Proton Therapy Congress 2016

The use of proton therapy in relatively new indications

Dr Jiří Kubeš - Proton Therapy Center Czech, Prague, Czech Republic

Pencil beam scanning is a new technology of how to deliver protons inside a patient. This is, from my point of view, much better than previous technologies like passive scattering because this technology allows us to achieve much better dose distribution inside a patient. That’s one important thing; the second, previous methods of proton beam didn’t allow us to change treatment plans during the treatment, the so-called adaptive approach, and pencil beam scanning allows it. This opens many new indications for proton beam where an adaptive approach is necessary and which could not be treated before pencil beam scanning.

Have the amount of patients in your clinic changed your ways of working?

We started with some simple diagnoses like prostate cancer or some brain tumours and during the time we developed approaches for more complicated diagnoses. As an example, one of these are head and neck cancer because those are very comprehensive and big target volumes which are changing during the treatment, so that’s one diagnosis where the adaptive approach is really necessary and we developed some procedures how to manage head and neck cancers during the whole treatment to have reproducible and appropriate dose delivery.

Another example which we started two years ago are moving targets, tumours inside the chest like malignant lymphomas. We started with some technology of motion management which depends on irradiation in deep respiration breath hold when the structures inside the thorax are stopping movement and the beam is gated. This beam is on only during the stopping phase of breathing, so that’s another example. The last diagnosis which we started was breast cancer when we combined this irradiation and deep respiration breath hold with some technology for detection of surface with stereotactic cameras which allow us to very precisely reproduce the position of patients for this radiation.

What’s next for proton centres?

All centres are going the same way, that the number of diagnoses is growing. Proton therapy isn’t limited for skull-based tumours in the past but there is a lot of new diagnosis like this, like head and neck and like lymphomas, like breast, like paediatric.

How will more research and money change proton therapy practice?

My opinion is that proton therapy will take more and more patients and will take some part of radiation oncology, I’m not sure how big this part will be, I suppose that it may be 30-40% of this. I’m sure that that technology will be cheaper and cheaper, treatment also because there is a trend to do some accelerated radiotherapy, not so long as in the photon world. During the few years I think that it will be a standard part of radiation therapy.