RINECKER PROTON THERAPY CENTER STATUS REPORT: EIGHTH MONTH OF CLINICAL OPERATION, NOVEMBER ‘09
IRRADIATION WITH PROTON-SCANNING: WHEN AND WHY? A CASE STUDY
The irradiation with proton-scanning is the worldwide approved form of the so-called particle or ion therapy. At the RPTC, which uses the scanning-method where the tumor is beam-scanned on a point-by-point basis with up to 10,000 target points in large tumors, it reaches its highest targeting precision. The clinical advantage compared to X-ray is the protection of the surrounding healthy tissue and the better general condition of the patient as the dose in the healthy tissue can be reduced by factors of 3-5 compared to X-ray. Therefore, the RPTC treats numerous cases where the proton-scanning version of the ion therapy is the last therapeutical hope to achieve recovery or at least a resolution of the symptoms and a life-extension.
A pleuramesothelioma, i.e. a tumor in the lung, was excised in a woman aged 65, who had also received chemo therapy. This combination-therapy was eventually unsuccessful: The tumor did recur. It expanded into the mediastinum, the area in the middle between both lungs, which is rich in organs and highly sensitive. The tumor growth, the inevitable deterioration of the lung function caused by the previous operation, and the side effects of the chemo therapy led to intolerable breathing difficulties, the patient was only able to walk at best 20 steps.
A further surgical intervention was technically impossible, another chemo therapy was considered futile, and the „shoot-through“ character of a X-ray therapy would inevitably have damaged the other still healthy lung to such an extent that the already impaired oxygen supply would no longer be sufficient.
The proton-scanning therapy at the RPTC (see image) still offered a chance for therapy: It was able to largely protect the healthy right lung while at the same time keeping the remaining healthy tissue in the affected lung free of radiation. A significant improvement of the breathing difficulties was already achieved after eight treatment days at the RPTC. The clinical monitoring using computer tomography showed already at the end of the therapy at the RPTC a clear reduction of the tumor volume (see image). „After completion of the proton therapy the patient was already able to walk for two hours without breathing difficulties.“, explained the medical director of the RPTC, Prof. Dr. med. Manfred Herbst.
However, the advantages of the particle-ion-therapy with proton-scanning are not only of use as a last resort for therapy. This therapy has yet one more thing in common with X-ray: the earlier during the course of the disease it is applied, the more effective it is, too. Maybe this patient could have been spared some of the suffering.
FIRST FOLLOW-UP REPORT: LIVE-SAVING TREATMENT ATTEMPT WITH PROTON-SCANNING OF RECURRENT BILE DUCT CARCINOMA AFTER PARTIAL SURGICAL HEPATECTOMY
In the Status Report May ´09 we reported on a case in which the patient suffered of a tumor recurrence after surgery, a bile duct carcinoma, despite chemo therapy. All other therapy options like further chemo therapies, renewed surgeries or the conventional irradiation were out of the question as they were technically infeasible or would not have spared and functionally preserved the remaining healthy liver tissue. The patient at that time tolerated our proton therapy very well. Five months after completion of the proton therapy a magnetic resonance tomography, which was conducted during of a follow up examination, showed a remission of the tumor, as was expected under the applied proton dosage (see image). Furthermore, it is crucial that no radiogenic worsening of the liver function has been observed, which proves the extreme aiming-precision of proton-scanning. The patient is fine.
EXPANSION OF OUR RADIOONCOLOGY TEAM AT THE RPTC: PD DR. MED. RAZVAN M. GALALAE
After the start of clinical operations of our second treatment unit and hence the doubling of our treatment capacity, we further expand our team. We are delighted to have gained in PD. Dr. Galalae a competent and experienced expert in the field of radio-oncology (see image).
Razvan Galalae, born 1962 in Galati (Romania), graduated from the university Hamburg with a degree in medicine. There, he was awarded his license to practice medicine in 1992, and his Dr. med. with Magna cum laude in 1999. He completed his specialty training in radio-oncology at the clinic for radio-oncology at the Christian-Albrechts-University in Kiel where he worked as an assistant physician and after that as senior physician from 1992 to 2005. There, Dr. Galalae was promoted to professor and was appointed associate director of the clinic for radio-oncology at the university hospital Kiel. In the framework of his PhD lecture qualification Dr. Galalae was concerned with the enhancement or clinical establishment of the so-called after loading therapy in prostatic carcinoma. He published the first long term results on this topic in 2002. Dr. Galalae is a founding member of the German society for radio-oncology DEGRO as well as a member of the German Cancer Society, ESTRO or GEC-ESTRO, ASTRO, EORTC – Quality of Life Group and the PTCOG. He worked as an expert for high-precision irradiation at the IAEA (international authority for nuclear energy) in Vienna.
„For our new colleague, PD. Dr. Galalae, it was a logic advancement in his career to focus on proton therapy, not least to incorporate it into the consensus of the different radiation-therapy-methods“, the medical director of the RPTC, Prof. Dr. med. Manfred Herbst commented on the start of the new colleague as the director of our radiology department