Pencil Beam Scanning to be primary proton delivery tool

Offering exceptional advantages in precision, dose conformity and patient throughput, Pencil Beam Scanning is poised to be the go-to proton delivery method at new proton therapy centers worldwide.

At 3 millimeters, about the diameter of a smart phone audio plug, the beam spot from Pencil Beam Scanning “is very high quality — meaning, at high energy, it’s very small in size and maintains good quality throughout the energies used for patient treatment,” says Jonathan Farr, Ph.D., Chief Medical Physicist at Westdeutsches Protonentherapiezentrum Essen (WPE), the proton therapy center in Essen, Germany. Farr is helping oversee the first large-scale commercial deployment of Pencil Beam Scanning in the world. Each of WPE’s four patient treatment rooms — three gantry rooms and one fixed-beam room — is equipped for Pencil Beam Scanning. WPE is expected to treat its first patient by the spring of 2011.

“The beam spot primarily defines how sharp the radiation field is,” Farr explains. “So, if you have a tumor abutting the brain stem or rectum or major organs, you want a sharp beam edge to keep to the tumor.” Pencil Beam Scanning also offers a very rapid dose delivery of about two minutes. “Time has a quality and efficiency implication,” Farr says, “because once you have the patient set up and still, you want the fractions to go quickly. And that ensures better patient treatment quality and throughput. So, in many clinical indications, Pencil Beam Scanning is a win-win: high definition, conformity and high efficiency at the same time.”

Pencil Beam Scanning usually omits the need for individualized brass apertures and range compensators that are required for each patient treated with single and double scattering or uniform scanning. “Pencil Beam Scanning doesn’t have anything in the way,” Farr says. “You mostly get pure protons.” Farr predicts Pencil Beam Scanning will enable swift adaptive radiotherapy at WPE, especially since staff will conduct imaging on proton therapy patients every day. “Daily imaging will provide a mountain of data,” says Farr, “allowing us to fine-tune treatments with a Pencil Beam Scanning system. Although new fields should be verified, for beam delivery, it’s a simple change to the computer file. Again, usually there’s no need to make a new brass aperture and compensator.”

Even though Pencil Beam Scanning is an extremely sophisticated tool, treatment plans for it are far less onerous to devise than those for other proton therapy methods, Farr notes. “Treatment plans for scattering treatments are very painstaking to develop,” he says. “They require highly experienced proton treatment planners and take a lot of time to produce. Now, we can look to well qualified radiation therapy personnel in general. Anyone who can devise a good-quality IMRT [intensity-modulated radiation therapy] treatment plan can do a good-quality Pencil Beam Scanning plan with just a little training. Then, the planning workflow can be as efficient as in photon therapy.” Considering the many advantages of Pencil Beam Scanning, “I don’t suppose any new center will be built without Pencil Beam Scanning,” Farr says.

First patients treated at Hampton University

The Hampton University Proton Therapy Institute in Hampton, Virginia, has treated its first cancer patient with protons, one month before its scheduled October 2010 grand opening.

The development of the Hampton University Proton Therapy Institute was conceived several years ago by University President William R. Harvey, Ph.D. He wanted the University to play a key role in narrowing the racial disparity in cancer care in the United States. Indeed, according to findings published in the journal Cancer, there were clear racial differences in cancer treatment in the United States. Researchers examined the cancer treatment of more than 143,000 Americans over age 65 from 1992 to 2002: whether being treated for lung, breast, colon, rectal or prostate cancer, black patients were consistently less likely than white patients to receive recommended procedures, the study found. Moreover, the disparity in cancer incidence rates between Black and White people was greater in Virginia (as certain types of cancer rather affect Black people, and Virginia lists a higher rate of Black people than in the rest of the country), but the new technology brought into the state was not duplicated anywhere in Virginia

Harvey was thus determined to help bridge the cancer care gap, at least in the mid-Atlantic states, the area from which the majority of patients are likely to be drawn, and convinced that developing a proton therapy center at the 140-year-old historically black college will help attain this objective, and in October 2007, the Hampton University joined the fight against cancer. Harvey declared: “Our proton therapy center will provide all our citizens — black and white, young and old, men and women — with another modality to fight cancer. It represents a revolution in science and cancer treatment”.

In November 2010, the Center opened and treated its first patient. The 64-year-old prostate cancer patient had been scheduled to have his prostate surgically removed in January 2010. But a friend suggested he consider “this proton institute thing.” Surprised it had been overlooked by his physician, the patient cancelled the surgery and sought out the oncologists at the Hampton proton center.

With four gantry rooms, one inclined-beam room, the latest options for patient positioning and nozzle technologies and en expected throughput of 125 patients treated a day, Hampton is the eighth proton therapy center to open in the U.S. It will focus primarily on prostate cancer, but also on treating patients with breast, lung, eye and pediatric cancers.

New cyclotron at Institut Curie in Orsay

In December 2006, Institut Curie – Orsay (CPO) decided to expand its Proton Therapy Center to double patient throughput. In July 2007, the installation began and was scheduled to be complete in 2010. Cancer patients are now being treated with protons generated by the newly installed cyclotron.

The Orsay Proton Therapy Center, acclaimed for its vast expertise and experience in treating the most complex cancer cases, has successfully expanded with new proton therapy equipment, a new medical wing, an anesthesia unit for pediatrics, offices and meeting rooms. A new cyclotron was added to the two existing fixed-beam treatment rooms, and an isocentric-gantry treatment room (primarily for pediatric patient care) was installed. “By acquiring the latest generation proton therapy equipment, thanks to major financial assistance from the French Ministry of Health, the Institut Curie is enhancing its position as a leading-edge hospital on the European scale”, said Dr. Claude Huriet, the Institut President. This addition should allow the center to treat twice as many patients.

The new cyclotron delivers a higher dose rate than the previous cyclotron, resulting in shorter treatment duration and overall improved treatment. The cyclotron was installed along with a new gantry room in a building extension to the proton center. The cyclotron also serves two fixed-beam treatment rooms that were a part of the original facility. Treatment preparation areas and the patient waiting room were also expanded. The new gantry room is expected to serve primarily pediatric cancer patients. A new Robotic Patient Positioning System — the first of its kind in Europe — facilitates targeted proton beam treatments.

Growing number of treatment centers thanks to ProCure

ProCure Treatment Centers, Inc. , the private proton therapy center development group based in Bloomington, Indiana, is bringing superior treatment to U.S. cancer patients with a simpler, more accessible business approach for medical teams.

The ProCure business model overcomes the need for physician specialists to be real estate developers and facility managers. Instead, hospital groups and radiation oncology practices can do what they do best: oversee clinical operations at ProCure Proton Therapy centers. ProCure secures project financing, oversees design and construction, and maintains facility ownership and operational responsibility. By 2012, patients will be treated at three ProCure facilities in the United States.

John Cameron, Ph.D., the nuclear physicist who founded ProCure in 2005, has kept his company focused on fulfilling its mission: to make proton therapy a viable and accessible option for people with cancer. “It is extraordinary how far we have come in five years, despite the struggling global economy,” Cameron says. “We completed our first proton therapy center in Oklahoma City last year, and we’ll have a facility opening in Illinois this November and a third in New Jersey in 2012.”

Clinical care at the ProCure Proton Therapy Center in Oklahoma City, Oklahoma, is delivered by the physician specialists of Radiation Medicine Associates. The center is affiliated with INTEGRIS HealthThe CDH Proton Center , is affiliated with Central DuPage Hospital in Warrenville, Illinois, near Chicago. Clinical services at the Illinois facility will be directed by physician specialists from Radiation Oncology Consultants, one of the largest private practice radiation oncology groups in the state.  Additional cancer care services will be provided by Central DuPage Hospital. The physician specialists of Princeton Radiation Oncology will provide clinical care at the ProCure Proton Therapy Center, located in Somerset,New Jersey. The facility will be affiliated with the CentraState Health System of Freehold, New Jersey.

To optimize patient access, each of the new facilities will utilize a 360-degree gantry room, a fixed-beam room and two inclined-beam rooms. A Robotic Patient Positioning System will adjust the patient alignment to ensure optimal beam delivery. Applying learnings from its Oklahoma City project, ProCure has reduced the time frames for construction and equipment installation at both newer projects by about three months after beating the prior U.S. record by nine months in the development of the Oklahoma center.