C.J. Rossi

Establishing and expanding the indications for proton and particle therapy

1 Department of Medical Physics, Aarhus University/Aarhus University Hospital, Aarhus, Denmark, 2 Department of Physics and Technology, University of Bergen, Bergen, Norway, 3 Scripps Proton Radiotherapy Center, San Diego, California, USA, 4 Procure Proton Therapy Centers, New York, New York, USA, 5 Proton Therapy Center, Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, and 6 Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden

Minimal toxicity after proton beam therapy for prostate and pelvic nodal irradiation: results from the proton collaborative group REG001-09 trial

Abstract Background: Proton beam therapy (PBT) reduces normal organ dose compared to intensity modulated radiation therapy (IMXT) for prostate cancer patients who receive pelvic radiation therapy. It is not known whether this dosimetric advantage results in less gastrointestinal (GI) and genitourinary (GU) toxicity than would be expected from IMXT. Material and methods: We evaluated treatment parameters and toxicity outcomes for non-metastatic prostate cancer patients who received pelvic radiation therapy and enrolled on the PCG REG001-09 trial. Patients who received X-ray therapy and/or brachytherapy were excluded. Of 3210 total enrolled prostate cancer patients, 85 received prostate and pelvic radiation therapy exclusively with PBT. Most had clinically and radiographically negative lymph nodes although 6 had pelvic nodal disease and one also had para-aortic involvement. Pelvic radiation therapy was delivered using either 2 fields (opposed laterals) or 3 fields (opposed laterals and a posterior beam). Median pelvic dose was 46.9 GyE (range 39.7–56) in 25 fractions (range 24–30). Median boost dose to the prostate +/− seminal vesicles was 30 GyE (range 20–41.4) in 16 fractions (range 10–24). Results: Median follow-up was 14.5 months (range 2.8–49.2). Acute grade 1, 2, and 3 GI toxicity rates were 16.4, 2.4, 0%, respectively. Acute grade 1, 2, and 3 GU toxicity rates were 60, 34.1, 0%, respectively. Conclusions: Prostate cancer patients who receive pelvic radiation therapy using PBT experience significantly less acute GI toxicity than is expected using IMXT. Further investigation is warranted to confirm whether this favorable acute GI toxicity profile is related to small bowel sparing from PBT.

Intensity-Modulated Proton Beam Therapy of Prostate Cancer-History, Results, and Future Directions

Proton beam radiation therapy is a form of external—beam radiation treatment which takes advantage of the superior physical properties of positively charged subatomic particles (i.e., low entrance dose and lack of exit dose) to deliver highly conformal radiation therapy with a lower integral dose (dose to normal tissue) than can be achieved with photon-based treatments. Proton beam radiation therapy first became available on an extremely limited basis in the late 1950s, and was initially used to treat prostate cancer in the late 1970s. More recently, intensity—modulated proton therapy (IMPT), in which all beam shaping and modulation is performed electromagnetically, has become available at a number of proton centers. This improvement in proton beam treatment delivery significantly expands the utility of proton therapy by allowing for treatment of complex target volumes such as the whole pelvis and by permitting the creation of highly individualized nonuniform dose distributions, including the use of simultaneous integrated boosting. This chapter will review the history of proton beam therapy of prostate cancer, beginning with the initial patient treatments at the Harvard Cyclotron Laboratory and continuing up to the present day, with particular emphasis being placed upon emerging trends in proton beam treatment technology and their potential impact on the future of proton beam therapy in prostate cancer.

Proton beam radiation therapy of prostate cancer - history, results, and future directions

Proton beam radiation therapy of organ-confined prostate cancer now constitutes one of the most commonly treated malignancies with this modality. This paper will provide a concise review of the history of proton beam therapy of prostate cancer, discuss the most recently published clinical data, examine the future uses of proton beam radiotherapy in prostate cancer treatment, and seek to place proton beam therapy in the context of other technological evolutions in radiation oncology.