RINECKER PROTON THERAPY CENTER STATUS REPORT: SEVENTH MONTH OF CLINICAL OPERATION, OCTOBER ‘09
TUMORS WHICH HAVE UP TO NOW BEEN TREATED AT THE RPTC
The scanning-method which is applied exclusively at the RPTC allows an optimal shaping of the dose distribution and hence the modulation to the tumor (see former status reports) compared to other proton irradiation methods or even conventional X-rays. This, together with the immobilization procedures used at the RPTC including the revolutionary suppression of any movements of the target area via the use of anesthesia, has allowed for the treatment of a large number of different tumor types in the first seven months alone. Overall, it has already been possible to treat tumors at 24 different locations in the body, from the scull to the neck, the thorax (chest), the abdomen all the way down to the pelvis (see table). With the current doubling of the treatment capacity at the RPTC this indication spectrum will be extended further. The operating license granted by the governmental authority extends to all tumors that are so far treatable by radiotherapy.
PRESENT COST COVERAGE BY HEALTH INSURANCES
The treatment of tumors with proton beams using the scanning-method is covered by compulsory health insurance. Several insurances have concluded a contract with the RPTC in this matter. Accordingly, the admission of patients who are insured with one of these companies runs smoothly. Moreover, a number of additional compulsory health insurances have indeed not yet concluded framework agreements with the RPTC. However, they have already met the costs for proton therapy at the RPTC on a by-case basis. A table of all the private as well as compulsory health insurances whose patients have already been treated at the RPTC can be found in the following overview.
PATIENTS‘ COUNTRIES OF ORIGINATION
Worldwide, proton therapy is offered at several therapy centers, especially in the USA and Japan. A series of additional centers is under construction and will start operations in the near future. However, the worldwide capacity is still by far not sufficient to satisfy the demand. Especially the scanning-method which is applied at the RPTC is unrivaled with regard to its precision and possible field of application). Therefore, it is not surprising that patients from all over the world solicit for a treatment at the RPTC. Hence, we have been able to irradiate patients from 15 countries in and out of Europe within the first seven months alone (see table).
DOUBLING IN THE TREATMENT CAPACITY AND COMPLETION OF THE RPTC
Gantry 1. Continuous clinical operation with the scanning-system since March 2009. This first treatment unit has already achieved a reliability of more than 97% within the first 100 days of operation. All patients which have been treated so far have been irradiated here.
Gantry 2. Beginning of clinical operations 30. October 2009. The second treatment unit is identical to the first and works also with the scanning-system. It doubles the treatment capacity of the RPTC.
Gantry 3. Beginning of clinical operations February 2010. Once more an identical treatment unit with the scanning-technique. The present treatment capacity will triple.
Gantry 4. Beginning of clinical operations June 2010. Likewise a scanning-gantry, with which the RPTC will have reached full capacity for larger tumors. However, this fourth and last gantry will already be equipped with a “faster” version of the controlling software which ensures a time saving switching from gantry to gantry in order not to lose any time and treatment capacity because of the switching.
Software-Upgrade Gantries 1 – 3. The first three gantries will be upgraded with this “faster“ software in July 2010. This leads to sufficient leeway with respect to time to connect also the fifth and last therapy unit.
Fixed Beam therapy unit for eyes and smaller tumors. This fifth and last therapy unit is to begin clinical operations in November 2010 or earlier. It is designed for the treatment of tumors which are so small that they can actually only be diagnosed and discovered when they affect the function of individual nerves at or in the brain. This includes tumors, mainly melanomas, in the eye. The use of individual apertures allows to sharpen the edges of the already very precise proton beam, than it would be possible with the spot-scanning-system for large tumors. This certainly applies to the eye, in the cases of small brain tumors this small-field-scattering-system will be in competition with our well-proven scanning-method. We have given precedence to the other treatment units since sufficient capacity is provided at a facility for the treatment of eye tumors in Berlin. Our eye treatment unit is designed with a novel and highly precise targeting system which constitutes a significant improvement. In contrast to the previous methods it also guarantees the mandatory complete documentation of the irradiation geometry. These improvements are currently under development.
Increase in the daily operating time. At present, the manufacturer, Varian, and the clinical operator, ProHealth share the facility between them. Unfortunately, radiation protection responsibility makes it impossible to work simultaneously which limits the time that is available for the treatment of patients. However, the work share of the manufacturer can be decreased from February 2010. We hope to thereby reduce our waiting lists. World-leading facility with scanning-system. As the RPTC possesses four treatment units with the scanning-system that permits an optimal dosage distribution (and keeps the patient free of the significant neutron-radiation which occurs when treating large tumors with the scattering-method) we expect to become the facility with the worldwide highest daily frequency of scanning-irradiations before the end of 2009. Furthermore, we expect to outperform facilities which are already using the scanning-system in the number of patients and experience in the first quarter of 2010.