Clinical outcomes and toxicity of proton beam radiation therapy for re-irradiation of locally recurrent breast cancer

Gabani, Prashant; Patel, Hetal; Thomas, Maria; Bottani, Beth; Goddu, S; Straube, William L.; Margenthaler, Julie A.; Ochoa, Laura; Bradley, J.D.; Zoberi, Imran

doi:10.1016/j.ctro.2019.09.005

Cited by 29 publications

(21 citation statements)

References 24 publications

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“…In the present study, we report favorable LRFS and OS following re-irradiation for locoregional recurrent breast cancer, similar to other cohorts [7,14,15,17,19,20,27]. Particularly, high rates of disease control were seen among curative intent patients undergoing complete surgical excision followed Proton therapy for breast cancer offers enhanced ability to spare non-target tissue, including the heart and lungs [24,[28][29][30][31][32][33], which is of particular importance and interest for re-irradiation. Reirradiation with PBT has been reported in multiple disease sites, including in CNS, head and neck, gynecological, gastrointestinal, and lung tumors [34][35][36][37][38][39][40][41].…”

Section: Discussionsupporting

confidence: 81%

“…Proton therapy for breast cancer offers enhanced ability to spare nontarget tissue, including the heart and lungs, 24 , 28 , 29 , 30 , 31 , 32 , 33 which is of particular importance and interest for reirradiation. Reirradiation with PBT has been reported in multiple disease sites, including in central nervous system, head and neck, gynecologic, gastrointestinal, and lung tumors.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported a variety of techniques for reirradiation to the breast or chest wall including limited radiation fields, electrons, twice-daily radiation, superficial chest wall brachytherapy, concurrent systemic therapy, and hyperthermia. 7 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 Whether improvements in radiation treatment delivery, such as optimized 3-dimensional conformal RT, intensity modulated RT, deep inspiratory breath hold, and particle therapy, increase the therapeutic ratio of reirradiation is not well established. Herein, we report toxicities and outcomes for a cohort of patients with breast cancer treated at a single institution with a second course of repeat breast/chest wall/nodal RT.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reirradiation for Locoregional Recurrent Breast Cancer

Fattahi

Ahmed

Park

et al. 2021

Advances in Radiation Oncology

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reirradiation for Locoregional Recurrent Breast Cancer

Fattahi

Ahmed

Park

et al. 2021

Advances in Radiation Oncology

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“…It is our general institutional practice to deliver chest wall reirradiation with standard, 1.8 Gy fractions based on available literature describing safety and efficacy. [30][31][32] Occasionally, a twice-daily (BID)b.i.d. schedule will be used, particularly if the interval between treatment courses is <6 months; however, patients with nonstandard fractionation schemes were excluded from analysis.…”

Section: Resultsmentioning

confidence: 99%

Assessing the Need for Adjusted Organ-at-Risk Planning Goals for Patients Undergoing Adjuvant Radiation Therapy for Locally Advanced Breast Cancer with Proton Radiation

DeCesaris

Pollock

Zhang

et al. 2021

Practical Radiation Oncology

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Locally advanced breast cancer requires surgical management via lumpectomy or mastectomy with or without systemic therapy followed by chest wall or breast (CW) and comprehensive nodal irradiation (CNI). Radiation (RT) dose constraints for the heart and ipsilateral lung have been developed based on photon RT. Proton therapy (PBT) can deliver significantly lower doses of RT to these organs-at-risk (OARs) and may warrant adjustments to OAR planning goals. Methods and Materials: The RT plans of consecutive patients undergoing adjuvant CW-CNI RT with PBT within a single center were reviewed. A inital treatment volume, comprised of CW/intact breast þ CNI (CTV_init) structure, including the CW and CNI but excluding any boost plans was analyzed. Frequency distributions were generated based on doses received by the heart, lungs, and esophagus for validated dosimetric parameters. Frequency distributions were generated and then stratified by laterality and compared using the Kruskal-Wallis H test. The 75th, 85th, and 95th percentiles for each dosimetric parameter were calculated, overall and by laterality. The 75th percentile (Q3), was used as a suggested primary goal, and the 95th percentile was used as a suggested secondary goal. Results: One hundred and seventy-two plans were analyzed. Forty-nine plans were right-sided, 107 were left-sided, and 16 were bilateral. The overall Q3 of the mean and V25 of the heart were 1.5 Gy and 1.7%, respectively. The mean and V25 to the heart differed significantly by laterality. Pulmonary values were similar to current recommendations. For all lateralites, the median volume of the esophagus receiving 70% prescription dose was 1 cm 3. Conclusions: We present the first dosimetric study providing complete OAR dose-volume histograms data for patients undergoing adjuvant pencil-beam scanning-PBT for locally advanced breast cancer, with detailed information on central tendencies, ranges and distributions of data. We have provided suggested planning goals and metrics for the lungs, heart, and esophagus; the latter 2 differing Sources of support: No outside funding was used in the development of this manuscript.

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“…The conservative approach can be proposed after careful evaluation of surgical feasibility, which must consider the IBTR dimension, size, focality, and the breast size in order to achieve cosmetically acceptable results. Several authors have described the use of adjuvant breast reirradiation with brachytherapy (BT) [26,27,28,29,30,31,32,33,34,35,36,37,38,39,40], intraoperative radiation therapy (IORT) [41,42,43,44,45,46], proton beam radiotherapy [47,48], or EBRT with or without concurrent hyperthermia to increase local control rate [49,50,51,52,53,54].…”

Section: Purposementioning

confidence: 99%

High-dose-rate Brachytherapy as Adjuvant Local rEirradiation for Salvage Treatment of Recurrent breAst cancer (BALESTRA): a retrospective mono-institutional study

Vavassori

Riva

Cavallo

et al. 2020

jcb

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To evaluate clinical results of catheter-based interstitial high-dose-rate (HDR) brachytherapy (BT) as adjuvant treatment in previously irradiated recurrent breast cancer. Material and methods: Between January 2011 and September 2015, 31 consecutive patients with histologically confirmed recurrent breast cancer after conservative surgery and conventional whole breast radiotherapy, were retreated with a second conservative surgical resection and reirradiated with adjuvant interstitial HDR-BT. None of the brachytherapy implant was performed during the quadrantectomy procedure. A dose of 34 Gy in 10 fractions, 2 fractions per day, with a minimal interval of 6 hours was delivered. Results: At the time of the implant, the median age of patients was 59.7 years (range, 39.3-74.9 years). The median time from first treatment until BT for local recurrence was 11.9 years (range, 2.5-27.8 years). The median interval between salvage surgery and BT was 3.6 months (range, 1-8.2 months). No acute epidermitis or soft tissue side effects higher than grade 2 were recorded, with good cosmetic results in all patients. Most of the patients presented grade 1-2 late side effects. Only one patient developed grade 3 liponecrosis. After a median follow-up of 73.7 months (range, 28.8-102.4 months), the overall survival and cancer specific survival were 87.1% and 90.3%, respectively; 5-year local control and 5-year progression-free survival rate were 90.3% and 83.9%, respectively. Conclusions: Our preliminary analysis showed that HDR-BT is a feasible treatment for partial breast reirradiation offering very low complications rate and fast procedure. Higher patients' cohort is warranted in order to define the role of this treatment modality in the breast conservative management of local recurrence.

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Clinical outcomes and toxicity of proton beam radiation therapy for re-irradiation of locally recurrent breast cancer

Abstract: HighlightsRe-irradiation using proton therapy for recurrent breast cancer has excellent local control.Re-irradiation using proton beam radiation therapy increases risk of skin toxicity.There is minimal increase in the late toxicity due to re-irradiation using proton beam therapy.

Cited by 29 publications

References 24 publications

Reirradiation for Locoregional Recurrent Breast Cancer

Reirradiation for Locoregional Recurrent Breast Cancer

Assessing the Need for Adjusted Organ-at-Risk Planning Goals for Patients Undergoing Adjuvant Radiation Therapy for Locally Advanced Breast Cancer with Proton Radiation

High-dose-rate Brachytherapy as Adjuvant Local rEirradiation for Salvage Treatment of Recurrent breAst cancer (BALESTRA): a retrospective mono-institutional study

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