Proton Therapy in the UK – Where are we? 1. Proton therapy has advantages over traditional x-ray therapy by depositing most of the radiation dose in the tumor target and minimizing dose to surrounding healthy tissues due to the Bragg peak effect. 2. The UK currently has two proton therapy centers (UCL and Christies) but commercial expansion is limited by the large size and costs of proton therapy equipment. 3. Research is ongoing to develop more compact and affordable proton therapy technologies like laser-driven ion accelerators and advanced beam delivery systems to help make proton therapy more widely available.

1. Proton Therapy in the UK –
Where are we?
Professor Mark Glaser

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Disclosure

3. Principles of Radiotherapy
• The goal of the Clinical Oncologist is to
achieve the best chance of local control with
radiotherapy.
Getting the balance right
The greatest chance of tumour kill vs The least damage to normal tissue

4. Motivation for Proton / Hadron therapy
• The Bragg peak gives us
the opportunity to reduce
the dose delivered to
healthy tissue while
maintaining the dose
delivered to the tumour
• But:
The mass of hadrons is at
least 2000 times greater,
making the equipment large
and costly.

5. 1. No exit Dose
2. Significantly less entrance dose
than target dose
3. Most dose deposited in target
1. Substantial exit dose
2. More entrance dose than target dose
3. Most dose deposited outside target
Proton Beam Therapy v X-ray Therapy

6. Proton Treatment Centres
• Approximately 54 facilities worldwide, but
some of these are dedicated for research
• Approximately 120,000 people have been
treated to date

7. Protons in the UK
• NHS - UCL and Christies
• Commercial ambitions
– LIGHT technique (Linac guided image technology)
– Compact cyclotron (Proteus One Gantry, IBA)

8. High Energy Physics
Staffrticle Therapy Group
– Physicists, clinicians, radiobiologists, healthcare
economists and engineers
Research and Evaluation
– Present and future clinical particle therapy
– Clinical indications
– Radiobiological studies
– Clinical particle therapy / healthcare economics

9. The question of RBE
• The radio biological
effectiveness (RBE) is the
ratio between the physical
dose required for radiation
of type i and the
equivalent dose required
for radiation of type x for
the same biological result.
• But: The RBE for hadrons is
less well known than for
conventional therapy.

10. Laser driven ion accelerators
• Laser driven acceleration of hadrons allows for
extremely compact accelerators with possible
enormous effects on costs.
• But: Energy spectrum of beam and use of
conventional beam formation contradict possible
savings
Activities:
collaboration with
other groups
including Dublin
and RAL

11. Space Charge Lenses
• For hadrons the focal
strength of these lenses
exceeds all other lens
systems by more than a
factor of 40.
• But the control of the
space charge cloud was
difficult in experiments.
Activities: Development,
manufacturing and test of lens
prototype. Test using laser
accelerated ions in near future at
Imperial College.

12. Advanced FFAG design for Treatment
Gantries
• Novel design of beam
delivery system will allow
beams with large
momentum spread being
delivered to patient.
• multiple energy particles
delivered simultaneously.
• But: New technology with
high requirements
concerning field quality.
Requires demonstrator. Activities: Development of theoretical model. Particle tracking
simulations performed successfully.

13. Dedicated Radio-biological Facility
• Delivery of
beam with
large energy /
mass variation
• For in vitro
and in vivo
experiments

14. Advanced Setup for Treatment
• Significantly
reduced footprint
• Advanced beam
handling and beam
delivery.
• Novel treatment
modalities for
reduced treatment
time.

15. Definitive Clinical Indications
National Specialised Commissioning
Team

16. Possible Future Indications
• These include the more common tumours and
if there is a therapeutic advantage using
Protons, the number of facilities needed will
increase enormously

17. • Increasing incidence. Clinically difficult to treat the edge of the tumour.
New surgical technology combined with high doses of radiation may
improve survival
• Complex treatment options (eg. robotic surgery). IMRT allows a high
dose to be given to the tumour with few lasting side effects. However
particle therapy has been used for many years at proton centres in the
USA. Further evaluation needed

18. • Cardiac toxicity and late effects: Being studied. Protons may be useful
where extended field treatment is necessary.
Photons Protons IMRT

19. • Immunotherapy: May improve survival. High incidents of local disease
progression in NSCLC. Difficulty in dose escalation if tumour is close to
critical structures ( Spinal cord / Oesophagus.)
• Tumour recurrences: Radiation therapy given at the original tumour site. At
present dangerous because of necrosis and harm to neighbouring organs.
Proton therapy may be of benefit.

20. The Future
• Few clinical trials at present
• More radiobiological data needed
• Definitive survivorship data
• ? Modification of equipment /Healthcare economics
• The role of radiotherapy in conjunction with surgery, chemotherapy ,
immunotherapy and genetic treatments
• Research into future generations of particles. Eg. carbon ions
• Hypofractionation so as to minimise lengths of treatments and to increase
therapeutic ratio
• Mixed treatments with Photon and Protons

21. Thank you