Current Status and Future Medical Perspectives at MedAustron

U. Mock EBG MedAustron GmbH

• Cancer treatment facility – Ion beam therapy with protons and carbon ions

• Research facility – Medical physics – Radiobiology – Experimental physics

3

Ground floor – functional design

ÖGRO, 20.11.2010

Personaleingang (Medical, research)

Rettung

Patienten

137 m

90 m

M. Benedikt

Medical treatment/research: Proton gantry (IR 4) Horizontal fix beam (IR 3) Horizontal and vertical fix beam (IR 2)

Non clinical research: Horizontal fix beam (IR 1)

• CERN, Geneva, Synchrotron-construction

• CNAO, Milano, and INFN, Italy for the development of the beam application system

© CERN

Technical Co-operation

Beam arrangements at the MedAustron Ion

Beam facility

MedAustron: Gantry

PSI Gantry 2

• Weight: 220 t

• Diameter: 7,5 m

PSI Gantry

21.10.2013

MedAustron robotic patient positioning system

HIT, Heidelberg

The robotic table

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2008 Start of the civil engineering pre-planning

2009 Submission of the documents for the mandatory

Environmental Impact Assessment Study

2011 Start of building construction

2012 Start technical infrastructure installation

2013 Accelerator - Trial operation

2015 Start patient treatment (horizontal beam room)

Project time schedule

12

• 2014: technical trial operation

• End 2015: presumably first ambulant patient`s irradiation with protons at the horizontal beam

• End 2016: Presumably first patient`s treatment with carbon ions

Milestones at MedAustron

Indications to ion beam therapy (at MedAustron)

Milestones at MedAustron

Proton therapy

Dose distribution

• Reduction of dose before the tumour

• Almost no dose after the tumour

thereby:

Dose – normal tissue/organs at risk

• Reduction of dose to normal tissues

• Reduction of dose to organs at risk

Optimal treatment for tumours in close proximity to radiosensitive organs like the optical nerve, spinal cord etc.

Carbon ions = higher biological effectiveness

Irradiation of the cranio-spinal axis in the treatment of medulloblastoma (most common pediatric brain tumour)

Conventional radiotherapy (Photons): - Limited dose to inner organs

Iontherapy (protons): No dose to inner organs

Reduction of acute and late side effects

General treatment strategy: Protons

• Slightly higher biological effectiveness compared to photons (RBE: ~ 1,1)

• (simply) replacing photons by protons without changing fractionation – and/or dose schedules will NOT improve local tumour control

• Reduction of treatment related side effects: e.g. paediatric tumours

• Improved local tumour control by dose escalation in the target region without exceeding tolerance doses of organs at risk

DEGRO-List of indications to proton therapy

2006 the “Deutsche Gesellschaft für Radioonkologie” (DEGRO) published a list of

established indications to proton therapy http://www.dzkf.de/heft/2006_01-02/14.pdf

DEGRO list of indications

Thoracic malignancies

• Lung cancer (NSCLC) Stage I and II (if the patient is medically inoperable/refuses surgery)

• Thoracic tumours which can not be treated by photons in a curative intent without exceeding the tolerance doses of critical organs at risk (e.g. spinal cord, lung) Example: selected patients with locally advanced lung cancer or pleural mesothelioma

• Retroperitoneal single metastasis in case of a locally controlled primary tumour

• Esophageal carcinoma (T3-4 or T1-2 tumours in medically inoperable patients), e.g. proton boost after combined radio-chemotherapy with photons).

• Breast carcinoma, if all regional lymph nodes have to be irradiated

DEGRO list of indications

Abdominal tumours

• Liver cancer (hepatocellular carcinoma): curative treatment intention

• Carcinoma of the upper abdominal region which can not be treated curatively with photons without exceeding the tolerance doses of surrounding organs at risk like the liver, kidneys, spinal cord. Clinical examples: patients with cholangio-cellular carcinoma or selected cases of retroperitoneal sarcoma (multimodal treatment concept)

• Liver metastases of colorectal carcinoma, if surgery is not indicated

• Single retroperitoneal metastases in locally controlled primary tumours

• Para spinal sarcoma and carcinoma (curative treatment intention)

• Non-operable osteo- und chondrosarcoma of the axial skeleton

• Prostate carcinoma (e.g. proton boost therapy after conventionally fractionated photon therapy) or locally advanced prostate carcinoma

• Locally advanced gynaecological tumours (e.g. proton-boost after conventionally fractionated photon therapy, if a Brachytherapy boost can not be applied

• Inoperable rectal carcinoma or recurrences without prior irradiation (e.g. proton boost after conventional fractionated photon therapy within combined radio-chemotherapy concepts

DEGRO list of indications Tumours of the extremities

• Large soft tissue sarcoma of the extremities (after extremity preserving tumour resection)

Head and Neck tumours

• Advanced tumours close to the scull base or paranasal sinus carcinoma

• Locally advanced head and neck tumours (e.g. proton-boost therapy after simultaneous radio-chemotherapy with conventional photon irradiation

Cerebral tumours

• Glioma Grad II/III in adults (e.g. within clinical studies aiming at a reduction of severe late toxicity)

• Meningioma of the scull base (e.g. proton-boost after conventional fractionated photon therapy)

Pediatric malignancies

General treatment strategies: Carbon ions

• Higher biological effectiveness in comparison to protons/ photons

• Especially indicated in relatively radioresistant tumours

• Especially indicated in tumours which can only be treated with limited effectiveness by conventional irradiation techniques

Carbon ions

Consolidated indications:

• Adenoid cystic carcinoma of the salivary glands

• Mucosal melanoma

• Chordoma of the scull base/spinal axis

• Soft tissue sarcoma (low- intermediate grading) without distant metastases, if the tumour is inoperable or only incomplete respectable

Prospective indications :

• Sarcomas after definite R1-resection (and in children)

• Lung carcinoma, surgical inoperable

• Locally aggressive growing prostate carcinoma

• Local recurrences of adeno-carcinoma in the pelvic region (after already performed photon therapy)

• Locally advanced squamous carcinoma of the head and neck region

• High grade glioma (in children and adults)

• Gastrointestinal tumours (liver cancer, pancreatic carcinoma, carcinoma of the stomach etc.)

Intended operation

• Start of treatment end of 2015 – Start in one treatment room = Horizontal fix beam with protons

– Continuous increase of patient numbers

– Treatment of almost all patients within clinical studies

• Operation concept Medicine/clinical research – Medical treatment 5 days/week,

– 06:00 – 22:00 incl. QA

• Operation concept Non clinical research

– 22:00 – 6:00 , and Saturday, Sunday, statutory holidays

Ion beam therapy facilities worldwide

Combined ion beam treatment facilities with protons and carbon ions worldwide

• HIBMC, Hyogo, Japan In operation since 2002 • HIT Heidelberg, Germany 1. patient treatment: 15.11.2009 • CNAO, Pavia, Italy 1. patient treatment Sept. 2011

Combined centres under construction: • MedAustron, Wiener Neustadt, A ~ Start intended end of 2015

Thank you!