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Trikalinos TA, Terasawa T, Ip S, et al. Particle Beam Radiation Therapies for Cancer [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2009 Nov. (Comparative Effectiveness Technical Briefs, No. 1.)
Summary TableSummary of the 8 items of section C per type of cancer
| Cancer Type, Histology Ocular | Patient populations | Available study types | Instrumentation and algorithms | Characteristics of particle beam (range of means or medians) [doses in GyE] | Prior or concurrent interventions | Efficacy (number of studies reporting outcome) | Serious harms (excluding those attributed to cointerventions by authors) |
|---|---|---|---|---|---|---|---|
| Ocular | |||||||
| Uveal melanoma (melanoma of the choroid, ciliary body, iris) | Ages: 35-66 Males: 20–64 Enrolled: 1975–2006 Variety of locations and sizes – metastasis a baseline and bilateral location excluded in most | 11 centers 91 studies Non-comparative: 4 P: n=50–2645 81 R: n=14–1922 Comparative, RCT (3): Sizes: 136–188 Higher (70 GyE) vs lower (50 GyE) proton dose Protons + laser TTT vs protons He ions vs I-125 Comparative, nonRCT (7): Sizes: 56–1272 Proton vs enucleation Proton vs I-125 or Ru-106 Proton vs Proton + laser TTT He ion vs I-125 | No details on instrumentation No details on algorithms Other: Use of tantalum markers to demarcate tumor on the sclera Specialized software (EYEPLAN) | Protons (68), He (21), Carbon (2): Dose: 45–80 (majority 60–70) Fractions: 4–5 Unit dose: 13–16 Duration: 1–2 wk | Prior Tx: Surgical excision (1) Proton or photon RT (1) Concurrent Tx: TTT (1) | Follow-up: Survival: OS (40); CSS (37) Local control (37): Local control, recurrence, response to Tx Other (24): Metastasis Eye retention Visual loss Visual acuity Tumor size | [Most studies do not explicitly distinguish acute from late] Late: Enucleation (secondary to complications) Neovascular glaucoma Rubeosis iridis Radiation maculopathy Radiation papillopathy Cataract Phthisis bulbi |
| Head and neck | |||||||
| chordoma, chondrosarcoma, or chondroid cancer | Ages: 13–66 Males: 34–73% Enrolled: 1974–2005 Various: previously treated & untreated; chordoma, chondrosarcoma, also a few meningioma, osteosarcoma, & others | 8 centers 33 studies Non-comparative: 2 P: n=37, 67 28 R: n=10–223 Comparative: 1 RCT(different doses): n=96 | Most studies report using “treatment planning system” | He (1); proton (21); C (7); Ne or C or He or Si (2); ND (2) Dose: 45–74 Fractions: 8–57 Unit dose: 1.4 to 4 Duration: 3–12 wk | Prior Tx: surgery (11); Photon (2); ND (20) Concurrent Tx: photon (9); surgery (5); ND (18) | Follow-up: 972 mo Survival: OS (26); CSS (18); ND (6) Local control: (24); ND (9) | Acute: moderate hearing loss; gr 3 mucositis Late: brain edema, cranial nerve deficit, fat necrosis, hemiparesis, visual loss, osteitis, basilar artery injury, pituitary dysfunction, fatal complications, seizure, radiation necrosis of brain stem, radiation transaction of the cord, short-term memory loss, somnolence, depression, severe hearing loss, ↓psychomotor performance, temporal muscle fibrosis, brain ulceration, optic neuropathy, breast cancer |
| glial cell tumor (astrocytoma, glioblastoma multiforme) | Ages: 6–55 Males: 41–71% Enrolled: 1977–2002 Various: previously treated & untreated; astrocytoma, glioblastoma multiforme, glioma, also a few meningioma | 4 centers 9 studies Non-comparative: 2 P: n=20, 48 6 R: n=7-93 Comparative: 1 RCT(different doses): n=15 | Most studies report using “treatment planning system” | Proton (7); C (1) Dose: 54–77 Fractions: 33–77 Unit dose: 1.4 to 4 Duration: 7–10 wk | Prior Tx: chemo (2); Photon (2) Concurrent Tx: photon (6); surgery (3) | Follow-up: 5 39 mo Survival: OS (6); CSS (5); ND (1) Local control: (5); ND (3) | Acute: gr 3 thrombocytopenia, gr 4 neurologic findings (minor?), gr 3 acute otitis media Late: radiation necrosis requiring surgery, seizure, cataract, pituitary deficiency, Moyamoya disease |
| Other head & neck (including oropharyngeal but not ocular) tumors | Ages: 12–65 Males: 22–74% Enrolled: 1973–2005 neuroblastoma, melanoma, liposarcoma, malignant meningioma, squamous, adenocystic, neuroendocrine, mesenchymal tumor | 6 centers 15 studies Non-comparative: 3 P: n=19–36 11 R: n=14–152 Comparative: Non-randomized (SFRT or IMRT alone vs with carbon particles): n=63 | Most studies report using “treatment planning system” | Proton (8); C (6) Dose: 20–76 Fractions: 11–45 Unit dose: 1.4 to 4 Duration: 6–11 wk | Prior Tx: chemo (2); Surgery (7) Concurrent Tx: photon (4); surgery (1); chemo (5) | Follow-up: 1290 mo Survival: OS (13); CSS (7); ND (2) Local control: (13); ND (2) | Acute: phrenic nerve paralysis, hemianopsia, cognitive deficits, seizure, focal necrosis with mass effect requiring surgery, gr 3 mucositis, tongue ulceration leading to fistula, recurrent bacterial infection & difficulties in wound healing (had reconstruction of orbit with a metal implant prior to radiation Rx) Late: vocal cord paralysis, epiglottitis, brain damage & necrosis, CSF leak with meningitis, visual loss, myelitis, osteonecrosis, esophageal stenosis, paresis, memory loss, pituitary deficiency, seizure, ocular paralysis, hearing loss, cerebellar syndrome, paresis of the trigeminal nerve |
| Spine | |||||||
| Spine & sacral cancer (chordoma (4), glioblastoma (1), others (4)) | Ages: 45–66 Males: 53–86% Enrolled: 1976–2003 Various: previously treated & untreated; chordoma, chondrosarcoma, osteosarcoma, giant cell | 4 centers 9 studies Non-comparative: 1 P: n=23 8 R: n=14–85 Comparative: None | No details on instrumentation No details on algorithms Other: Specialized software (e.g., HIPLAN) | He (1); Ne (1); proton (4); C (1); Ne & He (1); ND (2) Dose: 23–94 Fractions: 16–37 Unit dose: 1.8–4.6 Duration: 4–14 wk | Prior Tx: surgery (3); chemo (1); Photon (2); ND (4) Concurrent Tx: photon (5); surgery (3); ND (2) | Follow-up: 2065 mo Survival: OS (9); CSS (4); ND (1) Local control: (8); ND (2) | Acute: ≥ Gr 3 skin reaction Late: radiation injury leading to colostomy; brain stem, spinal cord, brachial plexus injury; visual complications; enucleation; osteonecrosis; secondary malignancy |
| Gastrointestinal | |||||||
| Gastrointestinal cancer (esophagus (3), pancreas (2), bile duct (2), unspecified (1)) | Ages: 59–74 Males: 32–87% Enrolled: 1975–1998 Various: squamous, adenocarcinoma, well & poorly differentiated | 2 centers 8 studies Non-comparative: 2 P: n=46, 94 3 R: n=11–68 Comparative: RCT (1): [Pancreas] He RT vs photon RT: 49 non-RCT (2): [Bile duct] Surgery + Photon RT vs Surgery + Proton RT: 22 [Bile duct] Photon RT vs Proton RT: 62 | No details on instrumentation No details on algorithms Other: Use of iridium markers to facilitate better localization of tumor Specialized software (e.g., LBL’s treatment planning system) | He (3); proton (2); Ne & He (2) Dose: 32–81 Fractions: 30–32 Unit dose: 1.8–3.5 Duration: 8–10 wk | Prior Tx: surgery (2); chemo (1); ND (2) Concurrent Tx: chemo (2); photon (2); brachy (2); ND (2) | Follow-up: 7-73 mo Survival: OS (7); CSS (4); ND (1) Local control: (6); ND (2) | Acute: GI bleed; ≥ Gr 3 esophagitis; cytopenia, fibrosis; radiation pneumonitis Late: radiation enteritis requiring surgery; esophageal ulceration requiring IV alimentation |
| Liver, HCC | Ages: 60–81 Males: 54–83% Enrolled: 1985–2006 Patients ineligible for other Tx strategies | 4 centers 13 studies Non-comparative 3 P: n=24, 30, 34 10 R: n=12–162 Comparative None | No details on instrumentation No details on algorithms Other: Use of iridium markers to facilitate better localization of tumor Specialized software (e.g., PT-PLAN/NDOSE, CANVAS 8) | Protons (12) & Carbon (1) Dose: 50–80 Fractions: 15–30 Unit dose: 2.0–9.0 Duration: 3–9 wk | Prior Tx: Surgery (4) TACE (6) PEI (4) Proton RT (2) Ablation (2) Photon RT (1) None (2) ND (5) Concurrent Tx: TACE (2) None (7) ND (4) | Follow-up: 11–71 mo Survival: OS (11); CSS (10) Local control (8): local control rate Other (5) response rate metastasis | Acute: ↓WBC, ↓PLT ↑Total Bilirubin ↑AST/ALT Hepatic failure Late: Infectious biloma Common bile duct stenosis GI bleeding Hepatic failure |
| Pelvis | |||||||
| Prostate cancer Adenocarcinoma | Ages: 67–73 Males: 100% Enrolled: 1972–2004 Patients with T1- 4 +/− regional lymphnode metastasis | 5 centers 19 studies Non-comparative 3 P: n=30–175 10 R: n=16–1255 Comparative, RCT: 3 (n=191–393) Photon RT plus standard dose vs. high-dose proton boost RT Photon RT plus photon boost RT vs. proton boost RT Photon RT plus photon boost RT vs. proton boost RT Comparative, non- RCT: 2 (n=180–185) Photon RT plus photon boost RT vs. proton boost RT Watchful waiting vs. surgery vs. standalone photon RT vs. photon RT plus proton boost RT vs. standalone proton RT | No details on instrumentation No details on algorithms Other: Use of iridium markers to facilitate better localization of tumor Specialized software (e.g., HIPLAN, modified MGH 3-D planning system, FOCUS-M) | Protons (15) & Carbon (4) Dose: 54–80 Fractions: 20–44 Unit dose: 1.8–3.6 Duration: 5–9 wk | Prior Tx: None (12) ND (7) Concurrent Tx: Hormornal (7) Photon RT (13) | Follow-up: 30– 157 mo Survival: OS (8); CSS (6) biochemical disease-free survival (7) Local control (9): local control rate Other (0) | Acute: Proctitis Urinary tract complication (unclear) Late: GI bleeding Cystitis, hematuria, urethral strincture, dysuria) |
| Bladder cancer Transitional and/or squamous cell carcinomas | Ages: 55–72 Males: 80–87% Enrolled: 1985–1999 Various patients with size T2 or greater | 1 center 3 studies Non-comparative: 2 P: n=25, 35 1 R: n=15 Comparative None | ND | Protons (add-on therapy) Dose: 74–85 Fractions: 24–34 Unit dose: 1.8–3.0 Duration: ND | Prior Tx: None (2), ND (1) Concurrent Tx: Resection + photon RT + chemotherapy | Follow-up: 21– 57 mo Survival: OS (3); CSS (3) Local control: (3): Recurrence- free survival, local control rate Other (1): Bladder conservation | Acute: None Late: Macrohematuria requiring surgery |
| Uterine cancer | Ages: 56–64 Males: 0% Enrolled: 1983–2005 Various: both previously treated & untreated patients | 2 centers 5 studies Non-comparative: 2 P: n=31, 44 2 R: n=15, 25 Comparative, non-RCT: 1 Carbon RT vs Photon RT & brachytherapy: 49 | ND | Protons (2) & Carbon (3) Dose: 62–88 Fractions: 24–30 Unit dose: 1.8–4.0 Duration: 6–8 wk | Prior Tx: ND (5) Concurrent Tx: photon (2), ND (3) | Follow-up: 26– 139 mo Survival: OS (4); CSS (3) Local control: (5): Recurrence-free survival, local control rate Other (x): | Acute: None Late: hemorrhagic cystitis needing surgery; intestinal perforation; fistulas (vesico-vaginal, recto- vaginal, sigmoid- vesico) |
| Others | |||||||
| Skin cancers Bowen, oral verrucous carcinoma, squamous cell carcinoma | Ages: 73 Males: 83% Enrolled: ND Refused surgery for primary disease | 1 center 1 study Non-comparative 1 P: n=12 Comparative None | ND | Protons Dose: 55 Fractions: 5 Unit dose: 10 Duration: 1 wk | Prior Tx: None Concurrent Tx: None | Follow-up: 49 mo Survival: OS Local control: Local control rate Other Response rate Metastasis | Acute: Skin erythema Late: Skin ulcer fistula |
| Bone and soft tissue, sarcoma Chordoma, osteosarcoma, nerve sheath tumor, rhabdomyosarcoma, Chondrosarcoma, liposarcoma, and other types | Ages: 4–50 Males: 55–83% Enrolled: 1973–2005 Inoperable patients or metastatic disease | 5 centers 6 studies Non-comparative 14 R: n=12–2371 Comparative None | HIPLAN software (2) Spot-scanning technology (1) ND (3) Immobilization techniques (2) ND (3) | Protons (4) & Carbon (2) Dose: 50–69 Fractions: 16–28 Unit dose: 1.5–3.0 Duration: 4–10 wk | Prior Tx: Chemotherapy (3) Surgery (2) None (1) ND (1) Concurrent Tx: Chemotherapy (2) None (2) ND (2) | Follow-up: 6– 59 mo Survival: OS (5); CSS (3) Local control (4): local control rate Other (nd) | Acute: Grade 1 or 2 Grade 3 or 4 Organ toxicities Late: osteomyelitis panyhypopituitarism & cataract focal frontal lobe necrosis Acute lymphocytic leukemia Failed allograft secondary to infection DVT and ureteral stenosis Radiation recall reaction Symptomatic subcapsular cataract Symptomatic grade 3 brain necrosis |
| Lung, NSCLC Adenocarcinoma, squamous cell carcinoma, or large cell carcinoma | Ages: 71–75 Males: 41–84% Enrolled: 1983–2005 Inoperable patients or refusal of surgery Mostly stage I | 4 centers 17 studies Non-comparative 6 P: n=21–79 11 R: n=13–146 Comparative None | No details on instrumentation No details on algorithms Other: Use of iridium markers to facilitate better localization of tumor Specialized software (e.g., HIPLAN) | Protons (8) & Carbon(9) Dose: 51–98 Fractions: 10–24 Unit dose: 1.8–6.0 Duration: 1–9 wk | Prior Tx: Lung resection (2) Chemotherapy (1) ND (14) Concurrent Tx: None (6) ND (11) | Follow-up: 6– 59 mo Survival: OS (13); CSS (9) Local control (11): local control rate Other (2) response rate metastasis | Acute: Pneumonitis Late: Skin reaction Pulmonary fibrosis Pleural effusion |
| Breast cancer | Ages: 46–75 Males: 0% Enrolled: 2004–2005 Lumpectomized cancers | 2 centers 2 studies Non-comparative: 2 P: both n=20 Comparative None | No details on instrumentation No details on algorithms | Protons Dose: 32–40 Fractions: 4–10 Unit dose: 4.0–8.0 Duration: 1–2 wk | Prior Tx: None (2) Concurrent Tx: Surgery (2) Chemo/hormonal Tx (1) ND (1) | Follow-up: 12 mo Survival: OS (1); CSS (0) Local control (1): local control rate Other (0) | Acute: None Late: None |
- Summary Table - Particle Beam Radiation Therapies for CancerSummary Table - Particle Beam Radiation Therapies for Cancer
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