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 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.

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)

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.

Latest proton therapy study shows hypofractionated proton therapy as safe and effective for patients with low-risk prostate cancer

A study published in August 2019 in the International Journal of Particle Therapy by Dr. Slater and his team, highlights the results of their latest phase I/II hypofractionated proton therapy study at Loma Linda University Hospital.

Prostate cancer is the most commonly diagnosed cancer in men, and many of these patients have low-risk, early disease. Prostate cancer at these stages remains highly treatable with local control rates over 90% and very low rates of late morbidity commonly reported for a variety of treatment modalities. The focus then turns to the avoidance of unnecessary negative treatment-related side effects that can occur, particularly through the use of conventional treatments such as surgery and x-ray (conventional) radiotherapy.

Proton radiation therapy has demonstrated itself to be an excellent option for low-risk prostate cancer as it delivers high control rates with very little toxicity. Proton beam thereby enhances the physician’s opportunity to minimise risks for the patient.

Hypofractionation is the process of delivering higher doses of radiation per fraction, but using fewer daily fractions. Doctors and physicists at Loma Linda University have successfully used hypofractionated proton therapy for several diseases, including cancers of the breast, lung, and liver. In each instance, control and survival rates have been maintained and unwelcome side effects have not increased. This experience prompted the medical team at Loma Linda to investigate hypofractionation for prostate cancer.

The purpose of the study was to determine whether a hypofractionated proton radiotherapy regimen can control early-stage prostate cancer while maintaining low rates of side effects similar to results obtained using standard-fraction proton radiotherapy.

A cohort of 146 patients with low-risk prostate cancer (Gleason score 7, prostate-specific antigen 10, tumor stage of T1–T2a) received 20 fractions of proton therapy (3.0 Gy per fraction over 4 weeks). Patients were evaluated at least weekly during treatment, at which time documentation of treatment tolerance and acute reactions was obtained. Follow-up visits were conducted every 3 months for the first 1 years, every 6 months for the next 3 years, then annually. Follow-up visits consisted of history and physical examination, PSA measurements, and evaluation of toxicity.

The 3-year biochemical progression-free survival rate was 99.3%, and the 5-year biochemical progression-free survival was 97.9%.

In conclusion, this study showed that hypofractionated proton therapy (60 Gy in 20 fractions) was safe and effective for patients with low-risk prostate cancer. A prospective multi-institutional randomised study is currently being conducted to confirm these results.

Sources:

Kil WJ, Nichols RC Jr, Hoppe BS, Morris CG, Marcus RB Jr, Mendenhall W, Mendenhall NP, Li Z, Costa JA, Williams CR, Henderson RH. Hypofractionated passively scattered proton radiotherapy for low- and intermediate-risk prostate cancer is not associated with post-treatment testosterone suppression. Acta Oncol. 2013;52:492–7

Mendenhall NP, Hoppe BS, Nichols RC, Mendenhall WM, Morris CG, Li Z, Su Z, Williams CR, Costa J, Henderson RH. Five-year outcomes from 3 prospective trials of image-guided proton therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2014;88:596–602

Mendenhall NP, Li Z, Hoppe BS, Marcus RB Jr, Mendenhall WM, Nichols RC, Morris CG, Williams CR, Costa J, Henderson R. Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2012;82:213–21

Shipley WU, Verhey LJ, Munzenrider JE, Suit HD, Urie MM, McManus PL, Young RH, Shipley JW, Zietman AL, Biggs PJ, Heney NM, Goitein M. Advanced prostate cancer: the results of a randomized comparative trial of high dose irradiation boosting with conformal protons compared with conventional dose irradiation using photons alone. Int J Radiat Oncol Biol Phys. 1995;32:3–12

Slater JD, Rossi CJ Jr, Yonemoto LT, Bush DA, Jabola BR, Levy RP, Grove RI, Preston W, Slater JM. Proton therapy for prostate cancer: the initial Loma Linda University experience. Int J Radiat Oncol Biol Phys. 2004;59:348–52

Slater JD, Rossi CJ Jr, Yonemoto LT, Reyes-Molyneux NJ, Bush DA, Antoine JE, Miller DW, Teichman SL, Slater JM. Conformal proton therapy for early-stage prostate cancer. Urology. 1999;53:978–84

Slater JD, Yonemoto LT, Rossi CJ Jr, Reyes-Molyneux NJ, Bush DA, Antoine JE, Loredo LN, Schulte RW, Teichman SL, Slater JM. Conformal proton therapy for prostate carcinoma. Int J Radiat Oncol Biol Phys. 1998;42:299–304

Slater JM, Slater JD, Kang JI, et al. Hypofractionated Proton Therapy in Early Prostate Cancer: Results of a Phase I/II Trial at Loma Linda University. Int J Part Ther. 2019;6(1):1–9. doi:10.14338/IJPT-19-00057

Zietman AL, Bae K, Slater JD, Shipley WU, Efstathiou JA, Coen JJ, Bush DA, Lunt M, Spiegel DY, Skowronski R, Jabola BR, Rossi CJ. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from Proton Radiation Oncology Group/American College of Radiology 95-09. J Clin Oncol. 2010;28:1106–11

New study shows proton therapy more effective than conventional radiotherapy in the treatment of intrahepatic cholangiocarcinoma (ICC)

In a recent study by the Massachusetts General Hospital Department of Radiation Oncology, the use of proton therapy for intrahepatic cholangiocarcinoma (ICC) was shown to more effectively control the cancer and improve the chances of survival – particularly in comparison to conventional (photon) radiotherapy.

Cholangiocarcinoma is a cancer that develops in the cells within the bile ducts; both inside and outside the liver. The terms cholangiocarinoma and bile duct cancer are often used to refer to the same condition. This condition occurs slightly more often in males than females and usually affects people who are between 50-70 years old. Signs and symptoms of intrahepatic cholangiocarcinoma include jaundice, abdominal pain, fever, weight loss, weakness and itching. Treatment options may include surgery (when possible) to remove the bile duct and parts of the liver, chemotherapy and radiation.

In certain cases cholangiocarcinoma is an unresectable form of cancer. Unresectable cancer is defined as a cancer or tumour that cannot be removed completely through surgery. In these cases, radiotherapy and chemotherapy offer the best chances of survival.

The aim of this study was to evaluate outcomes for patients with unresectable intrahepatic cholangiocarcinoma (ICC) treated with hypofractionated proton or photon radiation therapy.

66 patients with unresectable intrahepatic cholangiocarcinoma were treated with hypofractionated proton (32 patients) or photon (34 patients) radiation therapy. Median radiotherapy (RT) dose was 58.05 Gy, all delivered in 15 daily fractions. On multivariate analysis for overall survival (OS), compared with photon RT, there was a trend towards improved survival with proton RT (HR 0.50; p = 0.05).

Median follow-up times from diagnosis and RT start were 21 months and 14 months, respectively. In total, five patients (7.6%) developed local failure. The 2-year outcomes were 84% local control (LC) and 58% OS. Among the 51 patients treated with definitive intent, the 2-year LC rate was 93% and the OS rate was 62%.

The study concluded that hypofractionated radiation therapy yields high rates of local control and is an effective modality to optimize biliary control for unresectable/locally recurrent ICC.

At the ESMO World Congress on Gastrointestinal Cancer 2019, it was identified that high dose radiotherapy in unresectable ICC should be considered as a viable treatment option, in combination with systemic therapy.

This study adds to the growing body of evidence suggesting proton beam therapy as a safe and effective treatment for patients with unresectable ICC. It is proposed therefore, that – pending further research – proton therapy be utilised as a curative treatment for ICC.

Sources:

Hong TS, Wo JY, Yeap BY, Ben-Josef E, McDonnell EI, Blaszkowsky LS, Kwak EL, Allen JN, Clark JW, Goyal L, et al. Multi-institutional phase II study of high-dose Hypofractionated proton beam therapy in patients with localized, Unresectable hepatocellular carcinoma and intrahepatic Cholangiocarcinoma. J Clin Oncol. 2016;34(5):460–8

Ohkawa A, Mizumoto M, Ishikawa H, Abei M, Fukuda K, Hashimoto T, Sakae T, Tsuboi K, Okumura T, Sakurai H. Proton beam therapy for unresectable intrahepatic cholangiocarcinoma. J Gastroenterol Hepatol. 2015;30(5):957–63

Shimizu, S., Okumura, T., Oshiro, Y. et al. Clinical outcomes of previously untreated patients with unresectable intrahepatic cholangiocarcinoma following proton beam therapy. Radiat Oncol 14, 241 (2019)

Smart AC, Goyal L, Horick N, Petkovska N, Zhu AX, Ferrone CR, Tanabe KK, Allen JN, Drapek LC, Qadan M, Murphy JE, Eyler CE, Ryan DP, Hong TS, Wo JY. Hypofractionated Radiation Therapy for Unresectable/Locally Recurrent Intrahepatic Cholangiocarcinoma. Ann Surg Oncol. 2019 Dec 23. doi: 10.1245/s10434-019-08142-9 [Epub ahead of print]

Ustundag Y, Bayraktar Y. Cholangiocarcinoma: a compact review of the literature. World J Gastroenterol. 2008;14(42):6458–66

Superior Intellectual Outcomes After Proton Radiotherapy Compared With Photon Radiotherapy for Pediatric Medulloblastoma

Proton Radiotherapy Preserves Intellectual Function in Children suffering from Medulloblastoma – New study shows that children treated with Proton Therapy have superior intellectual outcomes, compared to children treated with conventional photon/x-ray radiotherapy.

Radiotherapy is essential for treating children’s brain tumours – however conventional radiotherapy treatment increases the risk of permanent cognitive impairment. Memory problems, learning problems, global IQ decline, and other serious cognitive impairments can occur. A new study published in the Journal of Clinical Oncology on the 27th November 2019 has demonstrated the superiority of proton therapy over traditional x-ray/photon radiotherapy in treating paediatric Medulloblastoma.

Medulloblastoma is an invasive, rapidly growing form of tumour, and the most commonly occurring type of brain cancer in children. This study showed that the use of proton therapy in treating these cancers (instead of conventional photon/x-ray radiotherapy) resulted in significantly improved long-term intelligence outcomes in children.

This study provides the strongest evidence to date that proton therapy preserves the intellectual function of children with medulloblastoma – as opposed to traditional x-ray radiation which can cause damage and result in a lower quality of life for children following treatment. The authors of the study concluded:

“Even in the context of CSI (craniospinal irradiation), patients treated with PRT (Proton RadioTherapy) exhibited stable intellectual outcomes in most domains and experienced significantly better long-term outcomes in global IQ, perceptual reasoning, and working memory compared with patients treated with XRT (conventional x-ray radiotherapy).”

These results expand on previous research suggesting an intellect-sparing benefit of proton therapy in the treatment of paediatric brain tumors, reported Lisa S. Kahalley, PhD, of Texas Children’s Hospital (TCH) in Houston, and colleagues in the Journal of Clinical Oncology.

“It’s getting very difficult to argue that there isn’t a very strong clinical benefit associated with proton, so now it really becomes an access issue. We have to think really hard about ways to improve access to families that aren’t located near proton centres.”

The Proton Therapy Center in Prague has considerable experience treating children’s brain tumours with protons, and has treated many children suffering from medulloblastoma – including British child Ashya King, who received proton therapy at the Prague Proton Therapy Center after an international manhunt in 2014. Ashya’s story received widespread public attention, and his successful proton therapy treatment in Prague resulted in him having less risk of cognitive problems following treatment.

Extreme hypofractionated proton radiotherapy for prostate cancer using pencil beam scanning: Dosimetry, acute toxicity and preliminary results

Prague Proton Therapy Medical Team Publishes their Latest Results, Using Proton Therapy to Treat Prostate Cancer.

Several treatment options exist for managing prostate cancer in men. Surgery and conventional radiotherapy have been shown to be equally effective at treating prostate cancer, however conventional treatments such as these can result in side effects that can reduce overall quality of life. Proton therapy is equally effective at treating prostate cancer, however causes less side effects, thereby preserving the quality of life of patients during and after treatment.

Proton therapy has been used to treat prostate cancer for over 25 years. Doctors at the Proton Therapy Center (PTC) in Prague have been treating prostate cancer with proton therapy since opening their facility in 2012. The Prague Proton Therapy Center uses the most advanced form of proton therapy available known as ‘Intensity-Modulated Proton Therapy’ (IMPT) – otherwise known as ‘Pencil-Beam Scanning’ (PBS). This highly accurate form of proton therapy allows high doses of cancer-killing proton radiation to be delivered to the tumour, while sparing healthy surrounding tissue from harm.

The PTC medical team have published their latest treatment findings, using IMPT proton therapy to treat prostate cancer. Their success in treating prostate cancer with proton therapy was published in the Journal of Medical Imaging and Radiation Oncology (the Official Journal of The Royal Australian and New Zealand College of Radiologists).

This study follows the progress of 200 prostate cancer patients that received an advanced and accelerated proton treatment program. The results show that this treatment is extremely effective at treating and removing prostate cancer. The research also shows that proton therapy for prostate cancer results in extremely low side effects. The PTC medical team was able to successfully remove the prostate cancer with almost no side effects using an accelerated, 2 week treatment schedule.

Side effects to the bladder and bowel are commonly reported among patients undergoing conventional radiotherapy for prostate cancer. The Radiation Therapy Oncology Group (RTOG) rates side effects on a ‘grading’ scale from 0 (none) to 4 (severe). Patients examined during the PTC study experienced an extremely low degree of bladder side effects, or in many cases, no side effects at all (grade 0). Only 22.5% of patients experienced grade 2 side effects. The majority of these grade 2 side effects completely disappeared following treatment. Patients undergoing treatment experienced absolutely no severe (i.e. no grade 3 or 4) bladder-related side effects.

In addition to low bladder-related side effects, patients undergoing proton therapy in Prague experienced virtually no bowel side effects. 20% of patients experienced mild, short-term bowel-related side effects that disappeared following treatment. Importantly, 80% of patients experienced no bowel-related side effects during or after treatment. Excitingly, no patients experienced severe (grade 3 or 4) side effects!

To read more about their latest results using proton therapy for prostate cancer, click here.