Proton Therapy for Bilateral Breast Cancer Maximizes Normal-Tissue Sparing.

Eric D Brooks, Raymond B Mailhot Vega, Emma Vivers, Teena Burchianti, Xiaoying Liang, Lisa R Spiguel, Bharti Jasra, Nancy P Mendenhall, Oluwadamilola T Oladeru, Julie A Bradley
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引用次数: 1

Abstract

Purpose: Treatment for bilateral breast cancer with radiation therapy is technically challenging. We evaluated the clinical and dosimetric outcomes of a small series of patients with synchronous bilateral breast cancer, including a photon dosimetric comparison, to identify optimal treatment planning approaches.

Materials and methods: We reviewed a registry of patients (simultaneously) diagnosed with synchronous bilateral breast cancers who underwent postoperative definitive adjuvant proton therapy at our institution between 2012 and 2021. All patients were treated with double-scattered proton or pencil-beam scanning therapies. For comparison, intensity-modulated radiation therapy photon plans optimized for organ sparing and coverage were generated after treatment.

Results: Six patients were included. The median patient age was 66 years; all were female with no history of breast cancer or radiation therapy. Two (33%) patients received breast/chest wall-only treatments, 1 (17%) required breast plus level I axillary treatment to one side and breast plus regional nodal irradiation (RNI) to the other, and 3 (50%) received bilateral breast/chest plus RNI; dosimetric results are reported for each group's median. Analysis showed clinical target coverage was comparable between proton and photon techniques (V95% of 96.4% with proton, 97.8% with photon). However, protons could deliver superior organ sparing at clinically relevant dose metrics for virtually all structures: a 6.7 Gy absolute reduction in the mean heart dose (7.5 Gy with photons to 0.7 Gy with protons), a 47% to 57% relative reduction in D0.1cm3 to coronary arteries, a 54% relative reduction in lung V20 Gy, and an absolute 7.6 Gy reduction to the brachial plexus. There was also greater esophagus and spinal cord sparing. The overall survival rate was 100% at 1.5 years of median follow-up (0.5-4.9), and all patients were free of disease. For toxicity, all patients had some form of acute side effects: 66% experienced grade 2 breast/chest pain or soreness; 100% had grade 2 radiation dermatitis or skin induration; 33% had grade 2 fatigue; and 17% had grade 2 esophagitis (per the Common Terminology Criteria for Adverse Events [CTCAE] version 5.0; US National Cancer Institute, Bethesda, Maryland). Subacute toxicity (within 6 months) was observed for 17% of patients with delayed onset of grade 3 dermatitis in the setting of preexisting lupus, 17% with a delayed surgical wound complication, and 17% with grade 2 soft tissue fibrosis. No grade 4 or 5 events were observed.

Conclusions: Substantial dose reductions to multiple organs at risk while maintaining target coverage make proton the preferred modality for bilateral breast cancer treatment when available.

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双侧乳腺癌质子治疗最大限度地保留正常组织。
目的:双侧乳腺癌的放射治疗在技术上具有挑战性。我们评估了一小部分同步双侧乳腺癌患者的临床和剂量学结果,包括光子剂量学比较,以确定最佳的治疗计划方法。材料和方法:我们回顾了2012年至2021年间在我们机构接受术后明确辅助质子治疗的诊断为同步双侧乳腺癌的患者(同时)登记。所有患者均接受双散射质子或铅笔束扫描治疗。为了进行比较,治疗后产生了优化的器官保留和覆盖的调强放射治疗光子计划。结果:纳入6例患者。患者年龄中位数为66岁;所有人都是女性,没有乳腺癌病史或放射治疗史。2例(33%)患者接受乳房/胸壁治疗,1例(17%)患者一侧需要乳房+一级腋窝治疗,另一侧需要乳房+区域淋巴结照射(RNI), 3例(50%)患者接受双侧乳房/胸部+ RNI治疗;报告了每组中位数的剂量学结果。分析显示质子技术和光子技术的临床靶覆盖率相当(V95%,质子技术为96.4%,光子技术为97.8%)。然而,在临床相关的剂量指标下,质子对几乎所有结构都能提供优越的器官保留:平均心脏剂量绝对减少6.7 Gy(光子7.5 Gy至质子0.7 Gy),冠状动脉D0.1cm3相对减少47%至57%,肺V20 Gy相对减少54%,臂丛绝对减少7.6 Gy。食管和脊髓也有较大的保留。中位随访时间为1.5年(0.5-4.9年),总生存率为100%,所有患者均无疾病。对于毒性,所有患者都有某种形式的急性副作用:66%经历2级乳房/胸痛或疼痛;100%为2级放射性皮炎或皮肤硬化;33%为2级疲劳;17%的患者有2级食管炎(根据不良事件通用术语标准[CTCAE] 5.0版;美国国家癌症研究所,贝塞斯达,马里兰州)。在先前存在狼疮的延迟发作的3级皮炎患者中,17%的患者有延迟的手术伤口并发症,17%的患者有2级软组织纤维化,观察到亚急性毒性(6个月内)。未观察到4级或5级事件。结论:在维持靶区覆盖的同时,对多个有危险器官的剂量大幅减少,使质子治疗成为双侧乳腺癌治疗的首选方式。
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来源期刊
International Journal of Particle Therapy
International Journal of Particle Therapy Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
3.70
自引率
5.90%
发文量
23
审稿时长
20 weeks
期刊最新文献
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