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Hyperfractionated-Accelerated Reirradiation with Proton Therapy for Radiation-Associated Breast Angiosarcoma.
Wen Shen Looi1, Julie A Bradley2, Xiaoying Liang3
1University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA.
International Journal of Particle Therapy
|May 9, 2022
Summary
Hyperfractionated-accelerated reirradiation (HART) with proton therapy shows promise for treating radiation-associated angiosarcoma (RAAS), achieving excellent local control. Close monitoring for distant metastasis is crucial, as toxicity appears comparable to traditional photon therapy.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- Radiation-associated angiosarcoma (RAAS) is a rare but serious complication following breast cancer radiation therapy.
- Hyperfractionated-accelerated reirradiation (HART) is an established technique to improve local control in challenging cases.
- Proton therapy offers potential advantages in sparing normal tissues during reirradiation, potentially improving the therapeutic ratio.
Purpose of the Study:
- To evaluate the efficacy and toxicity of HART with proton therapy in patients with localized RAAS.
- To assess local control rates and the incidence of distant metastasis in this patient cohort.
- To compare the toxicity profile of proton therapy-based HART with historical data from photon/electron reirradiation series.
Main Methods:
- A prospective registry study included six patients with localized RAAS treated with HART using proton therapy between 2015 and 2021.
- HART was delivered with fraction sizes of 1.0-1.5 Gy, twice or thrice daily, to a total dose of 45 Gy plus boosts up to 65-75 Gy.
- Toxicity was prospectively assessed using the Common Terminology Criteria for Adverse Events (CTCAE) v4.0.
Main Results:
- The median follow-up was 1.5 years; median patient age was 73 years, with a median latency of 8.9 years from prior radiation.
- All six patients achieved local control. Three of four patients receiving preoperative HART had a pathologic complete response.
- Two patients developed distant metastases. Grade 3 acute toxicities included wound dehiscence (n=2) and wound infection (n=1).
Conclusions:
- HART with proton therapy demonstrates significant efficacy for local control of RAAS, with a high rate of pathologic complete response and no observed local recurrences.
- Vigilant surveillance for distant metastatic disease is recommended.
- The toxicity profile appears manageable and comparable to historical photon/electron reirradiation series, suggesting proton therapy may optimize normal tissue sparing in this setting.
