Physics and biomedical challenges of cancer therapy with accelerated heavy ions

Durante, Marco; Debus, Jürgen; Loeffler, Jay S.

doi:10.1038/s42254-021-00368-5

Cited by 74 publications

(94 citation statements)

References 197 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With the advent of modern image guidance systems (7), like in-room Cone-Beam CT (CBCT), optical surface guidance, as well as dual-energy CT and particle imaging, particle therapy has recently enjoyed a boost in achievable treatment accuracy. Now, with commercial options for vertical CT systems (8,9), and the drive for reducing the upfront investment for opening new particle therapy centers (3,10), upright treatment positioning systems have gained renewed interest (11,12). Moreover, advanced techniques for intra-treatment verification and adaptation (13)(14)(15) are currently reaching clinical maturity.…”

Section: Introductionmentioning

confidence: 99%

Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

et al. 2022

Self Cite

View full text Add to dashboard Cite

Particle therapy is a rapidly growing field in cancer therapy. Worldwide, over 100 centers are in operation, and more are currently in construction phase. The interest in particle therapy is founded in the superior target dose conformity and healthy tissue sparing achievable through the particles’ inverse depth dose profile. This physical advantage is, however, opposed by increased complexity and cost of particle therapy facilities. Particle therapy, especially with heavier ions, requires large and costly equipment to accelerate the particles to the desired treatment energy and steer the beam to the patient. A significant portion of the cost for a treatment facility is attributed to the gantry, used to enable different beam angles around the patient for optimal healthy tissue sparing. Instead of a gantry, a rotating chair positioning system paired with a fixed horizontal beam line presents a suitable cost-efficient alternative. Chair systems have been used already at the advent of particle therapy, but were soon dismissed due to increased setup uncertainty associated with the upright position stemming from the lack of dedicated image guidance systems. Recently, treatment chairs gained renewed interest due to the improvement in beam delivery, commercial availability of vertical patient CT imaging and improved image guidance systems to mitigate the problem of anatomical motion in seated treatments. In this review, economical and clinical reasons for an upright patient positioning system are discussed. Existing designs targeted for particle therapy are reviewed, and conclusions are drawn on the design and construction of chair systems and associated image guidance. Finally, the different aspects from literature are channeled into recommendations for potential upright treatment layouts, both for retrofitting and new facilities.

show abstract

Section: Introductionmentioning

confidence: 99%

Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…Patient setup using an upright treatment posture has also been shown to reduce thoracic motion while increasing lung volume, and has been suggested as a potential motion mitigation strategy for lung cancer patients who cannot tolerate DIBH ( 174 ). A limitation of upright radiotherapy treatment posture is that for patient simulation it necessitates using a vertical CT to ensure accurate localization of anatomy between simulation and treatment; currently upright treatment of charged ion beams is limited to only a few centers ( 175 ).…”

Section: Future Technologiesmentioning

confidence: 99%

Management of Motion and Anatomical Variations in Charged Particle Therapy: Past, Present, and Into the Future

et al. 2022

View full text Add to dashboard Cite

The major aim of radiation therapy is to provide curative or palliative treatment to cancerous malignancies while minimizing damage to healthy tissues. Charged particle radiotherapy utilizing carbon ions or protons is uniquely suited for this task due to its ability to achieve highly conformal dose distributions around the tumor volume. For these treatment modalities, uncertainties in the localization of patient anatomy due to inter- and intra-fractional motion present a heightened risk of undesired dose delivery. A diverse range of mitigation strategies have been developed and clinically implemented in various disease sites to monitor and correct for patient motion, but much work remains. This review provides an overview of current clinical practices for inter and intra-fractional motion management in charged particle therapy, including motion control, current imaging and motion tracking modalities, as well as treatment planning and delivery techniques. We also cover progress to date on emerging technologies including particle-based radiography imaging, novel treatment delivery methods such as tumor tracking and FLASH, and artificial intelligence and discuss their potential impact towards improving or increasing the challenge of motion mitigation in charged particle therapy.

show abstract

“…However, there are only twelve operational carbon ion therapy centers worldwide. The availability of heavy ion treatment is quite limited worldwide due to the high requirement of related technological research and the costly construction of medically dedicated accelerator and support systems ( 27 ). The heavy ion equipment is large in size, high in installation and operating costs, and the rotating gantry treatment technology is easier to implement in the proton equipment.…”

Section: Proton and Carbon Ion Therapy Facilitiesmentioning

confidence: 99%

Flourish of Proton and Carbon Ion Radiotherapy in China

Jiang

et al. 2022

Front. Oncol.

View full text Add to dashboard Cite

Proton and heavy ion therapy offer superior relative biological effectiveness (RBE) in the treatment of deep-seated tumors compared with conventional photon radiotherapy due to its Bragg-peak feature of energy deposition in organs. Many proton and carbon ion therapy centers are active all over the world. At present, five particle radiotherapy institutes have been built and are receiving patient in China, mainly including Wanjie Proton Therapy Center (WPTC), Shanghai Proton Heavy Ion Center (SPHIC), Heavy Ion Cancer Treatment Center (HIMM), Chang Gung Memorial Hospital (CGMH), and Ruijin Hospital affiliated with Jiao Tong University. Many cancer patients have benefited from ion therapy, showing unique advantages over surgery and chemotherapy. By the end of 2020, nearly 8,000 patients had been treated with proton, carbon ion or carbon ion combined with proton therapy. So far, there is no systemic review for proton and carbon ion therapy facility and clinical outcome in China. We reviewed the development of proton and heavy ion therapy, as well as providing the representative clinical data and future directions for particle therapy in China. It has important guiding significance for the design and construction of new particle therapy center and patients’ choice of treatment equipment.

show abstract

Physics and biomedical challenges of cancer therapy with accelerated heavy ions

Cited by 74 publications

References 197 publications

Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

Management of Motion and Anatomical Variations in Charged Particle Therapy: Past, Present, and Into the Future

Flourish of Proton and Carbon Ion Radiotherapy in China

Contact Info

Product

Resources

About