Proton beam radiotherapy as part of comprehensive regional nodal irradiation for locally advanced breast cancer

Verma, Vivek; Iftekaruddin, Z.; Badar, Nida; Hartsell, William F.; Chang, J.; Gondi, Vinai; Pankuch, Mark; Gao, Ming; Schmidt, S.; Kaplan, D.; McGee, L.A.

doi:10.1016/j.radonc.2017.04.007

Cited by 61 publications

(41 citation statements)

References 23 publications

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“…Our rate of grade 3 or higher toxicity of 16% compares favorably with these studies. Unsurprisingly, this rate is higher than first time PBT for breast cancer with grade 3 toxicity reported at 0%‐8% . We had no grade 4 or 5 events.…”

Section: Discussionmentioning

confidence: 68%

“…However, to our knowledge, this is the first published manuscript on reRT with PBT. Several studies have shown that PBT for breast cancer is well tolerated with good outcomes . PBT limits the dose to organs at risk and normal tissue .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that PBT for breast cancer is well tolerated with good outcomes. [30][31][32][33][34] PBT limits the dose to organs at risk [35][36][37] and normal tissue. 36,37 For whole breast irradiation, PBT is superior to photon-based plans at limiting heart dose.…”

Section: Discussionmentioning

confidence: 99%

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Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

et al. 2019

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To investigate adverse events (AEs, CTCAE v4.0) and clinical outcomes for proton beam therapy (PBT) reirradiation (reRT) for breast cancer. From 2011 to 2016, 50 patients received PBT reRT for breast cancer in the prospective Proton Collaborative Group (PCG) registry. Acute AEs occurred within 180 days from start of reRT. Late AEs began or persisted beyond 180 days. Fisher's exact and Mann‐Whitney rank‐sum tests were utilized. Kaplan‐Meier methods were used to estimate overall survival (OS) and local recurrence‐free survival (LFRS). Median follow‐up was 12.7 months (0‐41.8). Median prior RT dose was 60 Gy (10‐96.7). Median reRT dose was 55.1 Gy (45.1‐76.3). Median cumulative dose was 110.6 Gy (70.6‐156.8). Median interval between RT courses was 103.8 months (5.5‐430.8). ReRT included regional nodes in 84% (66% internal mammary node [IMN]). Surgery included the following: 44% mastectomy, 22% wide local excision, 6% lumpectomy, 2% reduction mammoplasty, and 26% no surgery. Grade 3 AEs were experienced by 16% of patients (10% acute, 8% late) and were associated with body mass index (BMI) > 30 kg/m2 (P = 0.04), bilateral recurrence (P = 0.02), and bilateral reRT (P = 0.004). All grade 3 AEs occurred in patients receiving IMN reRT (P = 0.08). At 1 year, LRFS was 93%, and OS was 97%. Patients with gross disease at time of PBT trended toward worse 1‐year LRFS (100% without vs. 84% with, P = 0.06). PBT reRT is well tolerated with favorable local control. BMI > 30, bilateral disease, and IMN reRT were associated with grade 3 AEs. Toxicity was acceptable despite median cumulative dose > 110 Gy.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

et al. 2019

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“…The rates of acute grade 1, 2 and 3 esophagitis were 31, 33 and 0%, respectively. Like others the authors noted that their PBT delivery techniques were optimized over the course of the study period, suggesting that outcomes will only continue to improve as the field gains experience with PBT [65,68]. In summary, these promising reports suggest that the acute toxicity profile of PBT compares favorably compares with photons.…”

Section: Clinical Applications For Pbt In Breast Cancermentioning

confidence: 83%

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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“…Maximum fatigue was CTCAE grade 3. Verma et al [15] reported on 91 patients treated with adjuvant proton beam therapy (PBT) targeting the intact breast/chest wall and comprehensive regional nodes including the axilla, supraclavicular fossa, and internal mammary LN. The median PBT dose was 50.4 Gy(RBE) with a subsequent boost as clinically indicated (n = 61, median 10 Gy(RBE)).…”

Section: Clinical Indications Early Outcome Data and Status Of Clinmentioning

confidence: 99%

Proton Therapy for Primary Breast Cancer

Hug¹

2018

Breast Care

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Proton therapy reduces the integral dose received by normal tissues due to its physical properties of dose deposition in the Bragg peak. In a small but significant percentage of patients requiring adjuvant radiotherapy (RT) for left-sided breast cancer, photon-based RT can lead to cardiac complications during long-term follow-up. The risk of cardiac complications is correlated with the dose to the coronary arteries and to the general ‘mean heart dose'. Dosimetric comparison analysis has identified advantages of proton therapy in accomplishing sparing of the heart with increasing target complexity while permitting uncompromised target coverage of the chest wall ± breast plus draining lymphatics. Early clinical data indicate good clinical tolerance to proton therapy without unexpected complications. Several clinical trials are presently ongoing to prospectively confirm a clinical benefit and to identify the subgroup of patients benefitting most from proton therapy for breast cancer.

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Proton beam radiotherapy as part of comprehensive regional nodal irradiation for locally advanced breast cancer

Cited by 61 publications

References 23 publications

Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

Proton Therapy for Breast Cancer: Progress & Pitfalls

Proton Therapy for Primary Breast Cancer

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