Proton Therapy Updates

APRIL 2020
The aim of this newsletter is to promote knowledge on proton cancer therapy form a cross-disciplinary perspective: from development in equipment to impacts to healthcare.

PROF. DR. FELIPE CALVO MANUEL
DR. DIEGO AZCONA

In this second newsletter, an effort has been made to emphasise the contribution of proton therapy to contemporary Oncology. In the Radiation Physics and Technology section, a model-based system of patient selection and referral for proton therapy is analysed by the Australian Health Authorities. A potential dosimetric benefit is evaluated by comparing dose distribution in treatments using photon radiation (VMAT technique) versus proton radiation (IMPT).

A comprehensive analysis of clinical experiences from the 2016-2018 period (including chordomas, craniopharyngiomas, and ependymomas) showed significant differences in the dosimetric benefit in favour of proton therapy with respect to the relevant parameter for tumour control and long-term quality of life.

Re-irradiation is an increasingly frequent indication for cancer patients with oligometastatic or oligo-recurrent disease. Under these clinical conditions, proton therapy offers a unique opportunity to test an optimised dose distribution to prevent dose summation in normal dose‑sensitive tissues. A systematic review of the clinical data available is selected for the section on clinical Radiation Oncology.

The results of a randomised phase IIb trial involving the use of proton radiation versus IMRT photon therapy in oesophageal cancer, which are available in the cancer sites section, indicate a significant reduction in the incidence of severe adverse effects in the cohort treated with proton radiation.

An interdisciplinary evaluation has shown, for the first time ever, evidence of superior intellectual outcomes in patients with medulloblastomas treated with proton radiation versus IMRT photon radiation. This is a relevant finding, as it proves that a dosimetric benefit significantly impacts the measurable variables involved in human neurocognition.

Prof. Dr. Felipe Calvo Manuel 
Dr. Diego Azcona

Clinica Universidad de Navarra Proton Therapy Unit

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Comparative proton versus photon treatment planning for the Medicare Medical Treatment Overseas Program: The Royal Adelaide Hospital experience

Journal of Medical Imaging and Radiation Oncology 2020

Australia’s first proton beam therapy (PBT) service, The Australian Bragg Centre for Proton Therapy and Research, is scheduled to open in the near future providing PBT for patients closer to home. Patients currently access Commonwealth funding for PBT via the Medicare Medical Treatment Overseas Program (MTOP). Proton versus photon treatment planning is a pre‐requisite for the MTOP application. The Royal Adelaide Hospital (RAH) Department of Radiation Oncology has been providing this since 2016.

We aim to provide a descriptive overview of our proton versus photon treatment planning process, presenting a summary of the comparative planning results and the treatment pathways selected for the patients referred.

The RAH has provided an important service to demonstrate the dosimetric difference between PBT and photon therapy for Australian patients, an important step in supporting the funding of patients for treatment overseas.

Proton beam re-irradiation for gastrointestinal malignancies: a systematic review

Journal of Gastrointestinal Oncology 2020
 
Radiotherapy is part of the standard of care management of most gastrointestinal (GI) cancers. Even with advanced RT, systemic therapy, and surgical techniques, locoregional recurrences or second primary cancers can still occur within previously irradiated fields, which can present challenges in delivering effective and safe treatment.

Options for reirradiation are often limited, but given the favorable dosimetric aspects of proton-beam RT, it may provide an effective and safe re-irradiation option for patients with recurrent or second primary GI cancers.

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

Journal of Clinical Oncology 2020

Proton radiotherapy (PRT) may lessen the neuropsychological risk traditionally associated with cranial radiotherapy for the treatment of pediatric brain tumors by reducing the dose to normal tissue compared with that of photon radiotherapy (XRT).

We examined the change in intellectual scores over time in patients with pediatric medulloblastoma treated with craniospinal PRT versus XRT.

For the authors, this may be the first study to compare intellectual trajectories between pediatric patients treated for medulloblastoma with PRT versus those treated with XRT on comparable, contemporary protocols.

PRT was associated with more favorable intellectual outcomes in most domains compared with XRT, although processing speed emerged as a vulnerable domain for both groups. This study provides the strongest evidence to date of an intellectual sparing advantage with PRT in the treatment of pediatric medulloblastoma.

Randomized Phase IIB Trial of Proton Beam Therapy Versus Intensity-Modulated Radiation Therapy for Locally Advanced Esophageal Cancer

Journal of Gastrointestinal Oncology 2020

Whether dosimetric advantages of proton beam therapy (PBT) translate to improved clinical outcomes compared with intensity-modulated radiation therapy (IMRT) remains unclear. This randomized trial compared total toxicity burden (TTB) and progression-free survival (PFS) between these modalities for esophageal cancer.

In conclusion, for locally advanced esophageal cancer, PBT reduced the risk and severity of AEs compared with IMRT while maintaining similar PFS.