Vision : Proton therapy

Abstract

The first patients were treated with proton beams in 1955 at the Lawrence Berkeley Laboratory in California. In 1970, proton beams began to be used in research facilities to treat cancer patients using fractionated treatment regimens. It was not until 1990 that proton treatments were carried out in hospital-based facilities using technology and techniques that were comparable to those for modern photon therapy. Clinical data strongly support the conclusion that proton therapy is superior to conventional radiation therapy in a number of disease sites. Treatment planning studies have shown that proton dose distributions are superior to those for photons in a wide range of disease sites indicating that additional clinical gains can be achieved if these treatment plans can be reliably delivered to patients. Optimum proton dose distributions can be achieved with intensity modulated protons ͑IMPT͒, but very few patients have received this advanced form of treatment. It is anticipated widespread implementation of IMPT would provide additional improvements in clinical outcomes. Advances in the last decade have led to an increased interest in proton therapy. Currently, proton therapy is undergoing transitions that will move it into the mainstream of cancer treatment. For example, proton therapy is now reimbursed, there has been rapid development in proton therapy technology, and many new options are available for equipment, facility configuration, and financing. During the next decade, new developments will increase the efficiency and accuracy of proton therapy and enhance our ability to verify treatment planning calculations and perform quality assurance for proton therapy delivery. With the implementation of new multi-institution clinical studies and the routine availability of IMPT, it may be possible, within the next decade, to quantify the clinical gains obtained from optimized proton therapy. During this same period several new proton therapy facilities will be built and the cost of proton therapy is expected to decrease, making proton therapy routinely available to a larger population of cancer patients.

Future of medical physics: Real‐time MRI‐guided proton therapy

“…In 2009, Smith published a Vision 20/20 article entitled "Proton Therapy". 61 In this paper, the overwhelming predictions for the coming decade were that intensity-modulated proton beam therapy would be a key element in bringing proton therapy forward. Along with this, several new centers were anticipated, and the cost of proton therapy was expected to decrease dramatically with advances in accelerator technology and single room gantry solutions becoming available.…”

Determination of mean ionization potential using magnetic resonance imaging for the reduction of proton beam range uncertainties: theory and application

“…HCP therapy has a distinct advantage of being able to deliver a high dose at deep depths while potentially sparing healthy tissue proximal and distal to the target position (Smith, 2009). This advantage is physically manifested by the Bragg peak in which the HCPs (most commonly protons) deposit a significant portion of their dose immediately before reaching the end of their range.…”

Patient handling system for carbon ion beam scanning therapy

“…One way to improve efficiency and lower costs is to minimize occupancy time of the treatment room by minimizing the time required for patient positioning and immobilization (21) . In our new facility, the patient enters the preparation room, changes into an examination gown, lies on the treatment table on the shuttle, and then undergoes any necessary preprocessing such as filling the bladder with sterilized water or emptying the rectum by enema.…”