Destination Spotlight

Rinecker Proton Therapy Center - A New Chance to Fight Cancer

Destination Spotlight

Currently more than one in three people will develop cancer during their lifetime; currently 430,000 people develop cancer every year in Germany. About half of the malignancies are treated with radiotherapy, but still 50% of the irradiated patients die.

Now the Rinecker Proton Therapy Center in Munich, Germany offers a new chance to cure cancer. Modern proton therapy promises (after demanding structural, technical and financial investments) to be superior to the techniques of photon (x-ray) therapy.

Worldwide the number of proton therapy facilities is increasing rapidly, but so far non-experimental proton therapy centers in clinical operation have only been established in the US, China and Japan.

History of Proton Therapy

Historically, Robert A. Wilson proposed proton therapy in 1946 as an effective treatment to fight cancer. The first clinical trial treatments for patients started in the mid-1950s. Scientific investigations have been the foundation for the first clinical proton therapy facility installed in 1990 in Loma Linda. The spectrum of indications grew quickly, technical and clinical procedures were optimized, standardized and implemented into daily routine.

The General Massachusetts Hospital of Harvard University in Boston as well as other facilities in the US, such as in Bloomington, Houston and Jacksonville then in Japan followed suit with research institutes such as the PSI, Paul Scherer Institute in Switzerland and the Hahn Meitner Institute in Berlin. They have all gathered valuable results and studies. So far about 60,000 patients have been treated with Proton therapy, mostly since the late 90’s.

Advantages of Proton Therapy

This innovative therapeutic procedure involves the use of high-energy proton beams to treat cancer; it is able to generate a remarkable improvement in the healing process. The special characteristic of proton beams is that protons allow three-dimensional targeting of the tumor in contrast to the X-rays used in conventional radiation therapy.

This permits highly effective doses to be delivered to the tumor while reducing the side effects of radiation by minimizing trauma to the surrounding healthy tissue and there is NO “exit dose” beyond the tumor. Proton therapy has the possibility to save healthy tissue and especially sensitive and essential organs surrounding the target volume from damage.

Furthermore, technical innovations such as spot scanning and intensity modulations optimise the dose conformality of protons, leading to higher therapeutic efficiency at the RPTC. With conventional radiation the risk of a secondary tumor can be very high. With proton therapy this risk can be minimized, especially with the treatment of children – proton therapy is highly recommended.

The Rinecker Proton Therapy

The Rinecker Proton Therapy Center (RPTC) in Munich is the first fully certified proton radiation centre in Europe, offering a complete hospital setting with 5 treatment rooms that can accommodate up to 4,000 patients per year. This facility is equipped with the most modern and precise accelerator available worldwide.

For treatment planning RPTC uses a spot scanning system, which proves to be superior in comparison to conventional proton scattering techniques. Each of the 4 gantries weighing 150 tons can be rotated 360° within 1 minute and delivers the proton beam with accuracy better than 0.5 mm.

A fixed-beam therapy station delivers treatment in the areas of the eye and skull. Sophisticated MRI, CT and PET-CT systems offer precise diagnostics for 3D proton radiation therapy planning. The accelerator used for patient treatment at the RPTC is a superconducting cyclotron with output energy of 250 MeV corresponding to a beam penetration depth of 38 cm.

Technology for Proton Radiation at RPTC

Acceleration of Protons

There are large numbers of protons moving around in space, but on earth protons have to be obtained from hydrogen gas. Negatively charged electrons are removed from hydrogen atoms by applying an electric field. Positively charged protons remain. This procedure takes place on a minute scale. The quantity of hydrogen gas required to carry out a complete course of therapy is smaller than a champagne bubble.

In the particle accelerator – known as cyclotron – the protons are accelerated along a spiral-shaped path by applying a strong electromagnetic field, up to 60 % of light velocity. The fastest spiral pathway, at the edge of the cyclotron is deflected outwards by an electric field and therefore travels in a straight line out of the device. The beam is then guided through a vacuum tube – travelling up to 92 metres with magnetic lenses continually focussing the beam – into the gantry impacting the tumor at up to 180,000 km/sec.


The gantries are steel structures, each weighing 150 tons and measuring eleven metres in diameter. They carry strong magnets to provide a precise alignment of the proton beam. During gantry rotation the beam is consistently targeted at the same isocenter with an accuracy of better than 0.5 mm.

The nozzle is the device at the end of the vacuum beam line delivering the protons to the patient. The scanning system is located behind the nozzle. It essentially comprises the two final small pairs of bending magnets that deflect the beam in two dimensions, in one direction away from the gantry axis and in the other in parallel to the gantry axis. This provides precise targeting in two of the three dimensions.

The third dimension is scanned by adjusting the beam energy to change the penetration depth. This procedure allows treating the tumor from more than one direction during a single session. In addition the nozzle can be fitted with miniature templates to treat very small tumors for example in the brain.

The nozzle also contains beam detectors that control the radiation intensity, the beam energy and therefore the penetration depth as well as the deflection of the X and Y dimensions. Together with the precisely adjustable patient table the tumor can be irradiated with millimetre precision from any therapeutically necessary direction.

Patient Positioning and Immobilization

The patient table is made of carbon fiber and can be positioned freely in various directions and positions. An X-ray supported precision targeting system is automatically controlling and adjusting the patient into the correct position.

Using high precision radiotherapy such as spot scanning it is necessary to immobilise the patient every day in a reproducible and safe position. The patient is fixed into an individually fitted molded mattress. To identify shifts of the target volume fiducial markers are used routinely for several movable tumors.

For liver and lung tumors and other targets moving with respiration a controlled short anaesthesia will be effective during planning, positioning and irradiation procedures.

For treatments of brain, eye and head & neck tumors patients are treated with the fixed beam array and positioned with a bite block, similar to what is used in dentistry.

Which Cancers Can Be Treated?

In general every tumor that can be treated with today’s conventional x-ray radiation therapy can be advantageously treated with proton therapy. The RPTC tumorboard will consult about the patient’s eligibility after having reviewed patient records and medical reports.

General Information

So far RPTC received requests from 50 different countries. Since the start in March 2009 patients from Germany, Austria, Switzerland and Russia are in treatment and more international patients from Great Britain and the Netherlands are in line.

Patients are usually treated as outpatients, allowing them to continue their normal activities with minimized side effect from the treatment. The radiation itself usually only lasts about 1 minute and the treatment room is used for no longer than 20 minutes for each session.

The number of the radiation sessions varies depending on the patient’s individual diagnosis. The usual number of treatment sessions in most cases is 14 to 20 with treatments from Monday through Saturday.

In cooperation with the Dr. Rinecker Surgical Hospital and the Dr. Müller Hospital for Internal Medicine, combined treatments such as surgery and chemotherapy, as well as plastic and reconstructive surgery is available. If necessary, patients can also be hospitalized at the Dr. Rinecker Surgical Hospital.

The nearby Gästehaus AM RPTC offers comfortable accommodation for patients and their relatives in a very charming and elegant ambiance. The location of RPTC and the boarding house is close to downtown Munich, next to one of Munich’s most beautiful and largest recreation areas at the riverside of the Isar.

For international patients the Pro Health Complete Care Service Ltd. provides additional premium care on behalf of the RPTC with any service required such as translation of patient documents, interpreter service, travel arrangements, entry visa, airport transfer, hotel accommodations, limousine service, car rental, personal trainer, child care, etc. as well as ongoing assistance during the whole period of the treatment. Complete Care Service is available in several languages.

Munich is the third largest city in Germany with a total population of 1.3 million inhabitants and an exceptional and highly professional medical infrastructure. Munich International Airport services 34.5 million passengers, rated under Europe’s top ten and is a hub for international travel.

Munich is known for its unique charming atmosphere, the world famous Oktoberfest, their beer gardens in the summer, cultural events and the lovely countryside with mountains, lakes and the castles of King Ludwig close by.

Hans Rinecker

Dr. Hans Rinecker is Chairman of the Board of Pro Health AG and the operating company of Rinecker Proton Therapy Center.

Ursula Friedsam

Ursula Friedsam is Managing Director at PRO Health Complete Care Service LTD., an exclusive service company offering exclusive premium care support to patients and their family on behalf of the Surgical Hospital Dr. Rinecker and the Rinecker Proton Therapy Center.

Learn about how you can become a Certified Medical Tourism Professional→