title: Multi-institutional Phase II study of proton beam therapy for organ-confined prostate cancer focusing on the incidence of late rectal toxicities.
abstract: OBJECTIVE
  Proton beam therapy (PBT) is theoretically an excellent modality for external beam radiotherapy, providing an ideal dose distribution. However, it is not clear whether PBT for prostate cancer can clinically control toxicities. The purpose of the present study was to estimate prospectively the incidence of late rectal toxicities after PBT for organ-confined prostate cancer.
  
  
  METHODS
  The major eligibility criteria included clinical Stage T1-T2N0M0; initial prostate-specific antigen level of ≤20 ng/mL and Gleason score ≤7; no hormonal therapy or hormonal therapy within 12 months before registration; and written informed consent. The primary endpoint was the incidence of late Grade 2 or greater rectal toxicity at 2 years. Three institutions in Japan participated in the present study after institutional review board approval from each. PBT was delivered to a total dose of 74 GyE in 37 fractions. The patients were prospectively followed up to collect the data on toxicities using the National Cancer Institute-Common Toxicity Criteria, version 2.0.
  
  
  RESULTS
  Between 2004 and 2007, 151 patients were enrolled in the present study. Of the 151 patients, 75, 49, 9, 17, and 1 had Stage T1c, T2a, T2b, T2c, and T3a, respectively. The Gleason score was 4, 5, 6, and 7 in 5, 15, 80 and 51 patients, respectively. The initial prostate-specific antigen level was <10 or 10-20 ng/mL in 102 and 49 patients, respectively, and 42 patients had received hormonal therapy and 109 had not. The median follow-up period was 43.4 months. Acute Grade 2 rectal and bladder toxicity temporarily developed in 0.7% and 12%, respectively. Of the 147 patients who had been followed up for >2 years, the incidence of late Grade 2 or greater rectal and bladder toxicity was 2.0% (95% confidence interval, 0-4.3%) and 4.1% (95% confidence interval, 0.9-7.3%) at 2 years, respectively.
  
  
  CONCLUSIONS
  The results of the present prospective study have revealed a valuable piece of evidence that PBT for localized prostate cancer can achieve a low incidence of late Grade 2 or greater rectal toxicities.
authors.affiliation: Radiation Oncology Division, National Cancer Center Hospital East, Kashiwa, Japan. knihei@east.ncc.go.jp
authors.forename: Keiji
authors.initials: K
authors.lastname: Nihei
authors.forename: Takashi
authors.initials: T
authors.lastname: Ogino
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Onozawa
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Murayama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fuji
authors.forename: Masao
authors.initials: M
authors.lastname: Murakami
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Hishikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D061766:Proton Therapy; D011522:Protons / Q000009:adverse effects; D011832:Radiation Injuries / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D012002:Rectal Diseases / Q000209:etiology; D012007:Rectum / Q000528:radiation effects*; D001743:Urinary Bladder / Q000528:radiation effects; D014555:Urination Disorders / Q000209:etiology
chemical_list: D011522:Protons; D017430:Prostate-Specific Antigen