The M. D. Anderson proton therapy system.

PURPOSE: The purpose of this study is to describe the University of Texas M. D. Anderson proton therapy system (PTC-H) including the accelerator, beam transport, and treatment delivery systems, the functionality and clinical parameters for passive scattering and pencil beam scanning treatment modes, and the results of acceptance tests. METHODS: The PTC-H has a synchrotron (70-250 MeV) and four treatment rooms. An overall control system manages the treatment, physics, and service modes of operation. An independent safety system ensures the safety of patients, staff, and equipment. Three treatment rooms have isocentric gantries and one room has two fixed horizontal beamlines, which include a large-field treatment nozzle, used primarily for prostate treatments, and a small-field treatment nozzle for ocular treatments. Two gantry treatment rooms and the fixed-beam treatment room have passive scattering nozzles. The third gantry has a pencil beam scanning nozzle for the delivery of intensity modulated proton treatments (IMPT) and single field uniform dose (SFUD) treatments. The PTC-H also has an experimental room with a fixed horizontal beamline and a passive scattering nozzle. The equipment described above was provided by Hitachi, Ltd. Treatment planning is performed using the Eclipse system from Varian Medical Systems and data management is handled by the MOSAIQ system from IMPAC Medical Systems, Inc. The large-field passive scattering nozzles use double scattering systems in which the first scatterers are physically integrated with the range modulation wheels. The proton beam is gated on the rotating range modulation wheels at gating angles designed to produce spread-out-Bragg peaks ranging in size from 2 to 16 g/cm2. Field sizes of up to 25 x 25 cm2 can be achieved with the double scattering system. The IMPT delivery technique is discrete spot scanning, which has a maximum field size of 30 x 30 cm2. Depth scanning is achieved by changing the energy extracted from the synchrotron (energy can be changed pulse to pulse). The PTC-H is fully integrated with DICOM-RT ION interfaces for imaging, treatment planning, data management, and treatment control functions. RESULTS: The proton therapy system passed all acceptance tests for both passive scattering and pencil beam scanning. Treatments with passive scattering began in May 2006 and treatments with the scanning system began in May 2008. The PTC-H was the first commercial system to demonstrate capabilities for IMPT treatments and the first in the United States to treat using SFUD techniques. The facility has been in clinical operation since May 2006 with up-time of approximately 98%. CONCLUSIONS: As with most projects for which a considerable amount of new technology is developed and which have duration spanning several years, at project completion it was determined that several upgrades would improve the overall system performance. Some possible upgrades are discussed. Overall, the system has been very robust, accurate, reproducible, and reliable. The authors found the pencil beam scanning system to be particularly satisfactory; prostate treatments can be delivered on the scanning nozzle in less time than is required on the passive scattering nozzle.

Successful pregnancy outcome using sperm from severely diseased men with testicular cancer and collagen disease: Three case reports.

Objective: To confirm the feasibility of using fresh or frozen/thawed spermatozoa from cancer and collagen diseased patients for intracytoplasmic sperm injection (ICSI). Patients: Two participants were diagnosed with testicular carcinoma and one patient was diagnosed with collagen disease. Methods: Of the two carcinoma patients, one patient provided a fresh testicular biopsy sample and one patient ejaculated fresh sperm after surgical operation. One collagen diseased patient's sperm was frozen, and three samples were used in subsequent ICSI treatment cycles. Their female partners underwent controlled ovarian hyperstimulation for the retrieval of oocytes. Results: Two patients with testicular cancer and their respective partners achieved successful pregnancies from ICSI using fresh sperm after surgery. The patient suffering from collagen disease had a successful pregnancy from ICSI using sperm frozen prior to chemotherapy treatment. Conclusions: Patients with testicular carcinoma or collagen disease who might desire to father children in the future should be offered sperm preservation prior to the initiation of chemotherapy treatment. Under currently available treatment, patients with cases of severe disease can still become biological fathers. (Reprod Med Biol 2004; 3: 69-75).