Treatment Planning for Protons: An Essay

Abstract

The first proton radiotherapy patient was treated in 1957 at the Berkeley Radiation Laboratory. At the Harvard Cyclotron Laboratory, treatments commenced shortly after in the early 1960s under the direction of the Massachusetts General Hospital neurosurgeon Dr. Raymond Kjellberg. Neurosurgeons were well equipped to use the precision of proton beams without the availability of 3D imaging technologies such as CT. Their appreciation of the 3D cranial anatomy projected on X-rays sufficed to treat neoplasms such as pituitary abnormalities and arterial venous malformations. Both Dr. Kjellberg in Boston and Dr. Leksell in Stockholm pioneered the use of protons in the cranial anatomy. Dr. Kjellberg’s program, however, had ready access to the proton beam at the HCL (Fig. 7.1). Dr. Leksell’s program did not have ready access which led to the invention of the Leksell Gamma Knife as an alternative therapeutic system for stereotactic radiosurgery. Protons were thus the first modality used in cranial stereotactic radiosurgery, while the Gamma Knife made cranial stereotactic radiosurgery a standard modality.