Prostate Cancer Treatment with Pencil Beam Proton Therapy Using Rectal Spacers sans Endorectal Balloons
Purpose: Proton beam radiotherapy (PBT) has been used for the definitive treatment of localized prostate cancer with low rates of high-grade toxicity and excellent patient-reported quality-of-life metrics. Technological advances such as pencil beam scanning (PBS), Monte Carlo dose calculations, and...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-04-01
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| Series: | International Journal of Particle Therapy |
| Subjects: | |
| Online Access: | https://theijpt.org/doi/pdf/10.14338/IJPT-21-00039 |
| _version_ | 1827160216728240128 |
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| author | Matthew Forsthoefel, MD Ryan Hankins, MD Elizabeth Ballew, BS Cara Frame, MS David DeBlois, BS Dalong Pang, PhD Pranay Krishnan, MD Keith Unger, MD Keith Kowalczyk, MD John Lynch, MD Anatoly Dritschilo, MD Sean P. Collins, MD PhD Jonathan W. Lischalk, MD |
| author_facet | Matthew Forsthoefel, MD Ryan Hankins, MD Elizabeth Ballew, BS Cara Frame, MS David DeBlois, BS Dalong Pang, PhD Pranay Krishnan, MD Keith Unger, MD Keith Kowalczyk, MD John Lynch, MD Anatoly Dritschilo, MD Sean P. Collins, MD PhD Jonathan W. Lischalk, MD |
| author_sort | Matthew Forsthoefel, MD |
| collection | DOAJ |
| description | Purpose: Proton beam radiotherapy (PBT) has been used for the definitive treatment of localized prostate cancer with low rates of high-grade toxicity and excellent patient-reported quality-of-life metrics. Technological advances such as pencil beam scanning (PBS), Monte Carlo dose calculations, and polyethylene glycol gel rectal spacers have optimized prostate proton therapy. Here, we report the early clinical outcomes of patients treated for localized prostate cancer using modern PBS–PBT with hydrogel rectal spacing and fiducial tracking without the use of endorectal balloons.
Materials and Methods: This is a single institutional review of consecutive patients treated with histologically confirmed localized prostate cancer. Prior to treatment, all patients underwent placement of fiducials into the prostate and insertion of a hydrogel rectal spacer. Patients were typically given a prescription dose of 7920 cGy at 180 cGy per fraction using a Monte Carlo dose calculation algorithm. Acute and late toxicity were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE), version 5. Biochemical failure was defined using the Phoenix definition.
Results: From July 2018 to April 2020, 33 patients were treated (median age, 75 years). No severe acute toxicities were observed. The most common acute toxicity was urinary frequency. With a median follow-up of 18 months, there were no high-grade genitourinary late toxicities; however, one grade 3 gastrointestinal toxicity was observed. Late erectile dysfunction was common. One treatment failure was observed at 21 months in a patient treated for high-risk prostate cancer.
Conclusion: Early clinical outcomes of patients treated with PBS–PBT using Monte Carlo–based planning, fiducial placement, and rectal spacers sans endorectal balloons demonstrate minimal treatment-related toxicity with good oncologic outcomes. Rectal spacer stabilization without the use of endorectal balloons is feasible for the use of PBS– PBT. |
| first_indexed | 2024-04-12T12:47:30Z |
| format | Article |
| id | doaj.art-b05bc101a88c4657b6b1df3541218f5e |
| institution | Directory Open Access Journal |
| issn | 2331-5180 |
| language | English |
| last_indexed | 2025-03-21T00:09:30Z |
| publishDate | 2022-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Particle Therapy |
| spelling | doaj.art-b05bc101a88c4657b6b1df3541218f5e2024-08-03T09:58:35ZengElsevierInternational Journal of Particle Therapy2331-51802022-04-0191284110.14338/IJPT-21-00039i2331-5180-9-1-28Prostate Cancer Treatment with Pencil Beam Proton Therapy Using Rectal Spacers sans Endorectal BalloonsMatthew Forsthoefel, MD0Ryan Hankins, MD1Elizabeth Ballew, BS2Cara Frame, MS3David DeBlois, BS4Dalong Pang, PhD5Pranay Krishnan, MD6Keith Unger, MD7Keith Kowalczyk, MD8John Lynch, MD9Anatoly Dritschilo, MD10Sean P. Collins, MD PhD11Jonathan W. Lischalk, MD121 Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.2 Department of Urology, Georgetown University Hospital, Washington, DC, USA.1 Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.1 Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.1 Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.1 Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.3 Department of Radiology, Georgetown University Hospital, Washington, DC, USA.1 Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.2 Department of Urology, Georgetown University Hospital, Washington, DC, USA.2 Department of Urology, Georgetown University Hospital, Washington, DC, USA.1 Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.1 Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.4 Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital – Long Island, New York, NY, USAPurpose: Proton beam radiotherapy (PBT) has been used for the definitive treatment of localized prostate cancer with low rates of high-grade toxicity and excellent patient-reported quality-of-life metrics. Technological advances such as pencil beam scanning (PBS), Monte Carlo dose calculations, and polyethylene glycol gel rectal spacers have optimized prostate proton therapy. Here, we report the early clinical outcomes of patients treated for localized prostate cancer using modern PBS–PBT with hydrogel rectal spacing and fiducial tracking without the use of endorectal balloons. Materials and Methods: This is a single institutional review of consecutive patients treated with histologically confirmed localized prostate cancer. Prior to treatment, all patients underwent placement of fiducials into the prostate and insertion of a hydrogel rectal spacer. Patients were typically given a prescription dose of 7920 cGy at 180 cGy per fraction using a Monte Carlo dose calculation algorithm. Acute and late toxicity were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE), version 5. Biochemical failure was defined using the Phoenix definition. Results: From July 2018 to April 2020, 33 patients were treated (median age, 75 years). No severe acute toxicities were observed. The most common acute toxicity was urinary frequency. With a median follow-up of 18 months, there were no high-grade genitourinary late toxicities; however, one grade 3 gastrointestinal toxicity was observed. Late erectile dysfunction was common. One treatment failure was observed at 21 months in a patient treated for high-risk prostate cancer. Conclusion: Early clinical outcomes of patients treated with PBS–PBT using Monte Carlo–based planning, fiducial placement, and rectal spacers sans endorectal balloons demonstrate minimal treatment-related toxicity with good oncologic outcomes. Rectal spacer stabilization without the use of endorectal balloons is feasible for the use of PBS– PBT.https://theijpt.org/doi/pdf/10.14338/IJPT-21-00039prostate cancerradiation therapyproton therapyrectal spacerendorectal balloon |
| spellingShingle | Matthew Forsthoefel, MD Ryan Hankins, MD Elizabeth Ballew, BS Cara Frame, MS David DeBlois, BS Dalong Pang, PhD Pranay Krishnan, MD Keith Unger, MD Keith Kowalczyk, MD John Lynch, MD Anatoly Dritschilo, MD Sean P. Collins, MD PhD Jonathan W. Lischalk, MD Prostate Cancer Treatment with Pencil Beam Proton Therapy Using Rectal Spacers sans Endorectal Balloons International Journal of Particle Therapy prostate cancer radiation therapy proton therapy rectal spacer endorectal balloon |
| title | Prostate Cancer Treatment with Pencil Beam Proton Therapy Using Rectal Spacers sans Endorectal Balloons |
| title_full | Prostate Cancer Treatment with Pencil Beam Proton Therapy Using Rectal Spacers sans Endorectal Balloons |
| title_fullStr | Prostate Cancer Treatment with Pencil Beam Proton Therapy Using Rectal Spacers sans Endorectal Balloons |
| title_full_unstemmed | Prostate Cancer Treatment with Pencil Beam Proton Therapy Using Rectal Spacers sans Endorectal Balloons |
| title_short | Prostate Cancer Treatment with Pencil Beam Proton Therapy Using Rectal Spacers sans Endorectal Balloons |
| title_sort | prostate cancer treatment with pencil beam proton therapy using rectal spacers sans endorectal balloons |
| topic | prostate cancer radiation therapy proton therapy rectal spacer endorectal balloon |
| url | https://theijpt.org/doi/pdf/10.14338/IJPT-21-00039 |
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