Phase II trial of proton beam accelerated partial breast irradiation in breast cancer

Chang, Ji Hyun; Lee, Nam Kwon; Kim, Ja Young; Kim, Yeon Joo; Moon, Sung Ho; Kim, Tae Hyun; Kim, Joo Young; Kim, Dae Yong; Cho, Kwan Ho; Shin, Kyung Hwan

doi:10.1016/j.radonc.2013.06.008

Cited by 62 publications

(39 citation statements)

References 30 publications

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“…Breast cancer is therefore becoming a major application of protontherapy. [140][141][142] Breast cancer is indeed the most frequent cancer in females, and if proven, superior CPT could have a much larger use than in the past. The advantage here is not in the TCP, but in the reduced normal tissue toxicity, and this advantage, already considered the main justification for paediatric use of protons, 107 is likely to be decisive in the future of CPT.…”

Section: Late Effectsmentioning

confidence: 99%

New challenges in high-energy particle radiobiology

Durante

2014

BJR

125

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Densely ionizing radiation has always been a main topic in radiobiology. In fact, a-particles and neutrons are sources of radiation exposure for the general population and workers in nuclear power plants. More recently, high-energy protons and heavy ions attracted a large interest for two applications: hadrontherapy in oncology and space radiation protection in manned space missions. For many years, studies concentrated on measurements of the relative biological effectiveness (RBE) of the energetic particles for different end points, especially cell killing (for radiotherapy) and carcinogenesis (for late effects). Although more recently, it has been shown that densely ionizing radiation elicits signalling pathways quite distinct from those involved in the cell and tissue response to photons. The response of the microenvironment to charged particles is therefore under scrutiny, and both the damage in the target and non-target tissues are relevant. The role of individual susceptibility in therapy and risk is obviously a major topic in radiation research in general, and for ion radiobiology as well. Particle radiobiology is therefore now entering into a new phase, where beyond RBE, the tissue response is considered. These results may open new applications for both cancer therapy and protection in deep space.Biological effects of densely ionizing radiation have been studied since the beginning of radiobiology. As a matter of fact, a-particles deliver the main contribution to the background radiation dose on Earth, owing to inhalation of the indoor radon.1 Neutrons have also been extensively studied because of protection of workers in nuclear power plants; use of fast neutrons in radiotherapy; and of the exposure of the survivors of the atomic bomb in Hiroshima and Nagasaki, where a neutron component was added to g-rays. Bacq and Alexander 2 already elegantly described the radiobiology of a-particles and neutrons in their 1955 seminal book.More recently, radiobiology research has focused on highenergy protons and heavy ions, mostly for two reasons: charged particle therapy (CPT) in oncology and radiation protection in manned space missions. In both cases, charged particles at energies .100 MeV n 21 are involved. The characteristic depth-dose distribution with the sharp Bragg peak at the end of the range can be exploited for killing tumours; on the other hand, densely ionizing radiation can effectively delay tissue morbidity. Notwithstanding the many differences in exposure conditions, CPT and space radiation protection share several research topics, including individual sensitivity, non-targeted effects, late stochastic effects and so forth.3 Research in these fields requires large high-energy accelerators and is often performed by the same research groups with a common interest in particle radiobiology. Research is rapidly moving forward owing to the diffusion of CPT centres in the USA, Europe, and Asia 4 and to the growing interest in manned space exploration, now a priority for all space agencies, 5 but wi...

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Section: Late Effectsmentioning

confidence: 99%

New challenges in high-energy particle radiobiology

Durante

2014

BJR

125

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“…They reported favorable cosmetic outcomes, with 90% judged as good to excellent through 5 years of follow-up [63]. An additional Phase II experience of 30 treated proton patients supports the favorable toxicity profile of proton APBI when delivered with two or more fields per day, with good to excellent cosmesis noted among all but one patient treated with two fields [61].…”

Section: Clinical Applications For Pbt In Breast Cancermentioning

confidence: 74%

“…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%

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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“…Proton therapy has been proposed after mastectomy [52] , in patients with bilateral implants [53] , and as accelerated partial breast irradiation (PBI) [54][55][56][57] . It seems unlikely that PBT could be widely used in breast cancer and it is predictable that it will find selective use in specific clinical scenarios in which the patient's anatomy poses cardiac or pulmonary risks with the use of conventional XRT.…”

Section: Breast Cancermentioning

confidence: 99%

The actual Interest in Radiotherapy for the Utilization of Proton Beam, Highlighting Physics Basis, Technology and Common Clinical Indications

Amichetti

2016

Journal of Tumor

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. Since that years, commercial entities began to build cyclotrons and synchrotrons for clinical purposes. Over the last 10 years, PBT has gathered more interest in the scientific community and more media and patient attention and is now flourishing in the US and abroad. As of December, 2015, 57 proton therapy centers are in operation worldwide, others are under construction and many more in a planning phase [3] . Most patients who have been treated with heavy-particle therapy were treated with protons: PTCOG (Particle Therapy Co-Operative Group) reports that between 1954 and 2014, 137 000 patients globally received part or all of their radiation therapy with particles, and in particular 86% of them with protons [4] . The generation of these particles and the building of dedicated centers, however, requires large investments and operational costs and big infrastructure. Only relatively few studies have demonstrated the effectiveness of proton therapy and the effects are surrounded with uncertainty [5] being the cost-effectiveness still the core of the controversy around the use of PBT. ABSTRACTManaging expensive technology is a debated issue in modern radiation oncology. Proton beam therapy (PBT) represents, considering its cost and its foreseen benefits, a typical case of discussion waiting for more robust results demonstrating the presumable clinical gains against the available radiation therapy (XRT) treatment alternatives based on the use of photons. The treatment with particles utilizes many different beams (neutrons, protons, pions, or helium, neon, argon, and carbon ions) that represent a distinct entity respect conventional XRT which uses photons. PBT is the most common form of heavy-particle radiation therapy used so far; it is not a new invention, being its clinical use proposed in a seminal article by R. Wilson in 1946 [1] and the first patients treated in 1954 at the Lawrence Berkeley National Laboratory in California [2] . Since cyclotron or synchrotron, used to accelerate protons to therapeutic energies, were used primarily for research in particle or nuclear physics, the initial clinical activity in proton therapy was carried out in research facilities and the use of protons in clinical practice has grown slowly for several years in non-clinical setting. More than fifty years later, after a long period of seminal work in a limited number of Institutions, PBT has gained public attention in recent years because of the rapidly increasing number of centers around the world, regardless of their high cost. Hospital-based proton beam facilities have been in operation since 1990 after the opening of the first dedicated clinical center at Loma Linda Medical

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Phase II trial of proton beam accelerated partial breast irradiation in breast cancer

Cited by 62 publications

References 30 publications

New challenges in high-energy particle radiobiology

New challenges in high-energy particle radiobiology

Proton Therapy for Breast Cancer: Progress & Pitfalls

The actual Interest in Radiotherapy for the Utilization of Proton Beam, Highlighting Physics Basis, Technology and Common Clinical Indications

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