Dosimetric comparison of proton and photon three-dimensional, conformal, external beam accelerated partial breast irradiation techniques

Kozak, Kevin R.; Katz, Angela; Adams, Judith; Crowley, Elizabeth; Nyamwanda, Jacqueline A.; Feng, J.K.; Doppke, Karen P.; DeLaney, Thomas F.; Taghian, Alphonse G.

doi:10.1016/j.ijrobp.2006.04.025

Cited by 64 publications

(36 citation statements)

References 32 publications

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“…Compared with conventional X-rays and electron beams, it was found that partial breast irradiation using PBT was safer, more effective and technically feasible; furthermore, it may provide satisfactory target coverage and improve normal tissue sparing. Moreover, compared with intracavitary and interstitial brachytherapy, PBT was found to be more cost-effective (45)(46)(47)(48)(49)(50)(51)(52)(53)(54).…”

Section: Pbt For Different Cancersmentioning

confidence: 99%

The evolution of proton beam therapy: Current and future status (Review)

et al. 2017

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Abstract. Proton beam therapy (PBT) has been increasingly used in a variety of cancers due to its excellent physical properties and superior dosimetric parameters. PBT may improve patient survival by improving the local tumor treatment rate while reducing injury to normal organs, which may result in fewer radiation-induced adverse effects. However, the significant cost of establishing and maintaining proton facilities cannot be overlooked. In addition, there has been significant controversy regarding routine application of this treatment in certain types of cancer. The challenges of PBT in the future mainly include the lack of basic clinical trials, unclear biological effects, immature imaging technology and miniaturization of imaging guidance. Overcoming these limitations may promote the rapid development of PBT. We herein provide an overview of the existing literature on the efficacy and toxicity of common oncological applications of proton beam therapy.

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Section: Pbt For Different Cancersmentioning

confidence: 99%

The evolution of proton beam therapy: Current and future status (Review)

et al. 2017

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“…Of note, deterioration of cosmesis has been correlated with irradiated breast volume [54][55][56]. The relationship between irradiated breast volume and cosmesis supports a potential advantage of PBT, which markedly lowers the volume of normal breast exposed [57][58][59]. PBT may also extend APBI as an option for some women, such as those with a large or unfavorably situated seroma [60].…”

Section: Clinical Applications For Pbt In Breast Cancermentioning

confidence: 88%

“…PBT may also extend APBI as an option for some women, such as those with a large or unfavorably situated seroma [60]. In addition, PBT APBI reduces the dose to the heart, lungs, chest wall and pectoralis muscles compared with other APBI techniques [57][58][59].…”

Section: Clinical Applications For Pbt In Breast Cancermentioning

confidence: 99%

Proton Therapy for Breast Cancer: Progress & Pitfalls

Corbin

Mutter

2018

Breast Cancer Manag.

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Practice points• Proton therapy is under investigation for early stage and locally advanced breast cancer.• Due to unique physical properties, proton therapy reduces the dose to the heart, lungs, skin, muscle, and bone and is therefore hypothesized to reduce side effects from treatment.• Proton therapy may also enable improved target coverage in some breast cancer patients.• Due to its highly conformal nature, proton therapy requires careful attention to target volume delineation and implementation of strategies to mitigate uncertainties in setup and delivery.• Proton therapy for breast cancer is rapidly evolving with improvements in techniques for treatment delivery and optimizing of dose and fractionation schedules.• Research is ongoing to determine whether proton therapy improves treatment outcomes and quality of life compared with conventional photon techniques.As the number of patients cured from breast cancer increases with improvements in multidisciplinary care, emphasis on reducing late toxicities of treatment has increased, in order to improve long-term quality of life. Proton beam therapy (PBT) is a form of radiotherapy that uses particles with unique physical properties that enable treatment delivery with minimal dose deposition beyond the treatment target. Therefore, PBT has emerged as an exciting radiotherapy modality for breast cancer due to the ability to minimize exposure to the heart, lungs, muscle, and bone. Herein, we review the rationale for PBT in breast cancer, potential clinical applications, and the available clinical data supporting its use. We also address some of the technical and logistical challenges and areas of ongoing research that will ultimately establish the role for PBT for breast cancer in the years ahead.First draft submitted: 5 January 2018; Accepted for publication: 13 March 2018; Published online: 13 April 2018Keywords: breast cancer • cardiotoxicity • heart • particle therapy • pencil-beam scanning • proton therapy • radiation therapyBreast cancer accounts for 30% of new cancer diagnoses in women [1]. Although breast cancer remains the second leading cause of cancer death among women, advances in detection and treatment have resulted in improved outcomes, with 5-year expected survival of 90% [1]. Radiation therapy (RT) is indicated in the management of the majority of women with breast cancer [2]. For early stage breast cancer, breast irradiation following lumpectomy is an essential component of breast conserving therapy, lowering the risk of recurrence and improving breast cancer specific survival [3,4]. Recently published clinical trials also support the oncologic value of regional nodal irradiation (RNI) in some women with high risk node negative or axillary nodal metastases [5,6]. In addition, women with locally advanced breast cancer benefit from RT to the chest wall and regional lymph nodes, delivered in the post mastectomy setting [7]. While RT is widely utilized and improves breast cancer treatment outcomes, RT is also associated with late effects including cardi...

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“…IMPT significantly was show to significantly reduce the dose to normal tissue compared with 3 DCRT [119]. While studies have indicated that PBT, as well as IMPT using scanning beams produces superior dose distribution for multiple disease sites, IMPT is sensitive to delivery uncertainties [120] [121] [122]. The large variation in dose from these uncertainties can result in under-dosing of target tissues, or overdosing normal tissues.…”

Section: Proton Beammentioning

confidence: 99%