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Dose Reporting in Ion Beam Therapy

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Dose Reporting in Ion Beam Therapy IAEA-TECDOC-1560 Dose Reporting in Ion Beam Therapy Proceedings of a meeting organized jointly by the International Atomic Energy Agency and the International Commission on Radiation Units and Measurements, Inc. and held in Ohio, United States of America, 18–20 March 2006 June 2007 IAEA-TECDOC-1560 Dose Reporting in Ion Beam Therapy Proceedings of a meeting organized jointly by the International Atomic Energy Agency and the International Commission on Radiation Units and Measurements, Inc. and held in Ohio, United States of America, 18–20 March 2006 June 2007 The originating Section of this publication in the IAEA was: Applied Radiation Biology and Radiotherapy Section International Atomic Energy Agency Wagramer Strasse 5 P.O. Box 100 A-1400 Vienna, Austria DOSE REPORTING IN ION BEAM THERAPY IAEA, VIENNA, 2007 IAEA-TECDOC-1560 ISBN 978–92–0–105807–2 ISSN 1011–4289 © IAEA, 2007 Printed by the IAEA in Austria June 2007 FOREWORD Following the pioneering work in Berkeley, USA, ion beam therapy for cancer treatment is at present offered in Chiba and Hyogo in Japan, and Darmstadt in Germany. Other facilities are coming close to completion or are at various stages of planning in Europe and Japan. In all these facilities, carbon ions have been selected as the ions of choice, at least in the first phase. Taking into account this fast development, the complicated technical and radiobiological research issues involved, and the hope it raises for some types of cancer patients, the IAEA and the International Commission on Radiation Units and measurements (ICRU) jointly sponsored a technical meeting held in Vienna, 23–24 June 2004. That first meeting was orientated mainly towards radiobiology: the relative biological effectiveness (RBE) of carbon ions versus photons, and related issues. One of the main differences between ion beam therapy and other modern radiotherapy techniques (such as proton beam therapy or intensity modulated radiation therapy) is related to radiobiology and in particular the increased RBE of carbon ions compared to both protons and photons (i.e., high linear energy transfer (LET) versus low LET radiation). Another important issue for international agencies and commissions, such as the IAEA and the ICRU, is a worldwide agreement and harmonisation for reporting the treatments. In order to evaluate the merits of ion beam therapy, it is essential that the treatments be reported in a similar/comparable way in all centres so that the clinical reports and protocols can be understood and interpreted without ambiguity by the radiation therapy community in general. For the last few decades, the ICRU has published several reports containing recommendations on how to report external photon beam or electron beam therapy, and brachytherapy. A report on proton beam therapy, jointly prepared by the ICRU and the IAEA, is now completed and is being published in the ICRU series. In line with this tradition, the IAEA and the ICRU estimated it is the right time to prepare similar recommendations for reporting ion beam therapy. Experience indeed has shown that when different “traditions” for reporting the treatments are established in different centres, it becomes difficult to agree on a common approach even though everybody recognizes its importance. Harmonisation in reporting implies more than just an agreement on the selection of a dose level, it also implies an agreement on volumes related to the tumour (e.g., gross target volume, clinical target volume, planning target volume) and on reference points and/or volumes to report the dose to the normal tissues at risk. As a logical follow-up of the June 2004 Vienna meeting and the report produced on the RBE of ions, the ICRU and IAEA jointly organized a second meeting on ion beam therapy to further discuss the fundamental issues that have to be understood and resolved in order to reach an agreement for reporting. The meeting took place in Columbus, Ohio, 18–20 March 2006. It was organized by R. Gahbauer and hosted by the A. James Cancer Hospital. These proceedings consist of the different presentations prepared by the authors. This publication aims to initiate further discussions for the development of a set of recommendations for international harmonization of the reporting of ion-beam therapy. The dose distribution and the method of reporting are influenced by the beam delivery technique, dosimetry, method of RBE determination, treatment planning, medical judgment and intent of the prescription. These issues were presented and discussed at the Columbus meeting by worldwide experts in the field and are published in these proceedings. The IAEA is grateful to A. Wambersie and R. Gahbauer of ICRU for their assistance in the compilation of this publication. The IAEA staff members responsible for this publication were J. Hendry and S. Vatnitskiy of the Division of Human Health. EDITORIAL NOTE The papers in these proceedings are reproduced as submitted by the authors and have not undergone rigorous editorial review by the IAEA. The views expressed do not necessarily reflect those of the IAEA, the governments of the nominating Member States or the nominating organizations. The use of particular designations of countries or territories does not imply any judgement by the publisher, the IAEA, as to the legal status of such countries or territories, of their authorities and institutions or of the delimitation of their boundaries. The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to infringe proprietary rights, nor should it be construed as an endorsement or recommendation on the part of the IAEA. The authors are responsible for having obtained the necessary permission for the IAEA to reproduce, translate or use material from sources already protected by copyrights. CONTENTS Summary .................................................................................................................................... 1 Overview of light-ion beam therapy .......................................................................................... 5 W.T.T. Chu Radiobiological characterisation of clinical beams: Importance for the quality assurance (QA) programme in ion beam therapy .................................................................................. 29 J. Gueulette, A. Wambersie, M. Octave-Prignot, B.M. De Coster, V. Grégoire Synchrotron and control technology related to beam delivery for ion therapy........................ 41 K. Hiramoto From beam production to beam delivery, treatment planning and clinical requirements: The point of view of the vendors .......................................................................................... 53 C.P. Hoeppner, E. Rietzel, T. Zeuner, H. Wyczisk Radiobiological rationale and patient selection for ion beam therapy of cancer ..................... 67 J. Hendry, A.Wambersie, P. Andreo, J. Gueulette, R. Gahbauer, R. Pötter, V. Grégoire Review of RBE data on ion beams from Chiba: Influence of LET and biological system ..... 89 K. Ando Ion-beam dosimetry: Comparison of current protocols from Chiba and Darmstadt-Heidelberg, with reference to the IAEA recommendations ................................ 99 S. Vatnitsky, O. Jäkel Dose and volume specification for reporting radiation therapy: Summary of the proposals of the ICRU report committee on conformal therapy and IMRT with photon beams .............................................................................................................. 117 V. Grégoire, T.R. Mackie The Chiba clinical experience and current approach for prescribing and reporting ion beam therapy: Clinical aspects............................................................................................ 123 H. Tsujii Carbon ion radiotherapy: Clinical aspects of dose reporting and treatment results at GSI ... 131 D. Schulz-Ertner, O. Jäkel, J. Debus Quantities and units in ion beam therapy, conclusions of a joint IAEA/ICRU working group ..................................................................................................................... 139 A. Wambersie, J. Hendry Treatment planning and dosimetric requirements for prescribing and reporting ion beam therapy: The current Heidelberg-Darmstadt approach........................................................ 155 O. Jäkel, D. Schulz-Ertner Treatment planning and dosimetric requirements for prescribing and reporting ion-beam therapy: The current Chiba approach.................................................................. 169 N. Matsufuji, T. Kanai, N. Kanematsu, T. Miyamoto, M. Baba, T. Kamada, H. Kato S. Yamada, J. Mizoe, H.Tsujii List of Participants ................................................................................................................. 181 SUMMARY Interest in the use of ion beams in the radiotherapy of cancer is increasing. Initially ions were used in very few centres for treating rare cancers (tumours) near critical body structures. Now there are initiatives to create more carbon ion beam facilities, in particular in several centres in Europe, for treating a wider range of tumour types in different body sites. The rationale for introducing ion beams in tumour therapy is firstly the high level of physical selectivity that can be achieved with ions, so that treatments can be localised to the tumour even better than, or at least equal to, proton beams or modern photon techniques. Secondly, there is the potential biological advantage of ion beams for some tumour
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