Proton Therapy For Prostate Cancer Treatment Centers

Effectiveness And Toxicity: Reviewing The Literature

Although PBT has generated much enthusiasm, its utility can be best confirmed by clinical trials. Unfortunately, there are no randomized trials completed that directly compare 3D-CRT or IMRT with PBT, and thus we must rely mainly on single-arm studies.

Loma Linda University Medical Center was the first center to open a hospital-based proton facility in 1990, and reported the first large single-arm experience. The authors analyzed 1255 patients, 731 of whom received 3D-CRT plus a boost with PBT and 524 of whom received PBT only. Included were patients with low-, intermediate-, and high-risk prostate cancer. Using American Society for Therapeutic Radiology Oncology consensus criteria, the 5- and 8-year biochemical failure free survival was 75% and 73%, respectively. More importantly, there were very low rates of Radiation Therapy Oncology Group grade 3 or higher morbidity: 1% genitourinary and 0.2% GI. To put these numbers in perspective, patients treated with IMRT at our institution had 6% GU and 1% GI grade 3 or higher morbidity.

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A Prostate Cancer Treatment Unlike Any Other

Kidney cancer is an abnormal growth of cells in kidney tissue that eventually forms a tumor. Cells can break off from the tumor and spread to other tissue and organs. The most common kidney cancer is renal cell carcinoma.

Kidney cancer patients are at increased risk of prostate cancer.

Localized prostate cancer, which includes stage 1, stage 2, and stage 3 cancer, has not grown into nearby tissues or more distant body parts. There are three types:

• Very-low-risk and low-risk prostate cancer, where there is a risk of metastasis and/or recurrence but it is low.
• Intermediate-risk prostate cancer, which may grow or spread in a few years.
• High-risk prostate cancer, which has the highest likelihood of spreading and, even after treatment, recurring.

Prostate cancer will sometimes grow quickly and spread to lymph nodes, pea-sized pieces of tissue that filter a waste product called lymph. When this happens, a larger area needs to be targeted for treatment that includes the prostate gland and the lymph nodes. Proton therapy is particularly beneficial when treating large areas in the pelvis.

Data suggest that men who have undergone prostatectomy for prostate cancer may benefit from follow-up treatment with proton therapy, depending on several factors:

• Seminal vesicle and lymph nodes involvement

Among men treated for prostate cancer, up to 30 percent see their cancer return. Fewer than half of them can be cured by traditional treatment.

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Is Proton Beam Therapy Safer Than Other Options

Due to the concentrated nature of the radiation in proton therapy, there are usually fewer side effects than in conventional radiation therapy. Thats because theres less damage to healthy tissue around the tumor.

People who have proton therapy may have a significantly lower risk of short- and long-term complications compared with people receiving traditional photon therapy, according to a research study . These findings show a two-thirds reduction of adverse events in the 90 days after treatment, as well as a significantly reduced risk of having difficulties moving and performing daily activities.

However, long-term data is lacking on the safety of proton beam therapy. Furthermore, due to the high cost of treatment, current research has been limited in terms of demographics.

Who Is A Good Candidate

In most cases, you will be a good candidate for proton therapy if you were initially offered radiotherapy as an option. Patients who receive radiotherapy usually have no problems being a candidate for proton treatment. They are usually patients in an early stage or those with localized prostate cancer. It is also useful to keep advanced cancer under control for as long as possible and treat recurrent prostate cancer cases.

However, some patients may not benefit from proton therapy if they have one of these problems :

• In patients with hip replacements, because proton beams often cant reach beyond the prosthesis. In some proton therapy centers, these patients can still get a session when a hip replacement is limited to one side. But bilateral replacement makes it impossible to treat the patient with proton beam therapy.

• In patients with advanced prostate cancer in which treating the pelvic lymph nodes is fundamental. Since proton beam radiation is less likely to reach other tissues than the prostate, it is not applicable when treating surrounding lymph nodes.

• In overweight patients, because the proton beam can only go through a determined depth. This depth depends on the beams energy, and some centers may have a higher energy device that solves the problem.

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Proton Therapy Vs Traditional Radiation

Compared to conventional radiation treatment including Cyberknife/SBRT, proton therapy can deliver high radiation doses to the prostate and pelvic lymph nodes while better sparing the healthy bowel and bladder. For men with prostate cancer, the side effects of conventional radiation treatment can have serious quality of life implicationsparticularly relating to urinary, bowel and erectile function.

Because proton therapy reduces the amount of radiation to healthy organs near the prostate by 80%allowing significantly less unnecessary irradiation to the bladder, bowels, and surrounding healthy tissuesthere is reduced risk of secondary cancers and other long-term effects compared to conventional radiation.

For these reasons, proton therapy is particularly beneficial for men with high-risk prostate cancer that has spread or is at risk of spreading to the lymph nodes and in treating patients with prostate cancer that has returned after previous radiation therapy or prostatectomy.

Proton therapy treatments are delivered on an outpatient basis. Most patients continue their normal activities throughout treatment, without having their quality of life impacted by their proton therapy. Entire treatment courses in only five days with proton SBRT and novel clinical trials are offered to appropriate candidates.

Potential Benefits Of Pt And Reported Clinical Outcomes Of Prostate Treatments

Given the different beam characteristics of protons and photons, a modulated proton beam confines dose deposition to the target region, with a rapid depth- and lateral-dose fall-off favoring normal tissue sparing and target dose escalation. Several dosevolume comparison studies showed that both passive scattering and pencil beam scanning PT reduced the mean dose and percentage of volume receiving low dose in the rectum and bladder compared with IMRT. In the prostate, PT maintained dose coverage, demonstrating superior dose conformity over IMRT. In most circumstances, a simple bilateral proton beam is employed for localized prostate cancer. Other arrangements, such as anteriorposterior or anterioroblique beams may be used in patients with a hip prosthesis or previously irradiated hip . Nevertheless, PT has consistently been shown to have a smaller irradiated volume of normal tissue and lower integral non-target dose , as illustrated in Figure 1. A systematic review showed that the risk of radiation-induced second primary cancer appears to be small , but does increase over time . As prostate cancer survival improves, the risk of radiation-induced second malignancies becomes more relevant .

Integral dose comparison of volumetric modulated RapidArc therapy -full rotation and photon therapy -bilateral in prostate treatment plans. The most significant differences were in the 10% and 30% isodose distributions of the 78-Gy prescription.

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How Proton Beam Therapy Works

Proton therapy is an advanced form of radiation treatment that uses protons instead of X-rays.

In regular radiation therapy, the beam of energy goes into the body, through the tumor, and out the other side. This exit dose of radiation might affect healthy tissue beyond the tumor. Protons, in contrast, are larger particles than those used in regular radiation. They release more of their energy within the tumor itself. This burst of energy can appear on a graph as what is called the Bragg peak.

After delivering the energy to the tumor, the protons stop: They do not exit the tumor and go into healthy tissue on the other side.

In this way, proton therapy reduces radiation exposure and potential damage to healthy tissue, especially in sensitive areas such as the brain, eyes, spinal cord, heart, major blood vessels and nerves.

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Whos A Good Candidate For This Procedure

Anyone who can have radiation therapy can have proton therapy. Proton therapy can be used as primary treatment for early stage prostate cancer or as part of a total treatment plan for prostate cancer. Its also an effective treatment for people who require pelvic radiation therapy after undergoing previous therapies.

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What Is External Radiation Therapy

External beam radiation attacks cancer with high-powered beams of energy, such as X-rays. It uses a machine called a linear accelerator to send energy beams through the skin and into the body. While you lie on a table, the linear accelerator moves around you, sending radiation to the tumor from different angles.

Schedule: Treatment usually lasts five days a week for several weeks. This allows your team to deliver enough radiation to kill cancer cells while giving your body time to recover.

Type: Your team may consider several types of radiation therapy. They will recommend a treatment plan tailored to your overall health and the type and stage of your cancer.

What is it? 3D CRT uses computer-assisted scans to pinpoint the size, shape and location of your tumor and surrounding organs. This helps your doctor tailor radiation beams to the shape of the tumor. Because the shaped beam is so precise, we can deliver a higher dose of radiation without harming healthy cells.

How is it delivered? Most patients receive 3D CRT five days a week for several weeks. Your radiation oncologist will make a mold or cast of the body part being treated. This serves as a shield and helps you stay still so radiation targets the tumor and avoids healthy tissue. It helps destroy more cancer cells with each treatment and allows you to recover more quickly.

What cancers is it used for?

What Hospitals Offer Proton Therapy

The proton therapy center at Huntsman Cancer Institute is the very first in the Mountain West. Currently, the closest proton therapy centers are more than 700 miles away in southern Arizona, southern California, or western Washington. Having proton therapy at Huntsman Cancer Institute is a major benefit for our patients and caregivers who no longer have to travel far distances or incur the cost of long-term stays out of state.

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How Is Proton Therapy Delivered

Proton therapy is delivered by a device called a cyclotron, which sends a high-energy beam of protons through the skin toward the tumor. At Memorial Sloan Kettering, the first step is a CT or MRI scan to map the tumor in three dimensions. Then our radiation oncologists, in close collaboration with medical physicists, use computer programs to calculate how to deliver the treatment at the precise dose and location.You will receive proton therapy in a special treatment room, where you will be positioned on a treatment table. An immobilization device will make sure you stay in the exact position on the table.

Why Choose Us For Prostate Cancer Care

• Prostate cancer specialists: Because our team is subspecialized in prostate cancer, you get the most comprehensive, most personalized care plan available.
• Unparalleled in proton therapy: Weâve treated over 10,000 prostate cancer patients using proton therapy more than any other center in the world.
• Leaders in robotic surgery: Our surgeons perform more minimally-invasive robotic surgeries each year than those at any other teaching hospital in the West.
• State-of-the-art tech: As the largest urology group in the region, we offer you access to the most advanced technology available.
• Clinical trials: You have access to many clinical trials for prostate cancer, which may offer potential new treatments.

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Limitations Of The Studys Design

The study leaders and other experts noted several limitations to the studys design.

For instance, this observational study cant establish a cause-and-effect relationship between proton therapy and fewer side effects. In addition, all of the study participants were treated at a single institution, which can make it difficult to generalize the findings to a larger population.

Those are very significant limitations that shouldnt be understated, Dr. Buchsbaum emphasized.

Although single-institution studies have inherent limitations, Dr. Baumann noted, all patients in this study received high-quality treatment at a large academic medical center, regardless of whether it was proton or traditional radiation therapy, which suggests that the benefit of proton therapy that we saw is meaningful.

Also, because patients were not randomly assigned to treatment groups, there were differences between patients who got proton and traditional radiation, and that may have skewed the results.

For instance, patients who received proton therapy were, on average, older and had more health issues.

The proton therapy group may also have included more patients from privileged backgrounds, Drs. Park and Yu noted. Socioeconomic status and social support can affect treatment outcomes, they wrote.

In addition, fewer people with head and neck cancerwho are more likely to suffer from radiation-associated side effectswere included in the proton therapy group, the editorialists added.

Comparison With Other Treatments

The issue of when, whether, and how best to apply this technology is still under discussion by physicians and researchers. One recently introduced method, ‘model-based selection’, uses comparative treatment plans for IMRT and IMPT in combination with normal tissue complication probability models to identify patients who may benefit most from proton therapy.

Clinical trials are underway to examine the comparative efficacy of proton therapy for the following:

• Pediatric cancersby St. Jude Children’s Research Hospital, Samsung Medical Center
• Base of skull cancerby Heidelberg University
• Head and neck cancerby MD Anderson, Memorial Sloan Kettering and other centers
• Brain and spinal cord cancerby Massachusetts General Hospital, Uppsala University and other centers, NRG Oncology
• Hepatocellular carcinoma by NRG Oncology, Chang Gung Memorial Hospital, Loma Linda University
• Lung cancerby Radiation Therapy Oncology Group , Proton Collaborative Group , Mayo Clinic
• Esophageal cancerby NRG Oncology, Abramson Cancer Center, University of Pennsylvania
• Breast cancerby University of Pennsylvania, Proton Collaborative Group
• Pancreatic cancerby University of Maryland, Proton Collaborative Group

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Benefits Of Proton Prostate Cancer Treatment

Proton therapy improves the quality of life for prostate cancer patients and survivors by offering a number of compelling benefits:

• It is non-invasive and therefore painless
• It is more accurate than other kinds of radiation
• Full or higher doses of radiation can be used for treatment without damaging healthy tissues and organs
• Treatment is provided in an outpatient setting
• Proton radiation therapy does not require recovery time
• The treatment has little to no impact on a patients energy level
• Proton therapy poses minimal risk of impotency
• The treatment has lower risk of side effects compared with conventional treatment.

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Why Choose Memorial Sloan Kettering For Proton Therapy

• MSK radiation oncologists have vast experience in using proton therapy. Over the last five years, our specialists have used proton therapy to treat more than 2,000 MSK patients with a range of cancers. This is far more than anyone else in the New York City region. MSKs radiation oncology group has been at the forefront of developing the treatment guidelines and training specialists at other institutions how to properly use protons.
• Patients at MSK are cared for by a multidisciplinary team of cancer experts which includes radiation oncologists, medical physicists, oncologists, and surgeons that is among the most experienced in the world. This team will ensure that each patient receives the optimal treatment for his or her unique case.
• The MSK radiation oncologists who will practice at NYPC specialize in each type of cancer that can be treated effectively with proton therapy.
• Our experts are currently using pencil beam scanning technology, which is the most advanced form of proton therapy delivery. Pencil beam scanning allows proton therapy to be delivered in the most-focused form, reducing exposure to nearby healthy tissues in some cases more than any other form of radiation. The New York Proton Center offers pencil beam scanning with the smallest diameter and highest precision.

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Revolutionary Tumor Radiation Treatment

Precisely delivered within 2 millimeters, our intensity-modulated pencil beam scanning technology, offered in all five treatment rooms, releases a high dose of cancer-killing radiation that conforms precisely to the unique shape and size of the tumor. This highly targeted technology attacks the tumor with laser-like precision, while sparing surrounding healthy tissues and organs.

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Spaceoar Hydrogel: Reducing Radiation Exposure

The prostate and rectum are located very close to each other and are separated only by a small space. When undergoing proton therapy for prostate cancer, your doctor will determine if you are eligible for placement of a special hydrogel between the prostate and rectum . The SpaceOAR hydrogel creates additional space between the prostate and the rectum to further reduce radiation exposure to the rectum, thereby minimizing unwanted side effects and potential injury to the rectum during treatment. More than 50,000 patients worldwide have been successfully treated with SpaceOAR Hydrogel.

The placement of the hydrogel is a minimally invasive procedure done within our center and the hydrogel remains inside the body throughout treatment. The material that the SpaceOAR Hydrogel is made from has been used in other implants such as surgical sealants used in the eye, brain and spine. The biodegradable material naturally dissolves after a few months and is cleared in your urine.