Long-term Cosmetic Outcomes and Toxicities of Proton Beam Therapy Compared With Photon-Based 3-Dimensional Conformal Accelerated Partial-Breast Irradiation: A Phase 1 Trial

Galland-Girodet, S.; Pashtan, Itai; MacDonald, Shannon M.; Ancukiewicz, Marek; Hirsch, Ariel E.; Kachnic, Lisa A.; Specht, Michelle C.; Gadd, Michele A.; Smith, Barbara L.; Powell, Simon N.; Recht, Abram; Taghian, Alphonse G.

doi:10.1016/j.ijrobp.2014.04.008

Cited by 102 publications

(55 citation statements)

References 24 publications

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“…Doses ranging at 30-50 Gy RBE in 10-24 fractions are well tolerated; skin reactions of G1-2 severity are observed in 60-79% cases, telangiectasia at G1 grade in 15-26% and a cosmetic effect, self-assessed by the patients, as being good or satisfactory in 80-90% [65,[81][82][83][84].…”

Section: Breast Cancer (Bc)mentioning

confidence: 98%

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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Section: Breast Cancer (Bc)mentioning

confidence: 98%

Proton radiotherapy for treating the most common carcinomas

Sas-Korczyńska

Jakubowicz²,

Reinfuss³

2017

Nowotwory. Journal of Oncology

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“…Published experience of APBI with PBT has demonstrated high rates of tumor control [61][62][63]. Two series with long-term follow-up presented conflicting cosmetic outcomes, likely due to differences in technique and dosefractionation schedules.…”

Section: Clinical Applications For Pbt In Breast Cancermentioning

confidence: 99%

“…At 7 years, the rate of telangiectasia, pigmentation changes and other late skin toxicities with PBT was 69, 54 and 62%, respectively. Physician reported cosmesis was judged as fair in 38% [62]. Patients were treated with doses of 32 Gy delivered over eight fractions delivered twice daily.…”

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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“…A phase I trial examined relative toxicities in patients treated with APBI comparing 3D-CRT photon based techniques and PBT [123]. 98 patients with stage I breast cancer were given 32 Gy in 8 fractions twice daily, of which 19 were treated using PBT and 79 were treated with 3D-CRT photons.…”

Section: Proton Beammentioning

confidence: 99%