**Part 2**

**Particle Therapy**

66 Modern Practices in Radiation Therapy

[15] Liengswangwong V and Bonner JA. Point: The potential importance of elective nodal

[16] Suzuki K, Nagai K, Yoshida J, et al. Clinical predictors of N2 disease in the setting of a

[17] Ishida T, Yano T, Maeda K, et al. Strategy for lymphadenopathy in lung cancer 3cm or

[18] Matsuura K, Kimura T, Kashiwado K, et al. Results of a preliminary study using

[19] Yuan S, Sun X, Li M, et al. A randomized study of involved-field irradiation versus

[21] Chen M, Hayman JA, and Ten Haken RK, et al. Long-term results of high dose

[22] Chapet O, Ten Haken RK, Quint L, et al. Incidental irradiation to non-involved nodal

[24] Mac Manus M and Hicks RJ. The use of positron emission tomography (PET) in the

[25] Hong R, Halama J, Bova D, et al. Correlation of PET standard uptake value and CT

[26] Belderbos JSA, Kepka L, Kong FM, et al. Report from the international atomic agency

[28] Vanneste BGL, Haas RLM, Bard MPL, at al. Involved field radiotherapy for locally

[29] Bradley J, Govindan R and Komaki R: Lung. In Principles and Practice of Radiation

(eds). Lippincott-Raven, Philadelphia-New York: 1201-1243, 1998.

Failure (ENF)?- Int.J. Radiat. Oncol. Biol. Phys: 77; 337-343, 2010.

critical review. Int J Radiat Oncol Biol Phys 2008; 72: 1289-1306.

planning. Int J Radiat Oncol Biol Phys 2007; 67: 720-726.

irradiation? Int J Radiat Oncol Biol Phys 2006; 64: 120-126.

Oncology 2000; 10: 308-314.

Clin Oncol 2009; 14: 408-415.

178-184.

2008; 22: 245-250.

Cancer 2010; 70: 218-220.

Cardiovasc Surg 1999; 177: 593-8.

less in diameter. Ann Thorac Surg 1991; 50: 708-771.

irradiation in the treatment of non-small cell lung cancer. Seminars in Radiation

negative computed tomographic scan in patients with lung cancer. J Thorac

hypofractionated involved-field radiation therapy and concurrent carboplatin /paclitaxel in the treatment of locally advanced non-small-cell lung cancer. Int J

elective nodal irradiation in combination with concurrent chemotherapy for inoperable stage III nonsmall cell lung cancer. Am J Clin Oncol 2007; 30: 239- 244. [20] Fernandes AT, Shen J, Finlay J, et al. Elective nodal irradiation (ENI) vs. involved field

radiotherapy (IFRT) for locally advanced non-small cell lung cancer (NSVLC): A comparative analysis of toxicities and clinical outcomes. Radiother Oncol 2010; 95:

conformal radiotherapy for patients with medically inoperable T1-3N0 non-smallcell lung cancer. Is low incidence of regional failure due to incidental nodal

stations in patients with stage III non-small-cell lung cancer treated with 3-D conformal radiation therapy. Int J Radiat Oncol Biol Phys 2006; 66 (Suppl): S474-475. [23] Kimura T, Togami T, Nishiyama Y, et al. The impact of Incidental Irradiation on

Clinically Uninvolved Nodal Regions in Patients with Advanced Non-Small Cell Lung Cancer (NSCLC) Treated with Involved-Field Radiation Therapy (IF-RT) - Does Incidental Irradiation Contribute to the Low Incidence of Elective Nodal

staging/evaluation, treatment, and follow-up of patients with lung cancer: A

window-level thresholds for target delineation in CT-based radiation treatment

(IAEA) consultants'meeting on elective nodal irradiation in lung cancer: Nonsmall-cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 2008; 72: 335-342. [27] Nishiyama Y, Yamamoto Y, Kimura N, et al. Dual-time-point FDG-PET for evaluation

of lymph node metastasis in patients with non-small lung cancer. Ann Nucl Med

advanced non-small-cell lung cancer: isolated mediastinal node relapse. Lung

Oncology (4th edition), Perez CA, Halperin EC, Brady LW, Schmid-Ullrich RK

**5** 

 *Germany* 

**Scanned Ion Beam Therapy** 

*GSI Helmholtz Centre for Heavy Ion Research,* 

Nami Saito and Christoph Bert

**of Moving Targets with Beam Tracking** 

Ion beam therapy has been offering beneficial dose conformity based on the fact that ions deposit large dose sharply at depth and significantly less dose at the entrance or behind the peak, known as the Bragg curve. In the decades, delivery systems of ion beams, especially proton and carbon ions, have been developed and used in number of clinics, and they have demonstrated excellent dose conformity on static tumours. The conventional ion beam delivery utilizes broad ion beams with a collimator for a beam shaping laterally and a patient specific compensator to define the beam depth. Therefore the conventional broad beam delivery is in principle not able to adapt beams to the target if the target is moving internally and changing its radiological depth. On the other hand, the scanned beam delivery system (Haberer et al. 1993;Pedroni et al. 1995) uses narrow ion beams to scan the target volume by controlling scanning magnets without needs of any beam shaping collimator. The scanned ion beam delivery system utilizes no patient specific compensator materials instead the system changes beam energy to control the beam depth, therefore it has an ability to modulate dose peak location flexibly on demand in three-dimensions (3D). Flexibility of such an active beam delivery system allows us to implement an advanced irradiation control system so called beam tracking that tracks moving targets continuously with ion beams not only in lateral directions but also longitudinally. The longitudinal adaptation is a particular objective for ion beam tracking different from the beam tracking in radiotherapy with photon where only lateral direction are adapted with multi-leaf

collimators (Huang et al. 2008;Mao et al. 2008;Murphy 2004;Sawant et al. 2008).

In this chapter we describe an ion beam tracking system that is implemented at GSI Helmholtz centre for heavy ion research (GSI) in Germany based on the active scanned ion beam delivery system, so called the rasterscan (Haberer, Becher, Schardt, & Kraft 1993). At GSI, the rasterscan has been applied to treat static tumours in the head, neck and pelvis since 1997 (Kraft 2000;Schulz-Ertner et al. 2007). With the rasterscan technique, the target is actively scanned with precisely controlled narrow ion beams with horizontal- and verticalscanning magnets. The target volume is split into virtual slices based on the beam path length calculated from the patient's computed tomography (CT) data. For each virtual slice, the beam with the corresponding energy to reach the slice is delivered from the synchrotron accelerator (typical pulse period ~5 s) with pre-selected intensity and beam size. The Bragg peak of the beam is widened to approximately 3 mm with a ripple filter (Weber and Kraft

**1. Introduction** 
