The history of ion beam therapy in Germany

Jäkel, Oliver; Kraft, Gerhard; Karger, Christian P.

doi:10.1016/j.zemedi.2021.11.003

Cited by 18 publications

(14 citation statements)

References 98 publications

(115 reference statements)

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“…It is therefore not surprising that several groups have been, or are currently, investigating options for gantry-less particle therapy, including treatment delivery with the patient in an upright or seated position. In fact, for the pioneering studies on ion beam therapy, conducted at the Lawrence Berkeley National Laboratory (LBNL), patients were fixed in an upright position using a rotating chair setup and a vertical CT was installed (4). Gantry-less carbon ion therapy with a custom chair and even associated vertical CT imaging was reported by Kamada et al (5).…”

Section: Introductionmentioning

confidence: 99%

Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

et al. 2022

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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.

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Section: Introductionmentioning

confidence: 99%

Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

et al. 2022

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“…These attributes were historically considered during modality selection, which ultimately led to widespread use of carbon ions in Japan and Europe. 48 In the context of SHArc delivery, these attributes minimally altered effective dose patterns between the heavy ion species since dose is inherently more homogenously distributed in the low dose bath. Moreover, the LET d level afforded by SHArc using oxygen and carbon ions may increase volume of target yielding LET-RBE saturation (Figure S-1C) compared to conventional particle therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Particularly for higher beam energies, LET d in the Bragg peak will reduce due to energy straggling and fragmentation processes occurring with higher penetration depths (Figure S‐1A), resulting in increased low dose‐halo (Figure S‐1B) compared to carbon and oxygen ions, as well as increased entrance‐to‐peak ratios. These attributes were historically considered during modality selection, which ultimately led to widespread use of carbon ions in Japan and Europe 48 . In the context of SHArc delivery, these attributes minimally altered effective dose patterns between the heavy ion species since dose is inherently more homogenously distributed in the low dose bath.…”

Section: Discussionmentioning

confidence: 99%

Spot‐scanning hadron arc (SHArc) therapy: A proof of concept using single‐ and multi‐ion strategies with helium, carbon, oxygen, and neon ions

et al. 2022

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Purpose To present particle arc therapy treatments using single and multi‐ion therapy optimization strategies with helium (4He), carbon (12C), oxygen (16O), and neon (20Ne) ion beams. Methods and materials An optimization procedure and workflow were devised for spot‐scanning hadron arc therapy (SHArc) treatment planning in the PRECISE (PaRticle thErapy using single and Combined Ion optimization StratEgies) treatment planning system (TPS). Physical and biological beam models were developed for helium, carbon, oxygen, and neon ions via FLUKA MC simulation. SHArc treatments were optimized using both single‐ion (12C, 16O, or 20Ne) and multi‐ion therapy (16O+4He or 20Ne+4He) applying variable relative biological effectiveness (RBE) modeling using a modified microdosimetric kinetic model (mMKM) with (α/β)x values of 2, 5, and 3.1 Gy, respectively, for glioblastoma, pancreatic adenocarcinoma, and prostate adenocarcinoma patient cases. Dose, effective dose, linear energy transfer (LET), and RBE were computed with the GPU‐accelerated dose engine FRoG and dosimetric/biophysical attributes were evaluated in the context of conventional particle and photon‐based therapies (e.g., volumetric modulated arc therapy [VMAT]). Results All SHArc plans met the target optimization goals (3GyRBE) and demonstrated increased target conformity and substantially lower low‐dose bath to surrounding normal tissues than VMAT. SHArc plans using a singleion species (12C, 16O, or 20Ne) exhibited favorable LET distributions with the highest‐LET components centralized in the target volume, with values ranging from ∼80–170 keV/μm, ∼130–220 keV/μm, and ∼180–350 keV/μm for 12C, 16O, or 20Ne, respectively, exceeding mean target LET of conventional particle therapy (12C:∼55, 16O:∼75 20Ne:∼95 keV/μm). Multi‐ion therapy with SHArc delivery (SHArcMIT) provided a similar level of target LET enhancement as SHArc compared to conventional planning, however, with additional benefits of homogenous physical dose and RBE distributions. Conclusion Here, we demonstrate that arc delivery of light and heavy ion beams, using either a single‐ion species (12C, 16O, or 20Ne) or combining two ions in a single fraction (16O+4He or 20Ne+4He) affords enhanced physical and biological distributions (e.g., LET) compared with conventional delivery with photons or particle beams. SHArc marks the first single‐ and multi‐ion arc therapy treatment optimization approach using light and heavy ions.

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“…In the second set (Dokic et al 2016), survival of human alveolar adenocarcinoma A549 cells grown in monolayers was measured at the center of a scanned 1 cm spread out Bragg peak (SOBP) of clinical proton, helium, carbon and oxygen beams. Measurements were made at the Heidelberg Ion Therapy (HIT) facility (Combs et al 2010, Jäkel et al 2022.…”

Section: Association Of Id Parameters With Biological Effectmentioning

confidence: 99%

Ionization detail parameters and cluster dose: a mathematical model for selection of nanodosimetric quantities for use in treatment planning in charged particle radiotherapy

Faddegon,

Blakely,

Burigo

et al. 2023

Phys. Med. Biol.

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Objective: To propose a mathematical model for applying Ionization Detail (ID), the detailed spatial distribution of ionization along a particle track, to proton and ion beam radiotherapy treatment planning (RTP). Approach: Our model provides for selection of preferred ID parameters (Ip ) for RTP, that associate closest to biological effects. Cluster dose is proposed to bridge the large gap between nanoscopic Ip and macroscopic RTP. Selection of Ip is demonstrated using published cell survival measurements for protons through argon, comparing results for nineteen Ip : Nk ; k = 2,3,...,10, the number of ionizations in clusters of k or more per particle, and Fk ; k = 1,2,...,10, the number of clusters of k or more per particle. We then describe application of the model to ID-based RTP and propose a path to clinical translation. Main results: The preferred Ip were N4 and F5 for aerobic cells, N5 and F7 for hypoxic cells. Significant differences were found in cell survival for beams having the same LET or the preferred Nk . Conversely, there was no significant difference for F5 for aerobic cells and F7 for hypoxic cells, regardless of ion beam atomic number or energy. Further, cells irradiated with the same cluster dose for these Ip had the same cell survival. Based on these preliminary results and other compelling results in nanodosimetry, it is reasonable to assert that Ip exist that are more closely associated with biological effects than current LET-based approaches and microdosimetric RBE-based models used in particle RTP. However, more biological variables such as cell line and cycle phase, as well as ion beam pulse structure and rate still need investigation. Significance: Our model provides a practical means to select preferred Ip from radiobiological data, and to convert Ip to the macroscopic cluster dose for particle RTP.

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The history of ion beam therapy in Germany

Cited by 18 publications

References 98 publications

Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

Spot‐scanning hadron arc (SHArc) therapy: A proof of concept using single‐ and multi‐ion strategies with helium, carbon, oxygen, and neon ions

Ionization detail parameters and cluster dose: a mathematical model for selection of nanodosimetric quantities for use in treatment planning in charged particle radiotherapy

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