Proton reirradiation for recurrent or new primary breast cancer in the setting of prior breast irradiation Journal Article
| Authors: | Choi, J. I.; Khan, A. J.; Powell, S. N.; McCormick, B.; Lozano, A. J.; Del Rosario, G.; Mamary, J.; Liu, H.; Fox, P.; Gillespie, E.; Braunstein, L. Z.; Mah, D.; Cahlon, O. |
| Article Title: | Proton reirradiation for recurrent or new primary breast cancer in the setting of prior breast irradiation |
| Abstract: | Background and purpose: Late local recurrences and second primary breast cancers are increasingly common. Proton beam therapy (PBT) reirradiation (reRT) may allow safer delivery of a second definitive radiotherapy (RT) course. We analyzed outcomes of patients with recurrent or new primary breast cancer who underwent reRT. Materials and methods: In an IRB-approved retrospective study, patient/tumor characteristics, treatment parameters, outcomes, and toxicities were collected for all consecutive patients with recurrent or new primary non-metastatic breast cancer previously treated with breast or chest wall RT who underwent PBT reRT. Results: Forty-six patients received reRT using uniform (70%) or pencil beam (30%) scanning PBT. Median first RT, reRT, and cumulative doses were 60 Gy (range 45–66 Gy), 50.4 Gy(RBE) (40–66.6 Gy(RBE)), and 110 Gy(RBE) (96.6–169.4 Gy(RBE)), respectively. Median follow-up was 21 months. There were no local or regional recurrences; 17% developed distant recurrence. Two-year DMFS and OS were 92.0% and 93.6%, respectively. Nine of 13 (69.2%) patients who underwent implant or flap reconstruction developed capsular contracture, 3 (23.1%) requiring surgical intervention. One (7.7%) patient developed grade 3 breast pain requiring mastectomy after breast conserving surgery. No acute or late grade 4–5 toxicities were seen. Increased body mass index (BMI) was protective of grade ≥ 2 acute toxicity (OR = 0.84, 95%CI = 0.70–1.00). Conclusion: In the largest series to date of PBT reRT for breast cancer recurrence or new primary after prior definitive breast or chest wall RT, excellent locoregional control and few high-grade toxicities were encountered. PBT reRT may provide a relatively safe and highly effective salvage option. Additional patients and follow-up are needed to correlate composite normal tissue doses with toxicities and assess long-term outcomes. © 2021 Elsevier B.V. |
| Keywords: | breast cancer; radiation therapy; reirradiation; proton therapy |
| Journal Title: | Radiotherapy and Oncology |
| Volume: | 165 |
| ISSN: | 0167-8140 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2021-12-01 |
| Start Page: | 142 |
| End Page: | 151 |
| Language: | English |
| DOI: | 10.1016/j.radonc.2021.10.010 |
| PROVIDER: | scopus |
| PUBMED: | 34688807 |
| PMCID: | PMC9554730 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2021 -- Source: Scopus |
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