublished data at NIRS
Repair
Comparison of radiation cell survival levels in synchronized CHO cells irradiated with 4 Gy X-rays
and 2 Gy 70 keV/µm carbon ions.
Kato et al. unpublished data at NIRS
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Oxygen effect
γ-ray Carbon
hypoxic oxic
Ando et al. Int J Radiat Biol 1999
Beyond “4 Rs” with C-ion Beam Low repair Cell cycle non-specific Low OER(re-ox) Low repopulation
Advantages of Fractionation ?
Hypo-fractionation matches with high LET conformal C-ion beam
Experiments with carbon ions and fast neutrons demonstrated that increasing their fraction dose tended to lower the RBE for both the tumor and normal tissues, but the RBE for the tumor did not decrease as rapidly as the RBE for the normal tissues.
These results substantiate that the therapeutic ratio increases rather than decreases even though the fraction dose is increased.
Another Biological Background for Hypofractionated Radiotherapy with Carbon Ion beams
Koike S, et al: Radiat Prot Dos. 2002;99: 405-408. Ando et al. : J.Radiat.Res. 2005;46:51-57. Denekamp J: Int J Radiat Biol. 1997;71: 681-694,.
To prove efficacy and safety of C-ion RT
Carbon Ion Clinical Trials at NIRS
a) Establish safe and precise C- ion RT technique b) Conduct phase I study ⇒ phase II study 1. Achieve local control in radio-resistant tumor 2. Demonstrate hypo-fractionation in common cancer (and conduct comparative study, if necessary)
Based on “high physical selectivity” & “biological effectiveness”
Technical aspect of carbon ion radiotherapy at HIMAC
Tech or Procedure
Immobilization Beam delivery Targeting Treatment planning Respiration gating Patch field Spacer insertion
Fixed beam line Passive beam Hitting a moving target SOBP; Dose description
Key-words
Simulation and Rehearsals Treatment Planning
CT gantry PSD
LED
Obtain CT data (Respiratory-gated)
Immobilization Devices
CT+MRI
CT+PET
Treatment Planning for Head and Neck Tumor Using Fusion Images
ACC
After RT
Before RT
Dose distributions
Fabrication of Bolus and Collimator
Collimator is made of brass
Bolus is fabricated with NC machine
3-D alignment to check accuracy
Treatment in 2007(Pats;642) Bolus≒2,500 Collimator≒1000 *MLC was also used
Trea
tmen
t Pla
nnin
g
Key-Tech for C-ion RT at NIRS
End-expiratory irradiation
Respiration gating for irradiation
Reduction of volume Minohara et al. IJROBP 47:1097-1103, 2000
50%
90%
64GyE/16Fx/4weeks
Patch Field Technique for Ion Beam
CT image 8 years after (Alive NED at 10 years)
Spacer Insertion Liposarcoma of the retroperitoneum(p/o rec) 54F
Spacer
After Gore-Tex
Colon
Before
Retroperitoneal liposarcoma
Before After 6 months
70.4 GyE/16fx with spacer
Key Tech in C-ion RT at HIMAC
• Respiration gating: 3089 patients lung, liver, pancreas, kidney, sarcoma etc • Patch field : 294 patients Head & Neck, para-spinal etc. • Spacer insertion :150 patients pelvis and abdomen
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More than 3000 patients were treated with these techniques at NIRS.
The Image Intensifier was replaced by high resolution FPD
Treatment Room
Positioning with orthogonal projections
Horizontal Beam
Vertical Beam
I I FPD
Treatment Rooms
Room for Biological Experiments
Beam Lines for Physics Research
Ion Source Linear
Accelerators
Main Accelerator (Synchrotron)
HIMAC(Heavy Ion Medical Accelerator in Chiba)
• Ion : He ~ Ar Max energy: ~800Mev/n • Treatment room(3) Fixed vertical : room A Fixed horizontal : room C Fixed V & H : room B • The accelerated energy V. beam (290 or 350 MeV/u) H beam (290 or 400 MeV/u) • The range of C-ion beam in water 290-MeV/u : 15 cm 350-MeV/u : 20 cm 400-MeV/u : 25 cm • Maximum field size 15 cm by 15 cm
A B C
Specification of HIMAC
Sato et al. Nuclear Physics A. 1995; 588: 229—234 small
large
scatterer collimator compensator ridge filter
HIMAC Beam Delivery Techniques • Broad-beam(passive) irradiation
wobbler magnets
To produce uniform irradiation fields, a passive beam delivery system was employed. We use a pair of wobbler magnets and a scatterer. The range shifter is used for adjusting the residual range of carbon ions in the patient. The ridge filter is used to spread out the Bragg peak in the depth-dose distribution of carbon ions.
Kanai et al. IJROBP1999, 44:201-210
Irrespective of the size of SOBP, RBE value was estimated to be 3.0 at the distal part of SOBP. Ridge filter was designed to produce a physical dose gradient of SOBP so that the biological effect along SOBP became uniform. This was based on the biologic response of HSG tumor cells at 10 % survival level. The biologic response flatness along SOBP was checked by measurement of physical dose and dose-averaged LET.
Spread Out Bragg Peak in Carbon Ion Therapy at NURS
Kanai et al. Radiat Res 147:78-85,1997
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Depth-dose profile of 12C - 290 MeV/n
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Depth in Water [mm]
120 mm 100 mm80 mm
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Clinical Dose(GyE)
RBE=2.38
Ridge filter
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Carbon 290 MeV/n, 60mm SOBP
HSG
HeLa
T98HT1080
HK
t heor y
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Biological check
SOBP
Results
The Domain of Carbon Ion Therapy
• with large proportion of hypoxic cells • do not well re-oxygenate • with broad-shouldered dose survival curves by low LET
radiation • slowly proliferating
Tumors ; biological view points for high LET beam(theoretical)
Tumors ; clinical context (practical) •empirically radio-resistant, such as sarcomas, melanoma, RCC, thyroid ca, and re-irradiation •located close to the radiosensitive organs ; para-spinal •decline other therapies such as second surgery, limb amputation, concurrent chemo-radiation etc. •unresectable or medically inoperable •All quest for better outcomes
Site ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 ‘00 ‘01 ‘02 ‘03 ‘04 ’05 ‘06 ‘07 ‘08 ’09 ‘10 H&N: All sites
Lung :Peripheral Central Locally advanced Med.L/N
Liver
Prostate: C-ion+HR C-ion alone
B&STS
Uterus:Sqcc
Adc Brain
Skull base
Esoph: Pre-op/Radical
PK:pre-op
Radical
Rectum(P/0 rec)
Eye melanoma
Lacrimal gland
②16/4w
①18X/6w
①18x/6w ③ 16x/4w
①15x/5w
① 20x/5w
① X ray + chemo + C-ion
① 16x/4w
①
Preop, Radical (end)
① 16x/4w
② 9x/3w
③ 9x/3w
④ 9x/3w
② 12x/3w → 8x/2w → 4x/1w ③ 4x/1w
⑥ 4x/1w
②Hormone ③ High & Middle risk
Low risk
②C-ion alone ③+TMZ
② 16x/4w
② ③
① pre-op
Mucosal melanoma16x/4w
Phase I/II
Phase II
Sarcomas16x/4wks
② pre-op 8x/2w
① (5x/1w)
⑦ 16x/4w
1x/1day
④ 2x/2日
⑤ 16x/4w
①Pre-op 8x/2w ②Radical 12X/3wks
① 20x/5w
① 12x/3w
③ radical12x/3w ④+GEM
16x/4w
Protocols and Time Line of Carbon Ion Clinical Trials (1994-2010)
④ 12x/3w
Patient Distribution Enrolled in Carbon Ion Therapy at NIRS (Treatment: June 1994~July 2011)
Prostate 1382(20.9%)
CP:1057
Bone & Soft tissue 901(13.6%)
CP:666
Head & Neck 763(11.5%)
CP:440
Lung 695(10.5%)
CP:118
Liver 443(6.7%)
CP:213
P/O rectum341(5.2%
) CP:274
GYN170(2.6%)
Eye 114(1.7%)
CP:72
Pancreas 175(2.6%)
CP:1
CNS105(1.6%)
Skull Base 81(1.2%)
CP:52
Esophgus65(1.0%)
PA L/N 69(1.0%) CP:62
Lacrimal 23(0.3%)
Scanning 8(0.1%)
Re-irradiation 75(1.1%)
CP:16
Miscellaneous 1208(18.3%)
CP:538
Total 6,619
Clinical Practice: 3,509
1) C-ion RT is successful in the not treatable by other means
• Advanced Head & Neck cancers • Large skull base cancers • Post-op recurrent rectal cancer • Inoperable sarcoma • Re-irradiation after photon radiotherapy
• Lung cancer ( Single irradiation) • Liver cancer ( Two fractions) • Pancreatic cancer (8-12 fractions) • High risk prostate cancer (16 fractions)
2) Promising results are obtained in C-ion hypo- fractionated RT
Dose-fractionations determined by dose escalation studies for carbon ion RT at NIRS
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Carbon Ion Radiotherapy for Head-and-Neck Tumors
Phase II (9602) n=360 64 or 57.6 GyE/16 fr./4 wks
April 1997~
94 95 96 97 02 03 04 05 98 99 00 01 06 07 08 09
June 1994~
Phase I/II (9301)
18 fr./4 wks
April 1996~
Phase I/II (9504)
16 fr./4 wks
~ ongoing
0 20 40 60 80 100 120 140 160 Tx T1 T2 T3 T4
Rec. after surgery Rec. after chemotherapy
Rec. after surgery & Chemo
Mizoe et al. Int J Radiat Oncol Biol Phys. 2004;60:358-364 Hasegawa et al. Int J Radiat Oncol Biol Phys. 2006;64:396-401 Yanagi et al. Int J Radiat Oncol Biol Phys. 2009;74:15-20
PRO
BABI
LITY
TIME IN MONTHS
5-year Local Control Rate ACC (129) 76% MMM(102) 76% Adeno(42) 77% SCC(20) 70%
Local Control according to Histological Type (Apr 97~Aug 09) Phase II (9602) for Malignant Head-and-Neck Tumors
Carbon Ion Radiotherapy for Head-and-Neck Tumors
Phase II (9602) n=360 64 or 57.6 GyE/16 fr./4 wks
April 1997~
94 95 96 97 02 03 04 05 98 99 00 01 06 07 08 09
June 1994~
Phase I/II (9301)
18 fr./4 wks
April 1996~
Phase I/II (9504)
16 fr./4 wks
~ ongoing
Phase II (with chemo)n=85 Malignant Melanoma
16 fr./4 wks + DAV x 5 courses
April 2001~
Phase II (high dose )n=33 Bone & Soft Tissue
70.4 GyE/16 fr./4 wks
April 2001~
•Late recurrence in ACC with 57.6 GyE •High distant mets in melanoma •Poor local control in sarcomas with standard dose
→ 64 GyE
Local Control of ACC (n=129) according to Carbon ion Dose
57.6 GyE (n=75) 5-year; 73%
64 GyE (n=54) 5-year; 95%
TIME IN MONTHS
PRO
BABI
LITY
OF
LC
Phase II (9602) for Malignant Head-and-Neck Tumors
Combined Chemotherapy and C-ion RT for MMM
Local Control and Overall Survival of Mucosal Malignant Melanomas
TIME IN MONTHS
PRO
BABI
LITY
C-ions alone (n=102) 5-year; 76%
C-ions + DAV n=85) 5-year; 81%
PRO
BABI
LITY
C-ions alone (n=102) 3-year; 53%, 5-year; 37%
C-ions + DAV ( n=85) 3-year; 67%, 5-year; 62%
TIME IN MONTHS
Local Control Overall Survival
Five-year Survival Rates in Mucosal Malignant Melanoma of the Head & Neck
1) Gilligan D et al. Br J Radiol 1991; 64: 1147-1150. 2) Shibuya H et al. IJROBP 1992; 25: 35-39. 3) Chang AE et al. Cancer 1998; 78: 1664-1678. 4) Shah JP et al. Am J Surg 1977; 134: 531-535. 5) Patel SG et al. Head Neck 2002; 24: 247-257. 6) Lund VJ et al. Laryngoscope 1999; 109: 208-211. 7) Chaundhry AP et al. Cancer 1958; 11: 923-928.
Local Control and Overall Survival compared with Carbon Ion Dose
Bone and Soft-Tissue Sarcomas (Head & NECK) Low Dose Carbon vs. High Dose Carbon
TIME IN MONTHS
PRO
BABI
LITY
70.4 GyE (n=33) 3-year; 92%, 5-year; 79%
64 or 57.6 GyE( n=14) 5-year; 24%
PRO
BABI
LITY
70.4 GyE (n=33) 3-y; 76%, 5-y; 54%
64 or 57.6 GyE (n=14) 3-year; 43%, 5-year; 36%
TIME IN MONTHS
Local Control Overall Survival
Jingu et al. IJROBP.2011
Unresectable sacral chordoma 5 years after C-ion RT Sacral osteosarcoma
13 years after C-ion RT
Calf soft tissue sarcoma 5 years after C-ion RT
Pelvis chondrosarcoma 28 months after C-ion RT Married and had her baby
Late Skin Reaction in B & STSs
No of Pts Gr3-4 (%)
2000~2001 25 7 (28)
Total Dose : 73.6 Two direction Skin margin
70.4 or less Three direction or more Reduced skin margin
Risk factor
2002~2005 151 2 (Modified group)
Modifications
Yanagi et al.Radiotherapy and Oncology. 2010;95:60-65
Chordoma of the sacrum Case 1 Case 2 Case 3
•3% of all primary bone sarcoma (50% from sacrum bone) •Radio-chemo-resistant nature •Difficulty in surgery due to its location •Slow growing, sometimes presenting huge tumor size
Chordoma of the sacrum Case 1 Case 2 Case 3
6 years 5 years 6 years
Local Control & Survival Rate in Chordoma(sacrum & mobile spine)
No. Site treatment Local Survival of Pts. 5-year 5year 10year (new pts /y)
MGH 1) 21 S surgery 77% - 50% 1972-1992 (1.1) Sweden 2) 39 S+Sp surgery 44 84% 64% 1963-1998 (1.1)
MGH. 3) 27 S surgery 72 82 62 1982-2002 (2.7 ) + Proton
LBL 4) 14 S surgery 55 85 22 1977-1989 (1.2 ) + He-ion Mayo 5) 52 S surgery 56 74 52 1980-2001 (2.5 ) NIRS 6) 145 S+Sp C-ion 85 85 47 1996-2009.2 (11 ) 1) J Bone Joint Surg. 1998 2) Cancer.2000 3)IJROBP.2006 4) IJROBP.1993 5) J Bone Joint Surg. 2005 6)BJR. 2011
S:sacrum Sp:mobile spine
(disease free)
Factors in Re-irradiation • Regrowth of a radio-resistant clone; cancer stem-like cells? • Tumor bed effect: damage of tumor vasculatures and stromal elements(fibrosis and necrosis) - poor blood supply and impairment of local defense (immune? ) system • Low tolerance of surrounding normal tissue
High risk of serious morbidities with poor tumor control
Re-irradiation
80 70 60 50 40 30 20 10 0
1.0
.8
.6
.4
.2
0.0
Overall Survival (n=60)
Local control(n=68)
Local Control and Survival in Re-irradiation with Carbon Ion Beam
Months after C-ion
• 60 cases(68 lesions) treated Dec-’04. to Aug-’10. • X-ray Dose : 20-72 Gy(median 50 Gy) • X-ray to C-ion time : 4 - 275 months(median 31 mon.) • C-ion dose:36-70.4GyE/12-16Fr/3-4 weeks
Re-irradiation with C-ion beam
90%
70%
New insight
Cui et al. Cancer Res 71:3676-87, 2011
Carbon ion beam therapy may have an advantage over photon beam therapy by improved targeting of putative colon cancer stem–like cells.
X-ray C-ion
Control
Hypo-fractionation in C-ion RT •Pros •Similar effectiveness •Similar toxicity •Low OER and low repair in C-ion •High conformality •More patient easy •More capacity
•Cons •More toxic •Less effective •Less re-oxygenation •Less repair…etc •Small therapeutic window
phase Treatment No. 3year 5year of trial (Dose*/fx/week) of Pts local survival -1 I/II 59.4-95.4 GyE/18/6w 47 65% 41% -2 I/II 68.4-79.2GyE/9/3w 34 91% 40% -3 II 72.0 GyE /9fx/3w 50 95% 50% -4 I/II 52.8-60 GyE/4fx/1w 79 90% 36% -5 I/II 28 - 50GyE /1fx/1day 216 - -
Carbon Ion Radiotherapy, Stage I Non Small Cell Lung cancer
Single fraction treatment(4 direction)
Single Fraction Carbon ion therapy for Stage I non small cell lung cancer
Before
After 4months
Single fraction 28GyE of carbon ion for stage I non small cell lung cancer
After 58 months Alive NED (7 years)
year
Local control rate(5 y):79% Cause-spec. survival rate(5y):75% Overall survival rate(5y):64%
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Single Fraction Carbon ion therapy for Stage I non small cell lung cancer
Before After
T2N0M0 Sq.CC 71 F
NO Grade 3 Reactions in this series
Single dose of 36-46 Gy (n=121)
0
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60
80
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120
140
160
180
200
95 96 97 98 99 00 01 02 03 04 05 06 07 08 09
High risk 613(55%) Intermediate risk 307(28%) Low risk 188(17%) Total 1108
Number of Patients in Prostate Study
16f./4wks
Phase I/II Phase II
No. of Morbidity ≥ G2 Institutes Radiotherapy Dose (Gy/f) pts. Rectum GU Christie H.1) IMRT 60.0/20 60 9.5% 4.0% Princess Margaret H.2) IMRT 60.0/20 92 6.3% 10.0% Cleveland CF.3) IMRT 70.0/28 770 4.4% 5.2% Stanford U.4) SRT 36.25/5 41 15.0% 29.0% RTOG94065) 3DCRT 68.4-79.2/38-41 275 7-16% 18-29% 3DCRT 78.0/39 118 25-26% 23-28% Loma Linda U.6) Proton 75.0/39 901 3.5% 5.4% NIRS C-ion 63.0/20 216 1.9% 4.6% C-ion 57.6/16 274 0.7% 2.6% 1) JH Coote et al. IJROBP 74, 2009 2) JM Martin et al. IJROBP 69, 2007 3) PA Kupelian et al. IJROBP 68, 2007 4) CR King et al. IJROBP 73, 2009 5) JM Michalski et al. IJROBP 76, 2010 6) RW Schulte et al. Strahlenther Oncol 176, 2000
Morbidities in Prostate RT (Comparison with other RT)
Comparison with other RTx 5-year bNED in High risk group( iPSA≥20)
No. of Biochemical Institutes RTx Dose pts. NED (iPSA≥20) MDAnderson CC.1) Conventional 66-78Gy/33-39f 197 51%
Fox Chase CC.2) 3DCRT ≥76Gy/38f 232 26-63%
Cleveland CF.3) IMRT 70Gy/28f 293(High risk) 72%
Loma Linda U.4) Proton 75CGE/45f 901 45%
NIRS 5) Carbon 63-66/20, 57.6/16 222 87% 1) A Pollack et al. IJROBP 48, MR Storey et al.IJROBP 48, 2000 2) GE Hanks et al. IJROBP 46, 2000 3) PA Kupelian et al. IJROBP 68, 2007 4) JD Slater et al. IJROBP 59, 2004 5) H.Tsuji, et al. IJROBP 63, 2005
Hypofractionation in Prostate Cancer
20fr. / 5wks
Pilot study of 51.6GyE 7 pts.-recurrence after hormone therapy >>> No severe toxicity nor recurrence
Dose-escalation study >>> Recommended dose; 63.0GyE
New Clinical Trial
12fr. / 3wks
Fixed dose; 57.6GyE >>> Comparable Tumor Control with Lower Incidence of Toxicity
16fr. / 4wks
51.6GyE / 12fr. / 3wks applied to fresh cases(35pts treated)
8 years for 1 week reduction
7 years more for another 1 week reduction
Annual Patient Accrual for Carbon Ion Therapy at NIRS (Treatment: June 1994~ Augast 2011)
Clinical research
Clinical practice (40,000US$)
18
17 16 15
14 13 12
11
Fraction number/patient
1. Hypo-fractionated RT -- Reduction in fractions and time Average : 13.0 fr / 3 wks ( 750 pts treated in 2009)
Stage I Lung single fr, Hepatpma 2 fr, Prostate 12 fr, Pancreas 2. Photon- resistant and slow-growing tumors--Increased
biological effect Non-SCC (Adenoca, Adenoidcystic ca, Melanoma etc) Head and neck / Prostate / Pancreas/ Liver / Rectal ca(Pelvic rec) / Uterus Bone and soft tissue sarcoma Re-irradiation Slow-growing tumors : Renal cell cancer/ Thyroid cancer 3. Increased dose to the target near critical organs Skull base tumor / paravertebral tumor Pelvic tumors
Tsujii H: Radiother Oncol 73(Sippl 2): S41-S49,2004 Laramore GE: Seminars Oncol. 24:672-685, 1997 Linstdt: IJROBP,20:761,1991)
Tumor Types and Clinical Situations Where Carbon Ion Radiotherapy Offers a Therapeutic Advantage
~12 fr
and Future…
○3D Scanning (H&V): 2 rooms ○Rotating Gantry : 1 room
Iso-center0 1 2m
SMxQM SMy
Monitors
RGF
RSF
Wall
PRN1 PRN2
9.0 m3D Scanning
New treatment facility
HIMAC building
Hospital
Research Building for Charged Particle Therapy
Rotating Gantry
A New Project at NIRS
New Facility for C-ion Scanning
Treatment started as the clinical trial on May 17, 2011.
scatterer collimator compensator ridge filter
Beam delivery techniques
• Broad-beam irradiation
Scanning irradiation
More flexible in irradiation field shaping
wobbler magnets
scanning magnets
range shifter
63
Sep. 2010 - First beam in the scanning treatment room. Jan. 2011 - Commissioning report on the C-ion scanning treatment (170 pages) approved by the extramural review committee for Q/A. Feb. 2011 - IRB review and approval of the clinical protocol of the C-ion scanning. May. 2011 - First patient was treated. (1.5 months behind the schedule due to unstable power supply after the East Japan Earthquake)
From First Beam to First Patient in C-ion Scanning
Scanning : First patient : 5/17/’11 Patient # Site Start
#1 Pelvis 5/17~6/14
#2 H & N 5/25~6/21
#3 Pelvis 5/27~6/23
#4 H & N 6/1~6/29
#5 Pelvis 6/15~7/12
#6 Pelvis 6/21~7/15
#7 H & N 6/28~7/22
#8 H & N 7/19~8/11
Scanning Beam Monitor in Head & Neck #2
19min/patient(Ave):shortest : 8-47min! (positioning:13min., irradiation time:1min.)
JIGS(Jidou Ichi-Gime Souchi)
Automated positioning system
Stage 0------- Basic functions and procedures (IRB approval at Feb. 2011) Stage 1------- Dose painting (IRB review : 2012?) Stage 2------- Gated scanning for Moving target (IRB review : 2013) stage 3------- Light weight rotating gantry (IRB review : 2015) Stage 4------- Small synchrotron - next term? (IRB review : 2019?)
Next Decade in C-ion Scanning
Future Direction in Prostate More Hypo-fractionation : 8 fr./2 wks 4 fr./1wk or more…. Reduce the OAR dose Urethral Dose Reduction
It can be realized with“Dose-painting by precise image guided C-ion RT with scanning”
Beam monitor (scanning treatment)
Fast Re-scanning for Moving Target
↑ Moving target
↑ Position Monitor
Single scanning
8 times rescanning
< ±2.5%
Dose error
Confirmation of the 3D fast scanning(100m/sec) technology for moving target.
Furukawa et al. Med Phys. 2010;37(11):5672-82 Furukawa et al. Med Phys. 2010;37(9):4874-9.
52m
40m
Super MINIMAC - A Future Facility
C-ion : 400 MeV/n Synchrotron : diameter 6 m Gantry : Size 8x10 m (3 rooms) : Weight 100~150 tons
NM:350 tons
SCM:100 tons
C-ion400MeV/n Gantry
Super MINIMAC : Superconducting Magnet Installed Ion Medical Accelerator in Chiba
Specification of Super MINIMAC
◆In the past 17 years, more than 6,600 patients were treated with C-ion RT at NIRS.
◆Almost 50 protocol studies (Phase I/II and Phase II) have been performed to investigate optimal irradiation techniques, dose fractionation, and to find indications for C-ion RT.
◆For various types of tumors, hypofractionated carbon ion radiotherapy (average:13.0 frs per patient) has been established with acceptable morbidities.
◆Better local control and survival are brought by carbon ion therapy in many photon resistant advanced tumors.
◆The next generation carbon therapy system has been under development to provide more advanced treatment.
Clinical Study on C-ion RT at NIRS –Summary
No dose, No effect ! (….with some biological help)
Thank you for your attention
Carbon therapy--New horizon in cancer treatment