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    Proton beam therapy delivered using pencil beam scanning vs. passive scattering/uniform scanning for localized prostate cancer: Comparative toxicity analysis of PCG 001-09

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    Author
    Mishra, M.V.
    Khairnar, R.
    Bentzen, S.M.
    Date
    2019
    Journal
    Clinical and Translational Radiation Oncology
    Publisher
    Elsevier Ireland Ltd
    Type
    Article
    
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    https://doi.org/10.1016/j.ctro.2019.08.006
    Abstract
    Background and purpose: Patient-level benefits of proton beam therapy (PBT) relative to photon therapy for prostate cancer (PC) continue to be the focus of debate. Although trials comparing the two modalities are underway, most are being conducted using “conventional” PBT (passive scattering/uniform scanning [PS/US]) rather than pencil beam scanning (PBS). The dosimetric benefits of PBS are well-known, but comparative data are limited. This analysis compares PBS toxicity rates with those of PS/US in a prospective multicenter registry. Methods: We evaluated acute/late gastrointestinal (GI) and genitourinary (GU) toxicity rates for men with low-to-intermediate risk PC enrolled in PCG 001-09. Acute toxicities with the two techniques were compared using χ2 tests, and the cumulative incidence methods for late toxicity. Multivariable analyses (MVAs) for acute toxicity were performed using logistic regression, and cox proportional hazards models for late toxicity. Results: Patients were treated using PS/US (n = 1105) or PBS (n = 238). Acute grade ≥2 GI toxicity in PBS did not significantly differ from that with PS/US (2.9% and 2.1%, respectively; P = 0.47). Acute grade ≥2 GU toxicity was significantly higher with PBS (21.9% and 15.1%; P < 0.01). In MVA, PBS was significantly associated with increased acute grade ≥2 GU toxicity (RR = 1.57, p < 0.001). Late grade ≥2 GI and GU toxicities did not differ significantly between groups. Conclusions: This is the first multi-institutional comparative effectiveness evaluation of PBT techniques in PC. Differences in acute GU toxicity warrant further evaluation, and highlight the urgent need for prospective data using PBT. © 2019 The Authors
    Sponsors
    This research was funded through an American Society of Radiation Oncology Comparative Effectiveness Grant and was presented at the 2018 American Society of Radiation Oncology Annual Meeting. Appendix A
    Keyword
    Comparative effectiveness, Toxicity
    Passive scattering, uniform scanning
    Pencil beam scanning
    Prostate cancer
    Proton therapy
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85072730630&doi=10.1016%2fj.ctro.2019.08.006&partnerID=40&md5=09537119d2de04db6a733abd5c60b15f; http://hdl.handle.net/10713/11053
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ctro.2019.08.006
    Scopus Count
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    UMB Open Access Articles 2019

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