Proton Partial-Breast Irradiation for Early-Stage Cancer: Is It Really So Costly?

Ovalle, V.; Strom, Eric A.; Godby, Joy; Shaitelman, Simona F.; Stauder, Michael C.; Amos, R.; Kuerer, Henry Mark; Woodward, Wendy A.; Hoffman, Karen E.

doi:10.1016/j.ijrobp.2015.07.2285

Cited by 18 publications

(8 citation statements)

References 9 publications

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“…Differ-ent techniques, e.g. three-dimensional conformal RT [4], tomotherapy [5], proton beam therapy [6,7], and intensity-modulated RT (IMRT) [8] are being applied by different centers as international reference. This wide range of possibilities seems to go against multicenter study on APBI-EBRT application.…”

mentioning

confidence: 99%

Clinical implementation of combined modulated electron and photon beams with conventional MLC for accelerated partial breast irradiation

Míguez

Jiménez-Ortega

Palma

et al. 2017

Radiotherapy and Oncology

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mentioning

confidence: 99%

Clinical implementation of combined modulated electron and photon beams with conventional MLC for accelerated partial breast irradiation

Míguez

Jiménez-Ortega

Palma

et al. 2017

Radiotherapy and Oncology

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“…Using current Medicare reimbursement rates, Ovalle et al compared these treatments (amongst others) to proton APBI. 10 The cost of protons was lower than APBI with a brachytherapy device and whole breast IMRT, and very similar to a 6-week WBI schedule with a boost.…”

Section: Rebuttal: Valentina Ovalle MDmentioning

confidence: 85%

“…At PTCOG-NA, Ovalle et al presented their analysis of current costs of proton APBI compared to seven other partial-and whole breast irradiation techniques. 10 Using 2014 Medicare reimbursement rates, proton APBI costs were similar to six weeks of whole breast irradiation including a boost, and less costly than APBI with interstitial brachytherapy using a multilumen device or IMRT whole breast treatments. The key factors in these unexpected results are that (1) the small number of treatments required by proton APBI offsets the higher costs per fraction and that (2) reimbursement rates for the various options have significantly changed in the last decade.…”

Section: Opening Statementmentioning

confidence: 99%

Proton therapy is the most cost‐effective modality for partial breast irradiation

Ovalle¹,

DeWyngaert²,

Orton³

2015

Medical Physics

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“…Concern regarding the cost- effectiveness of proton therapy given the higher capital and operational costs of proton therapy facilities has been the primary limiting factor to the investigation of this technology for breast cancer [34, 35]. However, using Standard Medicare Payments, Ovalle and colleagues have previously shown that the cost of even 10 fractions of proton APBI is comparable with multiple other established whole breast and partial breast adjuvant radiotherapy techniques and regimens for early stage breast cancer [36]. Number of fractions administered is an important driver of radiotherapy cost.…”

Section: Discussionmentioning

confidence: 99%

3 fraction pencil-beam scanning proton accelerated partial breast irradiation: early provider and patient reported outcomes of a novel regimen

et al. 2019

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Background and purposeTo report dosimetry and early adverse effects, aesthetic, and patient-reported outcomes of a prospective study of 3-fraction pencil-beam scanning (PBS) proton accelerated partial irradiation (APBI).Materials and methodsEligibility included women age ≥ 50 years with estrogen receptor positive (ER+), sentinel lymph node negative invasive or in-situ breast cancer measuring ≤2.5 cm. The prescription was 21.9 Gy (RBE 1.1) in 3 daily fractions to the post-operative tumor bed with a 1 cm expansion. Toxicities were collected using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, 10-point Linear Analog Scale Assessment, Patient-Reported Outcomes Version of the CTCAE, and the Harvard Breast Cosmesis Scale.ResultsSeventy-six women were treated between 2015 and 2017. The median breast volume receiving 50% of prescription or more was 28%. Median mean heart, mean ipsilateral lung, and maximum skin dose were 0 Gy, 0.1 Gy, and 20.6 Gy, respectively. With a median follow-up of 12 months, no treatment-related toxicity grade ≥ 2 has been observed. Most common grade 1 adverse events were dermatitis (68%) and skin hyperpigmentation (18%). At 12 months, the only persistent toxicities were one patient with grade 1 breast edema and one patient with a grade 1 seroma. 90% of patients reported quality of life as ≥7 out of 10 (0 indicating “as bad as it can be” and 10 indicating “as good as it can be”) and 98% of patients reported excellent or good cosmesis.Conclusion3-fraction PBS proton APBI is well tolerated with low rates of physician and patient reported early adverse effects. Follow-up is ongoing to assess late toxicities and disease control outcomes. Further investigation of this novel adjuvant treatment strategy is warranted.

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Proton Partial-Breast Irradiation for Early-Stage Cancer: Is It Really So Costly?

Cited by 18 publications

References 9 publications

Clinical implementation of combined modulated electron and photon beams with conventional MLC for accelerated partial breast irradiation

Clinical implementation of combined modulated electron and photon beams with conventional MLC for accelerated partial breast irradiation

Proton therapy is the most cost‐effective modality for partial breast irradiation

3 fraction pencil-beam scanning proton accelerated partial breast irradiation: early provider and patient reported outcomes of a novel regimen

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