[The French project ETOILE: review of clinical data for light ion hadrontherapy]

[Progress in radiation therapy and integration in Tenon hospital (AP-HP) of new advances in routine practices of radiotherapy for non-small-cell lung cancer]

Much progress has been made in recent years in administration modalities for external radiotherapy of non-small-cell lung carcinoma. Three-dimensional conformal radiotherapy with or without intensity modulation, with respiratory gated radio-therapy (4D radiotherapy), and image-guided radiotherapy (IGRT) can be considered as a third revolution in radiation therapy after total dose fractionation and the development of megavoltage radiation therapy equipment. We describe progress in the three-dimensional radiotherapy technique and the integration of this technique in the department of Radiation Oncology at Tenon hospital (AP-HP).

Modelling the expected increase in demand for particle radiotherapy: implications for the UK

The present rapid worldwide expansion of particle radiotherapy services will inevitably have an impact on clinical practice within the UK. The most recent results of developmental trials using protons and carbon ions are impressive, with high cure rates and little or no functional normal tissue changes and a very low level of serious treatment-related morbidity. The potential numbers of patients that will demand or are referred for treatment abroad are estimated, assuming different rates of change and treatment capacities with time. Even if the maximum demand were to be under 10% of all patients presently treated by radiotherapy, significant numbers (amounting to several thousand patients per year) may be advised to seek treatment abroad between 5 and 10 years from now. The gap between overall demand and the estimated numbers could be partly, although substantially, filled by the establishment of a single large UK facility. Should demand increase beyond the estimated level, for example due to improved screening of cancer, then a network of UK particle radiotherapy centres will be required.

Clinical complementarities between proton and carbon therapies

Protons are characterised by low LET, but compared with photons and electrons have an improved physical depth dose distribution. Some indications for protons, i.e., ocular melanoma, chordoma and chondrosarcoma of the base of skull or cervical spine, are now accepted by the radiation oncology community as the treatment of choice. Others are still under evaluation, e.g. meningioma, locally advanced nasopharynx tumours, paediatric tumours. Neutrons have the biological advantage of a high LET, but their distribution of dose is in most cases suboptimal. Despite this, there are radiobiological arguments leading to expect that neutrons might be of some benefit in patients with tumours that are resistant to photons, slowly growing or containing a high proportion of hypoxic cells. There is some clinical evidence or rationale for a potential high LET advantage for locally extensive (I think that the current (jargon) word is extended in English..) salivary gland tumours, locally extensive(extended) prostate carcinoma, slowly growing inoperable soft tissue sarcoma, adenocarcinoma, adenoid cystic carcinoma of the paranasal sinuses, melanoma and rectal carcinoma. Light ions combine the high LET advantage of neutrons and the improved physical depth dose distribution of protons. The opportunity offered by an optimised distribution of dose should open a new era for high-LET particles, especially in deeply situated x-ray resistant tumours, where the use of neutron beams was restricted by the low quality of their depth-dose profiles. Preliminary results are encouraging.

Status of the “ETOILE” project for a French Hadrontherapy Centre

It is proposed to build a national centre for light-ion hadrontherapy in France, located in Lyon in the Rhône-Alpes region. Under the auspices of University Claude Bemard Lyon-I and with the support of a research contract between Rhône-Alpes region and the Minister of Research, a design has been elaborated. This paper reviews the medical and technical characteristics of the project, called ETOILE (Espace de Traitement Oncologique par Ions Légers dans le cadre Européen). The research programs associated with ETOILE concern mainly the tracking of moving organs, the design of an in-beam PET detector, the simulation of the interaction of carbon ions with tissues and radiobiological studies on the radiosensitivity and tolerance of normal tissues and on the radioresistance of tumours. The capital cost needed to realize ETOILE is about 90 M Euro. We expect a definitive decision to build ETOILE at the end of 2004. In that case the centre will treat its first patients in 2009. A routine flux of 1000 patients per year will be reached after 3 years with an operation cost of 15 M Euro.