Proton reirradiation for high-risk recurrent or new primary breast cancer Review
| Authors: | Chakraborty, M. A.; Khan, A. J.; Cahlon, O.; Xu, A. J.; Braunstein, L. Z.; Powell, S. N.; Choi, J. I. |
| Review Title: | Proton reirradiation for high-risk recurrent or new primary breast cancer |
| Abstract: | Simple Summary: Photon reirradiation (reRT) has often been avoided in patients with breast cancer recurrences or new primary breast cancer following prior radiation to the thoracic region due to concerns for severe toxicities from high cumulative dose delivery. However, some patients in this setting may benefit from a repeat course of definitive-intent reRT to improve locoregional control and potentially enhance survival outcomes. The aim of this review article is to highlight the potential of proton therapy as a method to more safely deliver curative, tumoricidal doses and more comprehensive reRT for breast cancer. Herein, we discuss which patient populations might benefit the most from proton breast reRT, review the available literature in this area, discuss reRT treatment planning considerations, and highlight questions in this space in need of further exploration. Radiotherapy is an integral component of multidisciplinary breast cancer care. Given how commonly radiotherapy is used in the treatment of breast cancer, many patients with recurrences have received previous radiotherapy. Patients with new primary breast cancer may also have received previous radiotherapy to the thoracic region. Curative doses and comprehensive field photon reirradiation (reRT) have often been avoided in these patients due to concerns for severe toxicities to organs-at-risk (OARs), such as the heart, lungs, brachial plexus, and soft tissue. However, many patients may benefit from definitive-intent reRT, such as patients with high-risk disease features such as lymph node involvement and dermal/epidermal invasion. Proton therapy is a potentially advantageous treatment option for delivery of reRT due to its lack of exit dose and greater conformality that allow for enhanced non-target tissue sparing of previously irradiated tissues. In this review, we discuss the clinical applications of proton therapy for patients with breast cancer requiring reRT, the currently available literature and how it compares to historical photon reRT outcomes, treatment planning considerations, and questions in this area warranting further study. Given the dosimetric advantages of protons and the data reported to date, proton therapy is a promising option for patients who would benefit from the added locoregional disease control provided by reRT for recurrent or new primary breast cancer. |
| Keywords: | overall survival; dosimetry; radiotherapy, conformal; treatment outcomes; proton therapy; breast neoplasms -- radiotherapy; multidisciplinary care team; neoplasm recurrence, local -- radiotherapy; neoplasm recurrence, local -- risk factors |
| Journal Title: | Cancers |
| Volume: | 15 |
| Issue: | 24 |
| ISSN: | 2072-6694 |
| Publisher: | MDPI |
| Date Published: | 2023-12-02 |
| Start Page: | 5722 |
| Language: | English |
| DOI: | 10.3390/cancers15245722 |
| PROVIDER: | EBSCOhost |
| PROVIDER: | cinahl |
| PMCID: | PMC10742022 |
| PUBMED: | 38136268 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: J. Isabelle Choi -- Source: Cinahl |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
-
331Powell -
66Xu -
169Braunstein -
152Khan -
69Choi
Related MSK Work