Radiation-Induced Toxicity Risks in Photon Versus Proton Therapy for Synchronous Bilateral Breast Cancer
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Radiation-Induced Toxicity Risks in Photon Versus Proton Therapy for Synchronous Bilateral Breast Cancer. / Stick, Line Bjerregaard; Jensen, Maria Fuglsang; Bentzen, Soren M.; Kamby, Claus; Lundgaard, Anni Young; Maraldo, Maja Vestmo; Offersen, Birgitte Vrou; Yu, Jen; Vogelius, Ivan Richter.
In: International Journal of Particle Therapy, Vol. 8, No. 4, 13.03.2022, p. 1-13.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Radiation-Induced Toxicity Risks in Photon Versus Proton Therapy for Synchronous Bilateral Breast Cancer
AU - Stick, Line Bjerregaard
AU - Jensen, Maria Fuglsang
AU - Bentzen, Soren M.
AU - Kamby, Claus
AU - Lundgaard, Anni Young
AU - Maraldo, Maja Vestmo
AU - Offersen, Birgitte Vrou
AU - Yu, Jen
AU - Vogelius, Ivan Richter
PY - 2022/3/13
Y1 - 2022/3/13
N2 - Purpose: This study compares photon and proton therapy plans for patients with synchronous bilateral early breast cancer and estimates risks of early and late radiationinduced toxicities.Materials and Methods: Twenty-four patients with synchronous bilateral early breast cancer receiving adjuvant radiation therapy using photons, 3-dimensional conformal radiation therapy or volumetric modulated arc therapy, were included and competing pencil beam scanning proton therapy plans were created. Risks of dermatitis, pneumonitis, acute esophageal toxicity, lung and breast fibrosis, hypothyroidism, secondary lung and esophageal cancer and coronary artery events were estimated using published dose-response relationships and normal tissue complication probability (NTCP) models.Results: The primary clinical target volume V95% and/or nodal clinical target volume V90% were less than 95% in 17 photon therapy plans and none of the proton plans. Median NTCP of radiation dermatitis > grade 2 was 18.3% (range, 5.4-41.7) with photon therapy and 58.4% (range, 31.4-69.7) with proton therapy. Median excess absolute risk (EAR) of secondary lung cancer at age 80 for current and former smokers was 4.8% (range, 0.0-17.0) using photons and 2.7% (range, 0.0-13.6) using protons. Median EAR of coronary event at age 80, assuming all patients have preexisting cardiac risk factors, was 1.0% (range, 0.0-5.6) with photons and 0.2% (range, 0.0-1.3) with protons.Conclusion: Proton therapy plans improved target coverage and reduced risk of coronary artery event and secondary lung cancer while increasing the risk of radiation dermatitis.
AB - Purpose: This study compares photon and proton therapy plans for patients with synchronous bilateral early breast cancer and estimates risks of early and late radiationinduced toxicities.Materials and Methods: Twenty-four patients with synchronous bilateral early breast cancer receiving adjuvant radiation therapy using photons, 3-dimensional conformal radiation therapy or volumetric modulated arc therapy, were included and competing pencil beam scanning proton therapy plans were created. Risks of dermatitis, pneumonitis, acute esophageal toxicity, lung and breast fibrosis, hypothyroidism, secondary lung and esophageal cancer and coronary artery events were estimated using published dose-response relationships and normal tissue complication probability (NTCP) models.Results: The primary clinical target volume V95% and/or nodal clinical target volume V90% were less than 95% in 17 photon therapy plans and none of the proton plans. Median NTCP of radiation dermatitis > grade 2 was 18.3% (range, 5.4-41.7) with photon therapy and 58.4% (range, 31.4-69.7) with proton therapy. Median excess absolute risk (EAR) of secondary lung cancer at age 80 for current and former smokers was 4.8% (range, 0.0-17.0) using photons and 2.7% (range, 0.0-13.6) using protons. Median EAR of coronary event at age 80, assuming all patients have preexisting cardiac risk factors, was 1.0% (range, 0.0-5.6) with photons and 0.2% (range, 0.0-1.3) with protons.Conclusion: Proton therapy plans improved target coverage and reduced risk of coronary artery event and secondary lung cancer while increasing the risk of radiation dermatitis.
KW - proton therapy
KW - bilateral breast cancer
KW - treatment planning
KW - bioeffect modeling
KW - normal tissue complication probability
KW - INTERNAL MAMMARY
KW - LUNG-CANCER
KW - RADIOTHERAPY
KW - IRRADIATION
KW - WOMEN
KW - HEART
KW - COMPLICATIONS
KW - DELINEATION
KW - RECURRENCE
KW - CARCINOMA
U2 - 10.14338/IJPT-21-00023.1
DO - 10.14338/IJPT-21-00023.1
M3 - Journal article
C2 - 35530186
VL - 8
SP - 1
EP - 13
JO - International Journal of Particle Therapy
JF - International Journal of Particle Therapy
SN - 2331-5180
IS - 4
ER -
ID: 286854897