Related Experiment Video
Updated: Aug 16, 2026
Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
Published on: February 6, 2019
Acute Radiation Side Effects of Proton Versus Photon Therapy Following Surgery for Early Breast Cancer, a Substudy of
Kristine Wiborg Høgsbjerg1, Stine Elleberg Petersen2, Else Maae3
1Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; The Faculty of Health, Aarhus University, Aarhus, Denmark.
Purpose:
Proton therapy (PT) is associated with favorable dosimetric characteristics compared with photon radiation therapy (γRT) in invasive breast cancer; however, clinical evidence on acute toxicity remains limited. This study aimed to compare acute treatment-related side effects between moderately hypofractionated PT and γRT in breast cancer.
Methods And Materials:
The Danish Breast Cancer Group Proton trial-acute side effects was a preplanned substudy of the national, phase 3 randomized trial, the Danish Breast Cancer Group Proton trial. Patients with invasive breast cancer or ductal carcinoma in situ scheduled for adjuvant radiation therapy (RT), who were expected to receive a high cardiac and/or pulmonary dose based on γRT planning computed tomography scan, were randomized 1:1 to PT or γRT. Acute side effects were prospectively assessed during RT and up to 6 months posttreatment. Outcomes included skin-related side effects, respiratory symptoms, dysphagia, fatigue, and arm/shoulder side effects.
Results:
A total of 167 patients (186 treated breasts) were included (PT 84 and γRT 83). Skin-related side effects peaked at week 5, with higher grade 2 to 3 dermatitis (71% PT vs 20% γRT), pruritus (20% vs 5%), and local pain (17% vs 4%) after PT compared with γRT. All skin-related grade 2 to 3 side effects were transient, resolving to grade 0 to 1 within 2 to 4 weeks after peaking. Respiratory symptoms, dysphagia, and fatigue were mild and similar between groups. Clinically relevant arm/shoulder morbidity was rare. No treatment discontinuations because of side effects were observed.
Conclusions:
Acute side effects after breast cancer RT were primarily skin-related, higher but transient after PT compared with γRT. Non-skin-related side effects, including respiratory symptoms, fatigue, and arm/shoulder morbidity, were comparable between PT and γRT. These prospective data, using modern techniques and moderate hypofractionation, suggest that PT is a feasible and clinically acceptable treatment approach for adjuvant treatment of invasive breast cancer or ductal carcinoma in situ, while acknowledging the higher incidence of transient acute skin-related side effects.
Related Concept Videos
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
02:49Cancer Therapies
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...