WO2010070241A1

WO2010070241A1 - Apparatus for orientation and retention of a patient during hadron therapy

Info

Publication number: WO2010070241A1
Application number: PCT/FR2009/052612
Authority: WO
Inventors: Pascal Sevret; Jean-Louis Habrand
Original assignee: Institut Gustave Roussy
Priority date: 2008-12-19
Filing date: 2009-12-18
Publication date: 2010-06-24
Also published as: FR2940130A1; FR2940130B1

Abstract

The present invention relates to an apparatus (100) for orientation and retention of a patient during hadron therapy by means of a fixed source of irradiation, comprising a table (15) for retention of said patient, said table (15) being made of a material substantially transparent to said source of irradiation and being mounted movably on holding means (11, 16) that hold said retention table (15) and form an inclined plane, said holding means (11, 16) having a first support part (11) and a second support part (16), said first and second parts being separated by a space (17) which allows the beams issuing from said source of irradiation to pass through the rear face of said retention table (15) in order to treat said patient in a recumbent position when held by said holding means (11, 16).

Description

PATIENT ORIENTATION AND CONTENT DEVICE FOR HADRONTHERAPY TREATMENT

The present invention relates to a device for orienting and restraining a patient for treatment with hadrontherapy.

Radiation therapy plays a vital role in healing patients with cancerous tumors. Radiotherapy is a localized treatment based on the use of high energy X-rays (X-ray photons of several megavolts) aimed at delivering a maximum dose of irradiation to the tumor while at the same time optimizing the healthy tissue in the vicinity of the tumor. Radiotherapy acts more particularly by ionizing nucleic acids

(DNA and RNA) treated cells, that is to say that it weakens the molecules of cancer cells, kills them or makes them unable to multiply, causing an alteration of chromosomes, disrupting divisions tumors.

Radiation therapy is today a booming medical specialty and the main progress is based on the modernization of the equipment, the technological and biological research to increase the efficiency on the tumor while sparing as much as possible the healthy tissues present around the tumor. .

It is in this context of effectiveness that an alternative to radiotherapy, hadrontherapy, is also experiencing considerable growth.

Hadrontherapy also uses beams of X-rays but beams of particles called hadrons, that is to say either protons or carbon ions 12.

Proton or proton therapy hadrontherapy is an irradiation technique that has the same biological properties as X-rays, but uses heavy particles that interact with the nucleus and electrons of the material, so that the protons slow down. progressive, with increase of the linear transfer until the stop of the particle. This slowing down of the particles makes it possible in particular to accurately treat the tumor by avoiding the irradiation of healthy tissue on the irradiation path.

In addition, proton therapy is a more precise irradiation technique, in particular because of a relatively low proton scattering angle, thus making it possible to minimize the lateral scattering of the irradiation beam and thus the irradiated surface of healthy tissue.

Proton therapy has a double advantage over radiotherapy; the first advantage is ballistic, the protons are much more precise than the X-rays, they allow to deliver the dose of irradiation with an extreme precision at the level of the tumor; the second advantage is biological, the protons are much more effective for certain tumors resistant to X-rays.

However, the implementation of these proton therapy treatments requires complex structures, heavy and expensive thus limiting the development of these treatments.

In fact, whereas conventional radiotherapy is performed on immobile patients by means of a rotary linear accelerator, making it possible to vary considerably the incidence of the beams used, the proton therapy uses an ion beam which is led to the patient. by a beam line composed of tubes with a high vacuum and powerful but heavy magnetic optics. Thus, it is close to one hundred tons that it is necessary to mobilize around the patient in order to obtain the same amplitude of treatment as with a linear accelerator.

This is why, in most clinical centers, protons are most often transported at the exit of the accelerator, to the patient by fixed horizontal lines. The patient is then moved relative to the proton beam by means of positioning devices of the treatment, vertical and / or horizontal displacement, either by changing the position of the patient, lying down, sitting.

However, this type of positioning makes it very difficult technically to use certain orientations of the beam, and in particular the use of posterior oblique beams on a person treated under general anesthesia.

To overcome this problem of beam orientation, proton therapy devices with an isocentric arm are provided to treat the patient in a supine position in all incidences, as used in conventional conventional radiotherapy.

However, these types of proton therapy devices with isocentric arms are very massive structures, of the order of one hundred tons, particularly complex, bulky and extremely expensive, of the order of several million euros, thus limiting their development. to a very small number of clinical centers around the world, depriving many patients of these effective treatments.

In this context, the present invention aims to provide a device for guiding and restraining a patient for a proton therapy treatment to effectively treat a patient regardless of the incidence of the beam and to overcome the use of an isocentric proton therapy device.

To this end, the invention proposes a device for orienting and restraining a patient for treatment by hadrontherapy by means of a fixed irradiation source, characterized in that said device comprises a support table of said patient, said table being made of a material substantially transparent to said irradiation source and being removably mounted on holding means of said support table forming an inclined plane, said holding means comprising a first support portion and a second support portion, said first and second parts being separated by a space capable of ensuring the passage of the beams from said irradiation source through the rear face of said compression table to effect the treatment of said patient in the extended position when the latter is maintained by said holding means.

By substantially transparent material is meant a so-called "transparent radio" material, that is to say a material that does not attenuate more than 3% of the radiation coming from the irradiation source.

Materials such as polystyrene or carbon are examples of materials that fulfill the requirements of transparency and attenuation necessary for carrying out the invention.

Thanks to the invention, it is possible to dispense with the use of an extremely costly isocentric irradiation source for the treatment of patient lying down regardless of the required incidence of the irradiation beam for the treatment. .

Thus the economic constraints due to the cost of these complex and bulky isocentric structures are eliminated. Indeed, the device according to the invention is a lightweight, transportable, economical device for treating patients regardless of the incidence of the irradiation beam such as an isocentric source and particularly posterior oblique beams.

The device will then make it possible to extend more significantly the treatment by hadrontherapy and in particular by proton therapy in the different treatment centers equipped with fixed source with a reduced cost. The device according to the invention may also have one or more of the following characteristics, considered individually or in any technically possible combination:

said second support portion supports an end of said support table; said support table slides longitudinally on said first support part;

said first support portion is formed by a one-piece inclined plane with an inclination angle of 30 °; said first support portion is formed by an inclined plane comprising means for varying the angle of inclination of said inclined plane, said angle of inclination varying between 0 ° and 50 °;

said first support portion is formed by a first plate and a second plate connected by a hinge, said first and second plates being movable about a hinge axis;

said restraint table comprises removable means for holding said patient in position on said support table;

- said support table comprises a support plate for the establishment of a headrest and / or a thermoformed compression mask; said headrest comprises a profile adapted to the morphology of the patient.

The present invention also relates to a device for treating a patient by hadrontherapy comprising a fixed irradiation source emitting beams of protons comprising a device for guiding and restraining a patient according to the invention. Other features and advantages of the invention will emerge more clearly from the description which is given below, by way of indication and in no way limitative, with reference to the appended figures, among which:

FIG. 1 illustrates a perspective view of a device for orienting and restraining a patient according to the invention; FIG. 2 illustrates the device for orienting and restraining a patient according to FIG. 1 in a rear view;

- Figure 3 illustrates more particularly in perspective the inclined plane according to the invention described in Figure 1;

FIG. 4 illustrates a second embodiment of an inclined plane of the device according to the invention.

In general, all the elements described in the following description are made from low density materials and / or do not create interference with an irradiation source. Figure 1 and Figure 2 show perspective views of a patient guidance and restraint device applicable to proton therapy. Figure 1 shows more particularly the device according to the invention in front view and Figure 2 shows the device according to the invention in rear view. The device 100 of orientation and restraint of a patient is a lightweight and transportable device placed on a treatment table 13 of a proton therapy device.

The device 100 comprises an inclined plane 1 1 typically forming an inclination angle θ of 30 ° with respect to a horizontal plane 12, resting on the treatment table 13 of the proton therapy machine, said treatment table 13 allowing an inclination of ± 10 ° with respect to a horizontal plane of the patient by electrical positioning means.

The device 100 according to the invention allows treatment by proton therapy, particularly by posterior oblique beams of 40 ° on a patient in a supine position.

The inclined plane 1 1 comprises a plurality of stops 14 for holding in position a contention table 15 placed on the inclined plane 1 1. The stops 14 are arranged so that they hold in position the contention table 15 to prevent slipping thereof on the inclined plane 1 1, and so they also allow lateral sliding along the axis AA 'of the compression table 15 to allow optimum positioning, according to the axis AA 'of the patient with respect to an irradiation source. The lateral displacement along the axis AA 'of the compression table 15 can be carried out indifferently manually or electrically.

For this purpose, the compression table 15 and the inclined plane 1 1 comprise measuring means, such as a graduation in millimeters, to know precisely the displacement, along the axis AA ', of the compression table 15 by compared to an initial reference position. The measuring means make it possible both to precisely position the patient with respect to the ray source and to have an effective reproducibility means necessary for the effective daily treatment of a tumor.

The inclined plane 1 1 is associated with a remote support 16 supporting the compression table 15 at its end thus avoiding any risk of non-reproducibility of the treatment by slight movements of the end of the compression table 15 by elastic deformation under the weight of the patient.

The remote support 16, of reduced thickness relative to the inclined plane 1 1 and having the same inclination angle θ, makes it possible to create a space

17 between the inclined plane 1 1 and said support 16 so that it is possible to position behind the compression table 15 the irradiation source, such as a source of protons, for the treatment of the patient. Indeed, the compression table 15 is made of a low density material thus avoiding the attenuation and / or the deflection of the proton beam.

The compression table 15 comprises a support plate 19 integral with the compression table 15 adapted to receive and support the body of a patient. For this purpose, the support plate 19 comprises holding flanges 24 formed by flexible strips 21 of thermoformable material, the ends of which comprise fastening brackets 20 secured by screwing, for example by means of plastic screws.

The fixing brackets 20 are removably mounted by means of plastic pins 23 on a rigid intermediate plate 22 inserted in the support plate 19, so that it is possible to fix / defix rapidly the flanges 24 for maintaining the patient.

The compression table 15 also comprises a support plate 18 for fixing a thermoformed compression mask placed on the patient's head before treatment. The means for fixing the thermoformed mask on the support plate 18 are typically the means usually used during the treatment of a patient by radiotherapy or proton therapy.

The support plate 18 has an impression in which is fitted by fitting a headrest 26 having a cup-shaped profile 25 adapted to the morphology of each patient, in order to provide optimum cushioning of the head and neck of the patient. patient.

Thus the position of the headrest 25 and the shape of the profile 25 are adapted to receive the head of the patient when it is in the extended position on the support plate 19 of the compression table 15. Each patient has a 26 personalized headrest made to measure; the headrest 26 being rapidly interchangeable on the support plate 18 in order to adapt to each treated patient.

In addition, to provide patient comfort, the profile is made of a relatively soft, low density foam-like material.

The compression table 15 is made to be removable on the inclined plane 1 1 and reversible thus allowing treatment of the patient irrespective of the incidence of the irradiation beam, left incidence or right incidence. For this, use materials particularly light and / or not causing interference with the spokes, polystyrene type, composite materials with a preference for carbon fiber whose properties are interesting in this type of application. Thus the use of carbon is particularly advantageous for the manufacture of parts such as brackets 20, support plate 18, headrest 26, and other parts requiring some rigidity.

According to a particular embodiment of the invention, the device is particularly suitable for the treatment of a child under general anesthesia while lying down. Thus, according to this particular embodiment, the compression table 15 is for example a table made of expanded polystyrene material having a length of the order of 140 cm, a width of 60 cm and a thickness of 3 cm. The compression table 15 is also supported on an inclined plane of 30 ° expanded polystyrene material relative to the laying plane of the treatment table 13 over a length of about 80cm.

FIG. 3 more particularly illustrates the inclined plane 1 1 previously described with reference to FIG. 1 and FIG.

The inclined plane 1 1 according to this first embodiment is formed by a one-piece piece whose inclination angle θ is predefined during the manufacture of the plane 1 1. Preferably, the inclination angle θ is of the order 30 °, but it is also possible to achieve the inclined plane 1 1 with an inclination angle θ between 20 ° and 40 °. The inclination of the inclined plane 1 1 combined with the inclination of the treatment table 14 varying between + 10 ° and -10 ° can cover an inclination of between 10 ° and 50 °.

FIG. 4 illustrates a second embodiment of an inclined plane 41 of the device according to the invention.

According to this second embodiment of the invention, the inclined plane 41 can be made by means of two plates 42 and 43 connected at one of their ends by a hinge 45. The two plates 42, 43 are then adjustable in inclination around a hinge axis 46 by means, for example, of a jack (not shown) making it possible to propose a plurality of angular positions θ of the plates 42 and 43, the angle of inclination advantageously varying between 0 ° to 50 °, see more. According to this embodiment, the patient is firstly lying on the compression table 15, placed on the inclined plane 41, while its inclination angle θ is 0 °. The inclination of the inclined plane is then accentuated, for example by means of jacks, so that the angular position of the patient allows effective treatment irrespective of the incidence of the irradiation beam.

Thus, the subject of the invention is a device for orienting and restraining a patient that is applicable to a proton therapy treatment that makes it possible to treat a patient lying down regardless of the required incidence of the irradiation beam for the treatment of the patient. a tumor by avoiding the use of an extremely expensive isocentric source.

Advantageously, the irradiation source is a source emitting a horizontal irradiation beam.

Of course, the invention is not limited to the embodiment just described.

The invention is applicable both for treatment of a patient by proton therapy and for treatment with hadrontherapy in general.

The invention has been particularly described in the case of proton therapy treatment of a child under general anesthesia; however, the invention is also applicable for the treatment of an adult patient under anesthesia or not.

It is also conceivable to use the device according to the invention prior to proton therapy treatment for example by a CT scan or an MRI (Magnetic Resonance Imaging), which allows to keep the same position, called reference position, of the patient and to facilitate the identification of the tumor as well as its treatment with proton therapy.

Other advantages of the invention include the following:

- lightweight and easily transportable device;

- low cost of implementation; - possibility of making a device tailored to the treatment of the patient;

- treatment of the left or right side of the patient with the same device; - reproducibility of the patient's position during the course of treatment.

Claims

1. Device (100) for orienting and restraining a patient for treatment with hadrontherapy by means of a fixed irradiation source, characterized in that said device comprises a compression table (15) of said patient, said table (15) being made of a material substantially transparent to said irradiation source and being removably mounted on means (1 1, 16, 41) for holding said contention table (15) forming an inclined plane, said means

(1 1, 16, 41) having a first support part (1 1, 41) and a second support part (16), said first and second parts being separated by a space (17) adapted to ensure the passage beams from said irradiation source through the rear face of said compression table (15) for performing the treatment of said patient in the extended position when the latter is held by said holding means (1 1, 16, 41) .

2. device (100) of orientation and restraint of a patient for a treatment by hadrontherapy according to claim 1 characterized in that said second support portion (16) supports an end of said support table (15).

3. Device (100) for orientation and restraint of a patient for treatment with hadrontherapy according to one of claims 1 to 2 characterized in that said compression table (15) slides longitudinally on said first support portion ( 11, 41).

4. Device (100) for orienting and restraining a patient for a treatment with hadrontherapy according to one of claims 1 to 3 characterized in that said first support portion (1 1) is formed by a monobloc inclined plane with an inclination angle of 30 °.

5. device (100) for orientation and restraint of a patient for treatment by hadrontherapy according to one of claims 1 to 3 characterized in that said first support portion (41) is formed by an inclined plane comprising means for varying the inclination angle of said inclined plane, said inclination angle varying between 0 ° and 50 °.

6. Device (100) for orienting and restraining a patient for a treatment by hadrontherapy according to claim 5 characterized in that said first support portion (41) is formed by a first plate (43) and a second plate (42) connected by a hinge (45), said first and second plates being movable about a hinge axis (46).

7. device (100) for orientation and restraint of a patient for treatment by hadrontherapy according to one of claims 1 to 6 characterized in that said compression table (15) comprises removable means (24) for the maintaining said patient in position on said compression table (15).

8. device (100) for orientation and restraint of a patient for a treatment by hadrontherapy according to one of claims 1 to 7 characterized in that said contention table (15) comprises a support plate (18) for the setting up a headrest (26) and / or a thermoformed compression mask.

9. A device (100) of orientation and restraint of a patient for a treatment by hadrontherapy according to claim 8 characterized in that said headrest (26) comprises a profile (25) adapted to the morphology of the patient.

10. Apparatus for treating a patient by hadrontherapy comprising a fixed irradiation source emitting beams of protons characterized in that it comprises a device (100) orientation and contention according to one of claims 1 to 9.