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Machine-read from the scan, so expect some errors. Lines that couldn’t be read are left out.
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PRdTON RADIOTHERAPY IN THE USSR A report on visits to three institutes, Sept. 24 - 28th 1972, by'J.F. Fowler, travelling under the auspices of W.H.O., Radiation Health Division. XNSTXTUTE OF CLINICAL 6 EXPERI?IEVTAL O::COLOGY, MOSCOW 0 Set la a large complex of oncology buildings where 1800 workers for further clinical cancer facilities. Prof. Rudennan (Head of Radiotherapy) A new complex is being built across the road (Proton beam physics 6 dosimetry) Prof. Rude mn described, with slides, some methods used to treat the 219 patients already treated at Moscow and a t Dubna, 100 Kr away range of cases had been treated, many being advanced although rt ages 1, I1 & XI1 of Ca cervix uteri were included. The efforts vert at first to evaluate the early effects on turnours and normal malignant tissues was expected (or found). The advantage was one of precise local is ation. yet. Patients have died of metastases as expected. Evaluation can only be by the recurrence and complication rates, not yet by li f es pan, He was in charge of the program which u a s run together 19 cases were pituitary abl at ions & 190 were real cancer". The work started on patients in 1967-68. Abi g*I No special radio sens ft ising effects of protons on It was too soon t o make definite statements Complications had been seen ina few cases, but um ally when the dose was obviously (by present standards) too high (cog. sme head and neck cases treated with reduced amber s of fractions but without reducing the total dose). Local recurrence had also been seen i n few ca6es where the dose had been low. -no cases of proc t it is and cystitis had been seen and only 3 recurrences so far, Both rates were promisingly For exampie i n 56 Ca cervix patients followed up for3 years (b) Cervix - special opp:icator which dilates vagina so treatment given i n lithotomy position. Some cases were preoperative but ur u ally ' thlt was the only treatment (3x 1000 rads la2 weeks).
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in front of patient flat. i.c.3x 400 rads per wk t o 4800 rads in4 weeks. Oesophagus - 3fields. Much less sclerosis seen in lung Brags peak i n oesophagus using solid state detector in oasoph.). Expected less also of the side effects of 6oCo including in farc ts as well as fibrosis. Dose: 6000 rads i n 30 fractions, USSR - surgery the same.) (About 5% cure rate from 6oCo both i n Europe & Yalignant melanoma - Preoperative high dose of 10-20,000 :ads 1 hr before surgical removal, t o prevent metastases during irradiation. Only a few cases. Osteogenic sarcoma = preop irradiation, (6000 rads i n 20 x 300 rads over G weeks), together with prophylactic ir radi a tim of the lungs t o 3000 rads in3 weeks. (Heart not such a probleui 3s lung because patients are young). block) being replaced by face-mask t o be mora comfortable. Treatments through the temporal . regions, as i f 25 beam Locations, moved automatically. Treatment takes hour previously but will be quicker with the reconstructed Larynx: 6000 rads i n 30 x 200 rads OVCT b weeks. dose given a s 2F/wk a t Dubna 5years ago,complications were seen and the treatment was since changed, Both a t Moscow and Dubna, the accelerators were/upgraded t o higher energy and output and are now out of action for about 1%years. They will be provided with better proton therapy facilities for continuing and increasing this work when they are in action again. In Ca vulva, some allergic reactions of the mucosa were seen, which I n only 2 cases out 05 30 was radiation ulcer rti cn after In discussion, i t was agreed that bladder Ca, especially T1 and .:? bladders, would be good f o r proton treatment. Thcre was no doubt that only i n Moscow and Dubna a t present - nec really in Swcdcn o r USA - were protons being used for therapy of tumours other than the pituitary.
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L.H. Pavlonsky, Design engineer Head of Accelerator Division Proton d aime try p nys i cist # Physicist (whom I had met a t Harmersmith Hospf tal) The machine was a t present halfway through an upgrading from 7 t o 10 CeV and from 15 pulses t o 24 pulses p e r minute of 5 x 1011 protons per pulse. Straight sections of vacuum ttibe were belag put in, so that extraction ci .fe Sean: would be easier. The machine was available 24 hours per day for therapy independently of physics experiments, because the medical bcun was run 8s 8 small pulse at adf ffe rent phase i n between the main pulse. Its energy could be adjusted from 70 t o 180 MeVin5MeV steps, with fine adjustment by absorbers. Pituitary ir radi at fs as always used 180 XsV. high t o avoid s cec ter,but low te keep neutron conten.; small. (i.e. through-and- through; a o t Brogg peak;. Other caacers used 70-15s MeV, varied by the time of ejection from the synchrotron ring. A ridge filter was used to obtain the depth profiles needed. The energy should be Scatter er sue re used t o spread the beam. Applicators were made Dosimetry had been done by a mall i o n chaanbcr‘xnd photographic a solid state detector: Uranium firs ion + etched tracks. If the QF was allowed for, the beam must be less than 1%of the c e n t r a l intensity within2 nun outside the edge of the small field ; and less than 0.5% within5 PIP outside the edge of the large field. I saw the accelerator hall during reconstruction, and the treatment room (about 15 feet square) with the patients’ couch and turntable. The engineering was good. For small fields (8.8. Pituitary5 mm diam.) The precision of rt tre o taxi c ccn::l:b& Patients were brought there by Ombutonce, a 20 min. journey by road from the Institute of Clinical & Experimental Oncology. -Dubns was 1 hour away from town; patients were taken there in
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ZG) :.ks:=w had no Dlans t o USJ ne-ativc pions b u t Dubna has; to in vc stig a. )the RBE 6 OER with the ffiomentr spread and total ' a e m that they produce. The output would be low. . Has Just o;oved out from centre of Leningrad and the new buildings will be completed within2 years. including ZOO beds and opera ti:g theatres. Clinics are 8lso on the site 3-4.. Volkov, 3e put y Director ---?zcrczs were available at Cratschna, on the other side of Leningrad, ezergy i s too high for direct use, and experiments will have t o be dote t o see whether: L,,.I.. & &rse were 1000 !ieV protons, o r 1300 MeV Helium nuclei. This h'cutron production i n the slowing material is prohibitive Scatter and straggle are ton rrmt. The plans were i n a preliminary stage, but it might be possible t o start patients within about 2 years if the decision to go ahead was There uould be = r e exphasis on pituitary work (using high-energy protons) and possibly less on oCer twurs. There were plans to build a small linear accelerator to replace gama sources (4 MeV with a short waveguide) and a microtron 13) The possibility of using a proton beam for therapy a t Novosibersk (Sfberia) was mentioned, as well as the joint Moscow-Dubna project. 14) The Institute here had 60 beds for Cynaecology including 10 fo: the discussed the following uith usat length: Eight fractionation schedules for treating Ca Cervix were being used: Each schedule was used t o give 1800 rads i n 2 weeks, then 2 wecks ~ a p ,then 1800 rads again. If intra cav it ary radiation was given, were done during and after treatmerit, but often no tumour could be found so only the early biopsies could be used t o assess the progress year suitable for the trial and so far had 60 in the series. We dircusscd the nunbers of patie.its rcquired. They would soon concentrate - it occup€ed 2 more weeks a f t e r a second gap of 2 weeks. Biopsies COPIED FOh o f therapy (by morpnology of cells etc.). They had 100 patients par
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2. Metastases of malignant tumours in lymph nodes - 16 -Malignant melanons and skin cancers 6. Osteogenic end synovial sarcomas . From Prof. Ruderman, Minakova, Lomanov, Vainson, et a1.