12 2011
IMAGING & ONCOLOGY
size and cost of the cyclotron or synchrotron equipment necessary for patient treatments. Several companies are currently working on developments to reduce the size of clinical systems to deliver proton radiotherapy to patients. Figure 6 shows compact designs from two separate proton manufacturers.
CHALLENGES AND OPPORTUNITIES FOR THE UK For a UK based proton radiotherapy centre to be operational, there will need to be a signifi cant investment in staff training and education. The inclusion of proton radiotherapy in the educational syllabi for medical physicists, therapeutic radiographers and clinical oncologists, should be considered in the near future. This would provide the necessary background knowledge of the technologies and clinical applications to staff entering the profession over the next few years.
In addition, due to the high capital cost of the required equipment, and the relatively slow throughput of patients in proton radiotherapy centres, the standard hours of operation of hospital based proton centres is usually in excess of 10 hours a day, requiring multiple staff shifts and patient treatments potentially from 8am to 10pm. A UK proton service will therefore be required to provide an appropriate patient service for a routinely extended day, beyond the normal experience of radiotherapy departments. Servicing and medical physics support is also likely to take place outside of the extended working day, producing a major change in working practice for this staff group. These major changes for staff need to be considered in the context of providing an appropriate proton radiotherapy service for the benefi t of patients in the UK.
In conclusion, there is a clinical need for proton radiotherapy in the UK although, ultimately, the clinical effectiveness of proton treatments should be demonstrated by clinical trials. The UK would be well placed to perform multi-institutional trials with close co-operation between UK institutions, with all proton treatments performed according to agreed protocols. Providing such evidence will lead to knowledge of the real proportion of patients for whom proton radiotherapy would be advantageous. It would also provide greater information about the cost effectiveness of proton radiotherapy, and allow for the future development of proton radiotherapy centres in the UK to be truly evidence based.
A UK national proton service, whether delivered within two or three treatment centres, provides a unique opportunity for consistent proton treatments according to nationally agreed protocols, with reliable and standardised long term follow-up of patients.
Carl Rowbottom leads the radiotherapy physics group at the Christie NHS Foundation Trust, Manchester. He is a fellow of the Institute of Physics in Engineering in Medicine and is the Institute’s representative on the National Radiotherapy Implementation Group.
Adult Base of Skull & Spinal Chordoma Base of Skull Chondrosarcoma Spinal & Paraspinal Bone and Soft Tissue Sarcomas (Non Ewing’s)
Paediatric Base of Skull & Spinal Chordoma Base of Skull Chondrosarcoma Spinal & Paraspinal ‘adult type’ Bone and Soft Tissue Sarcomas
Rhabdomyosarcoma Orbit Parameningeal & Head & Neck Pelvis
Ependymoma Ewing’s Sarcoma Retinoblastoma Pelvic Sarcoma Optic Pathway and other selected Low Grade Glioma Craniopharyngioma Pineal Parenchymal Tumours (not Pineoblastoma) Esthesioneuroblastoma
Table 1: List of approved diagnoses from the specialised commissioning service of the NHS.
REFERENCES 1. Wilson R. Radiological Use of Fast Protons, Radiology, 1946; 47:487-491.
2. J. Sisterson, Ion beam therapy in 2004, Nuclear Instruments and Methods in Physics Research B 2005; 241 713-716.
3. Department of Health. Improving Outcomes: A strategy for cancer. HMSO. London, January 2011.
4. Palm A, Johansson K A. A review of the
impact of photon and proton external beam radiotherapy treatment modalities on the dose distribution in fi eld and out-of-fi eld; implications for the long term morbidity of cancer survivors. Acta Oncologica, 2007, 46(4):462-73.
5. Zietman A, Goitein M, Tepper J E. ‘Technology evolution: is it survival of the fi ttest?’ J Clin Oncol. 2010 Sep 20; 28(27):4275-9.
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