Kliniken & Institute ... Kliniken Radiologische Klinik ... RadioOnkologie und... Research Research Clinical Research Group... TP1 Therapy of skull...

TP1 Treatment of meningeoma with helium, proton and carbon ions: Optimization of treatment planning, establishment of study concepts and in vivo verification

The goal of this project is to develop novel concepts for treatment with particle therapy as well as in vivo verification of skull base tumors with special focus on low- and high grade meningiomas.

The optimization of existing treatment options will be first of all investigated by means of treatment plan comparisons of the already applied proton and carbon ion beams with potentially benficial helium beams.

Special emphasis will be given to the possibility of reducing toxicities and radiation induced risks, which could in turn be connected to dose escalation studies. These comparisons will not only involve absorbed and biological RBE-weighted dose as provided by available TPSs, but will also include detailed comparison of relevant quantities such as dose-averaged LET and neutron dose which may be provided by dedicated Monte Carlo simulations. Moreover, the clinical feasibility of high dose conformality with reduced burden to surrounding critical structures will be addressed via prospective application of post-irradiation PET-based treatment verification within the framework of the MIRANDA IRB-approved clinical study.

Quelle: Universitätklinikum Heidelberg

Patient undergoing a PET/CT measurement after scanned ion irradiation at HIT.

The patient was treated for a primary brain tumor with a carbon ion boost. The top panel depicts the dose planned by the commercial TPS overlaid onto the planning CT in axial and sagittal views. The bottom panel depicts the PET image acquired ca. 8 minutes after irradiation and overlaid onto the control CT data, merged and visualised approximately in the same views as the top row. (S. Combs et al. 2012, BMC Cancer)

Quelle: Universitätsklinikum Heidelberg

Multifocal diffusely spreading atypical meningioma in a 55-year-old woman.

Contrast-agent enhanced CT and MRI scan were fused with a DOTATOC-PET/CT examination and used to calculate a two beam carbon ion radiotherapy plan. (Rieken et al. 2012, Radiat Oncol)

Selected publications

Nischwitz SP, Bauer J, Welzel T, Rief H, Jäkel O, Haberer T, Frey K, Debus J, Parodi K, Combs SE, Rieken S. Clinical implementation and range evaluation of in vivo PET dosimetry for particle irradiation in patients with primary glioma. Radiother Oncol. 2015 May;115(2):179-85.

Combs SE, Kessel K, Habermehl D, Haberer T, Jäkel O, Debus J. Proton and carbon ion radiotherapy for primary brain tumors and tumors of the skull base. Acta Oncol. 2013 Oct; 52(7):1504-9

Combs SE, Welzel T, Habermehl D, Rieken S, Dittmar JO, Kessel K, Jäkel O, Haberkorn U, Debus J. Prospective evaluation of early treatment outcome in patients with meningiomas treated with particle therapy based on target volume definition with MRI and 68Ga-DOTATOC-PET. Acta Oncol. 2013 Apr; 52(3):514-20.

Combs SE, Bauer J, Unholtz D, Kurz C, Welzel T, Habermehl D, Haberer T, Debus J, Parodi K. Monitoring of patients treated with particle therapy using positron-emission-tomography (PET): the MIRANDA study. BMC Cancer. 2012 Apr 3;12:133.

Rieken S, Habermehl D, Haberer T, Jaekel O, Debus J, Combs SE. Proton and carbon ionradiotherapy for primary brain tumors delivered with active rasterscanning at the Heidelberg Ion Therapy Center (HIT): early treatment results and study concepts. Radiat Oncol. 2012; 7: 41

Rieken S, Habermehl D, Nikoghosyan A, Jensen A, Haberer T, Jäkel O, Münter MW, Welzel T, Debus J and Combs SE. Assessment of early toxicity and response in patients treated with proton and carbon ion therapy at the Heidelberg Ion Therapy Center (HIT) using the rasterscanning technique. Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):793-801.

Combs SE, Haberkorn U, Debus J, Parodi K. PET-Bildgebung für die Protonen und Schwerionentherapie: Hintergrund, Entwicklungen und klinische Implementierung. Der Nuklearmediziner, 2011

Combs SE, Ellerbrock M, Haberer T, Habermehl D, Hoess A, Jäkel O, Jensen A, Klemm S, Münter M, Naumann J, Nikoghosyan A, Oertel S, Parodi K, Rieken S, Debus J. Heidelberg Ion Therapy Center (HIT): Initial Clinical Experience in the first 80 patients. Acta Oncol 2010 Oct 49(7):1132-40.

Combs SE, Kieser M, Rieken S, Habermehl D, Jäkel O, Haberer T, Nikoghosyan A, Haselmann R, Unterberg A, Wick W, Debus J. Randomized phase II study evaluating a carbon ion boost applied after combined radiochemotherapy with temozolomide versus a proton boost after radiochemotherapy with temozolomide in patients with primary glioblastoma: the CLEOPATRA trial. BMC Cancer 2010 Sep 6;10:478.

Mairani A, Brons S, Cerutti F, Fassò A, Ferrari A, Krämer M, Parodi K, Scholz M, Sommerer
F. The FLUKA Monte Carlo code coupled with the local effect model for biological
calculations in carbon ion therapy.
Phys Med Biol. 2010 Aug 7;55(15):4273-89

Sommerer F, Cerutti F, Parodi K, et al. In-beam PET monitoring of mono-energetic 16O and 12C beams: experiments and FLUKA simulations for homogeneous targets. Phys Med Biol 2009;54:3979-3996

Parodi K, Ferrari A, Sommerer F, et al. Clinical CT-based calculations of dose and positron emitter distributions in proton therapy using the FLUKA Monte Carlo code. Phys Med Biol 2007;52:3369-87

Parodi K, Paganetti H, Shih H, et al. Patient study on in-vivo verification of beam delivery and range using PET/CT imaging after proton therapy. Int J. Radiat. Oncol. Biol. Phys.2007;68:920-934.