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2. therapy

Proton therapy
Changing the way
you treat cancer
www.iba-protontherapy.com
Making a
difference
today,
leading the way
to the future
In the world of medical technology,
“state-of-the-art” is a continually moving
target. To be on the leading edge, you
need to offer the most advanced treatment.
The clinical advantages of proton therapy
compared to conventional radiation
therapy are well known: it is a viable
and successful option, with more than
80,000 patients treated worldwide. And
as more people in medical and patient
communities learn about the benefits of
this advanced treatment, demand will
increase, leading to the need for more
proton therapy facilities.
IBA has designed, developed and
equipped more proton therapy centers
around the world than anyone else,
providing equipment as well as scientific
and engineering expertise. We use a
pragmatic, modular approach that is
scalable to meet your specific business
goals. Whether you want a single- or
multi-room facility, freestanding or
as addition to your radiation therapy
department, we can help your vision
become a reality – and help you bring the
real advantages of proton therapy to more
patients and communities.
iba Proton therapy // 1
Proton therapy
Offer a compassionate
treatment solution
The most advanced cancer treatment
How proton therapy works
Proton therapy is used today to treat many cancers and is particularly appropriate in
situations where treatment options are limited and conventional radiation therapy presents
unacceptable risks to patients.
Proton therapy is an advanced form of
radiation therapy that uses a high-energy
proton beam for cancer treatment. In
contrast to conventional radiation therapy,
proton beams deliver their maximum
energy within a precisely controlled
range, known as the Bragg peak, thereby
reducing adverse effects to adjacent
healthy tissues.
These situations include eye and brain cancers, tumors close to the brain stem and spinal
cord, prostate, liver, lung and breast cancers, and pediatric cancers.
1
2
3
4
5
6
1. Central nervous system
Adult Low and High Grade Gliomas
Pediatric Gliomas
Acoustic Neuromas
· Recurrent or Unresectable
Meningiomas
· Recurrent or Unresectable
Craniopharyngiomas
Chordomas and Low Grade
Chondrosarcomas
Arteriovenous Malformations
Medulloblastomas
Pituitary Adenomas
Posterior Fossa Tumors
extremely high speed, generating a
controlled beam, which is delivered very
precisely in the treatment rooms, through a
nozzle, to the targeted tumor.
With proton therapy, there is significant
potential to reduce side effects, improve
overall outcomes in cancer treatment and
offer a better quality of life to patients.
In IBA-equipped proton therapy centers,
cyclotrons accelerate protons to an
Key advantages of the proton beam in
cancer treatment:
2. Eye & orbit
Uveal Melanomas
Macular Degeneration
Choroidal Melanomas
Retinoblastomas
Choroidal Metastases
Orbital Rhabdomyosarcomas
Choroidal Hemangiomas
Optic Gliomas
—L
ittle to no radiation outside
the tumor;
3. Head & Neck
Paranasal Sinus
Salivary Glands Carcinomas
Nasopharynx
·P
rimary and Recurrent
Esophogeal Carcinomas
Recurrent Carcinomas
—B
etter quality of life during and
after treatment.
—L
ower risk of induced disorders
(e.g. secondary cancers or child
growth abnormality);
4. Thorax
Non Small Cell Lung
Carcinomas
Breast Cancer
Early Stage-Medically Inoperable
Paraspinal Tumors
Soft Tissue Sarcomas
Lymphomas
5. Gastrointestinal malignancies
Oesophageal Carcinomas
Reccurent Rectal Cancer Pancreatic
Cancer
Hepatocellular Carcinomas
6. Pelvis
Early Stage Prostate Carcinomas
Locally Advanced Prostate
Carcinomas
Locally Advanced Cervix Carcinomas
Pelvic Sarcomas
Pediatric Malignancies
Ewing’s Sarcomas
Retroperitoneal Sarcomas
Gynecologic Carcinomas
2 // iba proton therapy
Bragg peak: proton beams release the majority
of their destructive energy within a small range
inside the tumor, depositing less entrance dose
and no exit dose. This peculiarity of proton
beams enables physicians to treat tumors with
unequaled precision, safety and efficiency.
“As a major cancer center,
you cannot really move
into the future without
adding proton therapy to
be part of what you can
offer patients.”
Dr. Zelig Tochner
Professor of Radiation
Oncology,
University of Pennsylvania
Health System.
iba Proton therapy // 3
Precise dose delivery, fewer side effects
Technological advances in conventional
external beam radiation therapy have led
to a new approach: Intensity Modulated
Radiation Therapy (IMRT). To reach the
right amount of dose in the target, IMRT
multiplies the number of beam incidences
needed and spreads unnecessary dose
in the surrounding healthy tissue. For
the patient, this means receiving a much
higher integral dose during IMRT treatment
compared to a similar treatment in proton
therapy.
With proton therapy, you avoid depositing
unnecessary dose in surrounding healthy
tissues because the physics of protons
enables the physician to deliver highly
conformal treatments. Proton therapy
delivers high-energy radiation doses
directly to the tumor.
Today, cancer affects us all:
— it is estimated that 1 person in every
3 will suffer from cancer during his
lifetime;
— analyses1 indicate that 13% of us
will contract more than one cancer,
a proportion that has dramatically
increased over the last years;
However, data is strongly suggestive that,
thanks to its precise dose delivery, proton
therapy reduces by 50 to 80% 2, 3, 4 the risk
of radiation-induced secondary cancers. In
the case of secondary cancers or cancer
resurgence, retreatment is made possible
by the lower Integral Dose delivered during
a proton therapy treatment.
For a deeper understanding of
proton therapy, reference may be
made to the following works:
— Thomas F. Delaney, Hanne M.
Kooy, “Proton and charged particle
radiotherapy”, 2007, Lippincott
Williams & Wilkins
Patient’s testimony*
When he learned he had prostate
cancer, Ben Smith, a 55 year old
aerospace engineer from Florida,
analyzed his options and looked for the
best treatment. Smith refused to risk the
possible side effects (impotence and
incontinence) and sought for a more
palatable solution: proton therapy. “The
proton beams are so precise; if that’s
where you want the radiation to go, that’s
where it goes”, he says. “After doing all
the research, I thought, ‘This is it. This is
what I have to have.’”
During his treatment at UFPTI, Smith,
married with two children, enjoyed
visits from his family and friends, read,
attended some college football games
and kept in shape at the local YMCA.
Three weeks after his last therapy
session, he returned to work.
One year later, Smith has regular blood
analyses done and returns to UFPTI
for follow-up visits. “Ben is doing great,”
says his doctor. “His prostate has shrunk
considerably and he has no side effects
from his treatments.”
* IBA Proton Therapy Today, October 2007.
— James M. Metz and Charles R.
Thomas, Jr., “Proton Therapy”,
2010, Radiation Medicine Rounds,
Volume 1, Issue 3
— Harald Paganetti, “Proton
Therapy Physics”, 2012, Series in
Medical Physics and Biomedical
Engineering, Massachusetts
General Hospital and Harvard
Medical School, Boston, USA
— the majority of the cancer patients will
receive radiation therapy at some point
during treatment.
1 Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. “Holland-Frei Cancer Medicine. 6th edition”. Hamilton
(ON): BC Decker; 2003.
2M
acDonald SM, et al. “Proton radiotherapy for childhood ependymoma: initial clinical outcomes and dose
comparisons”, International Journal of Radiation Oncology, Biology, Physics, 2008,71(4):979-86.
3M
erchant TE., et al. “Proton versus photon radiotherapy for common pediatric brain tumors: comparison of
models of dose characteristics and their relationship to cognitive function”, Pediatric Blood and Cancer, 2008,
51(1):110-7.
4C
hung CS, et al. “Comparative analysis of second malignancy risk in patients treated with Proton Therapy
versus conventional Photon Therapy”, International Journal of Radiation Oncology, Biology, Physics, 2008.
4 // iba proton therapy
More precise dose
delivery, fewer side
effects, excellent results –
proton therapy is changing
how cancer is treated. IBA
is helping to make this
compassionate treatment
modality available to more
patients worldwide.
iba Proton therapy // 5
Clinically efficient cancer treatment – examples1
Prostate Carcinoma.
Pediatric Ependymoma.
Current X-ray therapy methods can
result in excessive radiation doses in the
rectum and bladder. With proton therapy,
the prostate carcinoma can be treated
with only 2 lateral beams delivered with
the Pencil Beam Scanning method that
reduces the dose delivered to the rectum
and bladder. With this technique, the
Integral Dose given to the patient is much
Proton therapy spares the hormone and
intellectual centers of the brain, as well
as the middle ear, more than the most
sophisticated conventional radiation
therapy techniques. Current literature
indicates that avoiding even low doses
to these important areas of the brain can
significantly reduce adverse effects and the
risk of secondary cancer2.
lower; hence the patient has a lower risk
of induced complications in surrounding
healthy organs3.
Pencil Beam Scanning can be used
similarly for Intensity Modulated Proton
Therapy and Single Field Uniform Dose
treatments.
Left: proton therapy with scattering delivery technique. Right: X-ray radiation.
Left: proton therapy with Pencil Beam Scanning delivery technique. Right: X-ray radiation.
1 Images with the courtesy of Stefan Both PhD, Assistant Professor of Radiation Oncology, University of
Pennsylvania Health System.
2 Cotter SE, et al. “Proton radiotherapy for solid tumors of childhood”, Technology in Cancer Research and
Treatment 2012, 11(3):267-78.
3 Mendenhall NP, et al. “Early outcomes from three prospective trials of image-guided proton therapy for prostate
cancer” International Journal of Radiation Oncology, Biology, Physics, 2012, 82(1):213-21.
4 Sejpal, S. “Early findings on toxicity of proton beam therapy with concurrent chemotherapy for non small cell
lung cancer”, Cancer. 2011, 117(13):3004-13.
6 // iba proton therapy
Non Small Cell Lung Cancer (NSCLC).
The therapeutic dose delivered during
X-ray treatment of lung cancer is often
limited by the risk to healthy tissue
surrounding the tumor. With proton
therapy, the radiation dose delivered to the
collateral lung and other healthy tissues
surrounding the tumor can be reduced4,
creating a potential opportunity for dose
escalation and consequent improved
patient survival.
Left: proton therapy with scattering delivery
technique. Right: X-ray radiation.
iba Proton therapy // 7
Making
proton therapy
accessible
to patients worldwide
The key indications for proton therapy
represent up to 30% of all cancers treated
in conventional radiation therapy.
Despite this high potential, very few
patients today are treated with proton
therapy because access is so limited.
IBA is committed to changing this; we
are dedicated to making proton therapy
more available to patients, as well as more
affordable to healthcare systems.
8 // iba proton therapy
iba Proton therapy // 9
IBA, a safe path
to superior treatment
Benefit from unrivaled experience gained through
20+ projects
With more than 25 years of experience,
IBA, the market leader, has designed
and equipped the majority of clinically
operating proton therapy centers around
the world, with over 20 projects that are
already operational or at various stages of
development.
As access to proton therapy increases
around the world, IBA continues to
innovate and provide compassionate
solutions with more patient-friendly
treatment rooms and more precise
therapies. Partnering and collaborating
with renowned clinical institutions, IBA is
committed to making proton therapy, the
most precise cancer treatment, available
worldwide.
3 The Proton Therapy
Center LLC (TPTC)
Provision Healthcare
Knoxville, TN, USA
ROOMS
— IBA has installed over 50% of the
clinical PT treatment rooms in the
market.
— Over the first 10 projects,
IBA reduced installation and
commissioning times almost fivefold
(from 57 to 12 months).
— Record time to first patient
of 13 months from Building
Occupancy Date at CDH (Chicago).
2 Indiana University Health
Proton Therapy Center
Bloomington, IN, USA
ROOMS
Treating since 2011
2
ROOMS
Centre de Protonthérapie
de I’Institut Curie
Paris (Orsay), France
2
ROOMS
Skandionkliniken
Uppsala, Sweden
2
Bronowice Cyclotron
Center
Kraków, Poland
Treating since 2009
Treating since 2004
4
ROOMS
ProCure Proton Therapy
Center in Oklahoma City
Oklahoma City, OK, USA
ROOMS
Treating since 2009
4
ROOMS
Opening in 2013
4 Federal High-Tech Medical
Center
Dimitrovgrad, Russia,
Europe
ProCure Proton
Therapy Center
Seattle, WA, USA
ROOMS
Opening in 2013
Opening in 2013
1
ROOM
3
Willis-Knighton
Cancer Center
Shreveport, LA, USA
ROOMS
Treating since 1998
5 Hampton University
Proton Therapy Institute
Hampton, VA, USA
3
ROOMS
ROOMS
Treating since 2007
2
ROOMS
Treating since 2006
Leading institutions have already chosen
IBA. Join them to develop the future of
cancer care together.
National Cancer Center
Ilsan, Korea
Treating since 2010
Be part of a community of experts
Transparency and collaboration are key
in advancing proton therapy. This is the
reason why IBA and its customers work
together to lay the foundation for advancing
proton therapy as a universally accepted
clinical treatment.
National Cancer Center
Kashiwa, Japan
Opening in 2014
4 University of Florida
Proton Therapy Institute
Jacksonville, FL, USA
10 // iba proton therapy
Westdeutsches
Protonentherapiezentrum
Essen (WPE)
Essen, Germany
Opening in 2013
ROOMS
Today IBA is the sole player in the proton
therapy market that can enable its new
customers to leverage the experience of
its users’ community. IBA organizes on an
annual basis the “Proteus User Meeting”
which brings together practitioners
from all sites installed by IBA, joined by
IBA experts, in order to exchange best
practices. Customers benefit from a
learning curve that allows us to significantly
reduce the time required to reach first
patient treatments. Even before reaching
an agreement, IBA shares its know-how in
building design, project management and
project financing with its future partners.
4
ROOMS
Opening in 2014
Facts:
— In 2011, more than 40% of patients
who received proton therapy in an
hospital environment were treated
on an IBA system.
4 CDH Proton Therapy
Center, A ProCure Center
Chicago, IL, USA
ROOMS
4 ProCure Proton
Therapy Center
Princeton, NJ, USA
ROOMS
Treating since 2012
Wanjie Proton Therapy
Center
Zibo, China
Treating since 2004
5 University of
Pennsylvania Health
System Roberts Proton
Therapy Center
Philadelphia, PA, USA
ROOMS
3
ROOMS
Treating since 2009
Massachusetts
General Hospital
Burr Proton Therapy
Center
Boston, MA, USA
2
ROOMS
Agenzia Provinciale Per la
Protonterapia (ATreP)
Trento, Italy
Opening in 2013
1
ROOM
Universitatklinikum Carl
Gustav Carus
Dresden, Germany
Opening in 2014
4 Proton Therapy Center
Czech s.r.o.
Prague, Czech Republic
ROOMS
Opening in 2012
Treating since 2001
This map has been last updated in September 2012.
Proteus®PLUS
Proteus®ONE
25 years of experience and innovation, 22 reference centers
IBA leads the world in regulatory clearance
for Proton Therapy systems with FDA
clearance in the United States, CE
marking in Europe and KFDA clearance in
South Korea. This together with experience
gained on more than 20 projects worldwide
ensures a safe and fast path to treatment
while lowering substantially the technical
and financial risk of the project.
iba Proton therapy // 11
Proton therapy, at the heart of our company
Patient care is what really counts
Over the years and through countless
efforts in R&D and partnership with its
customers, IBA has played an active
role in developing proton therapy around
the globe.
Leveraging its experience and years
of collaboration with its customers and
partners, IBA has developed a deep
understanding of what it takes to build,
operate and maintain a proton therapy
center. This experience has laid the
basis for the services we have developed
to ensure that we bring our customers’
projects to completion in the most efficient
and cost-effective way, and make sure
you have the time to continue focusing
on the single most important element —
patient care.
We deeply believe that proton therapy will
help control cancer worldwide in the most
compassionate way possible.
Having pioneered the field of proton
therapy to become the worldwide leader
today, IBA remains committed to following
this path and offering its customers ever
more flexible and accessible state-of-theart proton therapy solutions to make this
extraordinary treatment modality available
to more and more patients worldwide.
Proton therapy is and will remain our focus
and the key driver of our company growth.
Years of continuous improvement lead IBA
to meet the highest standard of quality at
all levels of the organization. To ensure
that the quality is well managed, IBA is
certified ISO 13485 while meeting all
quality requirements of regional regulatory
bodies (FDA, CE marking, KFDA).
Facts:
— R&D represents 12% of IBA
turnover and 13% of its workforce.
— On December 31, 2011, the IBA
patent portfolio contained 326
patents or patent applications
covering 117 different inventions.
— In 2011, proton therapy revenue
growth was close to 50%.
IBA’s experience and knowledge cover all
aspects of the process, from site selection
to design, construction, system integration
and facility management.
the IBA service organization experience
has helped centers around the world to
successfully deliver more than 300,000
fractions to cancer patients.
Your team will be able to focus on the
clinical aspects of cancer care while the
IBA team ensures that your proton therapy
system runs at top performance and meets
the highest safety and reliability standards.
IBA’s service offering includes:
— Consulting Services
— Upgrades and Migration
— Financing Support
— Education and Training
— Maintenance and Operation
— Information and Communication
Our commitment is to ensure your clinical
success by providing reliable tools with
the highest availability possible. To date,
“Our experience with IBA
has been excellent. The
quality of the equipment
has been wonderful.
The people that they’ve
had on board have been
experts in their field, and
they’ve done a wonderful
job of maintaining our
system and providing for a
smooth operation.”
Stuart Klein,
MHA Executive Director.
University of Florida
Proton Therapy Institute.
12 // iba proton therapy
iba Proton therapy // 13
Proteus Series: Meeting your every need in proton therapy
IBA offers a modular approach to proton
therapy that is scalable and adaptable
to the specific goals of a particular
medical group. A number of customers
choose to start with a larger center of 3
or 4 treatment rooms, while others opt
to expand their existing radiation therapy
practice with a single proton therapy
treatment room.
Based on this approach, IBA Proton
Therapy has developed 3 proton therapy
solutions with specific configurations to
meet your every need in proton therapy:
2. Proteus ®TK2: The turnkey tworoom proton therapy center
This proton care center combines the latest
technologies from the best partners and
every device required to optimize cancer
treatment. IBA has established long-term
partnerships and collaboration programs
with suppliers to achieve seamless
interoperability with the ProteusTK2.
Everything has been designed to ensure a
fast, smooth and risk-free set up.
2
1. Proteus ®PLUS: The universal
proton therapy solution
It offers the possibility to configure the
center in accordance with customer needs,
providing a choice of 4 different beam
delivery modes and 4 types of treatment
rooms ensuring perfect patient positioning.
This proven proton therapy solution
combines the latest technologies with
the experience gained over 20 years of
partnership with top clinical institutions.
1
Proteus®ONE in combination with Philips Ambient Experience, improving the overall patient and staff experience.
3. Proteus®ONE 1 : The compact
and affordable proton therapy
solution
ProteusTK2 is a turnkey solution that offers a fully
integrated proton therapy center.
ProteusONE benefits from the latest
technologies and offers extended treatment
solutions, while having a footprint lower
than the size of a tennis court. Its design
enhances the patient experience by
fostering a soothing environment while
making the medical staff daily practice
safer and easier. Smaller, more affordable,
easier to install and easier to operate,
ProteusONE helps make proton therapy
available to more patients worldwide.
protons are possible
For many institutions, a barrier to
proton therapy is the complexity of the
project (high costs, large equipment,
long project). To counter these
barriers, IBA experts have developed
the ProteusONE: a compact singleroom system that substantially
minimizes the space, reduces the
cost and shortens the installation time
required to build a proton therapy
center.
With ProteusONE, protons are
possible for more patients worldwide.
3
ProteusPLUS is the most reliable and proven proton
therapy system today.
ProteusONE is a compact single-room proton
therapy solution.
14 // iba proton therapy
1 ProteusONE is the brand name of a new
configuration of the Proteus 235 including some
new developments subject to review by competent
authorities (FDA, Notified bodies, et al...) before
marketing.
iba Proton therapy // 15
Contact us
Americas
Toll-free: 1 877 IBA 4 PBT
T +1 904 224 6100
Europe, Middle East and Africa
T +32 10 203 342
F +32 10 475 923
Russia & CIS
T/F +7 495 648 69 00
E-mail: [email protected]
Asia Pacific
T +86 10 8080 9186
E-mail: [email protected]
Visit us online at:
www.iba-protontherapy.com
While all care has been taken to ensure
that the information contained in this
publication is correct, we accept no
responsibility for any inaccuracy and
reserve the right to modify this information.
Technical specifications are based on
standard operating conditions and may
be subject to variations. Pictures and
illustrations are not contractual.
ProteusPLUS is the brand name of the
Proteus 235 FDA cleared and CE marked
product. ProteusTK2 is a solution including
a configuration of the Proteus 235.
ProteusONE is the brand name of a new
configuration of the Proteus 235 including
some new developments subject to review
by competent authorities (FDA, Notified
bodies, et al...) before marketing.
Empath is a registered trademark of
IBA Particle Therapy.
IBA, a Belgian company, is listed on
the pan-European stock exchange
EURONEXT and its annual reports
can be downloaded on the website:
www.iba-worldwide.com.
Published by IBA S.A.,
Chemin du Cyclotron, 3
1348 Louvain-la-Neuve, Belgium.
This brochure is printed on ECF woodfree
coated paper. It was produced with
plants that comply with ISO 14001,
the environmental management standard.
16 // iba proton therapy
IBA Group | IBAL01/2033 | Proton therapy 2012
IBA Proton Therapy
Having pioneered in the field of proton therapy to become
the worldwide leader today, IBA remains committed to
following this path and offering its customers ever more
compact, flexible and accessible state-of-the-art proton
therapy solutions.
Every day, our experts work relentlessly to make this
extraordinary treatment modality available to more patients
worldwide. Years of collaboration between IBA and its
customers and partners helped treat over 20 000 patients
worldwide. Leveraging this experience, IBA has developed
a deep understanding of what it takes to build a proton
therapy center.
Our customers benefit from a learning curve of over 20 years
that allowed IBA to significantly reduce the time required to
reach “first patient” treatment.
Leading institutions have chosen IBA to set-up their proton
therapy center. Join them to develop the future of cancer
care together.
Visit us online at:
www.iba-protontherapy.com
www.iba-protontherapy.com