Indications

So far, more than 100,000 patients were already treated with protons worldwide. The standard indications for proton therapy today are chordomas and chondrosarcomas of the base of the skull as well as the axial skeleton, tumours of the fundus (interior surface of the eye) and, to an increasing extent, solid tumours during childhood.

For long-term usage, the WPE has a total of 4 treatment rooms with different proton modalities and the possibility to provide image guidance using X-ray, CT and MRI. Since we are in the initial phase of the parallel completion of the next rooms and systems currently taking place, we have a limited capacity and will first restrict ourselves to a few selected indications (see Diagnosis Table below). This assessment was made after considering the technical requirements and potential medical opportunities. With the technical and capacitive structure of our treatment rooms, the indication list is constantly being expanded.

At the WPE, we currently irradiate in particular non-pre-irradiated, static tumours in the head, spine and pelvic area (i.e. mainly primary brain tumours and sarcomas of the skull base, facial skull, spine and pelvis). Even prostate carcinoma and nasopharyngeal carcinoma are considered.
Also for tumours in children, proton therapy has a great advantage since it reduces stress on the immature, sensitive tissue. The treatment of children is, therefore, a focus of our work. Even younger children (< 5 years) who are confronted with the possibility of anaesthesia can benefit from proton therapy.

Particularly for tumours during childhood, proton therapy has a great advantage since it reduces stress on the immature, sensitive tissue. . Even younger children (< 5 years) who are confronted with the possibility of anaesthesia can benefit from proton therapy. The treatment of children is currently the largest field at the WPE.

We do not yet treat mobile tumours such as those in the following areas: breast, lung, liver, stomach, intestine and pancreas.

For the first time in January 2015, the WPE began what is called the craniospinal proton therapy, i.e. the radiation of the entire central nervous system. This form of irradiation is crucial for some patients. Thanks to the proton beams, the internal organs such as the heart, intestine, thyroid or ovaries can thereby be spared. For the first time in Europe, this complex form of treatment can be offered routinely to children under anaesthesia.

Possible Indications for Proton Therapy at the WPE

Diagnosis:

    Tumours in children (CNS, ENT, Spine, Pelvis)

    Tumors in adults

    • Glioma Grade II and III
    • Glioblastomas
    • Meningiomas
    • Craniopharyngiomas
    • Pituitary adonemas
    • Ependymomas, Medulloblastomas, st-PNET, Germinomas (also Craniospinal treatments)
    • Chordomas/Chondrosarcomas of the base of the skull
    • Chordomas/Chondrosarcomas of the spine/sacrum
    • Glomus tumors
    • Osteosarcomas and soft tissue sarcomas of  the base of the skull, spine and pelvis
    • Nasopharyngeal cancer (as Boost or lymph drainage)
    • Carcinomas of the paranasal sinuses
    • Esthesioneuroblastomas
    • Salivary gland tumors and Adenoid cystic carcinomas
    • Prostate carcinomas (especially intermediate/high risk)
    • Progressed pelvic tumors with lymph drainage
    • Complex recurrent situation

    s

Clinical Experience

Proton Therapy for Tumours of the Eye

Meanwhile, the treatment of choroidal melanoma with protons at leading centers in the US and Europe is firmly established. With protons, a successful therapy of the eye is achieved in up to 90% of patients and often includes the preservation of vision. The therapy is therefore recognized by health insurance companies as a standard method and will be refunded.

Proton Therapy for Chordomas and Chondrosarcomas

Also chordomas and chondrosarcomas of the skull base are now considered an approved indication for proton therapy. These tumours are located in close proximity to critical structures such as the brain stem, optic nerves and temporal lobes. Often these locally aggressive tumours can not be completely removed surgically or treated properly with other radiation therapies. Here, proton therapy is used – and the cost of treatment for proton therapy is usually covered by health insurance.

Proton Therapy in Children

Compared to the conventional photon radiation, proton therapy in children is increasingly being used due to the protection of normal tissues as well as reducing the risk of secondary tumours and long-term side effects.

In Germany, protons are being employed within the scope of the interdisciplinary studies of the Society for Paediatric Oncology and Haematology (GPOH), especially for localized brain tumours and sarcomatous diseases.

The health insurance companies support the use of proton therapy in children.