Initial Report of a Prospective Dosimetric and Clinical Feasibility Trial Demonstrates the Potential of Protons to Increase the Therapeutic Ratio in Breast Cancer Compared With Photons
Initial Report of a Prospective Dosimetric and Clinical Feasibility Trial Demonstrates the Potential of Protons to Increase the Therapeutic Ratio in Breast Cancer Compared With Photons
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DOI：
10.1016/j.ijrobp.2015.09.018
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发表时间：
2016-05-01
影响因子：
7
通讯作者：
Mendenhall, Nancy P.
中科院分区：
文献类型：
--
作者：
Bradley, Julie A.;Dagan, Roi;Mendenhall, Nancy P.
目的：比较质子治疗（PT）和常规放射治疗之间的剂量学终点，并确定PT的可行性区域淋巴结照射（RNI）在妇女乳腺cancer.Methods和Materials：从2012年至2014年，18名妇女（阶段IIA-IIIB）需要RNI前瞻性地参加了试点研究。中位年龄为51.8岁（范围：42-73岁）。该队列包括保乳治疗（BCT）和乳房切除术患者以及右侧和左侧癌症。在计算机断层扫描上描绘了治疗靶点和危险器官，并制定了PT和常规计划。使用不良事件通用术语标准4.0版前瞻性记录毒性。Wilcoxon符号秩和检验比较了剂量-体积参数。主要终点是心脏V5的降低。结果：中位随访时间为20个月（范围，2-31个月）。对于所有患者，PT计划更好地满足剂量测定目标，并用于治疗。10例患者（9例乳腺切除术后，1例BCT后）单独使用质子治疗，8例患者（6例BCT，2例乳腺切除术后立即扩张重建）使用质子-光子联合治疗。质子治疗改善了2级腋窝的覆盖率（P=.0005）。PT（中位D95，50.3戈伊;范围，46.6-52.1戈伊）持续实现了内乳淋巴结的充分覆盖，但常规放疗（中位D95，48.2戈伊;范围，40.8-55戈伊; P=.0005）未实现。PT组中位V5为0.6%，常规放疗组中位V5为16.3%（P
Purpose: To compare dosimetric endpoints between proton therapy (PT) and conventional radiation and determine the feasibility of PT for regional nodal irradiation (RNI) in women with breast cancer.Methods and Materials: From 2012 to 2014, 18 women (stage IIA-IIIB) requiring RNI prospectively enrolled on a pilot study. Median age was 51.8 years (range, 42-73 years). The cohort included breast-conserving therapy (BCT) and mastectomy patients and right-and left-sided cancers. Treatment targets and organs at risk were delineated on computed tomography scans, and PT and conventional plans were developed. Toxicity was prospectively recorded using Common Terminology Criteria for Adverse Events version 4.0. A Wilcoxon signed-rank sum test compared the dose-volume parameters. The primary endpoint was a reduction in cardiac V5.Results: Median follow-up was 20 months (range, 2-31 months). For all patients, the PT plan better met the dosimetric goals and was used for treatment. Proton therapy alone was used for 10 patients (9 postmastectomy, 1 after BCT) and combined proton-photon in 8 (6 BCT, 2 postmastectomy with immediate expander reconstruction). Proton therapy improved coverage of level 2 axilla (P=.0005). Adequate coverage of internal mammary nodes was consistently achieved with PT (median D95, 50.3 Gy; range, 46.6-52.1 Gy) but not with conventional radiation therapy (median D95, 48.2 Gy; range, 40.8-55 Gy; P=.0005). Median cardiac V5 was 0.6% with PT and 16.3% with conventional radiation (P