Pub Date : 2021-08-18DOI: 10.5772/intechopen.95959
Ameer L. Elaimy, L. Ding, C. Bradford, Yansong Geng, H. Bushe, I-lin Kuo, Yankhua Fan, Fenhong Liu, A. Khalifeh, Suhong Yu, J. Saleeby, James Shen, Kevin O’Connor, K. Ulin
The use of proton therapy in oncology is not a new idea. The unique physical properties of protons and potential advantages in radiation therapy were initially recognized in the 1940s. Since the first patients were treated in the 1950s, technology and clinical applications have evolved as evidenced by the increasing number of proton therapy centers and patients being treated throughout the world. This chapter will review the history of proton therapy providing a detailed overview of the cyclotron and synchrotron techniques used and how they have advanced with time.
{"title":"History and Overview of Proton Therapy","authors":"Ameer L. Elaimy, L. Ding, C. Bradford, Yansong Geng, H. Bushe, I-lin Kuo, Yankhua Fan, Fenhong Liu, A. Khalifeh, Suhong Yu, J. Saleeby, James Shen, Kevin O’Connor, K. Ulin","doi":"10.5772/intechopen.95959","DOIUrl":"https://doi.org/10.5772/intechopen.95959","url":null,"abstract":"The use of proton therapy in oncology is not a new idea. The unique physical properties of protons and potential advantages in radiation therapy were initially recognized in the 1940s. Since the first patients were treated in the 1950s, technology and clinical applications have evolved as evidenced by the increasing number of proton therapy centers and patients being treated throughout the world. This chapter will review the history of proton therapy providing a detailed overview of the cyclotron and synchrotron techniques used and how they have advanced with time.","PeriodicalId":185991,"journal":{"name":"Proton Therapy - Current Status and Future Directions","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125912883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-18DOI: 10.5772/intechopen.95984
S. Álvarez, F. L. Ruiz, F. M. Magos, A. M. García
Around 50% of cancer patients will require radiotherapy (RT) and 10–15% of these patients could be eligible for proton beam radiotherapy (PBT). Dosimetric advantages are undeniable, mainly in pediatric and reirradiation scenarios. Though, PBT facilities are scarce worldwide and the IAEA has reported 116 functional particle facilities, of which 98 are PBT, virtually absent in low- and middle-income countries (LMIC). The Latin America and Caribbean region represent a unique opportunity for a PBT center, as there are currently no functional facilities and current RT needs are significant. The challenges can be summarized as high initial investment and maintenance, geographic coverage, required baseline technology and certification, over-optimistic workload, unclear rates and reimbursement, unmet business plan and revenue expectations, and lack of trained human resources. Investment costs for a PBT facility are estimated to be at around 140 million euros; therefore, this seems unsuitable for LMIC. Mexico’s geographical advantage, GDP, baseline technologies and high demand for RT makes it an ideal candidate. Nevertheless, a PBT center would account for a third of Mexico’s annual health expenditure for 2020. Enormous efforts must be made by both the private sector and governmental authorities to provide funding.
{"title":"Proton Therapy in Lower-Middle-Income Countries: From Facts and Reality to Desire, Challenges and Limitations","authors":"S. Álvarez, F. L. Ruiz, F. M. Magos, A. M. García","doi":"10.5772/intechopen.95984","DOIUrl":"https://doi.org/10.5772/intechopen.95984","url":null,"abstract":"Around 50% of cancer patients will require radiotherapy (RT) and 10–15% of these patients could be eligible for proton beam radiotherapy (PBT). Dosimetric advantages are undeniable, mainly in pediatric and reirradiation scenarios. Though, PBT facilities are scarce worldwide and the IAEA has reported 116 functional particle facilities, of which 98 are PBT, virtually absent in low- and middle-income countries (LMIC). The Latin America and Caribbean region represent a unique opportunity for a PBT center, as there are currently no functional facilities and current RT needs are significant. The challenges can be summarized as high initial investment and maintenance, geographic coverage, required baseline technology and certification, over-optimistic workload, unclear rates and reimbursement, unmet business plan and revenue expectations, and lack of trained human resources. Investment costs for a PBT facility are estimated to be at around 140 million euros; therefore, this seems unsuitable for LMIC. Mexico’s geographical advantage, GDP, baseline technologies and high demand for RT makes it an ideal candidate. Nevertheless, a PBT center would account for a third of Mexico’s annual health expenditure for 2020. Enormous efforts must be made by both the private sector and governmental authorities to provide funding.","PeriodicalId":185991,"journal":{"name":"Proton Therapy - Current Status and Future Directions","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125557787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-18DOI: 10.5772/intechopen.96188
Ameer L. Elaimy, L. Ding, J. Glanzman, L. Shanmugham, Beth B. Herrick, J. Morr, Daniel C. Han, Jeffrey C. Buchsbaum, Thomas J. FitzGerald
Due to space requirements and a substantial financial burden, the feasibility of health systems adopting proton therapy has been called into question. However, advances in facility design and treatment delivery have allowed institutions offering proton therapy to reduce footprint while incorporating technological improvements at reduced costs. As the number of centers and patients treated continue to increase, this chapter will review the layout and interface of proton therapy facilities providing a detailed overview of the design, costs and faculty and staff considerations.
{"title":"Proton Therapy Center Layout and Interface","authors":"Ameer L. Elaimy, L. Ding, J. Glanzman, L. Shanmugham, Beth B. Herrick, J. Morr, Daniel C. Han, Jeffrey C. Buchsbaum, Thomas J. FitzGerald","doi":"10.5772/intechopen.96188","DOIUrl":"https://doi.org/10.5772/intechopen.96188","url":null,"abstract":"Due to space requirements and a substantial financial burden, the feasibility of health systems adopting proton therapy has been called into question. However, advances in facility design and treatment delivery have allowed institutions offering proton therapy to reduce footprint while incorporating technological improvements at reduced costs. As the number of centers and patients treated continue to increase, this chapter will review the layout and interface of proton therapy facilities providing a detailed overview of the design, costs and faculty and staff considerations.","PeriodicalId":185991,"journal":{"name":"Proton Therapy - Current Status and Future Directions","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129398102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-20DOI: 10.5772/INTECHOPEN.97935
T. Fitzgerald, L. Ding, C. Riberdy, Jack Bailey, M. Anderegg, Ameer L. Elaimy, James Shen, Kevin O’Connor, C. Bradford, I-lin Kuo, Yankhua Fan, Fenghong Liu, Suhong Yu, H. Bushe, J. Saleeby, P. Rava, S. Sioshansi, M. Cicchetti, J. Moni, E. Ko, Allison Sacher, Daniel Han, M. Bishop‐Jodoin
Proton therapy is increasing in utilization worldwide at a rapid rate. With process improvements in costs, footprints, and continued advances in the delivery of care, including intensity modulation and image guidance, proton therapy may evolve into standard treatment with photon radiation therapy. This chapter reviews process improvements in proton therapy and the application in modern care.
{"title":"The Future of Proton Therapy","authors":"T. Fitzgerald, L. Ding, C. Riberdy, Jack Bailey, M. Anderegg, Ameer L. Elaimy, James Shen, Kevin O’Connor, C. Bradford, I-lin Kuo, Yankhua Fan, Fenghong Liu, Suhong Yu, H. Bushe, J. Saleeby, P. Rava, S. Sioshansi, M. Cicchetti, J. Moni, E. Ko, Allison Sacher, Daniel Han, M. Bishop‐Jodoin","doi":"10.5772/INTECHOPEN.97935","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.97935","url":null,"abstract":"Proton therapy is increasing in utilization worldwide at a rapid rate. With process improvements in costs, footprints, and continued advances in the delivery of care, including intensity modulation and image guidance, proton therapy may evolve into standard treatment with photon radiation therapy. This chapter reviews process improvements in proton therapy and the application in modern care.","PeriodicalId":185991,"journal":{"name":"Proton Therapy - Current Status and Future Directions","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115022697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-26DOI: 10.5772/INTECHOPEN.95960
N. Denunzio, M. Lawell, T. Yock
Care of patients with proton therapy has increased in the past decade. It is important to report on outcomes and disease specific utilization of particle therapy. In this chapter, we review our experience in developing a registry for pediatric patients treated with radiation to assess outcomes and provide a platform for shared research interests.
{"title":"Multi-Institutional Data Collection and Analysis via the Pediatric Proton/Photon Consortium Registry","authors":"N. Denunzio, M. Lawell, T. Yock","doi":"10.5772/INTECHOPEN.95960","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.95960","url":null,"abstract":"Care of patients with proton therapy has increased in the past decade. It is important to report on outcomes and disease specific utilization of particle therapy. In this chapter, we review our experience in developing a registry for pediatric patients treated with radiation to assess outcomes and provide a platform for shared research interests.","PeriodicalId":185991,"journal":{"name":"Proton Therapy - Current Status and Future Directions","volume":"368 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114783963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-08DOI: 10.5772/INTECHOPEN.95958
P. Taylor
This chapter will provide an overview of quality assurance processes to credential proton therapy centers for clinical trial participation. There are a number of credentialing audit steps, including independent output verification, anthropomorphic phantom audits, image guidance credentialing, knowledge assessments, and on-site dosimetry review. The purpose of these credentialing steps is to ensure consistency across proton centers participating in clinical trials, and well as comparability with photon centers for randomized trials. This uniformity ensures high quality data for measuring patient outcomes, which are pivotal at a time when proton therapy is being assessed for superior outcomes.
{"title":"Credentialing Proton Centers for Clinical Trials","authors":"P. Taylor","doi":"10.5772/INTECHOPEN.95958","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.95958","url":null,"abstract":"This chapter will provide an overview of quality assurance processes to credential proton therapy centers for clinical trial participation. There are a number of credentialing audit steps, including independent output verification, anthropomorphic phantom audits, image guidance credentialing, knowledge assessments, and on-site dosimetry review. The purpose of these credentialing steps is to ensure consistency across proton centers participating in clinical trials, and well as comparability with photon centers for randomized trials. This uniformity ensures high quality data for measuring patient outcomes, which are pivotal at a time when proton therapy is being assessed for superior outcomes.","PeriodicalId":185991,"journal":{"name":"Proton Therapy - Current Status and Future Directions","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122696530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-27DOI: 10.5772/INTECHOPEN.95957
P. Taylor
Although proton therapy was developed almost 80 years ago, widespread clinical implementation has been limited until the past decade. With the growing use of proton therapy, there is a desire to prove the equivalence or superiority of proton therapy across a number of cancer disease sites. Dozens of clinical trials have been developed to accomplish this within individual institutions, among a few centers, and across national and international networks such as the National Cancer Institute’s National Clinical Trial Network. The protocols include proton therapy imbedded in trials with photon therapy as well as randomized photon vs. proton trials. This chapter provides an overview of the design of such trials as well as some of the challenges facing protocols with proton therapy.
{"title":"Clinical Trials Evaluating Proton Therapy","authors":"P. Taylor","doi":"10.5772/INTECHOPEN.95957","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.95957","url":null,"abstract":"Although proton therapy was developed almost 80 years ago, widespread clinical implementation has been limited until the past decade. With the growing use of proton therapy, there is a desire to prove the equivalence or superiority of proton therapy across a number of cancer disease sites. Dozens of clinical trials have been developed to accomplish this within individual institutions, among a few centers, and across national and international networks such as the National Cancer Institute’s National Clinical Trial Network. The protocols include proton therapy imbedded in trials with photon therapy as well as randomized photon vs. proton trials. This chapter provides an overview of the design of such trials as well as some of the challenges facing protocols with proton therapy.","PeriodicalId":185991,"journal":{"name":"Proton Therapy - Current Status and Future Directions","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134081171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-22DOI: 10.5772/intechopen.94937
F. A. Manuel, E. Panizo, S. Martin, J. Serrano, M. Cambeiro, D. Azcona, D. Zucca, B. Aguilar, Á. Lassaletta, J. Aristu
Proton therapy is an efficient high-precision radiotherapy technique. The number of installed proton units and the available medical evidence has grown exponentially over the last 10 years. As a technology driven cancer treatment modality, specific sub-analysis based on proton beam characteristics and proton beam generators is feasible and of academic interest. International synchrotron technology-based institutions have been particularly active in evidence generating actions including the design of prospective trials, data registration projects and retrospective analysis of early clinical results. Reported evidence after 2010 of proton therapy from synchrotron based clinical results are reviewed. Physics, molecular, cellular, animal investigation and other non-clinical topics were excluded from the present analysis. The actual literature search (up to January 2020) found 192 publications, including description of results in over 29.000 patients (10 cancer sites and histological subtypes), together with some editorials, reviews or expert updated recommendations. Institutions with synchrotron-based proton therapy technology have shown consistent and reproducible results along the past decade. Bibliometrics of reported clinical experiences from 2008 to early 2020 includes 58% of publications in first quartile (1q) scientific journals classification and 13% in 2q (7% 3q, 5% 4q and 17% not specified). The distribution of reports by cancer sites and histological subtypes shown as dominant areas of clinical research and publication: lung cancer (23%), pediatric (18%), head and neck (17%), central nervous system (7%), gastrointestinal (9%), prostate (8%) and a miscellanea of neplasms including hepatocarcinoma, sarcomas and breast cancer. Over 50% of lung, pediatric, head and neck and gastrointestinal publications were 1q.
{"title":"Proton Cancer Therapy: Synchrotron-Based Clinical Experiences 2020 Update","authors":"F. A. Manuel, E. Panizo, S. Martin, J. Serrano, M. Cambeiro, D. Azcona, D. Zucca, B. Aguilar, Á. Lassaletta, J. Aristu","doi":"10.5772/intechopen.94937","DOIUrl":"https://doi.org/10.5772/intechopen.94937","url":null,"abstract":"Proton therapy is an efficient high-precision radiotherapy technique. The number of installed proton units and the available medical evidence has grown exponentially over the last 10 years. As a technology driven cancer treatment modality, specific sub-analysis based on proton beam characteristics and proton beam generators is feasible and of academic interest. International synchrotron technology-based institutions have been particularly active in evidence generating actions including the design of prospective trials, data registration projects and retrospective analysis of early clinical results. Reported evidence after 2010 of proton therapy from synchrotron based clinical results are reviewed. Physics, molecular, cellular, animal investigation and other non-clinical topics were excluded from the present analysis. The actual literature search (up to January 2020) found 192 publications, including description of results in over 29.000 patients (10 cancer sites and histological subtypes), together with some editorials, reviews or expert updated recommendations. Institutions with synchrotron-based proton therapy technology have shown consistent and reproducible results along the past decade. Bibliometrics of reported clinical experiences from 2008 to early 2020 includes 58% of publications in first quartile (1q) scientific journals classification and 13% in 2q (7% 3q, 5% 4q and 17% not specified). The distribution of reports by cancer sites and histological subtypes shown as dominant areas of clinical research and publication: lung cancer (23%), pediatric (18%), head and neck (17%), central nervous system (7%), gastrointestinal (9%), prostate (8%) and a miscellanea of neplasms including hepatocarcinoma, sarcomas and breast cancer. Over 50% of lung, pediatric, head and neck and gastrointestinal publications were 1q.","PeriodicalId":185991,"journal":{"name":"Proton Therapy - Current Status and Future Directions","volume":"58 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113939392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-20DOI: 10.5772/intechopen.94530
N. Burela
Anatomic and dosimetric changes occur in head and neck cancer during fractionated proton radiotherapy, and the actual dose received by patient is considerably different from original plan. Adaptive radiotherapy aims to modify treatment according to changes that occur during proton therapy. Intensity modulated proton therapy for head and neck cancer (HNC) patients benefitted by adaptation to correct the dose perturbations caused by weight loss, tumor volume changes, setup and range uncertainties. The following sections have elaborated the rationale of adaptation in HNC, proton physics in HNC, studies comparing non-adaptive and adaptive intensity modulated proton therapy (IMPT) plans, reasons for adaptation and how to mitigate these changes.
{"title":"Adaptive Proton Therapy in Head and Neck Cancer","authors":"N. Burela","doi":"10.5772/intechopen.94530","DOIUrl":"https://doi.org/10.5772/intechopen.94530","url":null,"abstract":"Anatomic and dosimetric changes occur in head and neck cancer during fractionated proton radiotherapy, and the actual dose received by patient is considerably different from original plan. Adaptive radiotherapy aims to modify treatment according to changes that occur during proton therapy. Intensity modulated proton therapy for head and neck cancer (HNC) patients benefitted by adaptation to correct the dose perturbations caused by weight loss, tumor volume changes, setup and range uncertainties. The following sections have elaborated the rationale of adaptation in HNC, proton physics in HNC, studies comparing non-adaptive and adaptive intensity modulated proton therapy (IMPT) plans, reasons for adaptation and how to mitigate these changes.","PeriodicalId":185991,"journal":{"name":"Proton Therapy - Current Status and Future Directions","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128087826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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