The ENLIGHT network invests in training

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RESEARCH PROJECTS

The ENLIGHT network invests in training For the 'rst time, ENLIGHT brings training into the core programme of its network meetings

The annual meeting of the ENLIGHT network gathers experts and delegates from most of the European centres and research institutions working on particle therapy for cancer treatment. This year, the meeting was hosted by the University of Utrecht, The Netherlands, from 1516 September 2016. The convention was attended by almost 100 participants from 15 countries, and chaired by the ENLIGHT co-ordinator, Manjit Dosanjh, and the local organisers, Els Koffeman and Jan Visser from Nikhef, the National Institute for Subatomic Physics in The Netherlands. The location was carefully selected as one of the key topics of discussion of the meeting was the design and realisation of four brand new centres for proton therapy in The Netherlands – Groningen, Maastricht, Delft and Amsterdam – that followed the recent approval by the Dutch government of a plan for making proton therapy available nationwide.

MANJIT DOSANJH VIRGINIA GRECO

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BLEDDYN JONES

In addition to the collaborative model of the new Dutch centres for treatment with proton and heavier ions, many other hot topics were discussed, including the recent progress and technological breakthroughs in medical imaging, the need for access to and sharing of clinical data,

The poster session was one of the highlights of the annual meeting of the ENLIGHT network. From left to right: CERN’s Manjit Dosanjh, with the three poster winners: Ander Biguri (University of Bath), Thyrza Jagt (Erasmus MC Cancer Institute) and Armin Luhr (Oncoray, Dresden)

and the importance of using a standard Normal Tissue Complication Probability (NCTP) model for selecting patients for treatment with proton and heavier ions. Time was also given to young researchers, who were able to exhibit posters summarising their research. The second day of the meeting was closed, with the authors of the best three posters giving oral presentations of their work to participants. Els Koffman and Jan Visser from

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Nikhef presented the prizes for best posters to: Ander Biguri (University of Bath, UK), Thyrza Jagt (Erasmus MC Cancer Institute, The Netherlands) and Armin Luhr (Oncoray, Dresden, Germany).

Proton therapy boosted in The Netherlands

Leading medical experts from the new Dutch centres for proton therapy (Hans Langendijk, Marco van Vulpen, Bart Vanhauten and Geert Bosmans) presented the national programme and the current state of the facilities in Delft, Groningen, Maastricht and Amsterdam. This ambitious and extensive national programme was launched in 2013 by the Dutch government and is being implemented in a relatively short time. The Holland Proton Therapy Centre (Holland PTC) of Delft and the UMC Groningen PTC are already under construction and they expect to treat the first patients at the end of 2017 (August 2017 for the Delft centre and December 2017 for the Groningen centre). The proton therapy centre in Maastricht is heading towards the construction phase and there are plans to integrate the proton facility in the existing radiotherapy centre, so that hospital structures and experts can be shared. They expect to treat

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the first patients in 2018. Finally, the fourth centre, which will be established in Amsterdam, is currently choosing the company that will provide the facility’s technical equipment. All these centres will have one or two treatment rooms equipped with gantries, which allow a complete rotation of the beam axis around the patient to target the tumour better. Given the paramount importance of medical imaging for treatment planning and adaptation, MRI and PET scan machines will be available in the same centres, while CT scans will be performed inroom. Once the four centres are operating, The Netherlands will be able to treat more than 1,000 patients per year with protons. In order to run, particle centres need highly specialised staff composed of medical doctors, physicists, radiobiologists and technicians, who have to be specially trained. At the moment, there are only a few experts in this emerging field, and therefore emphasis will be given to training young professionals. There will also be a focus on research, with each centre running its own research programme designed to improve proton therapy and to develop more precise, effective treatment procedures with fewer side effects. The status of particle facilities Europe-wide was

summarised by Beate Timmermann of the West German Proton Therapy Centre Essen (WPE), and Karin Haustermann, of the Academic Hospital (UZ) of Leuven, Belgium. Karin also talked about the challenging path that has to be followed to move from the project design of a new centre to implementation and clinical practice. It is a tough and time-consuming process, which never completely reaches an end, since the rapid evolution of technologies and discoveries has to be responded to.

New perspectives in medical imaging

A significant space was given to talks and discussions about medical imaging, since it is essential for accurate and effective treatment, with recent developments presented in two dedicated sections. In order to deliver a really effective treatment and, at the same time, to avoid side effects – such as killing healthy cells, damage to critical organs and secondary tumours caused by irradiation – it is important to localise the cancerous mass in the best way, and to be aware of its modification during the treatment period. Positron emission tomography (PET), magnetic resonance imaging (MRI) and computed tomography (CT) scans are used alone or in combination (multi-modal imaging) to assess

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the volume and the position of the tumour before, after and during treatment, whenever possible. Particularly complicated is the case of moving organs, such as the lungs, which has to be addressed by using in-room multi-modal imaging, associated with an adaptive treatment workflow. Theoretically, tracking would be the best solution, which requires online, real-time 3D information, as highlighted by Antje-Christin Knopf of the Institute of Cancer Research (ICR) in London, UK. The advantages of having simultaneous MRI and treatment irradiation were discussed by Bas Raaymakers of the University Medical Centre (UMC) in Utrecht, The Netherlands. The integration of MRI with Linac can provide image-guidance concurrent with treatment, minimising the patient’s exposure to the additional ionising radiation of CT scans. It can also offer a real-time view of what happens in a patient’s body during each treatment, taking advantage of MRI’s strength in imaging soft tissue and thus enable adjustment of the targeted radiation treatments.

Some of the participants of the ENLIGHT annual meeting. The convention was held in Utrecht, The Netherlands, from 15-16 September 2016

Tailor-made treatments

Image-guided proton therapy (IGPT) is one of the applications of the new paradigm that is emerging in oncology: that is the shift to a personalised and precise medicine, where the treatment is tailormade for the individual patient. Also working towards this end is the idea of developing a proton therapy decision-support system that would help medical doctors to choose the best combination of treatments for their

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patients. In order to make an informed decision, the practitioner has to be able to rely on as much data from previous cases as possible. This is where the emerging big data systems come into play, since they would allow the doctor to analyse a single patient’s condition in comparison with a model extracted from an analysis of information from past cases. Of course this system can be built only if clinical data are accessible, which is still a controversial issue, because of privacy concerns. Nevertheless, as Philippe Lambin

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of the University Hospital of Maastricht, The Netherlands, highlighted, this is needed and actions have to be taken in this direction. An important change in culture is actually ongoing, since society is quickly moving towards massive data gathering and sharing.

Advisory committee

Training at ENLIGHT

For the first time since the establishment of the network in 2002, the annual ENLIGHT meeting was followed by a one-day training course on keys aspects of particle therapy, including radiobiology, medical imaging and data sharing. The network was very fortunate that highprofile scientists and medical doctors made their expertise available to colleagues and young researchers through a number of lectures, which were given in the fantastic setting of a historic building at the University of Utrecht. This training was much appreciated by members of the community, and a similar course will be organised at the next annual meeting, which will be held in June 2017 in Aarhus, Denmark. Aarhus is an appropriate setting for the meeting as it will soon be home to the first particle therapy centre in Denmark. The meeting will coincide with the installation of the cyclotron.

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The ENLIGHT network organised its first multidisciplinary training session open to all participants

In 2015, at the ENLIGHT meeting in Krakow, it was agreed that a core group should be formed composed of representatives of the various technological and clinical disciplines, which would help the ENLIGHT co-ordinator set the network’s scientific policy. The Utrecht meeting this year closed with the announcement of the members of this committee, voted for by network members. They are: Damien Bertrand (IBA), Stephanie Combs (radiation oncologist, Munich, Germany), Marco Durante (physicist, radiobiologist, Trento, Italy), Piero Fossati (radiation oncologist, CNAO, Pavia, Italy), Bleddyn Jones (radiation oncologist, Oxford, UK), Pawel Olko (physicist, Krakow, Poland), Katia Parodi (medical physicist, Munich, Germany), and Richard Pötter (radiation oncologist, Vienna, Austria). Manjit Dosanjh CERN, Switzerland

Faculty members of the training course organised during the ENLIGHT meeting. From left to right: Kari Tanderup, Richard Pötter, Machiel Jansen, Bas Raaymakers, Bleddyn Jones and Martin Pruschy

Virginia Greco CERN, Switzerland Bleddyn Jones University of Oxford, UK and CERN, Switzerland

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