High-level evidence on hypofractionated proton therapy (PT) for localized and locally advanced prostate cancer (PCa) patients is currently missing. The aim of this study is to provide a systematic literature review to compare the toxicity and effectiveness of curative radiotherapy with photon therapy (XRT) or PT in PCa.
PubMed, Embase, and the Cochrane Library databases were systematically searched up to April 2022. Men with a diagnosis of PCa who underwent curative hypofractionated RT treatment (PT or XRT) were included. Risk of grade (G) ≥ 2 acute and late genitourinary (GU) OR gastrointestinal (GI) toxicity were the primary outcomes of interest. Secondary outcomes were five-year biochemical relapse-free survival (b-RFS), clinical relapse-free, distant metastasis-free, and prostate cancer-specific survival. Heterogeneity between study-specific estimates was assessed using Chi-square statistics and measured with the I2 index (heterogeneity measure across studies).
A total of 230 studies matched inclusion criteria and, due to overlapped populations, 160 were included in the present analysis. Significant lower rates of G ≥ 2 acute GI incidence (2 % vs 7 %) and improved 5-year biochemical relapse-free survival (95 % vs 91 %) were observed in the PT arm compared to XRT. PT benefits in 5-year biochemical relapse-free survival were maintained for the moderate hypofractionated arm (p-value 0.0122) and among patients in intermediate and low-risk classes (p-values < 0.0001 and 0.0368, respectively). No statistically relevant differences were found for the other considered outcomes.
The present study supports that PT is safe and effective for localized PCa treatment, however, more data from RCTs are needed to draw solid evidence in this setting and further effort must be made to identify the patient subgroups that could benefit the most from PT.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2024 Mar 30 [Epub ahead of print]
Giulia Corrao, Giulia Marvaso, Federico Mastroleo, Annalisa Biffi, Giacomo Pellegrini, Samuele Minari, Maria Giulia Vincini, Mattia Zaffaroni, Dario Zerini, Stefania Volpe, Simona Gaito, Giovanni Carlo Mazzola, Luca Bergamaschi, Federica Cattani, Giuseppe Petralia, Gennaro Musi, Francesco Ceci, Ottavio De Cobelli, Roberto Orecchia, Daniela Alterio, Barbara Alicja Jereczek-Fossa
Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy., Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy., Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy; Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy., National Centre of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy., Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy. Electronic address: ., Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK; Division of Clinical Cancer Science, School of Medical Sciences, The University of Manchester, Manchester, UK., Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy., Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy., Division of Urology, European Institute of Oncology IRCCS, Milan, Italy., Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Nuclear Medicine and Theranostics, IEO European Institute of Oncology, IRCCS, Milan, Italy., Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Urology, European Institute of Oncology IRCCS, Milan, Italy., Scientific Directorate, European Institute of Oncology IRCCS, Milan, Italy.