scholarly journals Particle therapy in the future of precision therapy

2020 ◽  
Vol 93 (1114) ◽  
pp. 20200183 ◽  
Author(s):  
Lukas Schaub ◽  
Semi Ben Harrabi ◽  
Juergen Debus
Keyword(s):  
Charged Particles ◽  
Clinical Results ◽  
Particle Therapy ◽  
Carbon Ions ◽  
Depth Dose ◽  
Precision Therapy ◽  
Treatment Facilities ◽  
Beam Delivery ◽  
Under Construction ◽  
Number Of Treatment

The first hospital-based treatment facilities for particle therapy started operation about thirty years ago. Since then, the clinical experience with protons and carbon ions has grown continuously and more than 200,000 patients have been treated to date. The promising clinical results led to a rapidly increasing number of treatment facilities and many new facilities are planned or under construction all over the world. An inverted depth–dose profile combined with potential radiobiological advantages make charged particles a precious tool for the treatment of tumours that are particularly radioresistant or located nearby sensitive structures. A rising number of trials have already confirmed the benefits of particle therapy in selected clinical situations and further improvements in beam delivery, image guidance and treatment planning are expected. This review summarises some physical and biological characteristics of accelerated charged particles and gives some examples of their clinical application. Furthermore, challenges and future perspectives of particle therapy will be discussed.

CHARGED PARTICLE THERAPY STEPS INTO THE CLINICAL ENVIRONMENT

2007 ◽  
Vol 16 (04) ◽  
pp. 1205-1220 ◽  
Author(s):  
TH. HABERER
Keyword(s):  
Charged Particle ◽  
Charged Particles ◽  
Basic Research ◽  
Particle Therapy ◽  
Treatment Modalities ◽  
Carbon Ions ◽  
Clinical Environment ◽  
Heavy Charged Particles ◽  
Charged Particle Therapy ◽  
Beam Delivery

Beams of heavy charged particles like protons or carbon ions represent the ideal tool for the treatment of deep-seated, inoperable and radioresistant tumors. For more than 4 decades research with beams of charged particles has been performed. In total more than 40000 patients have been treated, mostly using protons being delivered by accelerators that were designed for basic research centers. In Berkeley, USA heavier particles like helium or neon ions were used to conduct clinical trials until 1992. Based on that somewhat limited technological standard and triggered by the promising results from Berkeley the first dedicated charged particle facilities were constructed. In order to maximally exploit the advantageous physical and radiobiological characteristics of these beams enormous effort was put into developing dynamic beam delivery techniques and tailoring the capabilities of the accelerators, the planning systems and the quality assurance procedures and equipment to the requirements resulting from these new treatment modalities. Active beam delivery systems integrated in rotating gantries, if necessary, will allow the production of superior dose distributions that precisely follow the medical prescription. The technological progress being made during the last 10 years defines the state of the art of the upcoming next-generation facilities for the clinical environment in Europe and Japan.

scholarly journals Carbon Ion Radiobiology

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 3022 ◽  
Author(s):  
Walter Tinganelli ◽  
Marco Durante
Keyword(s):  
Normal Tissue ◽  
Biological Response ◽  
Metastatic Potential ◽  
Clinical Results ◽  
Heavy Ion ◽  
Particle Therapy ◽  
X Rays ◽  
Carbon Ions ◽  
Treatment Protocols ◽  
Target Region

Radiotherapy using accelerated charged particles is rapidly growing worldwide. About 85% of the cancer patients receiving particle therapy are irradiated with protons, which have physical advantages compared to X-rays but a similar biological response. In addition to the ballistic advantages, heavy ions present specific radiobiological features that can make them attractive for treating radioresistant, hypoxic tumors. An ideal heavy ion should have lower toxicity in the entrance channel (normal tissue) and be exquisitely effective in the target region (tumor). Carbon ions have been chosen because they represent the best combination in this direction. Normal tissue toxicities and second cancer risk are similar to those observed in conventional radiotherapy. In the target region, they have increased relative biological effectiveness and a reduced oxygen enhancement ratio compared to X-rays. Some radiobiological properties of densely ionizing carbon ions are so distinct from X-rays and protons that they can be considered as a different “drug” in oncology, and may elicit favorable responses such as an increased immune response and reduced angiogenesis and metastatic potential. The radiobiological properties of carbon ions should guide patient selection and treatment protocols to achieve optimal clinical results.

scholarly journals Carbon Ion Radiobiology

2020 ◽  
Author(s):  
Walter Tinganelli ◽  
Marco Durante
Keyword(s):  
Normal Tissue ◽  
Biological Response ◽  
Metastatic Potential ◽  
Clinical Results ◽  
Heavy Ion ◽  
Particle Therapy ◽  
X Rays ◽  
Carbon Ions ◽  
Treatment Protocols ◽  
Target Region

Radiotherapy using accelerated charged particles is rapidly growing worldwide. About 85% of the cancer patients receiving particle therapy is irradiated with protons, which have physical advantages compared to X-rays but similar biological response. In addition to the ballistic advantages, heavy ions present specific radiobiological features that can make them attractive for treating radioresistant, hypoxic tumors. An ideal heavy ion should have lower toxicity in the entrance channel (normal tissue), and being exquisitely effective in the target region (tumor). Carbon ions have been chosen because they represent the best combination in this direction. Normal tissue toxicities and second cancer risk are similar to those observed in conventional radiotherapy. In the target region, they have increased relative biological effectiveness and reduced oxygen enhancement ratio compared to X-rays. Some radiobiology properties of densely ionizing carbon ions are so distinct from X-rays and protons that they can be considered as a different “drug” in oncology, and may elicit favorable responses such as increased immune response and reduced angiogenesis and metastatic potential. The radiobiological properties of carbon ions should guide patient selection and treatment protocols to achieve optimal clinical results.

RURAL MEDICINE. CONDITION AND ISSUES

2020 ◽  
pp. 103-110
Author(s):  
Yuliya M. Beglyakova ◽  
◽  
Aleksander S. Shchirskii ◽  
Keyword(s):  
Health Services ◽  
Medical Care ◽  
Rural Areas ◽  
Rural Population ◽  
Rural Medicine ◽  
Self Medication ◽  
Medical Facilities ◽  
Treatment Facilities ◽  
Number Of Treatment ◽  
The Village

The article analyses the accessibility of medical facilities in rural areas of modern Russia and the specifics of their organization and development. The authors reveal causes why rural residents have much less opportunities to seek quality medical care than urban ones, what leads to a disparity between the inhabitants of the city and the village. The thesis is substantiated that state programmes that should make health services accessible to the rural population to a greater extent do not cope with the task at hand. An attempt is made to highlight the public’s response to the existing disparity in the health services of the villagers compared to urban dwellers. Such a reaction can be considered an outflow of people from rural areas, and an increase in self-medication among rural people as a result of the difficulty in obtaining health services. The decrease in the number of treatment facilities in rural areas leads to a deterioration in the medicine situation in rural areas. That, according to the authors of the article, justifies the need to study the issues associated with the provision of medical care to the rural population.

scholarly journals Critical Appraisal of Experimental Radiation Modalities for Malignant Astrocytomas

1990 ◽  
Vol 17 (2) ◽  
pp. 199-208 ◽  
Author(s):  
N.J. Laperriere
Keyword(s):  
Critical Appraisal ◽  
Clinical Results ◽  
Particle Therapy ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Initial Management ◽  
Altered Fractionation ◽  
Malignant Astrocytomas ◽  
Prospective Trials ◽  
Radiation Sensitizers

ABSTRACT:The management of patients with supratentorial malignant astrocytomas has remained a major problem. Patients continue to die from a lack of local control in 90% of cases despite an improvement of median survival seen with the use of postoperative radiation therapy. Because of this, there has been considerable interest in exploring novel ways of possibly improving results. This paper reviews the rationale and clinical results with the use of altered fractionation schemes, brachytherapy, radiation sensitizers, hyperthermia, particle therapy, and radiosurgery in the treatment of these patients. Currently, there is no demonstrated advantage with the use of these experimental modalities in the initial management of patients. There would appear to be some benefit for selected patients who are treated with brachytherapy at recurrence, but its efficacy as part of initial management remains to be determined in ongoing randomized prospective trials.

scholarly journals Physical advantages of particles: protons and light ions

2020 ◽  
Vol 93 (1107) ◽  
pp. 20190428 ◽  
Author(s):  
Oliver Jäkel
Keyword(s):  
Energy Loss ◽  
Biological Effects ◽  
Ion Beam ◽  
National Laboratory ◽  
Carbon Ions ◽  
Nuclear Fragmentation ◽  
Depth Dose ◽  
Light Ions ◽  
Argon Ions ◽  
First Time

Proton and ion beam therapy has been introduced in the Lawrence Berkeley National Laboratory in the mid-1950s, when protons and helium ions have been used for the first time to treat patients. Starting in 1972, the scientists at Berkeley also were the first to use heavier ions (carbon, oxygen, neon, silicon and argon ions). The first clinical ion beam facility opened in 1994 in Japan and since then, the interest in radiotherapy with light ion beams has been increasing slowly but steadily, with 13 centers in clinical operation in 2019. All these centers are using carbon ions for clinical application. The article outlines the differences in physical properties of various light ions as compared to protons in view of the application in radiotherapy. These include the energy loss and depth dose properties, multiple scattering, range straggling and nuclear fragmentation. In addition, the paper discusses differences arising from energy loss and linear energy transfer with respect to their biological effects. Moreover, the paper reviews briefly the existing clinical data comparing protons and ions and outlines the future perspectives for the clinical use of ions like oxygen and helium.

scholarly journals Cost-effectiveness analysis (CEA) of IMRT plus C12 boost vs IMRT only in adenoid cystic carcinoma (ACC) of the head and neck

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
A D Jensen ◽  
Jürgen Debus
Keyword(s):  
Cost Effectiveness ◽  
Local Control ◽  
Recurrent Disease ◽  
Treatment Options ◽  
Combined Treatment ◽  
Intensity Modulated Radiotherapy ◽  
Experimental Treatment ◽  
Clinical Results ◽  
Particle Therapy ◽  
Combination Regimen

Abstract Background Particle therapy provides steep dose gradients to facilitate dose escalation in challenging anatomical sites which has been shown not only to improve local control but also overall survival in patients with ACC. Cost-effectiveness of intensity-modulated radiotherapy (IMRT) plus carbon ion (C12) boost vs IMRT alone was performed in order to objectivise and substantiate more widespread use of this technology in ACC. Methods Patients with pathologically confirmed ACC received a combination regimen of IMRT plus C12 boost. Patients presenting outside C12 treatment slots received IMRT only. Clinical results were published; economic analysis on patient-level data was carried out from a healthcare purchaser’s perspective based on costs of healthcare utilization. Cost histories were generated from resource use recorded in individual patient charts and adjusted for censoring using the Lin I method. Cost-effectiveness was measured as incremental cost-effectiveness ratio (ICER). Sensitivity analysis was performed regarding potentially differing management of recurrent disease. Results The experimental treatment increased overall costs by € 18,076 (€13,416 – €22,922) at a mean survival benefit of 0.86 years. Despite improved local control, following costs were also increased in the experimental treatment. The ICER was estimated to 26,863 €/LY. After accounting for different management of recurrent disease in the two cohorts, the ICER was calculated to 20,638 €/LY. Conclusion The combined treatment (IMRT+C12 boost) substantially increased initial and overall treatment cost. In view of limited treatment options in ACC, costs may be acceptable though. Investigations into quality of life measures may support further decisions in the future.

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