Post-mastectomy intensity modulated proton therapy after immediate breast reconstruction: Initial report of reconstruction outcomes and predictors of complications

Smith, Na L.; Jethwa, Krishan R.; Viehman, Jason K.; Harmsen, William S.; Gonuguntla, Karthik; Elswick, Sarah M.; Grauberger, Jennifer; Amundson, A.; Whitaker, Thomas J.; Remmes, Nicholas B.; Harless, Christin A.; Boughey, Judy C.; Nguyen, Minh Doan T.; Park, Sean S.; Corbin, Kimberly S.; Mutter, Robert W.

doi:10.1016/j.radonc.2019.05.022

Cited by 38 publications

(26 citation statements)

References 51 publications

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“…Firstly, two-thirds of the patients were treated with conventional fractionation while a few large-volume hospitals preferred hypofractionation RT schedules with various regimens. Data supporting hypofractionation RT following mastectomy are still very limited, especially, when accompanied by breast reconstruction [ 17 ]. In 2019, we previously reported that hypofractionation RT (40 Gy in 15 fractions) may mitigate the risk of complications in two-stage prosthetic breast reconstruction [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Post-mastectomy radiation therapy in breast reconstruction: a patterns of care study of the Korean Radiation Oncology Group

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Post-mastectomy radiation therapy in breast reconstruction: a patterns of care study of the Korean Radiation Oncology Group

et al. 2020

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“…Target and normal tissue dose-volume objectives have previously been reported. 1 , 28 The first planning priority for both cohort A and cohort B was for 90% of the CTV (D90%) to receive ≥90% of the prescription dose under even the worst-case uncertainty analysis. The BP was contoured according to the validated and standardized method of Hall et al 29 For the BP, the Eclipse plan physical dose constraint for cohort B only was maximum dose received by at least 0.01 cm 3 of the volume (D0.01 cm 3 ) ≤ 102% (RBE = 1.1).…”

Section: Methodsmentioning

confidence: 99%

Incorporation of Biologic Response Variance Modeling Into the Clinic: Limiting Risk of Brachial Plexopathy and Other Late Effects of Breast Cancer Proton Beam Therapy

Mutter

Jethwa

Tseung

et al. 2020

Practical Radiation Oncology

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The relative biologic effectiveness (RBE) rises with increasing linear energy transfer toward the end of proton tracks. Presently, there is no consensus on how RBE heterogeneity should be accounted for in breast cancer proton therapy treatment planning. Our purpose was to determine the dosimetric consequences of incorporating a brachial plexus (BP) biologic dose constraint and to describe other clinical implications of biologic planning. Methods and Materials: We instituted a biologic dose constraint for the BP in the context of MC1631, a randomized trial of conventional versus hypofractionated postmastectomy intensity modulated proton therapy (IMPT). IMPT plans of 13 patients treated before the implementation of the biologic dose constraint (cohort A) were compared with IMPT plans of 38 patients treated on MC1631 after its implementation (cohort B) using (1) a commercially available Eclipse treatment planning system (RBE Z 1.1); (2) an in-house graphic processor unit-based Monte Carlo physical dose simulation (RBE Z 1.1); and (3) an in-house Monte Carlo biologic dose (MCBD) simulation that assumes a linear relationship between RBE and dose-averaged linear energy transfer (product of RBE and physical dose Z biologic dose). Results: Before implementation of a BP biologic dose constraint, the Eclipse mean BP D0.01 cm 3 was 107%, and the MCBD estimate was 128% (ie, 64 Gy [RBE Z biologic dose] in 25 fractions for a 50-Gy [RBE Z 1.1] prescription), compared with 100.0% and 116.0%, respectively, after the implementation of the constraint. Implementation of the BP biologic dose constraint did not significantly affect clinical target volume coverage. MCBD plans predicted greater internal mammary node coverage and higher heart dose than Eclipse plans.

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“…Immediate breast reconstruction undoubtedly maintains body image as well as quality of life, which remains relatively unperturbed, but the opportunities of such an approach must be weighed against potential oncologic and toxicity challenges ( 21 ). Smith and colleagues similarly reviewed outcomes of 51 patients who underwent immediate implant reconstruction with adjuvant proton therapy ( 22 ). Reconstruction failure occurred in 15% of patients, raising concerns regarding toxicity with this approach.…”

Section: Clinical Outcomes For Proton Therapymentioning

confidence: 99%

Particle Therapy for Breast Cancer: Benefits and Challenges

et al. 2021

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Hadron therapy with protons and carbon ions is widely attracting interest as a potential competitor of conventional photon radiotherapy. Exquisite dose distribution of charged particles allows for a higher local control of the tumor and lower probability of damage to nearby healthy tissues. Heavy ions have presumed biological advantages rising from their high-linear energy transfer (LET) characteristics, including greater cell-killing effectiveness and reduced heterogeneity dependence of radiation response. Although these advantages are clear and supported by data, only 18.0% of proton and carbon ion radiotherapy (CIRT) facilities in Europe are treating breast cancers. This review summarizes the physical and radiobiological properties of charged particles, clinical use of particle beam for breast cancer, and suggested approaches to overcome technical and financial challenges.

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Post-mastectomy intensity modulated proton therapy after immediate breast reconstruction: Initial report of reconstruction outcomes and predictors of complications

Cited by 38 publications

References 51 publications

Post-mastectomy radiation therapy in breast reconstruction: a patterns of care study of the Korean Radiation Oncology Group

Post-mastectomy radiation therapy in breast reconstruction: a patterns of care study of the Korean Radiation Oncology Group

Incorporation of Biologic Response Variance Modeling Into the Clinic: Limiting Risk of Brachial Plexopathy and Other Late Effects of Breast Cancer Proton Beam Therapy

Particle Therapy for Breast Cancer: Benefits and Challenges

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