Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Urol Oncol. 2019 Sep;37(9):628-636. doi: 10.1016/j.urolonc.2018.11.012. Epub 2018 Dec 4.
Men diagnosed with localized prostate cancer have many curative treatment options including several different radiotherapeutic approaches. Proton radiation is one such radiation treatment modality and, due to its unique physical properties, offers the appealing potential of reduced side effects without sacrificing cancer control. In this review, we examine the intriguing dosimetric rationale and theoretical benefit of proton radiation for prostate cancer and highlight the results of preclinical modeling studies. We then discuss the current state of the clinical evidence for proton efficacy and toxicity, derived from both large claim-based datasets and prospective patient-reported data. The result is that the data are mixed, and clinical equipoise persists in this area. We place these studies into context by summarizing the economics of proton therapy and the changing practice patterns of prostate proton irradiation. Finally, we await the results of a large prospective randomized clinical trial currently accruing and also a large prospective pragmatic comparative study which will provide more rigorous evidence regarding the clinical and comparative effectiveness of proton therapy for prostate cancer.
被诊断为局限性前列腺癌的患者有许多治疗方法，包括几种不同的放射治疗方法。质子放射治疗是一种放射治疗方法，由于其独特的物理特性，具有降低副作用的吸引力，而不会牺牲癌症控制。在这篇综述中，我们研究了质子放射治疗前列腺癌的令人感兴趣的剂量学原理和理论益处，并强调了临床前模型研究的结果。然后，我们讨论了来自大型基于索赔的数据集和前瞻性患者报告数据的质子疗效和毒性的当前临床证据的状态。结果是数据混杂，该领域的临床均衡仍然存在。我们通过总结质子治疗的经济学和前列腺质子照射的实践模式变化，将这些研究置于上下文中。最后，我们正在等待目前正在进行的一项大型前瞻性随机临床试验的结果，以及一项大型前瞻性实用比较研究的结果，该研究将提供关于质子治疗前列腺癌的临床和比较有效性的更严格证据。
