Early toxicity in patients treated with postoperative proton therapy for locally advanced breast cancer.
Early toxicity in patients treated with postoperative proton therapy for locally advanced breast cancer.
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DOI：
10.1016/j.ijrobp.2015.01.005
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发表时间：
2015-06-01
期刊：
影响因子：
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通讯作者：
Cahlon O
中科院分区：
文献类型：
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作者：
Cuaron JJ;Chon B;Tsai H;Goenka A;DeBlois D;Ho A;Powell S;Hug E;Cahlon O
目的：报告乳腺癌术后质子放射治疗患者的剂量学和早期毒性数据。从2013年3月到2014年4月，30名无放射病史的非转移性乳腺癌患者在一个质子治疗中心接受质子治疗。通过复习图表获得患者特征和剂量学信息。在治疗期间，在放射治疗完成后1个月，以及此后每隔3至6个月观察患者。使用不良事件通用术语标准版本4.0对毒性进行评分。毒副作用的频率被列在表格中。中位剂量为50.4Gy5周(相对生物当量)。靶体积包括乳房/胸壁和区域淋巴结，包括内乳房淋巴结(93%)。没有患者需要休息治疗。在随访3个月(n=28)的患者中，发生2级皮炎20例(71.4%)，其中8例(28.6%)出现湿性脱皮。发生2级食管炎8例(28.6%)。1例出现3级重建并发症。规划目标体积V95中位数为96.43%(范围79.39%~99.60%)。所有患者心脏剂量的中位数为0.88(RBE)[范围为0.01~3.20(RBE)]，左侧肿瘤患者的平均心脏剂量为1.00(RBE)。同侧肺V20中位数为16.50%(6.1%~30.3%)。对侧肺V5中位数为0.34%(范围为0%~5.30%)。食道中位最大点剂量为45.65Gy0~65.4Gy.对侧乳房中位剂量为0.29(RBE)[范围为0.03~3.50(RBE)]。术后质子治疗耐受性好，皮肤毒性可接受。质子治疗有利于在不影响靶区覆盖的情况下保留正常组织。有必要进行进一步的随访，以评估临床结果和心肺毒性。
To report dosimetry and early toxicity data in breast cancer patients treated with postoperative proton radiation therapy. From March 2013 to April 2014, 30 patients with nonmetastatic breast cancer and no history of prior radiation were treated with proton therapy at a single proton center. Patient characteristics and dosimetry were obtained through chart review. Patients were seen weekly while on treatment, at 1 month after radiation therapy completion, and at 3- to 6-month intervals thereafter. Toxicity was scored using Common Terminology Criteria for Adverse Events version 4.0. Frequencies of toxicities were tabulated. Median dose delivered was 50.4 Gy (relative biological equivalent [RBE]) in 5 weeks. Target volumes included the breast/chest wall and regional lymph nodes including the internal mammary lymph nodes (in 93%). No patients required a treatment break. Among patients with >3 months of follow-up (n = 28), grade 2 dermatitis occurred in 20 patients (71.4%), with 8 (28.6%) experiencing moist desquamation. Grade 2 esophagitis occurred in 8 patients (28.6%). Grade 3 reconstructive complications occurred in 1 patient. The median planning target volume V95 was 96.43% (range, 79.39%-99.60%). The median mean heart dose was 0.88 Gy (RBE) [range, 0.01–3.20 Gy (RBE)] for all patients, and 1.00 Gy (RBE) among patients with left-sided tumors. The median V20 of the ipsilateral lung was 16.50% (range, 6.1%–30.3%). The median contralateral lung V5 was 0.34% (range, 0%–5.30%). The median maximal point dose to the esophagus was 45.65 Gy (RBE) [range, 0–65.4 Gy (RBE)]. The median contralateral breast mean dose was 0.29 Gy (RBE) [range, 0.03–3.50 Gy (RBE)]. Postoperative proton therapy is well tolerated, with acceptable rates of skin toxicity. Proton therapy favorably spares normal tissue without compromising target coverage. Further follow-up is necessary to assess for clinical outcomes and cardiopulmonary toxicities.