Proton therapy for prostate cancer: current state and future perspectives

Wu, Yao-Yu; Fan, Kang‐Hsing

doi:10.1259/bjr.20210670

Cited by 14 publications

(7 citation statements)

References 101 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As prostate cancer is the most common solid cancer in men, 1 it accounts for a substantial portion of proton beam therapy (PBT) in the United States. 2,3 Much of this adoption is being driven by the theoretical benefits of proton beam radiation over intensity-modulated radiation therapy (IMRT) because of physical advantages in radiation dose deposition that could potentially translate to a reduction in treatment-related genitourinary (GU) and GI toxicity for men undergoing prostate radiation. 3 However, despite these theoretical benefits, early evaluation of the comparative effectiveness of proton and photon beam treatments using Medicare claims and nonrandomized patient-reported outcomes demonstrated that there were no significant benefits to PBT compared with IMRT.…”

Section: Introductionmentioning

confidence: 99%

Updated Analysis of Comparative Toxicity of Proton and Photon Radiation for Prostate Cancer

Yu,

DeStephano,

Jeffers

et al. 2024

JCO

View full text Add to dashboard Cite

PURPOSE Previous comparative effectiveness studies have not demonstrated a benefit of proton beam therapy (PBT) compared with intensity-modulated radiation therapy (IMRT) for prostate cancer. An updated comparison of GI and genitourinary (GU) toxicity is needed. METHODS We investigated the SEER-Medicare linked database, identifying patients with localized prostate cancer diagnosed from 2010 to 2017. Procedure and diagnosis codes indicative of treatment-related toxicity were identified. As a sensitivity analysis, we also identified toxicity based only on procedure codes. Patients who underwent IMRT and PBT were matched 2:1 on the basis of clinical and sociodemographic characteristics. We then compared GI and GU toxicity at 6, 12, and 24 months after treatment. RESULTS The final sample included 772 PBT patients matched to 1,544 IMRT patients. The frequency of GI toxicity for IMRT versus PBT was 3.5% versus 2.5% at 6 months ( P = .18), 9.5% versus 10.2% at 12 months ( P = .18), and 20.5% versus 23.4% at 24 months ( P = .11). The frequency of only procedure codes indicative of GI toxicity for IMRT versus PBT was too low to be reported and not significantly different. The frequency of GU toxicity for IMRT versus PBT was 6.8% versus 5.7% ( P = .30), 14.3% versus 12.2% ( P = .13), and 28.2% versus 25.8% ( P = .21) at 6, 12, and 24 months, respectively. When looking only at procedure codes, the frequency of GU toxicity for IMRT was 1.0% at 6 months, whereas it was too infrequent to report for PBT ( P = .64). GU toxicity for IMRT versus PBT was 3.3% versus 2.1% ( P = .10), and 8.7% versus 6.7% ( P = .10) at 12 and 24 months, respectively. CONCLUSION In this observational study, there were no statistically significant differences between PBT and IMRT in terms of GI or GU toxicity.

show abstract

Section: Introductionmentioning

confidence: 99%

Updated Analysis of Comparative Toxicity of Proton and Photon Radiation for Prostate Cancer

Yu,

DeStephano,

Jeffers

et al. 2024

JCO

View full text Add to dashboard Cite

show abstract

“…Notably, PArc has demonstrated great potential to improve treatment quality for prostate cancer over bilateral robustly optimized proton pencil beam scanning, while being deliverable within a clinically acceptable time [21]. Specifically, PArc could significantly spare the femoral heads compared to the conventional PT method [21,22]. Although PArc is a new modality, it is gaining increased interest and is an active area of research and the clinical implementation is ongoing [11,[23][24][25].…”

Section: Introductionmentioning

confidence: 99%

The Role of Proton Therapy for Prostate Cancer in the Setting of Hip Prosthesis

Moteabbed,

Bobić,

Paganetti

et al. 2024

Cancers

View full text Add to dashboard Cite

Purpose: Given that the current standard of proton therapy (PT) for prostate cancer is through bilateral beams, this modality is typically avoided when it comes to treatment of patients with hip prosthesis. The purpose of this study was to evaluate whether novel PT methods, i.e., anterior proton beams and proton arc therapy (PArc), could be feasible options to treat this patient subpopulation. We evaluate PT methods in the context of dosimetry and robustness and compare with standard of practice volumetric modulated arc therapy (VMAT) to explore any potential benefits. Methods: Two PT and one VMAT treatment plans were retrospectively created for 10 patients who participated in a clinical trial with a weekly repeat CT (rCT) imaging component. All plans were robustly optimized and featured: (1) combination anterior oblique and lateral proton beams (AoL), (2) PArc, and (3) VMAT. All patients had hydrogel spacers in place, which enabled safe application of anterior proton beams. The planned dose was 70 Gy (RBE) to the entire prostate gland and 50 Gy (RBE) to the proximal seminal vesicles in 28 fractions. Along with plan dose–volume metrics, robustness to setup and interfractional variations were evaluated using the weekly rCT images. The linear energy transfer (LET)-weighted dose was evaluated for PArc plans to ensure urethra sparing given the typical high-LET region at the end of range. Results: Both PT methods were dosimetrically feasible and provided reduction of some key OAR metrics compared to VMAT except for penile bulb, while providing equally good target coverage. Significant differences in median rectum V35 (22–25%), penile bulb Dmean (5 Gy), rectum V61 (2%), right femoral head Dmean (5 Gy), and bladder V39 (4%) were found between PT and VMAT. All plans were equally robust to variations. LET-weighted dose in urethra was equivalent to the physical dose for PArc plans and hence no added urethral toxicity was expected. Conclusions: PT for treatment of prostate cancer patients with hip prosthesis is feasible and equivalent or potentially superior to VMAT in quality in some cases. The choice of radiotherapy regimen can be personalized based on patient characteristics to achieve the best treatment outcome.

show abstract

“…This allows for the effective sparing of surrounding healthy tissue and organs at risk and thus reducing treatment toxicity. Proton therapy is routinely used for the treatment of various tumor sites [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] and is a dynamically developing form of radiotherapy [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Beam Position Projection Algorithms in Proton Pencil Beam Scanning

Nesteruk,

Bradley,

Kooy

et al. 2024

Cancers

View full text Add to dashboard Cite

Beam position uncertainties along the beam trajectory arise from the accelerator, beamline, and scanning magnets (SMs). They can be monitored in real time, e.g., through strip ionization chambers (ICs), and treatments can be paused if needed. Delivery is more reliable and accurate if the beam position is projected from monitored nozzle parameters to the isocenter, allowing for accurate online corrections to be performed. Beam position projection algorithms are also used in post-delivery log file analyses. In this paper, we investigate the four potential algorithms that can be applied to all pencil beam scanning (PBS) nozzles. For some combinations of nozzle configurations and algorithms, however, the projection uses beam properties determined offline (e.g., through beam tuning or technical commissioning). The best algorithm minimizes either the total uncertainty (i.e., offline and online) or the total offline uncertainty in the projection. Four beam position algorithms are analyzed (A1–A4). Two nozzle lengths are used as examples: a large nozzle (1.5 m length) and a small nozzle (0.4 m length). Three nozzle configurations are considered: IC after SM, IC before SM, and ICs on both sides. Default uncertainties are selected for ion chamber measurements, nozzle entrance beam position and angle, and scanning magnet angle. The results for other uncertainties can be determined by scaling these results or repeating the error propagation. We show the propagation of errors from two locations and the SM angle to the isocenter for all the algorithms. The best choice of algorithm depends on the nozzle length and is A1 and A3 for the large and small nozzles, respectively. If the total offline uncertainty is to be minimized (a better choice if the offline uncertainty is not stable), the best choice of algorithm changes to A1 for the small nozzle for some hardware configurations. Reducing the nozzle length can help to reduce the gantry size and make proton therapy more accessible. This work is important for designing smaller nozzles and, consequently, smaller gantries. This work is also important for log file analyses.

show abstract

Proton therapy for prostate cancer: current state and future perspectives

Cited by 14 publications

References 101 publications

Updated Analysis of Comparative Toxicity of Proton and Photon Radiation for Prostate Cancer

Updated Analysis of Comparative Toxicity of Proton and Photon Radiation for Prostate Cancer

The Role of Proton Therapy for Prostate Cancer in the Setting of Hip Prosthesis

Beam Position Projection Algorithms in Proton Pencil Beam Scanning

Contact Info

Product

Resources

About