Proton Therapy Unit. Clínica Universidad de Navarra

Proton Therapy Unit

Proton therapy, the most accurate and safe external beam radiotherapy Clínica Universidad de Navarra is building at its Madrid campus what will be the most advanced Proton Therapy Unit in Europe and the first in a cancer centre, giving it access to all of the facilities and health care, academic and research resources of a third-level hospital.

The new Proton Therapy Unit, which will start treating patients in the first quarter of 2020, incorporates one of the most advanced systems in the world, developed

by Hitachi and currently in use in 27 academic centres, some of which are global leaders in the treatment of cancer.

The Unit occupies an area of 3,600 m2 and comprises:

• A synchrotron • A proton beam delivery system • Two patient treatment rooms with 360° gantries • Treatment-related work areas • Support facilities

Proton therapy, the most accurate external beam radiotherapy modality, provides superior dose distribution (via highly accurate dosimetry) and therefore less irradiation of healthy tissue and lower risk of radiation-induced tumours.

Its lower toxicity makes it especially suitable for the treatment of difficult-to-access tumours or those close to organs at risk that are highly sensitive to radiation, as well as tumours that can be treated by external beam radiation in children and the elderly, such as the brain, spinal cord and eyes.

In addition, it enables the delivery of higher radiation doses to tumours and thus better local control of diseases.

Its implementation represents a major clinical advance, based on the dosimetric breakthrough, which is superior for proton therapy than all other high-precision radiotherapy modalities available.

Proton therapy, due to its lower toxicity, is especially indicated for the treatment of difficult-to-access tumours or those close to organs at risk.

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Each treatment room can treat 300 patients per year.

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Clínica Universidad de Navarra

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How does it work?

Indications

Proton therapy is based on a different type of radiation to conventional radiotherapy. While radiotherapy relies on a high-energy X-ray beam (photons), proton therapy uses a high-energy beam of accelerated particles (protons), which allows more accurate guidance of the radiation to the tumour.

There is consensus among the American (ASTRO), Spanish (SEOR) and Japanese (JASTRO) scientific societies in their advice for proton therapy treatment. Updated in 2017, the recommendations can be summarised as:

This is a result of the physical characteristics of the protons themselves: due to their mass, they do not experience alterations in their trajectory while penetrating patient tissue, depositing most of their energy in the tumour.

Proton therapy sessions are estimated to last about 25 minutes, most of which is for patient placement and image-guided positioning. The irradiation time is generally less than 1 minute.

High dose Low dose

Children In general, proton therapy is the treatment of choice for tumours that are amenable to external beam radiotherapy because it best preserves healthy tissues and reduces adverse effects on growing tissues compared with other treatment modalities.

• Tumours: - skull base - brain - neck • Ocular melanoma • Lung tumours • Liver tumours • Lymphoma • Sarcomas

Recomendadas En investigación

Recomendadas Recommended Recomendadas

Adults

En investigación Under investigation

En investigación

It is considered the treatment of choice for the following tumours:

Protons

Photons

• Tumours near or at the base of the skull, including chondromas and chondrosarcomas • Primary or metastatic tumours in the spinal cord • Eye tumours, including ocular melanoma • Patients with genetic syndromes with particular susceptibility to toxicity • Re-irradiation in selected cases Its application to other tumours is currently being studied: • Non-T4 or resectable head and neck tumours • Thoracic tumours (including primary non-metastatic lung or oesophageal tumours and mediastinal lymphomas) • Non-metastatic abdominal tumours (pancreas, biliary or adrenal cancer) • Pelvic non-metastatic tumours (rectal, anal, cervical and bladder) • Non-metastatic prostate cancer Recomendadas En investigación • Breast cancer Recomendadas Recommended Recomendadas

En investigación

En investigación Under investigation

Technology, key to a health care and research project

Synchrotron, a clean accelerator

The new centre will avail of the same technology and knowledge that is already available in hospitals such as the Mayo Clinic (at its Rochester and Phoenix sites), St. Jude Children’s Research Hospital and MD Anderson Cancer Center in the United States and Hokkaido University Hospital in Japan. In 2019, the technique will also come online at Johns Hopkins Hospital. This Hitachi technology has been used to treat more than 50,000 patients worldwide.

As particle accelerator, the system incorporates a synchrotron, the most modern currently available and, because it produces less unwanted radiation, considerably more energy efficient than the cyclotron. It is thus considered a “clean” accelerator, because it allows acceleration of the proton beam just up to the energy required for each patient’s tumour in an individualised way, without needing artificial filters for the process of beam “braking” or degradation1.

By acquiring this system, Clínica Universidad de Navarra is establishing a strategic alliance with Hitachi and becomes part of the clinical and research community formed by the centres currently possessing the technique.

In addition, the technology being installed in the clinic includes a system that allows the proton therapy of tumours affected by respiratory movement, a process fully integrated into the equipment. Real-time tracking or scanning is able to locate and quantify the tumour movement and instantly guide the irradiation time to minimise the impact on healthy tissue.

In operation

Under construction

For research

1

This process is necessary in the production of the neutrons characteristic to conventional radiotherapy.

+34 91 353 19 20 atpacientecun@unav.es Calle Marquesado de Santa Marta 1 28027 Madrid, Spain cun.es