anti cancer treathment 3 x 20 minutes cure 080218hit_br_ss_broschuere_engl

8/7/2019 anti cancer treathment 3 x 20 minutes cure 080218HIT_BR_SS_Broschuere_engl

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UniversittsKlinikum Heidelberg

Heidelberg Ion-Beam Therapy Centre


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University Hospital Heidelberg

In winter 2008 the rst patients will be treated in the

Heidelberg Ion-Beam Therapy Center. For the rst time,

patients with certains inoperable tumors are oered arealistic chance o successul treatment.

The University Hospital Heidelberg is proud to bring a

worldwide unique radiation therapy acility into operation.

HIT will be o great help to our patients and will lay the

scientic groundwork or new cancer therapies.

The technical and scientic parts are just as innovative

as the nancing concept. As joint investor the University

Hospitals engagement proves that major projects can be

handled i they are based on rm nancial grounds andscientic advancement.

Heidelberg, February 2008

Pro. Dr. Dr. h. c. J. Rdiger Siewert

Medical Director

Universittsklinikums Heidelberg

Irmtraut Grkan

Administrative Director


Pro. Dr. med. Dr. rer. nat. Jrgen Debus

Medical Director

Radioonkologie und Strahlentherapie


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Partly under ground, covering hal the size o a soccer feld

the Heidelberg Ion Therapy Centre (HIT) is a gigantic high

tech device. HIT will start operations in winter 2008 as thefrst installation o its kind in Europe with the purpose o

helping patients suering rom malignant, oten otherwise

incurable tumors.

Beams consist o very small particles, heavy ions like the

nuclei o carbon atoms or protons, the nuclei o hydrogen

atoms. They are substantially dierent rom conventional

X-rays or Gamma rays because they are eective in the

depth o tissues. Furthermore, due to modern techniques

they can be targeted more precisely. Thereore, patients su-

ering rom tumors deep inside the body have the greatestbenet rom heavy ion radiation or instance tumors in the

head, in the chest and hidden in the abdominal cavity. Every

year about 1,300 patients will benet rom HIT.

HIT Building

The development o HIT is a joint project o our institutions:

the Universittsklinik r Radioonkologie und Strahlenthera-

pie, Heidelberg, the Gesellschat r SchwerionenorschungGSI, Darmstadt, the Deutsche Krebsorschungszentrum,

Heidelberg, and the Forschungszentrum Rossendor near

Dresden (see page 12), close collaborators since 1993.

Their preparatory work provided the basis or the develop-

ment o HIT.

Radiation devices with heavy ions or protons already exist

in Europe and elsewhere abroad. However, HIT has special

characteristics which make its position in the world excep-

tional:

HITistherstcombinedProton/HeavyIonTherapyDevice in Europe which is operated by a hospital and

used or treating patients as well as clinical studies.

ItistheonlydevicewhichusestheIntensity-Controlled

Raster Scan Method and thereore provides unequalled

precision in three-dimensional tumor radiation.

Itsrotatableheavyiongantryisunique.

Theclinicalandscienticenvironmentprovidedbythe

Universittsklinikum Heidelberg, the Nationale Centrum

r Tumorerkrankungen NCT and the Deutsche Krebs-

orschungszentrum ocusing on cancer research and

treatment is unsurpassed.

The Heidelberg Ion-Beam Therapy Center HIT

Heidelberg Ion-Beam Therapy Centre4


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Variations in Radiation Therapy

For many years, radiation therapy has been an indispensab-

le part o cancer therapy. Especially, X-rays and Gamma rays,

consisting o small particles called photons, have been usedor attacking the tumor. They remove electrons out o tumor

cell atoms and destroy larger molecules within the cells by

destroying smaller chemical compounds beore. Radiation

beams also damage the genetic code, the DNA o the cells

and thereby the construction plans or essential proteins.

Furthermore, cells cannot replicate any more. Consequently,

they die. However, the energy is only partly transerred to

the tumor.

This problem has been partly solved by modern technique:

Photonbeamshitthetumorfrommultipledirectionsandmeet at a dened target where they discharge a maximum o

energy. At the same time mobile apertures screen the sen-

sitive healthy tissue rom radiation. The so called Intensity

Modied Radiation Therapy (IMRT) improves the treatment

results o conventional radiotherapy considerably.

Ion radiation does not use photons, but positively charged

ions, atomic nuclei which have lost their electrons rom the

atom shell. The particles mainly used are Hydrogen atomic

nuclei (protons) and Carbon atomic nuclei, which are very

heavy. This particular type o ions is thereore called heavy

ion. Atomic nuclei are accelerated in large devices to about

three quarters o the speed o light and shot into the tumor.

The depth o penetration can be enhanced by speeding up

the ions.

Ion beams have always been interesting candidates or radi-

ation therapy, since they have special physical characteris-

tics: When they hit the body they travel very ast through theouter layers and lose hardly any energy beore they decele-

rate in the depth and eventually get stuck and transer their

entire deleterious energy to the surrounding tissue.

Scientists call this moment the Bragg peak ater its disco-

verer, the English physicist William Henry Bragg. Thereore,

ion beams are tailor made or treating tumors located deeply

inside the body. Also, tumors with irregular edges can be

scanned accurately to the millimeter with the Intensity-Con-

trolledRasterScanMethod(seepage8/9).

Heidelberg Ion-Beam Therapy Centre 5

100%

50%

0%

dose

2 6 10 14 18

depth in tissue (cm)

10

8

6

4

2

0

effectived

ose(

arb.

units)

3 6 9 tumor 18 (cm)

Biologically eective doses or photons, protons and carbon ionsDose distribution or X-ray and ion beams in biological tissues

carbon

protons

photons

tumor

X-rays

Ion beam


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Which Patients beneit most rom HIT?

Ion beams hit their targets precisely and transer an exact

dosage o energy to the tumor. Is heavy ion or proton radiati-

on thereore the panacea or all radiosensitive tumors?

About 5 to ten percent o all cancer patients will benet rom

ionradiationsaysProfessorDr.Dr.JrgenDebus,Medical

Director o the Universittsklinik r RadioOnkologie und

Strahlentherapie and HIT. These patients suer rom tumors

which are deeply situated in the body and are thereore

hardly attainable or conventional radiation treatment.

Doctors and scientists in Heidelberg diligently prepare the

wider implementation o ion radiation by conducting clinical

studies comparing the treatment results rom HIT with con-ventional radiotherapy. So ar, the eectiveness o heavy

ion radiotherapy is solely documented or a small number o

tumors. These are malignant sot tissue tumors on the spine

(Chordoma) and cartilage at the base o the scull (Chondro-

sarcoma). Furthermore, rare tumors o the salivary glands

(Adenocarcinoma) can be successully treated with heavy

ion radiation. It is likely that the treatment results or other

tumors can also be improved, or instance or certain types

o lung cancer and prostate cancer.

Ion beam treatment is especially benecial or children su-

ering rom malignant tumors, because it avoids long-term

side eects. It is possible to treat gently and with greatestcare and at the same time prevent urther cancer growth and

occurrence o new tumors.

The German Health insurance companies have already agreed

to bear the expenses i the treatment in HIT. The costs or

one treatment cycle are approximately three times as high

as or conventional radiation, but are in the same dimension

as extensive medication or operation o patients.


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What happens beore und during the Treatment?

Beore treatment starts, tumor specications and dimen-

sions will be determined accurately with modern imaging

techniques like Computer Tomography (CT) and MagneticResonance Imaging (MRI). The HIT physicists adjust the ion

beam to the coordinates. In order to ensure maximum pre-

cision the patient is xated in an individually manuactured

suspensiondevice.Patientswithbrainorskulltumorswear

individually manuactured masks out o plastic material.

Similar splints are available or other parts o the body, or

instance when tumors o the spine are treated.

The patient is xated in his suspension device and placed

by technical assistants with the help o a robot arm on a

high tech table which is used or the rst time ever in HIT.Thereby, the calculated position o the patient is reached

with a precision o less than a millimeter. An X-ray picture

ensures that that the patient has been positioned correctly

and the ion beam will be targeted at the tumor: Doctors

compare the bone structures o the X-ray pictures with the

previous CT and MRI images.

Then radiation commences. The patient does not notice

anything when the ion beam hits his tumor with very high

speed. Radiation lasts between one and ve minutes.

During the entire radiation sensors monitor 20,000 times

per second whether the beam hits precisely the target .The

therapeutic beam also scans the tumor or any deviation.

This Intensity-Controlled Raster Scan Method was especially

developed or Ion Beam radiation by scientists rom the GSI.

The entire procedure putting on the mask, positioning the

patient and the radiation takes about 20 minutes. Likewi-

se conventional radiotherapy, one treatment is not enoughto destroy the tumor and avoid harm to the surrounding tis-

sue. Thereore, treatment has to be repeated in the ollowing

days. An average treatment cycle lasts about 15 days.

Several weeks ater the treatment cycle, with the help o CT

and MRI images doctors check up whether the tumor has

shrunk or has even vanished altogether.

HIT treatment room



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Hightech and complex Technology

Questions and Answers on HIT

How large is the Heidelberg Ionenstrahl Therapiezentrum HIT?It is the size o hal a soccer eld and contains three foors.

Two foors are underground, one is above ground level.

What does the building contain?

It contains two buildings in one. The rst is a long glass

building with oces or doctors, assistants, nurses, physi-

cists, engineers and technicians. Adjacent to it is a copper

block which houses the accelerator and the three treatment

rooms. Walls, ceilings and foors are additionally protected

by two meter thick concrete blocks. The building is set in a

mound.

How much did HIT cost?

HIT costed about 100 Million Euro and is jointly nanced

by the German government and the Universittsklinikum

Heidelberg.

What are Protons?

Protonsarethepositivelychargednucleiofhydrogenatoms.

What are Heavy Ions?

Heavy ions are atomic nuclei heavier than hydrogen nuclei

which have lost their electrons. HIT uses a variety o ions

which are heavier than protons, or instance helium, carbon

and oxygen nuclei. Carbon and oxygen nuclei are more

eective in the treatment o cancer than protons and helium

nuclei.

Are protons as eective in the treatment o cancer as heavy

ions?

Heavy ions are three times as eective in comparison to

protons and helium ions. In body tissue, heavy ions can bedirected with millimetric precision and are thereore superi-

or to protons in the treatment o certain tumors.

How are the particles accelerated?

A very large and sophisticated device is needed (pages 10, 11).

Firstly, ions are accelerated in a ve meter long straight tubewhich leads into a roundabout, the so called synchrotron.

There, the circulating particles are accelerated to about

three quarters o light velocity.

How deep do the particles penetrate into body tissue?

The beam can penetrate 30 cm (12 inches) into the body,

depth increasing with velocity.

How much energy is needed or running HIT?

Three megawatts, as much as a small size town with 10,000

inhabitants.

How many people are working in the HIT building?

More than 70 doctors, nurses, technical assistants, physi-

cists, engineers and technicians co-operating closely. The

acceleratoriscontinuouslyoperated.Patientsaretreatedin

a two shit operation rom Monday to Saturday.

The intensity-controlled raster scan method

The tumor volume is subdivided into layers o equal depth. By varying the energy o the ions, the penetration depth o the

beam is adjusted. The individual layers are scanned line by line, similar to the image on a TV screen. The lateral defection

o the beam is achieved by means o rapidly controllable dipole magnets. To control the intensity, each line is subdivided

into pixels. The beam remains in a given pixel until the calculated target dose has been reached. As a result, this method o

intensity-controlled raster scans allows a precise three-dimensional scanning o the target volume dened by the physician.This approach represents a signicant improvement over conventional treatment methods with photons, as well as over

passive beam application techniques previously used in proton and ion beam therapy.



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How many treatment rooms are available?

Three. Two or horizontal radiation: The beam travels

through a vacuum tube out o the wall. The patient is placedon a mobile table adjusted by a high tech robot. The tumor

is hit by a precisely directed beam. The third treatment room

contains a rotatable, worldwide unique gantry which allows

radiation treatment rom all directions.

How does the Gantry work?

This gigantic device is three levels high and weighs 600 tons.

Because the gantry can be rotated around the patient, the

tumor can be radiated rom all directions with high accuracy:

the beam deviates only hal a millimeter rom the target. The

beam transport system is placed in a complicated struc-ture, similar to a radio telescope. The gantry room has to

be climatised in order to avoid dierences in temperature

which deorm the construction.


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1. Ion SourcesIons are positively charged atoms. In order to obtain ions, atoms must lose

their negatively charged electrons. For that purpose, carbon dioxide gas

fows into the ion chamber. Free electrons in the gas are accelerated by ma-

gnetic elds and microwaves. While traveling through the ion chamber, the

electrons hit carbon dioxide molecules. Ater this collision the molecules

dissociate and 4 o the 6 electrons that are part o any carbon atom are se-

parated. Electrical elds extract the carbon ions out o the chamber; special

magnets transport them urther on in a regular fow in the vacuum.

2. Linear acceleratorThe ve metre long tubes consist o two sections: The rst part converts the

regular fow into a pulsating fow with 217 million micropulses per second.

In this procedure the beam is collimated and the ions are accelerated. Sub-

sequently, in the second part o the tube, electromagnetic elds accelerate

the ions up to more than 10 percent o the speed o light. Exiting the acce-

lerator through a carbon oil, the carbon atoms lose their last two electrons,

such that only the 6-old positively charged nucleus remains.

5. Horizontal treatmentThe ion beam enters these treatment rooms through a window. In order to

achieve a precise irradiation, the patient is xed in lying position on a ro-

botically positioned treatment couch. A plastic mask keeps head, body and

extremities in a dened position. The irradiation takes up to 5 minutes.

6. Digital X-ray (radiology)Beore radiating, the physician checks the correct position o the patient or

saety reasons. Bones and other anatomic body eatures serve as position

marks. The robot at the ceiling carries an X-ray source on top and a receiver

on the bottom. The instrument can make both single layer shots like com-

puter tomography. The images are transerred immediately to the monitor in

the control room.

7. GantryThis three-story high giant weighs 600 tons. The elaborate constructionallows the exact positioning o the ion beam in an optimum angle to the pa-

tient. It penetrates up to 30 cm into the human tissue and has a maximum

deviation o 0.5 mm rom the target. The vacuum tubes that guide the beam

are attached to a rod assembly that is also used in satellite technology.

3. SynchrotronThe ions merge in a circular fow. Huge magnets defect the beam at six

turns o 60 each, until the circle is completed. Now the ions are accelera-

ted up to 73% o the speed o light. They race through the ring 3.4 million

times per second. According to their growing speed, the technicians must

increase the magnetic orce. This explains the term synchrotronor this

part o the installation.

4. High Energy Beam Transport

Vacuum tubes and magnets lead the beam urther on. Shortly beoreentering the treatment rooms the beam passes through two scanners.

These scanners are magnets which can shit the beam horizontally and

vertically. With their help the ion beam can be precisely guided by raster

scan method.

8. Ion beam and X-rayHere the beam leaves the tube. Two X-ray detectors are installed at the right

and let hand side. The X-ray source is located in the bottom o the gantry

and can be rotated with the instrument. This way, the doctors can check the

position o the patient once more beore starting the treatment.


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The Pilot Project Partners

Within o the pilot project, the project partners have develo-

ped new, trendsetting methods that represent key technolo-

gies or HIT as well as uture projects. This groundwork incombination with the expertise o the participating insti-

tutes in various areas o particle therapy represents an

ideal basis or a successul completion o the new project,

jointly with industrial partners.

The main research eld oncology o the medical aculty (Uni-

versity Heidelberg) and the Radiology Clinic are important

pilot project partners. The Universittsklinik r RadioOnko-

logie und Strahlentherapie is one o Germanys largest ra-

diation therapy centers, with about 3,800 new patients per

year. In addition to patient care, a broad research programin the area o radiation oncology is pursued at Heidelberg.

The clinical studies o ion beam therapy in the context o the

pilot project are also being conducted under its manage-

ment.

The Deutsche Krebsorschungszentrum in Heidelberg, with a

ocused program on radiological diagnostics and therapy, is

the center o internationally renowned research and deve-

lopment in the eld o leading edge techniques in radiation

therapy. Here, major scientic achievements have been

made in the eld o three-dimensional treatment planning

and precision radiotherapy, including dosimetry and quality

assurance. New therapeutic methods are developed and

clinically tested in the Clinical Cooperative Unit or Radiothe-

rapeutic Oncology, in conjunction with the Universittsklinik

r RadioOnkologie und Strahlentherapie.

The Gesellschat r Schwerionenorschung GSI in Darmstadt

is among the internationally leading centers o heavy-ion

research. More than 1,000 scientists rom over 30 countriescurrently conduct research at its accelerator acility. Since

its establishment, GSI has also been conducting studies in

radiation biology, especially concerning the radiobiologic

eects o ions. In addition, there is abundant expertise in

the areas o accelerator technology and the development o

highly precise irradiation methods. With the SIS heavy-ion

synchrotron, GSI currently has at its disposal the only acce-

lerator system in Europe where patients with deep-seated

tumors can be treated with ions.

The Forschungszentrum Rossendor near Dresden con-ducts basic and applied research in the elds o materials

research, biomedicine and biochemistry, environmental

research, as well as nuclear, hadron and radiation physics.

The planned clinical acility will especially benet rom this

institutes in-depth expertise in the biomedical application

ofpositronemissiontomography(PET).

DEUTSCHES

KREBSFORSCHUNGSZENTRUM

IN DER HELMHOLTZ-GEMEINSCHAFT

Gesellschaft fr Schwerionenforschung Darmstadt

RadioOnkologieUniversittsklinikum Heidelberg

Gantry Room

Beore Gantry assembly



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Milestones o the HIT Project

1991 Scientists in Darmstadt develop the Intensity-Controlled Raster Scan Method.

1992 - 1995 Technicians in Darmstadt develop special sotware or a biologically based radiationplanning system.

1993 Four partners initiate the pilot project on ion beam therapy:

Gesellschat r Schwerionenorschung, GSI, Darmstadt, die Radiologische

Universittsklinik Heidelberg, das Deutsche Krebsorschungszentrum, Heidelberg,

das Forschungszentrum Rossendor near Dresden.

1997 For the rst time in Europe, patients are treated in Darmstadt with ion beams (Carbon).

September 2000 GSI presents the easibility study or the Heidelberg Heavy Ion-Beam Therapy Centre HIT.

May 2003 The German Science Council gives permission to the commissioning o accelerator parts.

October 2003 Commissioning o the Arge SIT (Strabag, M+W Zander) as main contractor or

the building site.

12th May 2004 The oundation o HIT is laid.

20thJune2005 Topping-outCeremonyoftheHITbuilding.

5th October 2005 Installation o the accelerator is started.

1st September 2006 The HIT building is taken over by the Universittsklinikum.

January2007 Assemblyofthegantry.

Nov/Dec.2006 Firstbeamafterthelinearaccelerator(LINAC).

February 2007 Maximum speed in Synchrotron reached.

Installation o medical devices or horizontal radiation places nished.

March 2007 First beam reaches horizontal radiation places.

Winter 2008 First patient will be treated in HIT.



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Imprint

StabsstellePresse-undffentlichkeitsarbeit

(PressandPublicRelationsOfce)des

Universittsklinikums Heidelberg und derMedizinischen Fakultt der Universitt Heidelberg

Im Neuenheimer Feld 672

69120 Heidelberg

[email protected]

www.klinikum.uni-heidelberg.de

Design and Photography

Medienzentrum

Stabsstelle des Universittsklinikums

und der Medizinischen Fakultt der Universitt Heidelberg

www.medienzentrum.klinikum.uni-heidelberg.de

Treatment Questions

Universittsklinikum Heidelberg

RadioOnkologie und Strahlentherapie

Prof.Dr.med.Dr.rer.nat.JrgenDebus

[email protected]

Tel.: +49 6221 568201

www.klinikum.uni-heidelberg.de/

Radioonkologie-und-Strahlentherapie.227.0.html

Picture credits

page 5: Gesellschat r Schwerionenorschung, Darmstadt

page8/9:Rasterscanmethod:sourceandStern

page10/11:HITfacility:sourceandStern

photos: Universittsklinikum Heidelberg, Medienzentrum

February 2008

Main involved companies

Gesellschat r Schwerionenorschung

accelerator systems (dierent suppliers)

MT Mechatronics GmbH

heavy ion Gantry

Siemens AG Medical Solutions

medical technology

Arge SIT (Strabag AG, M+W Zander)

building general contractor

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anti cancer treathment 3 x 20 minutes cure 080218hit_br_ss_broschuere_engl

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