Preliminary exploration of clinical factors affecting acute toxicity and quality of life after carbon ion therapy for prostate cancer

Abstract

Purpose To assess toxicity and quality-of-life (QOL) after carbon ion radiotherapy (CIRT) at the Shanghai Proton and Heavy Ion Center (SPHIC) and identify clinical factors that correlate with urinary, bowel and sexual function. Methods Sixty-four patients with localized prostate cancer admitted from July 2015 to January 2018 underwent CIRT. At baseline and 5 time-points after radiotherapy, we assessed patients’ QOL using the 26-item edition of the Expanded Prostate Cancer Index-Composite (EPIC-26) Chinese version. Logistic regression was performed to identify clinical factors associated with acute genitourinary (GU) toxicity and relative QOL. Results By the end of CIRT, urinary irritation/obstruction temporarily declined (− 7.92 ± 1.76, p < .001). For urinary incontinence, bowel and sexual QOL, the scores remained stable at 2-year follow-up. The occurrences of acute Grade 1 and 2 GU toxicity were 20.3 and 10.9%, respectively, and of late Grade 1 and 2 GU toxicity were 3.1 and 1.6%, respectively. No acute or late gastrointestinal (GI) toxicity occurred. Transurethral resection of the prostate (TURP) was a risk factor that predicted a decline in urinary related QOL, and age made a difference to bowel-related QOL. For sexual QOL, castration status was a remarkable risk factor. An international prostate symptom score (IPSS) ≥8 increased the risk of Grade 1–2 acute GU toxicity 5.3-fold. Conclusion Patients with prostate cancer had favorable QOL after CIRT. IPSS ≥8 was a risk factor to acute GU toxicity, and TURP predicted a decline in urinary QOL. Age was related to bowel QOL, and castration status was associated with sexual QOL. Trial registration Carbon Ion Radiotherapy for the Treatment of Localized Prostate Cancer, NCT02739659 . Registered April 15, 2016.

Estimating the Number of Patients Eligible for Carbon Ion Radiotherapy in the United States

“…The number of patients eligible for CIRT was then estimated for each disease site, based on inclusion criteria from previously published protocols and retrospective studies from Germany and Japan. The following disease sites were included: glioblastoma (based on the CLEOPATRA protocol, using CIRT as a boost [17]), hepatocellular carcinoma (PROMETHEUS-01 protocol/NCT01167374 [18]), cholangiocarcinoma (J-CROS study [19]), locally advanced pancreatic cancer (PHOENIX and CIPHER/NCT03536182 studies [9]), early and locally advanced non-small cell lung cancer (multiple retrospective studies [20][21][22][23]), localized prostate cancer (multiple retrospective studies [23][24][25][26]), soft tissue sarcomas (multiple retrospective studies [27,28]) and head and neck cancers, including salivary gland cancers (COSMIC protocol/NCT01154270 [29]), sinonasal cancers (NCT01220752 and retrospective studies [30]) and nasopharyngeal cancers (multiple retrospective studies [31,32]). Further histologic classification (such as adenoid cystic carcinoma or mucosal melanoma) of the general disease sites was possible given the limitations of the various databases used ( Table 1).…”

Carbon Ion Therapy: A Modern Review of an Emerging Technology

“…Late grade 1 and grade 2 GU toxicity were 3.1 and 1.6%, respectively. Notably, there was a 0% rate of late GI toxicity (83).…”

Changes in sexual function and serum testosterone levels in patients with prostate cancer after image-guided proton therapy

“…Few studies have investigated health-related QOL after radiation therapy for ADT-free prostate cancer in Japan and, thus, further accurate assessments are needed [ 39 , 43 ]. In a Chinese study with a follow-up period of 24 months, the sexual domain scores were ~21, and no significant difference was noted before and after carbon-ion radiotherapy [ 44 ]. These results will be useful for comparisons among surgery, IMRT, carbon-ion radiotherapy and PT.…”