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IN LONDONProton therapy enters the fight against cancer

Report
10 min
09/05/2019

london

In 2020, a centre for cancer treatment with high-energy proton beam therapy will open in the UK capital. Bouygues UK, with consortium partner Bouygues Travaux Publics, is designing and building this facility, which is as exceptional as it is complex.
By Isabelle Godar

A STATE-OF-THE-ART FACILITY

It is five o’clock on a September afternoon, and the streets of Fitzrovia are bustling. School children in uniforms, blue-col- lar and white-collar workers,and stunningly dressed young women pass one another on the pavements of this central London neighbourhood. Behind a small red brick building housing a pub, the first floors of the future proton therapy centre of University College London Hospitals (UCLH) are under construction. The centre is scheduled to open in July 2020, and when it does, it will be one of only two such facilities in the UK offering this advanced technology for the treatment of cancer (see inter- view, page 79). A few streets from the present UCLH complex, Bouygues UK and Bouygues Travaux Publics, working together in an integrated consortium, are constructing a new building. It will have 107 hospital beds on its upper floors, eight operat- ing theatres, and a centre for proton therapy treatment on the basement levels. The demolition, excavation, and construction of the foundations began in 2015 and lasted 18 months. During the project as a whole, almost 400 workers were on the job at the busiest periods.

EXTRAORDINARY EXCAVATION

Last June and July, the cyclotron (the particle accelerator that produces the proton beam) along with the equipment for one of the four treatment rooms was delivered to the worksite. The cyclotron arrived at the end of a 640-kilometre journey from Germany, where it was manufactured. Amazing from the standpoint of its weight (70 tonnes) in relation to its size (that of an automobile), it was lowered into its concrete enclosure by a 750-tonne mobile crane. Owing to the building’s location in the city centre, the related space constraints, and characteristics of the proton therapy technology, the treatment centre has been placed in the basement1. This is the deepest excavation ever done in London”, says project director Charles Pérès.

Almost 80,000 cu. metres of materials have been extracted in digging a huge hole the size of 650 London buses!

1. The expertise of Bouygues Travaux Publics in civil engineering was crucial to the very deep excavation work for the underground portion of the project.

Steve Meecham, civil engineering works manager
How does a cyclotron work?
The cyclotron is a particle accelerator that produces a beam of protons (the nucleus of a hydrogen atom is a proton). Cooled to a temperature of –269°C by liquid helium, it accelerates protons of ionized hydrogen gas to velocities as high as 73% of the speed of light. Guided by magnets along a beam to the treatment room, the protons are targeted with extreme precision on the patient’s tumour and thus do not damage healthy tissue.

The dense urban environment and the close proximity of the surrounding buildings have not made the task any easier for the workers from Bouygues Travaux Publics. “We have dug the foundation down to a depth of 28 metres, through the water table, and within just 10 metres of a London tube line. To get to that depth, we had to construct a diaphragm wall shored up by four levels of struts2”, adds Steve Meecham, civil engineering works manager. As a consequence, and to meet requirements related to radiation absorption, walls and slabs up to 2.50 metres thick were built around the cyclotron. “The quantity of concrete per surface area is huge, with 80% of the volume located in the lower levels of the building. It’s as though we were constructing a mini nuclear power plant.”

2. Wooden or metal elements used in the shoring of excavation pits and as temporary supports.

Gérald Farque
Operations Director
at Bouygues UK
In our consortium, Bouygues UK’s experience in hospital construction, with six references in England, is combined with the expertise of Bouygues Travaux Publics in civil engineering and the construction of nuclear infrastructures.”

COORDINATION
FLAWLESS

Complete lines of piping awaiting installation lie along the corridors on the lower floors. Altogether, more than 8 kilometres of pipes and a large number of electrical conduits will be incorporated in the concrete structure to meet multiple needs, including the colossal cooling capacity required for the operation of the cyclotron and the treatment rooms. The delivery and installation of the last pieces of proton therapy equipment had to be organised so as to disrupt the other activities on the site as little as possible. Because of the number of operations going on simultaneously and the diversity of the work, a digital mock-up is being used to facilitate coordination among all the people involved. “We took an innovative approach from the start of the work by using a very advanced version of a digital mock-up, with 3D up to 6D modelling. The last will be for the maintenance of the structure”, explains Gérald Farque, operations director at Bouygues UK. “It’s going to be widely used in the industry in future years.” In this complex proj- ect, the Bouygues Construction teams’ commitment is total. Charles Pérès sums it up this way: “Working on a project whose purpose is to improve the chances of recovery of young patients is a privilege at the same time as a source of motivation shared by everyone.”

Two questions to...

Dr Yen-Ch’ing Chang, Radiotherapy Department, UCLH
How does proton beam therapy improve cancer treatment?
Proton beam therapy is an alternative type of radiotherapy that has the advantage of not affecting the healthy tissue around the tumour. This is particularly important when treating children and adolescents, who are continuing to grow. In difficult to treat tumours it can reduce the probability of a relapse, and it can reduce long-term side effects such as having less impact on fertility than conventional radiotherapy may have.
What are your expectations from this proton beam therapy centre?
Having a proton beam therapy centre available at the UCLH is going to change the lives of British families, who until now have had to travel to other European countries or America, which is very disruptive of their family life. We will be able to treat nearly 750 patients a year and many more young people and adults whose cancers are in virtually inaccessible areas or located near a vital organ, including tumours of the brain, in the pelvic region, or around the spinal cord.
©Jérémie Souteyrat
The extension of the University College London Hospitals will house a centre for treating cancer patients with proton beam therapy. It will also have eight operating theatres and 107 beds.
During the construction of the upper floors, a mobile crane installed the proton beam therapy equipment on the fourth basement level. A protective covering was spread over and removed from equipment as necessary.
The concrete structure that houses the cyclotron was built on the building’s fourth basement level because of the radiation it will emit.
During the project as a whole, almost 400 workers were on the job at the busiest periods.