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Thread: Particle therapy for prostate cancer: The past, present and future

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    Particle therapy for prostate cancer: The past, present and future

    Particle therapy for prostate cancer: The past, present and future [2019, Review, Full Text]

    Abstract

    Although prostate cancer control using radiotherapy is dose‐dependent, dose–volume effects on late toxicities in organs at risk, such as the rectum and bladder, have been observed. Both protons and carbon ions offer advantageous physical properties for radiotherapy, and create favorable dose distributions using fewer portals compared with photon‐based radiotherapy. Thus, particle beam therapy using protons and carbon ions theoretically seems suitable for dose escalation and reduced risk of toxicity. However, it is difficult to evaluate the superiority of particle beam radiotherapy over photon beam radiotherapy for prostate cancer, as no clinical trials have directly compared the outcomes between the two types of therapy due to the limited number of facilities using particle beam therapy. The Japanese Society for Radiation Oncology organized a joint effort among research groups to establish standardized treatment policies and indications for particle beam therapy according to disease, and multicenter prospective studies have been planned for several common cancers. Clinical trials of proton beam therapy for intermediate‐risk prostate cancer and carbon‐ion therapy for high‐risk prostate cancer have already begun. As particle beam therapy for prostate cancer is covered by the Japanese national health insurance system as of April 2018, and the number of facilities practicing particle beam therapy has increased recently, the number of prostate cancer patients treated with particle beam therapy in Japan is expected to increase drastically. Here, we review the results from studies of particle beam therapy for prostate cancer and discuss future developments in this field.
    From the Full Text:

    Conclusions

    Due to a lack of direct evidence, the superiority of particle beam RT over photon beam RT for prostate cancer has not been confirmed in terms of the rates of overall survival or bRFS as end‐points. However, charged particles, such as protons and carbon ions, reduce the irradiated volumes and doses in the organs at risk surrounding the prostate, and previous studies have shown very low incidences of GI and GU toxicities after particle beam RT. Here, we reviewed treatment outcomes during different eras of particle beam RT, and the adverse events induced by particle beam RT have consistently been acceptable. Long‐term observation in a large‐scale randomized study is necessary for the most accurate evaluation of the efficacy of particle beam RT for prostate cancer, but particle beam RT seems a reasonable RT method delivering a high RT dose safely. During 2015–2017, the JASTRO committee for particle beam RT discussed this matter. At that time, particle beam RT was still considered an advanced medical treatment, and it was expected that patients would not refuse randomization in clinical trials. Therefore, we are carrying out a multi‐institutional prospective study of IMRT, PBT and CIRT, and registration of all studies will be completed by April 2020. Together with the recent increase in the number of facilities offering particle beam RT in Japan (Table 5), data on treatment outcomes for various diseases including prostate cancer have accumulated, and are stored in a nationwide database. In addition, it is possible that the treatment devices will become smaller in size and less expensive in the near future. We are facing an important point at which particle beam RT can be compared directly with not only IMRT, but also other alternative treatments, such as surgery or brachytherapy, from several points of view, such as recurrence, adverse events, QOL and cost.
    From Fig. 2:

    However [Proton Beam Therapy] uses fewer beams to create a favorable dose distribution, thereby minimizing the irradiated volumes in the bladder and rectum at low‐to‐moderate doses.
    [All emphasis mine] photon-based = traditional RT modalities, as opposed to proton-based.

    A nice major review and look forward, with good illustrations. If I counted correctly, Japan has 17 PBT centers currently in operation.
    Last edited by DjinTonic; 07-15-2019 at 02:23 PM.

 

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