Which centre has the best experience in carbon ion treatment?
The National Institute of Radiological Sciences (NIRS) Chiba, Japan, has been treating cancer with high-energy carbon ions since 1994. So far, more than 8000 patients have had this treatment at NIRS, and the centre thus has by far the greatest experience in carbon ion treatment worldwide.
Where are proton therapy centres in the world?
Many proton therapy centres are active in the USA, Europe, and Asia, but only a few centres use heavy ions, even though these ions are much more effective than x-rays owing to the special radiobiological properties of densely ionising radiation.
Is charged particle radiotherapy cutting-edge?
Carbon ion radiotherapy in Japan: an assessment of 20 years of clinical experience Charged particle therapy is generally regarded as cutting-edge technology in oncology.
Where is carbon ion therapy available?
While carbon ion therapy was discovered in the United States in the 1970s, there currently are no carbon ion therapy treatment centers in North America. The technology is available only at a handful of centers in Asia and Europe.
How much do radiation treatment machines cost?
X-ray radiation therapy machines cost $3 million each; a big clinic would have several. But patients are used to getting what they want, especially in cancer care, where any chance at living longer with fewer side effects is worth trying, especially if someone else is picking up the tab.
What kinds of tumors are most suitable to be treated with high energetic carbon ions accelerator based heavy ion therapy?
Clinical experience at NIRS shows that carbon ions are effective in treating various solid-tumor histologic subtypes, including adenocarcinoma, adenoid cystic carcinoma, malignant melanoma, and various types of sarcomas, which are often resistant to conventional x-rays.
What are the 3 types of radiation treatment?
Three common types of internal radiation therapy include:Brachytherapy involves radioactive material that is implanted in the body. ... Intraoperative radiation therapy (IORT) is used to treat an exposed tumor during cancer surgery. ... Stereotactic radiosurgery (SRS) is not actually surgery.
How much does an IMRT machine cost?
The mean cost for SBRT was $49,504, compared with $57,244 for IMRT (P < .
Why is radiation therapy so expensive?
Radiation therapy can be expensive. It uses complex machines and involves the services of many health care providers. The exact cost of your radiation therapy depends on the cost of health care where you live, what type of radiation therapy you get, and how many treatments you need.
How does carbon ion therapy work?
What is carbon ion therapy / heavy ion therapy? With carbon ion irradiation, charged carbon nuclei are directed at the tumor. These are particularly heavy and loaded with energy; thus, this radiation is also called heavy ion therapy. HIT is one of a few centers worldwide offering heavy ion therapy.
What is heavy ion radiation?
In the field of radiation oncology, heavy ion beams are defined as radiation that is obtained by accelerating charged nuclei heavier than protons.
What is ion therapy?
Ion therapy is regarded as a new valuable addition to the arsenal of cancer control methods. The method of therapy is based on the physical characteristics of ions – electrically charged particles, which enter the human tissue with enormous speed and an accuracy, thereby releasing energy.
Which radiation therapy is best?
Other imaging options include X-rays, ultrasound, systems that track internal seeds and cameras that track a surface as it moves. Stereotactic radiosurgery/Gamma Knife radiosurgery: The Gamma Knife is considered the "gold standard" for radiation treatment for brain tumors or lesions.
Do tumors grow back after radiation?
Normal cells close to the cancer can also become damaged by radiation, but most recover and go back to working normally. If radiotherapy doesn't kill all of the cancer cells, they will regrow at some point in the future.
What is the success rate of radiation therapy?
“In fact, based on the literature reviewed, it appears that external-beam radiation therapy is a superior treatment in some cases. “When patients are treated with modern external-beam radiation therapy, the overall cure rate was 93.3% with a metastasis-free survival rate at 5 years of 96.9%.
How long does it take to get a lesion irradiated?
The time of actual irradiation varies depending on the location and size of the lesion and whether respiratory gating is required. Short treatments take less than 1 minute, and long treatments last 10 minutes or longer. There is no sensation of stimuli such as pain or heat as a result of the irradiation.
Can you participate in a rehearsal for intraocular cancer?
If you have an intraocular tumor, you can also participate in a treatment rehearsal. Before starting treatment, the hospital cancer board reviews matters such as the appropriateness of performing carbon ion radiotherapy, the suitability of the treatment and treatment plan, and whether the patients adequately understand the details ...
How long does photon radiotherapy last?
This cancer usually has a dismal prognosis. With photon radiotherapy plus chemotherapy, for inoperable tumours, 5-year local control is typically less than 50% and survival less than 20%, although control rates up to 75% and survival of 40% have been reported in small, highly selected case series.
What is NIRS radiotherapy?
NIRS is a pioneer in carbon ion radiotherapy and has contributed major paradigm shifts for radiotherapy and more generally for oncology. Besides improvements over the already favourable results achieved for some rare cancers, such as bone and soft-tissue tumours, the results reported lately support the hypothesis that carbon ion radiotherapy improves outcomes for several common cancers with poor prognosis. Therefore, more patients worldwide should have access to treatments based on carbon ion radiotherapy.
Why are protons used in head and neck cancer?
Results of proton therapy for cancers of the head and neck are difficult to interpret, because protons were frequently used as a boost or combined with surgery in large variety of pathological types. Studies at NIRS
What is the purpose of the NIRS radiobiology programme?
The NIRS radiobiology programme should intensify its efforts to strengthen international collaborations, especially with carbon ion radiotherapy facilities in Europe, to achieve the goal of an international standard for the use of the biologically effective dose in treatment planning with ion beams.
What is charged particle therapy?
Charged particle therapy is generally regarded as cutting-edge technology in oncology. Many proton therapy centres are active in the USA, Europe, and Asia, but only a few centres use heavy ions, even though these ions are much more effective than x-rays owing to the special radiobiological properties of densely ionising radiation. The National Institute of Radiological Sciences (NIRS) Chiba, Japan, has been treating cancer with high-energy carbon ions since 1994. So far, more than 8000 patients have had this treatment at NIRS, and the centre thus has by far the greatest experience in carbon ion treatment worldwide. A panel of radiation oncologists, radiobiologists, and medical physicists from the USA and Europe recently completed peer review of the carbon ion therapy at NIRS. The review panel had access to the latest developments in treatment planning and beam delivery and to all updated clinical data produced at NIRS. A detailed comparison with the most advanced results obtained with x-rays or protons in Europe and the USA was then possible. In addition to those tumours for which carbon ions are known to produce excellent results, such as bone and soft-tissue sarcoma of the skull base, head and neck, and pelvis, promising data were obtained for other tumours, such as locally recurrent rectal cancer and pancreatic cancer. The most serious impediment to the worldwide spread of heavy ion therapy centres is the high initial capital cost. The 20 years of clinical experience at NIRS can help guide strategic decisions on the design and construction of new heavy ion therapy centres.
Is sacral chordoma incurable?
Medically inoperable sacral chordomas are deemed to be incurable. Therefore, the 5-year local control rate of 88% and survival of 86% achieved at NIRS are excellent outcomes; however, they carry a cost of late side-effects. 15 of 95 patients with sacral chordoma developed severe sciatic nerve side-effects, but eight remained able to walk with or without a supportive device.
Why is carbon ion radiotherapy used?
Since carbon ion radiotherapy uses carbon particles which are 12 times heavier than protons, it possesses properties that make it suitable for the treatment of cancer due to its improved physical dose distribution and biological effects.
What does aligning the carbon ion peak area with the location and size of the lesion mean?
Accordingly, aligning the carbon ion peak area with the location and size of the lesion means that both physically and biologically a greater dosage (impact) can be given to the lesion instead of to the surrounding healthy tissue.
When did carbon ion radiotherapy start?
Before NIRS started carbon ion radiotherapy in 1994, the US NCI supported clinical trials14 for two decades to investigate the clinical effi cacy of heavy-charged particles at the Lawrence Berkeley National Laboratory, Berkeley, CA, until the closure of the Bevalac accelerator facility (1975–93). In the fi rst decade after the inception of the carbon ion radiotherapy clinical trials at NIRS, it was the only facility in the world conducting carbon ion radiotherapy. The second decade (2004–13) was marked by acceptance of the clinical worth of carbon ion radiotherapy by medical communities worldwide, and clinical facilities were constructed and clinical trials started at the Heidelberg Ion Therapy Centre50 (Heidelberg, Germany; start of treatment in 2009), CNAO51 (Pavia, Italy; 2012), and three other carbon ion radiotherapy facilities in Japan and two in China. Several other facilities are under construction and will soon become available for clinical trials.3The coming third decade of carbon ion radiotherapy is expected to be the period when clinical trials will be undertaken at several facilities worldwide. A few phase 3 clinical trials on protons versus carbon ions are already under way at the Heidelberg Ion Therapy Centre.12 Similar trials are planned at CNAO, where a trial in collaboration with France Hadron (Lyon) is also planned, comparing carbon ion radiotherapy with intensity-modulated radiotherapy for head and neck tumours with 16 fractions. The J-CROS project will involve the Japanese facilities in multicentre trials for several new tumour sites, which are emerging as most attractive for carbon ion radiotherapy randomised trials. To facilitate a meaningful comparison of these carbon ion radiotherapy results, worldwide announcement and international registration of these coordinated clinical trials will be provided.Through international cooperation, the carbon ion radiotherapy community should coordinate therapy planning and delivery in such a way that clinical results can be compared readily, with reliable and verifi able dosimetry reporting. In this respect, the report on dose and volume specifi cations for prescribing and reporting ion beam therapy is eagerly awaited.
What is NIRS radiotherapy?
NIRS is a pioneer in carbon ion radiotherapy and has contributed major paradigm shifts for radiotherapy and more generally for oncology. Besides improvements over the already favourable results achieved for some rare cancers, such as bone and soft-tissue tumours, the results reported lately support the hypothesis that carbon ion radiotherapy improves outcomes for several common cancers with poor prognosis. Therefore, more patients worldwide should have access to treatments based on carbon ion radiotherapy.
What is hypofractionated radiotherapy?
Hypofractionated radiotherapy is regarded as an alternative to surgery for localised non-small-cell lung cancer, with x-ray stereotactic body radiotherapy23 or protons. At NIRS, for peripheral stage I non-small-cell lung cancer, the number of fractions was reduced in diff erent trials from 18 to nine, then four, and fi nally to a single fraction. Respiratory gating treatments were used to mitigate the eff ect of target motion. The results with carbon ion radiotherapy in stage IA non-small-cell lung cancer are similar to the best stereotactic body radiotherapy results reported worldwide. For stage IB disease, carbon ion radiotherapy results seem superior to those reported for photon stereotactic body radiotherapy in terms of local control and lung toxicity. Despite high local control, survival is much lower in stage IB than in stage IA because distant metastatic recurrences are Combination of carbon ion radiotherapy with systemic therapy is therefore essential to improve survival. A dose-escalation study for single-fraction treatment is under way at NIRS, in which higher local control and survival have been observed with minor toxicity. At present, the single-fraction dose is escalated to 50 GyE with high local control and acceptable adverse eff ects.
Is sacral chordoma incurable?
Medically inoperable sacral chordomas are deemed to be incurable. Therefore, the 5-year local control rate of 88% and survival of 86% achieved at NIRS are excellent outcomes; however, they carry a cost of late side-eff ects. 15 of 95 patients with sacral chordoma developed severe sciatic nerve side-eff ects, but eight remained able to walk with or without a supportive device.24 In view of the poor prognosis for these patients without carbon ion radiotherapy, these side-eff ects could be acceptable, but eff orts to reduce adverse eff ects on the sciatic nerve are
Résumé
Avec un premier patient traité en 1994, le Japon s’est imposé comme précurseur dans l’utilisation des ions carbone pour le traitement des tumeurs.
Clinical trials
Fig. 2. Schematic of the Gunma University Heavy Ion Medical Center (GHMC) facility, which opened in March. The insets show the facility's various components.
Future outlook
Following on from the pilot facility at GHMC, two additional projects for carbon-ion radiotherapy have been initiated in Japan: the Saga Heavy Ion Medical Accelerator in Tosu (Saga-HIMAT) and the Kanagawa Prefectural project. The Saga-HIMAT project started construction of a carbon-ion radiotherapy facility in February 2010.