PMID- 35647397
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230916
IS  - 2452-1094 (Print)
IS  - 2452-1094 (Electronic)
IS  - 2452-1094 (Linking)
VI  - 7
IP  - 3
DP  - 2022 May-Jun
TI  - Intensity Modulated Proton Therapy for Bilateral Breast or Chest Wall and 
      Comprehensive Nodal Irradiation for Synchronous Bilateral Breast Cancer: Initial 
      Clinical Experience and Dosimetric Comparison.
PG  - 100901
LID - 10.1016/j.adro.2022.100901 [doi]
LID - 100901
AB  - PURPOSE: Synchronous bilateral breast cancer (SBBC) poses distinct challenges for 
      radiation therapy planning. We report our proton therapy experience in treating 
      patients with SBBC. We also provide a dosimetric comparison of intensity 
      modulated proton therapy (IMPT) versus photon therapy. METHODS AND MATERIALS: 
      Patients with SBBC who received IMPT at our institution were retrospectively 
      analyzed. The clinical target volume (CTV) included the breast or chest wall and 
      comprehensive regional lymph nodes, including axilla, supraclavicular fossa, and 
      the internal mammary chain. Intensity modulated proton therapy and volumetric 
      modulated arc therapy (VMAT) plans were generated with the goal that 90% of the 
      CTV would recieve at least 90% of the prescription dose (D90>=90%). Comparisons 
      between modalities were made using the Wilcoxon signed rank test. 
      Physician-reported acute toxic effects and photography were collected at 
      baseline, end of treatment, and each follow-up visit. RESULTS: Between 2015 and 
      2018, 11 patients with SBBC were treated with IMPT. The prescription was 50 Gy in 
      25 fractions. The median CTV D90 was 99.9% for IMPT and 97.6% for VMAT 
      (P = .001). The mean heart dose was 0.7 Gy versus 7.2 Gy (P = .001), the total 
      lung mean dose was 7.8 Gy versus 17.3 Gy (P = .001), and the total lung volume 
      recieving 20 Gy was 13.0% versus 27.4% (P = .001). The most common acute toxic 
      effects were dermatitis (mostly grade 1-2 with 1 case of grade 3) and grade 1 to 
      2 fatigue. The most common toxic effects at the last-follow up (median, 32 
      months) were grade 1 skin hyperpigmentation, superficial fibrosis, and extremity 
      lymphedema. No nondermatologic or nonfatigue adverse events of grade >1 were 
      recorded. CONCLUSIONS: Bilateral breast and/or chest wall and comprehensive nodal 
      IMPT is technically feasible and associated with low rates of severe acute toxic 
      effects. Treatment with IMPT offered improved target coverage and normal-tissue 
      sparing compared with photon therapy. Long-term follow-up is ongoing to assess 
      efficacy and toxic effects.
CI  - (c) 2022 The Authors.
FAU - Garda, Allison E
AU  - Garda AE
AD  - Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
FAU - Hunzeker, Ashley E
AU  - Hunzeker AE
AD  - Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
FAU - Michel, Ann K
AU  - Michel AK
AD  - Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
FAU - Fattahi, Sayeh
AU  - Fattahi S
AD  - Mayo Clinic Alix School of Medicine, Rochester, Minnesota.
FAU - Shiraishi, Satomi
AU  - Shiraishi S
AD  - Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
FAU - Remmes, Nicholas B
AU  - Remmes NB
AD  - Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
FAU - Schultz, Heather L
AU  - Schultz HL
AD  - Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
FAU - Harmsen, W Scott
AU  - Harmsen WS
AD  - Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, 
      Minnesota.
FAU - Shumway, Dean A
AU  - Shumway DA
AD  - Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
FAU - Yan, Elizabeth S
AU  - Yan ES
AD  - Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
FAU - Park, Sean S
AU  - Park SS
AD  - Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
FAU - Mutter, Robert W
AU  - Mutter RW
AD  - Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
FAU - Corbin, Kimberly S
AU  - Corbin KS
AD  - Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
LA  - eng
GR  - P30 CA015083/CA/NCI NIH HHS/United States
PT  - Journal Article
DEP - 20220124
PL  - United States
TA  - Adv Radiat Oncol
JT  - Advances in radiation oncology
JID - 101677247
PMC - PMC9133394
EDAT- 2022/06/02 06:00
MHDA- 2022/06/02 06:01
PMCR- 2022/01/24
CRDT- 2022/06/01 11:47
PHST- 2021/08/04 00:00 [received]
PHST- 2022/01/09 00:00 [accepted]
PHST- 2022/06/01 11:47 [entrez]
PHST- 2022/06/02 06:00 [pubmed]
PHST- 2022/06/02 06:01 [medline]
PHST- 2022/01/24 00:00 [pmc-release]
AID - S2452-1094(22)00008-2 [pii]
AID - 100901 [pii]
AID - 10.1016/j.adro.2022.100901 [doi]
PST - epublish
SO  - Adv Radiat Oncol. 2022 Jan 24;7(3):100901. doi: 10.1016/j.adro.2022.100901. 
      eCollection 2022 May-Jun.