• 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
12
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
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.
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
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
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