Particle therapy

Particle therapy
Intervention
ICD-9: 92.26

Particle therapy is a form of external beam radiotherapy using beams of energetic protons, neutrons, or positive ions for cancer treatment. The most common type of particle therapy as of 2009 is proton therapy. Although a photon, used in x-ray or gamma ray therapy, can also be considered a particle, photon therapy is not considered here. Additionally, electron therapy is generally put into its own category. Because of this, particle therapy is sometimes referred to, more correctly, as hadron therapy (that is, therapy with particles that are made of quarks).

Muon therapy has occasionally been attempted; it is a rare type of particle therapy that does not belong to the previously mentioned categories.

Contents

Method

The dose from protons to tissue is maximum just over the last few millimeters of the particle’s range, quite different from that of electrons or x rays.

Particle therapy works by aiming energetic ionizing particles at the target tumor[1][2]. These particles damage the DNA of tissue cells, ultimately causing their death. Because of their reduced ability to repair damaged DNA, cancerous cells are particularly vulnerable to attack.

The figure shows how beams of electrons, X-rays or protons of different energies (expressed in MeV) penetrate human tissue. Electrons have a short range and are therefore only of interest close to the skin (see electron therapy). Bremsstrahlung X-rays penetrate more deeply, but the dose absorbed by the tissue then shows the typical exponential decay with increasing thickness. For protons and heavier ions, on the other hand, the dose increases while the particle penetrates the tissue and loses energy continuously. Hence the dose increases with increasing thickness up to the Bragg peak that occurs near the end of the particle's range. Beyond the Bragg peak, the dose drops to zero (for protons) or almost zero (for heavier ions).

The advantage of this energy deposition profile is that less energy is deposited into the healthy tissue surrounding the target tissue.

The ions are first accelerated by means of a cyclotron or synchrotron. The final energy of the emerging particle beam defines the depth of penetration, and hence, the location of the maximum energy deposition. Since it is easy to deflect the beam by means of electro-magnets in a transverse direction, it is possible to employ a raster scan method, i.e., to scan the target area quickly like the electron beam scans a TV tube. If, in addition, the beam energy and hence, the depth of penetration is varied, an entire target volume can be covered in three dimensions, providing an irradiation exactly following the shape of the tumor. This is one of the great advantages compared to conventional x-ray therapy.

At the end of 2008, 28 treatment facilities were in operation worldwide, and over 70000 patients had been treated by means of pions[3][4], protons and heavier ions worldwide. Most of this therapy has been with protons.[5].

Proton therapy

see the main article Proton therapy.

Fast neutron therapy

Heavy ion therapy

Heavy ion therapy is the use of particles more massive than protons or neutrons, such as carbon ions. Compared to protons, carbon ions have an advantage: due to the higher density of ionisation at the end of their range[6], correlated damages of the DNA structure within one cell occur more often so that it becomes more difficult for the cancerous cell to repair the damage. This increases the biological efficiency of the dose by a factor between 1.5 and 3. Compared to protons, carbon ions have the disadvantage that beyond the Bragg peak, the dose does not decrease to zero[6], since nuclear reactions between the carbon ions and the atoms of the tissue lead to production of lighter ions which have a higher range. Therefore, some damage occurs also beyond the Bragg peak.

By the end of 2008, more than 5000 patients had been treated using carbon ions[5].

Carbon ion centers in operation

The Particle Therapy Co-Operative Group continuously lists treatment centers in operation and in the planning or construction stage[5]. At present (end of 2008), only two centers using carbon ions are in operation, both in Japan: the HIMAC[7] at Chiba and the HIBMC[8] at Hyogo. In Germany, treatment at the Gesellschaft für Schwerionenforschung (GSI)[9] in Darmstadt, which is primarily a physics laboratory, has been discontinued in 2008, but the new HIT[10] in Heidelberg, which is a dedicated facility, started in November 2009. The CNAO in Pavia, Italy is going to open in 2011 and will be one of the most advanced centers for particle therapy with hadrons. CNAO will combine precise dose delivery with highly accurate patient alignment based on stereoscopic X-ray imaging[11]. Sophisticated approaches in image-guided particle therapy (IGPT) augments the radiotherapy machines with imaging capabilities and the latest computer vision technology to increase accuracy of target localization and enable patient alignment accuracies of 0.5 mm and better.

References

  1. ^ U. Amaldi, G. Kraft: Radiotherapy with beams of carbon ions. Rep. Progr. Physics 68 (2005) 1861, 1861 - 1882
  2. ^ O. Jäkel: State of the art in hadron therapy. AIP Conference Proceedings, vol. 958, no.1, 2007, pp. 70-77
  3. ^ von Essen CF, Bagshaw MA, Bush SE, Smith AR, Kligerman MM (September 1987). "Long-term results of pion therapy at Los Alamos". Int. J. Radiat. Oncol. Biol. Phys. 13 (9): 1389–98. PMID 3114189. 
  4. ^ "TRIUMF: Cancer Therapy with Pions". http://triumf.ca/welcome/pion_trtmt.html. 
  5. ^ a b c PTCOG: Particle Therapy Co-Operative Group
  6. ^ a b http://www.extreme-light-infrastructure.eu/Hadron-therapy-for-cancer-treatment_5_5.php (See fig 2)
  7. ^ National Institute of Radiological Sciences
  8. ^ Hyogo Ion Beam Medical Center
  9. ^ Gesellschaft für Schwerionenforschung
  10. ^ Heidelberger Ionenstrahltherapiezentrum
  11. ^ Boris Peter Selby, et al. (2010) Full Automatic X-Ray based Patient Positioning and Setup Verification in Practice: Accomplishments and Limitations. In: Proceedings of the 49th Conference of the Particle Therapy Co-Operative Group (PTCOG). Gunma, Japan, 49

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