Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Department of Radiation Oncology, New York Proton Center and Memorial Sloan Kettering Cancer Center, New York, New York.
Int J Radiat Oncol Biol Phys. 2021 Oct 1;111(2):337-359. doi: 10.1016/j.ijrobp.2021.05.110. Epub 2021 May 25.
Radiation therapy plays an important role in the multidisciplinary management of breast cancer. Recent years have seen improvements in breast cancer survival and a greater appreciation of potential long-term morbidity associated with the dose and volume of irradiated organs. Proton therapy reduces the dose to nontarget structures while optimizing target coverage. However, there remain additional financial costs associated with proton therapy, despite reductions over time, and studies have yet to demonstrate that protons improve upon the treatment outcomes achieved with photon radiation therapy. There remains considerable heterogeneity in proton patient selection and techniques, and the rapid technological advances in the field have the potential to affect evidence evaluation, given the long latency period for breast cancer radiation therapy recurrence and late effects. In this consensus statement, we assess the data available to the radiation oncology community of proton therapy for breast cancer, provide expert consensus recommendations on indications and technique, and highlight ongoing trials' cost-effectiveness analyses and key areas for future research.
放射治疗在乳腺癌的多学科综合管理中起着重要作用。近年来，乳腺癌的生存率有所提高，人们越来越意识到与照射器官的剂量和体积相关的潜在长期发病率。质子治疗降低了非靶结构的剂量，同时优化了靶区的覆盖。然而，尽管质子治疗的成本随着时间的推移有所降低，但仍存在额外的财务成本，而且研究尚未表明质子治疗能改善光子放射治疗的治疗效果。在质子患者的选择和技术方面仍存在很大的异质性，而且鉴于乳腺癌放射治疗复发和晚期效应的潜伏期较长，该领域的快速技术进步有可能影响证据评估。在这份共识声明中，我们评估了放射肿瘤学界可获得的关于乳腺癌质子治疗的数据，就适应证和技术提供了专家共识建议，并强调了正在进行的临床试验的成本效益分析和未来研究的重点领域。
