+1 Recommend
0 collections
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Proton therapy- the modality of choice for future radiation therapy management of Prostate Cancer?

      , *

      Technical Innovations & Patient Support in Radiation Oncology


      Prostate cancer, Proton therapy, Photon therapy, PR, Proton Therapy, PT, Photon Therapy, IMRT, Intensity Modulated Radiation Therapy, GI, Gastrointestinal, GU, Genitourinary, QALY, Quality-Adjusted Life Year, RTOG, Radiation Therapy Oncology Group, HT, Helical Tomography, SW, Sliding Window, RA, Rapid Arc, CTCAE, Common Terminology Criteria Adverse Effects, IPSS, International Prostate Symptom Scale, EPIC, Expanded Prostate Cancer Index Composite, VMAT, Volumetric Modulated Arc Therapy, USPT, Uniform Scanning Proton Therapy, LR, Low Risk, int/HR, intermediate/High risk, RBE, Radiobiological Effectiveness, MFO-IMPR, Multi Field Optimisation-Intensity Modulated Proton Therapy, PBS, Pencil Beam Scanning, US, Uniform Scanning, SFUD, Single Field Uniform-Dose, SBRT, Stereotactic Body Radiation, BT, Brachytherapy, 3DC-PR, 3D Conformal- Proton Therapy, IMPR, Intensity Modulated Proton Therapy, CT, Computed Tomography, ITV, Internal Target Volume, IGRT, Image Guidance Radiation Therapy

      Read this article at

          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.


          • The clinical outcome of the dosimetric benefits of proton therapy in prostate cancer is unclear.

          • Proton therapy plan robustness for prostate cancer remains contentious.

          • Cost effectiveness of proton therapy for all prostate cancer cases is not proven.



          Proton Therapy (PR) is an emerging treatment for prostate cancer (Pca) patients. However, limited and conflicting data exists regarding its ability to result in fewer bladder and rectal toxicities compared to Photon Therapy (PT), as well as its cost efficiency and plan robustness.

          Materials and Methods

          An electronic literature search was performed to acquire eligible studies published between 2007 and 2018. Studies comparing bladder and rectal dosimetry or Gastrointestinal (GI) and Genitourinary (GU) toxicities between PR and PT, the plan robustness of PR relative to motion and its cost efficiency for Pca patients were assessed.


          28 studies were eligible for inclusion in this review. PR resulted in improved bladder and rectal dosimetry but did not manifest as improved GI/GU toxicities clinically compared to PT. PR plans were considered robust when specific corrections, techniques, positioning or immobilisation devices were applied. PR is not cost effective for intermediate risk Pca patients; however PR may be cost effective for younger or high risk Pca patients.


          PR offers improved bladder and rectal dosimetry compared to PT but this does not specifically translate to improved GI/GU toxicities clinically. The robustness of PR plans is acceptable under specific conditions. PR is not cost effective for all Pca patients.

          Related collections

          Most cited references 95

          • Record: found
          • Abstract: found
          • Article: not found

          Intensity-modulated radiation therapy, protons, and the risk of second cancers.

           Eric Hall (2006)
          Intensity-modulated radiation therapy (IMRT) allows dose to be concentrated in the tumor volume while sparing normal tissues. However, the downside to IMRT is the potential to increase the number of radiation-induced second cancers. The reasons for this potential are more monitor units and, therefore, a larger total-body dose because of leakage radiation and, because IMRT involves more fields, a bigger volume of normal tissue is exposed to lower radiation doses. Intensity-modulated radiation therapy may double the incidence of solid cancers in long-term survivors. This outcome may be acceptable in older patients if balanced by an improvement in local tumor control and reduced acute toxicity. On the other hand, the incidence of second cancers is much higher in children, so that doubling it may not be acceptable. IMRT represents a special case for children for three reasons. First, children are more sensitive to radiation-induced cancer than are adults. Second, radiation scattered from the treatment volume is more important in the small body of the child. Third, the question of genetic susceptibility arises because many childhood cancers involve a germline mutation. The levels of leakage radiation in current Linacs are not inevitable. Leakage can be reduced but at substantial cost. An alternative strategy is to replace X-rays with protons. However, this change is only an advantage if the proton machine employs a pencil scanning beam. Many proton facilities use passive modulation to produce a field of sufficient size, but the use of a scattering foil produces neutrons, which results in an effective dose to the patient higher than that characteristic of IMRT. The benefit of protons is only achieved if a scanning beam is used in which the doses are 10 times lower than with IMRT.
            • Record: found
            • Abstract: not found
            • Article: not found

            Radiological use of fast protons.

             R. Wilson (1946)
              • Record: found
              • Abstract: found
              • Article: not found

              Charged particles in radiation oncology.

              Radiotherapy is one of the most common and effective therapies for cancer. Generally, patients are treated with X-rays produced by electron accelerators. Many years ago, researchers proposed that high-energy charged particles could be used for this purpose, owing to their physical and radiobiological advantages compared with X-rays. Particle therapy is an emerging technique in radiotherapy. Protons and carbon ions have been used for treating many different solid cancers, and several new centers with large accelerators are under construction. Debate continues on the cost:benefit ratio of this technique, that is, on whether the high costs of accelerators and beam delivery in particle therapy are justified by a clear clinical advantage. This Review considers the present clinical results in the field, and identifies and discusses the research questions that have resulted with this technique.

                Author and article information

                Tech Innov Patient Support Radiat Oncol
                Tech Innov Patient Support Radiat Oncol
                Technical Innovations & Patient Support in Radiation Oncology
                11 October 2019
                September 2019
                11 October 2019
                : 11
                : 1-13
                Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Dublin 2, Ireland
                Author notes
                [* ]Corresponding author. leechm@ 123456tcd.ie
                © 2019 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                Particle Theory Paper


                Comment on this article