Proton Therapy for Prostate Cancer: Challenges and Opportunities
The dosimetric advantages of proton therapy (PT) treatment plans are demonstrably superior to photon-based external beam radiotherapy (EBRT) for localized prostate cancer, but the reported clinical outcomes are similar. This may be due to inadequate dose prescription, especially in high-risk disease...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-02-01
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| Series: | Cancers |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6694/14/4/925 |
| _version_ | 1797482080749223936 |
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| author | Darren M. C. Poon Stephen Wu Leon Ho Kin Yin Cheung Ben Yu |
| author_facet | Darren M. C. Poon Stephen Wu Leon Ho Kin Yin Cheung Ben Yu |
| author_sort | Darren M. C. Poon |
| collection | DOAJ |
| description | The dosimetric advantages of proton therapy (PT) treatment plans are demonstrably superior to photon-based external beam radiotherapy (EBRT) for localized prostate cancer, but the reported clinical outcomes are similar. This may be due to inadequate dose prescription, especially in high-risk disease, as indicated by the ASCENDE-RT trial. Alternatively, the lack of clinical benefits with PT may be attributable to improper dose delivery, mainly due to geometric and dosimetric uncertainties during treatment planning, as well as delivery procedures that compromise the dose conformity of treatments. Advanced high-precision PT technologies, and treatment planning and beam delivery techniques are being developed to address these uncertainties. For instance, external magnetic resonance imaging (MRI)-guided patient setup rooms are being developed to improve the accuracy of patient positioning for treatment. In-room MRI-guided patient positioning systems are also being investigated to improve the geometric accuracy of PT. Soon, high-dose rate beam delivery systems will shorten beam delivery time to within one breath hold, minimizing the effects of organ motion and patient movements. Dual-energy photon-counting computed tomography and high-resolution Monte Carlo-based treatment planning systems are available to minimize uncertainties in dose planning calculations. Advanced in-room treatment verification tools such as prompt gamma detector systems will be used to verify the depth of PT. Clinical implementation of these new technologies is expected to improve the accuracy and dose conformity of PT in the treatment of localized prostate cancers, and lead to better clinical outcomes. Improvement in dose conformity may also facilitate dose escalation, improving local control and implementation of hypofractionation treatment schemes to improve patient throughput and make PT more cost effective. |
| first_indexed | 2024-03-09T22:24:11Z |
| format | Article |
| id | doaj.art-811502c9765648f0bd031e6977489a19 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T22:24:11Z |
| publishDate | 2022-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-811502c9765648f0bd031e6977489a192023-11-23T19:08:39ZengMDPI AGCancers2072-66942022-02-0114492510.3390/cancers14040925Proton Therapy for Prostate Cancer: Challenges and OpportunitiesDarren M. C. Poon0Stephen Wu1Leon Ho2Kin Yin Cheung3Ben Yu4Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong 999077, ChinaMedical Physics Department, Hong Kong Sanatorium & Hospital, Hong Kong 999077, ChinaMedical Physics Department, Hong Kong Sanatorium & Hospital, Hong Kong 999077, ChinaMedical Physics Department, Hong Kong Sanatorium & Hospital, Hong Kong 999077, ChinaMedical Physics Department, Hong Kong Sanatorium & Hospital, Hong Kong 999077, ChinaThe dosimetric advantages of proton therapy (PT) treatment plans are demonstrably superior to photon-based external beam radiotherapy (EBRT) for localized prostate cancer, but the reported clinical outcomes are similar. This may be due to inadequate dose prescription, especially in high-risk disease, as indicated by the ASCENDE-RT trial. Alternatively, the lack of clinical benefits with PT may be attributable to improper dose delivery, mainly due to geometric and dosimetric uncertainties during treatment planning, as well as delivery procedures that compromise the dose conformity of treatments. Advanced high-precision PT technologies, and treatment planning and beam delivery techniques are being developed to address these uncertainties. For instance, external magnetic resonance imaging (MRI)-guided patient setup rooms are being developed to improve the accuracy of patient positioning for treatment. In-room MRI-guided patient positioning systems are also being investigated to improve the geometric accuracy of PT. Soon, high-dose rate beam delivery systems will shorten beam delivery time to within one breath hold, minimizing the effects of organ motion and patient movements. Dual-energy photon-counting computed tomography and high-resolution Monte Carlo-based treatment planning systems are available to minimize uncertainties in dose planning calculations. Advanced in-room treatment verification tools such as prompt gamma detector systems will be used to verify the depth of PT. Clinical implementation of these new technologies is expected to improve the accuracy and dose conformity of PT in the treatment of localized prostate cancers, and lead to better clinical outcomes. Improvement in dose conformity may also facilitate dose escalation, improving local control and implementation of hypofractionation treatment schemes to improve patient throughput and make PT more cost effective.https://www.mdpi.com/2072-6694/14/4/925prostateproton therapymagnetic resonance imaging |
| spellingShingle | Darren M. C. Poon Stephen Wu Leon Ho Kin Yin Cheung Ben Yu Proton Therapy for Prostate Cancer: Challenges and Opportunities Cancers prostate proton therapy magnetic resonance imaging |
| title | Proton Therapy for Prostate Cancer: Challenges and Opportunities |
| title_full | Proton Therapy for Prostate Cancer: Challenges and Opportunities |
| title_fullStr | Proton Therapy for Prostate Cancer: Challenges and Opportunities |
| title_full_unstemmed | Proton Therapy for Prostate Cancer: Challenges and Opportunities |
| title_short | Proton Therapy for Prostate Cancer: Challenges and Opportunities |
| title_sort | proton therapy for prostate cancer challenges and opportunities |
| topic | prostate proton therapy magnetic resonance imaging |
| url | https://www.mdpi.com/2072-6694/14/4/925 |
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