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Proton Therapy for Bilateral Breast Cancer Maximizes Normal-Tissue Sparing.

Eric D Brooks1, Raymond B Mailhot Vega1, Emma Vivers2

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Proton therapy significantly reduces radiation dose to organs at risk for bilateral breast cancer patients compared to photon therapy. This approach maintains target coverage and shows promising survival rates with manageable toxicity.

Keywords:
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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Oncology

Background:

  • Bilateral breast cancer treatment with radiation therapy presents significant technical challenges.
  • Optimizing treatment planning is crucial for minimizing toxicity and maximizing efficacy in complex cases.

Purpose of the Study:

  • To evaluate clinical and dosimetric outcomes of proton therapy for synchronous bilateral breast cancer.
  • To compare proton therapy with intensity-modulated radiation therapy (IMRT) photon plans for organ sparing and target coverage.

Main Methods:

  • Retrospective review of six patients with synchronous bilateral breast cancer treated with proton therapy (2012-2021).
  • Comparison with generated IMRT photon plans using double-scattered proton or pencil-beam scanning techniques.
  • Dosimetric analysis focused on target coverage and organ-at-risk sparing.

Main Results:

  • Proton therapy demonstrated comparable clinical target coverage (V95% of 96.4%) to photons (97.8%).
  • Significant organ-at-risk sparing with proton therapy: reduced mean heart dose by 6.7 Gy, coronary artery dose by 47-57%, lung V20 Gy by 54%, and brachial plexus dose by 7.6 Gy.
  • Achieved 100% overall survival at 1.5 years median follow-up with no disease recurrence; manageable acute and subacute toxicities (grades 2-3) were observed.

Conclusions:

  • Proton therapy offers substantial dose reductions to organs at risk in bilateral breast cancer patients.
  • The technique maintains excellent target coverage, making it a preferred modality when available.
  • Favorable clinical outcomes and toxicity profile support the use of proton therapy for this patient population.