Proton versus photon-based radiation therapy for prostate cancer: emerging evidence and considerations in the era of value-based cancer care

Kamran, Sophia C.; Light, Jay O.; Efstathiou, Jason A.

doi:10.1038/s41391-019-0140-7

Cited by 30 publications

(30 citation statements)

References 84 publications

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“…Many of these technological advances have increased the costs of radiation treatment before high-quality data emerged to demonstrate an improvement in outcomes. [1][2][3][4][5][6] Proton therapy delivers radiotherapy with proton particles rather than with photons (X-rays). A PBT treatment plan may provide an improved therapeutic ratio as a result of its unique physical characteristics compared to photon-based EBRT.…”

Section: Introductionmentioning

confidence: 99%

Overall Survival After Treatment of Localized Prostate Cancer With Proton Beam Therapy, External-Beam Photon Therapy, or Brachytherapy

Liu

Patel

Jani

et al. 2021

Clinical Genitourinary Cancer

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With limited high-level evidence, we carried out a comparative effectiveness study for the effect of proton beam therapy (PBT) on overall survival compared to external-beam radiotherapy (EBRT) and brachytherapy (BT) among patients with localized prostate cancer using a national database. PBT was associated with a significant overall survival benefit compared to EBRT and had a similar performance as BT. Background: There are few comparative outcomes data regarding the therapeutic delivery of proton beam therapy (PBT) versus the more widely used photon-based external-beam radiation (EBRT) and brachytherapy (BT). We evaluated the impact of PBT on overall survival (OS) compared to EBRT or BT on patients with localized prostate cancer. Patients and Methods: The National Cancer Data Base (NCDB) was queried for 2004-2015. Men with clinical stage T1-3, N0, M0 prostate cancer treated with radiation, without surgery or chemotherapy, were included. OS, the primary clinical outcome, was fit by Cox proportional hazard model. Propensity score matching was implemented for covariate balance. Results: There were 276,880 eligible patients with a median follow-up of 80.9 months. A total of 4900 (1.8%) received PBT, while 158,111 (57.1%) received EBRT and 113,869 (41.1%) BT. Compared to EBRT and BT, PBT patients were younger and were less likely to be in the high-risk group. On multivariable analysis, compared to PBT, men had worse OS after EBRT (adjusted hazard ratio [HR] ¼ 1.72; 95% confidence interval [CI], 1.51-1.96) or BT (adjusted HR ¼ 1.38; 95% CI, 1.21-1.58). After propensity score matching, the OS benefit of PBT remained significant compared to EBRT (HR ¼ 1.64; 95% CI, 1.32-2.04) but not BT (adjusted HR ¼ 1.18; 95% CI, 0.93-1.48). The improvement in OS with PBT was most prominent in men 65 years old with low-risk disease compared to other subgroups (interaction P < .001). Conclusion: In this national data set, PBT was associated with a significant OS benefit compared to EBRT, and with outcomes similar to BT. These results remain to be validated by ongoing prospective trials.

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Section: Introductionmentioning

confidence: 99%

Overall Survival After Treatment of Localized Prostate Cancer With Proton Beam Therapy, External-Beam Photon Therapy, or Brachytherapy

Liu

Patel

Jani

et al. 2021

Clinical Genitourinary Cancer

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“…On the other hand, proton therapy has proven to provide the best dosage delivery to cancer cells with the lowest adverse effects to surrounding tissues. The energy being deposited by the protons can be steered so that it reaches a specific depth in the tissue and covers the entire length of the tumor (known as the Bragg peak effect) [ 38 , 39 ]. Proton therapy minimizes the radiation exposure of adjacent tissues to the tumor and allows to increase the doses of RT delivered to the cancer cells.…”

Section: Types Of Radiation Therapymentioning

confidence: 99%

Radiation-Induced Heart Disease

Quintero-Martinez

Cordova-Madera

Villarraga

2021

JCM

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Cancer incidence and survivorship have had a rising tendency over the last two decades due to better treatment modalities. One of these is radiation therapy (RT), which is used in 20–55% of cancer patients, and its basic principle consists of inhibiting proliferation or inducing apoptosis of cancer cells. Classically, photon beam RT has been the mainstay therapy for these patients, but, in the last decade, proton beam has been introduced as a new option. This newer method focuses more on the tumor and affects less of the surrounding normal tissue, i.e., the heart. Radiation to the heart is a common complication of RT, especially in patients with lymphoma, breast, lung, and esophageal cancer. The pathophysiology is due to changes in the microvascular and macrovascular milieu that can promote accelerated atherosclerosis and/or induce fibrosis of the myocardium, pericardium, and valves. These complications occur days, weeks, or years after RT and the risk factors associated are high radiation doses (>30 Gy), concomitant chemotherapy (primarily anthracyclines), age, history of heart disease, and the presence of cardiovascular risk factors. The understanding of these mechanisms and risk factors by physicians can lead to a tailored assessment and monitorization of these patients with the objective of early detection or prevention of radiation-induced heart disease. Echocardiography is a noninvasive method which provides a comprehensive evaluation of the pericardium, valves, myocardium, and coronaries, making it the first imaging tool in most cases; however, other modalities, such as computed tomography, nuclear medicine, or cardiac magnetic resonance, can provide additional value.

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“…Proton beam technology has the physical advantage of depositing energy in the tissue at the end-of-range, thus potentially sparing critical normal tissues such as the rectum and bladder in prostate cancer patients (82). Studies to date have not demonstrated an improvement in toxicity rates or clear benefit for protons.…”

Section: Advances In Radiotherapy Techniques Treatment Deliverymentioning

confidence: 99%

Current State of Personalized Genitourinary Cancer Radiotherapy in the Era of Precision Medicine

Kamran

Efstathiou

2021

Front. Oncol.

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Radiation therapy plays a crucial role for the management of genitourinary malignancies, with technological advancements that have led to improvements in outcomes and decrease in treatment toxicities. However, better risk-stratification and identification of patients for appropriate treatments is necessary. Recent advancements in imaging and novel genomic techniques can provide additional individualized tumor and patient information to further inform and guide treatment decisions for genitourinary cancer patients. In addition, the development and use of targeted molecular therapies based on tumor biology can result in individualized treatment recommendations. In this review, we discuss the advances in precision oncology techniques along with current applications for personalized genitourinary cancer management. We also highlight the opportunities and challenges when applying precision medicine principles to the field of radiation oncology. The identification, development and validation of biomarkers has the potential to personalize radiation therapy for genitourinary malignancies so that we may improve treatment outcomes, decrease radiation-specific toxicities, and lead to better long-term quality of life for GU cancer survivors.

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Proton versus photon-based radiation therapy for prostate cancer: emerging evidence and considerations in the era of value-based cancer care

Cited by 30 publications

References 84 publications

Overall Survival After Treatment of Localized Prostate Cancer With Proton Beam Therapy, External-Beam Photon Therapy, or Brachytherapy

Overall Survival After Treatment of Localized Prostate Cancer With Proton Beam Therapy, External-Beam Photon Therapy, or Brachytherapy

Radiation-Induced Heart Disease

Current State of Personalized Genitourinary Cancer Radiotherapy in the Era of Precision Medicine

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