Postmastectomy Intensity Modulated Proton Therapy: 5-Year Oncologic and Patient-Reported Outcomes

Gao, Robert W.; Mullikin, T.C.; Aziz, Khaled; Afzal, Arslan; Smith, Na L.; Routman, David M.; Gergelis, Kimberly; Harmsen, William S.; Remmes, Nicholas B.; Tseung, Hok Seum Wan Chan; Shiraishi, S.; Boughey, Judy C.; Ruddy, Kathryn J.; Harless, Christin A.; Garda, Allison E.; Waddle, Mark R.; Park, Sean S.; Shumway, Dean A.; Corbin, Kimberly S.; Mutter, Robert W.

doi:10.1016/j.ijrobp.2023.05.036

Cited by 6 publications

(5 citation statements)

References 48 publications

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“…Furthermore, while our facility was mainly designed for heavy ions, the proton beam focus width for low energy is known to be larger than cyclotron-based centers. However, despite this fact, and most probably linked to the use of a smaller range shifter (only 2 cm) compared to other facilities for shallow target treatments (between 5 and 7 cm), no compromise in the quality of our plan between target coverage and sparing of OAR was needed, and our dosimetric and NTCP predictions were similar to other published work [44][45][46][47][48], as shown in Tables 6 and 7. 4.2 (1.9-5.9) 1.1 (0.3-1.3)…”

Section: Discussionsupporting

confidence: 80%

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Exploring Helium Ions’ Potential for Post-Mastectomy Left-Sided Breast Cancer Radiotherapy

Bonaccorsi,

Tessonnier,

Hoeltgen

et al. 2024

Cancers

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Proton therapy presents a promising modality for treating left-sided breast cancer due to its unique dose distribution. Helium ions provide increased conformality thanks to a reduced lateral scattering. Consequently, the potential clinical benefit of both techniques was explored. An explorative treatment planning study involving ten patients, previously treated with VMAT (Volumetric Modulated Arc Therapy) for 50 Gy in 25 fractions for locally advanced, node-positive breast cancer, was carried out using proton pencil beam therapy with a fixed relative biological effectiveness (RBE) of 1.1 and helium therapy with a variable RBE described by the mMKM (modified microdosimetric kinetic model). Results indicated that target coverage was improved with particle therapy for both the clinical target volume and especially the internal mammary lymph nodes compared to VMAT. Median dose value analysis revealed that proton and helium plans provided lower dose on the left anterior descending artery (LAD), heart, lungs and right breast than VMAT. Notably, helium therapy exhibited improved ipsilateral lung sparing over protons. Employing NTCP models as available in the literature, helium therapy showed a lower probability of grade ≤ 2 radiation pneumonitis (22% for photons, 5% for protons and 2% for helium ions), while both proton and helium ions reduce the probability of major coronary events with respect to VMAT.

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Section: Discussionsupporting

confidence: 80%

“…Dosimetric indices comparison among our work and some of the most recent results published on proton therapy for breast-cancer treatments[29,[44][45][46][47][48]. VMAT: Volumetric Modulated Arc Therapy, IMPT: Intensity Modulated Proton Therapy, LAD: left anterior descending artery.…”

mentioning

confidence: 98%

Exploring Helium Ions’ Potential for Post-Mastectomy Left-Sided Breast Cancer Radiotherapy

Bonaccorsi,

Tessonnier,

Hoeltgen

et al. 2024

Cancers

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“…In comparison to non-PBS, PBS has the advantage of skin dose-sparing [ 7 8 ]. Table 5 displays the incidences of grade 2–3 dermatitis after PBT [ 3 4 5 23 24 25 26 27 28 29 30 31 32 33 34 ]. In patients who received conventional fractionated PBT without PBS, the rates of grade 2–3 dermatitis ranged from 71% to 100% (median, 82%).…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Correlation of Acute Radiation Dermatitis in Patients With Breast Cancer Undergoing Hypofractionated Proton Beam Therapy Using Pencil Beam Scanning

Huang,

Ho,

Wang

2024

J Breast Cancer

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Purpose Pencil-beam scanning (PBS) is a modern delivery technique used in proton beam therapy (PBT) to reduce normal tissue reactions. No dosimetric correlation between dermatitis and PBS has been reported for breast cancer. The current study aimed to investigate the factors associated with grade 2 or higher dermatitis in patients with breast cancer undergoing PBT using PBS. Methods The medical data of 42 patients with breast cancer who underwent adjuvant radiotherapy between December 2019 and September 2023 were reviewed. All patients received hypofractionated radiotherapy (HFRT), either 26 Gy (relative biological effectiveness [RBE])/five fractions or 40.05 or 43.5 Gy (RBE)/15 fractions, for the whole breast/chest wall with or without nodal irradiation. The duration of acute radiation dermatitis was defined as within 90 days from the start of radiotherapy. The Kaplan–Meier method and Cox proportional hazards model were used for univariate and multivariate analyses of the actuarial rates of grade 2–3 dermatitis. Results Twenty-two (52.4%) and 20 (47.6%) patients were diagnosed with grade 1 and 2 dermatitis, respectively. Multivariate analysis revealed a clinical target volume (CTV) ≥ of 320 cc ( p = 0.035) and a skin dose of D 10cc ≥ 38.3 Gy (RBE) ( p = 0.009) as independent factors of grade 2 dermatitis. The 10-week cumulative grade 2 dermatitis rates were 88.2%, 39.4%, and 8.3% ( p < 0.001) for patients with both high, either high, and neither high CTV and D 10cc , respectively. Conclusion To the best of our knowledge, this is the first study on dosimetric correlations for dermatitis in patients with breast cancer who underwent hypofractionated PBT using PBS. In the era of HFRT, skin dose modulation using PBS may reduce the incidence of dermatitis.

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“…Surface imaging and interval verification scans have been utilized to identify interfraction and intrafraction variations in anatomy [69][70][71]. Adaptive re-planning can be used for patients with significant anatomy variations, but this tends to be required for only a small minority of patients [24,37,72].…”

Section: Treatment Planning Approach and Considerationsmentioning

confidence: 99%

Proton Reirradiation for High-Risk Recurrent or New Primary Breast Cancer

Chakraborty,

Khan,

Cahlon

et al. 2023

Cancers

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Radiotherapy is an integral component of multidisciplinary breast cancer care. Given how commonly radiotherapy is used in the treatment of breast cancer, many patients with recurrences have received previous radiotherapy. Patients with new primary breast cancer may also have received previous radiotherapy to the thoracic region. Curative doses and comprehensive field photon reirradiation (reRT) have often been avoided in these patients due to concerns for severe toxicities to organs-at-risk (OARs), such as the heart, lungs, brachial plexus, and soft tissue. However, many patients may benefit from definitive-intent reRT, such as patients with high-risk disease features such as lymph node involvement and dermal/epidermal invasion. Proton therapy is a potentially advantageous treatment option for delivery of reRT due to its lack of exit dose and greater conformality that allow for enhanced non-target tissue sparing of previously irradiated tissues. In this review, we discuss the clinical applications of proton therapy for patients with breast cancer requiring reRT, the currently available literature and how it compares to historical photon reRT outcomes, treatment planning considerations, and questions in this area warranting further study. Given the dosimetric advantages of protons and the data reported to date, proton therapy is a promising option for patients who would benefit from the added locoregional disease control provided by reRT for recurrent or new primary breast cancer.

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Postmastectomy Intensity Modulated Proton Therapy: 5-Year Oncologic and Patient-Reported Outcomes

Cited by 6 publications

References 48 publications

Exploring Helium Ions’ Potential for Post-Mastectomy Left-Sided Breast Cancer Radiotherapy

Exploring Helium Ions’ Potential for Post-Mastectomy Left-Sided Breast Cancer Radiotherapy

Dosimetric Correlation of Acute Radiation Dermatitis in Patients With Breast Cancer Undergoing Hypofractionated Proton Beam Therapy Using Pencil Beam Scanning

Proton Reirradiation for High-Risk Recurrent or New Primary Breast Cancer

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