Abstract
BackgroundWe aimed at determining the safety and feasibility of spot-scanning carbon ion radiotherapy (CIRT) for patients with localized prostate cancer.MethodsWe enrolled 118 patients with localized prostate cancer who underwent treatment with spot-scanning CIRT at the Shanghai Proton and Heavy Ion Center (SPHIC) from January 2016 to December 2020. The dose was gradually increased from relative biological effectiveness (RBE)-weighted dose (DRBE) = 59.2–65.6 Gy in 16 fractions. The primary endpoint was the occurrence of acute and late toxicities, while the secondary endpoints were biochemical relapse-free survival (bRFS), distant metastasis-free survival (DMFS), prostate cancer-specific survival (PCSS), and overall survival (OS).ResultsThe median follow-up time was 30.2 months (4.8–62.7 months). Acute grade 1 and 2 genitourinary (GU) toxicities were 15.3% and 18.6%, while acute grade 1 and 2 gastrointestinal (GI) toxicities were 2.5% and 0%, respectively. Late grade 1 and 2 GU toxicities were 4.2% and 1.7%, respectively. No late GI toxicity was observed. Moreover, there were no cases of severe acute or late toxicity (≥ grade 3). No significant association were observed between the factors and the acute GU toxicities, except for clinical target volume (CTV) (p = 0.031) on multivariate analysis. The 2-year bRFS, DMFS, PCSS, and OS were 100%, 100%, 100%, and 98.8%, respectively.ConclusionThe 2-year outcomes were encouraging, providing additional and useful information on the feasibility and safety of spot-scanning CIRT for treating prostate cancer. Thus, we recommend long-term follow-up and prospective multicentered studies to reinforce the role of CIRT in the management of localized prostate cancer.
Highlights
Radiotherapy is a radical treatment option for localized prostate cancer
The purpose of this study was to assess the 2-year toxicity, biochemical relapsefree survival, distant metastasis-free survival (DMFS), prostate cancer-specific survival (PCSS), and overall survival (OS) of the 118 patients treated with Carbon ion radiotherapy (CIRT) in 16 fractions
The number of patients irradiated with an RBEweighted dose of 59.2, 60.8, 62.4, 64.0, and 65.6 Gy was 43 (36.4%), 10 (8.5%), 9 (7.6%), 25 (21.2%), and 31 (26.3%), respectively
Summary
Radiotherapy is a radical treatment option for localized prostate cancer. Randomized studies have demonstrated that doseescalated radiotherapy improves cancer control [1, 2]. If the dose to the prostate can be increased without increasing the dose to the OARs, the treatment outcome and quality of life of patients will be improved. Carbon ion beams produce the Bragg peak through the release of enormous energy at the end of their range [6], maximizing the destructive energy delivered to the tumor site while minimizing unwanted damage to the surrounding normal tissues [7, 8]. These properties make CIRT theoretically efficient in improving tumor control and reducing radiation-related toxicity. We aimed at determining the safety and feasibility of spot-scanning carbon ion radiotherapy (CIRT) for patients with localized prostate cancer
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