笔形束扫描质子治疗乳腺癌和胸壁患者的基于体积的皮肤保留计划技术的剂量学和治疗期临床结果。
Dosimetric and On-treatment Clinical Results of a Volumetric-based Skin-sparing Planning Technique for Patients Treated to the Breast and Chest Wall With Pencil-Beam Scanning Proton Therapy.
作者信息
Rao Avani D, Goughenour Alexander, Kebede Betelehem, Bamberger Caroline, MacLennan Grayden, Castro Jackeline, Stephenson Lisa, Negussie Amanuel, Seracino Sydney, Wang Hongkun, Hetelekidis Stella, Gao Sarah J, Majithia Lonika, Chawla Ashish, Parniani Ashkan, Wang Peng, Fan Jiajin
机构信息
Department of Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, Virginia.
Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, District of Columbia.
出版信息
Adv Radiat Oncol. 2024 Oct 30;10(2):101653. doi: 10.1016/j.adro.2024.101653. eCollection 2025 Feb.
PURPOSE
This study evaluates the hypothesis that a volumetric skin-sparing planning technique (SSPT) will reduce acute dermatitis in patients treated to the breast or chest wall (CW) with proton pencil-beam scanning (PBS).
METHODS AND MATERIALS
In January 2022, our center incorporated volumetric-based skin-sparing objectives in addition to skin hot spot evaluation as an SSPT. The SSPT incorporated an objective to limit the volume of a skin evaluation structure (skin-eval) receiving 95% of the prescription dose or more (V95%Rx) to ideally < 50%. We compared target coverage, robustness, skin-eval dosimetry, and acute on-treatment skin toxicity in patients treated with and without incorporation of this SSPT. Patients with skin/dermal lymphatic invasion or inflammatory breast cancer were excluded.
RESULTS
A total of 84 patients who received breast/CW PBS were included (43 planned without and 41 with the SSPT). There was no difference in percentages of patients treated with intact breast/CW/immediate CW reconstruction between groups. Mean skin-evalV95%Rx was 72% vs 30%, < .0001, for those treated without versus with an SSPT. Maximum %Rx to the skin-eval volume of 0.03, 0.3, and 1 cc was higher in patients treated without versus with an SSPT (103.1% vs 101.5%; 101.3% vs 100.4%; and 101.8% vs 99.7% [all ≤ .0001]), respectively. There was a small difference in the mean clinical target volume V97.5%Rx in patients treated without versus with the SSPT (97.8% vs 96.5%, = .0003). Patients planned using the SSPT demonstrated reduced rates of grade 1 breast pain at week 2 (12% vs 33%, = .0424) and grades 2 and 3 dermatitis at weeks 4 and 5 (week 4 dermatitis ≥ grade 2, 18% vs 43%, = .0224; week 5 dermatitis ≥ grade 2, 45% vs 69%, = .0006). There were numerically more patients requiring a treatment break or not completing the full intended prescription (4 vs 1) in the pre-SSPT cohort.
CONCLUSIONS
The use of an SSPT may reduce acute skin toxicity in patients with breast cancer treated with PBS.
目的
本研究评估一种容积性皮肤保留计划技术（SSPT）能否减少接受质子笔形束扫描（PBS）治疗的乳腺癌或胸壁（CW）患者的急性皮炎。
方法和材料
2022年1月，我们中心除了将皮肤热点评估作为一种SSPT外，还纳入了基于容积的皮肤保留目标。SSPT纳入了一个目标，即将接受95%或更高处方剂量的皮肤评估结构（皮肤评估）的体积（V95%Rx）限制在理想情况下<50%。我们比较了采用和未采用这种SSPT治疗的患者的靶区覆盖情况、稳健性、皮肤评估剂量测定以及治疗期间的急性皮肤毒性。排除有皮肤/真皮淋巴管侵犯或炎性乳腺癌的患者。
结果
总共纳入了84例接受乳腺/CW PBS治疗的患者（43例未采用SSPT计划，41例采用SSPT计划）。两组之间接受完整乳腺/CW/即刻CW重建治疗的患者百分比没有差异。未采用SSPT治疗的患者与采用SSPT治疗的患者相比，皮肤评估V95%Rx的平均值分别为72%和30%，<0.（此处原文有误，推测应为<0.0001）。未采用SSPT治疗的患者与采用SSPT治疗的患者相比，皮肤评估体积为0.03、0.3和1 cc时的最大%Rx更高（分别为103.1%对101.5%；101.3%对100.4%；101.8%对99.7%[均≤0.0001]）。未采用SSPT治疗的患者与采用SSPT治疗的患者相比，平均临床靶区体积V97.5%Rx存在微小差异（97.8%对96.5%，P = 0.0003）。采用SSPT计划的患者在第2周时1级乳腺疼痛发生率降低（12%对33%，P = 0.0424），在第4周和第5周时2级和3级皮炎发生率降低（第4周≥2级皮炎，18%对43%，P = 0.0224；第5周≥2级皮炎，45%对69%，P = 0.0006）。在SSPT前队列中，需要中断治疗或未完成全部预定处方的患者在数量上更多（4例对1例）。
结论
使用SSPT可能会降低接受PBS治疗乳腺癌患者的急性皮肤毒性。
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