PMID- 19615828
OWN - NLM
STAT- MEDLINE
DCOM- 20100305
LR  - 20220408
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 76
IP  - 3
DP  - 2010 Mar 1
TI  - Postoperative proton radiotherapy for localized and locoregional breast cancer: 
      potential for clinically relevant improvements?
PG  - 685-97
LID - 10.1016/j.ijrobp.2009.02.062 [doi]
AB  - PURPOSE: To study the potential reduction of dose to organs at risk (OARs) with 
      intensity-modulated proton radiotherapy (IMPT) compared with intensity-modulated 
      radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) photon 
      radiotherapy for left-sided breast cancer patients. METHODS AND MATERIALS: 
      Comparative treatment-planning was performed using planning computed tomography 
      scans of 20 left-sided breast cancer patients. For each patient, three 
      increasingly complex locoregional volumes (planning target volumes [PTVs]) were 
      defined: whole breast (WB) or chest wall (CW) = (PTV1), WB/CW plus 
      medial-supraclavicular (MSC), lateral-supraclavicular (LSC), and level III 
      axillary (AxIII) nodes = (PTV2) and WB/CW+MSC+LSC+AxIII plus internal mammary 
      chain = (PTV3). For each patient, 3D-CRT, IMRT, and IMPT plans were optimized for 
      PTV coverage. Dose to OARs was compared while maintaining target coverage. 
      RESULTS: All the techniques met the required PTV coverage except the 3D-CRT plans 
      for PTV3-scenario. All 3D-CRT plans for PTV3 exceeded left-lung V20. IMPT vs. 
      3D-CRT: significant dose reductions were observed for all OARs using IMPT for all 
      PTVs. IMPT vs. IMRT: For PTV2 and PTV3, low (V5) left lung and cardiac doses were 
      reduced by a factor >2.5, and cardiac doses (V22.5) were by a factor of >20 lower 
      with IMPT compared with IMRT. CONCLUSIONS: When complex-target irradiation is 
      needed, 3D-CRT often compromises the target coverage and increases the dose to 
      OARs; IMRT can provide better results but will increase the integral dose. The 
      benefit of IMPT is based on improved target coverage and reduction of low doses 
      to OARs, potentially reducing the risk of late-toxicity. These results indicate a 
      potential role of proton-radiotherapy for extended locoregional irradiation in 
      left breast cancer.
CI  - Copyright (c) 2010 Elsevier Inc. All rights reserved.
FAU - Ares, Carmen
AU  - Ares C
AD  - Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland. 
      carmen.ares@psi.ch
FAU - Khan, Shaka
AU  - Khan S
FAU - Macartain, Anne M
AU  - Macartain AM
FAU - Heuberger, Jurg
AU  - Heuberger J
FAU - Goitein, Gudrun
AU  - Goitein G
FAU - Gruber, Guenther
AU  - Gruber G
FAU - Lutters, Gerd
AU  - Lutters G
FAU - Hug, Eugen B
AU  - Hug EB
FAU - Bodis, Stephan
AU  - Bodis S
FAU - Lomax, Antony J
AU  - Lomax AJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20090715
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
RN  - 0 (Protons)
SB  - IM
MH  - Breast Neoplasms/diagnostic imaging/pathology/*radiotherapy
MH  - Female
MH  - Heart/diagnostic imaging/radiation effects
MH  - Humans
MH  - Lung/diagnostic imaging/radiation effects
MH  - *Proton Therapy
MH  - Radiation Injuries/*prevention & control
MH  - Radiography
MH  - Radiotherapy Dosage
MH  - Radiotherapy Planning, Computer-Assisted/*methods
MH  - Radiotherapy, Conformal/*methods
MH  - Radiotherapy, Intensity-Modulated/methods
MH  - Tumor Burden
EDAT- 2009/07/21 09:00
MHDA- 2010/03/06 06:00
CRDT- 2009/07/21 09:00
PHST- 2008/12/03 00:00 [received]
PHST- 2009/02/23 00:00 [revised]
PHST- 2009/02/24 00:00 [accepted]
PHST- 2009/07/21 09:00 [entrez]
PHST- 2009/07/21 09:00 [pubmed]
PHST- 2010/03/06 06:00 [medline]
AID - S0360-3016(09)00365-4 [pii]
AID - 10.1016/j.ijrobp.2009.02.062 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3):685-97. doi: 
      10.1016/j.ijrobp.2009.02.062. Epub 2009 Jul 15.