Proton Therapy for Isolated Local Regional Recurrence of Breast Cancer After Mastectomy Alone

Overview

Journal Front Oncol

Specialty Oncology

Date 2022 Dec 15

PMID 36518323

Authors

Brady S Laughlin

Ronik S Bhangoo

Joshua R Niska

Cameron S Thorpe

Marlene E Girardo

Justin D Anderson

Heidi E Kosiorek

Lisa A McGee

William F Hartsell

John H Chang

Carl J Rossi

Henry K Tsai

Isabelle J Choi

Carlos E Vargas

Affiliations

Soon will be listed here.

Abstract

Purpose/objectives: To assess adverse events (AEs) and disease-specific outcomes after proton therapy for isolated local-regional recurrence (LRR) of breast cancer after mastectomy without prior radiotherapy (RT).

Materials/methods: Patients were identified from a multi-institutional prospective registry and included if diagnosed with invasive breast cancer, initially underwent mastectomy without adjuvant RT, experienced an LRR, and subsequently underwent salvage treatment, including proton therapy. Follow-up and cancer outcomes were measured from the date of RT completion.

Results: Nineteen patients were included. Seventeen patients were treated with proton therapy to the chest wall and comprehensive regional lymphatics (17/19, 90%). Maximum grade AE was grade 2 in 13 (69%) patients and grade 3 in 4 (21%) patients. All patients with grade 3 AE received > 60 GyE (p=0.04, Spearman correlation coefficient=0.5). At the last follow-up, 90% of patients were alive with no LRR or distant recurrence.

Conclusions: For breast cancer patients with isolated LRR after initial mastectomy without adjuvant RT, proton therapy is well-tolerated in the salvage setting with excellent loco-regional control. All grade 3 AEs occurred in patients receiving > 60 GyE.

References

Patel S, Lu H, Nyamwanda J, Jimenez R, Taghian A, MacDonald S . Postmastectomy radiation therapy technique and cardiopulmonary sparing: A dosimetric comparative analysis between photons and protons with free breathing versus deep inspiration breath hold. Pract Radiat Oncol. 2017; 7(6):e377-e384. DOI: 10.1016/j.prro.2017.06.006. View

Hernandez M, Zhang R, Sanders M, Newhauser W . A treatment planning comparison of volumetric modulated arc therapy and proton therapy for a sample of breast cancer patients treated with post-mastectomy radiotherapy. J Proton Ther. 2017; 1(1). PMC: 5669383. DOI: 10.14319/jpt.11.9. View

DeCesaris C, Rice S, Bentzen S, Jatczak J, Mishra M, Nichols E . Quantification of Acute Skin Toxicities in Patients With Breast Cancer Undergoing Adjuvant Proton versus Photon Radiation Therapy: A Single Institutional Experience. Int J Radiat Oncol Biol Phys. 2019; 104(5):1084-1090. DOI: 10.1016/j.ijrobp.2019.04.015. View

MacDonald S, Patel S, Hickey S, Specht M, Isakoff S, Gadd M . Proton therapy for breast cancer after mastectomy: early outcomes of a prospective clinical trial. Int J Radiat Oncol Biol Phys. 2013; 86(3):484-90. DOI: 10.1016/j.ijrobp.2013.01.038. View

Straus K, Lichter A, Lippman M, Danforth D, Swain S, Cowan K . Results of the National Cancer Institute early breast cancer trial. J Natl Cancer Inst Monogr. 1992; (11):27-32. View

Bradley J, Dagan R, Wei Ho M, Rutenberg M, Morris C, Li Z . 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. Int J Radiat Oncol Biol Phys. 2015; 95(1):411-421. DOI: 10.1016/j.ijrobp.2015.09.018. View

Verma V, Shah C, Mehta M . Clinical Outcomes and Toxicity of Proton Radiotherapy for Breast Cancer. Clin Breast Cancer. 2016; 16(3):145-54. DOI: 10.1016/j.clbc.2016.02.006. View

Halverson K, Perez C, Kuske R, Garcia D, Simpson J, Fineberg B . Isolated local-regional recurrence of breast cancer following mastectomy: radiotherapeutic management. Int J Radiat Oncol Biol Phys. 1990; 19(4):851-8. DOI: 10.1016/0360-3016(90)90004-4. View

Smith N, Jethwa K, Viehman J, Harmsen W, Gonuguntla K, Elswick S . Post-mastectomy intensity modulated proton therapy after immediate breast reconstruction: Initial report of reconstruction outcomes and predictors of complications. Radiother Oncol. 2019; 140:76-83. PMC: 7734651. DOI: 10.1016/j.radonc.2019.05.022. View

10.

Recht A, Edge S, Solin L, Robinson D, Estabrook A, Fine R . Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001; 19(5):1539-69. DOI: 10.1200/JCO.2001.19.5.1539. View

11.

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A . Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002; 347(16):1227-32. DOI: 10.1056/NEJMoa020989. View

12.

Veronesi U, Luini A, Galimberti V, Zurrida S . Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute trials. World J Surg. 1994; 18(1):70-5. DOI: 10.1007/BF00348194. View

13.

Recht A, Comen E, Fine R, Fleming G, Hardenbergh P, Ho A . Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. Pract Radiat Oncol. 2016; 6(6):e219-e234. DOI: 10.1016/j.prro.2016.08.009. View

14.

Momoh A, Ahmed R, Kelley B, Aliu O, Kidwell K, Kozlow J . A systematic review of complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy. Ann Surg Oncol. 2013; 21(1):118-24. PMC: 4153348. DOI: 10.1245/s10434-013-3284-z. View

15.

Fowble B, Park C, Wang F, Peled A, Alvarado M, Ewing C . Rates of Reconstruction Failure in Patients Undergoing Immediate Reconstruction With Tissue Expanders and/or Implants and Postmastectomy Radiation Therapy. Int J Radiat Oncol Biol Phys. 2015; 92(3):634-41. DOI: 10.1016/j.ijrobp.2015.02.031. View

16.

Cuaron J, Chon B, Tsai H, Goenka A, DeBlois D, Ho A . Early toxicity in patients treated with postoperative proton therapy for locally advanced breast cancer. Int J Radiat Oncol Biol Phys. 2015; 92(2):284-91. PMC: 4972493. DOI: 10.1016/j.ijrobp.2015.01.005. View

17.

Thorpe C, Niska J, Girardo M, Kosiorek H, McGee L, Hartsell W . Proton beam therapy reirradiation for breast cancer: Multi-institutional prospective PCG registry analysis. Breast J. 2019; 25(6):1160-1170. DOI: 10.1111/tbj.13423. View

18.

Wang S, Fang H, Song Y, Wang W, Hu C, Liu Y . Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer: a randomised, non-inferiority, open-label, phase 3 trial. Lancet Oncol. 2019; 20(3):352-360. DOI: 10.1016/S1470-2045(18)30813-1. View

19.

Kim K, Chie E, Han W, Noh D, Oh D, Im S . Prognostic factors affecting the outcome of salvage radiotherapy for isolated locoregional recurrence after mastectomy. Am J Clin Oncol. 2009; 33(1):23-7. DOI: 10.1097/COC.0b013e31819e2c02. View

20.

Grantzau T, Overgaard J . Risk of second non-breast cancer among patients treated with and without postoperative radiotherapy for primary breast cancer: A systematic review and meta-analysis of population-based studies including 522,739 patients. Radiother Oncol. 2016; 121(3):402-413. DOI: 10.1016/j.radonc.2016.08.017. View