1 maart 2015:Bron: de Volkskrant:

De Volkskrant schrijft dat er in zowel Groningen als Delft een nieuw protonencentrum gebouwd gaat worden die vanaf 2017 operabel moeten zijn. Ondanks dat minister Schippers slechts toestemming heeft gegeven voor slechts 1 centrum.

Maar lees het artikel maar:

http://www.volkskrant.nl/wetenschap/nederland-krijgt-twee-centra-voor-behandeling-kanker-met-protonen~a3873487/

En dit schrijft prof. dr. Kaanders mij, dus niet meer naar hemn en zijn collega bellen:

In uw berichtgeving over protonentherapie vermeldt u steeds mijn naam als contact- en informatie-persoon. Mensen zijn daardoor in de veronderstelling dat ze bij mij terecht kunnen voor informatie en dat ik een verwijzing naar een protonencentrum voor ze kan regelen. Ik krijg daarom veel verzoeken via telefoon en e-mail. Helaas moet ik deze mensen steeds weer teleurstellen omdat ik geen verwijsmogelijkheden heb en bovendien juist kritisch sta tegenover protonentherapie (zie o.a. bericht Trouw 28 feb).

Ik wil u daarom dringend verzoeken mijn naam en contactgegevens van uw site te verwijderen.

Hetzelfde geldt overigens voor mijn collega, prof. Terhaard.

Hartelijke groet,

Prof. Dr. J.H.A.M. Kaanders

Dr. C.H.J. Terhaard, radiotherapeut, afdeling Radiotherapie, Universitair Medisch Centrum Utrecht, Postbus 85500, 3508 GA
Utrecht, tel.: 088 755 55 55, e-mailadres: c.h.j.terhaard@umcutrecht.nl,

Prof. dr. J.H.A.M. Kaanders, radiotherapeut, afdeling Radio-therapie, Huispost 874, route 874, Universitair Medisch Centrum St Radboud, Postbus 9101, 6500 HB Nijmegen, tel.: 024 361 45 05,
e-mailadres: j.kaanders@rther.umcn.nl

7 maart 2014: Twee ziekenhuizen. UMC - Groningen en samenwerkingsverband van Erasmus Medisch Centrum - Rotterdam, TU Delft en LUMC - Leiden, hadden officieel al toestemming gekregen van minister Schippers om protonen bestraling te gaan toepassen. Aanvragen van Maastricht en Amsterdam zijn inmiddels ook goedgekeurd.

1 augustus 2013: Chinese Journal of cancer research

In 2011 werd een studierapport gepresenteerd in welke gevallen protonenbestraling ingezet kan worden bij primaire leverkanker. Het volledige studierapport: Proton therapy for hepatocellular carcinoma kan gratis worden ingezien. Onderaan het abstract van deze studie plus een referentie lijst van studies gedaan met een protonen behandeling. Hieronder een andere studiepublicatie van protonen bestraling bij primaire leverkanker uit 2010

14 mei 2010: bron: European Association for the Study of the Liver (EASL) 45th Annual Meeting. Presented April 15, 2010.

Protonenbestraling geeft goede resultaten bij patiënten met primaire leverkanker (HCC - hepatocellular carcinoma). Er moet wel bij opgemerkt worden dat de patiënten vooraf werden geselcteerd en dit geen gerandomiseerde studie is. Toch zijn de resultaten echt goed te noemen. mediane overlevingstijd was 20 maanden, mediane ziektevrije tijd 36 maanden. De patiënten die 1 tumor hadden van 5 cm. of kleiner of maximaal 3 tumoren van 3 cm. of kleiner hadden de grootste kans op overleven. toch bleken ook patiënten met tumoren tot 10 cm. te profiteren van de protonenbestraling.

De 3-jaars overleving voor patiënten binnen de criteria van Milaan (geen tumor groter dan 5 cm. en niet meer dan 3 en geen uitzaaiingen buiten de lever) was 48%; voor patiënten buiten de criteria van Milaan, was dit 12%.

De resultaten waren vergelijkbaar voor progressie-vrije overleving, met 3 jaar progressie-vrije overleving voor degenen binnen de criteria van Milaan op 60%, en voor degenen die buiten de criteria vielen op 20%.

European Association for the Study of the Liver (EASL) 45th Annual Meeting. Presented April 15, 2010.

In the study presented here, each patient received 15 fractions over 3 weeks, for a total treatment of 63 cobalt Gy-equivalent (CGE), or 4.2 CGE per session.

Patients were included regardless of their eligibility for a transplant or their Child-Pugh score.

About half of the patients (47%) had a Child-Pugh score of 7 to 9; 29% had a score of 5 or 6; and 24% had a score of 10 to 15.

Nearly half of the patients (45%) had a Model for End-Stage Liver Disease (MELD) score of 11 to 14; 38% had a MELD score of 6 to 10; 13% had a MELD score of 15 to 20; and 4% had a MELD score of greater than 20.

Roughly half the patients (46%) fell within the Milan criteria. The average tumor size was 5.5 cm.

Patients were not included in the study if they had more than 3 lesions or had only a single lesion of less than 2 cm, if the tumor had spread outside the liver, or if they had other limiting medical conditions.

The safety and toxicity of the treatment was encouraging; the average MELD scores saw only a slight up-tick, from 12 points before treatment to 14 points 3 months after treatment, Dr. Kayali said. That was not a significant change (P = .12).

The 3-year overall survival rate for patients within the Milan criteria was 48%; for patients outside the Milan criteria, it was 12%.

Results were similar for progression-free survival, with 3-year progression-free survival for those within the Milan criteria at 60%, and for those outside the criteria at 20%.

Fifteen patients (20%) had local tumor recurrence, 23 patients (30%) had intrahepatic recurrence, and 13 (17%) had extrahepatic recurrence.

The study received no commercial financial support. Dr. Kayali and Dr. Thursz have disclosed no relevant financial relationships.

European Association for the Study of the Liver (EASL) 45th Annual Meeting. Presented April 15, 2010.

28 januari 2010:

Al in januari 2003 kwam ABC News met een reportage over de veilige nagenoeg zonder bijwerkingen zijnde protonenbestraling i.p.v. klassieke bestraling. Inmiddels zijn in o.a. Basel en Dusseldorf centra die protonen behandelingen geven en ook in Nederland komen komende jaren twee centra te staan. Hier een recente studie met protonenbestraling bij patiënten met inoperabele grotere levertumoren.(HCC - Hepatocellular Carcinoma) daaronder verslag van ABC news uit 2003.

De resultaten uit de studie met 22 patienten met HCC - primaire leverkanker en inoperabele grotere levertumoren (11 - 14 cm.) waren:

Resultaten:
De mediane follow-up periode was 13,4 maanden (tussen 1,5 en 85 maanden). Lokale ziektecontrole op 2 jaars meting was 87%. Overall en progressie-vrije overleving was 64% en 62%, respectievelijk. 2-jaars overall overleving en progressie-vrije overleving was 36% en 24%, respectievelijk. Tumor progressie werd vooral veroorzaakt door nieuwe levertumoren buiten het "bestraalde" gebied. Geen post behandelings gerelateerde toxiciteit van graad 3 of hoger werd waargenomen bij deze protonentherapie.

Uit International Radiation Oncology

Proton Beam Therapy for Large Hepatocellular Carcinoma

Shinji Sugahara, M.D., Yoshiko Oshiro, .†, Hidetsugu Nakayama, M.D.†, Kuniaki Fukuda, M.D.‡, Masashi Mizumoto, M.D.†, Masato Abei, M.D.‡, Junichi Shoda, M.D.‡, Yasushi Matsuzaki, M.D.§, Eriko Thono, M.D., Mari Tokita, B.A.¶, Koji Tsuboi, M.D.†, Koichi Tokuuye, M.D.†

Purpose

To investigate the safety and efficacy of proton beam therapy (PBT) in patients with large hepatocellular carcinoma (HCC).

Methods and Materials

Twenty-two patients with HCC larger than 10 cm were treated with proton beam therapy at our institution between 1985 and 2006. Twenty-one of the 22 patients were not surgical candidates because of advanced HCC, intercurrent disease, or old age. Median tumor size was 11 cm (range, 10–14cm), and median clinical target volume was 567 cm3 (range, 335–1,398 cm3). Hepatocellular carcinoma was solitary in 18 patients and multifocal in 4 patients. Tumor types were nodular and diffuse in 18 and 4 patients, respectively. Portal vein tumor thrombosis was present in 11 patients. Median total dose delivered was 72.6 GyE in 22 fractions (range, 47.3–89.1 GyE in 10–35 fractions).

Results

The median follow-up period was 13.4 months (range, 1.5–85 months). Tumor control rate at 2 years was 87%. One-year overall and progression-free survival rates were 64% and 62%, respectively. Two-year overall and progression-free survival rates were 36% and 24%, respectively. The predominant tumor progression pattern was new hepatic tumor development outside the irradiated field. No late treatment-related toxicity of Grade 3 or higher was observed.

Conclusions

The Bragg peak properties of PBT allow for improved conformality of the treatment field. As such, large tumor volumes can be irradiated to high doses without significant dose exposure to surrounding normal tissue. Proton beam therapy therefore represents a promising modality for the treatment of large-volume HCC. Our study shows that PBT is an effective and safe method for the treatment of patients with large HCC.

Neutron Therapy
January 16, 2003 — Curing Cancer-it's being done with a little known treatment called "Neutron Therapy". Only three sites in the U.S. offer this option and one is located just outside of Chicago.
While neutron therapy may sound new --it's not. This form of radiation has been used on patients for nearly 30 years at Fermilab in Batavia, Illinois. Some doctors say for certain types of tumors neutron therapy can do what conventional therapies cannot. But it's not a popular alternative because most people haven't heard about it. In fact, many who have undergone "neutron therapy" -- only found out about it through word of mouth or the internet.

91-year-old Louise Szilage has just taken a very unusual elevator ride. She was sent below to meet up with a neutron beam. The goal to --eradicate a stubborn cancerous tumor. Doctors say it appears to be working.

"It just so happens she has a tumor that is of the type that is treated here very successfully," said Pam Moser, daughter.

It sounds a bit like science fiction --but "neutron therapy" has been around for quite a while. It's a form of radiation that works differently than conventional treatments. Most radiation therapy uses photons --lightweight particles that damage cancerous cells. Neutrons, which are much heavier that photons, seem to work better at blasting away very dense tumors that have less oxygen inside.

"A neutron beam is better able to deal with bigger tumors than conventional treatment," said Dr. Geoffrey Smoron, radiation oncologist, Provena St. Joseph Hospital.

There are only three sites in the united states that offer this form of radiation --mostly because it's not easy to create. Fermi lab-- which is a research facility for high energy physics.. Has what's known as a particle accelerator. Protons from the accelerator are deflected by a magnet to a target which creates the neutron beam.

"This radiation has effectively the same kind of side effects the same risks the same problems as any other form of radiation," said Arlene Lennox, Ph.D., Fermilab Neutron Therapy Facility.

This now converted freight elevator happened to be in just the right place to bring patients to the beam which can't be moved. the treatment itself is short--but it's the mapping and measuring to make sure the beam hits exactly where it's needs to -- that takes time.

Bharat Mittalis the chief of radiation oncology at "northwestern memorial medical center". He believes there needs to be more research on neutron therapy --but has sent several patients to the facility.

"It's my belief that neutrons is not an established superior modality as compared to photons in the majority of cancer. However in certain tumors the results are encouraging," said Dr. Bharat Mittal, radiation oncologist, Northwestern Memorial Medical Center.

Proponents say neutron therapy has proved to be an effective treatment for cancer of the salivary glands. It's also been used to treat certain types of lung, pancreatic, colon, kidney and prostate cancers.

"We have treated some patients where doctors have pretty much given up and patients were referred her as a last resort with no other hope and have turned out to be cured by that treatment."

Diane Sawlis is hoping to be one of those miracles. The Elgin school teacher is battling what is called spindle cell sarcoma. the softball size tumor is in her chest wall. Diane is done with her treatments --she's in a lot less pan and her tumor appears to be shrinking.

"I'm not going to say cure all but if it busy me some time I'm grateful. I'm grateful for every single day," said Diane Sawlis, Neutron Therapy patient.

Again --this therapy is not for all cancers. It works best on larger, denser tumors that are in an advanced stage. The neutron therapy facility at Fermilab is affiliated with "Provena Saint Joseph Hospital" in Elgin. Patients are accepted through physician referral or self-referral. Cost for treatment is comparable to the price of conventional radiation. Neutron Therapy Facility at Fermilab: 630-840-3865.

The inherent physical attributes of proton radiotherapy offer a way to maximize tumor control via dose escalation while avoiding excessive radiation to the remaining liver, thus increasing biological effectiveness

2012 Dec;24(4):361-7. doi: 10.3978/j.issn.1000-9604.2012.10.09.

Proton therapy for hepatocellular carcinoma.

Ling TC, Kang JI, Bush DA, Slater JD, Yang GY.

Source

Department of Radiation Medicine, Loma Linda University Medical Center, CA 92354, USA.

Abstract

Proton radiotherapy has seen an increasing role in the treatment of hepatocellular carcinoma (HCC). Historically, external beam radiotherapy has played a very limited role in HCC due to a high incidence of toxicity to surrounding normal structures. The ability to deliver a high dose of radiation to the tumor is a key factor in improving outcomes in HCC. Advances in photon radiotherapy have improved dose conformity and allowed dose escalation to the tumor. However, despite these advances there is still a large volume of normal liver that receives a considerable radiation dose during treatment. Proton beams do not have an exit dose along the beam path once they enter the body. The inherent physical attributes of proton radiotherapy offer a way to maximize tumor control via dose escalation while avoiding excessive radiation to the remaining liver, thus increasing biological effectiveness. In this review we discuss the physical attributes and rationale for proton radiotherapy in HCC. We also review recent literature regarding clinical outcomes of using proton radiotherapy for the treatment of HCC.