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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

Published on: February 6, 2019

Accelerated partial-breast irradiation using proton beams: initial clinical experience.

Kevin R Kozak¹, Barbara L Smith, Judith Adams

¹Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.

International Journal of Radiation Oncology, Biology, Physics

|October 3, 2006

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Proton partial-breast irradiation shows excellent cosmetic results and patient satisfaction for early-stage breast cancer. However, it causes significant acute skin toxicity and potential late rib toxicity, prompting technique modifications.

Area of Science:

Oncology
Radiation Oncology
Medical Physics

Background:

Partial-breast irradiation is an alternative to whole-breast irradiation for early-stage breast cancer.
Proton therapy offers dosimetric advantages over photon therapy.
Three-dimensional conformal proton beam therapy allows for precise dose delivery.

Purpose of the Study:

To evaluate the initial clinical experience and outcomes of proton, three-dimensional, conformal, external beam, partial-breast irradiation (3D-CPBI).
To assess efficacy, cosmetic results, toxicity, and patient satisfaction in patients with Stage I breast cancer treated with proton 3D-CPBI.

Main Methods:

A Phase I/II clinical trial was conducted involving 20 patients with Stage I breast cancer.
Patients received proton 3D-CPBI and were followed for recurrence, cosmetic outcome, toxicity, and satisfaction.

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Follow-up assessments occurred at 3-4 weeks, 6-8 weeks, 6 months, and every 6 months thereafter.

Main Results:

No recurrent disease was detected with a median follow-up of 12 months.
Physician- and patient-reported global breast cosmesis was good or excellent in 89%-100% of cases.
Significant acute skin toxicity (79% moderate-to-severe skin color changes, 22% moist desquamation) and some late toxicities (telangiectasia, rib tenderness/fracture) were observed.

Conclusions:

Proton 3D-CPBI demonstrates favorable cosmetic outcomes and high patient satisfaction.
Significant acute skin toxicity and potential late rib toxicity were noted.
Modifications to the proton 3D-CPBI technique are being investigated to mitigate acute skin toxicity.