the fast neutron therapy facility in essen– 90% adenoidcystic carcinoma. fast neutron therapy in...
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The Fast Neutron Therapy Facility in Essen
Andrea Wittig,Reinhard Hentschel, Wolfgang Baumhoer,
Wolfgang Sauerwein, Martin Stuschke
University Hospital Essen
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Centers for Neutron Therapy
• Essen: d(14)+Be
– First patient treated in 1978– 769 patients treated– Isocentric Gantry, irregular field sizes– Annual recruitment about 10 patients– 90% adenoidcystic carcinoma
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Fast neutron therapy in EssenPatients over the years
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1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006
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Fast neutron therapy in Essen
Hospital based facility in close connectionwith the PET Centre
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TCC cyclotron CV28
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CirceCyclotron Isocentric Neutron Therapy Facility
Radiological Center Essen
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Collimator inserts
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Liner wedge
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50° wedge filter
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Depth dose distribution of d(14)+Be neutrons with 11x11cm2 collimator
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Adenoid Cystic Carcinoma:5 years follow up after neutron irradiation
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Fast neutron therapy in Essen
• In 2003 for the first time, the German health care system has paid for fast neutron therapy.
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fast neutron therapyclinical applications accepted and covered
by the German health care system
• salivary gland:– adenoid cystic carcinoma
• that are inoperable or where there is residual disease after surgery (including R1)
• all recurrent not yet irradiated tumors • extensive perineural invasion
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Adenoid cystic Carcinoma:
procedures (1999)
• Recurrent or inoperable or R2 resected and R1 operated adenoidcystic carcinoma
R1 first boost with 6 x 0,8 Gy neutrons followed by 50 Gyphotons
R2 first boost with 6 x 0,9 Gy neutrons followed by 50 Gyphotons
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Recurrent or inoperable or R2 and R1 operated adenoidcystic carcinoma. In case of an extended perineural invasion also after R0 resection
R1 first boost with 3 x 0,8 Gy neutrons followed by 45-50 Gyphotons
R2 first boost with 4 x 0,8 Gy neutrons followed by 50 GyphotonsThe neutron “boost” is chosen to cover the tumour including safety margins, the photon irradiation is applied as conformal as possible
Adenoid cystic Carcinoma:
procedures (2003)
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Treatment of deep seated tumours
Possible because of the isocentric gantryusing multiple fields or moving beam therapy
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fast neutron therapy in locally advanced prostate carcinoma
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• Collaboration with Orleans:Photon irradiation applied in Essen Neutron irradiation in Orleans
• Accepted by health care system• Optimal use of the different energies
Treatment of deep seated tumours
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Collaboration with Orléans
Liposarcoma prior, 6 weeks and 3 years after combined photon/neutron irradiation
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Fast neutron therapy in EssenInternational collaboration
• Measurement of the spectrum of the beam, dosimetry, mathematical modelling– IRSN (F)– PTB (D)– INEEL (USA)– Nice (F)– JRC Petten (NL)
• Radiation Biology– Orléans (F)– Louvain-la-Neuve (B)
• Quality Assurance– The Cyclotron Trust (UK)
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fast neutron therapy:where is the future?
• combined photon-neutron therapy• optimized spatial dose distribution• 3D Treatment planning• BNCT enhanced fast neutron therapy• controlled clinical trials• coordinated and well structured collaboration between
the existing centers (stop the stand alone solutions!)
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International Workshop on Fast Neutron Therapyin Essen on 14-16 September 2006
Organization:
Wolfgang SauerweinDon Grocott
Reinhard HentschelAndrea Wittig
Gundula FranzIna GrübelBritta Hahn
Martina Rossi