Verma Vivek, Iftekaruddin Zaid, Badar Nida, Hartsell William, Han-Chih Chang John, Gondi Vinai, Pankuch Mark, Gao Ming, Schmidt Stacey, Kaplan Darren, McGee Lisa
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, USA.
Northwestern Medicine Chicago Proton Therapy Center, Warrenville, USA.
Radiother Oncol. 2017 May;123(2):294-298. doi: 10.1016/j.radonc.2017.04.007. Epub 2017 Apr 27.
This study evaluates acute toxicity outcomes in breast cancer patients treated with adjuvant proton beam therapy (PBT).
From 2011 to 2016, 91 patients (93 cancers) were treated with adjuvant PBT targeting the intact breast/chest wall and comprehensive regional nodes including the axilla, supraclavicular fossa, and internal mammary lymph nodes. Toxicity was recorded weekly during treatment, one month following treatment, and then every 6months according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Charts were retrospectively reviewed to verify toxicities, patient parameters, disease and treatment characteristics, and disease-related outcomes.
Median follow-up was 15.5months. Median PBT dose was 50.4 Gray relative biological effectiveness (GyRBE), with subsequent boost as clinically indicated (N=61, median 10 GyRBE). Chemotherapy, when administered, was given adjuvantly (N=42) or neoadjuvantly (N=46). Grades 1, 2, and 3 dermatitis occurred in 23%, 72%, and 5%, respectively. Eight percent required treatment breaks owing to dermatitis. Median time to resolution of dermatitis was 32days. Grades 1, 2, and 3 esophagitis developed in 31%, 33%, and 0%, respectively.
PBT displays acceptable toxicity in the setting of comprehensive regional nodal irradiation.
本研究评估接受辅助质子束治疗（PBT）的乳腺癌患者的急性毒性结果。
2011年至2016年，91例患者（93处癌症）接受了辅助PBT治疗，靶区为完整乳房/胸壁以及包括腋窝、锁骨上窝和内乳淋巴结在内的综合区域淋巴结。在治疗期间每周记录毒性反应，治疗后1个月记录，然后根据不良事件通用术语标准（CTCAE）v4.0每6个月记录一次。对图表进行回顾性审查，以核实毒性反应、患者参数、疾病和治疗特征以及疾病相关结果。
中位随访时间为15.5个月。PBT的中位剂量为50.4格雷相对生物效应剂量（GyRBE），随后根据临床指征进行追加照射（N = 61，中位剂量10 GyRBE）。化疗在使用时，辅助化疗（N = 42）或新辅助化疗（N = 46）。1级、2级和3级皮炎的发生率分别为23%、72%和5%。8%的患者因皮炎需要中断治疗。皮炎消退的中位时间为32天。1级、2级和3级食管炎的发生率分别为31%、33%和0%。
在综合区域淋巴结照射的情况下，PBT显示出可接受的毒性。
