Clinical studies

Proton therapy is an increasingly recognised and preferred method in the world. The results of the world’s proton centres and the Prague Proton Therapy Center clearly confirm that proton therapy opens up completely new possibilities for the treatment of cancer.

Proton therapy is not a new method. Since 1991, the first exclusively clinical (not academic) workplace located at Loma Linda University, California, USA has treated many tens of thousands of cancer patients using proton therapy. Proton therapy is a technologically mature treatment proven by almost three decades of clinical operation.

Despite many years of proton radiotherapy being used for the treatment of selected types of cancer, some healthcare professionals are still of the opinion that the higher radiation doses used in standard (photon) radiotherapy to which healthy tissues are exposed do not justify the use of proton beam therapy.

New clinical data is available from extensive studies suggesting that the frequency of acute toxicity (complications monitored for 90 days after initiation of treatment) is significantly lower in proton irradiation than in a comparable group of patients treated with photon radiotherapy.

A team of physicians from the University of Washington monitored almost 1,500 patients with various types of cancer, of whom about 400 underwent proton beam therapy while the rest were irradiated with state-of-the-art photon radiotherapy techniques. All the patients from this group were irradiated and at the same time were administered concomitant chemo-radiotherapy. The study researchers focused on the emergence of toxicity at grade III and higher, which already requires hospitalisation and intensive medical treatment and care.

The study has shown that the observed toxicity (the complications associated with irradiation) in patients treated with protons is two-thirds lower than in the group treated with photon radiotherapy. Specifically, serious adverse complications were reported by 11.5% of patients irradiated with protons as compared with 27.6% of patients irradiated with photons.

 

Please find below some clinical studies (diagnoses are listed in alphabetical order):

Brain and CNS

• Study Shows Proton Therapy Improves Overall Survival in Patients With Chordoma and Chondrosarcoma - 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. Read more

• Protonová radioterapie chordomů a chondrosarkomů – proveditelnost, akutní toxicita a časné výsledky: zkušenosti PTC Praha (Proton Radiotherapy of Chordomas and Chondrosarcomas – Feasibility, Acute Toxicity and Early Results: PTC Prague Experience) – Intensity-modulated proton therapy is a safe technique for chordoma and chondrosarcoma patients due to its low acute toxicity.

Breast

• Radioterapie v léčbě karcinomu prsu (Radiotherapy in the Treatment of Breast Cancer) – 2008 16. onkologicko-urologické sympozium a 12. mammologické symposium (2008 16th Cancer and Urology Symposium and 12th Mammological Symposium) – Radiotherapy is essential in the treatment of breast cancer, however, radiation exposure to nearby critical organs, especially the lungs and heart, can lead to late cardiovascular and pulmonary morbidity. This abstract discusses radiotherapy indications at the Institute of Radiation Oncology at University Hospital Bulovka.
• Indikace postmastektomické lokoregionální radioterapie v léčbě karcinomu prsu u pacientek s 1 až 3 pozitivními axilárními lymfatickými uzlinami (Indication of Postmastectomy Locoregional Radiotherapy in the Treatment of Breast Cancer in Patients With 1 to 3 Positive Axillary Lymph Nodes) – 2006 11. ročník odborného sympózia na téma Onkologie v gynekologii a mammologii (2006 11th year of the Symposium on Oncology in Gynecology and Mammology) – A summary of three randomised trials evaluating the need for post-mastectomy radiotherapy to reduce the risk of loco-regional failure.

Head and Neck

• Proton Therapy for Head and Neck Cancer Patients Reduces Rates of Xerostomia - Unlike conventional radiotherapy, which destroys both cancerous and healthy cells, proton therapy has the ability to destroy cancer cells while sparing surrounding healthy tissue from damage. Therefore, important quality of life outcomes such as neurocognitive function, vision, swallowing, hearing, taste and speech can be preserved in head and neck cancer patients. Read more
• Nasopharyngeal Cancer Successfully Treated with Pencil-Beam Proton Radiotherapy at the Prague Proton Therapy Center. An Effective Treatment with Less Side Effects. - Radiotherapy plays a crucial role in the treatment of nasopharyngeal cancer. Due to the high curability of nasopharyngeal cancer, the focus is now upon preserving quality of life, particularly in view of this high curability, and the long life spans ahead for patients suffering with these particular forms of cancer. Read more

• Protonová chemoradioterapie technikou pencil beam scanning v léčbě nádorů hlavy a krku s nutností ozařování bilaterálních krčních uzlin (Proton Chemoradiotherapy With Pencil Beam Scanning in the Treatment of Head and Neck Tumours With the Need for Irradiation of Bilateral Cervical Nodes) – Proton Radiotherapy for head and neck tumours using Pencil Beam Scanning allows for excellent dose coverage for large, complex target volumes while minimising the dose to nearby organs.
• Technika concomitant boost v léčbě nádorů ORL oblasti – biologické odůvodnění a vlastní zkušenosti (Concomitant Boost Technique in the Treatment of ENT Tumours – Biological Rationale and Our Own Experience) – 2005 2. ročník semináře o brachyterapii a technice IMRT (2005 2nd Year Seminar on Brachytherapy and IMRT Technique) – Two techniques can improve the effectiveness of radiotherapy for locally advanced head and neck cancers, applying concomitant chemotherapy, known as concomitant boost (CB), and the use of alternative fractionation modes. For suitable patients, CB has shown to be feasible with acceptable toxicity and promising therapeutic outcomes.

Lymphoma

• Proton Therapy for Adults With Mediastinal Lymphomas: The International Lymphoma Radiation Oncology Group Guidelines – The deciding factor in the choice of treatment modality for Hodgkin and non-Hodgkin lymphoma patients with mediastinal tumours depends on if the dose of excess radiation to organs at risk (OAR) can be minimised. Proton therapy may help to reduce the radiation dose to the OARs and reduce toxicities, especially the risk of cardiac morbidity and secondary cancers.
• Predicted Cardiac and Second Cancer Risks in Hodgkin Lymphoma Patients Treated With Advanced Proton Beam Therapy Compared to Photon Radiation Therapy – A comparison between proton radiotherapy and photon radiotherapy in the treatment of Hodgkin lymphoma patients using deep inspiration breath hold. Proton therapy using pencil beam scanning was found to reduce the risk of future cardiovascular diseases and secondary cancers when compared to 3D-CRT and PartArc RT.
• Pencil Beam Scanning Proton Therapy for Lymphoma Patients With Mediastinal Involvement: Prague’s Single Institution Experience – Proton radiotherapy using pencil beam scanning in deep inspiration breath hold offers a promising and safe possibility for patients who are indicated for mediastinal radiotherapy.
• Proton Radiotherapy for Mediastinal Hodgkin Lymphoma: Single Institution Experience. 10th International Symposium on Hodgkin Lymphoma (download PDF) – The treatment of mediastinal Hodgkin lymphoma using proton radiotherapy results in low acute toxicity and a potential to decrease the risk of significant late toxicity.
• Pencil Beam Scanning Proton Therapy for Lymphoma Patients with Mediastinal Involvement: A Dosimetric Study and Preliminary Clinical Data (download PDF) – When compared to standard photon radiotherapy, proton radiotherapy using pencil beam scanning for mediastinal lymphoma patients significantly reduces the dose of radiation to nearby organs.
• The Role of Radiotherapy in the Treatment of Malignant Lymphomas – Recommendations of the Czech Lymphoma Study Group – This paper is regarding the consensus between haematologist-oncologists and radiation oncologists defining the role of radiotherapy in lymphoma treatment and specific recommendations on total doses of radiotherapy in lymphoma treatment.
• Postavení radioterapie v léčbě maligních lymfomů – doporučení Kooperativní lymfomové skupiny (The Position of Radiotherapy in the Treatment of Malignant Lymphomas – Recommendations of the Cooperative Lymphoma Group) – An overview of indications for radiotherapy in malignant lymphomas, including recommended total doses for RT.
• Role of [18F]-fluoro-2-deoxy-D-glucose Positron Emission Tomography in Early and Late Therapy Assessment of Patients With Advanced Hodgkin Lymphoma Treated With Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Vincristine, Procarbazine and Prednisone – A study aimed at defining the prognostic value of positron emission tomography in the assessment of early therapy response after the end of treatment for advanced Hodgkin lymphoma. The study concluded that an interim PET after four cycles of chemotherapy is a strong prognostic marker for progression-free survival in advanced Hodgkin lymphoma patients.
• FDG-PET for Assessment of Early Treatment Response After Four Cycles of Chemotherapy in Patients With Advanced-Stage Hodgkin’s Lymphoma Has a High Negative Predictive Value – Examination of the prognostic value of positron emission tomography after four cycles of combination therapy in advanced-stage Hodgkin’s lymphoma patients.
• Early and Late Response Assessment With FDG-PET After Beacopp-Based Chemotherapy in Advanced-Stage Hodgkin Lymphoma Patients Has a High Negative Predictive Value – Positron emission tomography (PET) is a powerful prognostic factor in the treatment of Hodgkin lymphoma. The study analyses the prognostic values of PET for early and late response to BEACOPP-based chemotherapy in patients who are diagnosed with advanced-stage HL.

Oesophagus

• Proton Beam Therapy vs Intensity-Modulated Radiation Therapy for Locally Advanced Oesophageal Cancer - 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. Read more

Paediatric

• The Benefits of Proton Therapy for Childhood Cancers Clearly Acknowledged by Medical Professionals - For instance through the use of proton therapy, the radiation dose to normal healthy tissues is estimated at 60% lower than with conventional radiotherapy. Additionally, the benefits of proton radiotherapy are now being widely accepted by insurance companies and other health service providers. Read more
• Superior Intellectual Outcomes After Proton Radiotherapy Compared With Photon Radiotherapy for 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. Read more

Pancreas

• Protonová radioterapie nádorů pankreatu, regionální lymfatika a “setrvalá beznaděj”? (Proton Radiotherapy of Pancreatic Tumours, Regional Lymphatics and “Persistent Hopelessness”?) – The use of proton radiotherapy to treat pancreatic cancer is well tolerated and highly efficient due to its great dosimetric parameters.

Prostate

• New Study Shows Hypofractionated Proton Therapy for Prostate Cancer Is as Effective As Standard Proton Treatment - Researchers at the University of Pennsylvania and the Roberts Proton Center looked at data on prostate cancer patients treated with 28 doses of proton therapy instead of 44, and found that the rates of cancer control at four years was the same in both groups, with notably low rates of urologic and gastrointestinal effects from… Read more
• Study Shows Proton Therapy for Prostate Cancer to Be Safe - The study examined prostate cancer patients treated between 2014 and 2017. These patients were asked to complete quality-of-life (QoL) questionnaires at baseline and subsequently at follow-ups. In addition to this, patient characteristics and tumor histology were obtained by medical chart review. Read more
• A Suitable and Effective Treatment Option for Localised Prostate Cancer | Proton Therapy in Japan - 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,… Read more
• 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… Read more
• Latest Proton Therapy Study Shows Hypofractionated Proton Therapy as Safe and Effective For Patients With Low-Risk Prostate Cancer - 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. Read more
• Extreme Hypofractionated Proton Radiotherapy for Prostate Cancer Using Pencil Beam Scanning: Dosimetry, Acute Toxicity and Preliminary Results - 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. Read more