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## Meet the editors

Dr. FitzGerald is the Professor and Chair of the Department of Radiation Oncology at the University of Massachusetts Medical School. The department has a strong academic mission and provides clinical care to multiple communities throughout central Massachusetts with several community centers providing advanced technology clinical care. Dr. FitzGerald has been Principal Investigator of the Quality Assurance Review Center

(QARC) for more than 25 years. QARC provides imaging and radiation oncology data acquisition and data management service to the National Clinical Trials Network (NCTN) and industry partners. QARC is now part of the Imaging and Radiation Oncology Core (IROC), which centralizes data management and quality assurance service for NCTN clinical trials with offices in Rhode Island, Houston, TX, Columbus, OH, and Philadelphia, PA. In this capacity, proton institution applications are credentialed for clinical trial participation and data are reviewed for protocol compliance. Dr. FitzGerald serves in an advisory capacity for The Cancer Imaging Archive (TCIA).

Maryann Bishop-Jodoin, MEd, is an instructor and scientific writer in the Department of Radiation Oncology, University of Massachusetts Medical School. Ms. Bishop-Jodoin has worked with Dr. FitzGerald at the Quality Assurance Review Center (QARC) program for more than 25 years. She writes and edits manuscripts, books, and grants as well as the QARC quality management system documentation.

Contents

**Section 1**

**Section 2**

**Section 3**

*by Paige A. Taylor*

*by Paige A. Taylor*

*by Nagarjuna Burela*

History and Overview of Proton Therapy

Proton Therapy Center Layout and Interface

*Jeffrey C. Buchsbaum and Thomas J. FitzGerald*

Credentialing Proton Centers for Clinical Trials

Adaptive Proton Therapy in Head and Neck Cancer

Clinical Trials Evaluating Proton Therapy

Proton/Photon Consortium Registry

*by Ameer L. Elaimy, Linda Ding, Jonathan Glanzman, Lakshmi Shanmugham, Beth Herrick, Jody Morr, Dan Han,* 

*Harry Bushe, I-Lin Kuo, Yankhua Fan, Fenhong Liu, Abdulnasser Khalifeh, Suhong Yu, Jonathan Saleeby, James Shen, Kevin O'Connor and Kenneth Ulin*

*by Ameer L. Elaimy, Linda Ding, Carla Bradford, Yansong Geng,* 

**Preface XI**

Introduction **1**

**Chapter 1 3**

Design and Structure of a Proton Facility **13**

**Chapter 2 15**

Clinical Trials in Proton Therapy **23**

**Chapter 3 25**

**Chapter 4 35**

**Chapter 5 43**

**Chapter 6 53**

Multi-Institutional Data Collection and Analysis via the Pediatric

*by Nicholas J. DeNunzio, Miranda P. Lawell and Torunn I. Yock*

### Contents



Preface

It is a privilege to have the opportunity to provide a comprehensive update on the status and future direction of proton therapy in radiation oncology. Over the past twenty-five years, proton therapy has become more prominent worldwide, as it is an important component of clinical radiation therapy for both adult and pediatric clinical care. Proton therapy has the potential to alter the landscape of daily radiation therapy treatment due to its inherent ability to spare normal tissue. Colleagues contributing to this book have provided insight into the history and footprint of proton care, the status of protons in registries and clinical trials, and

Proton therapy has a rich history and historically was limited to a few centers of excellence. The systems required unique expertise in the field of radiation therapy both for treatment planning and treatment execution. Because of the unique nature of treatment delivery, often single fields were treated each day using compensation devices designed to modulate dose distribution. The devices used were early-stage three-dimensional models that became radioactive themselves, therefore cost associated with maintenance of equipment and disposal were unique even in the field of radiation oncology. Pioneers of care at both Massachusetts General Hospital and Loma Linda, CA played important roles in the genesis and application of proton

Because of the unique properties of proton dosimetry, and with exit dose conspicuous by absence, investigators had envisioned strategies for proton care to be delivered at an enterprise level. Design changes with pencil beam applications coupled with miniaturization of the cyclotron design, smaller units became commercially available and proton care became available in a more geographically transparent manner. Today, nearly 100 centers have proton capability, which will expand as cost and production adjust with the demand. Of equal importance, proton applications are now disease sites and anatomically transparent with advantages in all areas of the body. The advantage for pediatric patients has always been clear with decrease dose to normal tissue. Modern applications are now applied for lymphoma for cardio-pulmonary tissue sparing, head/neck, central nervous system, abdomen, pelvis, and extremities with advantages in tissue sparing in all regions. The modern proton unit has image guidance, tracking, and multi-leaf collimation in a manner similar to photons, thus bringing the nimble advantage of photon care to proton treatment execution. Radiosurgery can now be performed with protons in a facile manner in all target areas and investigators are evaluating the role of ultra-rapid dose rate delivery of protons to further exploit the therapeutic advantage of

This book reviews many aspects of proton care including the application of protons in modern clinical trials. It also reviews problems associated with the migration of proton care worldwide. Finally, the book examines the future direction of proton care and the expectation that years from now, proton care will be as applicable

future directions.

care in the United States.

particle care.

*and Maryann Bishop-Jodoin*
