Carbon Hadrontherapy in Lyon: Current and Future Organization of Research

Particle therapy with carbon ions (PTCI), one variant of hadrontherapy, uses an advanced technology to cure unresectable and radioresistant tumors (~ 5-10% of the cancers to be irradiated). PTCI is based on nuclear physics and accelerator technology, for which France has a global expertise. No dedicated center for PTCI exists in France yet. However, pioneer carbon centers have been operated in Japan since 1994 and Europe since 1998. About 10.000 pateints have been treated so far, but this type of treatment is still undergoing development and requires improvements in terms of availability, standard recommendations, quality insurance tools, screening for candidate tumors, associated therapy, economical efficiency, fundamental radiobiology, etc. PTCI projects have been existing in France since about 25 years with the late EULIMA project in the 80's, the ETOILE medical and research project strated in the late 90's, and the ARCHADE technological project since 2005. They have attracted attention and gathered around them research topics that were first structured in a comprehensive program by Lyon's University in 2002: the Regional Program for Hadrontherapy Research (PRRH) with public funding. At the national level the MI2B-GDR gathers CNRS/IN2P3 physicists involved in this domain. A medical randomized trial protocol supported via INCa-PHRC is driven by Lyon. The objective to build the French national PTCI center, ETOILE, in Lyon obtained State approval in 2005. This stimulated applied research activities in this domain and encouraged for the application of more public support as could be provided by the Investments for the Future (PIA), also known as 'Grand Emprunt'. A mandatory condition was to federate all the active bodies in a unique organization. Two entangled organizations thus appeared, that embrace all the laboratories, projects and teams involved in hadrontherapy in France. Both are supported by the PIA for 15 and 8M euros, respectively. These organizations are: 1) the France HADRON (FrHA) national infrastructure unifying teams and sites: ETOILE (Lyon) and ARCHADE (Caen) as carbon sites; Centre Antoine Lacassagne (Nice), Institut Curie/ICPO (Orsay) and Institut Claudius Regaud (Toulouse), as proton sites, but also the CNRS/IN2P3 and the IRSN (Radiation protection and nuclear safety institute). FrHA's scientific program is multidisciplinary, organized in 4 work packages integrated into and supported by a national governance: clinical research; modeling and computer simulation; radiation biology; and instrumentation. 2) the PRIMES Laboratory of Excellence that encompasses all the teams involved in PTCI research in Rhone-Alpes-Auvergne associated with other researchers in experimental radiotherapy and medical imaging. In this way, the former research teams of the PRRH are now included in a larger environment: PRIMES, and will benefit from beam access and technical support from FrHA, as well as from continuing or future European projects (ENLIGHT++).