Technical Delivery Of Proton Therapy
A minimum standard of treatment delivery must be followed to ensure the accuracy and effectiveness of proton therapy for prostate cancer. The goals of delivery should be to overcome 3 fundamental radiation therapy challenges: to minimize uncertainty regarding the precise location of the target during beam exposure, to maximize target coverage, and to minimize radiation exposure to organs at risk.
Although intrafraction and interfraction variability must be accounted for with both proton- and photon-based treatment planning, there is a proton-specific uncertainty called range uncertainty, which refers to the effect on the proton beam range that the slight variations in prostate position may have on the composition of tissues in the beam path. Range uncertainty is based on modeling studies and includes the addition of a margin to the proximal and distal edge of the target.
When Will Proton Beam Therapy Be Available To Nhs Patients In The Uk
Proton beam therapy has been available to UK patients since 2008 through the NHS-funded overseas programme, and The Clatterbridge Cancer Centre has treated patients with rare eye cancers with low-energy protons for many years.
The Christie is the first NHS high-energy PBT centre in the UK as part of a £250m programme for a national PBT service. A second PBT centre is also currently being built at University College London Hospitals NHS Foundation Trust. The new facility is due to open in 2020 with the PBT service ramping up in 2021.
Comparative Studies Of Patient
A few retrospective comparisons have been published evaluating toxicity and patient-reported QOL for patients treated with photon or proton beam radiation. The results have been mixed with some studies finding that PT reduces the risk for acute side effects of radiation therapy, as well as bowel frequency and urgency in comparison to photon based radiation, while other studies suggest that PT yields equivalent or worse outcomes. For example, Gray et al. evaluated 3-dimensional conformal photon radiation, IMRT, and PT using prospectively collected patient-reported QOL data . In the first 3 months of follow-up, the authors reported worse patient-reported QOL in the bowel/rectal, urinary irritative/obstruction, and incontinence domains for patients treated with 3D conformal radiotherapy and IMRT when compared to patients treated with PT however, by 12 and 24 months of follow-up, no significant differences in patient-reported QOL were seen among the three groups.
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My Father Underwent Proton
My father underwent Proton Treamtent at Loma Linda back in 1997. He is doing fine today with no cancer reccurance.At time of treatment his was an overall Gleason 6. They gave him both Proton treatments and then some regular radiation treatments at Loma Linda. This was in the early days of proton and they were trying different methods to determine what worked best.
His sides effects at the time were urgent, frequent need to urinate. Mucus discharge from the bowell, tiredness and about 5 years post treatment the loss of erection ability. He will turn 80 this August.
Was it the proton center that made the reccomendation to you?
Larry
What Is Proton Therapy For Prostate Cancer
Proton therapy for prostate cancer is a treatment option that involves using a focused ray of proton particles to destroy cancerous tissues. The treatment is capable of delivering precise, high doses of radiation to accurately target cancer cells without causing damage to healthy tissue surrounding the prostate.
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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Proton Therapy Success Stories
Its one thing to hear about the success rate of proton therapy treatment for prostate cancer. Its another thing to hear the success stories straight from the mouths of survivors.
Walter Knight, an Army pilot, biker, and all around adventurer, was diagnosed with prostate cancer only six weeks after being prescribed testosterone for his anemia.
There are unending volumes in thousands of books that attempt to describe the kaleidoscope of feelings and emotions that follow a diagnosis of metastatic cancer, said Knight in his journal entitled the Proton Chronicles. Im sure that like many, I attempted to rationalize or even justify the situation, but when faced with real mortality, your life and that of your family is forever altered.
After considering surgery and consulting multiple online forums, Knight finally decided on proton therapy to treat his cancer. Over the course of 20 hypofractionated treatments, Knight continued to bike on his favorite trails and play hockey in the local ice rink.
Its really kind of difficult to get your head around the whole situation, said Knight about his proton treatment. This is happening at the cellular level and its absolutely painless.
Earl Malpass, a mission pilot and pastor, also received proton therapy after being diagnosed with prostate cancer. Malpass, whos lived in Alaska for over 15 years with his wife, Lynn, chose to seek medical care in other states after receiving his diagnosis.
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.
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Proton Therapy Advantages And Disadvantages
Proton radiation may represent an incremental improvement over IMRT due to the reduced exposure of surrounding normal body tissues to radiation. Therefore, in the situations outlined above where IMRT would normally be considered, men may prefer to choose proton radiation over IMRT. The purported advantages of proton radiation over IMRT remain theoretical and clinically unproven. No head to head studies comparing the IMRT and proton radiation exist.
Disadvantages associated with proton radiation are related to its high cost and the fact that not all insurance programs cover proton radiation. In addition, there are relatively few centers doing proton radiation, so geographic inconvenience can be a major factor considering that numerous visits are required over a 5 to 9-week period.
Men considering treatment for prostate cancer need to do their homework. Side effects from radiation can be irreversible. The selection of optimal radiation varies with patient circumstances. Many factors need to be considered when radiation is contemplated.
An Alternative To Traditional Prostate Cancer Treatment
Proton radiation for prostate cancer delivers precise doses of radiation with a lower risk of side effects. The difference is in the protons themselves. Since physicians have greater control over the distribution of the proton radiation dose, higher, more effective doses can be used.
And since proton therapy lacks an exit dose, and has a lower entrance dose than conventional X-rays, damage to critical tissue near the prostate is reduced, potentially lessening the likelihood of prostate cancer side effects like impotence, incontinence and gastrointestinal disorders. The figure to the right demonstrates the difference in radiation dose distribution between a conventional IMRT plan on the bottom and a proton plan on the top.
As apparent, much less of the pelvis is exposed to radiation with the proton plan, likely leading to a lower risk of secondary cancers in prostate cancer survivors. Also apparent is a lower dose of radiation to the rectum, which may lead to a lower risk of rectal injury with proton therapy.
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What Is Proton Beam Therapy
Proton beam therapy is a relatively new type of radiotherapy that uses tiny, high energy particles, so-called protons to target and kill cancer cells. It reduces the damage to surrounding healthy tissues and vital organs which is why certain groups of people such as young children or people whose cancer is close to vital organs benefit from the treatment. However, for other groups of patients or types of cancer, there has been little evidence of significantly improved treatment benefits, such as better cancer control and reduced side effects, than compared to conventional radiotherapy treatment.
Safety And Efficacy Of Proton Therapy
Many people with locally advanced cancers are treated with a combination of chemotherapy and either traditional or proton radiation. For patients getting chemotherapy and radiation at the same time, finding ways to limit side effects without making the treatment less effective is a high priority, Dr. Baumann said.
He and his colleagues analyzed data from nearly 1,500 adults with 11 different types of cancer. All participants had received simultaneous chemotherapy plus radiation at the University of Pennsylvania Health System between 2011 and 2016 and had been followed to track side effects and cancer outcomes, including survival. Almost 400 had received proton therapy and the rest received traditional radiation.
Those who received proton therapy experienced far fewer serious side effects than those who received traditional radiation, the researchers found. Within 90 days of starting treatment, 45 patients in the proton therapy group and 301 patients in the traditional radiation group experienced a severe side effectthat is, an effect severe enough to warrant hospitalization.
In addition, proton therapy didnt affect peoples abilities to perform routine activities like housework as much as traditional radiation. Over the course of treatment, performance status scores were half as likely to decline for patients treated with proton therapy as for those who received traditional radiation.
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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.
Possible Side Effects Of Ebrt
Some of the side effects from EBRT are the same as those from surgery, while others are different.
Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.
Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.
Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.
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Who Are They Looking For
This study is looking for people who have been diagnosed with adenocarcinoma of the prostate within the last year. Only patients with early stage tumors will be accepted.
Patients with cancer spread beyond the prostate, who already underwent surgery, radiation therapy or chemotherapy cannot take part in this trial. Patients who received hormone therapy will also be excluded. Other conditions, such as autoimmune diseases , HIV infection, inflammatory bowel disease and previous hip replacement surgery also represent exclusion criteria.
Ideas For Future Studies Of Proton Therapy
Despite the studys limitations, these intriguing findings raise questions that should inform future prospective phase 3 trials, Dr. Buchsbaum said, although there are barriers to large studies of proton therapy.
For instance, it is particularly encouraging that proton therapy appeared to be safer in a group of older and sicker patients who typically experience more side effects, Dr. Baumann noted.
Dr. Buchsbaum agreed that proton therapy may be especially helpful for older and sicker patients, but he noted that ongoing phase 3 trials were not designed to analyze this group of patients.
And because proton therapy may cause fewer side effects, future trials could also explore whether combining proton therapy with chemotherapy might be more tolerable for patients, the authors wrote.
For example, both chemotherapy and traditional radiation for lung cancer can irritate the esophagus, making it painful and difficult for patients to eat. But proton therapy might limit damage to the esophagus, making it easier for a patient to tolerate the combination, Dr. Baumann explained.
Future studies could also explore whether combining proton therapy with higher doses of chemotherapy might increase cures without causing more side effects, he added.
Dr. Buchsbaum agreed, saying that it would be worthwhile to explore this possibility. Just asking the question: Is more effective? might not be giving it a fair opportunity to demonstrate its benefit to society, he said.
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Proton Vs Photon Radiation
Proton radiation is different from other types of radiation, which rely on photons. Photon radiation comes in three types: intensity-modulated radiation therapy , radioactive seed radiation , and stereotactic body radiation therapy . Sometimes a combination of brachytherapy in conjunction with one of the other types of beam radiation is used.
All types of radiation are effective, resulting in the death of cancer cells. All can potentially cause side effects if the radiation touches adjacent normal organs, such as the bladder, rectum, and urethra.
Proton Therapy Vs Traditional Radiation Therapy
So, what makes proton therapy so much more successful than other prostate cancer treatments? The answer lies in the protons themselves.
Unlike proton therapy, traditional radiation treatment uses photons, which deliver low levels of radiation to the cancer tissues. These lower levels of radiation, in addition to the lower mass of the beam in comparison to a proton treatment, mean the radiation will cause damage to both the cancerous tissue and the surrounding healthy tissue.
On the other hand, proton therapy uses positively charged subatomic particles called protons, which are located in the nucleus of an atom. Because the mass of the proton beam is higher than the photon beam, a clinician can control the proton radiation in the patients body. The electrons in the patients body slow down the protons delivered from the beam. This results in an energy release that can destroy cancerous tissue, but avoid unnecessary radiation to surrounding areas. Unlike traditional 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.
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I Am A Uk Resident Living In One Of The Devolved Administrations Can I Receive Nhs Funded Proton Beam Therapy At The Christie
The NHS in England is a residence-based system, unlike many other countries, which have insurance-based healthcare systems. This means that visitors to England may have to pay for NHS healthcare, depending on their circumstances.
The devolved administrations, Scotland, Wales and Northern Ireland can access proton beam therapy at The Christie if the respective administrations approve it.
Further information can be found at NHS Choices.
Proton Therapy Vs Traditional Radiation
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. Compared to conventional treatment, proton therapy can deliver high radiation doses to the lymph nodes while better sparing the healthy bowel and bladder.
Additionally, prostate tumors treated with proton therapy reduce the risks of secondary cancers in the treated areas. Proton therapy is also effective in treating patients with prostate cancer that has returned after previous radiation therapy or prostatectomy.
Proton therapy is outpatient, noninvasive and totally painless. The majority of patients continue on as normal, without having their quality of life throughout treatment impacted by their proton therapy. Entire treatment courses in only five days with proton SBRT and novel clinical trials are offered to appropriate candidates.
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Comparative Studies Of Proton Therapy Versus Photon
Hoppe et al compared prospectively collected patient-reported QOL data for patients treated with proton therapy or photon radiation therapy for localized prostate cancer. The investigators analyzed prospective patient-reported QOL data from men with prostate cancer who received high-dose photon-based therapy through the PROST-QA study. Those patients were treated with IMRT and received doses between 75.6 and 79.2 Gy delivered at 1.8 to 2 Gy per fraction. Patients treated with proton therapy were from a single institution , and patient-reported outcomes were measured prospectively as well as after radiation therapy of 78 to 82 GyRBE delivered at 1.8 to 2 GyRBE per fraction. At 2 years of follow-up, there were no differences in EPIC bowel, urinary irritative/obstructive, or sexual summary scores between the 2 groups. On multivariate analysis, the patients treated with IMRT had significantly more moderate or big problems with rectal urgency and bowel frequency than did those treated with proton therapy.