Proton therapy for locally advanced breast cancer: A systematic review of the literature

Kammerer, Emmanuel; Guévelou, Jennifer Le; Chaikh, Abdulhamid; Danhier, S.; Geffrelot, Julien; Lévy, Christelle; Saloux, Éric; Habrand, Jean‐Louis; Thariat, Juliette

doi:10.1016/j.ctrv.2017.11.006

Cited by 47 publications

(37 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Concerning cardiac toxicity, patients successfully treated with RT for BC have still an increased risk of developing subsequent heart disease, although lower than in earlier eras [38]. The risk of heart disease is higher for women who received RT for left-sided BC compared with women who received right-sided RT [39] and even higher if the internal mammary chain is irradiated [10]. By applying different models on radiation-associated cardiovascular toxicity that have been published since 2009, i.e., in the post QUANTEC era, we obtained different risk estimates (Supporting Information Table 2) with different potential gains in RR reduction by IMPT plans, according to the specific clinical endpoint.…”

Section: Discussionmentioning

confidence: 99%

“…Among the different techniques, the advantages of proton beam therapy have been reported by Ranger et al [6] in a comprehensive dosimetric analysis showing high levels of conformation able to achieve the most balanced compromise between higher conformation around the target and the lowest OAR doses. In particular, proton therapy seems to be the best technical solution for cardiac sparing when treatment of the regional lymph nodes is indicated [9,10]. However, concerns exist about radiation-induced skin toxicities given the higher skin dose related to a proton beam compared with a photon beam, and different levels of dermatitis have been reported in clinical studies, ranging from 5% to 43% for grade 3 dermatitis [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement

et al. 2019

View full text Add to dashboard Cite

2019) Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement, Acta Oncologica, 58:6, 934-942, ABSTRACT Background: Different modern radiation therapy treatment solutions for breast cancer (BC) and regional nodal irradiation (RNI) have been proposed. In this study, we evaluate the potential reduction in radiation-induced skin morbidity obtained by intensity modulated proton therapy (IMPT) compared with intensity modulated photon therapy (IMXT) for left-side BC and RNI. Material and Methods: Using CT scans from 10 left-side BC patients, treatment plans were generated using IMXT and IMPT techniques. A dose of 50 Gy (or Gy [RBE] for IMPT) was prescribed to the target volume (involved breast, the internal mammary, supraclavicular, and infraclavicular nodes). Two single filed optimization IMPT (IMPT 1 and IMPT 2 ) plans were calculated without and with skin optimization. For each technique, skin dose-metrics were extracted and normal tissue complication probability (NTCP) models from the literature were employed to estimate the risk of radiation-induced skin morbidity. NTCPs for relevant organs-at-risk (OARs) were also considered for reference. The non-parametric Anova (Friedman matched-pairs signed-rank test) was used for comparative analyses. Results: IMPT improved target coverage and dose homogeneity even if the skin was included into optimization strategy (HI IMPT2 ¼ 0.11 vs. HI IMXT ¼ 0.22 and CI IMPT2 ¼ 0.96 vs. CI IMXT ¼ 0.82, p < .05). A significant relative skin risk reduction (RR ¼ NTCP IMPT /NTCP IMXT ) was obtained with IMPT 2 including the skin in the optimization with a RR reduction ranging from 0.3 to 0.9 depending on the analyzed skin toxicity endpoint/model. Both IMPT plans attained significant OARs dose sparing compared with IMXT. As expected, the heart and lung doses were significantly reduced using IMPT. Accordingly, IMPT always provided lower NTCP values. Conclusions: IMPT guarantees optimal target coverage, OARs sparing, and simultaneously minimizes the risk of skin morbidity. The applied model-based approach supports the potential clinical relevance of IMPT for left-side BC and RNI and might be relevant for the setup of cost-effectiveness evaluation strategies based on NTCP predictions, as well as for establishing patient selection criteria. ARTICLE HISTORY

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Radiation oncologists implement several methods to decrease IR dose to the heart for minimizing the risk of RACVD (76), such as prone positioning (77), heart block with electronic compensation (57), heart-sparing three-dimensional printing technique (78), continuous positive airway pressure (CPAP) (79), real-time position management (RPM) inspiration gating (80,81), proton-beam irradiation (82)(83)(84)(85), and deep-inspiration breath-hold technique (DIBH) (86)(87)(88)(89)(90). However, even with the highly recommended visual-guided DIBH technique, residual variations of the heart position are still noticeable (91).…”

Section: Clinical Challenges Of Decreasing the Risk Of Racvd In Modermentioning

confidence: 99%

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

Lee

Liu

Hung

et al. 2020

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Radiotherapy (RT) is a crucial treatment modality in managing cancer patients. However, irradiation dose sprinkling to tumor-adjacent normal tissues is unavoidable, generating treatment toxicities, such as radiation-associated cardiovascular dysfunction (RACVD), particularly for those patients with combined therapies or pre-existing adverse features/comorbidities. Radiation oncologists implement several efforts to decrease heart dose for reducing the risk of RACVD. Even applying the deep-inspiration breath-hold (DIBH) technique, the risk of RACVD is though reduced but still substantial. Besides, available clinical methods are limited for early detecting and managing RACVD. The present study reviewed emerging challenges of RACVD in modern radiation oncology, in terms of clinical practice, bench investigation, and multidisciplinary care. Several molecules are potential for serving as biomarkers and therapeutic targets. Of these, miRNAs, endogenous small non-coding RNAs that function in regulating gene expression, are of particular interest because low-dose irradiation, i.e., 200 mGy (one-tenth of conventional RT daily dose) induces early changes of pro-RACVD miRNA expression. Moreover, several miRNAs, e.g., miR-15b and miR21, involve in the development of RACVD, further demonstrating the potential bio-application in RACVD. Remarkably, many RACVDs are late RT sequelae, characterizing highly irreversible and progressively worse. Thus, multidisciplinary care from oncologists and cardiologists is crucial. Combined managements with commodities control (such as hypertension, hypercholesterolemia, and diabetes), smoking cessation, and close monitoring are recommended. Some agents show abilities for preventing and managing RACVD, such as statins and angiotensin-converting enzyme inhibitors (ACEIs); however, their real roles should be confirmed by further prospective trials.

show abstract

“…Due to its unique energy deposition profile, proton therapy can reduce the volume of the heart and lungs exposed to radiation, thereby potentially reducing the side-effect [2][3][4][5][6][7][8]. Therefore, in the past few years, there is an increasing interest in the use of proton therapy in the treatment of breast cancer [9,10]. While proton therapy offers significant dosimetric advantages for sparing organs at risk (OARs), it is also sensitive to setup errors.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric consequences of image guidance techniques on robust optimized intensity-modulated proton therapy for treatment of breast Cancer

Liang

Vega

et al. 2020

Radiat Oncol

View full text Add to dashboard Cite

Purpose: To investigate the consequences of residual setup error on target dose distribution using various image registration strategies for breast cancer treated with intensity-modulated proton therapy (IMPT). Materials and methods: Among 11 post-lumpectomy patients who received IMPT, 44 dose distributions were computed. For each patient, the original plan (Plan-O) and three verification plans were calculated using different alignments: bony anatomy (VPlan-B), breast tissue (VPlan-T), and skin (VPlan-S). The target coverage were evaluated for each alignment technique. Additionally, 2 subvolumes-BreastNearSkin (1-cm rim of anterior CTV) and BreastNearCW (1-cm rim of posterior CTV)-were created to help localize CTV underdosing. Furthermore, we divided the setup error into the posture error and breast error. Patients with a large posture error and those with good posture setup but a large breast error were identified to evaluate the effect of posture error and breast error.

show abstract

Proton therapy for locally advanced breast cancer: A systematic review of the literature

Cited by 47 publications

References 57 publications

Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement

Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

Dosimetric consequences of image guidance techniques on robust optimized intensity-modulated proton therapy for treatment of breast Cancer

Contact Info

Product

Resources

About