Hadron therapy facility benefits for the region L

Hadron therapy facility benefits for the region L. Litov Sofia University L. Litov SEEIIST meeting Trieste 25. 01. 2018

Outlook Ø Arguments to establish the Institute Ø political Ø scientific Ø Arguments in favour of hadron therapy center Ø Estimates of the needs of the region of hadron therapy treatment Ø Estimates of the real cost of the center Ø Conclusions L. Litov SEEIIST meeting Trieste 25. 01. 2018

SEEIIST Ø Objectives of the project ü to promote collaboration between science, technology and industry ü to build unique research infrastructure (Europe, World) ü perform fundamental and applied research ü educational center ü transfer of technologies Ø The goals can only be achieved with one major new Institute based on the latest technologies to enable world class research L. Litov SEEIIST meeting Trieste 25. 01. 2018

Arguments q Political arguments Ø EU declared its interest in projects leading to prosperity, stability and security in the Balkan region Ø Bulgaria considers very important development of the regional relations and collaboration in all fields Ø Bulgaria currently holds the presidency of EU Ø One of the main priorities are Western Balkans Ø The goal is Ø to mitigate the tensions in the region and to bust the economical and technological development of the region Ø improvement of the relations with EU common market and creations of conditions for prosperity of the region Ø The SEEIIST is considered as one of the important subpriorities L. Litov SEEIIST meeting Trieste 25. 01. 2018

Scientific and economical benefits Ø Ø Ø Extension of the research infrastructure in the region Creates conditions for common research projects and work Oriented towards the future development Development of new educational programs Cooperation between EU member states and states applying for EU membership Ø Reduction of the brain drain Ø Attraction of scientists to return in the region Ø Attraction of leading scientist Ø Participation in EU projects in different areas of science, technologies and innovations Ø Attraction of additional financial resources for research and inovations L. Litov SEEIIST meeting Trieste 25. 01. 2018

SEEIIST Ø Two options under consideration – both based on accelerators ü Synchrotron Light Source with a new technique which is used for the first time in Lund, Sweden ü Facility for Tumor Therapy and Biomedical Research with protons and heavier ions Ø Both options are very promising, realistic and ensuring achievement of the project goals Ø They are complementary Ø We should work for realization of both of them Ø Probably we’ll be forced to choose one of them Ø Some arguments for HT option L. Litov SEEIIST meeting Trieste 25. 01. 2018

Some additional arguments for HT Tendency of increase of the new cancer cases and dead cases in the region Bulgarian data, to be normalized to the decreasing number of population L. Litov SEEIIST meeting Trieste 25. 01. 2018

Some additional arguments for HT Practically unavailable for the citizens of the region Very expensive – 50 000 Euro at HIT L. Litov SEEIIST meeting Trieste 25. 01. 2018

Some additional arguments for HT The hadron therapy is one of the most advanced and effective methods for tumor treatment 160 In operation – 76 140 Ion therapy - 11 120 In construction – 42 100 Ion therapy - 3 80 60 Planned – 22 40 Ion therapy – 1 20 Patient treated /2016/ - 149 345 0 1959 1969 1979 1989 1999 2009 2019 2029 with protons In 2016 – 21 580 with carbon ions L. Litov SEEIIST meeting Trieste 25. 01. 2018

Some additional arguments for HT Where is Europa? 90000 80000 70000 60000 North America/Protons 50000 Japan/China/Korea Protons Japan/China/Korea c-ion 40000 Europe/Russia, Protons Europe/Russia, C-ions 30000 20000 10000 0 1995 L. Litov 2000 2005 2010 2015 SEEIIST meeting 2020 Trieste 25. 01. 2018

Some additional arguments for HT Do we need it? Based on Bulgarian statistics and protocols for cancer treatment Cancer Patients Percent For Radio therapy Percent for PT or CI Patient for PT or CI Percent of total number Breast cancer 3830 42, 3% 1620 5 % 81 26, 5% Prostate cancer 2287 15, 8 % 361 10 % 36 11, 9% Lung cancer 2955 10, 1% 298 15 % 45 14, 6% Head and neck cancer 699 45, 8% 320 45 % 144 47, 1% Total number of patient: 306 L. Litov SEEIIST meeting Trieste 25. 01. 2018

Some additional arguments for HT Ø Ø Bulgarian population 7. 3 million The population of the 9 countries in the project – 33 million If Greece joins – 43 million Population of Balkan peninsula (including European part of Turkey) – 75 millions Ø Estimated number of expected patients ü SEEIIST member states ~ 1400 ü + Greece ~ 1800 ü Balkans ~ 3200 Ø Numbers strongly depend from the national protocols for cancer treatment and can vary significantly ü The above numbers should be considered as a lower limit L. Litov SEEIIST meeting Trieste 25. 01. 2018

Some additional arguments for HT Ø We have to build a unique research infrastructure ü Existing ion therapy centers are treatment centers ü Only little part of the beam time is used for research ü There are many open questions to be answered Ø More than 50% of the beam time can be used for research Ø This center can be unique research center in the world ü Attract researchers from Europe and rest of the world Ø Discussions with CERN Ø New design of the accelerator Ø Training of experts in accelerator physics ü The Bio. LEIR program can be moved to this center ü More 1000 scientist all over the world will perform investigations at the centre L. Litov SEEIIST meeting Trieste 25. 01. 2018

Some additional arguments for HT Ø Sustainable running of the centre ü First requirement is to prove that the centre will run and be used in the most efficient way Ø In case we build HT centre with four beam lines ü Two of them – patients treatment ü Two – research program Nominal treatment capacity of the Centre Number of rooms Exploitation level till break-even point 2 Days of operation/year 250 Treatment hours/day 14 Time for fraction 20 min Room utilization 95 % Average number of fractions/patient Room availability 95 % Number of patients/year Maximal number of fractions/year L. Litov Capacity reached 70% 18 600 700 14 214 SEEIIST meeting Trieste 25. 01. 2018

What is the real cost of the project Ø The center will be build in 6 years YEAR 1 2 3 4 5 6 7 Engineering design Building & Construction Accelerator installation Commissioning Tests Certification Patient treatment Ø Will start to work in 7 th year Ø Needs 3 more years to reach full capacity – 9 years L. Litov SEEIIST meeting Trieste 25. 01. 2018

What is the real cost of the project Ø The real cost strongly depends from the investment model Ø Three different schemes were simulated ü 100% grant from EU or other sources ü 80% grant and 20 % by the member states ü 25% MS capital and 75% obtained by means of different financial instruments of EU (bank loans, Juncker plan etc. ) Ø Other parameters ü Two treatment rooms ü Two experimental beams ü Flexible prices (25000, 35000, 50000) ü Center running cost § Constant part - ~ 7 -8 million § Patient dependent part - ~ 5 milion L. Litov SEEIIST meeting Trieste 25. 01. 2018

What is the real cost of the project Ø Equipment price – 165 millions ü Includes – infrastructure, building, accelerator, treatment rooms, diagnostic medical center, research center, education and training of the personal, contingency fund Ø Additional spending to run the center in the first years, loans etc. Ø Total price ü depends from the funding scheme ü between 200 – 225 mln euro Ø Important – sustainable running of the institute ü Four rooms – two patient treatment – will cover significant part of the running cost L. Litov SEEIIST meeting Trieste 25. 01. 2018

What is the real cost of the project Scenario 1 Scenario 2 Scenario 3 205, 182 224 226 16 34. 4 56. 5 MF of Members 5, 000 Cost per treatment 20, 738 22 000 34600 Budget Equity of Members Ø At full capacity the center can generate income enough to cover the running cost Ø To invest about 3 -5 million for research Ø Additional 5 million member states contribution Ø Total research budget 8 – 10 million Ø Sustainable functioning of the center L. Litov SEEIIST meeting Trieste 25. 01. 2018

Conclusions Ø There are many very strong political scientific and economic arguments to establish SEEIIST Ø Many benefits, majority common for all member states Ø Write political moment to start the project Ø There is a number of strong arguments in favour of HT option Ø Unique research infrastructure at European and world level Ø Possible significant participation of CERN Ø Sustainable running of the Institute Ø Cost estimates Ø Strongly depend on investment scheme Ø Real cost at the level of 205 – 230 million euro Ø Bulgaria will work for the realization of both options L. Litov SEEIIST meeting Trieste 25. 01. 2018