Main field of
Atypical and malignant meningioma is an intermediate/high grade brain tumour that arises from the linings of the brain. They tend to affect adults with a peak incidence at age 40-60 years. The 5-year tumour recurrence rates are reported as between 39 and 58%. The primary treatment for atypical meningioma is surgical resection. The EORTC has embarked in a phase II dose-escalation study (PI: Damien Charles Weber) that assessed the value of high-dose radiotherapy after surgery for non-radical resection (i.e. Simpson >3). The results of this prospective trial (EORTC 2242-26042) will be analyzed in 2016. A translational research study on pathology (bio-baking) is scheduled for 2015-2016. The second generation of prospective study (ROAM-EORTC 1308) within the EORTC network is scheduled to open in 2015-2016 (Co-PI: Damien Charles Weber). This study will assess whether early adjuvant fractionated external beam radiotherapy reduces the risk of tumour recurrence compared to active monitoring in newly diagnosed atypical meningioma only. Patient retention will be high as patients with atypical meningioma are routinely followed up long term and data will be collected at routine clinic visits however an adjustment to allow for a 10% loss to follow up has been made, requiring a total number of 190 patients needing to be recruited.
Quality Assurance in Radiotherapy (RTQA).
The goal of Quality Assurance (RTQA) in RT is to reduce variabilities and uncertainties related to the different steps of treatment planning and actual patient irradiation, including but not limited to patient positioning and precise dose delivery to the target volume that may have an impact on tumor control or on the normal tissue toxicity. As such, QA is of paramount importance when delivering high dose radiation to cancers for routine cancer patient care or in the context of a clinical trial. The RTQA platform (Co-Chair Strategic Committee, Damien Charles Weber) of the EORTC (Radiation Oncology Group) have shown that RTQA acceptable and non-acceptable variations occurs in prospective trials with radiotherapy. It has long been presumed that deviations from study requirements decrease therapeutic effectiveness and/or increase complication rates. However, only recently has evidence supporting this hypothesis been published by the RTQA group. Moreover, this group has shown that RTQA is cost effective for Head & Neck cancers (EORTC 22071-24071).
Proton beam radiation therapy (PT) has been administered traditionally through a passive delivery system (aperture, compensator, and range shifter wheel) that conforms, both laterally and in depth, the dose distribution to the target volume (passive scattering). Proton dose distribution can also be achieved with increased conformality using narrow pencil proton beams, with a near monoenergetic Bragg peak, superposition of which constitutes the treated volume. It is possible to dynamically position such Bragg peaks in three dimensions throughout the target volume (active scanning). The single “spots” of dose (Bragg peaks) are conformed to the target after magnetic deflection. To modulate the beam range, material from a range shifter is dynamically inserted in the beam line (gantry nozzle). This active dose delivery concept, originally suggested by Kanai et al., has gained substantial popularity based on the positive experiences of the Paul Scherrer Institut (PSI). The center (CPT) led by Prof Weber is focusing on innovation and is currently focusing on clinical focus points; enhanced operation, advanced treatment delivery, motion management, treatment planning and image guidance. In addition, the start of the clinical program, within the collaboration with Zürich University Hospital (USZ), of Gantry 3 is expected in 2016. This treatment unit will be integrated within the high-precision center for Radiotherapy–USZ/ University of Zürich (UZH) and managed by CPT. This collaboration will be significantly consolidated during the 2017-2020 period.
Main field of Research, Key words
Meningioma, Brain tumor, RTQA, Quality assurance, Particle beam therapy, Proton therapy, Pencil Beam Scanning.
Techniques and Equipment
The Center for Proton Therapy (CPT) collaborates actively with other department of PSI and with ETH. The Paul Scherrer Institute, PSI, is the largest research center for natural and engineering sciences within Switzerland. We perform world-class research in three main subject areas: Matter and Material; Energy and the Environment; and Human Health. By conducting fundamental and applied research, PSI works on long-term solutions for major challenges facing society, industry and science.
Education and Training
The CPT holds regular journal clubs and group meetings. It hosts annually the Proton therapy Winter School (http://www.psi.ch/winterschool/ ). Prof Weber gives lectures to the USZ and to Inselspital-Unibern.