TY - JOUR
T1 - Outcomes and toxicities of proton and photon radiation therapy for testicular seminoma
AU - Pasalic, Dario
AU - Prajapati, Surendra
AU - Ludmir, Ethan B.
AU - Tang, Chad
AU - Choi, Seungtaek
AU - Kudchadker, Rajat
AU - Frank, Steven J.
N1 - Funding Information:
Conflicts of Interest: Steven J. Frank, MD, is an Associate Editor of the International Journal of Particle Therapy. The authors report no other conflicts of interest relevant to this work. Steven J. Frank, MD, reports personal fees from Varian, C4 imaging, Hitachi, Boston Scientific, and the National Comprehensive Cancer Center; grants from C4 Imaging, Eli Lilly, Elekta, and Hitachi; and advisory board positions for Breakthrough Chronic Care, Hitachi, and Varian. Chad Tang, MD, reports personal fees from Reflexion and AstraZeneca. Funding: Supported in part by Cancer Center Support (Core) Grant P30 CA016672 from the National Cancer Institute, National Institutes of Health, to The University of Texas MD Anderson Cancer Center. Ethical Approval: All patient data have been collected under internal review board (IRB)–approved protocol.
Publisher Copyright:
© 2020 The Author(s)
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Purpose: To determine the clinical outcomes and toxicities of proton beam therapy (PBT) versus 3D-conformal photon radiation therapy (XRT) in patients with testicular seminoma. Materials and Methods: This observational study evaluated consecutive patients with testicular seminoma who were treated with inguinal orchiectomy and radiation therapy at a single, tertiary, high-volume center in 2008-19. Acute toxicity was scored with the Common Terminology Criteria for Adverse Events V 4.0. Organs at risk were contoured retrospectively by 2 investigators. Recurrences and secondary malignancies were based on routine follow-up imaging, either computed tomography or magnetic resonance imaging. Results: Fifty-five patients were treated with radiation therapy, 11 in the PBT-arm and 44 in the XRT-arm, with a median follow-up interval of 61 months (interquartile range [IQR]: 32-79 months). Acute treatment-related diarrhea, grade 1 to 2, was more common among XRT-treated patients (0% vs 29.5%, P ¼.039), and dermatitis, grade 1, was more likely among PBT-treated patients (27.3% vs 2.3%, P ¼.004). Dosimetrically, PBT-treated patients, relative to XRT-treated patients, had lower dose to organs at risk including the kidney, bladder, femoral head, spinal cord, bowel, pancreas, and stomach. The 5-year overall survival rate was 100% and disease-free survival rate was 96.4% for all patients. Two patients, all in the XRT-arm, had disease recurrence: 1 in the pelvis and 1 in the lung. Three patients, all in the XRT-arm, were diagnosed with a secondary malignancy: 1 in-field pancreaticoblastoma, 1 in-field colon adenocarcinoma, and a stage IV T-cell lymphoma. Conclusion: Proton beam therapy for testicular seminoma resulted in excellent clinical outcomes and was associated with lower rates of acute diarrhea but higher rates of acute dermatitis. Proton beam therapy resulted in no in-field secondary malignancies and a more favorable dosimetric profile for organs at risk relative to XRT. Reduced dose to organs at risk, such as the kidneys, may result in long-term improvement in function.
AB - Purpose: To determine the clinical outcomes and toxicities of proton beam therapy (PBT) versus 3D-conformal photon radiation therapy (XRT) in patients with testicular seminoma. Materials and Methods: This observational study evaluated consecutive patients with testicular seminoma who were treated with inguinal orchiectomy and radiation therapy at a single, tertiary, high-volume center in 2008-19. Acute toxicity was scored with the Common Terminology Criteria for Adverse Events V 4.0. Organs at risk were contoured retrospectively by 2 investigators. Recurrences and secondary malignancies were based on routine follow-up imaging, either computed tomography or magnetic resonance imaging. Results: Fifty-five patients were treated with radiation therapy, 11 in the PBT-arm and 44 in the XRT-arm, with a median follow-up interval of 61 months (interquartile range [IQR]: 32-79 months). Acute treatment-related diarrhea, grade 1 to 2, was more common among XRT-treated patients (0% vs 29.5%, P ¼.039), and dermatitis, grade 1, was more likely among PBT-treated patients (27.3% vs 2.3%, P ¼.004). Dosimetrically, PBT-treated patients, relative to XRT-treated patients, had lower dose to organs at risk including the kidney, bladder, femoral head, spinal cord, bowel, pancreas, and stomach. The 5-year overall survival rate was 100% and disease-free survival rate was 96.4% for all patients. Two patients, all in the XRT-arm, had disease recurrence: 1 in the pelvis and 1 in the lung. Three patients, all in the XRT-arm, were diagnosed with a secondary malignancy: 1 in-field pancreaticoblastoma, 1 in-field colon adenocarcinoma, and a stage IV T-cell lymphoma. Conclusion: Proton beam therapy for testicular seminoma resulted in excellent clinical outcomes and was associated with lower rates of acute diarrhea but higher rates of acute dermatitis. Proton beam therapy resulted in no in-field secondary malignancies and a more favorable dosimetric profile for organs at risk relative to XRT. Reduced dose to organs at risk, such as the kidneys, may result in long-term improvement in function.
KW - PBT
KW - Particle therapy
KW - Testicular cancer
KW - XRT
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U2 - 10.14338/IJPT-20-00018.1
DO - 10.14338/IJPT-20-00018.1
M3 - Article
C2 - 33274253
AN - SCOPUS:85106151170
SN - 2331-5180
VL - 7
SP - 11
EP - 20
JO - International Journal of Particle Therapy
JF - International Journal of Particle Therapy
IS - 2
ER -