ESTRO PT 2018

Historical niche of proton therapy indications

Pediatric

Type • Imaging 1950-1970s – Indirect target imaging of hadron therapy

No. Pathology

1 2 3 4 5 6 7 8 9

Skull base & spinal chordoma Skull base chondrosarcoma

Protons Protons Protons Protons Protons Protons Protons Protons Protons Protons Protons Protons Protons

Spinal & paraspinal “adult” soft tissue sarcomas

• Bone, air • Contrast – Radio-opaque markers-spacers – Target edges • Calculation • Informed guess

Pelvic sarcoma

Rhabdomyosarcoma Ewing’s sarcoma

Retinoblastoma

Optic pathway & other selected low-grade gliomas

Ependymoma

10 11 12 13

Craniopharyngeoma

Pineal parenchymal tumors Esthesioneuroblastoma

Medulloblastoma/primitive neuroectodermal tumors (PNET) Central nervous system (CNS) germ-cell tumors

14

Protons

• Immobile targets – Nearby bone – Superficial

Adult • Skull base, paraspinal and sacral chordoma and (chondro)sarcoma • Glioma

– No moving organs in path