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APTCB_Brochure_ENGLISH.pdf

ADVANCED PARTICLE THERAPY CENTER FOR THE BALTIC STATES

( APTCB )

Core idea of APTCB

Development of a modern large-scale scientific research infrastructure and clinical treatment centre in the Baltic States by integrating CERN-designed particle accelerator technology

Aims of

APTCB

To foster multidisciplinary research

To contribute to the breakthrough innovation development

To provide cross-sectoral economic growth in the Baltic States

Multi-functional facility

Scientific research institution

Clinical treatment center

Industry involvement infrastructure

Enabling broad research programme in domains of clinical, natural and technological sciences Attracting highly skilled researchers from all Baltic States and beyond

Providing the established proton therapy and contributing to helium ion therapy research Enabling novel radioisotope production for modern nuclear medicine approaches

Increasing the capacity and “know-how” of local industries in particle accelerator technologies Providing long term R&D possibilities for the establishment of a regional innovation ecosystem

CERN Baltic Group NIMMS (Next Ion Medical Machine Study)

Overall development of the initiative, stakeholder engagement activities

Crucial collaborators as core of the APTCB facility is based upon technologies

developed by NIMMS

Group of 14 scientific universities and research institutions in the Baltic States - Estonia, Latvia

and Lithuania - with the aim of coordination of scientific collaboration with CERN, and

strenghtening of local scientific communities in high-energy physics and accelerator sciences

Multi-faceted motivation for APTCB initiative

Ion sources

Linear accelerator

Helium synchrotron

Static treatment

beam

Treatment beam with a gantry

Research beamline

Animal house +

biology laboratories

Clinical medical space

Technical space Radioisotope production area

Envisioned infrastructure

NIMMS developed helium synchrotron ( HeLICS ) as the base of APTCB facility

Involved in APTCB initiative

Scientific research driven Clinically driven

Economically driven

Particle therapy centres in Europe, ENLIGHT 2018

MedAustron facility

Developing high technology-driven research programmes in clinical sciences, medical physics, high-energy physics, nuclear physics, material sciences, radiochemistry, accelerator physics and technologies and several other related fields

Attracting international expertise

Driving competence development in early-stage researchers

Encouraging collaboration with high-tech industries and open science communities, contributing to the creation of a Baltic innovation ecosystem

APTCB has significant potential of delivering long-term socio-economic return as Big Science center

Boosting local innovation ecosystems

Enhancing the capacity of national economies to generate, adopt, and commercialize advanced technologies

Providing environment for highly-skilled workforce development

Improving career prospects for early-stage researchers, engineers and specialists

Delivering wide-ranging societal benefits, such as public access to cutting-edge cancer treatment therapies, cultural engagement and technological spillovers

Enabling economies of scale in knowledge generation

Incentivizing innovation and product development across industries

Transformative clinical role by oering advanced cancer treatment modalities including: clinically established proton therapy, emerging cutting-edge helium ion therapy, production of innovative radioisotopes for nuclear medicine

Enabling pre-clinical, clinical and radiobiology research

Contributing to research necessary for clinical translation of novel approaches: helium ion therapy, FLASH therapy, etc.

Improving therapeutic outcomes, minimizing side eects and elevating the standard of care

CERN-based initiative, working on cutting-edge particle accelerator technology development for a new generation of compact and cost-eective

ion-therapy facilities

Central focus: helium synchrotron technology

Main milestones Spring ’22 Development of the facility concept and dedicated working group

Aug ’22 Baltic Assembly support - adressing the prime ministers of the Baltics

Oct - Nov ’22 Bi-lateral stakeholder discussions in the three Baltic States

May ’23 NIMMS HeLICS implementation in the Baltic States presented at the International Particle Accelerator Conference

25th of May ’23 Workshop at CERN: “Particle therapy - future for the Baltic States?”

From the inception of the initiative: several discussions with dierent scientific universities, medical professional societies, and political stakeholders in the Baltic States

Oct ’23 Report of the Workshop approved by the CERN Baltic Group

Spring ’24 Workshop findings published in Health and Technology special issue focused on innovations in particle therapy From the start of 2024

Work towards proposal of the

Feasibility Study

Jan and Oct ’24 Presentation of the initative at CERN Medical Applications Steering Committee - CERN engagement at the highest level

Apr ’24 Initial discussions with a potential collaborator - Heidelberg Ion-Beam Therapy center - currently the only institution globally with availability of helium ion therapy

Throughout 2024 Collaborative eort with local radiotherapy facilities, University of Oxford and the International Agency for Research on Cancer to assess current practices in the Baltic States

Dec ’24 The APTCB Feasibility Study Strategy Group is established by the CERN Baltic Group

Next significant milestone:

Feasibility Study In order to proceed with this promising initiative,

a full-scale Feasibility Study of the project is needed

Centralized co-ordination and funding between the 3 Baltic States is necessary for the launch of the Feasibility Study

Clinics and

Epidemiology

Alternative solutions

for the facility

Regulatory and

legal approvals

Information and

data flow

Risk analysis and

evaluation

Education and

training

Economics and

Innovation

Technology and

Implementation

APTCB

Main aims of the

Feasibility Study

To investigate the feasibility of APTCB facility implementation

To identify and evaluate potential alternative solutions

To provide a fact-based Feasibility Study Report to be used as the decision-making tool for the approval of APTCB facility

Involved institutions

Carried out by Baltic States scientific institutions, involving also regional medical communities and organisations in relevant fields, researcher groups and all other relevant local and international stakeholders, while consulting with international experts. CERN NIMMS - a close collaborator on the techology itself

Expected duration 2 years

Research programme in clinical sciences

Relevant medical statistics in the region

Eligibility criteria for proton therapy

Patient referral, connections with PT community

Research programme in natural and technical sciences

Technical requirements of the facility

Integration study and future upgradability

Basis of cost estimates for the accelerator and the facility

Research on long-term funding, business engagement

Organizational structure and governance model

Evaluation of revenue streams

Full cost estimation and economic benefit analysis

ECONOMICS AND

INNOVATION

TECHNOLOGY AND

IMPLEMENTATION

CLINICAL AND

EPIDEMIOLOGY

Researchers or PhD students from each of the Baltic countries

Education and training necessities

Aspects on regulatory and legal approvals Information flow between work groups for cost estimates

Risk analysis and evaluation

TRANSVERSAL TASKS Alternative solutions for the facility

Researchers or PhD students from each of the Baltic countries

Work planAPTCB Feasibility Study:

Organizational structureAPTCB Feasibility Study:

SCIENTIFIC ADVISORY BOARD

STAKEHOLDER ADVISORY BOARDSTEERING COMMITTEE

CERN Baltic Group named Feasibility Study Coordinator and Deputy Coordinator

+ 4 Working Group Coordinators

+ 1 Technical Expert from CERN

4 Working Group Coordinators +

Involvement of Technical Expert from CERN

Task Coordinators of “Clinics and Epidemiology”

Working Group

Task Coordinators of “Technology and Implementation”

Working Group

Task Coordinators of “Economics and Innovation”

Working Group

Task Coordinators of Transversal Tasks

COLLABORATION BOARD

Long-term timeline of APTCB

Expected outcomesAPTCB Feasibility Study:

1. Design

2. Staged construction and commisioning

3. “START - UP” phase

4. “RAMP - UP” phase

5. FULL OPERATION phase

6. (Future expansion and Decommissioning)

Should include the full APTCB facility with possible space for expansion

Stage a : L + I Stage b : L + I + S + R Stage c : L + I + S + R + F Stage d : L + I + S + R + F + G

Proton / helium ion research & proton treatment ( 1 shift/day )

Proton / helium ion research & proton/helium ion treatment ( 1 shift/day )

Proton / helium ion research ( 2+ shifts/day )

20 –

30 y

ea rs

L - Low energy accelerator I - Isotope production line and room S - Synchrotron R - Research beamline and room F - Fixed line G - Gantry treatment room

& proton/helium ion treatment

Feasibility Study Report

Summary of all the factual basis collected during the investigation

The Feasibility Study Report is to be used as a decision making

tool for the future of the APTCB project : facility construction and implementation of the proposal

Risk analysis and risk management strategy

Finalized proposal for layout of the facility

Finalized beam-time usage proposal

Finalized list of selection criteria for the choice of the most suitable construction site

Initial proposal for the expected staging during the development of the facility

Initial basis for a business plan for the facility

Roadmap for the innovation and industry collaboration strategy

Roadmap for the regulatory compliance

Reinforcement of the synergies between the dierent Baltic research groups and medical societies, while strengthening

the collaboration between Baltic research groups and CERN

ADVANCED PARTICLE THERAPY CENTER FOR THE BALTIC STATES

Anchored in research excellence, the initiative provides an opportunity for transformative scientific and socio-economic

development in the Baltic States

UNIFYING OPPORTUNITY WITH ENORMOUS POTENTIAL

FOR THE BALTIC STATES

Establishing the Baltic States as one of the leaders in accelerator-driven biomedical research

Expanding Europe's capacity for clinical translation of helium ion therapy

Enabling regional access to high technology based cancer care

Fostering a local high-tech innovation ecosystem with global relevance

APTCB_Brochure_ESTONIAN.pdf

TULEVIKKU VAATAV KIIRITUSRAVI KESKUS BALTI RIIKIDELE

( ADVANCED PARTICLE THERAPY CENTER FOR THE BALTIC STATES - APTCB )

APTCB põhieesmärk

Luua mastaapne tulevikku vaatav teadustaristu ja kiiritusravi keskus Baltimaades, võttes kasutusele CERNis välja töötatud osakeste kiirendamise tehnoloogia

APTCB eesmärgid

Tõhustada multidistsiplinaarseid teadusuuringuid

Aidata kaasa murrangulisele innovatsioonile

Toetada valdkonnaülest majanduskasvu Balti riikides

Multifunktsionaalsus

Teaduskeskus

Täppisravi keskus

Ettevõtlusinkubaator

Võimaldada laiapõhjalisi teadusuuringuid arsti- ja terviseteaduste, loodusteaduste ning tehnika ja tehnoloogia valdkonnas Kaasata kõrgkvalifitseeritud teadlasi Baltimaadest ja kaugemalt

Pakkuda prootonravi ja panustada heeliumioonravi arendamisesse Radionukliidide tootmine tänapäevase nukleaarmeditsiini tarbeks

Suurendada tööstusettevõtete võimekust ja oskusteavet osakeste kiirendite vallas Pikaajalised teadus- ja arendustegevuse võimalused innovatsiooni ökosüsteemi loomiseks piirkonnas

CERNi Balti rühm NIMMS (Next Ion Medical Machine Study)

Algatuse üldine arendamine, sidusrühmade kaasamine

Võtmetähtsusega partnerid, sest APTCB keskmeks on NIMMSi poolt välja

arendatud tehnoloogiad

Rühma kuulub 14 teadusülikooli ja uurimisasutust Balti riikidest – Eestist, Lätist ja Leedust – eesmärgiga koordineerida teaduskoostööd

CERNiga, tugevdamaks piirkonnas tegutsevaid teaduskogukondi kõrge energiaga füüsika ja

kiirenditeaduste alal

Laiapõhjaline vajadus APTCB loomiseks

Iooniallikad Lineaarkiirendi

Heelium- sünkrotron

Staatiline kiiritus

Kiiritusravi allikas koos portaaliga

Uuringuseadmed

Vivaarium +

bioloogia laborid

Raviruumid

Tehnoruumid Radionukliidide tootmine

Kavandatud taristu

NIMMSi poolt välja töötatud heeliumsünkrotron ( HeLICS ) on APTCB rajatise alus

APTCB algatuse osapooled

Teadusuuringud Meditsiiniline

Majandusareng

Osakeste kiiritusravi keskused Euroopas, ENLIGHT 2018

MedAustron

Kõrgtehnoloogilised teadusuuringud arsti- ja terviseteadustes, meditsiinifüüsikas, kõrge energia füüsikas, tuumafüüsikas, materjaliteadustes, radiokeemias, kiirendifüüsikas ja -tehnikas ning mitmes teises sidusvaldkonnas

Rahvusvaheliselt tunnustatud oskusteabe kaasamine

Nooremteadlaste pädevuste arendamin

Koostöö ergutamine kõrgtehnoloogiaettevõtetega ja avatud teaduse kogukondadega, toetades Baltimaade innovatsiooniökosüsteemi loomist

Suure teaduskeskusena on APTCB-l märkimisväärne potentsiaal kestva sotsiaal- majandusliku kasu toomiseks

Innovatsiooni ökosüsteemide võimestamine lokaalsel tasemel

Riikide majandusekasvu hoogustamine kõrgtehnoloogiate loomise ning nende rakendamise ja kommertsialiseerimise kaudu

Keskkonna loomine kõrge kvalifikatsiooniga tööjõu arendamiseks Nooremteadlaste, -inseneride ja -spetsialistide karjääri väljavaadete parandamine

Ühiskonna ja avalikkuse teenimine, tagades tipptasemel vähiravi kättesaadavuse, kultuurilise nihke ja tehnoloogiasiirde

Oskusteabe loomisel mastaabisäästu võimaldamine

Innovatsiooni ja tootearenduse ergutamine

Transformatiivne meditsiiniline roll, pakkudes tulevikku vaatavaid vähiravimeetodeid, sealhulgas: prootonravi, arendatavat tipptasemel heeliumioonravi, innovatiivseid radiofarmatseutikume nukleaarmeditsiini jaoks

Prekliinilised, kliinilised ja radiobioloogilised teadusuuringud

Uudsed siirdemeditsiini teadusuuringud heeliumioonravi, FLASH-ravi jmt. alal

Ravi tulemuslikkuse parandamine, kõrvaltoimete vähendamine ja ravistandardite tõstmine

NIMMS on CERNi algatus tipptasemel osakestekiirendi tehnoloogi ja uue

põlvkonna kompaktsete kulutõhusate ioonravi rajatiste arendamiseks

Keskne fookus: heeliumsünkrotroni tehnoloogia

Peamised verstapostid Kevad 2022 APTCB rajatise kontseptsiooni loomine ja spetsiaalse töörühma moodustamine

August 2022 Balti Assamblee toetus ja pöördumine kolme Balti riigi peaministrite poole

Oktoober–november 2022 Kahepoolsed arutelud sidusrühmadega kolmes Balti riigis

Mai 2023 Rahvusvahelisel osakeste kiirendite konverentsil esitleti NIMMS HeLICSi rakendamise kavatsust Baltimaades

25. mai 2023 CERNis toimus töötuba „Osakesteravi – tulevik Balti riikidele?“

Algusest alates: arutelud Balti riikide teadusülikoolide, meditsiinivaldkonna erialaühenduste ja poliitiliste sidusrühmadega

Oktoober 2023 Töötoa aruande kinnitamine CERNi Balti rühma pooltKevad 2024 Töötoa tulemused avaldati

ajakirja Health and Technology erinumbris, mis keskendus osakesteravile Alates 2024. aasta

algusest Teostatavusuuringu

ettepaneku ettevalmistamine

Jaanuar ja oktoober 2024 Algatuse tutvustus CERNi meditsiinirakenduste juhtkomitees – CERNi kõrgeimal osalustasemel

Aprill 2024 Esmased arutelud võimaliku koostööpartneriga, Heidelbergi Ioonravi Keskusega, mis ainsa asutusena maailmas pakub heeliumiioonravi

Läbi 2024. aasta Koostöö kohalike kiiritusravi osutajatega, Oxfordi Ülikooli ja Rahvusvahelise Vähiuuringute Agentuuriga, et hinnata praegust ravipraktikat Balti riikides

Detsember 2024 CERNi Balti rühm moodustab APTCB teostatavusuuringu strateegiagrupi

Järgmine oluline verstapost:

Teostatavusuuring Selle paljulubava algatuse arendamine eeldab täiemahulise

teostatavusuuringu tegemist

Teostatavusuuringu käivitamiseks on vajalik kolme Balti riigi poolne tsentraliseeritud koordineerimine ja rahastamine

Ravi ja

Epidemioloogia

Rajatise alternatiivsed lahendused

Regulatiivsed ja

õiguslikud aspektid

Teabe- ja

andmevoog

Riskianalüüs ja

hindamine

Haridus ja

väljaõpe

Majandus ja

innovatsioon

Tehnoloogia ja

Rakendused

APTCB

Teostatavusuuringu peamised eesmärgid

Uurida APTCB rajamise teostatavust

Uurida ja hinnata võimalikke alternatiivseid lahendusi

Koostada faktipõhine teostatavusuuringu aruanne, mida kasutataks otsustustoena APTCB arendamise vaagimiseks

Kaasatud asutused

Balti riikide teadusasutused, kaasates piirkonna meditsiinikogukondi ja valdkondlikke organisatsioone, uurimisrühmi ning teisi asjakohaseid kohalikke ja rahvusvahelisi sidusrühmi ja rahvusvaheliselt tunnustatud eksperte. CERN NIMMS on vahetu koostööpartner tehnoloogia arendamisel

Eeldatav kestus 2 aastat

Arsti- ja terviseteaduslikud uuringud

Asjakohane tervise- ja tervishoiuvaldkonna statistika

Prootonravi näidustused

Patsientide suunamine, ühenduse pidamine prootonravi kogukonnaga

Loodusteaduslikud ja tehnikateaduslikud uuringud

Tehnilised nõuded rajatisele

Integratsiooniuuring ja tulevased uuendused

Kiirendi ja rajatise maksumuse hindamise põhimõtted

Kestva rahastuse ja ettevõtlusekaasamise analüüs

Organisatsiooniline struktuur ja juhtimismudel

Rahavoogude analüüs

Terviklik kuluhinnang ja majandusliku kasu analüüs

MAJANDUS JA

INNOVATSIOON

TEHNOLOOGIA JA

RAKENDUSED

RAVI JA

EPIDEMIOLOOGIA

Teadurid või doktorandid igast Balti riigist

Hariduse ja väljaõppe vajadused

Regulatiivsed ja õiguslikud aspektid Teabevoog valdkondadevaheliste kuluhinnangute jaoks

Riskianalüüs ja -hindamine

LÄBIVAD ÜLESANDED Rajatise alternatiivsed lahendused

Teadurid või doktorandid igast Balti riigist

TööplaanAPTCB teostatavusuuring:

Organisatsiooniline struktuurAPTCB teostatavusuuring:

TEADUSNÕUKODA SIDUSRÜHMADE

NÕUKODAJUHTKOMITEE CERNi Balti rühma poolt nimetatud teostatavusuuringu

koordinaator ja koordinaatori asetäitja +

4 töögruppide koordinaatorit +

1 tehniline ekspert CERNist

4 töögruppide koordinaatorit +

CERNist kaasatud tehniline ekspert

„Ravi ja epidemioloogia“ töögrupi ülesannete

koordinaatorid

„Tehnoloogia ja rakenduste“ töögrupi ülesannete

koordinaatorid

„Majanduse ja innovatsiooni“ töögrupi ülesannete

koordinaatorid

Läbivate ülesannete töögrupi koordinaatorid

KOOSTÖÖNÕUKOGU

APTCB pikk ajakava

Oodatavad tulemusedAPTCB teostatavusuuring: 20

– 30

a as

ta t

Teostatavusuuringu aruanne

Kõigi tasuvusuuringu käigus kogutud faktipõhiste andmete

kokkuvõte

Teostatavusuuringu aruannet kasutatakse otsustustoena APTCB

projekti tuleviku vaagimiseks rajatise ehitamise ja kasutuselevõtmise kohta

Riskianalüüsi ja riskijuhtimise strateegia

Rajatise põhiplaani lõplik kavand

Kiirgusvoo kasutusaja lõplik kavand

Lõplik loetelu rajatisele sobivaima asukoha leidmise valikukriteeriumitest

Esialgne ettepanek rajatise arenduse etappide kohta

Rajatise äriplaani esialgsed aluspõhimõtted

Innovatsiooni ja ettevõtluskoostöö strateegia teekaart

Regulatiivse vastavuse teekaart

Sünergiate tugevdamine Baltimaade erinevate teadusgruppide ja meditsiinivaldkonnaerialaühenduste vahel, tihendades

samaaegselt Baltimaade teadusgruppide ja CERNi vahelist koostööd

1. Kavandamine

2. Etapiviisiline ehitus ja kasutuselevõtt

3. Käivitusfaas

4. Võimendusfaas

5. Täismahulise toimimise faas

6. (Tulevane laienemine ja käitusest kõrvaldamine)

Peaks hõlmama täielikult APTCB rajatise ja selle võimaliku laienemise

Etapp a : L + I Etapp b : L + I + S + R Etapp c : L + I + S + R + F Etapp d : L + I + S + R + F + G

Prootonite / heeliumi ioonide uurimine ja prootonravi (1 vahetus päevas)

Prootonite / heeliumi ioonide uurimine ja kiiritusravi prootonite/ heeliumi ioonidega (1 vahetus päevas)

Prootonite / heeliumi ioonide uurimine ja kiiritusravi prootonite/ heeliumi ioonidega (2 või enam vahetust päevas)

20 –

30 a

as ta

t

L - Madala energiaga kiirendi I - Isotoopide tootmisliin ja -ruum S - Sünkrotron R - Uurimisseadmed ja ruum F - Statsionaarne liin G - Portaalraviruum

Etapp d Etapp c

Etapp b

Etapp a

Iooniallikad

Lineaarkiirendi

Radionukliidide tootmine

Heelium- sünkrotron

Uuringuseadmed

Kiiritusravi allikas koos portaaliga

Staatiline kiiritus

TULEVIKKU VAATAV KIIRITUSRAVI KESKUS BALTI RIIKIDELE

Tipptasemel teadusuuringutele tuginev algatus annab võimaluse Baltimaade murranguliseks

teaduslikuks ja sotsiaalmajanduslikuks arenguks

BALTI RIIKIDE JAOKS TOHUTU POTENTSIAALIGA

ÜHENDAV VÕIMALUS

Tagada Balti riikidele juhtpositsioon kiirendipõhistes biomeditsiinilistes teadusuuringutes

Laiendada Euroopa võimekust heeliumiioonravi kliiniliseks rakendamiseks

Võimaldada piirkonnas kõrgtehnoloogial põhineva vähiravile kättesaadavus

Edendada piirkonnas globaalse tähtsusega kõrgtehnoloogilist innovatsiooni ökosüsteemi

APTCB_Executive_summary.pdf

CERN Baltic Group

Proposal for

Feasibility Study

of

Advanced Particle Therapy Centre for the Baltics

Implementation plan

Document has been prepared by CERN Baltic Group "Advanced Particle Therapy Centre for

the Baltic States" (APTCB) and "Advanced Particle Therapy Centre for the Baltic States:

Feasibility Study Strategy Group" (APTCB FSSG) Working Groups:

Convener of the APTCB WG: Prof. Toms Torims (Riga Technical University, LV)

Deputy Convener of the APTCB WG: Prof. Diana Adlienė (Kaunas University of

Technology, LT)

Convener of the APTCB FSSG WG: Assoc. Prof. Erika Korobeinikova (Lithuanian

University of Health Sciences, LT)

Deputy Convener of the APTCB FSSG WG: Kristaps Palskis (Riga Technical

University, LV)

Assoc. prof. Brigita Abakevičienė (Kaunas University of Technology, Convener of CERN

Baltic Group, LT)

Assoc. prof. Karlis Dreimanis (Riga Technical University, Deputy Convener of CERN

Baltic group, LV)

Dr. Maurizio Vretenar (CERN, CH)

Dr. Alberto Degiovanni (Riga Technical University, LV)

Dr. Andris Ratkus (Riga Technical University, LV)

Prof. Saulė Mačiukaitė-Žvinienė (Vilnius University, LT)

Dr. Giedrė Kvedaravičienė (Vilnius University, LT)

Dr. Eduard Gershkevitsh (North Estonia Medical Centre, EE)

Prof. Maija Radziņa (University of Latvia and Riga Stradins University, LV)

Dr. Jevgenijs Proskurins (Riga Stradins University, LV)

Dr. Gediminas Stankūnas (Lithuanian Energy Institute, LT)

Dr. Andrius Tidikas (Lithuanian Energy Institute, LT)

Assoc. prof. Elīna Pajuste (University of Latvia, LV)

Prof. Kristaps Jaudzems (University of Latvia, LV)

Dr. Šarūnas Meškinis (Kaunas University of Technology, LT)

Dr. Erika Rajackaitė (Kaunas University of Technology, LT)

Assoc. prof. Laimonas Jaruševičius (Lithuanian University of Health Sciences, LT)

Dr. Jonas Venius (National Cancer institute, LT)

Dr. Juras Kišonas (National Cancer institute, LT)

Prof. Sergei Nazarenko (Tallinn University of Technology, EE)

Assoc. prof. Fjodor Sergejev (Tallinn University of Technology, EE)

Executive summary

Overview

The Advanced Particle Therapy Centre for the

Baltics (APTCB) is an initiative established in

2022 by CERN Baltic Group (CBG). The main

goal of the initiative is to develop a modern

large-scale scientific research infrastructure,

often referred to as Big Science Centre, and

clinical treatment centre in the Baltic States by

integrating CERN NIMMS designed HeLICS

particle accelerator technology. Proposed

infrastructure would foster multidisciplinary

research, contribute to the breakthrough

innovation development, cross-sectoral

economic growth, and strengthen regional

integration of Baltic States into the European

Research Area.

At this stage, a dedicated, scientifically and

factually driven Feasibility Study is necessary

to consider any future developments of the

initiative and envision such a facility. The main

goal of the Feasibility Study would be to

investigate the feasibility of implementation of

the proposed facility and possible scenarios.

This document presents the overall concept of

the envisioned centre, rationale of its

development, with the focus on the proposed

design of the planned Feasibility Study.

Strategic Relevance. Alignment with EU

priorities

The APTCB would serve as a catalyst for

deep-tech commercialization, industrial

collaboration and the emergence of local high-

tech ecosystems in the Baltic States.

It aligns closely with EU strategic priorities in

healthcare innovation, cancer treatment, and

medical artificial intelligence, contributing to the

reduction of regional disparities in research and

development capacity.

Addressing a Critical Regional Gap

The absence of such a multi-disciplinary

large-scale infrastructure in the Baltic States

places the region at a significant disadvantage

compared to Western Europe. A dedicated

particle accelerator research facility would

bridge gap in scientific research, technological

and healthcare domains. It would expand the

access to advanced cancer therapies and enhance

participation of regional scientific groups in EU-

funded research and innovation programmes.

Clinical Potential

The European Commission’s Mission on

Cancer (2023) underscores the urgency of

reducing inequalities in cancer care across

Member States. The APTCB could play a

transformative role by offering advanced cancer

treatment modalities including:

• clinically established proton therapy;

• emerging cutting-edge helium ion therapy;

• production of innovative radioisotopes for

nuclear medicine.

APTCB would also contribute to research

necessary for clinical translation of other novel

approaches such as FLASH therapy.

These technologies mark a new era in high-

precision oncology, improving therapeutic

outcomes, minimizing side effects, and elevating

the standard of care. Their implementation would

also foster innovation in medical technologies

and high-impact clinical and fundamental

research.

Multidisciplinary Research

Equally central to the APTCB’s mission is the

promotion of world-class research beyond

clinical research. The facility would form a solid

base for high technology-driven research

programmes in medical physics, high-energy

physics, nuclear physics, material sciences,

radiochemistry, accelerator physics and

technologies and several other related fields. It

would attract international expertise, drive

competence development in early-stage

researchers and encourage collaboration with

high-tech industries and open science

communities, contributing to the creation of a

Baltic innovation ecosystem.

Proposal for Feasibility Study

Implementation Plan

Economic Impact

Big Science Centres have demonstrated their

potential to deliver long-term socio-economic

returns. The APTCB could provide the following

benefits:

• boost innovation ecosystems and enhance

the capacity of national economies to

generate, adopt, and commercialize advanced

technologies;

• provide environment for high-skilled

workforce development, including upskilling

and improved career prospects for early-stage

researchers, engineers, and professionals in

various fields;

• deliver wide-ranging societal benefits, such as

public access to cutting-edge cancer treatment

therapies, cultural engagement, and

technological spillovers;

• create public value through Big Science

infrastructure, enabling economies of scale in

knowledge generation and incentivizing

innovation and product development across

industries.

Stakeholder Support

The initiative has progressed through the

dedicated efforts of two Working Groups within

CBG and has secured strong backing from

stakeholders across the medical, scientific, and

policy sectors in the Baltic States.

Framework of the Feasibility Study

A dedicated, scientifically and factually driven

Feasibility Study is essential to assess the

viability and implementation scenarios of the

proposed APTCB facility. Outcome of it - a

comprehensive Feasibility Study Report - will

support informed decision-making on

continuation of the initiative.

Feasibility Study is to be led by Baltic

scientific institutions in close collaboration with

CERN. Feasibility study will also involve both

local and international stakeholders through the

Stakeholder Advisory Board. To ensure

communication with international experts,

Scientific Advisory Board will also be formed by

renowned experts in relevant domains of APTCB

initiative. The technical design for full-scale

implementation will be based on CERN NIMMS

HeLICS technology, while alternative

approaches will be investigated.

Feasibility Study will be structured in 3 core

Working Groups focusing investigations on

crucial domains of the facility:

• clinical needs and regional epidemiology

assessment;

• technological aspects and

implementation of it;

• economics and innovation.

Each Working Group will address scientific,

clinical, and innovation aspects of the respective

domain. Additionally, transversal tasks will

cover legal frameworks, risk analysis,

coordination, education planning, and alternative

implementation approaches, combing inputs

from 3 Working Groups.

The study would be also benchmarked

against leading European centres such as CNAO,

MedAustron, and HIT, to ensure optimized

technology investment, cost-effective

operations, and sustainable business models.

The duration of the Feasibility Study is

planned to be two years, while earlier termination

is possible upon finishing investigations.

Proposal for Feasibility Study

Implementation Plan

APTCB_publication.pdf

ORIGINAL PAPER

Health and Technology (2024) 14:965–972 https://doi.org/10.1007/s12553-024-00875-2

Kristaps Paļskis [email protected]

1 Riga Technical University, Riga, Latvia 2 European Organization for Nuclear Research (CERN),

Meyrin, Switzerland 3 Lithuanian University of Health Sciences, Kaunas, Lithuania 4 Lithuanian Society for Radiation Therapy, Kaunas, Lithuania 5 Latvian Therapeutic Radiology Association, Riga, Latvia 6 The National Center for Oncological Hadrontherapy

(CNAO), Pavia, Italy

7 Imperial College London, London, United Kingdom 8 SEEIIST Association, Geneva, Switzerland 9 Fondation Tera-Care, Geneva, Switzerland 10 University of Latvia, Riga, Latvia 11 Latvian Radiology Association, Riga, Latvia 12 Riga Stradins University, Riga, Latvia 13 Kaunas University of Technology, Kaunas, Lithuania 14 University of Oxford, Oxford, United Kingdom

Abstract Background Baltic States remains one of the few regions in the Europe without a dedicated particle therapy center. An initiative since 2021 has been started by CERN Baltic Group on a novel particle therapy center development in the region in partnership with CERN NIMMS collaboration. With a conceptual design idea in early 2022 and stakeholder engagement activities in late 2022 - next step forward was necessary for the initiative for a more in-depth analysis. Methods A dedicated workshop “Particle therapy - future for the Baltic States? State-of-play, synergies and challenges” was held. The workshop was attended by medical community from the Baltics, as well as CERN technical experts and par- ticle therapy practicing clinicians, with scientific programme split in 5 main areas of investigation. Results Current cancer epidemiology statistics and RT technological possibilities in the region were analyzed, with first estimates of eligible number of patients calculated. Technological development level of the proposed accelerator complex was discussed, as well the clinical needs and synnergy possibilities with the nuclear medicine field. Conclusions The current state and calculated first estimates presented here have shown a promising starting point, which prompts even further in-depth work – a feasibility study for development of a novel particle therapy center in the Baltic States.

Received: 8 March 2024 / Accepted: 19 April 2024 / Published online: 6 May 2024 © The Author(s) 2024

“Particle therapy - future for the Baltic states?” – synthesis of the expert workshop report

Kristaps Paļskis1,2 · Erika Korobeinikova3,4 · Dace Bogorada-Saukuma5 · Anna Maria Camarda6 · Rebecca Taylor2,7 · Elena Benedetto8,9 · Edgars Mamis2,10 · Maija Radziņa10,11,12 · Andrejs Ērglis10 · Diana Adliene13 · Manjit Dosanjh2,14 · Maurizio Vretenar2 · Toms Torims1

1 Background and introduction

According to data of the World Health Organization (WHO), cancer remains one of the most significant causes of death globally – accounting for nearly one in every six

deaths globally in 2020 [1]. In 2022 alone, 19.98 million new cancer cases and 9.3 million cancer deaths were reg- istered [2]. Throughout the years, various regions around the world have seen an increase in the incidence rates, with current estimates predicting an increase of almost 3 times

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by year 2050–58.6 million cases globally [3]. With global cancer burden expected to grow, effective cancer manage- ment strategies are to be considered in healthcare systems and novel treatment methods to be explored and researched.

Out of the three primary methods for cancer treatment – surgery, chemotherapy and radiotherapy (RT) – RT as treat- ment modality in course of care is beneficial and required in more than 50% of patients [4]. RT is frequently used in the treatment of the most widespread cancer types – breast, lung, colorectal, cervical and others. Despite the benefits of RT in cancer care path, the access to these technologies globally is inadequate, especially in countries categorized as low- or middle- income [4]. Even further, a specific modal- ity of RT – particle therapy (PT), using positively charged ions instead of gamma photons in conventional therapy – has proven to be favourable in certain types of cancer. While clinical evidence base needs to be expanded further, proton therapy has already shown benefits in the reduction of nor- mal tissue complications in selected types of cancer and car- bon ion therapy –in treatment of radioresistant and hypoxic tumours [5–8]. Despite this, the access to this type of treat- ment globally is even more challenging due to increased

costs of particle accelerator used. Currently, approximately 130 centres in the world offer PT, out of which only 13 offer the unique opportunities of carbon ion therapy [9], while many new development projects are in construction or plan- ning stages.

Analysing access to particle therapy, the Baltic States – Lithuania, Latvia and Estonia – is one of the European regions without a dedicated proton or carbon ion therapy treatment centre (see Fig. 1.). Therefore, in 2021, a collabo- ration of research institutions and universities in the region – CERN Baltic Group (CBG) [10] – started dedicated and focused efforts on exploring possible particle therapy devel- opment paths in the region. As the name suggests, the main goal of CBG is about strengthening collaboration of Baltic States with the European Organization for Nuclear Research (CERN). Already from first discussions, development of a dedicated facility, not a commercial solution, was deemed more attractive for the region – providing more capabili- ties and research opportunities. Such a collaboration frame- work has already proven to be successful within the CERN PIMMS study, which resulted in CNAO and MedAustron ion therapy centres [11].

Fig. 1 Particle therapy centres in Europe (ENLIGHT data, 2020) [12]

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The initiative took the form of a dedicated working group “Advanced Particle Therapy centre for the Baltic States” within CBG in April 2022. The conceptual design idea was developed by the working group in the spring of 2022. Until the end of 2022, active engagement and discussions took place with relevant stakeholders – medical profes- sionals involved in RT, scientific university representatives and involved political bodies. Following these events, key areas were identified that should be taken as first for fur- ther exploration and in-depth analysis: statistics and overall situation with cancer management in the region and clinical indications for PT eligibility, as well as technical aspects on proposed particle accelerator complex for such a facil- ity and integration of another clinical area – nuclear medi- cine. To address and work on these areas, workshop with medical professionals from the Baltic region, CERN techni- cal experts and PT practicing clinical representative from CNAO was held on May 25th, 2023 at CERN - “Particle therapy - future for the Baltic States? State-of-play, syner- gies and challenges”.

The aim of this work is to present key findings and points made during the workshop, as well to indicate overall con- clusions and future outlooks of the initiative.

2 Overview of current status of radiotherapy technologies in the Baltic States

This section reports on key data presented regarding the cancer burden and RT treatment statistics within the region. Data regarding cancer statistics and access to RT technolo- gies – both diagnostic and treatment units, were collected during participation of Baltic States in the “Access to Radio- therapy Technologies” (ART) study during 2022, held by The International Cancer Expert Corps (ICEC) organization [13]. Additional data corresponding to aspects specific to PT were collected in a tailored questionnaire to RT-practising clinical institutions within the region.

As of data from 2021 (or 2020 depending on data avail- ability within the country), the 3 Baltic States have a total of 6.02 million inhabitants with a total of 38,031 newly registered cancer cases and 17,900 cancer causes deaths - a crude (non-age-specific) cancer incidence and mortality rate on average for region being 632 and 298 per 100 000 inhabitants, respectively. Country specific data are given in Table 1.

According to data collected for the year of 2020, a total of 13 045 patients within the 3 countries received RT (both external beam and brachytherapy) as part of their cancer treatment course – 6343, 4146 and 2556 for Lithuania, Latvia and Estonia, respectively. RT in the Baltic States is delivered with state-of-the-art linear accelerators − 27 in total for the region. Almost all the units are capable of deliv- ering modern RT techniques – intensity modulation (IMRT), volumetrically modulated arcs (VMAT), as well as the high precision stereotactic techniques (SRS, SRT, SBRT) and incorporating image guidance in therapy (IGRT). The num- ber of linear accelerator for RT for the given population can be deemed sufficient, in accordance with international guidelines (4 units per 1 million) [14], [15]. Data regard- ing medical personnel working in RT practice was also col- lected – a total of 86 radiation oncologists, 129 radiation therapy technologists (RTT) and 67 medical physicists in the 3 countries as of 2021.

Additionally, more in-depth data were also collected, such as percentage of incidence and mortality for certain cancer types and cancer localizations typically treated with protons or carbon ions (paediatrics, brain tumours, head and neck region and others). Cancer types with the highest incidence rate follow the global trends [2]: prostate, non- melanoma skin cancer, lung and breast cancer (see Table 2). Similarly, the trends are also followed for highest mortality rate: lung, colorectal, stomach and liver.

Exploring indications specific for particle therapy, more in-depth analysis was done regarding paediatric cancers. Over the period 2018–2022, a total of about 1000 paediatric cancer cases have been registered in the 3 countries, out of which about 1/5 (211 patients) have received RT as part of their treatment course. 41 of these patients were treated in

Table 1 Overview of main cancer statistics metrics in the Baltic States for year 2021 (2020, if specific data unavailable)

Lithuania Latvia Estonia Total of region

Inhabitants (millions) 2.801 1.884 1.331 6.016 Registered cancer cases 17,073 12,051 8907 38,031 Cancer deaths 8168 5892 3840 17,900 Crude cancer incidence rate (per 100 000)

610 640 669 632

Crude cancer mortal- ity rate (per 100 000)

292 313 289 298

Table 2 Cancer localizations with highest incidence rates (as percent- age of total) in Lithuania and Estonia from 2018 to 2022 (numeri- cal data are not provided for Latvia due to lack of national cancer registry)

Lithuania Estonia Cancer localizations with highest incidence

Prostate – 13% Non-melanoma skin cancer – 13% Lung, trachea, bronchus – 9% Breast – 9% Colon – 6%

Non-melanoma skin cancer – 15% Prostate – 12.9% Lung, trachea, bronchus – 9.6% Breast – 9.2% Colon – 7.2%

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Although this is a very simplified approach, it does pro- vide first estimates for assessing the feasibility of PT in the region. According to the statistics of European PT centres [26], on average 223 adult patients and around 150 paediat- ric patients are treated per centre, as per data of 2020. First estimates do suggest that the number of PT eligible patients from the Baltic States might be sufficient for such a facility. Though, more in-depth analysis should be done in the future based on cancer incidence and RT practice for different can- cer types in the clinics within the Baltic States. This is a currently on-going work and to be extended even further.

It should be noted, due to lacking clinical evidence in particular cancer types, throughout the years alternative methods have been developed for patient selection for PT. Such examples are cost-effectiveness assessment, dosimet- ric comparison and recently emerging normal tissue compli- cation probability (NTCP) modelling. The latter approach proves to be a beneficial estimation tool in head and neck tumours, with development efforts for algorithms as well in brain, breast and other types of cancer [27–29]. As these tools would be highly beneficial in the case of the Baltic States, the necessity of modern cancer registries becomes of uttermost importance.

4 A novel path – helium ion therapy

From the technical perspective, the core technology consid- ered for development of such a facility is the helium synchro- tron – a compact medical synchrotron in active development by the Next Ion Medical Machine Study (NIMMS) collabo- ration [30] at CERN. The choice of helium-4 ions as the design particle for the machine has been made to address the recent re-emergence of interest in application of this ion type for cancer therapy. A clear research interest can be seen in ion therapy centres both in Europe and Asia [31–33]. As the role of helium ion therapy for cancer treatment is yet to be explored, particle accelerator systems for helium ion therapy would be highly beneficial to allow the necessary clinical research.

From clinical perspective, use of helium-4 ions for can- cer therapy was already explored in the early stages of PT back at Lawrence Berkley National Laboratory [34], with the current renaissance mainly emerging from Heidelberg Ion Therapy centre, with the first patient treated in 2022 [31]. From a physical perspective, use of helium ions com- pared to protons could greatly increase the dose conformal- ity due to reduced range straggling and lateral scattering (see Fig. 2.) and also increase the biological effectiveness. While in comparison to carbon ion beams, helium provided reduced fragmentation tail and more importantly - smaller and less demanding accelerator system would be necessary.

the last reported year – 2022, with the most common indica- tions being leukaemia, central nervous system tumours and lymphoma.

3 Eligibility for particle therapy: statistics implications in Baltic States case

Though various international guidelines exist from sources such as the American Society for Radiation Oncology (ASTRO) [16], as well as the healthcare systems of the United Kingdom [17] and Japan [18], overall, the most common indications for particle therapy in treatment cen- tres are central nervous system (CNS), skull base, head and neck, and paranasal sinus tumours [5–8]. Clinical experi- ence was shared from The National Centre for Oncological Hadrontherapy by Dr. Anna Maria Camarda, outlining clin- ical indications with the highest benefit and existing clinical evidence - skull base chordoma, chondrosarcoma, sinonasal carcinoma, brain tumours, head and neck tumours, radio- resistant tumours and others [19]. For future perspectives, particle therapy could also provide clinical benefits in the treatment of lymphoma, lung, breast, and prostate can- cers. However, a significant increase in clinical evidence is needed, as the current evidence is either conflicting, incon- clusive, or lacking in general [19, 20].

In order to provide initial estimates of eligible number of cancer patients for PT, a literature review was conducted to study possible mathematical estimation approaches. Results of the literature review study are summarized in Table 3.

Based on the data provided in the Table 3 and the data collected previously – 13,045 RT receiving patients in year 2020 for all 3 countries, one can do a simple mathematical estimate:

● based on Burnet et al. estimates [22]: around 196 pa- tients eligible;

● based on Glimelius et al. estimates [23]: around 1957 patient eligible.

Table 3 Overview of publications studying RT patient eligibility for PT

Percentage of patients esti- mated to benefit from PT

Ebner et al. (2022) [21] 2.2% of RT patients (consid- ered eligible and treated)

Burnet et al. (2020) [22] 1.5% of RT patients (consid- ered eligible and treated)

Glimelius et al. (2005) [23] 14–15% of RT patients (con- sidered eligible due to benefit)

Burnet et al. (2022) [24] 4.3% of RT patients (consid- ered eligible due to benefit)

Lee et al. (2021) [25] 10% of RT patients (treated)

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facility allows more customizability and opportunities for research and skill development of the personnel. Most of the components necessary for the technology are rather standard, with additional R&D mainly required for FLASH delivery: beam extraction, beam delivery system and deliv- ery method itself, as well as dosimetry, beam monitoring and other safety systems. With these unique opportunities, such a facility would allow development of a vast program both in clinical domain and scientific research.

5 Beyond particle therapy – possible integration of nuclear medicine

Although the core function of the accelerator complex is the use in particle therapy, as mentioned, the dual func- tion linear accelerator will also allow parallel production of radioisotopes for nuclear medicine. The usage of a lin- ear accelerator would allow more efficient production with deuteron and alpha particle beams compared to cyclotrons due to increased beam transmission [38, 39]. Production of radioisotopes would be completely independent from the ion therapy and scientific research functions, as it would be done with additional beam pulses in the linear accelerator structure only. Operation mode for the synchrotron is fore- seen at 1 Hz, while for the linear accelerator – at 50 Hz. As the linear accelerator can be modulated on pulse-to-pulse basis, the beam can be independently adapted for the differ- ent functions of the facility [38, 39].

Early treatment plan modelling studies have indeed shown helium-4 ions as a possible evolution of proton therapy, reducing the normal tissue toxicity in certain clinical sce- narios [35–37].

One of the main design considerations for the develop- ment of this accelerator is also to reduce the footprint of the facility and the cost, compared to carbon ion therapy facilities. The technology under development is a compact normal conducting (1.65 Tesla magnets) synchrotron with an estimated footprint of about 2200 m2 [38]. The system is designed for acceleration of fully stripped helium-4 ions with treatment relevant energies up to 220 MeV/u, with the possibility of proton acceleration, as well, correspondingly to energies of about 700 MeV, thus usable for full-body radiography applications and research. A flexible extraction system is foreseen, able to deliver ultra-high dose rates suit- able for the novel FLASH therapy. The linear accelerator injector system could also provide novel dual functionality, being able to produce radioisotopes for nuclear medicine. A schematic representation of the preliminary design of a facility incorporating the proposed accelerator is given in Fig. 3. In the preliminary design of the facility two treat- ment rooms are foreseen, with a dedicated beam-line for research, though possible adaptations can be considered in further development stages of the initiative.

Although the design particle of the machine is helium-4 ion, the synchrotron could also deliver clinically established proton therapy as for helium-4 ion usage the process of clin- ical trials is yet to start. Adopting such a design for a clinical

Fig. 2 Comparison of physical percentage depth doses for vari- ous types of ionizing radiation

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a unique opportunity for the region to evolve both in clini- cal and scientific research capacity. From the technological point of view, the accelerator complex provides customiz- ability to user needs, vast research spectrum possibilities, while keeping R&D risk minimal owing to standard tech- nology usage in the design. The customizability also cor- responds to the envisioned usage of such a facility – both as a scientific research centre and a clinical treatment facility. One of the key considerations before further developments was, of course, whether the number of patients eligible for particle therapy would be sufficient to run such a facility. The first estimates presented here have shown a promising starting point, which prompts for more in-depth analysis of this aspect in the future.

An important aspect regarding the availability of cancer statistics data for such an initiative was also put forward. For long-term goals of this initiative, development strategies are needed to provide state-of-the-art national cancer registries. Improvements can be considered for the existing registries in Lithuania and Estonia, though this aspect is even more important in Latvia, as currently a dedicated registry is lack- ing, which already complicated some of the data collection procedures. A consensus within the workshop was reached that the creation and improvement of national cancer regis- tries are crucial for the success of such a proposed facility, as this data is necessary to make joint decisions between the

While various radioactive isotopes for production have been considered from the technical possibility perspective, survey data from clinical users were presented within the framework of the PRISMAP Consortium [40–42]. With a total of 114 respondents from 30 European countries and 104 different institutions (out of which 48 respondents from research institutions and 40 clinical institutions) the main interests and demands for the future in nuclear medicine are for theragnostic and targeted alpha therapy isotopes – actinium-225 and other alphas emitters, copper-64 and iso- topes from scandium and terbium families. Possible use of such isotopes would also be a novelty for the Baltic States, as currently only more conventional isotopes are used such as fluorine-18, technetium-99m, iodine-123 and iodine-131, lutetium-177, radium-223.

Integrating these clinical interests into the technical design of the facility is highly important. As production of non-conventional isotopes could be done in the proposed facility, possible export pathways should be considered in co-operation with the 2 soon-operational cyclotron produc- tion facilities in Lithuania and Latvia [43][44].

5.1 Findings of the workshop. Future outlooks

Development of a particle therapy centre within the Baltic States based on NIMMS helium synchrotron technology is

Fig. 3 Preliminary layout of the proposed facility using helium synchrotron

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Code availability Not applicable.

Declarations

Ethics approval Not applicable.

Consent to participate Not applicable.

Consent for publication Not applicable.

Competing interests The authors have no relevant financial or non- financial interests to disclose.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons. org/licenses/by/4.0/.

References

1. Cancer. accessible online: https://www.who.int/news-room/ fact-sheets/detail/cancer.

2. Cancer Today. accessible online: https://gco.iarc.fr/today/. 3. Cancer Tomorrow. accessible online: https://gco.iarc.fr/

tomorrow/. 4. World Health Organization. Technical specifications of Radio-

therapy Equipment for Cancer Treatment. World Health Organi- zation; 2021.

5. Chen Z, Dominello MM, Joiner MC, Burmeister JW. Proton versus photon radiation therapy: a clinical review. Front Oncol. 2023; 13.

6. Mohan R. A review of proton therapy – current status and future directions. Precision Radiation Oncol. 2022;6(2):164–76.

7. Mohamad O, Yamada S, Durante M. Clinical indications for Car- bon Ion Radiotherapy. Clin Oncol. 2018;30(5):317–29.

8. Malouff TD, Mahajan A, Krishnan S, Beltran C, Seneviratne DS, Trifiletti DM. Carbon Ion Therapy: a modern review of an Emerg- ing Technology. Front Oncol. 2020; 10.

9. PTCOG - Facilities in Operation. accessible online: https://www. ptcog.site/index.php/facilities-in-operation-public.

10. CERN Baltic Group. · Indico, accessible online: https://indico. cern.ch/category/10023/.

11. Bryant PJ, Badano L, Benedikt M, et al. Progress of the Proton- Ion Medical Machine Study (PIMMS). Strahlenther Onkol. 1999;175(S2):1–4.

12. Home | THE EUROPEAN NETWORK FOR LIGHT ION HAD- RON THERAPY. accessible online: https://enlight.web.cern.ch/.

13. ART (Access to Radiotherapy Technologies) Study. - ICEC, accessible online: https://www.iceccancer.org/artstudy/.

14. IAEA (International Atomic Energy Agency) (2011). Plan- ning national radiotherapy services: a practical tool. IAEA Human Health Series No.14. Vienna, Austria: International Atomic Energy Agency.[15] IAEA (International Atomic Energy

3 Baltic States on the number of eligible patients, as well as patient referral and reimbursement system functioning. From a clinical perspective, strengthening the support of the Baltic medical community for this initiative is crucial. A long-term project of this scale cannot be planned without clear and direct support from the medical communities of the region.

Throughout the workshop, the importance of scientific research function was discussed heavily, as well. As the helium synchrotron would be a custom-made particle accel- erator, the scientific research function of the proposed facil- ity is of high importance, with a broad programme to be foreseen. Pre-clinical and clinical research will be of high importance to develop the role of helium ion therapy in cancer treatment. The facility would also provide research opportunities in medical physics, dosimetry, accelerator physics, and related technology development, while the use of the linear accelerator for radioisotope production – in nuclear medicine, nuclear physics, radiochemistry, material science, and others. The proposed facility has a large scien- tific research potential, thus a more detailed programme is to be developed in the future within the foreseen feasibility study, as discussed next.

Findings of the workshop have gathered support both from medical communities and political bodies within the Baltic States for further investigations of the feasibility of such a facility. Such investigations are planned to be carried out in a dedicated longer-term feasibility study done by Bal- tic States specialists and researchers in close collaboration with CERN experts. The length of the feasibility study is envisioned to be 2 years, with the finalization of the pro- gramme and working plan currently on-going. The feasibil- ity study is to focus on 3 main areas: cancer epidemiology in the Baltic States and clinical aspects, technical integration of the helium synchrotron into a dedicated facility and lastly – economic aspects.

Acknowledgements We want to express our gratitude to all the speak- ers and moderators of the workshop, included as co-authors of this work – without them such fruithful results would not be reached!

Author contributions All authors contributed to the study conception, design and data acquisition provided in the study. The first draft of the manuscript was written by Kristaps Paļskis, with corrections done by Erika Korobeinikova, Manjit Dosanjh, Maurizio Vretenar and Toms Torims. All authors have read and approved the final manuscript.

Funding This work has been partly funded by Latvian State Research programme VPP-IZM-CERN-2022/1–0001 and partly funded by the European Union’s Horizon 2020 research and innovation program un- der grant agreement No 101008548 (HITRIplus). Open access funding provided by CERN (European Organization for Nuclear Research)

Data availability Not applicable.

1 3

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Health and Technology (2024) 14:965–972

aiming at reduction of side effects: the model-based approach. Radiother Oncol. 2013;107(3):267–73.

30. NIMMS | Knowledge Transfer. accesible online: https://kt.cern/ medtech/nimms.

31. Tessonnier T, Ecker S, Besuglow J, et al. Commissioning of Helium Ion Therapy and the first patient treatment with active Beam Delivery. International Journal of Radiation Oncology Biology Physics; 2023.

32. Gambino N, Kausel M, Guidoboni G, et al. First injector commis- sioning results with Helium Beam at MedAustron. Ion Therapy Centre J Phys : Conf Ser. 2022;2244(1):012109.

33. Quantum Scalpel Project 2021 National Centre of Radiological Sciences (NIRS). accesible online: https://www.qst.go.jp/site/ innovative-project-english/quantum-scalpel.html.

34. Saunders W, Castro JR, Chen GTY, et al. Helium-Ion Radiation Therapy at the Lawrence Berkeley Laboratory: recent results of a Northern California Oncology Group Clinical Trial. Radiat Res. 1985;104(2):S227.

35. Tessonnier T, Mairani A, Chen W et al. Proton and Helium ion radiotherapy for meningioma tumors: a Monte Carlo-based treat- ment planning comparison. Radiat Oncol 2018; 13(1).

36. Wickert R, Tessonnier T, Deng M, et al. Radiotherapy with Helium ions has the potential to Improve both Endocrine and Neurocognitive Outcome in Pediatric patients with Ependy- moma. Cancers. 2022;14(23):5865.

37. Bonaccorsi SG, Tessonnier T, Hoeltgen L, et al. Exploring helium ions’ potential for Post-mastectomy Left-sided breast Cancer Radiotherapy. Cancers. 2024;16(2):410.

38. Vretenar M, Angoletta ME, Benedetto E et al. A Compact Syn- chrotron for Advanced Cancer Therapy with Helium and Proton Beams. Proceedings of the 13th International Particle Accelerator Conference. 2022; IPAC2022: Thailand.

39. Vretenar M, Mamaras A, Bisoffi G, Foka P. Production of radio- isotopes for cancer imaging and treatment with compact linear accelerators. J Phys : Conf Ser. 2023;2420(1):012104.

40. Project description, accesible online. https://www.prismap.eu/ about/project/.

41. Radzina M, Mamis E, Saule L et al. Deliverable 5.1 - Question- naire on industrial and clinical key players and needs. 2022, accesible online: https://zenodo.org/records/7154340.

42. Radzina M, Saule L, Mamis E et al. Novel radionuclides for use in Nuclear Medicine in Europe: where do we stand and where do we go? EJNMMI Radiopharm chem. 2023; 8(1).

43. State-of-the. -art nuclear medicine centre opens in Riga - Labs of Latvia, accesible online: https://labsoflatvia.com/en/news/ state-of-the-art-nuclear-medicine-centre-opens-in-riga.

44. One of the most expensive purchases of the health system reached Lithuania. - a cyclotron - LRT, accesible online: https://www. lrt.lt/naujienos/sveikata/682/2009504/lietuva-pasieke-vienas- brangiausiu-sveikatos-sistemos-pirkiniu-ciklotronas?utm_ source=ground.news&utm_medium=referral

Publisher’s Note Springer Nature remains neutral with regard to juris- dictional claims in published maps and institutional affiliations.

Agency), Slotman BJ, Cottier B, Bentzen SM, Heeren G, Lievens Y, van den Bogaert W. Overview of national guidelines for infra- structure and staffing of radiotherapy. ESTRO-QUARTS: Work package 1. Radiotherapy and Oncology 2005; 75(3): 349.E1-349. E6.

15. Slotman BJ, Cottier B, Bentzen SM, Heeren G, Lievens Y, van den Bogaert W. Overview of national guidelines for infrastructure and staffing of radiotherapy. ESTRO-QUARTS: Work package 1. Radiotherapy and Oncology 2005; 75(3): 349.E1–349.E6.

16. ASTRO Proton Beam Therapy Model Policy. accesible online: https://www.astro.org/ASTRO/media/ASTRO/Daily%20Prac- tice/PDFs/ASTROPBTModelPolicy.pdf.

17. „NHS commissioning » Proton beam therapy. accesible online: https://www.england.nhs.uk/commissioning/spec-services/ highly-spec-services/pbt/.

18. English Translation of JASTRO treatment policy of proton beam therapy. accessible online: https://www.jastro.or.jp/en/news/pro- ton_guideline_jastro_7_13_2017-2_cmarkandwatermark.pdf.

19. Camarda AM. Workshop „Particle therapy - future for the Baltic States? State-of-play, synergies and challenges session II: Clini- cal indications for proton and particle therapy. Existing clinical evidence and on-going clinical trials, accesible online: https:// indico.cern.ch/event/1251461/contributions/5334487/attach- ments/2653325/4594489/Camarda_Clinical%20indications%20 for%20particle%20therapy.pdf.

20. Mohan R, Grosshans D. Proton therapy - Present and future. Adv Drug Deliv Rev. 2017;109:26–44.

21. Ebner D, Malouff T, Waddle M, Foote R. HSR22-137: Pro- ton Radiotherapy Utilization for patients diagnosed in 2018: a National Cancer Database Analysis. J Natl Compr Canc Netw. 2022;20(35):HSR22–137.

22. Burnet NG, Mackay RI, Smith E, Chadwick AL, Whitfield GA, et al. Proton Beam therapy: perspectives on the national health service England clinical service and research programme. Br J Radiol. 2020;93(1107):20190873.

23. Glimelius B, Ask A, Bjelkengren G, et al. Number of patients potentially eligible for proton therapy. Acta Oncol. 2005;44(8):836–49.

24. Burnet NG, Mee T, Gaito S et al. Estimating the percentage of patients who might benefit from proton beam therapy instead of X-ray radiotherapy. BJR. 2022; 95(1133).

25. Lee SU, Yang K, Moon SH, Suh Y-G, Yoo GS. Patterns of Proton Beam Therapy Use in Clinical practice between 2007 and 2019 in Korea. Cancer Res Treat. 2021;53(4):935–43.

26. Tambas M, van der Laan HP, Steenbakkers RJHM, et al. Current practice in proton therapy delivery in adult cancer patients across Europe. Radiother Oncol. 2022;167:7–13.

27. Tambas M, Steenbakkers RJHM, van der Laan HP, et al. First experience with modelbased selection of head and neck cancer patients for proton therapy. Radiother Oncol. 2020;151:206–13.

28. Dutz A, Lühr A, Troost EGC, et al. Identification of patient benefit from proton beam therapy in brain tumour patients based on dosi- metric and NTCP analyses. Radiother Oncol. 2021;160:69–77.

29. Langendijk JA, Lambin P, De Ruysscher D, Widder J, Bos M, Verheij M. Selection of patients for radiotherapy with protons

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E-kiri.eml

Tähelepanu! Tegemist on välisvõrgust saabunud kirjaga.
Tundmatu saatja korral palume linke ja faile mitte avada.

Dear Ministry of Social Affairs of the Republic of Estonia,

On behalf of the CERN Baltic Group, we hereby send the Support Request for the Feasibility Study of Advanced Particle Therapy Centre for the Baltic States (APTCB).

Enclosed:

Support request letter for the Feasibility Study of Advanced Particle Therapy Centre for the Baltic States (APTCB).
Full text of recent expert publication, outlining key aspects and highlighting the strategic significance of APTCB: Paļskis, K., Korobeinikova, E. et al. “Particle therapy - future for the Baltic states?” – synthesis of the expert workshop report, Health and Technology, 2024 – outlining key aspects of the initiative.
Brochures on APTCB initiative and Feasibility Study in Estonian and English.
Executive summary of the Feasibility Study Proposal.

Sincerely

Dr. Brigita Abakevičienė

| Chair of the CERN Baltic Group

Kaunas University of Technology

Institute of Materials Science | https://materials.ktu.edu

K. Barsausko st. 59, Room A-216, 51423 Kaunas, Lithuania

+370 686 07546 | [email protected] |