Intensity modulated proton therapy for postmastectomy radiation of bilateral implant reconstructed breasts: A treatment planning study

Jimenez, Rachel; Gomà, Carles; Nyamwanda, Jacqueline A.; Kooy, Hanne M.; Halabi, Tarek; Napolitano, Brian; McBride, Sean; Taghian, Alphonse G.; Lu, Hsiao‐Ming; MacDonald, Shannon M.

doi:10.1016/j.radonc.2013.03.028

Cited by 75 publications

(40 citation statements)

References 12 publications

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“…As proton therapy becomes more readily available for breast cancer treatment, a similar question naturally arises: will the BH technique still be effective for sparing the cardiac dose in proton therapy? The reported heart mean dose for proton treatments planned with FB is generally within 1 Gy (RBE) [8][9][10][11]. The already low heart dose with FB implies that room for dose reduction with BH would be limited.…”

Section: Introductionmentioning

confidence: 99%

Free Breathing versus Breath-Hold Scanning Beam Proton Therapy and Cardiac Sparing in Breast Cancer

Park

Herman

et al. 2016

International Journal of Particle Therapy

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Purpose: To assess dose errors caused by the interplay effects of free-breathing (FB) motion and to assess the value of breath-hold (BH) in terms of cardiac dose reduction for scanning beam proton therapy (SBPT). Materials and Methods: Three patients with left-sided breast cancer previously treated with photon therapy were included in this dosimetric study: 2 following breast-conserving surgery with 2 hypothetical target volumes (whole breast alone and whole breast plus regional nodes, including supraclavicular, axillary, and internal mammary lymph nodes); and 1 postmastectomy, with the target volume including the chest wall plus regional nodes. SBPT plans were generated with various beam angles that ranged between 2 tangential directions. For treatment with FB, nominal dose and dose with interplay effects considered were calculated based on FB 4-dimensional computed tomography scans. SBPT plans on the BH computed tomography were also calculated for one of the patients, who was selected to be treated with photon therapy with BH. Results: Dosimetric differences between nominal and interplay dose were small (average target mean dose, −0.06 Gy; range, −0.23 to 0.06 Gy; average heart mean dose, 0.001 Gy; range, −0.12 to 0.05 Gy). The largest dose deviations occurred in plans calculated with tangential beam arrangements; the smallest was noted with the en face beam. The average value of the mean heart dose with FB was <1 Gy. For the selected patient, the mean heart doses were 0.5 and 0.2 Gy for FB and BH, respectively. Conclusion: Dose deviations caused by the interplay effects of respiratory motion during FB do not have a significant impact in SBPT with en face beam arrangement. BH does not significantly reduce cardiac dose. SBPT delivery is feasible with FB and can provide optimal target coverage and maximal sparing of the cardiopulmonary system, which can translate into improved clinical outcomes and a decrease in treatment-related morbidity in left-sided breast cancer patients or those who require internal mammary node coverage.

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Section: Introductionmentioning

confidence: 99%

Free Breathing versus Breath-Hold Scanning Beam Proton Therapy and Cardiac Sparing in Breast Cancer

Park

Herman

et al. 2016

International Journal of Particle Therapy

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“…Numerous dosimetric studies clearly support the advantage of PBT at improving target coverage while simultaneously decreasing dose to the heart, coronary vessels, lungs and contralateral normal tissue compared with photon advanced planning techniques. These advantages are evident whether the target is partial breast, whole breast/chest wall or breast/chest wall and regional lymph nodes (Table 1) [20,[37][38][39][40][41][42][43]. A recent paper assessed the potential absolute gains with PBT compared with photon therapy in patients with left-sided breast cancer requiring comprehensive nodal irradiation.…”

Section: Second Malignancymentioning

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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“…The sparing effects of proton radiotherapy on critical organs is particularly apparent in cases of left-sided BC where using IMPT, as compared with IMRT, allowed a 20-fold reduction of heart dose and for the left anterior descendens (LAD) artery region (a lower arm of the left coronary artery), which is a critical structure in the development of late cardiac complications [67,[75][76][77][78][79][80]. Such findings are indicative of a potential benefit in using proton radiotherapy for adjuvant radiotherapy of BC patients, especially when risk factors for cardiac complications are present [80].…”

Section: Breast Cancer (Bc)mentioning

confidence: 99%

Proton radiotherapy for treating the most common carcinomas

Sas-Korczyńska

Jakubowicz²,

Reinfuss³

2017

Nowotwory. Journal of Oncology

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A literature review is presented on proton radiotherapy when used for treating the most common carcinoma types such as cancer of the lung, breast and prostate. This is based on analytic parameters of dosimetry and clinical outcomes (efficacy and toxicity), along with studies on cost-effectiveness as compared to those achieved by conventional photon radiotherapy. NOWOTWORY J Oncol 2016; 66, 5: 396-402

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Intensity modulated proton therapy for postmastectomy radiation of bilateral implant reconstructed breasts: A treatment planning study

Cited by 75 publications

References 12 publications

Free Breathing versus Breath-Hold Scanning Beam Proton Therapy and Cardiac Sparing in Breast Cancer

Free Breathing versus Breath-Hold Scanning Beam Proton Therapy and Cardiac Sparing in Breast Cancer

Proton Therapy for Breast Cancer: Progress & Pitfalls

Proton radiotherapy for treating the most common carcinomas

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