New frontiers in proton therapy: applications in breast cancer

Purpose of review The aim of this article is to review published data on proton therapy in the multimodality treatment of breast cancer so as to provide an overview of the advantages and critical issues relating to this irradiation modality. Recent findings In-silico studies show a clear advantage in terms of dose homogeneity to the target and dose reduction to the non-target structures including heart, lungs, and healthy breast tissues. Clinical studies have shown the feasibility of proton therapy in breast cancer and allowed optimizing the technique by using multiple beams and intensity modulation. Summary Proton therapy is able to optimize the dose to the target and to reduce the irradiation of the healthy tissues. Clinical studies are expected to show a decreased risk of late side effects with potential improvement of the quality of life of breast cancer patients.

[1]  R. Gelber,et al.  Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015 , 2015, Annals of oncology : official journal of the European Society for Medical Oncology.

[2]  S. Vennarini,et al.  Proton beam versus photon beam dose to the heart and left anterior descending artery for left-sided breast cancer , 2013, Acta oncologica.

[3]  (P022) proton therapy on an incline beam line: acute toxicity outcomes in locally advanced breast cancer patients. , 2015, Oncology.

[4]  Zuofeng Li,et al.  Can Proton Therapy Improve the Therapeutic Ratio in Breast Cancer Patients at Risk for Nodal Disease? , 2014, American journal of clinical oncology.

[5]  Barbara L. Smith,et al.  Long-term cosmetic outcomes and toxicities of proton beam therapy compared with photon-based 3-dimensional conformal accelerated partial-breast irradiation: a phase 1 trial. , 2014, International journal of radiation oncology, biology, physics.

[6]  E. Strom,et al.  Initial clinical experience using protons for accelerated partial-breast irradiation: longer-term results. , 2014, International journal of radiation oncology, biology, physics.

[7]  J. Slater,et al.  Partial breast radiation therapy with proton beam: 5-year results with cosmetic outcomes. , 2014, International Journal of Radiation Oncology, Biology, Physics.

[8]  J. Langendijk,et al.  Whole breast proton irradiation for maximal reduction of heart dose in breast cancer patients , 2014, Breast Cancer Research and Treatment.

[9]  A. Zietman,et al.  Promise and pitfalls of heavy-particle therapy. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  X. Kostaras,et al.  Recommendations for the referral of patients for proton-beam therapy, an Alberta Health Services report: a model for Canada? , 2014, Current oncology.

[11]  A. Lomax,et al.  The effectiveness of combined gating and re-scanning for treating mobile targets with proton spot scanning. An experimental and simulation-based investigation , 2014, Physics in medicine and biology.

[12]  M. S. Thomsen,et al.  Risk of second primary lung cancer in women after radiotherapy for breast cancer. , 2014, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[13]  M. Jermann.  Particle Therapy Statistics in 2013 , 2014 .

[14]  D. Mah,et al.  Use of proton beams with breast prostheses and tissue expanders. , 2014, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[15]  Tae Hyun Kim,et al.  Phase II trial of proton beam accelerated partial breast irradiation in breast cancer. , 2013, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[16]  W. Woodward,et al.  Accelerated partial-breast irradiation using intensity-modulated proton radiotherapy: do uncertainties outweigh potential benefits? , 2013, The British journal of radiology.

[17]  Barbara L. Smith,et al.  Proton therapy for breast cancer after mastectomy: early outcomes of a prospective clinical trial. , 2013, International journal of radiation oncology, biology, physics.

[18]  H. Kooy,et al.  Intensity modulated proton therapy for postmastectomy radiation of bilateral implant reconstructed breasts: a treatment planning study. , 2013, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[19]  H. Kooy,et al.  Proton radiotherapy for chest wall and regional lymphatic radiation; dose comparisons and treatment delivery , 2013, Radiation oncology.

[20]  P. Hall,et al.  Risk of ischemic heart disease in women after radiotherapy for breast cancer. , 2013, The New England journal of medicine.

[21]  A. Lomax,et al.  Postoperative proton radiotherapy for localized and locoregional breast cancer: potential for clinically relevant improvements? , 2007, International journal of radiation oncology, biology, physics.