Proton therapy for early breast cancer patients in the DBCG proton trial: planning, adaptation, and clinical experience from the first 43 patients
| Autor: | Birgitte Vrou Offersen, Pia Randers, Hanna Rahbek Mortensen, Petra Witt Nyström, Maria Fuglsang Jensen, Ebbe Laugaard Lorenzen, Morten Høyer, Camilla Kronborg, E.S. Yates, Line Bjerregaard Stick, Linh My Hoang Thai, S.E. Petersen |
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| Rok vydání: | 2021 |
| Předmět: |
Oncology
SELECTION Organs at Risk medicine.medical_specialty treatment planning Breast Neoplasms Breast cancer Internal medicine RADIATION-THERAPY plan evaluation medicine proton therapy Proton Therapy Humans Radiology Nuclear Medicine and imaging RECONSTRUCTION skin and connective tissue diseases Radiation treatment planning RECURRENCE Proton therapy TARGET VOLUME DELINEATION Mastectomy Early breast cancer business.industry Radiotherapy Planning Computer-Assisted WOMEN Radiotherapy Dosage Hematology General Medicine medicine.disease CONSENSUS GUIDELINE Plan evaluation HEART INITIAL REPORT Female Radiotherapy Intensity-Modulated Protons business RADIOTHERAPY |
| Zdroj: | Jensen, M F, Stick, L B, Hoyer, M, Kronborg, C J S, Lorenzen, E L, Mortensen, H R, Nystrom, P W, Petersen, S E, Randers, P, Thai, L M H, Yates, E S & Offersen, B V 2022, ' Proton therapy for early breast cancer patients in the DBCG proton trial : planning, adaptation, and clinical experience from the first 43 patients ', Acta Oncologica, vol. 61, no. 2, pp. 223-230 . https://doi.org/10.1080/0284186X.2021.1986229 |
| ISSN: | 1651-226X |
| Popis: | Background The Danish Breast Cancer Group (DBCG) Proton Trial randomizes breast cancer patients selected on high mean heart dose (MHD) or high lung dose (V20Gy/V17Gy) in the photon plan between photon and proton therapy. This study presents the proton plans and adaptation strategy for the first 43 breast cancer patients treated with protons in Denmark. Material and methods Forty-four proton plans (one patient with bilateral cancer) were included; 2 local and 42 loco-regional including internal mammary nodes (IMN). Nineteen patients had a mastectomy and 25 a lumpectomy. The prescribed dose was either 50 Gy in 25 fractions (n = 30) or 40 Gy in 15 fractions (n = 14) wherefrom five received simultaneous integrated boost to the tumor bed. Using 2-3 en face proton fields, single-field optimization, robust optimization and a 5 cm range shifter ensured robustness towards breathing motion, setup- and range uncertainties. An anatomical evaluation was performed by evaluating the dose after adding/removing 3 mm and 5 mm tissue to/from the body-outline and used to define treatment tolerances for anatomical changes. Results The nominal and robust criteria were met for all patients except two. The median MHD was 1.5 Gy (0.5-3.4 Gy, 50 Gy) and 1.1 Gy (0.0-1.5 Gy, 40 Gy). The anatomical evaluations showed how 5 mm shrinkage approximately doubled the MHD while 5 mm swelling reduced target coverage of the IMN below constraints. Ensuring 3-5 mm robustness toward swelling was prioritized but not always achieved by robust optimization alone emphasizing the need for a distal margin. Twenty-eight patients received plan adaptation, eight patients received two, and one received five. Conclusion This proton planning strategy ensured robust treatment plans within a pre-defined level of acceptable anatomical changes that fulfilled the planning criteria for most of the patients and ensured low MHD. |
| Databáze: | OpenAIRE |
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