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A Suitable and Effective Treatment Option for Localised Prostate Cancer | Proton Therapy in Japan

There are an estimated 17 million new cases of cancer globally each year. The top four cancers occurring worldwide are lung, breast, bowel, and prostate cancer, respectively. In men, prostate cancer is the most common form of non-skin cancer.

There are a variety of treatment options available when treating prostate cancer, and surgery and radiotherapy are the main treatment options presented to patients. These techniques are, however, associated with sexual, urinary, and bowel-related side effects.

One of the standard treatments for localised prostate cancer is conventional radiation therapy. However, conventional radiation therapy brings considerable acute and late adverse effects to the gastrointestinal (GI) and genitourinary (GU) tract. These side effects continue to be a major concern for both patients and physicians. For instance, in a study conducted by Fiorino et al., the risk of experiencing ≥grade 2 GI and GU side effects is about 5%–20% when undergoing conventional radiotherapy. 

With the materialisation of modern conventional radiotherapy techniques, the risk of toxicity on organs at risk, namely the bladder, rectum, and seminal vesicle, have decreased to 5%–10%. The use of proton beams in radiation therapy further reduces this risk with its characteristic Bragg peak, whereby protons can be controlled to stop directly within the tumour, analogous to its energy.

In order to improve life expectancy and overall quality of life, the Japanese government have applied efforts into funding advanced research for the treatment of cancer, with one such effort being proton beam therapy.

Currently there are 14 proton beam facilities within Japan, and as of April 2018, proton beam therapy for prostate cancer is included in Japanese public insurance coverage, thereby removing the financial burden for patients who will undergo this procedure. The number of patients being treated for localised prostate cancer with proton therapy in Japan continues to increase in popularity, due to its promise as a superior treatment for localised prostate cancer.

In a January 2019 literary review of proton therapy for localised prostate cancer in Japan by Japanese researchers in the Journal of Clinical Medicine, proton therapy for prostate cancer was highlighted as superior to other forms of conventional radiotherapy across multiple studies. The incidence of acute and late toxicities concerning the GI and GU tract, as well as radiation doses to organs of risk such as the bladder, bowel and seminal vesicles, were shown to be significantly lower compared to conventional radiotherapy treatments. Proton therapy has also shown its benefits in patients’ prognosis and quality of life. Biochemical control of patients who completed proton therapy are significantly favourable in prostate cancer patients, including high and very high risk cases. The researchers concluded that proton beam therapy is an effective and suitable treatment option for localised prostate cancer.

To find out if proton therapy is appropriate for you or a loved one, please do not hesitate to contact us.

Resources used:

Cancer Research UK. World Cancer Statistics. Available online (accessed on 12 June 2020).

Fiorino, C.; Sanguineti, G.; Cozzarini, C.; Fellin, G.; Foppiano, F.; Menegotti, L.; Piazzolla, A.; Vavassori, V.; Valdagni, R. Rectal dose-volume constraints in high-dose radiotherapy of localized prostate cancer. Int. J. Radiat. Oncol. Biol. Phys. 2003, 57, 953–962.

Hoshina, R.M.; Matsuura, T.; Umegaki, K.; Shimizu, S. A Literature Review of Proton Beam Therapy for Prostate Cancer in Japan. J. Clin. Med. 2019, 8, 48. 

Sakurai, H.; Ishikawa, H.; Okumura, T. Proton beam therapy in Japan: Current and future status. Jpn. J. Clin. Oncol. 2016, 46, 885–892. 

Takagi, M.; Demizu, Y.; Terashima, K.; Fujii, O.; Jin, D.; Niwa, Y.; Daimon, T.; Murakami, M.; Fuwa, N.;
Okimoto, T. Long-term outcomes in patients treated with proton therapy for localized prostate cancer. Cancer Med. 2017, 6, 2234–2243.

Proton Therapy: An Effective Treatment For Prostate Cancer You Should Insist On

Amongst males in the UK, prostate cancer is the 2nd most common cause of cancer death, with around 12,000 deaths in 2017. Prostate cancer accounts for 14% of all cancer deaths in males in the UK. Prostate cancer patients are usually presented with conventional treatment options such as surgery and conventional x-ray radiotherapy. Another option is proton therapy.

This article will explain why proton therapy in Prague is an effective treatment option for many prostate cancer patients.

The Prostate and Prostate Cancer

The prostate surrounds the urethra and is located beneath the bladder. Cancer begins to develop in the prostate when the cells of the gland begin to grow uncontrollably and form a malignant tumour. Left untreated, prostate cancer can spread to other parts of the body such as the bladder, rectum, bones, and lymph nodes where it can become life threatening.

Modern medicine, however, has made the survival rates of prostate cancer reasonably high.

Common Types of Prostate Cancer

The vast majority of prostate cancers involve adenocarcinomas – these are cancers which develop immediately within the gland cells. It is possible to develop other types of prostate cancer, including:

  • Ductal adenocarcinoma – begins in the ducts of the prostate gland
  • Transitional cell cancer – begins in the bladder and spreads to the urethra, prostate, and nearby tissues
  • Squamous cell cancer – begins in the flat cells of the prostate gland
  • Small cell prostate cancer – a type of neuroendocrine cancer made up of round, small cells

Risk Factors and Prevention

Risk factors such as age, ethnicity, and family history have been known to influence the chances of an individual’s chance of developing prostate cancer. Individuals over the age of 50 are more likely to develop prostate cancer.

A family history of prostate cancer can have an impact on your chances of developing cancer. Only 5% of prostate cancer cases are inherited, but up to 20% of cases are familial, meaning common lifestyle factors and shared genes may have had an influence on the development of cancer.

To lower your risk of developing prostate cancer, it’s recommended to eat a low-fat diet and exercise regularly. However, it’s best to monitor your health by receiving routine checkups and prostate screenings (such as the PSA blood test) from your doctor.

Proton Treatment for Prostate Cancer Patients

Also known as proton beam therapy, proton therapy involves the focusing of proton particles into a beam, which is then delivered to the cancer cells in a non-surgical procedure. The positively charged particles can be controlled to stop at the tumour site, enabling the cancerous tissues to be destroyed with high levels of radiation without causing damage to near healthy tissue and vital organs.

Proton therapy is considered more accurate than other types of radiation therapy, and also non-surgical and noninvasive with minimal side effects. What’s more, the treatment requires little to no recovery time, nor does the radiation have an impact on the patient’s energy levels in comparison to other cancer treatment options. Those who choose proton therapy experience fewer complications than those who choose other types of treatment such as surgery or conventional x-ray radiation.

Proton Therapy vs. Conventional Radiation Therapy

Unlike proton therapy, conventional radiation treatments use x-rays to deliver radiation to the cancerous tumour. Unfortunately, these x-rays cause damage not only to the cancerous tissue, but also the surrounding healthy tissue. Proton therapy uses positively charged subatomic particles called protons. Unlike conventional radiation therapy, the clinician can use the proton beam to target the cancer cells in the body specifically, allowing for a more successful and far less damaging procedure.

Proton Therapy Shown to Enhance Quality of Life

According to an American national survey, those who received proton therapy to treat prostate cancer reported experiencing a better quality of life involving urinary and bowel function during and after their proton therapy treatments, in contrast to patients who received x-ray radiation treatments. More than 70% of prostate cancer patients who received proton therapy additionally noted that the treatment had no impact on their quality of life overall.

Proton Therapy Success Stories

It’s one thing to hear about the success rate of proton therapy treatment for those with prostate cancer in comparison to conventional treatments. It’s another thing to hear the success stories straight from those who have survived and continue to survive today. To learn more about the experiences of others who underwent proton therapy in Prague, click here.

Proton Therapy has the Potential to Reduce the Risk of Long-Term Medical Problems Associated with Anal and Rectal Cancer Treatments

Proton beam Therapy (PBT) is increasingly used for the treatment of paediatric, central nervous system, skull base, and head and neck tumours. Today, there are over 75 particle therapy facilities in operation worldwide, with more in development. Whether proton therapy can play an important role as well in the treatment of anal and rectal cancer is under active investigation.

Anal and rectal cancers are surrounded by radio-sensitive organs, limiting the treatment options available to medical practitioners responsible for treating these forms of cancer. Proton radiotherapy has the potential to remove these limitations, and could be used to treat certain rectal and anal cancers with greater efficacy than conventional radiotherapy.

In a study published by medical researchers at the Harvard Medical School, the potential use of proton therapy was shown to reduce toxicities associated with treatment, increase patient compliance with treatment, minimise treatment interruptions and enables for the possibility of dose escalation (also known as hypofractionation).

The authors observe that currently, “… the maximal efficacy of radiation plans for primary and recurrent anorectal cancer is constrained by delivery techniques and modalities which must consider feasibility challenges and toxicity secondary to exposure of organs at risk.”

Given the minimal difference in biological effect between both protons and x-ray radiotherapy modalities, protons have drawn interest as a way of sparing adjacent organs at risk from unnecessary radiation, while delivering “tumoricidal” doses, and increasing the therapeutic effect of treatment.

Researchers are highly optimistic about proton therapy as an effective treatment for anal and rectal cancers (especially as intensity-modulated proton therapy and pencil-beam scanning techniques become more prevalent). Additionally, decreased doses to bone marrow and bowel may “improve tolerance of multi-modal treatment” and allow for dose escalation, in turn improving clinical and patient-reported outcomes.

In summary, proton therapy has the potential to more effectively treat anal and rectal cancers. Proton therapy can result in less short- and long-term side effects, and due to its precision, allows for dose escalation (hypofractionation), thereby increasing the chance of completely eliminating the disease.

To find out if proton therapy is appropriate for you or a loved one, please do not hesitate to contact us.

Sources:

Colaco RJ, Nichols RC, Huh S, et al. Protons offer reduced bone marrow, small bowel, and urinary bladder exposure for patients receiving neoadjuvant radiotherapy for resectable rectal cancer. J Gastrointest Oncol 2014;5:3-8.

Raldow AC, Hong TS. Will There Be a Clinically Significant Role for Protons in Patients With Gastrointestinal Malignancies? Semin Radiat Oncol 2018;28:125-30.

Verma V, Lin SH, Simone CB, et al. Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: A systematic review. J Gastrointest Oncol 2016;7:644-64.

Vaios EJ, Wo JY. Proton beam radiotherapy for anal and rectal cancers. J Gastrointest Oncol. 2020;11(1):176‐186. doi:10.21037/jgo.2019.04.03

Wolff HA, Wagner DM, Conradi LC, et al. Irradiation with protons for the individualized treatment of patients with locally advanced rectal cancer: A planning study with clinical implications. Radiother Oncol 2012;102:30-7.

COVID-Free Clinic

In connection with the spread of the new coronavirus (COVID-19) and in the light of the current situation and information, the Proton Therapy Center has adopted several measures and recommendations in order to protect the safety of our patients and staff.

Thanks to these measures we have promptly introduced, we have been able to continue to operate ensuring optimal continuum of cancer care to adult and paediatric patients worldwide during the COVID-19 pandemic.

🤝 It is prohibited to shake hands due to the risk of transmission of the virus.
🤭 Do not touch your face. Use the disinfectant to clean your hands.
🗣️ Cough or sneeze into your elbow, covering your mouth.
🥵 If you have a fever, call us and let us know before coming to the clinic.
😷 Everyone entering the building is required to wear a mask.
🌡️ Upon arrival to the clinic, patients’ temperature is taken.

It is prohibited to shake hands due to the
 risk of transmission of the virus.
Do not touch your eyes and face. 
Use the disinfectant to clean your hands.
Cough or sneeze into your elbow, 
covering your mouth.
If you have a fever, call us and let us know before coming to the clinic.
Everyone entering the building is required to wear a mask.
Upon arrival to the clinic, patients’ temperature is taken.

Starting March 16, 2020, we have introduced a new system which allows employees to keep a safe distance from each other, a strict hygienic entry regime, and higher level of disinfection of the premises. As an extra precaution, doctors work on rotation in two separate shifts minimising the risk to both medical staff and our patients.

Patients need to follow their appointments schedule strictly, so that the centre is never crowded.

Additionally, in order to meet our commitment and at the same time protect everyone at the Proton Therapy Center (patients and staff), it is necessary that all patients coming from abroad undergo COVID-19 testing. Our treatment coordinators will be happy to help you find the closest clinic to your home.

Patients Coming From Abroad

The first step is to assess suitability for proton irradiation, which you can do remotely from the comfort of your home. This assessment is free and it only takes a few business days.

Should you be suitable for treatment at our facility, we can offer you a remote consultation with one of our oncologists to discuss treatment in greater detail.

Should you decide to go ahead with treatment at our facility, we will provide you with an official document which will allow you to travel.

Although airway transportation is limited, there are some flights coming to Prague. Alternatively, it is possible to reach us by car.

Should none of the options above be suitable for you, we cooperate with Meditrans ambulance service which can transport patients to Prague from anywhere in Europe and UK. Should this be your preferred option, our treatment coordinators will be happy to arrange it for you.

We hope you will appreciate and support our efforts. Only with mutual cooperation the therapy will be safe for you, other patients, and the Proton Therapy Center employees.

We are delighted to say, thanks to the favourable epidemiological conditions in the Czech Republic, the situation will soon return to normal.

We will be happy to provide you with more detailed information. Please do not hesitate to contact us.

Study Shows Proton Therapy Improves Overall Survival in Patients with Chordoma and Chondrosarcoma

Chordomas and chondrosarcomas are difficult to manage using conventional cancer treatment methods. Areas of the body frequently affected by this type of cancer include the spine, skull, pelvis, hip, and shoulder.

Effective treatment of these tumours using surgical resection is not usually achievable due to neurovascular involvement. As a result, recurrence of the tumour when surgery is used in isolation poses a significant risk for both chordomas and chondrosarcomas. Due to the low risk of metastasis and relative chemoresistance, the use of definitive radiotherapy or perioperative radiotherapy is very important in maintaining local control.

Previous research has shown proton therapy to be beneficial in treating these types of tumours. Using protons, health professionals are able to treat chordoma and chondrosarcoma with higher doses of radiation due to the increased accuracy of proton therapy.

A 2019 study published in the journal ‘Cancer’ entitled: The role of dose escalation and proton therapy in perioperative or definitive treatment of chondrosarcoma and chordoma has shown that proton therapy improves overall survival for those with these forms of cancer.

This study analysed a total of 863 patients with chondrosarcoma and 715 patients with chordoma treated with proton or conventional radiation therapy. The primary endpoint of overall survival (OS) was evaluated, and clinical features, including age, sex, grade, clinical stage, and Charlson‐Deyo comorbidity index, were compared.

This study found that for chondrosarcoma, a high radiation dose of proton therapy was associated with improved OS at 5 years.

For chordoma, proton therapy was associated with improved OS at 5 years and a high dose for chordoma was significant for improved OS.

The authors concluded that in the largest retrospective series to date, dose escalation and proton radiotherapy were associated with improved overall survival in patients with chondrosarcoma and chordoma. Evidence continues to accumulate in support of improved outcomes with high‐dose proton therapy in the treatment of chordoma and chondrosarcoma with acceptable toxicity.

If you or a loved one are suffering with chordoma or chondrosarcoma, the Prague Proton Therapy Center oncologists are available for consultation.

Associated Resources:

DEGRO. Stellungnahme zur Strahlentherapie mit Protonen in Deutschland Juni 2015.

T. F. DeLaney, N. J. Liebsch, F. X. Pedlow et al., “Phase II study of high-dose photon/proton radiotherapy in the management of spine sarcomas,” International Journal of Radiation Oncology∗Biology∗Physics, vol. 74, no. 3, pp. 732–739, 2009.

E. B. Holliday, H. S. Mitra, J. S. Somerson et al., “Postoperative proton therapy for chordomas and chondrosarcomas of the spine: adjuvant versus salvage radiation therapy,” Spine, vol. 40, no. 8, pp. 544–549, 2015.

B. Rombi, T.F. DeLaney, S.M. MacDonald, et al. “Proton radiotherapy for pediatric Ewing’s sarcoma: initial clinical outcomes” Int J Radiat Oncol Biol Phys, 82 (2012), pp. 1142-1148

Prostate Cancer Studies

Extreme hypofractionated proton radiotherapy for prostate cancer using pencil beam scanning: Dosimetry, acute toxicity and preliminary results
https://www.ncbi.nlm.nih.gov/pubmed/31486267

Quality of life and toxicity from passively scattered and spot-scanning proton beam therapy for localized prostate cancer
http://www.ncbi.nlm.nih.gov/pubmed/24139077

Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate
http://www.ncbi.nlm.nih.gov/pubmed/20124169

Comparison of high-dose proton radiotherapy and brachytherapy in localized prostate cancer: a case-matched analysis
http://www.ncbi.nlm.nih.gov/pubmed/21470787

Dose-volume comparison of proton therapy and intensity-modulated radiotherapy for prostate cancer
http://www.ncbi.nlm.nih.gov/pubmed/17904306

Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer
http://www.ncbi.nlm.nih.gov/pubmed/21093164

Erectile function, incontinence, and other quality of life outcomes following proton therapy for prostate cancer in men 60 years old and younger
http://www.ncbi.nlm.nih.gov/pubmed/22253020

Five-Year Outcomes from 3 Prospective Trials of Image-Guided Proton Therapy for Prostate Cancer
http://www.redjournal.org/article/S0360-3016(13)03310-5/abstract

Hypo-fractionated passively scattered proton radiotherapy for low-and intermediate-risk prostate cancer is not associated with post-treatment testosterone suppression
http://www.ncbi.nlm.nih.gov/pubmed/23477360

Long-term quality of life outcome after proton beam monotherapy for localized prostate cancer
http://www.ncbi.nlm.nih.gov/pubmed/21621343

Management of complications of prostate cancer treatment
http://www.ncbi.nlm.nih.gov/pubmed/18502900

Patient-reported long-term outcomes after conventional and high-dose combined proton and photon radiation for early prostate cancer
http://www.ncbi.nlm.nih.gov/pubmed/20233822

Urinary functional outcomes and toxicity five years after proton therapy for low-and intermediate-risk prostate cancer: results of two prospective trials
http://www.ncbi.nlm.nih.gov/pubmed/23477359

Long-term Efficacy and Toxicity of Hypofractionated Salvage Radiation Therapy for Biochemically Recurrent Prostate Cancer
https://www.redjournal.org/article/S0360-3016(15)01755-1/fulltext

Prague Proton Therapy Center Study Shows Proton Therapy Greatly Reduces the Risk of Side Effects Compared with Conventional Radiotherapy

Patients who undergo conventional radiotherapy treatment are exposed to a far greater amount of unnecessary radiation to healthy tissue, in comparison to patients undergoing proton therapy treatment. As a more targeted treatment modality, proton therapy spares a greater quantity of healthy tissue. Treatment plans using proton radiotherapy reduce radiation exposure by 50% compared to conventional radiotherapy treatment.

The Prague Proton Therapy Center Medical Team published their treatment plan comparison findings for patients with advanced prostate carcinoma in the December 2019 edition of Radiation Protection Dosimetry, entitled ‘Low dose bath from IMPT vs IMXT for the pelvic area when treating advanced prostate cancer‘. This study compared treatment plans for patients undergoing Intensity Modulated Proton Therapy (IMPT) with patients undergoing conventional Intensity Modulated X-Ray Therapy (IMXT) for advanced prostate cancer.

Existing studies have already shown that cancer patients receiving proton therapy experience a significantly lower risk of unnecessary side-effects from radiation therapy in comparison to patients receiving traditional photon radiation. Cure rates remain however essentially identical between the two groups.

The results of this study confirm these existing findings, demonstrating the clear superiority of proton therapy over conventional x-ray (photon) radiotherapy. Proton therapy treatment was shown to halve the amount of dangerous radiation exposure to the abdominal cavity and rectum (50% less radiation to healthy tissue). This thereby reduces the risk of side-effects and offers patients a greater chance at maintaining a higher quality of life during and after their cancer treatment.

Proton therapy was also shown to use a significantly lower number of treatment fields for the same target dose coverage, when compared to conventional photon (x-ray) treatment techniques. The authors state that proton therapy treatment ‘irradiates just half of the tissue volume with a low dose compared to conventional x-ray treatments without compromise in target volume coverage’. In this way the risk of secondary cancer development and other possible complications is also greatly reduced.

Optimum proton dose distributions can be achieved with intensity modulated proton therapy. Currently, proton therapy is undergoing transitions that will move it into the mainstream of cancer treatment. For example, proton therapy is now reimbursed, there has been rapid development in proton therapy technology, and many new options are available for equipment, facility configuration, and financing.

Proton therapy might be an appropriate treatment option for you or a loved one that is suffering from cancer. Please contact us if you would like to find out more.

Associated Resources:

B. Glimelius, U. Isacsson, E. Blomquist, E. Grusell, B. Jung, and A. Montelius, “ Potential gains using high‐energy protons for therapy of malignant tumors,” Acta Oncol. 10.1080/028418699431537 38, 137– 145 (1999)

B. Glimelius et al., “ Number of patients potentially eligible for proton therapy,” Acta Oncol. 10.1080/02841860500361049 44, 836– 849 (2005)

R. Flynn, D. Barbee, T. Mackie, and R. Jeraj, “ Comparison of intensity modulated x‐ray therapy and intensity modulated proton therapy for selective subvolume boosting: A phantom study,” Phys. Med. Biol. 10.1088/0031‐9155/52/20/001 52, 6073– 6091 (2007)

L. Haisen, H. Romeijn, H. Fox, J. Palta, and J. Dempsey, “ A computational implementation and comparison of several intensity modulated proton therapy treatment planning algorithms,” Med. Phys. 10.1118/1.2836954 35, 1103– 1112 (2008)

A. J. Lomax et al., “ A treatment planning inter‐comparison of protons and intensity‐modulated photon therapy,” Radiother. Oncol. 10.1016/S0167‐8140(99)00036‐5 51, 257– 271 (1999)

Luca’s Craniopharyngioma Story

Luca is a young boy who was diagnosed with craniopharyngioma. His mother, Mariana, has decided to share their journey.

When I found out about Luca’s craniopharyngioma I started researching all the possible treatment opinions both in my country, Romania, and abroad. At that time, there were three neurosurgeons in America with whom I corresponded and they recommended surgical removal of the tumor followed by proton therapy. It was the first time I heard of such therapy.

Two surgeries were performed in the hospitals in Bucharest and the tumor was completely removed along with the pituitary gland. The doctors hoped that everything would go well and we would not need proton therapy. Shortly after, however, we realised that it was not the case and the doctors gave us two options: we could repeat the surgeries whenever the tumor recurred or we could do proton therapy. We chose proton therapy. We had to decide which of the centres in Europe to go to. A Romanian student who was studying in Prague recommended us the Proton Therapy Center (PTC). He recommended PTC as it is one of the newest centres, therefore with the latest technology, but also with a lot of experience and well trained doctors. Thus Prague became our home for two months. We didn’t imagine that treating such a disease could go so smoothly!

Before going to Prague for Luca’s treatment, I had never left Romania. I didn’t know any foreign language but Susanna, the treatment coordinator who was assigned to our case, helped us with all the details. Susanna found the accommodation most suitable for us, she informed us in detail and patiently explained each step of the process, always making sure we understood. Moreover, the PTC organised for a car to pick us up at the airport as well as take us back to the airport at the end of Luca’s treatment.

Luca loves the Proton Therapy Center and the people here. He didn’t experience any side effects, hair loss, or nausea. In addition Luca began to love walking because of the many beautiful places Prague has to offer!

Easter Traditions in the Czech Republic

Easter, known as Velikonoce, in the Czech Republic is a celebration of the arrival of spring. Celebrated on Monday, not Sunday, Easter has many unusual traditions that may vary depending on the region. Some of the most popular Easter traditions and symbols include:

Kraslice (Easter eggs) – girls decorate Easter eggs using a variety of techniques. The eggs will be given to the boys on Easter Monday.

Pomlázka (Pussywillow) – it is thought that by whipping someone with pussywillow twigs you bring them health and youth. Boys will collect twigs and braid them to create whips, which will then be used to whip the girls while reciting a short Easter poem. The girls reward the boys with candy, a painted egg or a ribbon to tie around his whip.

Lamb shaped cake – a staple of any Czech Easter meal. Other dishes that are common for Easter include potato salad, gingerbread and in many households, slivovice which is homemade plum brandy.

The colour red – symbolising the energy of new life, which is what spring brings. Many people will dye their eggs red or wear a red outfit during Easter.

The warning off of Judas – during holy week, for three days, boys will travel around their village shaking wooden rattles to scare off Judas. On Saturday, the third day, the boys will make their rounds to houses where they will make noise with their rattles until they are given a present.

Proton Beam Therapy vs Intensity-Modulated Radiation Therapy for Locally Advanced Oesophageal Cancer

Radiation therapy has become an important component in the curative management of oesophageal cancer worldwide. Since most of the oesophageal cancers seen in the Western hemisphere (i.e., Europe and the United States) are located in the mid- to distal-oesophageal locations, heart and lungs invariably receive significant radiation doses. Much of the normal tissue exposure could be reduced with the utilisation of advanced radiation technologies such as intensity modulated proton therapy. Proton beam therapy (PBT) provides the ability to reduce normal tissue exposure (compared to conventional treatments) due to its lack of exit dose, which enables medical teams to provide clinically meaningful benefits to oesophageal cancer patients.

A Randomized Trial of Proton Beam Therapy Versus Intensity-Modulated Radiation Therapy for Locally Advanced oesophageal Cancer found that proton beam therapy was associated with less toxicity and similar progression-free survival vs intensity-modulated radiation therapy in patients with locally advanced oesophageal cancer.

In the trial, 145 patients were randomly assigned to proton beam therapy or intensity-modulated radiation therapy. Median follow-up was 44.1 months. The posterior mean total toxicity burden was 2.3 times higher in the intensity-modulated radiation therapy group vs the proton beam therapy group. The mean postoperative complication score was 7.6 times higher in the intensity-modulated radiation therapy group vs the proton beam therapy group (2.5, 95% highest posterior density interval = 0.3–5.2). At 3 years, overall survival was 51.2% vs 50.8% and median overall survival was 42.1 months vs 73.6 months.

The investigators concluded: “For locally advanced oesophageal cancer, proton beam therapy reduced the risk and severity of adverse events compared with intensity-modulated radiation therapy while maintaining similar progression-free survival.”

Treating oesophageal cancer with an adequate dose of radiation can be difficult because of the close proximity of the oesophagus to critical structures, such as the heart, lungs and spinal cord. Because protons deposit their highest dose of radiation at the tumor or area of concern, proton therapy can be an excellent choice for treating patients with oesophageal cancer.

Proton therapy offers patients and their doctors a unique option for effectively treating oesophageal cancer while reducing damage to other critical organs and tissues. The Prague Proton Therapy Center is one of the few centres of its kind treating oesophageal cancer with proton technology.