质子疗法治疗男性乳腺癌

Julie A. Bradley, Jayden Gracie, Raymond B. Mailhot Vega, Eric D. Brooks, Tenna Burchianti, Oluwadamilola T. Oladeru, Xiaoying Liang, Nancy P. Mendenhall
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Results Five male patients were identified. All had estrogen receptor (ER)–positive, Her2neu-negative disease and received adjuvant endocrine therapy. One had genetic testing positive for BRCA2, one had a variant of unknown significance (VUS) in the APC gene, and one had a VUS in MSH2. Median age was 73 years (range, 41–80). Baseline comorbidities included obesity (n = 1), diabetes (n = 1), hypertension (n = 4), history of deep vein thrombosis (n = 1), personal history of myocardial infarction (n = 3; 1 with a pacemaker), and a history of lung cancer (n = 1). All received PT to the left chest wall and comprehensive regional lymphatics. One received passive-scattering PT, and 4 received pencil beam scanning. One patient received a boost to the mastectomy incision via electrons. 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引用次数: 0

摘要

【摘要】目的男性乳腺癌的治疗涉及多模式治疗,包括放射治疗;然而,很少有男性接受质子治疗(PT)。此外,心脏病是男性死亡的主要原因,心脏放射治疗剂量与心脏毒性相关,突出了对心脏保护放射技术的需求。因此,我们对男性乳腺癌队列中的PT进行了描述性分析。患者和方法从前瞻性数据库中确定2012年至2022年间接受局部乳腺癌PT治疗的男性。使用不良事件通用术语标准(CTCAE) 4.0版本前瞻性记录毒性。结果男性患者5例。所有患者均为雌激素受体(ER)阳性,her2new阴性,并接受辅助内分泌治疗。其中一人的BRCA2基因检测呈阳性,一人在APC基因中有未知意义的变异(VUS),一人在MSH2中有VUS。中位年龄为73岁(范围41-80岁)。基线合并症包括肥胖(n = 1)、糖尿病(n = 1)、高血压(n = 4)、深静脉血栓形成史(n = 1)、个人心肌梗死史(n = 3);1例(带起搏器),并有肺癌病史(n = 1)。所有患者均接受左胸壁PT和全面的局部淋巴管。1例接受被动散射PT, 4例接受铅笔束扫描。一名患者通过电子对乳房切除术切口进行了增强。心脏中位剂量为1gyrbe(范围0-1.0),左前降支0.1-cm3中位剂量为7.5 GyRBE(范围0-14.2),中位随访时间为2年(范围0.75-6.5);没有患者发生新的心脏事件,并且所有患者都没有乳腺癌复发和进展。结论:在一个罕见诊断的小病例系列中,胸壁和局部淋巴管,包括乳腺内淋巴结,导致心脏暴露低,局部区域疾病控制率高,毒性小。治疗男性乳腺癌应考虑质子治疗,以达到心脏保护。
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Proton Therapy in the Treatment of Men with Breast Cancer
Abstract Purpose Male breast cancer treatment involves multimodality therapy, including radiation therapy; nevertheless, few men have received proton therapy (PT) for it. Further, heart disease is an established leading cause of death in men, and radiation therapy heart dose correlates with cardiac toxicity, highlighting the need for cardiac-sparing radiation techniques. Thus, we provide a descriptive analysis of PT in a male breast cancer cohort. Patients and Methods Men who received PT for localized breast cancer between 2012 and 2022 were identified from a prospective database. Toxicities were prospectively recorded by using the Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. Results Five male patients were identified. All had estrogen receptor (ER)–positive, Her2neu-negative disease and received adjuvant endocrine therapy. One had genetic testing positive for BRCA2, one had a variant of unknown significance (VUS) in the APC gene, and one had a VUS in MSH2. Median age was 73 years (range, 41–80). Baseline comorbidities included obesity (n = 1), diabetes (n = 1), hypertension (n = 4), history of deep vein thrombosis (n = 1), personal history of myocardial infarction (n = 3; 1 with a pacemaker), and a history of lung cancer (n = 1). All received PT to the left chest wall and comprehensive regional lymphatics. One received passive-scattering PT, and 4 received pencil beam scanning. One patient received a boost to the mastectomy incision via electrons. Median heart dose was 1 GyRBE (range, 0–1.0), median 0.1-cm3 dose to the left anterior descending artery was 7.5 GyRBE (range, 0–14.2), and median follow-up was 2 years (range, 0.75–6.5); no patient experienced a new cardiac event, and all remain free from breast cancer recurrence and progression. Conclusion In a small case series for a rare diagnosis, PT to the chest wall and regional lymphatics, including internal mammary nodes, resulted in low cardiac exposure, high local regional disease control rates, and minimal toxicity. Proton therapy should be considered for treating men with breast cancer to achieve cardiac sparing.
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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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