7 October 2020
BJR publishes guidelines on heavy charged particle beam therapy and related new radiotherapy technologies
New guidelines aim to change clinical practice and improve cancer patient outcomes
BJR,the flagship research journal of the British Institute of Radiology, has published a Guidelines and Recommendations article entitled “Heavy charged particle beam therapy and related new radiotherapy technologies: The clinical potential, physics and technical developments required to deliver benefit for patients with cancer” by Karen Joy Kirkby and colleagues.
Radiotherapy plays a key role in effective treatment of cancer in the UK, and in 2018 high energy proton beam therapy began in the UK National Health Service. Heavier charged particles have potential advantages over protons, however they require more costly equipment. Following a meeting in 2019 between clinicians, clinical scientists, engineers, academics, industry representatives and funding agency stakeholders, it was agreed that the UK should develop a facility for heavier charged particle therapy.
This article summarises the discussions held during this meeting, and the proposed scenarios for building a National Ion Research Centre (NIRC) for developing charged particle beam therapy, which has the potential to change clinical practice and cancer patient outcomes in the future.
Access the article here: https://doi.org/10.1259/bjr.20200247
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Notes for Editors
BJR article information
Title: Heavy charged particle beam therapy and related new radiotherapy technologies: The clinical potential, physics and technical developments required to deliver benefit for patients with cancer
Authors: Karen Joy Kirkby, Norman Francis Kirkby, Neil Gunn Burnet, Hywel Owen, Ranald Iain Mackay, Adrian Crellin and Stuart Green
DOI: https://doi.org/10.1259/bjr.20200247
Abstract:
In the UK, one in two people will develop cancer during their lifetimes and radiotherapy (RT) plays a key role in effective treatment. High energy proton beam therapy commenced in the UK National Health Service in 2018. Heavier charged particles have potential advantages over protons by delivering more dose in the Bragg peak, with a sharper penumbra, lower oxygen dependence and increased biological effectiveness. However, they also require more costly equipment including larger gantries to deliver the treatment. There are significant uncertainties in the modelling of relative biological effectiveness and the effects of the fragmentation tail which can deliver dose beyond the Bragg peak. These effects need to be carefully considered especially in relation to long-term outcomes.
In 2019, a group of clinicians, clinical scientists, engineers, physical and life scientists from academia and industry, together with funding agency stakeholders, met to consider how the UK should address new technologies for RT, especially the use of heavier charged particles such as helium and carbon and new modes of delivery such as FLASH and spatially fractionated radiotherapy (SFRT).
There was unanimous agreement that the UK should develop a facility for heavier charged particle therapy, perhaps constituting a new National Ion Research Centre to enable research using protons and heavier charged particles. Discussion followed on the scale and features, including which ions should be included, from protons through helium, boron, and lithium to carbon, and even oxygen.
The consensus view was that any facility intended to treat patients must be located in a hospital setting while providing dedicated research space for physics, preclinical biology and clinical research with beam lines designed for bothin vitroandin vivoresearch. The facility should to be able to investigate and deliver both ultra-high dose rate FLASH RT and SFRT (GRID, minibeams etc.). Discussion included a number of accelerator design options and whether gantries were required. Other potential collaborations might be exploited, including with space agencies, electronics and global communications industries and the nuclear industry.
In preparation for clinical delivery, there may be opportunities to send patients overseas (for 12C or 4He ion therapy) using the model of the National Health Service (NHS) Proton Overseas Programme and to look at potential national clinical trials which include heavier ions, FLASH or SFRT. This could be accomplished under the auspices of NCRI CTRad (National Cancer Research Institute, Clinical and Translational Radiotherapy Research Working Group).
The initiative should be a community approach, involving all interested parties with a vision that combines discovery science, a translational research capability and a clinical treatment facility. Barriers to the project and ways to overcome them were discussed. Finally, a set of different scenarios of features with different costs and timelines was constructed, with consideration given to the funding environment (prer-Covid-19) and need for cross-funder collaboration.
About BJR
BJRis the flagship journal of the British Institute of Radiology. It is an international, multi-disciplinary journal covering the clinical and technical aspects of medical imaging, radiotherapy, oncology, medical physics, radiobiology and the underpinning sciences.BJRis essential reading for radiologists, medical physicists, radiation oncologists, radiotherapists, radiographers and radiobiologists.
Dating back to 1896,BJR’s history is radiology’s history, and the journal has featured some landmark papers such as the first description of CT "Computerized transverse axial tomography" by Godfrey Hounsfield in 1973. A valuable historical resource, the completeBJRarchive has been digitized from 1896.
The Editorial Board ofBJRfeatures a panel of international experts covering clinical radiology, radiation oncology, radiotherapy, radiobiology and medical physics. Our Editorial Board members provide their expertise and guidance in shaping the content and direction of the journal.
About The British Institute of Radiology
The British Institute of Radiology is an international membership organisation for everyone working in imaging, radiation oncology and the underlying sciences.
Our aims are to:
- support the work of our members and their colleagues to achieve professional excellence
- provide continuing professional development for our multidisciplinary community
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- influence and connect with the wider professional sector.
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