OncoLink Proton Education Modules

Over the last five to ten years the number of proton therapy centers in the United States has increased greatly with numerous new centers proposed. This will make proton therapy available to a greater number of patients and it will be crucial for medical practitioners to develop a good understanding of the advantages and limitations of proton therapy. This will help them identify patients, who would be good candidates for proton therapy as many patients may still need to travel a great distance for treatment. Additionally, those practitioners, who are developing proton facilities or, who are planning to develop proton facilities will need to become familiar with the types of facilities and equipment that are available as well as differences in patient treatment related to the use of proton therapy compared with photon based therapy.

The purpose of these education modules is to provide practitioners with the basic information needed to understand the physics of proton therapy and how these properties affect simulation, treatment planning, daily setup, and quality and assurance when using protons as compared to photons. The basic types of proton delivery systems, positioning systems and immobilization devices are also described. Safety and planning are also discusses as well as some of the early results from specific disease sites where protons have been used.

Module 1: An Introduction to Proton Therapy

* An introduction to proton therapy
* How is proton therapy similar to photon therapy?
* How are protons different from photons?
* What is driving the current growth of proton therapy in the USA?
* When and when not to use protons

Module 2: The Physics of Proton Therapy

* Energy loss of charged particles in matter, the Bragg peak, distal fall off and range uncertainties
* Multiple scattering and lateral dose fall off

Module 3: Equipment for proton therapy delivery

* Accelerators: cyclotrons and synchrotrons
* Beam transport, degraders, range modulation and current modulation
* Gantries and inclined beam systems
* Nozzles
* Passive scatter, apertures, and compensators
* Spot scanning systems
* Dose determination

Module 4: Radiobiology and Radiation Safety

* Radiobiology: Linear Energy Transfer (LET) and Relative Biological Effect (RBE)
* Whole body dose, neutron dose, and induced radioactivity in patients
* Radiation shielding and personnel safety

Module 5: Clinical Outcomes by Disease Site - The Use of Proton Therapy in the Treatment of Cancers and Benign Diseases of the Central Nervous System

* Benign disease
o Arteriovenous malformations (AVM)
o Accoustic neuromas (AN)
o Meningiomas
* Uveal melanoma

Module 5: Clinical Outcomes by Disease Site - The Use of Proton Therapy in the Treatment of Cancers of the Connective Tissues and Bone

* Osteosarcoma
* Chondrogenic tumors
* Soft tissue sarcomas

Module 5: Clinical Outcomes by Disease Site - The Use of Proton Therapy in the Treatment of Cancers of the Gastrointestinal System

* Cancers of the esophagus
* Cancers of the pancreas
* Cancers of the liver and biliary system

Module 5: Clinical Outcomes by Disease Site - The use of proton therapy in the treatment of cancers of the head and neck

* Adenoid cyst carcinoma
* Oropharynx

Module 5: Clinical Outcomes by Disease Site - The Use of Proton Therapy in the Treatment of Cancers of the Lung

Module 5: Clinical Outcomes by Disease Site - The Use of Proton Therapy in the Treatment of Cancers of the Prostate

* Tumor control with proton therapy
* Proton therapy in retreatment

Module 5: Clinical Outcomes by Disease Site - Tumor Control and Retreatment with Proton Therapy

Module 6: Simulation, Positioning, Verification and Immobilization

* Simulation
* Positioning: robotic treatment couches and chairs
* Verification systems: orthogonal X-rays, markers, and cone beam CT
* Field verification and in-situ PET imaging
* Immobilization

Module 7: Treatment Volumes and Treatment Planning in Proton Therapy

* Treatment volume, lateral and distal margins
* Treatment planning software
* Evaluating proton therapy plans
* Volume naming
* Match and patch fields
* Scattered beams, spot scanning beams and Intensity Modulated Proton Therapy (IMPT)
* 4D conformality and organ motion

Module 8: Pediatric Proton Therapy

* Sarcomas
o Orbital rhabdomyosarcoma
o Parameningeal rhabdomyosarcoma
* Central nervous system tumors
o Crainiopharyngioma
o Gliomas
o Neuroblastoma
o Medulloblastoma
o Retinoblastoma
* Secondary malignancies
* Quality of life and sociological impact
* Anesthetization and immobilization
* Neuro-psychiatric and cognitive testing in follow-up
* Endocrine testing