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Vieceli M, Park J, Hsi WC, Saki M, Mendenhall NP, Johnson P, Artz M. Potential Therapeutic Improvements in Prostate Cancer Treatment Using Pencil Beam Scanning Proton Therapy with LET d Optimization and Disease-Specific RBE Models. Cancers (Basel) 2024; 16:780. [PMID: 38398171 PMCID: PMC10886728 DOI: 10.3390/cancers16040780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE To demonstrate the feasibility of improving prostate cancer patient outcomes with PBS proton LETd optimization. METHODS SFO, IPT-SIB, and LET-optimized plans were created for 12 patients, and generalized-tissue and disease-specific LET-dependent RBE models were applied. The mean LETd in several structures was determined and used to calculate mean RBEs. LETd- and dose-volume histograms (LVHs/DVHs) are shown. TODRs were defined based on clinical dose goals and compared between plans. The impact of robust perturbations on LETd, TODRs, and DVH spread was evaluated. RESULTS LETd optimization achieved statistically significant increased target volume LETd of ~4 keV/µm compared to SFO and IPT-SIB LETd of ~2 keV/µm while mitigating OAR LETd increases. A disease-specific RBE model predicted target volume RBEs > 1.5 for LET-optimized plans, up to 18% higher than for SFO plans. LET-optimized target LVHs/DVHs showed a large increase not present in OARs. All RBE models showed a statistically significant increase in TODRs from SFO to IPT-SIB to LET-optimized plans. RBE = 1.1 does not accurately represent TODRs when using LETd optimization. Robust evaluations demonstrated a trade-off between increased mean target LETd and decreased DVH spread. CONCLUSION The demonstration of improved TODRs provided via LETd optimization shows potential for improved patient outcomes.
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Affiliation(s)
- Michael Vieceli
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Medical Physics Graduate Program, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Jiyeon Park
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Wen Chien Hsi
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Mo Saki
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Nancy P Mendenhall
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Perry Johnson
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Mark Artz
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
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Asadi A, Akhavanallaf A, Hosseini SA, Vosoughi N, Zaidi H. Development and validation of an optimal GATE model for proton pencil-beam scanning delivery. Z Med Phys 2023; 33:591-600. [PMID: 36424313 PMCID: PMC10751712 DOI: 10.1016/j.zemedi.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To develop and validate a versatile Monte Carlo (MC)-based dose calculation engine to support MC-based dose verification of treatment planning systems (TPSs) and quality assurance (QA) workflows in proton therapy. METHODS The GATE MC toolkit was used to simulate a fixed horizontal active scan-based proton beam delivery (SIEMENS IONTRIS). Within the nozzle, two primary and secondary dose monitors have been designed to enable the comparison of the accuracy of dose estimation from MC simulations with respect to physical QA measurements. The developed beam model was validated against a series of commissioning measurements using pinpoint chambers and 2D array ionization chambers (IC) in terms of lateral profiles and depth dose distributions. Furthermore, beam delivery module and treatment planning has been validated against the literature deploying various clinical test cases of the AAPM TG-119 (c-shape phantom) and a prostate patient. RESULTS MC simulations showed excellent agreement with measurements in the lateral depth-dose parameters and spread-out Bragg peak (SOBP) characteristics within a maximum relative error of 0.95 mm in range, 1.83% in entrance to peak ratio, 0.27% in mean point-to-point dose difference, and 0.32% in peak location. The mean relative absolute difference between MC simulations and measurements in terms of absorbed dose in the SOBP region was 0.93% ± 0.88%. Clinical phantom studies showed a good agreement compared to research TPS (relative error for TG-119 planning target volume PTV-D95 ∼ 1.8%; and for prostate PTV-D95 ∼ -0.6%). CONCLUSION We successfully developed a MC model for the pencil beam scanning system, which appears reliable for dose verification of the TPS in combination with QA information, prior to patient treatment.
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Affiliation(s)
- Ali Asadi
- Department of Energy Engineering, Sharif University of Technology, Tehran, Iran
| | - Azadeh Akhavanallaf
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | | | - Naser Vosoughi
- Department of Energy Engineering, Sharif University of Technology, Tehran, Iran
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland; Geneva University Neurocenter, Geneva University, Geneva, Switzerland; Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark.
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Henderson RH, Bryant CM, Nichols RC, Mendenhall WM, Hoppe BS, Su Z, Morris CG, Mendenhall NP. Five- and seven-year outcomes for image-guided moderately accelerated hypofractionated proton therapy for prostate cancer. Acta Oncol 2022; 61:468-477. [PMID: 34965846 DOI: 10.1080/0284186x.2021.2016948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND To report 5- and 7-year outcomes after image-guided moderately accelerated hypofractionated proton therapy (AHPT) for prostate cancer. MATERIAL AND METHODS We reviewed the first 582 prostate cancer patients enrolled on prospective outcomes tracking trial and treated with double-scattered moderately AHPT between 2008 and 2015. 269 patients had low-risk (LR) and 313 had intermediate-risk (IR) disease, including 149 with favorable intermediate-risk (FIR) and 164 with unfavorable intermediate-risk (UIR) disease. LR patients received a median 70.0GyRBE (2.5GyRBE/fraction) and IR patients received a median of 72.5 GyRBE. Seventeen patients (UIR, n = 12) received androgen deprivation therapy (ADT) for a median of 6 months. Toxicities were graded per the CTCAE, v4.0, and patient-reported quality-of-life data were reviewed. RESULTS Median follow-up was 8.0 years (0.9-12.2). The 5- and 7-year rates of freedom from biochemical progression (FFBP) overall and in the LR and IR subsets, respectively, were 96.8/95.2%, 98.8/98.8%, and 95.0/91.9%. For the FIR and UIR subsets, they were 97.2/95.2% and 93.1/88.8%. Actuarial 5- and 7-year rates of late CTCAE, v4.0, grade 2 gastrointestinal (GI), grade 3 GI, and grade 3 genitourinary (GU) toxicities were 9.9%/11.2%, 1.4/1.4% and 1.3/2.1%, respectively. No grade ≥4 GI or GU toxicities occurred. The mean (standard deviation, SD) IPSS and EPIC Composite bowel function and bother scores were 7 (SD = 5), 97 (SD = 7), and 94 (SD = 6), respectively at baseline, 7 (SD = 5), 92 (SD = 13), and 92 (SD = 9) at the 5-year follow-up, and 7 (SD = 5), 93 (SD = 12), and 92 (SD = 10) at the 7-year follow-up. CONCLUSION Image-guided AHPT 5- and 7-year outcomes show high efficacy, minimal physician-assessed toxicity, and excellent patient-reported outcomes in this cohort.
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Affiliation(s)
- Randal H. Henderson
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Curtis M. Bryant
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - R. Charles Nichols
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - William M. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Bradford S. Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Zhong Su
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Nancy P. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
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Shao W, Xie Y, Wu J, Zhang L, Jan S, Lu HM. Investigating beam range uncertainty in proton prostate treatment using pelvic-like biological phantoms. Phys Med Biol 2021; 66. [PMID: 34433134 DOI: 10.1088/1361-6560/ac212c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/25/2021] [Indexed: 11/12/2022]
Abstract
This study aims to develop a method for verifying site-specific and/or beam path specific proton beam range, which could reduce range uncertainty margins and the associated treatment complications. It investigates the range uncertainties from both CT HU to relative stopping power conversion and patient positioning errors for prostate treatment using pelvic-like biological phantoms. Three 25 × 14 × 12 cm3phantoms, made of fresh animal tissues mimicking the pelvic anatomies of prostate patients, were scanned with a general electric CT simulator. A 22 cm circular passive scattering beam with 29 cm range and 8 cm modulation width was used to measure the water equivalent path lengths (WEPL) through the phantoms at multiple points using the dose extinction method with a MatriXXPT detector. The measured WEPLs were compared to those predicted by TOPAS simulations and ray-tracing WEPL calculations. For the three phantoms, the WEPL differences between measured and theoretical prediction (WDMT) are below 1.8% for TOPAS, and 2.5% for ray-tracing. WDMT varies with phantom anatomies by about 0.5% for both TOPAS and ray-tracing. WDMT also correlates with the tissue types of a specific treated region. For the regions where the proton beam path is parallel to sharp bone edges, the WDMTs of TOPAS and ray-tracing respectively reach up to 1.8% and 2.5%. For the region where proton beams pass through just soft tissues, the WDMT is mostly less than 1% for both TOPAS and ray-tracing. For prostate treatments, range uncertainty depends on the tissue types within a specific treated region, patient anatomies and the range calculation methods in the planning algorithms. Our study indicates range uncertainty is less than 2.5% for the whole treated region with both ray-tracing and TOPAS, which suggests the potential to reduce the current 3.5% range uncertainty margin used in the clinics by at least 1% even for single-energy CT data.
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Affiliation(s)
- Wencheng Shao
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China.,Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, United States of America.,Department of Radiation Physics, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Yunhe Xie
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, United States of America
| | - Jianan Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, People's Republic of China.,Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Liyan Zhang
- Department of Engineering Physics, Tsinghua University, Beijing, People's Republic of China
| | - Schuemann Jan
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, United States of America
| | - Hsiao-Ming Lu
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, United States of America.,Hefei Ion Medical Center and Ion Medical Research Institute, University of Science and Technology of China, Hefei, People's Republic of China
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Kharod SM, Mercado CE, Morris CG, Bryant CM, Mendenhall NP, Mendenhall WM, Nichols RC, Hoppe BS, Liang X, Su Z, Li Z, Henderson RH. Postoperative or Salvage Proton Radiotherapy for Prostate Cancer After Radical Prostatectomy. Int J Part Ther 2021; 7:52-64. [PMID: 33829073 PMCID: PMC8019576 DOI: 10.14338/ijpt-20-00021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 01/08/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Postprostatectomy radiation improves disease control, but limited data exist regarding outcomes, toxicities, and patient-reported quality of life with proton therapy. Method and Materials The first 102 patients who were enrolled on an outcome tracking protocol between 2006 and 2017 and treated with double-scattered proton therapy after prostatectomy were retrospectively reviewed. Eleven (11%) received adjuvant radiation, while 91 (89%) received salvage radiation. Seventy-four received double-scattered proton therapy to the prostate bed only. Twenty-eight received a double-scattered proton therapy prostate-bed boost after prostate-bed and pelvic-node treatment. Eleven adjuvant patients received a median dose of 66.6 GyRBE (range, 66.0-70.2). Ninety-one salvage patients received a median dose of 70.2 GyRBE (range, 66.0-78.0). Forty-five patients received androgen deprivation therapy for a median 9 months (range, 1-30). Toxicities were scored using Common Terminology Criteria for Adverse Events v4.0 criteria, and patient-reported quality-of-life data were reviewed. Results The median follow-up was 5.5 years (range, 0.8-11.4 years). Five-year biochemical relapse-free and distant metastases-free survival rates were 72% and 91% for adjuvant patients, 57% and 97% for salvage patients, and 57% and 97% overall. Acute and late grade 3 or higher genitourinary toxicity rates were 1% and 7%. No patients had grade 3 or higher gastrointestinal toxicity. Acute and late grade 2 gastrointestinal toxicities were 5% and 2%. The mean values and SDs of the International Prostate Symptom Score, International Index of Erectile Function, and Expanded Prostate Cancer Index Composite bowel function and bother were 7.5 (SD = 5.9), 10.2 (SD = 8.3), 92.8 (SD = 11.1), and 91.2 (SD = 6.4), respectively, at baseline, and 12.1 (SD = 9.1), 10.1 (SD = 6.7), 87.3 (SD = 18), and 86.7 (SD = 13.8) at the 5-year follow-up. Conclusion High-dose postprostatectomy proton therapy provides effective long-term biochemical control and freedom from metastasis, with low acute and long-term gastrointestinal and genitourinary toxicity.
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Affiliation(s)
- Shivam M Kharod
- Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA
| | | | - Christopher G Morris
- Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA
| | - Curtis M Bryant
- Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA
| | - Nancy P Mendenhall
- Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA
| | - R Charles Nichols
- Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Xiaoying Liang
- Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA
| | - Zhong Su
- Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA
| | - Zuofeng Li
- Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA
| | - Randal H Henderson
- Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA
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Santos PMG, Barsky AR, Hwang WT, Deville C, Wang X, Both S, Bekelman JE, Christodouleas JP, Vapiwala N. Comparative toxicity outcomes of proton-beam therapy versus intensity-modulated radiotherapy for prostate cancer in the postoperative setting. Cancer 2019; 125:4278-4293. [PMID: 31503338 DOI: 10.1002/cncr.32457] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite increasing utilization of proton-beam therapy (PBT) in the postprostatectomy setting, no data exist regarding toxicity outcomes relative to intensity-modulated radiotherapy (IMRT). The authors compared acute and late genitourinary (GU) and gastrointestinal (GI) toxicity outcomes in patients with prostate cancer (PC) who received treatment with postprostatectomy IMRT versus PBT. METHODS With institutional review board approval, patients with PC who received adjuvant or salvage IMRT or PBT (70.2 gray with an endorectal balloon) after prostatectomy from 2009 through 2017 were reviewed. Factors including combined IMRT and PBT and/or concurrent malignancies prompted exclusion. A case-matched cohort analysis was performed using nearest-neighbor 3-to-1 matching by age and GU/GI disorder history. Logistic and Cox regressions were used to identify univariate and multivariate associations between toxicities and cohort/dosimetric characteristics. Toxicity-free survival (TFS) was assessed using the Kaplan-Meier method. RESULTS Three hundred seven men (mean ± SD age, 59.7 ± 6.3 years; IMRT, n = 237; PBT, n = 70) were identified, generating 70 matched pairs. The median follow-up was 48.6 and 46.1 months for the IMRT and PBT groups, respectively. Although PBT was superior at reducing low-range (volumes receiving 10% to 40% of the dose, respectively) bladder and rectal doses (all P ≤ .01), treatment modality was not associated with differences in clinician-reported acute or late GU/GI toxicities (all P ≥ .05). Five-year grade ≥2 GU and grade ≥1 GI TFS was 61.1% and 73.7% for IMRT, respectively, and 70.7% and 75.3% for PBT, respectively; and 5-year grade ≥3 GU and GI TFS was >95% for both groups (all P ≥ .05). CONCLUSIONS Postprostatectomy PBT minimized low-range bladder and rectal doses relative to IMRT; however, treatment modality was not associated with clinician-reported GU/GI toxicities. Future prospective investigation and ongoing follow-up will determine whether dosimetric differences between IMRT and PBT confer clinically meaningful differences in long-term outcomes.
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Affiliation(s)
- Patricia Mae G Santos
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew R Barsky
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xingmei Wang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stefan Both
- Department of Medical Physics, University Medical Center Groningen, Groningen, Netherlands
| | - Justin E Bekelman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Christodouleas
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neha Vapiwala
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Mangan S, Leech M. Proton therapy- the modality of choice for future radiation therapy management of Prostate Cancer? Tech Innov Patient Support Radiat Oncol 2019; 11:1-13. [PMID: 32095544 PMCID: PMC7033803 DOI: 10.1016/j.tipsro.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 08/09/2019] [Accepted: 08/30/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Proton Therapy (PR) is an emerging treatment for prostate cancer (Pca) patients. However, limited and conflicting data exists regarding its ability to result in fewer bladder and rectal toxicities compared to Photon Therapy (PT), as well as its cost efficiency and plan robustness. MATERIALS AND METHODS An electronic literature search was performed to acquire eligible studies published between 2007 and 2018. Studies comparing bladder and rectal dosimetry or Gastrointestinal (GI) and Genitourinary (GU) toxicities between PR and PT, the plan robustness of PR relative to motion and its cost efficiency for Pca patients were assessed. RESULTS 28 studies were eligible for inclusion in this review. PR resulted in improved bladder and rectal dosimetry but did not manifest as improved GI/GU toxicities clinically compared to PT. PR plans were considered robust when specific corrections, techniques, positioning or immobilisation devices were applied. PR is not cost effective for intermediate risk Pca patients; however PR may be cost effective for younger or high risk Pca patients. CONCLUSION PR offers improved bladder and rectal dosimetry compared to PT but this does not specifically translate to improved GI/GU toxicities clinically. The robustness of PR plans is acceptable under specific conditions. PR is not cost effective for all Pca patients.
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Key Words
- 3DC-PR, 3D Conformal- Proton Therapy
- BT, Brachytherapy
- CT, Computed Tomography
- CTCAE, Common Terminology Criteria Adverse Effects
- EPIC, Expanded Prostate Cancer Index Composite
- GI, Gastrointestinal
- GU, Genitourinary
- HT, Helical Tomography
- IGRT, Image Guidance Radiation Therapy
- IMPR, Intensity Modulated Proton Therapy
- IMRT, Intensity Modulated Radiation Therapy
- IPSS, International Prostate Symptom Scale
- ITV, Internal Target Volume
- LR, Low Risk
- MFO-IMPR, Multi Field Optimisation-Intensity Modulated Proton Therapy
- PBS, Pencil Beam Scanning
- PR, Proton Therapy
- PT, Photon Therapy
- Photon therapy
- Prostate cancer
- Proton therapy
- QALY, Quality-Adjusted Life Year
- RA, Rapid Arc
- RBE, Radiobiological Effectiveness
- RTOG, Radiation Therapy Oncology Group
- SBRT, Stereotactic Body Radiation
- SFUD, Single Field Uniform-Dose
- SW, Sliding Window
- US, Uniform Scanning
- USPT, Uniform Scanning Proton Therapy
- VMAT, Volumetric Modulated Arc Therapy
- int/HR, intermediate/High risk
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Affiliation(s)
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Dublin 2, Ireland
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Slater JM, Slater JD, Kang JI, Namihas IC, Jabola BR, Brown K, Grove R, Watt C, Bush DA. Hypofractionated Proton Therapy in Early Prostate Cancer: Results of a Phase I/II Trial at Loma Linda University. Int J Part Ther 2019; 6:1-9. [PMID: 31773043 DOI: 10.14338/ijpt-19-00057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/26/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose To determine whether a hypofractionated proton therapy regimen will control early-stage disease and maintain low rates of side effects similar to results obtained using standard-fraction proton therapy at our institution. Materials and Methods A cohort of 146 patients with low-risk prostate cancer according to National Comprehensive Cancer Network guidelines (Gleason score <7, prostate-specific antigen [PSA] <10, tumor stage of T1-T2a) received 60 Gy (cobalt Gy equivalent) of proton therapy (20 fractions of 3.0 Gy per fraction) in 4 weeks, a dose biologically equivalent to standard fractionation (44-45 fractions of 1.8 Gy to a total of 79.2 to 81 Gy in 0 weeks). Patients were evaluated at least weekly during treatment, at which time documentation of treatment tolerance and acute reactions was obtained. Follow-up visits were conducted every 3 months for the first 1 years, every 6 months for the next 3 years, then annually. Follow-up visits consisted of history and physical examination, PSA measurements, and evaluation of toxicity. Results The median follow-up time was 42 months (range, 3-96 months). Acute grade 2 urinary toxicity occurred in 16% (20/120) of the patients; acute grade 2 or higher gastrointestinal toxicity was seen in 1.7% (2/120). At 9 months, 1 patient had late grade 3 urinary toxicity, which resolved by 12 months; no grade 3 gastrointestinal toxicities occurred. The 3-year biochemical survival rate was 99.3% (144/145). The median time to PSA nadir was 30 months. Conclusion Hypofractionated proton therapy of 60 Gy in 20 fractions was safe and effective for patients with low-risk prostate cancer.
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Affiliation(s)
- Jason M Slater
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Jerry D Slater
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Joseph I Kang
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Ivan C Namihas
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA
| | - B Rodney Jabola
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Kelcie Brown
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Roger Grove
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Cherie Watt
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA
| | - David A Bush
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA
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Ma W, Poon DM, Chan C, Chan T, Cheung F, Ho L, Lee EK, Leung AK, Leung SY, So H, Tam P, Kwong PW. Consensus statements on the management of clinically localized prostate cancer from the Hong Kong Urological Association and the Hong Kong Society of Uro-Oncology. BJU Int 2019; 124:221-241. [PMID: 30653801 PMCID: PMC6850389 DOI: 10.1111/bju.14681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To formulate consensus statements to facilitate physician management strategies for patients with clinically localized prostate cancer (PCa) in Hong Kong by jointly convening a panel of 12 experts from the two local professional organizations representing PCa specialists, who had previously established consensus statements on the management of metastatic PCa for the locality. METHODS Through a series of meetings, the panellists discussed their clinical experience and the published evidence regarding various areas of the management of localized PCa, then drafted consensus statements. At the final meeting, each drafted statement was voted on by every panellist based on its practicability of recommendation in the locality. RESULTS A total of 76 consensus statements were ultimately accepted and established by panel voting. CONCLUSION Derived from the recent evidence and major overseas guidelines, along with local clinical experience and practicability, the consensus statements were aimed to serve as a practical reference for physicians in Hong Kong for the management of localized PCa.
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Affiliation(s)
- Wai‐Kit Ma
- Department of SurgeryQueen Mary HospitalUniversity of Hong KongHong KongHong Kong
| | - Darren Ming‐Chun Poon
- State Key Laboratory in Oncology in South ChinaDepartment of Clinical OncologySir YK Pao Centre for CancerHong Kong Cancer Institute and Prince of Wales HospitalChinese University of Hong KongHong KongHong Kong
| | - Chi‐Kwok Chan
- Division of UrologyDepartment of SurgeryPrince of Wales HospitalChinese University of Hong KongHong KongHong Kong
| | - Tim‐Wai Chan
- Department of Clinical OncologyQueen Elizabeth HospitalHong KongHong Kong
| | | | | | - Eric Ka‐Chai Lee
- Department of Clinical OncologyTuen Mun HospitalHong KongHong Kong
| | | | | | - Hing‐Shing So
- Division of UrologyDepartment of SurgeryUnited Christian HospitalHong KongHong Kong
| | - Po‐Chor Tam
- Department of SurgeryQueen Mary HospitalThe University of Hong KongHong KongHong Kong
| | - Philip Wai‐Kay Kwong
- Department of Clinical OncologyQueen Mary HospitalUniversity of Hong KongHong Kong
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Sánchez‐Parcerisa D, López‐Aguirre M, Dolcet Llerena A, Udías JM. MultiRBE: Treatment planning for protons with selective radiobiological effectiveness. Med Phys 2019; 46:4276-4284. [DOI: 10.1002/mp.13718] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/19/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Daniel Sánchez‐Parcerisa
- Grupo de Física Nuclear & IPARCOS, Departamento de Estructura de la Materia, Física Térmica y Electrónica CEI Moncloa Universidad Complutense de Madrid 28040Madrid Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) Madrid Spain
| | - Miguel López‐Aguirre
- Grupo de Física Nuclear & IPARCOS, Departamento de Estructura de la Materia, Física Térmica y Electrónica CEI Moncloa Universidad Complutense de Madrid 28040Madrid Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) Madrid Spain
| | | | - José Manuel Udías
- Grupo de Física Nuclear & IPARCOS, Departamento de Estructura de la Materia, Física Térmica y Electrónica CEI Moncloa Universidad Complutense de Madrid 28040Madrid Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) Madrid Spain
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Arjomandy B, Taylor P, Ainsley C, Safai S, Sahoo N, Pankuch M, Farr JB, Yong Park S, Klein E, Flanz J, Yorke ED, Followill D, Kase Y. AAPM task group 224: Comprehensive proton therapy machine quality assurance. Med Phys 2019; 46:e678-e705. [DOI: 10.1002/mp.13622] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Bijan Arjomandy
- Karmanos Cancer Institute at McLaren‐Flint McLaren Proton Therapy Center Flint MI USA
| | - Paige Taylor
- Imaging and Radiation Oncology Core (IROC) Houston University of Texas MD Anderson Cancer Center Houston TX USA
| | | | - Sairos Safai
- Center for Proton Therapy Paul Scherrer Institute Villigen Switzerland
| | - Narayan Sahoo
- University of Texas, MD Anderson Cancer Center Houston TX USA
| | - Mark Pankuch
- Northwestern Medicine Chicago Proton Center Warrenville IL USA
| | - Jonathan B. Farr
- Applications of Detectors and Accelerators to Medicine 1217Meyrin Switzerland
| | | | - Eric Klein
- Rhode Island Hospital, The Warren Alpert Medical School of Brown University Providence RI USA
| | - Jacob Flanz
- Massachusetts General Hospital, Burr Proton Therapy Center Boston MA
- Harvard Medical School Cambridge MA USA
| | | | - David Followill
- Imaging and Radiation Oncology Core (IROC) Houston University of Texas MD Anderson Cancer Center Houston TX USA
| | - Yuki Kase
- Proton Therapy Division Shizuoka Cancer Center Shizuoka Japan
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12
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Marteinsdottir M, Paganetti H. Applying a variable relative biological effectiveness (RBE) might affect the analysis of clinical trials comparing photon and proton therapy for prostate cancer. ACTA ACUST UNITED AC 2019; 64:115027. [DOI: 10.1088/1361-6560/ab2144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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13
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Polamraju P, Bagley AF, Williamson T, Zhu XR, Frank SJ. Hydrogel Spacer Reduces Rectal Dose during Proton Therapy for Prostate Cancer: A Dosimetric Analysis. Int J Part Ther 2019; 5:23-31. [PMID: 31773038 DOI: 10.14338/ijpt-18-00041.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/18/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose Proton therapy for prostate cancer may reduce bowel dose and risk of bowel symptoms relative to photon-based methods. Here, we determined the effect of using a biodegradable, injectable hydrogel spacer on rectal dose on plans for treating prostate cancer with intensity-modulated proton therapy (IMPT) or passive scattering proton therapy (PSPT). Materials and Methods Pairs of IMPT and PSPT plans for 9 patients were created from fused computed tomography/magnetic resonance imaging scans obtained before and after spacer injection. Calculated values of rectal V40, V60, V70, V80, and maximum dose (Dmax) were compared with Wilcoxon signed rank tests. Displacements at the base (BP), midgland (MP), and apex (AP) of the prostate relative to the anterior rectal wall with the spacer in place were averaged for each patient and correlated with V70 by using linear regression models. Results The presence of a spacer reduced all dosimetric parameters for both PSPT and IMPT, with the greatest difference in V70, which was 81.1% lower for PSPT-with-spacer than for IMPT-without-spacer. Median displacements at BP, MP, and AP were 12 mm (range 7-19), 2 mm (range 0-4), and 1 mm (range 0-5) without the spacer and 19 mm (range 12-23), 10 mm (range 8-16), and 7 mm (range 2-12) with the spacer. Modest linear trends were noted between rectal V70 and displacement for IMPT-with-spacer and PSPT-with-spacer. When displacement was ≥8 mm, V70 was ≤5.1% for IMPT-with-spacer and PSPT-with-spacer. Conclusion Use of biodegradable hydrogel spacers for prostate cancer treatment provides a significant reduction of radiation dose to the rectum with proton therapy. Significant reductions in rectal dose occurred in both PSPT and IMPT plans, with the greatest reduction for IMPT-with-spacer relative to PSPT alone. Prospective studies are ongoing to assess the clinical impact of reducing rectal dose with hydrogel spacers.
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Affiliation(s)
- Praveen Polamraju
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX, USA
| | - Alexander F Bagley
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tyler Williamson
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - X Ronald Zhu
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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14
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Proton versus photon-based radiation therapy for prostate cancer: emerging evidence and considerations in the era of value-based cancer care. Prostate Cancer Prostatic Dis 2019; 22:509-521. [PMID: 30967625 DOI: 10.1038/s41391-019-0140-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/30/2019] [Accepted: 02/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Advances in radiation technology have transformed treatment options for patients with localized prostate cancer. The evolution of three-dimensional conformal radiation therapy and intensity-modulated radiation therapy (IMRT) have allowed physicians to spare surrounding normal organs and reduce adverse effects. The introduction of proton beam technology and its physical advantage of depositing its energy in tissue at the end-of-range maximum may potentially spare critical organs such as the bladder and rectum in prostate cancer patients. Data thus far are limited to large, observational studies that have not yet demonstrated a definite benefit of protons over conventional treatment with IMRT. The cost of proton beam treatment adds to the controversy within the field. METHODS We performed an extensive literature review for all proton treatment-related prostate cancer studies. We discuss the history of proton beam technology, as well as its role in the treatment of prostate cancer, associated controversies, novel technology trends, a discussion of cost-effectiveness, and an overview of the ongoing modern large prospective studies that aim to resolve the debate between protons and photons for prostate cancer. RESULTS Present data have demonstrated that proton beam therapy is safe and effective compared with the standard treatment options for prostate cancer. While dosimetric studies suggest lower whole-body radiation dose and a theoretically higher relative biological effectiveness in prostate cancer compared with photons, no studies have demonstrated a clear benefit with protons. CONCLUSIONS Evolving trends in proton treatment delivery and proton center business models are helping to reduce costs. Introduction of existing technology into proton delivery allows further control of organ motion and addressing organs-at-risk. Finally, the much-awaited contemporary studies comparing photon with proton-based treatments, with primary endpoints of patient-reported quality-of-life, will help us understand the differences between proton and photon-based treatments for prostate cancer in the modern era.
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Patient-Reported Sexual Survivorship Following High-Dose Image-Guided Proton Therapy for Prostate Cancer. Radiother Oncol 2019; 134:204-210. [PMID: 31005217 DOI: 10.1016/j.radonc.2019.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To help guide individualized treatment, we sought to identify baseline predictive factors that impact long-term erectile function following high-dose image-guided radiotherapy (HD-IGRT). METHODS Potent men with localized prostate cancer treated with radiotherapy alone were enrolled in an institutional review board-approved prospective cohort study. Men received HD-IGRT as primary treatment of prostate cancer. Patient-reported inventories were used to assess erectile function at baseline, 6 months, 2 years, and 5 years after treatment. Long-term potency rates were compared to validated models, and baseline factors were used to create a novel, internally validated nomogram for predicting long-term function. RESULTS 1,159 men were treated with HD-IGRT. Among 676 men who were potent at baseline and did not receive hormone therapy, the potency rates at 6 months, 2 years, and 5 years were 81%, 68%, and 61%. Recursive partitioning categorized patients into 3 groups based on two factors: baseline response to EPIC Q57 (ability to have an erection) and pre-existing heart disease. At 5 years, the most favorable group reported "very good" on Q57 and had an 80% potency rate (n = 137; p = 0.83); the intermediate group reported "good" on Q57 and had no baseline cardiac disease with a 62% potency rate (n = 145; p = 0.86); and the remaining poor risk group had a 37% potency rate (n = 117; p = 0.19). CONCLUSIONS Patient-reported pretreatment sexual function and comorbidities enables stratification and prediction of erectile function. EPIC subset questions with baseline comorbidities may potentially serve as a quick and practical clinical tool for predicting sexual survivorship.
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Hoshina RM, Matsuura T, Umegaki K, Shimizu S. A Literature Review of Proton Beam Therapy for Prostate Cancer in Japan. J Clin Med 2019; 8:jcm8010048. [PMID: 30621278 PMCID: PMC6352078 DOI: 10.3390/jcm8010048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/23/2018] [Accepted: 12/28/2018] [Indexed: 12/14/2022] Open
Abstract
Aim: Patients of proton beam therapy (PBT) for prostate cancer had been continuously growing in number due to its promising characteristics of high dose distribution in the tumor target and a sharp distal fall-off. Considering the large number of proton beam facilities in Japan, the further increase of patients undergoing this treatment is due to the emendations by Japanese National Health Insurance (NHI) and the development of medical equipment and technology, it is necessary to know what kind of research and advancements has been done on proton therapy for prostate cancer in the country. For these reasons, this literature review was conducted. The aim of this review is to identify and discuss research studies of proton beam therapy for prostate cancer in Japan. These include observational, interventional, and secondary data analysis of published articles. Method: A literature review on published works related to proton beam therapy for prostate cancer in Japan was conducted using articles that were gathered in the PubMed database of June 2018. We went through abstracts and manuscripts written in English with the keywords ‘proton beam therapy’, ‘prostate cancer’, and ‘Japan’. Results: A total of 23 articles were included. Fourteen articles were observational studies, most of which focused on the adverse effects of Proton Beam Therapy (PBT). Seven articles were interventional studies related on treatment planning, equipment parts, as well as target positioning. Two were secondary data analysis. The included studies were published in 13 different journals by different institutions using various equipment. Conclusion: Despite the favorable results of proton beam therapy, future research should include more patients and longer follow-up schedules to clarify the definitive role of PBT, yet, up to recent retrospective studies, included in this paper, concluded that PBT can be a suitable treatment option for localized prostate cancer. In addition, interventional studies were conducted by several institutions to further embellish proton therapy.
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Affiliation(s)
- Rika Maglente Hoshina
- Faculty of Medicine and Surgery, University of Santo Tomas, España, Manila 1002, Philippines.
| | - Taeko Matsuura
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo 060-8648, Japan.
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo 060-8638, Japan.
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, Sapporo 060-8628, Japan.
| | - Kikuo Umegaki
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo 060-8648, Japan.
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo 060-8638, Japan.
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, Sapporo 060-8628, Japan.
| | - Shinichi Shimizu
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo 060-8648, Japan.
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo 060-8638, Japan.
- Department of Radiation Oncology, Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan.
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17
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Proton therapy for prostate cancer: A review of the rationale, evidence, and current state. Urol Oncol 2018; 37:628-636. [PMID: 30527342 DOI: 10.1016/j.urolonc.2018.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 12/17/2022]
Abstract
Men diagnosed with localized prostate cancer have many curative treatment options including several different radiotherapeutic approaches. Proton radiation is one such radiation treatment modality and, due to its unique physical properties, offers the appealing potential of reduced side effects without sacrificing cancer control. In this review, we examine the intriguing dosimetric rationale and theoretical benefit of proton radiation for prostate cancer and highlight the results of preclinical modeling studies. We then discuss the current state of the clinical evidence for proton efficacy and toxicity, derived from both large claim-based datasets and prospective patient-reported data. The result is that the data are mixed, and clinical equipoise persists in this area. We place these studies into context by summarizing the economics of proton therapy and the changing practice patterns of prostate proton irradiation. Finally, we await the results of a large prospective randomized clinical trial currently accruing and also a large prospective pragmatic comparative study which will provide more rigorous evidence regarding the clinical and comparative effectiveness of proton therapy for prostate cancer.
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18
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Letter to the editor in response to Hopper et al, “Salvage image guided radiation therapy to the prostate after cryotherapy failure”. Adv Radiat Oncol 2018; 3:469. [PMID: 30197945 PMCID: PMC6127876 DOI: 10.1016/j.adro.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/02/2018] [Accepted: 02/03/2018] [Indexed: 11/23/2022] Open
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Relative Biological Effectiveness Uncertainties and Implications for Beam Arrangements and Dose Constraints in Proton Therapy. Semin Radiat Oncol 2018; 28:256-263. [DOI: 10.1016/j.semradonc.2018.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Ho CK, Bryant CM, Mendenhall NP, Henderson RH, Mendenhall WM, Nichols RC, Morris CG, Kanmaniraja D, Hamlin DJ, Li Z, Hoppe BS. Long-term outcomes following proton therapy for prostate cancer in young men with a focus on sexual health. Acta Oncol 2018; 57:582-588. [PMID: 29359988 DOI: 10.1080/0284186x.2018.1427886] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND We investigated long-term outcomes for men ≤60 years old treated with proton therapy (PT). METHODS Of 254 men ≤60 years old were treated with proton therapy alone for prostate cancer. Risk stratification included 56% with low-, 42% with intermediate- and 2% with high-risk disease. Patients received 76-82 Gy at 2 Gy/fraction or 70-72.5 Gy at 2.5 Gy/fraction. Before treatment and every 6-12 months for 5 years, patients were evaluated by a physician, answered health-related quality of life surveys, including the EPIC, IIEF and IPSS, and had PSA evaluated. RESULTS Median follow-up for the cohort was 7.1 years; 7-year biochemical-free survival was 97.8%. Eight men (one high-risk; five intermediate-risk and two low-risk) experienced biochemical progression, including one who died of disease 9 years after treatment. Potency (erections firm enough for sexual intercourse) was 90% at baseline and declined to 72% at the first-year follow-up, but declined to only 67% at 5 years. Only 2% of patients developed urinary incontinence requiring pads. The bowel habits mean score declined from a baseline of 96 to 88 at 1 year, which improved over the following years to 93 at 5 years. CONCLUSIONS Young men with prostate cancer continue to have excellent results with respect to 7-year biochemical control and 5-year erectile function, without clinically significant urinary incontinence 5 years after proton therapy. Comparative effectiveness studies of proton therapy with surgery and IMRT are needed.
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Affiliation(s)
- Clement K. Ho
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Curtis M. Bryant
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Nancy P. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Randal H. Henderson
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - William M. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Romaine C. Nichols
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Dvaraju Kanmaniraja
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Derek J. Hamlin
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Zuofeng Li
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Bradford S. Hoppe
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
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Podder TK, Fredman ET, Ellis RJ. Advances in Radiotherapy for Prostate Cancer Treatment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1096:31-47. [PMID: 30324346 DOI: 10.1007/978-3-319-99286-0_2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Major categories of radiotherapy (RT) for prostate cancer (CaP) treatment are: (1) external beam RT (EBRT), and (2) brachytherapy (BT). EBRT are performed using different techniques like three-dimensional conformal RT (3D-CRT), intensity modulated RT (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic body radiation therapy (SBRT), stereotactic radiosurgery (SRS) and intensity modulated proton therapy (IMPT), etc., using a variety of radiation delivery machines, such as a linear accelerator (Linac), Cyberknife robotic system, Gamma knife, Tomotherapy and proton beam machine. The primary advantage of proton beam therapy is sparing of normal tissues and organ at risks (OARs) with comparable coverage of the tumor volume. MR-Linac is the latest addition in the image-guided RT. Robot-assisted brachytherapy is one of the latest technological innovations in the field. With the advancement of technology, radiation therapy for prostate cancer can be improved using high quality multimodal imaging, robot-assistance for brachytherapy as well as EBRT. This chapter presents the advances in radiation therapy for the treatment of prostate cancer.
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Affiliation(s)
- Tarun K Podder
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Elisha T Fredman
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Rodney J Ellis
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Nakajima K, Iwata H, Ogino H, Hattori Y, Hashimoto S, Nakanishi M, Toshito T, Umemoto Y, Iwatsuki S, Shibamoto Y, Mizoe JE. Acute toxicity of image-guided hypofractionated proton therapy for localized prostate cancer. Int J Clin Oncol 2017; 23:353-360. [PMID: 29098520 DOI: 10.1007/s10147-017-1209-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/26/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypofractionated proton therapy (HFPT) is expected to become an effective treatment approach for localized prostate cancer (PCa). The purpose of this study was to evaluate differences in acute toxicity among patients with localized PCa treated with either conventional fractionated proton therapy (CFPT) or HFPT. METHODS A total of 526 eligible patients treated with proton therapy between February 2013 and May 2016 in three phase II trials were analyzed. We prescribed 74 gray relative biological effectiveness equivalents [Gy (RBE)]/37 fractions for low-risk patients and 78 Gy (RBE)/39 fractions for intermediate- and high-risk patients in the CFPT group (n = 254) and 60 Gy (RBE)/20 fractions for low-risk and 63 Gy (RBE)/21 fractions for intermediate- and high-risk patients in the HFPT group (n = 272). Patients were evaluated for acute toxicity with the Common Terminology Criteria for Adverse Events, version 4.0, and urinary quality-of-life change using the International Prostate Symptom Score (IPSS). RESULTS No grade ≥3 acute toxicity was observed in either group. Among acute genitourinary toxicities, grade 2 rates were 15% (n = 38) in CFPT and 5.9% (n = 16) in HFPT (P ≤ 0.001). The median baseline IPSSs of the CFPT and HFPT groups were 7 (0-29) and 6 (0-31), respectively (P = 0.70). One-month post-treatment scores were 9 (0-32) and 11 (0-32), respectively (P = 0.036), and 6-month post-treatment scores were 7 (0-30) and 7 (0-33), respectively (P = 0.88). There were no significant differences in acute gastrointestinal toxicity between the two groups. CONCLUSION Our results demonstrated the safety of HFPT for localized PCa patients in terms of acute toxicity.
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Affiliation(s)
- Koichiro Nakajima
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan.
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Yukiko Hattori
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Shingo Hashimoto
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Mikiko Nakanishi
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Toshiyuki Toshito
- Proton Therapy Physics, Nagoya Proton Therapy Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Yukihiro Umemoto
- Department of Nephro-Urology, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Shoichiro Iwatsuki
- Department of Nephro-Urology, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Jun-Etsu Mizoe
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
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Pedersen J, Petersen JBB, Stokkevåg CH, Ytre-Hauge KS, Flampouri S, Li Z, Mendenhall N, Muren LP. Biological dose and complication probabilities for the rectum and bladder based on linear energy transfer distributions in spot scanning proton therapy of prostate cancer. Acta Oncol 2017; 56:1413-1419. [PMID: 29037095 DOI: 10.1080/0284186x.2017.1373198] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The increased linear energy transfer (LET) at the end of the Bragg peak causes concern for an elevated and spatially varying relative biological effectiveness (RBE) of proton therapy (PT), often in or close to dose-limiting normal tissues. In this study, we investigated dose-averaged LET (LETd) distributions for spot scanning PT of prostate cancer patients using different beam angle configurations. In addition, we derived RBE-weighted (RBEw) dose distributions and related normal tissue complication probabilities (NTCPs) for the rectum and bladder. MATERIAL AND METHODS A total of 21 spot scanning proton plans were created for each of six patients using a prescription dose of 78 Gy(RBE1.1), with each plan using two 'mirrored' beams with gantry angles from 110°/250° to 70°/290°, in steps of 2°. Physical dose and LETd distributions were calculated as well as RBEw dose distributions using either RBE = 1.1 or three different variable RBE models. The resulting biological dose distributions were used as input to NTCP models for the rectum and bladder. RESULTS For anterior oblique (AO) configurations, the rectum LETd volume and RBEw dose increased with increasing angles off the lateral opposing axis, with the RBEw rectum dose being higher than for all posterior oblique (PO) configurations. For PO configurations, the corresponding trend was seen for the bladder. Using variable RBE models, the rectum NTCPs were highest for the AO configurations with up to 3% for the 80°/280° configuration while the bladder NTCPs were highest for the PO configurations with up to 32% for the 100°/260°. The rectum D1cm3 constraint was fulfilled for most patients/configurations when using uniform RBE but not for any patient/configuration with variable RBE models. CONCLUSIONS Compared to using constant RBE, the variable RBE models predicted increased biological doses to the rectum, bladder and prostate, which in turn lead to substantially higher estimated rectum and bladder NTCPs.
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Affiliation(s)
- Jesper Pedersen
- Department of Medical Physics, Aarhus University Hospital/Aarhus University, Aarhus, Denmark
| | - Jørgen B. B. Petersen
- Department of Medical Physics, Aarhus University Hospital/Aarhus University, Aarhus, Denmark
| | - Camilla H. Stokkevåg
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | | | - Stella Flampouri
- University of Florida Proton Therapy Institute, Gainesville, FL, USA
| | - Zuofeng Li
- University of Florida Proton Therapy Institute, Gainesville, FL, USA
| | - Nancy Mendenhall
- University of Florida Proton Therapy Institute, Gainesville, FL, USA
| | - Ludvig P. Muren
- Department of Medical Physics, Aarhus University Hospital/Aarhus University, Aarhus, Denmark
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Does Race Influence Health-related Quality of Life and Toxicity Following Proton Therapy for Prostate Cancer? Am J Clin Oncol 2017; 39:261-5. [PMID: 24710124 PMCID: PMC4876577 DOI: 10.1097/coc.0000000000000050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective: This matched-paired analysis explores disparities in health-related quality of life (QOL) and common toxicities between African American (AA) and white patients following proton therapy for prostate cancer at our institution. Materials and Methods: A total of 1536 men with clinically localized prostate cancer were treated from 2006 to 2009 with definitive proton therapy to a median dose of 78 Gy +/− androgen deprivation therapy. A cohort of 92 consecutively treated AA men was matched to a cohort of 92 white men on the basis of National Comprehensive Cancer Network risk category and age. The 2 groups were compared with regard to comorbidities, demographics, and treatment regimen. Differences in genitourinary and gastrointestinal (GI) toxicity according to the Common Terminology Criteria for Adverse Events scale and QOL data from the Expanded Prostate Index Composite 26-question questionnaire were reported. Results: Median follow-up was 2.1 years. Baseline patient and treatment characteristics were similar between the 2 groups with the exception of prostate-specific antigen ≥10 (32% for AAs vs. 20% for whites; P=0.068) and use of androgen deprivation therapy (26% for AAs vs. 21% for whites; P=0.38). No difference in Expanded Prostate Index Composite 26-question sexual summary, urinary incontinence, urinary obstruction, or bowel summary scores was detected between the 2 groups, nor was there a difference in grade 2 or higher GI toxicity (P=0.45). AAs had a statistically nonsignificant higher absolute incidence of late grade 3 genitourinary toxicity (4.4% vs. 0%; P=0.12). Conclusions: After 2 years, there were no disparities in health-related QOL, physician-reported Common Terminology Criteria for Adverse Events GI toxicity, or biochemical relapse. Longer follow-up is needed to confirm these findings.
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Henderson RH, Bryant C, Hoppe BS, Nichols RC, Mendenhall WM, Flampouri S, Su Z, Li Z, Morris CG, Mendenhall NP. Five-year outcomes from a prospective trial of image-guided accelerated hypofractionated proton therapy for prostate cancer. Acta Oncol 2017; 56:963-970. [PMID: 28514929 DOI: 10.1080/0284186x.2017.1287946] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To report 5-year outcomes of a prospective trial of image-guided accelerated hypofractionated proton therapy (AHPT) for prostate cancer. PATIENTS AND METHODS 215 prostate cancer patients accrued to a prospective institutional review board-approved trial of 70Gy(RBE) in 28 fractions for low-risk disease (n = 120) and 72.5Gy(RBE) in 29 fractions for intermediate-risk disease (n = 95). This trial excluded patients with prostate volumes of ≥60 cm3 or International Prostate Symptom Scores (IPSS) of ≥15, patients on anticoagulants or alpha-blockers, and patients in whom dose-constraint goals for organs at risk (OAR) could not be met. Toxicities were graded prospectively according to Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. This trial can be found on ClinicalTrials.gov (NCT00693238). RESULTS Median follow-up was 5.2 years. Five-year rates of freedom from biochemical and clinical disease progression were 95.9%, 98.3%, and 92.7% in the overall group and the low- and intermediate-risk subsets, respectively. Actuarial 5-year rates of late radiation-related CTCAE v3.0 grade 3 or higher gastrointestinal and urologic toxicities were 0.5% and 1.7%, respectively. Median IPSS before treatment and at 4+ years after treatment were 6 and 5 for low-risk patients and 4 and 6 for intermediate-risk patients. CONCLUSIONS Image-guided AHPT 5-year outcomes show high efficacy and minimal physician-assessed toxicity in selected patients. These results are comparable to the 5-year results of our prospective trials of standard fractionated proton therapy for patients with low-risk and intermediate-risk prostate cancer. Longer follow-up and a larger cohort are necessary to confirm these findings.
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Affiliation(s)
- Randal H. Henderson
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - Curtis Bryant
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - Bradford S. Hoppe
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - R. Charles Nichols
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | | | - Stella Flampouri
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - Zhong Su
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - Zuofeng Li
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | | | - Nancy P. Mendenhall
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
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Bryant C, Hoppe BS, Henderson RH, Nichols RC, Mendenhall WM, Smith TL, Morris CG, Williams CR, Su Z, Li Z, Mendenhall NP. Race Does Not Affect Tumor Control, Adverse Effects, or Quality of Life after Proton Therapy. Int J Part Ther 2017; 3:461-472. [PMID: 31772996 DOI: 10.14338/ijpt-17-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/23/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose To compare 5-year biochemical control, toxicity, and patient-reported quality of life (QOL) outcomes for African American and White patients treated with proton therapy (PT) for prostate cancer. Materials and Methods We reviewed the medical records of 1,066 men with clinically localized prostate cancer. Patients were treated with definitive PT between 2006 and 2010. Patients received a median radiation dose of 78 Gy (RBE) with conventional fractionation (1.8- 2 Gy [RBE] per fraction). Sixty-eight (6.4%) men self-identified as African American and 998 (93.6%) self-identified as White. Five-year rates of biochemical control, grade 3 genitourinary and gastrointestinal toxicity, and patient-reported QOL are reported and compared between African American and White patients. Results Median biochemical follow-up was 5.0 years for both African American and White patients. Median follow-up for toxicity was 5.0 and 5.2 years, respectively. On multivariate analysis, race was not a significant predictor for 5-year freedom from biochemical failure (HR 0.8, p=0.55). No significant association was found between race and grade 3 genitourinary toxicity on multivariate analysis at 5 years (HR 2.5, p=0.10). Patient-reported QOL using median EPIC bowel, urinary incontinence, and irritative summaries scores were not significantly different between the groups. African Americans had higher median sexual summary scores at 2 years than White patients (75 vs. 54, p=0.01) but by 5+ years, the sexual summary scores were no longer significantly different (63 vs. 53, p=0.35). Conclusion With a median follow-up of 5 years, there were no racial disparities in biochemical control, grade 3 toxicity, or patient-reported QOL after PT for prostate cancer.
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Affiliation(s)
- Curtis Bryant
- 1Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Bradford S Hoppe
- 1Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Randal H Henderson
- 1Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Romaine C Nichols
- 1Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - William M Mendenhall
- 1Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Tamara L Smith
- 1Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Christopher G Morris
- 1Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Christopher R Williams
- 1Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Zhong Su
- 1Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Zuofeng Li
- 1Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA.,2Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Nancy P Mendenhall
- 1Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA.,2Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
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Ahmed KA, Demetriou SK, McDonald M, Johnstone PA. Clinical Benefits of Proton Beam Therapy for Tumors of the Skull Base. Cancer Control 2017; 23:213-9. [PMID: 27556661 DOI: 10.1177/107327481602300304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The unique radiobiological properties of protons have been understood for many years. In addition, many of the clinical benefits of radiotherapy were first noted in tumors involving the skull base. More public attention has been given to proton beam therapy due to the increasing number of centers now in operation or in the planning stages for offering this treatment option. METHODS We reviewed the physical properties of protons and the clinical studies performed to justify their use in the management of skull-base tumors and determine the benefits of proton beam therapy. RESULTS Published reports suggest a benefit to proton beam therapy for use in tumors of the skull base, including craniopharyngiomas, chordomas, skull-base sarcomas, and unresectable meningiomas. CONCLUSIONS Use of proton beam therapy may be beneficial in select patients. Surgical and medical oncologists should have a general understanding of such cases to facilitate their appropriate referral.
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Affiliation(s)
- Kamran A Ahmed
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Hoppe BS, Harris S, Rhoton-Vlasak A, Bryant C, Morris CG, Dagan R, Nichols RC, Mendenhall WM, Henderson RH, Li Z, Mendenhall NP. Sperm preservation and neutron contamination following proton therapy for prostate cancer study. Acta Oncol 2017; 56:17-20. [PMID: 27420031 DOI: 10.1080/0284186x.2016.1205219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The present study investigates the impact of scatter dose radiation to the testis on ejaculate and sperm counts from treatment of prostate cancer with passive-scatter proton therapy. MATERIAL AND METHODS From March 2010 to November 2014, 20 men with low- or intermediate-risk prostate cancer enrolled in an IRB-approved protocol and provided a semen sample prior to passive-scatter proton therapy and 6-12 months following treatment. Men were excluded if they had high-risk prostate cancer, received androgen deprivation therapy, were on alpha blockers (due to retrograde ejaculation) prior to treatment, had baseline sperm count <1 million, or were unable to produce a pre-treatment sample or could not provide a follow-up specimen. Sperm counts of 0 were considered azoospermia and <15 million/ml were classified as oligospermia. RESULTS Four patients were unable to provide a sufficient quantity of semen for analysis. Among the 16 remaining patients, only one was found to have oligospermia (7 million/ml). There was a statistically significant reduction in semen volume (median, 0.5 ml) and increase in pH (median 0.5). Although not statistically significant, there appeared to be a decline in sperm concentration (median, 16 million/ml), total sperm count (median, 98.5 million), normal morphology (median, 9%), and rapid progressive motility (median, 9.5%). DISCUSSION Men did not have azoospermia 6-12 months following passive-scatter proton therapy indicating minimal scatter radiation to the testis during treatment. Changes in semen quantity and consistency may occur due to prostate irradiation, which could impact future fertility and/or sexual activity.
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Affiliation(s)
- Bradford S. Hoppe
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Stephanie Harris
- The Department of Surgery, Division of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Alice Rhoton-Vlasak
- The Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Curtis Bryant
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christopher G. Morris
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Roi Dagan
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Romaine C. Nichols
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - William M. Mendenhall
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Randal H. Henderson
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Zuofeng Li
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Nancy P. Mendenhall
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
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Kurz C, Kamp F, Park YK, Zöllner C, Rit S, Hansen D, Podesta M, Sharp GC, Li M, Reiner M, Hofmaier J, Neppl S, Thieke C, Nijhuis R, Ganswindt U, Belka C, Winey BA, Parodi K, Landry G. Investigating deformable image registration and scatter correction for CBCT-based dose calculation in adaptive IMPT. Med Phys 2016; 43:5635. [DOI: 10.1118/1.4962933] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Yamoah K, Johnstone PA. Proton beam therapy: clinical utility and current status in prostate cancer. Onco Targets Ther 2016; 9:5721-5727. [PMID: 27695349 PMCID: PMC5033502 DOI: 10.2147/ott.s100518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Proton beam therapy has recently become available to a broader population base. There remains much controversy about its routine use in prostate cancer. We provide an analysis of the existing literature regarding efficacy and toxicity of the technique. Currently, the use of proton beam therapy for prostate cancer is largely dependent on continued reimbursement for the practice. While there are potential benefits supporting the use of protons in prostate cancer, the low risk of toxicity using existing techniques and the high cost of protons contribute to lower the value of the technique.
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Affiliation(s)
- Kosj Yamoah
- Radiation Oncology Department, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Peter As Johnstone
- Radiation Oncology Department, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Chan TY, Tan PW, Tang JI. Proton therapy for early stage prostate cancer: is there a case? Onco Targets Ther 2016; 9:5577-86. [PMID: 27672328 PMCID: PMC5024773 DOI: 10.2147/ott.s108559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Proton-beam therapy (PBT) for prostate cancer has been in used for several decades, with its technique evolving significantly over this period. A growing number of centers now routinely utilize pencil-beam scanning as an advanced technique of PBT. Interest and controversy concerning its use have recently come under scrutiny. While the past decade has produced an assemblage of evidence suggesting that PBT is safe and effective for early stage prostate cancer, it is still unknown whether the theoretical dosimetric advantages of PBT translate into meaningful clinical improvements over routine intensity-modulated radiation therapy, which is commonly used for these patients. Outcomes from early trials using whole courses of PBT have shown mixed results when compared with routine intensity-modulated radiation therapy. Therefore, randomized trials comparing these two techniques should be undertaken, as this would help in defining the role of PBT for this patient group. This article aims to describe the basics of PBT, review the reasons for the growing interest in PBT, review the evidence for PBT, review the controversy surrounding PBT, and inquire about PBT's future in the treatment of prostate cancer, with attention to its physical properties, comparative clinical and cost-effectiveness, and advances in its delivery.
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Affiliation(s)
- Tabitha Y Chan
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Poh Wee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Johann I Tang
- Department of Radiation Oncology, National University Cancer Institute, Singapore
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Bryant C, Smith TL, Henderson RH, Hoppe BS, Mendenhall WM, Nichols RC, Morris CG, Williams CR, Su Z, Li Z, Lee D, Mendenhall NP. Five-Year Biochemical Results, Toxicity, and Patient-Reported Quality of Life After Delivery of Dose-Escalated Image Guided Proton Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2016; 95:422-434. [DOI: 10.1016/j.ijrobp.2016.02.038] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
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Holtzman AL, Hoppe BS, Letter HP, Bryant C, Nichols RC, Henderson RH, Mendenhall WM, Morris CG, Williams CR, Li Z, Mendenhall NP. Proton Therapy as Salvage Treatment for Local Relapse of Prostate Cancer Following Cryosurgery or High-Intensity Focused Ultrasound. Int J Radiat Oncol Biol Phys 2016; 95:465-471. [DOI: 10.1016/j.ijrobp.2015.12.351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/11/2015] [Accepted: 12/12/2015] [Indexed: 11/16/2022]
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Underwood T, Giantsoudi D, Moteabbed M, Zietman A, Efstathiou J, Paganetti H, Lu HM. Can We Advance Proton Therapy for Prostate? Considering Alternative Beam Angles and Relative Biological Effectiveness Variations When Comparing Against Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 95:454-464. [DOI: 10.1016/j.ijrobp.2016.01.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/06/2016] [Accepted: 01/12/2016] [Indexed: 12/27/2022]
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Lee DT, Mendenhall NP, Smith TL, Morris CG, Nichols RC, Bryant C, Henderson RH, Mendenhall WM, Costa J, Williams CR, Li Z, Hoppe BS. Patient-Reported Quality of Life in Men with Transurethral Resection of the Prostate Undergoing Proton Therapy for Management of Prostate Cancer. Int J Part Ther 2016; 2:518-524. [PMID: 30079368 DOI: 10.14338/ijpt-15-00034.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose We report on quality of life (QOL) and early toxicity among men with prostate cancer who underwent transurethral resection of the prostate (TURP) before proton therapy. Materials and Methods Between 2006 and 2010, 1,289 patients were treated definitively with proton therapy for prostate cancer at our institution and enrolled on a prospective outcomes-tracking protocol. Ninety-six of the men had received a TURP before proton therapy, while 1,193 men had not. Baseline comorbidities, medications, expanded prostate index composite (EPIC) score, international prostate symptom score (IPSS), and CTCAE vs.3 toxicity assessment were collected prospectively. The Kaplan-Meier product limit method was used to estimate freedom from toxicity. Results Men who had TURP before proton therapy had lower baseline EPIC scores for urinary incontinence, bowel summary, and sexual summary compared with the non-TURP group, but no significant difference in urinary obstructive score was observed. After controlling for baseline scores, there was no significant difference in bowel summary or sexual summary scores between the two groups over time. There were, however, differences for urinary irritation/obstruction scores and urinary incontinence scores favoring those patients who did not have a TURP-like procedure. Toxicity assessment showed that the 2-year and 5-year rates of grade 3 genitourinary toxicity in the pretreatment TURP group were 12.3% and 17.2%, respectively. Conclusions Pretreatment TURP was associated with both a high incidence of physician-assessed toxicity and inferior patient-reported QOL scores both before and after proton therapy treatment. Studies investigating QOL and toxicity after specific prostate cancer therapies should stratify patients by pretreatment TURP. Longer follow-up is needed to confirm if these differences ever resolve.
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Affiliation(s)
- Derek T Lee
- University of Florida Proton Therapy Institute, Jacksonville, FL
| | | | - Tamara L Smith
- University of Florida Proton Therapy Institute, Jacksonville, FL
| | | | | | - Curtis Bryant
- University of Florida Proton Therapy Institute, Jacksonville, FL
| | | | | | - Joseph Costa
- University of Florida Proton Therapy Institute, Jacksonville, FL
| | | | - Zuofeng Li
- University of Florida Proton Therapy Institute, Jacksonville, FL
| | - Bradford S Hoppe
- University of Florida Proton Therapy Institute, Jacksonville, FL
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Habl G, Uhl M, Katayama S, Kessel KA, Hatiboglu G, Hadaschik B, Edler L, Tichy D, Ellerbrock M, Haberer T, Wolf MB, Schlemmer HP, Debus J, Herfarth K. Acute Toxicity and Quality of Life in Patients With Prostate Cancer Treated With Protons or Carbon Ions in a Prospective Randomized Phase II Study--The IPI Trial. Int J Radiat Oncol Biol Phys 2016; 95:435-443. [PMID: 27084659 DOI: 10.1016/j.ijrobp.2016.02.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to compare safety and feasibility of proton therapy with that of carbon ion therapy in hypofractionated raster-scanned irradiation of the prostate, in a prospective randomized phase 2 trial. METHODS AND MATERIALS In this trial, 92 patients with localized prostate cancer were enrolled. Patients were randomized to receive either proton therapy (arm A) or carbon ion therapy (arm B) and treated with a total dose of 66 Gy(relative biological effectiveness [RBE]) administered in 20 fractions (single dose of 3.3 Gy[RBE]). Patients were stratified by the use of antihormone therapy. Primary endpoint was the combined assessment of safety and feasibility. Secondary endpoints were specific toxicities, prostate-specific antigen progression-free survival (PFS), overall survival (OS), and quality of life (QoL). RESULTS Ninety-one patients completed therapy and have had a median follow-up of 22.3 months. Among acute genitourinary toxicities, grade 1 cystitis rates were 34.1% (39.1% in A; 28.9% in B) and 17.6% grade 2 (21.7% in A; 13.3% in B). Seven patients (8%) required urinary catheterization during treatment due to urinary retention, 5 of whom were in arm A. Regarding acute gastrointestinal toxicities, 2 patients treated with protons developed grade 3 rectal fistulas. Grade 1 radiation proctitis occurred in 12.1% (13.0% in A; 11.1% in B) and grade 2 in 5.5% (8.7% in A; 2.2% in B). No statistically significant differences in toxicity profiles between arms were found. Reduced QoL was evident mainly in fatigue, pain, and urinary symptoms during therapy and 6 weeks thereafter. All European Organization for Research and Treatment of Cancer QLQ-C30 and -PR25 scores improved during follow-up. CONCLUSIONS Hypofractionated irradiation using either carbon ions or protons results in comparable acute toxicities and QoL parameters. We found that hypofractionated particle irradiation is feasible and may be safe. Due to the occurrence of gel in the rectal wall and the consecutive occurrence of 2 rectal fistulas, we stopped using the insertion of spacer gel. Longer follow-up is necessary for evaluation of PFS and OS. (Ion Prostate Irradiation (IPI); NCT01641185; ClinicalTrials.gov.).
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Affiliation(s)
- Gregor Habl
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiation Oncology, Technische Universität München, Munich, Germany
| | - Matthias Uhl
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Sonja Katayama
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Kerstin A Kessel
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiation Oncology, Technische Universität München, Munich, Germany
| | - Gencay Hatiboglu
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lutz Edler
- Department of Biostatistics, German Cancer Research Center of Heidelberg, Heidelberg, Germany
| | - Diana Tichy
- Department of Biostatistics, German Cancer Research Center of Heidelberg, Heidelberg, Germany
| | - Malte Ellerbrock
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Thomas Haberer
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Maja B Wolf
- Department of Radiology, German Cancer Research Center of Heidelberg, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center of Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Klaus Herfarth
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
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Taylor PA, Kry SF, Alvarez P, Keith T, Lujano C, Hernandez N, Followill DS. Results From the Imaging and Radiation Oncology Core Houston's Anthropomorphic Phantoms Used for Proton Therapy Clinical Trial Credentialing. Int J Radiat Oncol Biol Phys 2016; 95:242-248. [PMID: 27084644 DOI: 10.1016/j.ijrobp.2016.01.061] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/25/2016] [Accepted: 01/29/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to summarize the findings of anthropomorphic proton phantom irradiations analyzed by the Imaging and Radiation Oncology Core Houston QA Center (IROC Houston). METHODS AND MATERIALS A total of 103 phantoms were irradiated by proton therapy centers participating in clinical trials. The anthropomorphic phantoms simulated heterogeneous anatomy of a head, liver, lung, prostate, and spine. Treatment plans included those for scattered, uniform scanning, and pencil beam scanning beam delivery modalities using 5 different treatment planning systems. For every phantom irradiation, point doses and planar doses were measured using thermoluminescent dosimeters (TLD) and film, respectively. Differences between measured and planned doses were studied as a function of phantom, beam delivery modality, motion, repeat attempt, treatment planning system, and date of irradiation. RESULTS The phantom pass rate (overall, 79%) was high for simple phantoms and lower for phantoms that introduced higher levels of difficulty, such as motion, multiple targets, or increased heterogeneity. All treatment planning systems overestimated dose to the target, compared to TLD measurements. Errors in range calculation resulted in several failed phantoms. There was no correlation between treatment planning system and pass rate. The pass rates for each individual phantom are not improving over time, but when individual institutions received feedback about failed phantom irradiations, pass rates did improve. CONCLUSIONS The proton phantom pass rates are not as high as desired and emphasize potential deficiencies in proton therapy planning and/or delivery. There are many areas for improvement with the proton phantom irradiations, such as treatment planning system dose agreement, range calculations, accounting for motion, and irradiation of multiple targets.
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Affiliation(s)
- Paige A Taylor
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Stephen F Kry
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paola Alvarez
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tyler Keith
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carrie Lujano
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nadia Hernandez
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David S Followill
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
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Schiller KC, Habl G, Combs SE. Protons, Photons, and the Prostate - Is There Emerging Evidence in the Ongoing Discussion on Particle Therapy for the Treatment of Prostate Cancer? Front Oncol 2016; 6:8. [PMID: 26858936 PMCID: PMC4729886 DOI: 10.3389/fonc.2016.00008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 01/11/2016] [Indexed: 12/19/2022] Open
Abstract
Proton therapy is actively and repeatedly discussed within the framework of particle therapy for the treatment of prostate cancer (PC). The argument in favor of treating the prostate with protons is partly financial: given that small volumes are treated, treatment times are low, resulting in a hypothetical high patient throughput. However, such considerations should not form the basis of medical decision-making. There are also physical and biological arguments which further support the use of particle therapy for PC. The only relevant randomized data currently available is the study by Zietman and colleagues, comparing a high to a low proton boost, resulting in a significant increase in PSA-free survival in the experimental (high dose) arm (1). With modern photon treatments and image-guided radiotherapy (IGRT), equally high doses can be applied with photons and, thus, a randomized trial comparing high-end photons to protons is warranted. For high-linear energy transfer (LET) particles, such as carbon ions, the increase in relative biological effectiveness could potentially convert into an improvement in outcome. Additionally, through the physical differences of protons and carbon ions, the steeper dose gradient with carbon ions and the lack of beam broadening in the carbon beam lead to a superior dose distribution supporting the idea of hypofractionation. Biological and clinical data are emerging, however, has practice-changing evidence already arrived?
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Affiliation(s)
- Kilian C Schiller
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM) , München , Germany
| | - Gregor Habl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM) , München , Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), München, Germany; Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Oberschleißheim, Germany; Deutsches Konsortium für Translationale Krebsforschung (dktk), Partner Site München, München, Germany
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Laine AM, Pompos A, Timmerman R, Jiang S, Story MD, Pistenmaa D, Choy H. The Role of Hypofractionated Radiation Therapy with Photons, Protons, and Heavy Ions for Treating Extracranial Lesions. Front Oncol 2016; 5:302. [PMID: 26793619 PMCID: PMC4707221 DOI: 10.3389/fonc.2015.00302] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/14/2015] [Indexed: 12/14/2022] Open
Abstract
Traditionally, the ability to deliver large doses of ionizing radiation to a tumor has been limited by radiation-induced toxicity to normal surrounding tissues. This was the initial impetus for the development of conventionally fractionated radiation therapy, where large volumes of healthy tissue received radiation and were allowed the time to repair the radiation damage. However, advances in radiation delivery techniques and image guidance have allowed for more ablative doses of radiation to be delivered in a very accurate, conformal, and safe manner with shortened fractionation schemes. Hypofractionated regimens with photons have already transformed how certain tumor types are treated with radiation therapy. Additionally, hypofractionation is able to deliver a complete course of ablative radiation therapy over a shorter period of time compared to conventional fractionation regimens making treatment more convenient to the patient and potentially more cost-effective. Recently, there has been an increased interest in proton therapy because of the potential further improvement in dose distributions achievable due to their unique physical characteristics. Furthermore, with heavier ions the dose conformality is increased and, in addition, there is potentially a higher biological effectiveness compared to protons and photons. Due to the properties mentioned above, charged particle therapy has already become an attractive modality to further investigate the role of hypofractionation in the treatment of various tumors. This review will discuss the rationale and evolution of hypofractionated radiation therapy, the reported clinical success with initially photon and then charged particle modalities, and further potential implementation into treatment regimens going forward.
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Affiliation(s)
- Aaron Michael Laine
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Arnold Pompos
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Steve Jiang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Michael D Story
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - David Pistenmaa
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Hak Choy
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
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Doyen J, Falk AT, Floquet V, Hérault J, Hannoun-Lévi JM. Proton beams in cancer treatments: Clinical outcomes and dosimetric comparisons with photon therapy. Cancer Treat Rev 2016; 43:104-12. [PMID: 26827698 DOI: 10.1016/j.ctrv.2015.12.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/24/2015] [Accepted: 12/29/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE To review current evidence of the role of proton therapy (PT) in other tumors than skull base, sinusal/parasinusal, spinal and pediatric tumors; to determine medico-economic aspects raised by PT. MATERIAL AND METHODS A systematic review on Medline was performed with the following keywords: proton therapy, proton beam, protontherapy, cancer; publications with comparison between PT and photon-therapy were also selected. RESULTS In silico studies have shown superiority (better dose delivery to the target and/or to organs at risk) of PT toward photon-therapy in most of thoracic and abdominal malignant tumors. Potential benefits of PT could be: reduction of toxicities (including radiation-induced cancer), increase of tumor control through a dose-escalation approach, hypofractionation. Cost of treatment is always cited as an issue which actually can be managed by a precise patient selection making PT a cost-effective procedure. Comparison plan with photon therapy may be useful to determine the dosimetric and clinical advantages of PT (Normal Tissue Complications Probability). CONCLUSION PT may be associated with a great advantage compared to the best photon-therapies in various types of cancers. Accumulation of clinical data is on-going and will challenge the in silico data analysis. Some indications are associated with strong superiority of PT and may be discussed as a new standard within prospective observational studies.
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Affiliation(s)
- Jérôme Doyen
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Alexander Tuan Falk
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Vincent Floquet
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Joël Hérault
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Jean-Michel Hannoun-Lévi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France.
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A Prospective Comparison of the Effects of Interfractional Variations on Proton Therapy and Intensity Modulated Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2015; 95:444-453. [PMID: 26907917 DOI: 10.1016/j.ijrobp.2015.12.366] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/24/2015] [Accepted: 12/21/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE To quantify and compare the impact of interfractional setup and anatomic variations on proton therapy (PT) and intensity modulated radiation therapy (IMRT) for prostate cancer. METHODS AND MATERIALS Twenty patients with low-risk or intermediate-risk prostate cancer randomized to receive passive-scattering PT (n=10) and IMRT (n=10) were selected. For both modalities, clinical treatment plans included 50.4 Gy(RBE) to prostate and proximal seminal vesicles, and prostate-only boost to 79.2 Gy(RBE) in 1.8 Gy(RBE) per fraction. Implanted fiducials were used for prostate localization and endorectal balloons were used for immobilization. Patients in PT and IMRT arms received weekly computed tomography (CT) and cone beam CT (CBCT) scans, respectively. The planned dose was recalculated on each weekly image, scaled, and mapped onto the planning CT using deformable registration. The resulting accumulated dose distribution over the entire treatment course was compared with the planned dose using dose-volume histogram (DVH) and γ analysis. RESULTS The target conformity index remained acceptable after accumulation. The largest decrease in the average prostate D98 was 2.2 and 0.7 Gy for PT and IMRT, respectively. On average, the mean dose to bladder increased by 3.26 ± 7.51 Gy and 1.97 ± 6.84 Gy for PT and IMRT, respectively. These values were 0.74 ± 2.37 and 0.56 ± 1.90 for rectum. Differences between changes in DVH indices were not statistically significant between modalities. All volume indices remained within the protocol tolerances after accumulation. The average pass rate for the γ analysis, assuming tolerances of 3 mm and 3%, for clinical target volume, bladder, rectum, and whole patient for PT/IMRT were 100/100, 92.6/99, 99.2/100, and 97.2/99.4, respectively. CONCLUSION The differences in target coverage and organs at risk dose deviations for PT and IMRT were not statistically significant under the guidelines of this protocol.
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Zeitlin R, McPhillips M, Harris S, Mandia S, Williams CR, Costa J, Morris CG, Su Z, Li Z, Mendenhall NP. Fiducial Markers, Saline, and Balloons to Locate and Stabilize the Prostate during Proton Therapy. Int J Part Ther 2015. [DOI: 10.14338/ijpt-15-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Cuaron JJ, Harris AA, Chon B, Tsai H, Larson G, Hartsell WF, Hug E, Cahlon O. Anterior-oriented proton beams for prostate cancer: A multi-institutional experience. Acta Oncol 2015; 54:868-74. [PMID: 25591937 DOI: 10.3109/0284186x.2014.986288] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Proton beam therapy (PBT) for prostate cancer generally involves the use of two lateral beams that transverse the hips. In patients with hip replacements or a previously irradiated hip, this arrangement is contraindicated. The use of non-lateral beams is possible, but not well described. Here we report a multi-institutional experience for patients treated with at least one non-lateral proton beam for prostate cancer. MATERIAL AND METHODS Between 2010 and 2014, 20 patients with organ-confined prostate cancer and a history of hip prosthesis underwent proton therapy utilizing at least one anterior oblique beam (defined as between 10° and 85° from vertical) at one of three proton centers. RESULTS The median follow-up was 6.4 months. No patients have developed PSA failure or distant metastases. The median planning target volume (PTV) D95 was 79.2 Gy (RBE) (range 69.7-79.9). The median rectal V70 was 9.2% (2.5-15.4). The median bladder V50, V80, and mean dose were 12.4% (3.7-27.1), 3.5 cm3 (0-7.1), and 14.9 Gy (RBE) (4.6-37.8), respectively. The median contralateral femur head V45 and max dose were 0.01 cm3 (0-16.6) and 43.7 Gy (RBE) (15.6-52.5), respectively. The incidence of acute Grade 2 urinary toxicity was 40%. There were no Grade≥3 urinary toxicities. There was one patient who developed late Grade 2 rectal proctitis, with no other cases of acute or late ≥Grade 2 gastrointestinal toxicity. Grade 2 erectile dysfunction occurred in two patients (11.1%). Mild hip pain was experienced by five patients (25%). There were no cases of hip fracture. CONCLUSION PBT for prostate cancer utilizing anterior oblique beam trajectories is feasible with favorable dosimetry and acceptable toxicity. Further follow-up is needed to assess for long-term outcomes and toxicities.
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Affiliation(s)
- John J Cuaron
- Memorial Sloan Kettering Cancer Center and Procure Proton Therapy Center , Somerset, NJ , USA
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Rectal Toxicity After Proton Therapy For Prostate Cancer: An Analysis of Outcomes of Prospective Studies Conducted at the University of Florida Proton Therapy Institute. Int J Radiat Oncol Biol Phys 2015; 91:172-81. [DOI: 10.1016/j.ijrobp.2014.08.353] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 01/06/2023]
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Bryant C, Hoppe BS, Mendenhall NP, Henderson RH, Nichols RC, Morris CG, Williams CR, Harris SE, Su Z, Li Z, Mendenhall WM. Testosterone Replacement Therapy in Men with Prostate Cancer after Proton Therapy. Int J Part Ther 2014. [DOI: 10.14338/ijpt-14-00004.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Fang P, Mick R, Deville C, Both S, Bekelman JE, Christodouleas JP, Guzzo TJ, Tochner Z, Hahn SM, Vapiwala N. A case-matched study of toxicity outcomes after proton therapy and intensity-modulated radiation therapy for prostate cancer. Cancer 2014; 121:1118-27. [PMID: 25423899 DOI: 10.1002/cncr.29148] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 10/14/2014] [Accepted: 10/17/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND The authors assessed whether proton beam therapy (PBT) for prostate cancer (PCa) was associated with differing toxicity compared with intensity-modulated radiation therapy (IMRT) using case-matched analysis. METHODS From 2010 to 2012, 394 patients who had localized PCa received 79.2 Gray (Gy) relative biologic effectiveness (RBE) delivered with either PBT (181 patients) or IMRT (213 patients). Patients were case-matched on risk group, age, and prior gastrointestinal (GI) and genitourinary (GU) disorders, resulting in 94 matched pairs. Both exact matching (risk group) and nearest-neighbor matching (age, prior GI/GU disorders) were used. Residual confounding was adjusted for by using multivariable regression. Maximum acute and late GI/GU Common Terminology Criteria for Adverse Events-graded toxicities were compared using univariate and multivariable logistic and Cox regression models, respectively. RESULTS Bladder and rectum dosimetry variables were significantly lower for PBT versus IMRT (P ≤ .01). The median follow-up was 47 months (range, 5-65 months) for patients who received IMRT and 29 months (range, 5-50 months) for those who received PBT. On multivariable analysis, which exploited case matching and included direct adjustment for confounders and independent predictors, there were no statistically significant differences between IMRT and PBT in the risk of grade ≥ 2 acute GI toxicity (odds ratio, 0.27; 95% confidence interval [CI], 0.06-1.24; P = .09), grade ≥ 2 acute GU toxicity (odds ratio, 0.69; 95% CI, 0.32-1.51; P = .36), grade ≥ 2 late GU toxicity (hazard ratio, 0.56; 95% CI, 0.22-1.41; P = .22), and grade ≥ 2 late GI toxicity (hazard ratio, 1.24; 95% CI, 0.53-2.94; P = .62). CONCLUSIONS In this matched comparison of prospectively collected toxicity data on patients with PCa who received treatment with contemporary IMRT and PBT techniques and similar dose-fractionation schedules, the risks of acute and late GI/GU toxicities did not differ significantly after adjustment for confounders and predictive factors.
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Affiliation(s)
- Penny Fang
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
The optimal management of radiation proctitis is ill defined. A variety of alternatives are available and include topical agents (ie, sucralfate enemas, formalin), oral agents (ie, pentoxyfylline, vitamin A), hyperbaric oxygen, and endoscopic interventions (ie, argon plasma coagulation). It is prudent to manage patients conservatively and to intervene only when necessary with the option least likely to exacerbate the proctitis. Rectal biopsies should be avoided as they may precipitate a complication. More aggressive measures, such as argon laser coagulation, should be employed only when more conservative approaches fail.
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Takamatsu S, Yamamoto K, Kawamura M, Sato Y, Asahi S, Kondou T, Tameshige Y, Maeda Y, Sasaki M, Kumano T, Gabata T. Utility of an initial adaptive bladder volume control with ultrasonography for proton-beam irradiation for prostate cancer. Jpn J Radiol 2014; 32:618-22. [PMID: 25129127 DOI: 10.1007/s11604-014-0347-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Our purpose was to evaluate the utility of time-fixed bladder volume control and adaptive bladder volume control with ultrasonography (US). MATERIALS AND METHODS Seventy-five patients with prostate cancer treated with proton-beam therapy were enrolled. Treatment plans were created using computed tomography (CT) images obtained 60 min after urination with usual water intake. Just before each irradiation, bladder volume was measured with US at the directed urine collection time. Bladder volume was calculated according to orthogonal diameters. A bladder volume of <50 ml was considered to reflect a collapsed bladder. The percentage of collapsed bladders was examined in total and from the first to fifth irradiations. RESULTS In total, 1,439 US confirmations (51 %) in 2,821 fractions were obtained and analyzed. A collapsed bladder was observed 152 of 1,439 times (11 %) in total, and the percentages of collapsed bladders from the first to fifth irradiations were 32 %, 18 %, 16 %, 12 %, and 7 %, respectively. CONCLUSION Time-fixed bladder control is associated with a risk of bladder volume insufficiency. Adaptive bladder volume control with initial US feedback could decrease the risk of bladder volume insufficiency.
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Affiliation(s)
- Shigeyuki Takamatsu
- Department of Radiotherapy, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan,
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Kil WJ, Mendenhall NP, Morris CG, Nichols RC, Henderson RH, Mendenhall WM, Bryant C, Williams C, Li Z, Hoppe BS. Patient-reported Hip Symptoms following Treatment with Proton Therapy for Prostate Cancer. Int J Part Ther 2014. [DOI: 10.14338/ijpt.13-00005.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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