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Reducing Radiation Dermatitis for PBS Proton Therapy Breast Cancer Patients Using SpotDelete.

Samantha G Hedrick1, Laura Buchanan1, Stephen Mahan1

  • 1Thompson Proton Center, Knoxville, TN 37909, USA.

International Journal of Particle Therapy
|September 19, 2024
PubMed
Summary
This summary is machine-generated.

SpotDelete, a technique eliminating proton spots in the skin, reduced radiation dermatitis severity and delayed its onset in breast cancer patients undergoing proton therapy. This method shows promise for improving patient outcomes by mitigating skin side effects.

Keywords:
BreastDermatitisPBSSide effects

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Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Pencil beam scanning proton therapy offers precise dose delivery but can cause radiation dermatitis.
  • The skin is susceptible to radiation-induced damage, particularly at the Bragg Peak where relative biological effectiveness (RBE) may be higher.
  • Mitigating radiation dermatitis is crucial for improving patient quality of life during breast cancer treatment.

Purpose of the Study:

  • To evaluate the effectiveness of the SpotDelete technique in reducing the severity of radiation dermatitis for breast cancer patients receiving pencil beam scanning proton therapy.
  • To test the hypothesis that eliminating proton spots in the skin rind minimizes RBE and subsequent skin toxicity.

Main Methods:

  • Retrospective review of breast cancer patients treated with hypofractionation (16 fractions) before (MinDepth) and after (SpotDelete) implementing the SpotDelete technique.
  • Analysis of physician-reported radiation dermatitis scores and treatment plans, including calculation of linear energy transfer (LET) and application of three RBE models.
  • Comparison of dermatitis incidence, severity, onset, LET, and RBE between the MinDepth and SpotDelete cohorts, assuming an α/β of 10 for skin.

Main Results:

  • The SpotDelete cohort (n=27) showed a reduction in grade 3 radiation dermatitis (0% vs. 7%) and a delay in the onset of dermatitis by one week compared to the MinDepth cohort (n=28).
  • Incidence rates for grade 1 and 2 dermatitis were 67% and 37% in the SpotDelete group, respectively.
  • No significant differences in LET or RBE were observed between the cohorts in the 0.5 cm skin rind.

Conclusions:

  • The SpotDelete technique effectively reduces the severity and delays the onset of radiation dermatitis in breast cancer patients treated with proton therapy.
  • While LET and RBE did not correlate with the observed reduction in dermatitis, the clinical benefit of SpotDelete is evident.
  • Further research into skin-specific α/β values and RBE models may elucidate the underlying mechanisms of SpotDelete's efficacy.