Proton Therapy and Carbon Ion Therapy – High-Precision Cancer Treatment
„Since 2009, this highly effective yet safe radiation therapy has been offered at Heidelberg Ion Beam Therapy Center (HIT for short) for certain cancer types, as the first European Center.“
Professor Dr. Dr. Jürgen Debus
Medical Director, Department of Radiation Oncology / Heidelberg Ion Beam Therapy Center
What is proton therapy?
It is a new type of irradiation that destroys tumor cells more effectively. The most common radiation therapy worldwide is carried out with tiny light particles (usually x-rays), called photons. In contrast, with proton therapy, the rays consist of charged nuclei (=ions) of hydrogen atoms. Thanks to highly complex equipment at HIT, these rays can be directed with high precision and more than 75% of light speed at the tumor and the destructive effects focus there.
What is carbon ion therapy / heavy ion therapy?
With carbon ion irradiation, charged carbon nuclei are directed at the tumor. These are particularly heavy and loaded with energy; thus, this radiation is also called heavy ion therapy. HIT is one of a few centers worldwide offering heavy ion therapy. The biological effectiveness of carbon ions is even greater than that of protons and is used for certain types of cancer.
Both proton and carbon ion therapy are performed at the same radiation facility (only the particle/ion type that is accelerated and directed at the tumor differ).
What diseases are treated at HIT?
We currently treat the following cancers in children and adults:
- Salivary gland cancer (e.g. adenocystic carcinoma)
- ENT tumors, e.g. paranasal carcinoma
- Chordoma / Chondrosarcoma of the base of the skull or the pelvis
- Prostate cancer
- Brain tumors, e.g. glioblastoma, glioma, meningioma, pylocytic astrocytoma
- Pancreatic cancer
- Liver cancer
- Recurrent rectal cancer
- Lung cancer
- Cancers for which ion radiation is favorable, especially deeply placed tumors that can be treated effectively or those where particular care is necessary for the surrounding tissues
- Lymphomas, e.g. malignant mediastinal lymphomas
Other illnesses (Benign tumors and diseases):
- Cerebral arteriovenous malformation (AVM)
- Juvenile angiofibroma
What are the advantages of proton therapy / carbon ion therapy at HIT?
In some cases, ion therapy is the best possible therapy, because it is particularly effective and can be directed with high precision, causing few side effects.
- Ion radiation (also called particle therapy) in relation to photons is biologically more effective and thus, can improve chances of recovery. In addition, tumors not responding to conventional radiation can be effectively treated.
- Ion beams can reach tumors lying deep in the body. Charged particles (=ions) are accelerated to more than three fourth of light speed at HIT and targeted into the tumor tissue. Depending on speed and energy, ions can reach up to 30 centimeters deep into the tissue. Photons, however, do not – they would lose a large part of their energy to the surrounding tissues on the way to a deeper tumor and are most effective at 3 centimeters depth of the tissue.
- Destructive effects are particularly strong with heavy ions – and here, for the first time patients with particular tumors, for example chordomas and chondrosarcomas stand a chance of effective therapy.
- Ions hit the tumor more precisely, releasing their destructive force more accurately within-- surrounding healthy tissue is spared and there are fewer side effects. This advantage is particularly important with tumors close to vital tissues, such as at the base of the skull, the optic nerve or intestine.
- Proton therapy is preferred especially in children, since fewer long-term side effects are expected than from conventional therapy.
- At HIT, protons and carbon ions can be directed with the highest precision – thanks to
- an intensity-modulated raster scan procedure, developed by Heidelberg experts – here, the high-precision dose distribution is ensured.
- the world's first Carbon Ion-Gantry –construction of 600t steel makes it possible to direct rays at the body from any direction – without the gantry, rays can only be directed horizontally.
- and, online therapy control – the rays are checked up to 100,000 times per second.
What benefits does ion radiation therapy at Heidelberg University Hospital offer me?
HIT is closely connected (in location as well as organization) to the National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, the first Comprehensive Cancer Center and thus, a leading oncological center in Germany.
For all cancers, almost all state-of-the-art and diverse innovative treatment methods are available.
For complex situations, interdisciplinary teams of experts develop the appropriate treatment strategy for each patient. If needed, combined chemotherapy can be offered in the adjacent buildings of the Children's Hospital or the National Center for Tumor Diseases (NCT). For further treatment needs, experts of more than 40 medical departments at Heidelberg University Hospital are available.
To check whether you are a candidate for treatment at HIT, our medical experts require some information from you. Please provide the following information quickly and securely over our telemedicine portal
- Current doctor's letter with information about your disease and previous treatment, in English or German
- MRI / CT images in DICOM format (the radiologist will give them on a CD) prior to any surgeries / after any performed surgeries and – if these images are more than 3 months old, current images are necessary as well
- Histological report – if not included in the letter
- Radiation protocol, if radiation has been previously performed
Additional information regarding this process can be found here.
Costs are calculated on a case by case basis, since they depend on the individual treatment plan. After submission of your documents, we can create a cost plan.
An appointment will generally be obtained within 2-3 weeks. If capacity at the Heidelberg Center is insufficient, the site in Marburg, Germany, also operated by Heidelberg University Hospital with the same expertise and similar facilities, can be used.
- Initial preliminary consultation
You receive an appointment for a preliminary consultation with a physician, and any other necessary tests are carried out.
- Radiation therapy planning / Positioning
On the basis of current imaging, the doctors create an exact plan of radiation (dose distribution, number of radiation units, etc.)
Radiation can generally be begun approximately 1-2 weeks after the first appointment. In some cases, settings must be prepared beforehand so that the exact position for each radiation is ensured.
- First Radiation
You will receive detailed information about the specific procedure at your first radiation appointment. After positioning on the treatment table, the location of the tumor is thoroughly re-checked, for example by means of laser technology and digital x-ray technology, and compared with radiation planning so that the rays will be exactly placed.
Depending on tumor size, radiation will last a few minutes to 60 minutes, rarely any longer. During radiation you will feel nothing. You will notice only that the robot-controlled table moves from time to time. In cases of anesthesia (for children), use of camera and cardiovascular monitoring will ensure safety of all patients during radiation.
- Therapy phase
The treatment is repeated between 5 and a maximum of 38 sessions – in which radiation is generally performed 5-6 days per week with a radiation unit (fraction) repeated daily. For example: when radiation with 30 fractions is planned, the therapy phase lasts around six weeks.
In most cases this can be carried out as an outpatient and a hospital stay is not necessary.
- Final Review Consultation
The final consultation often occurs on the last day of radiation, and you receive a doctor's letter (in English) as well as a CD with the radiation plan and images for your homeland physician.
Generally, a journey home can be made immediately after the end of treatment.
Fundamentally, ion radiation therapy has hardly any side effects. Rarely, some side effects typical of radiation therapy occur, and that depends on the body region that is irradiated. Possible side effects include fatigue, local skin lesions, and mucous membrane irritation.
No. There are many diseases or situations in which photon radiation is sufficient or even superior. Ion therapy is clearly superior only in some diseases. The choice of which radiation therapy is best is made on an individual case basis.
You will find more information on further radiation therapy offers at Heidelberg University Hospital here
Proton therapy is preferred especially for specific cancer types in children, since surrounding healthy tissue is maximally spared. Thus, growth and development deficits as well as the development of further tumors can be prevented.
In infants and small children, depending on the age, radiation is only possible under anesthesia (twilight sleep / no general anesthesia) because they must remain completely still. Even with positioning assistance, this can often still not be obtained with children. Daily anesthesia is performed by experienced anesthesiologists and with the least possible amount of medications given. Treatment takes place in close collaboration with the Department of Pediatric Oncology, Hematology, and Immunology. Because the children may not have breakfast, these treatments are always performed first in the morning. Children like to bring a stuffed animal for comforting.
A Publication list for Ion Research at Heidelberg University Hospital can be found here.