Proton beam radiotherapy as part of comprehensive regional nodal irradiation for locally advanced breast cancer

Publication date: Available online 27 April 2017
Source:Radiotherapy and Oncology
Author(s): Vivek Verma, Zaid Iftekaruddin, Nida Badar, William Hartsell, John Han-Chih Chang, Vinai Gondi, Mark Pankuch, Ming Gao, Stacey Schmidt, Darren Kaplan, Lisa McGee
PurposeThis study evaluates acute toxicity outcomes in breast cancer patients treated with adjuvant proton beam therapy (PBT).MethodsFrom 2011 to 2016, 91 patients (93 cancers) were treated with adjuvant PBT targeting the intact breast/chest wall and comprehensive regional nodes including the axilla, supraclavicular fossa, and internal mammary lymph nodes. Toxicity was recorded weekly during treatment, one month following treatment, and then every 6months according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Charts were retrospectively reviewed to verify toxicities, patient parameters, disease and treatment characteristics, and disease-related outcomes.ResultsMedian follow-up was 15.5months. Median PBT dose was 50.4 Gray relative biological effectiveness (GyRBE), with subsequent boost as clinically indicated (N=61, median 10 GyRBE). Chemotherapy, when administered, was given adjuvantly (N=42) or neoadjuvantly (N=46). Grades 1, 2, and 3 dermatitis occurred in 23%, 72%, and 5%, respectively. Eight percent required treatment breaks owing to dermatitis. Median time to resolution of dermatitis was 32days. Grades 1, 2, and 3 esophagitis developed in 31%, 33%, and 0%, respectively.ConclusionsPBT displays acceptable toxicity in the setting of comprehensive regional nodal irradiation.



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