Defining the future of Proton Therapy with Arc & Flash
ENLIGHT Annual Meeting - Caen, July 3, 2019
Claude Dupont, PT Sales Director
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This document may contain express or implied forward-looking statements,
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subject to a variety of risks and uncertainties, many of which are beyond IBA’s
control, and some of which could cause actual results that differ materially from
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any warranty or commitment with respect to the Statements.
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Proteus ONE
IBA world-class innovative proton therapy solutions
Proteus PLUS
ENLIGHT Visit @ CYCLHAD P1
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Think Big, Scale Smart
ONE
Proteus®ONE Think Big, Scale Smart
STATE-OF-ART DELIVERY
Most precise IMPT
COMPACT Proven Arc capability
Compact design Motion management
Low-energy consumption
Flash capability with ultra-
high dose rate
BEST IMAGE GUIDANCE
Instant 6 DOF
CBCT
FASTEST WORKFLOW All @ Isocenter
Open gantry environment
Wireless operation
Complete suite of imaging
All TPS & OIS supported
S/W integration
In room and Out of room
Operations 6
IBA INTERNAL USE ONLY
Next generation beam production system
Superconducting synchro-cyclotron
S2C2
Diameter 2.20 m
Weight 46 tons
Coils Superconducting NbTi
Field 5.14T to 5.65T
D voltage 10 kV peak
RF frequency 85 MHz to 64 MHz
Pulse beam frequency 1 kHz
Energy 230 MeV
Compact design
Low-energy consumption
Flash capability with ultra-high dose rate 7
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ProteusONE - A game changer
• Smaller footprint (360m²)
• Easier to finance (leasing…)
• Faster to install
(18 months from order to clinical)
• Most advanced clinical features (PBS, CBCT…)
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PROTEUS®PLUS: Tailor-Made Image-Guided IMPT Solution 9
Proteus®PLUS Excellence in Proton Therapy
Fixed Beam
ROBUST
Full Gantries Proven availability
Low-energy
Research room consumption
Flash capability with
ultra-high dose rate
FASTEST WORKFLOW
Fast room switching
Wireless operation
STATE-OF-ART DELIVERY BEST IMAGE GUIDANCE Complete suite of imaging
Most precise IMPT Instant 6 DOF All TPS & OIS supported
Fast delivery Ortho S/W integration
Room matching CBCT In room and Out of room
Proven Arc capability All @ Isocenter Operations
Motion management 10
IBA INTERNAL USE ONLY
IBA cyclotron: a robust solution with a proven record
Cyclotron C230
Diameter 4.34 m
Weight 200 tons
Coils Copper
Field 1.7T to 2.2T
D voltage 150 kV peak
RF frequency 106 MHz
Beam frequency Continuous
Energy 230 MeV
Lower energy for shallow tumors (H&N, Pediatrics, Eye)
Faster and easier commissioning
Lowest power consumption (multiroom systems)
Flash capability with ultra-high dose rate
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Excellence in Proton Therapy
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IBA proton therapy centers – Largest network & experience
54 Centers sold 25 Proteus®ONE 29 Centers in operation
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11/06/2019
50+ PARTNERS perfecting
cancer care
IBA’s research partners are shaping proton therapy
2001 2008 2009 2014 2014
First treatment at MGH First treatment by Pencil Introduction of Gantry First Compact IMPT First clinical use of Cone
Beam Scanning at MGH Rolling Floor and robotic solution with Proteus®ONE Beam CT (CBCT) at
couch at Procure at Willis-Knighton University of
Oklahoma Pennsylvania
IBA ONLY IBA ONLY IBA ONLY
IBA ONLY
?
2015 2015 2018 2019 202X
First clinical use of In- Use of Prompt Gamma First irradiation of spot First Flash irradiation at … at partners’ site
Room CT in Trento Camera prototype in clinical scanning proton arc plan at isocenter in a clinical gantry
treatment in Dresden and Beaumont Health Proton at UMCG and Rutherford 15
UPenn Therapy Center Cancer Centre
From translational Research to Clinical adoption & Patients
Continuous improvement of the IBA Installed Based (upgrades and workflow improvements)
Motion Management Proton Arc Therapy Flash Therapy
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IBA CONFIDENTIAL
Streamlining your proton therapy center
SPOT-SCANNING PROTON ARC THERAPY
FASTER. SIMPLER. ON TARGET.
In partnership with
The study is supported by IBA Research fund & Herb and Betty
Fisher research seed grant award from Beaumont Hospital.
A patent related to SPArc has been licensed to IBA.
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Feature in development
Brain tumor case
IMPT Spot Scanning Arc Proton Therapy
3 beams with one non-coplanar 1 partial arc
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Li, Kabolizadeh, Ding, et al., The First Prototype of Spot-Scanning Proton Arc Treatment Delivery, Radiotherapy & Oncology 2019
Brain tumor case
IMPT Spot Scanning Arc Proton Therapy
Patient setup: 10 minutes Patient setup: 10 minutes
Spot3Beam
Scanning
beams with one Proton Arc Therapy
non-coplanar
delivery*: 11 minutes
has the potential
1 partialto
arcsignificantly
Beam delivery: 4 minutes
workflow efficiency performed on a phantom
Real irradiation
* Includes motion between fields improve
60% Faster beam delivery
Li, Kabolizadeh, Ding, et al., The First Prototype of Spot-Scanning Proton Arc Treatment Delivery, Radiotherapy & Oncology 2019
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Head & Neck case
Spot Scanning
VMAT IMPT Proton Arc Therapy
Ipsilateral parotid VMAT IMPT PT Arc
Mean Dose (cGy) 2662 -5.3% -31.3%
Contralateral parotid VMAT IMPT PT Arc
Mean Dose (cGy) 2178 -19% -52.3%
Oral Cavity VMAT IMPT PT Arc
Mean Dose (cGy) 3098 -33.8% -88%
Potential superior clinical outcomes
Xerostomia
Dysphagia
Tube feeding dependence
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H&N plan comparison with courtesy of Ding, Li, Kabolizadeh, Beaumont Health
Decrease of interplay effect for lung case
IMPT Spot Scanning Proton Arc Therapy
ITV volume of 402cc, S-I motion of 1.2 cm. Similar robust target volume coverage and
(including shift isosSpot
andScanning significant
verify) Proton Arc Therapy reduction
: Potentially of the doses to critical
more Robust
structures as well as decreasing the
interplay effect. 21
Li, Kabolizadeh, Ding et al., Radiation Oncology 2018
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Spot Scanning Proton Arc Therapy is becoming a reality
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Li, Kabolizadeh, Ding, et al., The First Prototype of Spot-Scanning Proton Arc Treatment Delivery, Radiotherapy & Oncology 2019
From translational Research to Clinical adoption & Patients
Continuous improvement of the IBA Installed Based (upgrades and workflow improvements)
Treatment of moving targets Proton Arc Therapy Flash Therapy
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A paradigm shift in radiation therapy?
FLASH THERAPY
A REVOLUTION THAT COULD CHANGE
PATIENT TREATMENT
CLINICAL OPERATION
RESEARCH
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Hypothesis to obtain the Flash Effect
Delivery of a high dose
> 8 Gy
at an ultra-high dose rate
> 40 Gy/s *
in the entire volume of the target
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* Depends on delivery technique
Proton Flash Therapy? Less toxicities to healthy tissues!
Normal Tissue Standard RT – 17 Gy Flash – 17 Gy
0 Gy/s 0.03 Gy/s 60 Gy/s
Could allow dose escalation with less complications
Flash irradiation protects lungs from radiation-induced fibrosis*
Favaudon: M.D. & Researcher @ Institut Curie (France) – IBA Proteus®PLUS user
* Favaudon et al. Ultrahigh dose-rate flash irradiation increases the differential response between normal and tumor tissue in mice, 2016
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Pardadigm shift? Proton Flash Therapy !
FLASH radiation offers a rare
opportunity that could completely
transform the field of radiation
oncology in the next few years.
James Metz, MD
Chair of Radiation Vincent Favaudon, PhD
Department Emeritus Researcher
UPenn Institut Curie
Flash forces us to go back to
chemistry to understand the
mechanism and determine the
maximal effect.
Talks and Discussions on Flash Irradiation at the
IBA Proteus User Meeting 2019
Miami, Feb 1 2019
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What are the potential patient benefits?
60 Gy
Skin complications 2 beams
Lung complications
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Potential FLASH advantage: reduced risk of lung fibrosis*
Lung complications
BEAM 1 BEAM 2
BEAM 1 BEAM 2
Deud (Gy) Conventional Flash Deud (Gy) Conventional Flash
Right Lung 17.7 95.9% 31.3% 14.1 51% 4.7%
Left Lung 0.7 0% 0% 0.4% 0% 0%
Dose rate increase to 40 Gy/s could potentially reduce the risk of fibrosis from 96% to 31% in right lung
*IBA internal models based on literature 30
Favaudon, V., Caplier, L., Monceau, V., Pouzoulet, F., Sayarath, M., Fouillade, C., Vozenin. (2014). Ultrahigh dose-rate FLASH irradiation increases the differential response
between normal and tumor tissue in mice. Sci Transl Med., 6(245), 245ra93
Potential FLASH advantage: decreased skin toxicity*
Skin complications
BEAM 1 BEAM 2
BEAM 1 BEAM 2
Deud (Gy) Conventional Flash Deud (Gy) Conventional Flash
Skin 25.6 Depilation Hair Regrowth 19.7 Hair regrowth Hair regrowth
Dose rate increase could potentially prevent depilation
Potential dose escalation and increase skin dose without skin fibrosis for treatment such as breast cancer
*IBA internal models based on literature 31
Marie-Catherine Vozenin, Pauline De Fornel, Kristoffer Petersson, Vincent Favaudon, Maud Jac- card, et al.. The advantage of Flash radiotherapy confirmed in mini-pig and
cat-cancer patients. Clinical Cancer Research, American Association for Cancer Research, In press, 25 (1), pp.35-42. <10.1158/[Link]-17-3375>. <hal-01812514v2>
Flash irradiations in a clinical gantry treatment room
Performed on March 2, 2019 at the University of Medical Centre Groningen
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Thank you ! [Link]@[Link]
50+ PARTNERS perfecting
cancer care
