Treatment with charged-particle radiation therapy: an overview of systematic reviews_Chinese Journal of Evidence-Based Medicine

Authors：

CHENG Yifan ¹ , JIANG Zixuan ² , FANG Ke ² , LIN Yifei ³ , LONG Youlin ⁴ ,  DU Liang ^1,5 , HUANG Jin ⁴

1. Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. West China School of Public Health, Sichuan University, Chengdu 610041, P.R.China;
3. Precision Medicine Key Laboratory of Sichuan Province & Precision Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
4. Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
5. West China Medical Publishers, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding author：

DU Liang, Email: duliang0606@vip.sina.com

Keywords：

Charged-particle radiation therapy; Proton radiotherapy; Heavy ion radiotherapy; Overview of systematic reviews

DOI：

10.7507/1672-2531.202108172

Video：

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Objective To overview the systematic reviews of the effectiveness and safety of the charged-particle radiation therapy. Methods Databases including CNKI, WanFang Data, PubMed, and EMbase were electronically searched from January 2007 to November 2020. Two investigators independently screened literature, extracted data, and assessed the quality of the included studies by AMSTAR 2, and then reported results through a narrative synthesis of outcomes. Results A total of 6 systematic reviews were identified. One systematic review demonstrated moderate quality and the other 5 demonstrated critically low quality. The charged-particle radiation therapy had a wide range of applications. Its effectiveness was superior to traditional radiotherapy methods on various types of tumors in various regions of the body, with acceptable side effects. Specifically, the effectiveness and safety outcomes of carbon ion radiotherapy was superior to those of proton radiotherapy. Conclusions Current evidence shows that the charged-particle radiation therapy has superior effectiveness and limited toxicity, though the studies are of relatively low quality. High quality and larger sample size researches are required in the future.

Citation： CHENG Yifan, JIANG Zixuan, FANG Ke, LIN Yifei, LONG Youlin, DU Liang, HUANG Jin. Treatment with charged-particle radiation therapy: an overview of systematic reviews. Chinese Journal of Evidence-Based Medicine, 2021, 21(12): 1441-1449. doi: 10.7507/1672-2531.202108172 Copy

1.	International Agency for Research on Cancer World Health Organization. World Cancer Report: Cancer Research for Cancer Prevention. Avaiable at:https://www.iarc.who.int/featured-news/new-world-cancer-report/.
2.	Durante M, Loeffler JS. Charged particles in radiation oncology. Nat Rev Clin Oncol, 2010, 7(1): 37-43.
3.	Schulz-Ertner D, Tsujii H. Particle radiation therapy using proton and heavier ion beams. J Clin Oncol, 2007, 25(8): 953-964.
4.	Rackwitz T, Debus J. Clinical applications of proton and carbon ion therapy. Semin Oncol, 2019, 46(3): 226-232.
5.	Dokic I, Mairani A, Niklas M, et al. Next generation multi-scale biophysical characterization of high precision cancer particle radiotherapy using clinical proton, helium-, carbon- and oxygen ion beams. Oncotarget, 2016, 7(35): 56676-56689.
6.	Mohan R, Grosshans D. Proton therapy - present and future. Adv Drug Deliv Rev, 2017, 109: 26-44.
7.	Debus J, Abdollahi A. For the next trick: new discoveries in radiobiology applied to glioblastoma. Am Soc Clin Oncol Educ Book, 2014: e95-e99.
8.	Mohamad O, Sishc BJ, Saha J, et al. Carbon ion radiotherapy: a review of clinical experiences and preclinical research, with an emphasis on DNA damage/repair. Cancers (Basel), 2017, 9(6): 66.
9.	Peschke P, Karger CP, Scholz M, et al. Relative biological effectiveness of carbon ions for local tumor control of a radioresistant prostate carcinoma in the rat. Int J Radiat Oncol Biol Phys, 2011, 79(1): 239-246.
10.	Chiblak S, Tang Z, Campos B, et al. Radiosensitivity of patient-derived glioma stem cell 3-dimensional cultures to photon, proton, and carbon irradiation. Int J Radiat Oncol Biol Phys, 2016, 95(1): 112-119.
11.	Wilson RR. Radiological use of fast protons. Radiology, 1946, 47(5): 487-491.
12.	Particle Therapy Co-Operative Group. Particle therapy facilities in clinical operation. 2021. Avaiable at: https://www.ptcog.ch/.
13.	Swisher-McClure S, Hahn SM, Bekelman J. Proton beam therapy: the next disruptive innovation in healthcare. Postgrad Med J, 2015, 91(1075): 241-243.
14.	谢俊祥, 张琳. 质子/重离子放射治疗技术及应用. 中国医疗器械信息, 2017, (1): 1-4,35.
15.	Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
16.	Dell'Oro M, Short M, Wilson P, et al. Clinical limitations of photon, proton and carbon ion therapy for pancreatic cancer. Cancers (Basel), 2020, 12(1): 163.
17.	Verma V, Simone CB 2nd, Mishra MV. Quality of life and patient-reported outcomes following proton radiation therapy: a systematic review. J Natl Cancer Inst, 2018, 110(4): 341-353.
18.	Leroy R, Benahmed N, Hulstaert F, et al. Proton therapy in children: a systematic review of clinical effectiveness in 15 pediatric cancers. Int J Radiat Oncol Biol Phys, 2016, 95(1): 267-278.
19.	Verma V, Lin SH, Simone CB, et al. Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: a systematic review. J Gastrointest Oncol, 2016, 7(4): 644-664.
20.	Goetz G, Mitic M, Mittermayr T, et al. Health technology assessment of carbon-ion beam radiotherapy: a systematic review of clinical effectiveness and safety for 54 oncological indications in 12 tumour regions. Anticancer Res, 2019, 39(4): 1635-1650.
21.	Igaki H, Mizumoto M, Okumura T, et al. A systematic review of publications on charged particle therapy for hepatocellular carcinoma. Int J Clin Oncol, 2018, 23(3): 423-433.
22.	Chen CJ, Chivukula S, Ding D, et al. Seizure outcomes following radiosurgery for cerebral arteriovenous malformations. Neurosurg Focus, 2014, 37(3): E17.
23.	Amichetti M, Cianchetti M, Amelio D, et al. Proton therapy in chordoma of the base of the skull: a systematic review. Neurosurg Rev, 2009, 32(4): 403-416.
24.	Mohan R, Liu AY, Brown PD, et al. Proton therapy reduces the likelihood of high-grade radiation-induced lymphopenia in glioblastoma patients: phase II randomized study of protons vs photons. Neuro Oncol, 2021, 23(2): 284-294.
25.	Habl G, Uhl M, Katayama S, et al. Acute toxicity and quality of life in patients with prostate cancer treated with protons or carbon ions in a prospective randomized phase II study-the IPI trial. Int J Radiat Oncol Biol Phys, 2016, 95(1): 435-443.
26.	Pijls-Johannesma M, Pommier P, Lievens Y. Cost-effectiveness of particle therapy: current evidence and future needs. Radiother Oncol, 2008, 89(2): 127-134.
27.	Amin NP, Sher DJ, Konski AA. Systematic review of the cost effectiveness of radiation therapy for prostate cancer from 2003 to 2013. Appl Health Econ Health Policy, 2014, 12(4): 391-408.
28.	Fernandes RRA, Vianna CMM, Guerra RL, et al. Cost-effectiveness of proton versus photon therapy in pediatric medulloblastoma treatment: a patient volume-based analysis. Value Health Reg Issues, 2019, 20: 122-128.
29.	Becerra V, Ávila M, Jimenez J, et al. Economic evaluation of treatments for patients with localized prostate cancer in Europe: a systematic review. BMC Health Serv Res, 2016, 16(1): 541.

1. International Agency for Research on Cancer World Health Organization. World Cancer Report: Cancer Research for Cancer Prevention. Avaiable at:https://www.iarc.who.int/featured-news/new-world-cancer-report/.
2. Durante M, Loeffler JS. Charged particles in radiation oncology. Nat Rev Clin Oncol, 2010, 7(1): 37-43.
3. Schulz-Ertner D, Tsujii H. Particle radiation therapy using proton and heavier ion beams. J Clin Oncol, 2007, 25(8): 953-964.
4. Rackwitz T, Debus J. Clinical applications of proton and carbon ion therapy. Semin Oncol, 2019, 46(3): 226-232.
5. Dokic I, Mairani A, Niklas M, et al. Next generation multi-scale biophysical characterization of high precision cancer particle radiotherapy using clinical proton, helium-, carbon- and oxygen ion beams. Oncotarget, 2016, 7(35): 56676-56689.
6. Mohan R, Grosshans D. Proton therapy - present and future. Adv Drug Deliv Rev, 2017, 109: 26-44.
7. Debus J, Abdollahi A. For the next trick: new discoveries in radiobiology applied to glioblastoma. Am Soc Clin Oncol Educ Book, 2014: e95-e99.
8. Mohamad O, Sishc BJ, Saha J, et al. Carbon ion radiotherapy: a review of clinical experiences and preclinical research, with an emphasis on DNA damage/repair. Cancers (Basel), 2017, 9(6): 66.
9. Peschke P, Karger CP, Scholz M, et al. Relative biological effectiveness of carbon ions for local tumor control of a radioresistant prostate carcinoma in the rat. Int J Radiat Oncol Biol Phys, 2011, 79(1): 239-246.
10. Chiblak S, Tang Z, Campos B, et al. Radiosensitivity of patient-derived glioma stem cell 3-dimensional cultures to photon, proton, and carbon irradiation. Int J Radiat Oncol Biol Phys, 2016, 95(1): 112-119.
11. Wilson RR. Radiological use of fast protons. Radiology, 1946, 47(5): 487-491.
12. Particle Therapy Co-Operative Group. Particle therapy facilities in clinical operation. 2021. Avaiable at: https://www.ptcog.ch/.
13. Swisher-McClure S, Hahn SM, Bekelman J. Proton beam therapy: the next disruptive innovation in healthcare. Postgrad Med J, 2015, 91(1075): 241-243.
14. 谢俊祥, 张琳. 质子/重离子放射治疗技术及应用. 中国医疗器械信息, 2017, (1): 1-4,35.
15. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
16. Dell'Oro M, Short M, Wilson P, et al. Clinical limitations of photon, proton and carbon ion therapy for pancreatic cancer. Cancers (Basel), 2020, 12(1): 163.
17. Verma V, Simone CB 2nd, Mishra MV. Quality of life and patient-reported outcomes following proton radiation therapy: a systematic review. J Natl Cancer Inst, 2018, 110(4): 341-353.
18. Leroy R, Benahmed N, Hulstaert F, et al. Proton therapy in children: a systematic review of clinical effectiveness in 15 pediatric cancers. Int J Radiat Oncol Biol Phys, 2016, 95(1): 267-278.
19. Verma V, Lin SH, Simone CB, et al. Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: a systematic review. J Gastrointest Oncol, 2016, 7(4): 644-664.
20. Goetz G, Mitic M, Mittermayr T, et al. Health technology assessment of carbon-ion beam radiotherapy: a systematic review of clinical effectiveness and safety for 54 oncological indications in 12 tumour regions. Anticancer Res, 2019, 39(4): 1635-1650.
21. Igaki H, Mizumoto M, Okumura T, et al. A systematic review of publications on charged particle therapy for hepatocellular carcinoma. Int J Clin Oncol, 2018, 23(3): 423-433.
22. Chen CJ, Chivukula S, Ding D, et al. Seizure outcomes following radiosurgery for cerebral arteriovenous malformations. Neurosurg Focus, 2014, 37(3): E17.
23. Amichetti M, Cianchetti M, Amelio D, et al. Proton therapy in chordoma of the base of the skull: a systematic review. Neurosurg Rev, 2009, 32(4): 403-416.
24. Mohan R, Liu AY, Brown PD, et al. Proton therapy reduces the likelihood of high-grade radiation-induced lymphopenia in glioblastoma patients: phase II randomized study of protons vs photons. Neuro Oncol, 2021, 23(2): 284-294.
25. Habl G, Uhl M, Katayama S, et al. Acute toxicity and quality of life in patients with prostate cancer treated with protons or carbon ions in a prospective randomized phase II study-the IPI trial. Int J Radiat Oncol Biol Phys, 2016, 95(1): 435-443.
26. Pijls-Johannesma M, Pommier P, Lievens Y. Cost-effectiveness of particle therapy: current evidence and future needs. Radiother Oncol, 2008, 89(2): 127-134.
27. Amin NP, Sher DJ, Konski AA. Systematic review of the cost effectiveness of radiation therapy for prostate cancer from 2003 to 2013. Appl Health Econ Health Policy, 2014, 12(4): 391-408.
28. Fernandes RRA, Vianna CMM, Guerra RL, et al. Cost-effectiveness of proton versus photon therapy in pediatric medulloblastoma treatment: a patient volume-based analysis. Value Health Reg Issues, 2019, 20: 122-128.
29. Becerra V, Ávila M, Jimenez J, et al. Economic evaluation of treatments for patients with localized prostate cancer in Europe: a systematic review. BMC Health Serv Res, 2016, 16(1): 541.

Chinese Journal of Evidence-Based Medicine

Treatment with charged-particle radiation therapy: an overview of systematic reviews

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