Proton Beam Therapy
An advanced and precise form of radiotherapy
Proton beam therapy (PBT) is an advanced form of radiotherapy. It has the potential to improve the precision and targeting of radiation therapy (RT) leading to fewer side effects, faster recovery and better outcomes for a select group of patients. PBT has the potential to target radio-resistant hypoxic tumours and tumours that are very close to critical organs because there is no exit dose.
Proton Beam Therapy Overview
PBT is delivered by very large, complex and expensive machinery. Unlike conventional X-ray radiotherapy, protons deliver the dose in a Bragg peak. By modulating the energy and position of the Bragg peak the dose can be painted over the tumour volume allowing more dose to be delivered to the tumour while sparing the healthy tissue surrounding it.
The Christie NHS Foundation Trust in Manchester is the first of only two NHS high-energy PBT centres in the UK. In 2018, the team at The Christie treated its first patient. There are three treatment gantries and one dedicated research room. Integrating research into the clinical facility contributes to the success of the service and ensures that patients always have access to the latest developments in the field.
Proton Beam Therapy Research in Manchester
PBT research is undertaken by the PRECISE group (Proton research at The Christie and the University’s Division of Cancer Sciences) and is led by Professor Karen Kirkby. This is a multidisciplinary research team, bringing together The University of Manchester, The Christie and the Cancer Research UK Manchester Centre and Cancer Research UK RadNet Manchester. The group has seen rapid growth and now has over 30 researchers with academic and clinical expertise.
The PRECISE group has secured funding of over £21m in the last five years. This comes from most major research funding bodies in the UK including CRUK, EPSRC, STFC, NC3Rs, EU Horizon 2020 and the Christie Charity. This has enabled us to focus on and tackle the key scientific and technological challenges for PBT, including biological optimisation, range verification, proton imaging, computational oncology, new accelerator developments for PBT, translational technical radiotherapy, translational radiobiology, and clinical trials.
Key successes for the group include:
- Development and delivery of the high-throughput Radiobiology Hypoxia End-Station, international collaborations with world leading proton therapy centres and industry providers (Varian), Topas N-Bio collaboration and commissioning of the research beamline to have FLASH capabilities.
- Leading the European research project, Infrastructure in Proton International Research (INSPIRE) project to develop a world-leading infrastructure activity for PBT across Europe and the UK.
- Involvement in the Engineering and Physical Sciences Research Council (EPSRC) Proton Therapy network.
- STFC network
- EPSRC BioProton
Manchester is pioneering novel approaches in proton beam therapy to solve the biggest cancer challenges of our age. In the Cancer Futures article, ‘Manchester’s Place in Tomorrow’s World‘, Professor Karen Kirkby outlines the proton beam therapy research activities taking place in Manchester.
A National and European Facility
In October 2020, the dedicated PBT research room at The Christie was successfully commissioned. Experiments will take place weekly around clinical practice, including:
- Measurement of DNA damage and repair, through surrogate markers such as gamma-H2AX, as a function of position in the proton SOBP
- Measurement of cell survival following proton irradiation under various oxygen tensions using the Don Whitley Scientific end station
- High-throughput cell irradiation (a mix of up to 36 T75 flasks & 96-well plates) controlled through Fanuc 6-axis robotic arm
- Measurement of oxygen depletion under high-dose rate irradiation
- Analysis of range uncertainty through prompt-gamma measurement
The research room will be run as a national facility. It will be available to national and EU users through forums such as the EPSRC Network grant (EP/N027167/1) and EU grant INSPIRE (grant agreement No 730983). Users will receive training and support from facility experts whilst using the research room. They will have the opportunity to collaborate with colleagues at Manchester and this will enhance the project findings. It will also help to drive forward the field of proton therapy and identify new areas of research.
Please contact the team for information on how to access the facility.
Future Aspirations in Proton Beam Therapy Research
Manchester is at the forefront of proton research in the UK, with major investment in state of the art technology, innovative projects and international collaborations. Upcoming research projects and activities include:
- H2020 Advanced Proton Therapy European Infrastructure – this will take the existing H2020 EU INSPIRE grant to the next level and help to implement research in the clinic.
- Flash Radiotherapy – involving the rapid delivery of high doses of proton radiation, research into FLASH is a growing area in Manchester. The existing in vitro research beamline will be upgraded to have FLASH capabilities. Find out more about FLASH in this video from the ‘Transforming Radiotherapy in a FLASH‘ workshop.
- Clinical Trials in proton therapy
- Development of a second beamline (in vivo) within the existing facility – The in vivo beamline will be used to augment the capabilities of the PBT research room by adding the ability to conduct pre-clinical studies, enhancing the translational pipeline to the clinic. Although other pre-clinical PBT beamlines exist worldwide this will be the first that is capable of delivering spot scanning, with animal sized spots (typically 1mm), integrated with an imaging capability.
- NIHR/EPSRC/BRC funded collaboration with GM Cancer that will identify digital phenotypes that are relevant for patient recovery of RT treatment. These will be correlated against Patient Reported Outcome Measures.
- Ongoing research agreement with PBT equipment leaders Varian to understand Radiation Protection