A Technical Guide for Passive Scattering Proton Radiation Therapy for Breast Cancer

Bradley, Julie A.; Ho, Meng Wei; Li, Zuofeng; Liang, Xiaoying; Rutenberg, M.S.; Dagan, Roi; Mendenhall, Nancy P.

doi:10.14338/ijpt-16-00025.1

Cited by 11 publications

(7 citation statements)

References 37 publications

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“…Treatment was planned using Varian Eclipse TPS (V13.5) (Varian Medical Systems, Palo Alto, CA) with passive-scattering proton therapy. Two en face angles between 0 o and 60 o were used to minimize the effect of respiratory breathing and to improve the homogeneity of dose distribution [ 5 , 14 ]. Each patient received 50–50.4 cobalt Gy equivalent (CGE) at 1.8 or 2 CGE per daily fraction (5 and 18 patients, respectively).…”

Section: Methodsmentioning

confidence: 99%

Prognostic factors of radiation dermatitis following passive-scattering proton therapy for breast cancer

et al. 2018

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BackgroundTo identify prognostic factors for grade 3 radiation dermatitis following passive-scattering proton therapy for breast cancer.MethodsThis retrospective study included data on 23 (11 post-mastectomy and 12 post-lumpectomy) breast cancer patients who underwent proton therapy with the passive scattering technique in our institute from 2012 to 2016. Each patient received 50–50.4 cobalt Gy equivalent (CGE) at 1.8 or 2 CGE per daily fraction. Logistic regression analysis was performed to identify prognostic factors for grade 3 skin toxicity. Receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) were used to evaluate the performance of the models.Results43% of the studied patients developed grade 3 radiation dermatitis. The dose-volume histogram (DVH) parameters of V52.5CGE and D10cm3 to skin5mm were correlated with grade 3 radiation dermatitis in both univariate and multivariate logistic regression analyses. Univariate logistic regression analysis suggested that D10cm3 to skin5mm (AUC = 0.69) and V52.5CGE to skin5mm (AUC = 0.70) were prognostic for grade 3 skin toxicity. The models using the combination of D10cm3 to skin5mm or V52.5CGE to skin5mm with breast volume marginally increased the AUC to 0.72 and 0.73, respectively. Models using the combination of D10cm3 to skin5mm or V52.5CGE to skin5mm with history of smoking increased the AUC to 0.75 and 0.83, respectively.ConclusionIn the current study, we identified prognostic factors for grade 3 radiation dermatitis in patients treated with passive-scattering proton therapy for breast cancer. This study provides promising tool for identifying high risk patients for whom treatment plan adjustment could be done to reduce the risk of radiation-induced grade 3 skin toxicity.

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Section: Methodsmentioning

confidence: 99%

Prognostic factors of radiation dermatitis following passive-scattering proton therapy for breast cancer

et al. 2018

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“…In one study of IMRT, 28% of patients had acute G3 dermatitis versus our finding of 36% (5 of 14 patients) [ 36 ]. Passive scatter PRT for superficial targets, such as cervical lymph nodes, has been linked with dermatitis that is comparable to or worse than that occurring after photon radiation therapy [ 42 ]. However, all but 1 patient in our study (93%; 13 of 14) was treated with IMPT, which has been associated with superior skin sparing compared with passive scatter.…”

Section: Discussionmentioning

confidence: 99%

“…Seven patients (50%) underwent tonsillectomy, which was negative for primary disease in all cases. Four patients (29%) received induction systemic therapy for multiple bulky lymph nodes (n ¼ 4), [38][39][40][41][42][43][44][45][46][47][48][49][50] and three patients (21%) had concurrent chemotherapy with PRT for extensive postsurgical extracapsular extension (n ¼ 1) or multiple bulky lymph nodes (n ¼ 2).…”

Section: Patient Clinicopathologic Detailsmentioning

confidence: 99%

Proton Beam Therapy for Head and Neck Carcinoma of Unknown Primary: Toxicity and Quality of Life

Sherry

Pasalic

Gunn

et al. 2021

International Journal of Particle Therapy

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Purpose Proton radiation therapy (PRT) may offer dosimetric and clinical benefit in the treatment of head and neck carcinoma of unknown primary (HNCUP). We sought to describe toxicity and quality of life (QOL) in patients with HNCUP treated with PRT. Patients and Methods Toxicity and QOL were prospectively tracked in patients with HNCUP from 2011 to 2019 after institutional review board approval. Patients received PRT to the mucosa of the nasopharynx, oropharynx, and bilateral cervical lymph nodes with sparing of the larynx and hypopharynx. Patient-reported outcomes were tracked with the MD Anderson Symptom Inventory–Head and Neck Module, the Functional Assessment of Cancer Therapy–Head and Neck, the MD Anderson Dysphagia Inventory, and the Xerostomia-Related QOL Scale. Primary study endpoints were the incidence of grade ≥ 3 (G3) toxicity and QOL patterns. Results Fourteen patients (median follow-up, 2 years) were evaluated. Most patients presented with human papillomavirus–positive disease (n = 12, 86%). Rates of G3 oral mucositis, xerostomia, and dermatitis were 7% (n = 1), 21% (n = 3), and 36% (n = 5), respectively. None required a gastrostomy. During PRT, QOL was reduced relative to baseline and recovered shortly after PRT. At 2 years after PRT, the local regional control, disease-free survival, and overall survival were 100% (among 7 patients at risk), 79% (among 6 patients at risk), and 90% (among 7 patients at risk), respectively. Conclusion Therefore, PRT for HNCUP was associated with highly favorable dosimetric and clinical outcomes, including minimal oral mucositis, xerostomia, and dysphagia. Toxicity and QOL may be superior with PRT compared with conventional radiation therapy and PRT maintains equivalent oncologic control. Further prospective studies are needed to evaluate late effects and cost-effectiveness.

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“…Proton therapy was delivered with either pencil-beam scanning (PBS) or double-scatter proton modalities. Generally, 2 en face beams provided target coverage, a technique previously described for breast carcinoma proton therapy [ 32 ]. Individualization of treatment fields was required as target volumes were often more extensive than standard breast target volumes.…”

Section: Methodsmentioning

confidence: 99%

Hyperfractionated-Accelerated Reirradiation with Proton Therapy for Radiation-Associated Breast Angiosarcoma

Looi

Bradley

Liang

et al. 2022

International Journal of Particle Therapy

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Purpose Radiation-associated angiosarcoma (RAAS) is a rare complication among patients treated with radiation therapy for breast cancer. Hyperfractionated-accelerated reirradiation (HART) improves local control after surgery. Proton therapy may further improve the therapeutic ratio by mitigating potential toxicity. Materials and Methods Six patients enrolled in a prospective registry with localized RAAS received HART with proton therapy between 2015 and 2021. HART was delivered twice or thrice daily in fraction sizes of 1.5 or 1.0 Gy, respectively. All patients received 45 Gy to a large elective volume followed by boosts to a median dose of 65 (range, 60-75) Gy. Toxicity was recorded prospectively by using the Common Terminology Criteria for Adverse Events, version 4.0. Results The median follow-up duration was 1.5 (range, 0.25-2.9) years. The median age at RAAS diagnosis was 73 (range, 60-83) years with a median latency of 8.9 (range, 5-14) years between radiation therapy completion and RAAS diagnosis. The median mean heart dose was 2.2 (range, 0.1-4.96) Gy. HART was delivered postoperatively (n = 1), preoperatively (n = 3), preoperatively for local recurrence after initial management with mastectomy (n = 1), and as definitive treatment (n = 1). All patients had local control of disease throughout follow-up. Three of 4 patients treated preoperatively had a pathologic complete response. The patient treated definitively had a complete metabolic response on her posttreatment PET/CT (positron emission tomography–computed tomography) scan. Two patients developed distant metastatic disease despite local control and died of their disease. Acute grade 3 toxicity occurred in 3 patients: 2 patients undergoing preoperative HART experienced wound dehiscence and 1 postoperatively developed grade 3 wound infection, which resolved. Conclusion HART with proton therapy appears effective for local control of RAAS with a high rate of pathologic complete response and no local recurrences to date. However, vigilant surveillance for distant metastasis should occur. Toxicity is comparable to that in photon/electron series. Proton therapy for RAAS may maximize normal tissue sparing in this large-volume reirradiation setting.

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A Technical Guide for Passive Scattering Proton Radiation Therapy for Breast Cancer

Cited by 11 publications

References 37 publications

Prognostic factors of radiation dermatitis following passive-scattering proton therapy for breast cancer

Prognostic factors of radiation dermatitis following passive-scattering proton therapy for breast cancer

Proton Beam Therapy for Head and Neck Carcinoma of Unknown Primary: Toxicity and Quality of Life

Hyperfractionated-Accelerated Reirradiation with Proton Therapy for Radiation-Associated Breast Angiosarcoma

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