Hypofractionated radiotherapy with carbon ion beams for prostate cancer

Tsuji, Hiroshi; Yanagi, Takeshi; Ishikawa, Hitoshi; Kamada, Tadashi; Mizoe, Jun‐etsu; Kanai, Tatsuaki; Morita, Shinroku; Tsujii, Hirohiko

doi:10.1016/j.ijrobp.2005.04.022

Cited by 127 publications

(105 citation statements)

References 15 publications

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“…In light of the favorable outcome with the adopted fractionation scheme and minimal rate of late morbidity, the use of higher dose per fraction is currently under consideration. 20 Indeed, carbon-ion data compare favorably with published results for equivalent doses with Xrays, and in fact, the RBE for carbon ions may exceed 3.0. 24 The effect of alterations in dose fractionation schedule for charged particles is difficult to estimate.…”

Section: Particle Therapy In Prostate Cancer C Grecosupporting

confidence: 51%

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Particle therapy in prostate cancer: a review

Greco

2007

Prostate Cancer Prostatic Dis

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While dose escalation is proving important to achieve satisfactory long-term outcomes in prostate cancer, the optimal radiation modality to deliver the treatment is still a topic of debate. Charged particle beams can offer improved dose distributions to the target volume as compared to conventional 3D-conformal radiotherapy, with better sparing of surrounding healthy tissues. Exquisite dose distributions, with the fulfillment of dose-volume constraints to normal tissues, however, can also be achieved with photon-based intensity-modulated techniques. This review summarizes the literature on the use of particle therapy in prostate cancer and attempts to put in perspective its relative merits compared to current photon-based radiotherapy.

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Section: Particle Therapy In Prostate Cancer C Grecosupporting

confidence: 51%

“…20 No grade X3 toxicities were observed. The incidence of grade 2 late rectal toxicity was 1% and the incidence of GU late grade 2 toxicity was 6%.…”

Section: Particle Therapy In Prostate Cancer C Grecomentioning

confidence: 96%

Particle therapy in prostate cancer: a review

Greco

2007

Prostate Cancer Prostatic Dis

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“…In light of the favorable outcome with the adopted fractionation scheme and minimal rate of late morbidity, the use of higher dose per fraction is currently under consideration. 78 Indeed, carbon-ion data compare favorably with published results for equivalent doses with x-rays, and the RBE for carbon ions may exceed 3.0.…”

Section: Light Ionsmentioning

confidence: 56%

“…Analysis of the long-term outcome and toxicity data in a large group of patients has been reported recently. 78 No grade 3 toxicities were observed. Grade 2 late rectal toxicity was 1%.…”

Section: Light Ionsmentioning

confidence: 95%

Current status of radiotherapy with proton and light ion beams

Greco

Wolden

2007

Cancer

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Several model studies have shown potential clinical advantages with charged particles (protons and light ions) compared with 3D-conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) in many disease sites. The newly developed intensity-modulated proton therapy (IMPT) often yields superior dose distributions to photon IMRT, with the added advantage of a significant reduction in the volume of healthy normal tissues exposed to low-to-medium doses. Initially, the major emphasis in clinical research for proton and light ion therapy was dose escalation for inherently radioresistant tumors, or for lesions adjacent to critical normal structures that constrained the dose that could be safely delivered with conventional x-ray therapy. Since the advent of IMRT the interest in particle therapy has gradually shifted toward protocols aimed at morbidity reduction. Lately the emphasis has mostly been placed on the potential for reduced risk of radiation-induced carcinogenesis with protons. Compared with 3D-CRT, a 2-fold increase has been theoretically estimated with the use of IMRT due to the larger integral volumes. In the pediatric setting, due to a higher inherent susceptibility of tissues, the risk could be significant, and the benefits of protons have been strongly emphasized in the literature. There is a significant expansion of particle therapy facilities around the world. Increasing public awareness of the potential benefits of particle therapy and wider accessibility for patients require that treating physicians stay abreast of the clinical indications of this radiotherapy modality. The article reviews the available literature for various disease sites in which particle therapy has traditionally been considered to offer clinical advantages and to highlight current lines of clinical research. The issue of radiation-induced second malignancies is examined in the light of the controversial epidemiological evidence available. The cost-effectiveness of particle therapy is also discussed. Cancer 2007;109: 1227-38. 2007 American Cancer Society.KEYWORDS: radiotherapy, proton therapy, light ions, intensity modulated radiotherapy, second cancers. C harged particles (protons and light ions) have a finite range in tissues. The interaction probability to cause ionization increases as they lose velocity traversing through tissues, so that a peak of dose occurs at a depth proportional to the energy of each particle. Beyond this peak no further dose deposition occurs. This phenomenon was described by William Bragg over 100 years ago.1 The dose peak may be 'spread out' to achieve a plateau of uniform dose to precisely cover the target while sparing adjacent normal structures. Passively scattered beams of a certain aperture can be produced by means of range-shifting modulators of variable thickness providing spread-out Bragg peaks (SOBP) for clinical use. The recent introduction of the spot scanning method represents a major advance in particle therapy.2 In this method, small pencil beams of a certain

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“…[1][2][3][4] Developments in radiation technology have lead to the clinical improvement of C-ion irradiation with well-localized energy distributions (high LET). While the development of high LET has a number of advantages over the more traditional radiation technology for the treatment of cancer, the mechanisms underlying the superior biological effectiveness of C-ion irradiation is not fully understood.…”

Section: Introductionmentioning

confidence: 99%

Upregulation of stress-response genes with cell cycle arrest induced by carbon ion irradiation in multiple murine tumors models

Imadome¹,

Iwakawa²,

Nojiri³

et al. 2008

Cancer Biology & Therapy

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Objective: To elucidate the in vivo biological effects induced by carbon-ion irradiation using comprehensive expression analysis.Results: In all tumors, the level of expression of several tens of genes, including Ccl3, Ccng1, Cd80, Cdkn1a, Cxcl2, IL7r, Lrdd, Mgmt, Mmp8 and Polk, was significantly altered 6 h and day 1 following C-ion irradiation. At day 3, several hundred genes, many of which are also classified as stress-response or cell-communication genes, including Tnfrsf5, Ikbke and Icam1, were upregulated following C-ion irradiation. The expression level of the majority of these genes was similar following g-ray treatment, although the change was not as extensive and intertumor variance was apparent. Several genes, including Ikbke, Serpina3n and Saa3, responded differentially following C-ion irradiation than after g-ray irradiation. Pathological investigation and immunohistochemical analysis of Cdkn1a revealed cell cycle arrest with mitotic catastrophe in tumors irradiated by C-ions. Materials and Methods: We examined gene expression changes after carbon-ion (C-ion) irradiation (290 MeV/m, SOBP 6 cm middle, 50 kev/mm) with a single dose of 30 Gy in four mouse tumors (NR-S1, SCCVII, NFSa and #8520) transplanted into the hind legs of C3H/HeNrs mice, using 44K single-color oligomicroarrays at six hours (h), one day and three days after irradiation. Gamma rays of 30 Gy and 50 Gy were used as a reference beam. Identification of C-ion-responsive genes was based on a false discovery rate of <5% using the Wilcoxon test (p < 0.001) and the Benjamini-Hochberg correction.Conclusions: This study revealed significant C-ion induced upregulation of stress-responsive and cell-communication genes common to different tumor types. These findings provide evidence for the efficacy of this modality for the treatment of local tumors.

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Hypofractionated radiotherapy with carbon ion beams for prostate cancer

Cited by 127 publications

References 15 publications

Particle therapy in prostate cancer: a review

Particle therapy in prostate cancer: a review

Current status of radiotherapy with proton and light ion beams

Upregulation of stress-response genes with cell cycle arrest induced by carbon ion irradiation in multiple murine tumors models

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