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Table 2 Main results in the participating centers

From: A step towards international prospective trials in carbon ion radiotherapy: investigation of factors influencing dose distribution in the facilities in operation based on a case of skull base chordoma

Country Institution A
Pt Statistics
B
Equipment
C
Positioning and immobilization devices
D
Definition of the target volumes
E
Prescription schedule(s) and dose constrains to OARs
F
Treatment planning system and dose calculation
G
Beam delivery system and positioning control
Opening date Total patients treated (per nov 2017) Ion source Injector Type of accelerator, diameter Manufacturer Max C ions energy (MeV/u) Max beam Intensity (C/spill) and Repetition rate (Hz) Max field size Treatment room(s) Patient position Immobilization device Image fusion? GTV definition Procedure for CTV(s) delineation CTV-PTV margin Portal-specific PTV? Treatment schedule Dose unit reported in the original protocol Dose prescription for PTV Dose constraints for OAR TPS Biological modeling Beam delivery System Beam energy Methods to ensure positioning reproducibility
Japan Chiba (HIMAC) pilot facility 1994 10,692 10 GHz Kei2 ECR, 18 GHz ECR & PIG RFQ + Alvarez linac Dual synchrotron, 42 m Research machine 400 1.2 × 10^9
0.3 Hz
22 cm 3 (1H, 1 V, 1H&V) Lying (Supine position) Customized cradles (Moldcare®), thermoplastic mask, Vacuum bags for the body 2D to 2D T1 post gadolinium
and T2 (fat sat or Flair fat sat)
CTV1 = CTV2: minimum margin of 5 mm around the pre-op GTV.
Only one CTV and one dose level applied
2–3 mm yes B GyE 16 fractions, 4 days a week over 4 weeks.
The target reference point dose is defined as the isocenter, and the PTV is encompassed by the minimum 90% dose line of the reference point dose.
Brain stem: Dmax ≤30 Gy EQD;
Optic pathway: Dmax ≤40 Gy EQD;
Temporal lobe: V50 ≤ 5 cc
Xio-N (ELEKTA and Mitsubishi Electric, Tokyo, Japan) + K2DOSE; Biological adjustment with HSG cell line
Modified MKM
passive conventional and spiral beam wobbling 290–400 Orthogonal X-ray images
Chiba (HIMAC) new facility 2011 Toshiba 430 6 × 10^9
0.3 Hz
22 cm (gantry: 20 cm) +  3 (2H&V, 1 gantry) active Pencil-beam 3D scanning 290–430
Gunma (GHMC) 2010 2231 10 GHz KeiGM ECR RFQ + APF linac Synchrotron, 20 m Mitsubishi Electric 400 1.2 × 10^9
0.5 Hz
15 cm 3 (1H, 1H&V, 1 V) Lying (supine, prone, or lateral) position with rolling depending on tumor location and beam direction 2D to 2D CTV1: pre-op GTV + a margin of 3-5 mm including suspected subclinical disease
CTV2: same as GTV visible on MRI
2 mm no Passive (Single or Spiral Wobbling),
Layer-Stacking technique available
290–400
Germany Darmstadt (GSI) 1998–2009 440 14.5 GHz CAPRICE ECR RFQ+ IH-DTL + Alvarez (UNILAC) Synchrotron, 20 m Research machine 430 1 × 10^8 0.1–0.5 Hz 20 cm 1H / / / / / / / CGE / / / / active raster scanning, intensity modulated / /
Heidelberg (HIT) 2009 2430 14.5 GHz Supernanogan ECR ×2 RFQ+ IH-DTL linac Synchrotron, 20 m GSI and Siemens 430 1 × 10^9
0.3 Hz
20 cm 3 (2H, 1 gantry) Lying (Supine position) Thermoplastic mask and individual mouthpiece 2D to 2D and 2D to 3D CTV1 (primary plan): pre-op GTV + whole clivus + prevertebral muscles down to C2
CTV2 (Boost plan): postop GTV + 2 mm
3 mm no A Gy_E 22 fractions, 5 (MIT) or 6 (HIT) days a week over 3.5–4.5 weeks; coverage of the PTV with the 95%-isodose line of the prescribed dose. Dose specification is based on equieffective dose Optic pathways: Dmax ≤50 Gy EQD;
Brainstem surface*: Dmax ≤54 Gy EQD
*1% of the volume
Syngo inverse RT Planning (Siemens, Erlangen, Germany) LEM 50–430 Orthogonal x-rays or cone-beam-CTs
Marburg (MIT) 2015 95 14.5 GHz Supernanogan ECR ×2 RFQ+ IH-DTL linac Synchrotron, 20 m Siemens 430 1 × 10^9
0.3 Hz
20 cm 4 (3H, 1 45 deg)
Italy Pavia (CNAO) 2012 816 14.5 GHz Supernanogan ECR ×2 RFQ+ IH-DTL linac Synchrotron, 24.5 m Prototype 480 4 × 10^8
0.3 Hz
20 cm 4 (3H, 1 V) Lying (Supine position), if needed with head rotation Customized rigid non-perforated thermoplastic-masks, mouth-bites and head-rests and/or moldable body-pillows 2D-3D automatic fusion CTV1 (low dose): pre op GTV plus 5–10 mm margins excluding optic chiasm and brainstem, but including surgical routes and prevertebral muscles. Caudal level determined on a case by case basis.
CTV2 (high dose): 5 mm expansion from post op GTV, excluding brainstem and optic chiasm, including whole clivus and eventually cavernous sinus
2 mm no? A or B Gy [RBE] Treatment planning aims to the coverage of the PTV with the 95%-isodose line of the prescribed dose. Dose specification is based on equieffective dose Schedule A: optic pathways: Dmax ≤53 Gy EQD; brainstem: Dmax ≤55 Gy EQD; one cochlea: Dmax ≤45 Gy EQD.
Schedule B: optic pathways: Dmax ≤40 Gy EQD, D20% ≤ 28 Gy EQD; brainstem: Dmax ≤35 Gy EQD; one cochlea: Dmax ≤45 Gy EQD
Syngo inverse RT Planning (Siemens, Erlangen, Germany)
+
RayCarbonPlanning module (RaySearch Laboratories AB, Sweden)
LEM active raster scanning, intensity modulated 115–400 Optoelectronic pre-alignment with infrared reflecting beads and cameras, daily orthogonal X-ray and 2D-3D fusion; in-room optical tracking system (OTS) and patient verification system (PVS)
TOTAL 16,704  
  1. Column A: patient statistics (source PTCOG website); Column B: Equipment; Column C: Positioning and immobilization devices; Column D: Definition of the target volumes; Column E: Prescription schedule(s) and dose constrains to OAR; Column F: TPS and dose calculation; Column G: Beam delivery system and positioning control