11 October 2019
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
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.
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.