Abstract
Introduction
To evaluate the dosimetric data, early toxicity, and patient-reported cosmetic outcomes
in breast cancer patients treated with adjuvant proton-based radiotherapy (RT) after
breast-conserving surgery.
Materials and Methods
We performed a retrospective review of our institutional database to identify breast
cancer patients treated with breast-conserving surgery followed by proton-based RT
from 2015 to 2020. Patient-reported cosmetic outcomes were graded as excellent, good,
fair, or poor. Early toxicity outcomes were graded by the treating physician during
treatment. Dose-volume histograms were reviewed to obtain dosimetry data.
Results
We identified 21 patients treated with adjuvant proton-based RT. Median whole breast
dose delivered was 46.8 Gy (range, 40.0-50.4 Gy). Target volumes included the regional
lymph nodes in 17 patients (81%). Seventeen patients (81%) received a lumpectomy boost.
The median planning target volume V95 was 94% (range, 77%-100%), V100 71% (range,
60%-97%), V110 2% (range 0%-18%), and median max point dose was 115% (range, 105%-120%).
The median ipsilateral breast V105 was 367.3 cc (range, 0-1172 cc) and V110 was 24.1
cc (range, 0-321.3 cc). Grade 2 and 3 dermatitis occurred in 62% and 14% of patients,
respectively. Grade 2 and 3 pain was reported by 33% and 10% of patients, respectively.
Median follow-up at the time of cosmetic evaluation was 27 months (range, 5-42 months).
Four patients (21%) reported fair cosmetic outcome and 15 patients (79%) reported
good or excellent cosmetic outcome. No poor cosmesis was reported.
Conclusion
Adjuvant proton-based radiotherapy after breast-conserving surgery is well tolerated
with acceptable rates of acute toxicities and a high rate of good-to-excellent patient-reported
cosmetic outcomes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Breast CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Comparing dosimetric, morbidity, quality of life, and cancer control outcomes after 3D conformal, intensity-modulated, and proton radiation therapy for prostate cancer.Semin Radiat Oncol. 2013; 23: 182-190
- Factors determining esthetic outcome after breast cancer conservative treatment.Breast J. 2007; 13: 140-146
- Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised.Br J Surg. 2003; 90: 1505-1509
- The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC 'boost vs. no boost' trial. EORTC radiotherapy and breast cancer cooperative groups.Radiother Oncol. 2000; 55: 219-232
- Toxicity and cosmetic outcome of hypofractionated whole-breast radiotherapy: predictive clinical and dosimetric factors.Radiat Oncol. 2014; 9: 97
- Factors influencing cosmetic results after conservation therapy for breast cancer.Int J Radiat Oncol Biol Phys. 1995; 31: 753-764
- Conservative surgery and radiation therapy for early breast cancer. Long-term cosmetic results.Arch Surg. 1989; 124: 153-157
- Radiotherapy breast boost with reduced whole-breast dose is associated with improved cosmesis: the results of a comprehensive assessment from the St. George and Wollongong randomized breast boost trial.Int J Radiat Oncol Biol Phys. 2012; 82: 682-689
- Differences in disease presentation, management techniques, treatment outcome, and toxicities in African-American women with early stage breast cancer treated with breast-conserving therapy.Cancer. 2010; 116: 3485-3492
- Long-term clinical and cosmetic outcomes after breast conservation treatment for women with early-stage breast carcinoma according to the type of breast boost.Int J Radiat Oncol Biol Phys. 2011; 79: 1048-1054
- Long-term cosmesis following a novel schedule of accelerated partial breast radiation in selected early stage breast cancer: result of a prospective clinical trial.Radiat Oncol J. 2017; 35: 325-331
- Psychological factors in women choosing radiation therapy for breast cancer.Psychosomatics. 1984; 25 (9): 464-466
- Quantitative and qualitative cosmetic evaluation after conservative treatment for breast cancer.Eur J Cancer. 1991; 27: 1395-1400
- Cosmetic assessment of breast-conserving surgery for primary breast cancer.Breast. 1999; 8: 162-168
- Cosmetic outcome and breast morbidity in breast-conserving treatment–results from the Danish DBCG-82TM national randomized trial in breast cancer.Acta Oncol. 2002; 41: 369-380
- Breast appearance and function after breast conserving surgery and radiotherapy.Acta Oncol. 1990; 29: 291-295
- Long-term cosmetic outcome and toxicity in patients treated with quadrantectomy and radiation therapy for early-stage breast cancer.Oncology. 1995; 52: 177-181
- Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer. 1. Comparison of patients' ratings, observers' ratings, and objective assessments.Radiother Oncol. 1992; 25: 153-159
- Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France.J Clin Oncol. 1997; 15: 963-968
- Long-term cosmetic outcomes and toxicities of proton beam therapy compared with photon-based 3-dimensional conformal accelerated partial-breast irradiation: a phase 1 trial.Int J Radiat Oncol Biol Phys. 2014; 90: 493-500
- Partial breast radiation therapy with proton beam: 5-year results with cosmetic outcomes.Int J Radiat Oncol Biol Phys. 2014; 90: 501-505
- Improved long-term patient-reported health and well-being outcomes of early-stage breast cancer treated with partial breast proton therapy.Cancer Med. 2018; 7: 6064-6076
- Phase 2 trial of accelerated, hypofractionated whole-breast irradiation of 39 Gy in 13 fractions followed by a tumor bed boost sequentially delivering 9 Gy in 3 fractions in early-stage breast cancer.Int J Radiat Oncol Biol Phys. 2013; 87: 1037-1042
- Phase II study of proton beam radiation therapy for patients with breast cancer requiring regional nodal irradiation.J Clin Oncol. 2019; 37: 2778-2785
- Initial report of a prospective dosimetric and clinical feasibility trial demonstrates the potential of protons to increase the therapeutic ratio in breast cancer compared with photons.Int J Radiat Oncol Biol Phys. 2016; 95: 411-421
- Proton beam radiotherapy as part of comprehensive regional nodal irradiation for locally advanced breast cancer.Radiother Oncol. 2017; 123: 294-298
- A novel schedule of accelerated partial breast radiation using intensity-modulated radiation therapy in elderly patients: survival and toxicity analysis of a prospective clinical trial.Radiat Oncol J. 2017; 35: 32-38
Article info
Publication history
Published online: November 30, 2022
Accepted:
November 26,
2022
Received in revised form:
November 22,
2022
Received:
June 6,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
