24 September 2008 ENLIGHT, ESF Workshop-Oxford

European Network for Light Ion Therapy ENLIGHT

Manjit DosanjhENLIGHT Coordinator

& CERN

24 September 2008 ENLIGHT, ESF Workshop-Oxford

Hadron therapy history …

TodayToday

51,000 patients51,000 patients(44,000 protons, (44,000 protons,

2900 carbon ions). 2900 carbon ions).

……in 1997in 199722,000 patients since the beginning 22,000 patients since the beginning

(18,300 protons)(18,300 protons)

19541954

BerkeleyBerkeley

First patientFirst 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 1996 - 2000 CERN–TERA–MedAustron Collaboration for optimized medical CERN–TERA–MedAustron Collaboration for optimized medical

synchrotronsynchrotron

and protons

linacs forcarbon

ions

pp

C Cp

RF cavity Resonance sextupole

Betatroncore

Injection septum

Electrostatic septum

Extraction septum

Sextupole horiz. chromaticity

Sextupole vert.chromaticity

Sextupole vert. chromaticity

Sextupole horiz. chromaticity

Circumference C = 76.84 mTune horizontal Qx = 1.67

Tune vertical Qz = 1.72

400 MeV/u synchrotron

16 Bending Magnets16 Bending Magnets3 extraction systems:3 extraction systems:

betatron corebetatron core1/3 resonance1/3 resonanceRF knock-outRF 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 The first two dual Carbon/proton centres in Heidelberg and Pavia are foreseen to start operation in 2008/9…..and Pavia are foreseen to start operation in 2008/9…..

• Approved: Marburg (Germany), Etoile (France), Approved: Marburg (Germany), Etoile (France), MedAustron (Austria) and ARCHADE (France)MedAustron (Austria) and ARCHADE (France)

• Sweden, Belgium, Netherlands, Spain, UK ………Sweden, Belgium, Netherlands, Spain, UK ………

Clear desire for continuing the network Clear desire for continuing the network focusing on new and on un- completed focusing on new and on un- completed

researchresearchtopics and helping new initiatives….topics and helping new initiatives….

24 September 2008 ENLIGHT, ESF Workshop-Oxford

From ENLIGHT… to ENLIGHT++

In 2006 ENLIGHT++: In 2006 ENLIGHT++:

+ one “plus” for + one “plus” for more hadrons (specifically protons),more hadrons (specifically protons),

++ the second “plus” ++ the second “plus” refers to more Countries (17 countries,refers to more Countries (17 countries,with >60 Institutions)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 European Commission funding project (Framework programme 7)(Framework programme 7)

Training 25 young Training 25 young researchers - researchers -

5.6 million euro project5.6 million euro project

QuickTime™ and a decompressor

are needed to see this picture.

Research in Research in optimizing optimizing

8.5 million euro 8.5 million euro projectproject

• 25 researcher positions• 21 PhDs and 4 Post-doc• Positions posted: www.cern.ch/PARTNER• 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-Oxford2.9.2008 Manjit Dosanjh

HEALTH- 2009-1.2-4: Novel imaging systems for in vivomonitoring 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 andtools for monitoring, in vivo and preferably in real time, the 3-dimensionaldistribution 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 PETAdvantages

24 September 2008 ENLIGHT, ESF Workshop-Oxford

PET is not applicable to

- real time monitoring:

▪ too slow▪ T1/2(15O) = 2 min, T1/2(11C) = 20 min▪ dose specific activity: ~ 1000 - 7000 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 PETDisadvantages 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 MeetingNovel 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 MeetingNovel 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-Oxford2.9.2008Manjit Dosanjh

TERAINFNIFIC/CSIC IN2P3OncoRayCERNPoliAnnecyOxfordIBAICXEtoileGSIHITPoliMilanoSiemensMarburgBHTCMUViennaCiemat--------------

TERA/CNAO/PoliMilano/UBernINFNIFIC-CSIC/CiematIN2P3/CEA?OncoRayCERNOxfordIBAICXEtoile/PoliAnnecy/Archade?GSIHIT/MarburgSiemensBHTCMUVienna------------------

FIRST LIST SECOND 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