|
|
Research
NIPTRC will have dedicated research beam facilities to address fundamental questions in radiation physics, chemistry and biology with the goal of applying this new knowledge to improved clinical protocols. The physical rationale for the use of proton beam radiotherapy is the ability to concentrate dose to within the tumor volume using the Bragg curve, which delivers maximum dose at the tumor and minimum dose where the protons enter the body. Proton therapy has been applied to a wide range of cancers and some non-cancer diseases with a large measure of success. Generally speaking, all research areas of clinical interest will focus on achieving higher effective doses to the target, greater sparing of normal tissues and shorter treatment times. In addition, new disease sites for radiation in general and protons in particular are always being explored. The beam delivery at NIPTRC will be performed using pencil beam scanning (also called IMPT or intensity modulated proton therapy), to reduce dose even further on the proximal side of the tumor. This leads to even greater dose reduction to normal tissues and therefore reductions in normal tissue complications. The pencil beam scanning has also opened research into the RBE of scanned proton beams.
Radiobiological research at NIPTRC will focus on multiple clinical issues including the development of chemotherapeutic agents or radio-sensitizing agents to achieve greater tumor damage during or after the proton radiation, finding suitable radio-protectors for proton therapy that will spare normal tissue and reduce side effects of proton radiation, extending current research to investigate potential changes in RBE ( relative biological effectiveness) which may result from the use of pencil beam scanning, and investigating new applications of protons such as treatment of tremors from Parkinson's disease or refractory temporal lobe siezures.
One active area of research to achieve these goals is the use of therapeutic drugs in combination with proton therapy as discussed below. Another research area is improved imaging technologies to obtain more accurate delineation of the target volume and better simulations of the dose distributions in the patient. Incorporating biological response to radiation in treatment planning software is still in its infancy. Advances here will give better predictions of patient outcomes and allow the physician to find better beam configurations for the patients. In addition to the established cancers for which protons have shown considerable success, diseases such as arteriovenous malformations (AVMs) of the brain and macular degeneration of the eye have been succesfully treated with protons. Future intercranial uses may include treatment of refractory tremors in Parkinson's disease patients, and of refractory temporal lobe seizures where relatively large target volumes may be ideally suited for proton beam therapy.
Medical physics research at NIPTRC will focus on better tumor control and lower side effects through improvements in imaging and tighter target margins. With advanced features for patient treatments such as IMPT (intensity modulated proton therapy) and PET imaging technology, clinicians will be able to target tumors better and prescribe higher tumor doses than previously possible, while maintaining safe limits for normal tissues and organs. With improved imaging tools such as proton CT and 4 dimensional X-ray CT, clinicians will be able to safely explore new limits in radiation therapy and study outcomes that were not previously possible. The advent of respiration gated beam delivery, planned from 4 dimensional CT, will allow tighter margins around some thoracic and abdominal tumors and potentially lower toxicity.
In addition to scientific research, NIPTRC will also begin the development of a comprehensive research agenda involving treatment protocols for delivery of proton treatment to patients. It is the goal of NIPTRC to treat all patients under a treatment protocol to allow for the collection of data for further research. The clinical research efforts at NIPTRC will include pediatric malignancies, improved treatment of rectal cancer patients, and small cell lung cancer.
The aim of this project is to develop treatment protocols utilizing proton and neutron beam therapies. Proton therapy has been available for decades but because of the few number of facilities available and evolving chemotherapies, it is necessary to expand available proton protocols and develop new protocols utilizing both protons and neutrons.
The development of these new treatment protocols will be based on existing data and review of current treatment protocols. Through the analysis of multiple case studies treated under real-life conditions, variables and/or synergistic combinations of variables which impact the effectiveness of neutron and proton therapy will be identified for future clinical study. In addition, optimal treatment strategies for individuals with sets or patterns of similar conditions can be hypothesized.
|
