Proton Partial Breast Irradiation: Detailed Description of Acute Clinico-Radiologic Effects
Introduction: Accelerated partial breast irradiation (APBI) with protons results in a very different acute effect profile than standard whole breast irradiation. We reviewed our initial experience with proton APBI and felt that a detailed description of these effects were needed to permit a common t...
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doaj-5da9f349701e43d28efc5ae8983b3bd82020-11-24T22:49:49ZengMDPI AGCancers2072-66942018-04-0110411110.3390/cancers10040111cancers10040111Proton Partial Breast Irradiation: Detailed Description of Acute Clinico-Radiologic EffectsValentina Ovalle0Eric A. Strom1Simona Shaitelman2Karen Hoffman3Richard Amos4George Perkins5Welela Tereffe6Benjamin D. Smith7Michael Stauder8Wendy Woodward9Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USAIntroduction: Accelerated partial breast irradiation (APBI) with protons results in a very different acute effect profile than standard whole breast irradiation. We reviewed our initial experience with proton APBI and felt that a detailed description of these effects were needed to permit a common tool to compare experience with this developing technology. Methods: Sixty sequential patients treated with proton APBI on a prospective protocol were evaluated and 43 patients with a minimum six-month follow-up underwent detailed photographic and radiologic analysis. The tumorectomy cavity plus an additional 1.5 cm clinical target volume (CTV) was treated with two or three passively-scattered proton beams to a dose of 34 Gy in 10 fractions in one week. Photographs were taken at the end of radiation, at two weeks, six weeks, and every six months thereafter. Mammography was obtained at six months after radiation and annually thereafter. All visual changes were categorized using the smallest meaningful gradations in findings and are demonstrated herein. All treatment-related mammographic findings are reported. Findings: Visual and mammographic findings showed a clear time-dependent relationship and significant variation between individuals. Peak skin reaction occurred at two to six weeks after completion of therapy. At two weeks most patients had either no visible effects and patchy erythema involving <50% of the treated skin (60%). At six weeks most patients had either patchy erythema involving <50% of the overlying skin (33%) or patchy erythema involving >50% of the treated skin (28%). Only one patient developed any moist desquamation. At six months most patients had no visible skin changes (57%) or a small, circular area of mild hyperpigmentation (33%). Mammographic changes seen at six months were regional skin thickening (40%), residual seroma (14%), localized retraction (26%), and fat necrosis (2%). A subcategorized variant on the CTCAE 4.0 was developed to foster granular recording of these findings.http://www.mdpi.com/2072-6694/10/4/111breast conservationbreast cancerproton radiationproton APBI |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Valentina Ovalle Eric A. Strom Simona Shaitelman Karen Hoffman Richard Amos George Perkins Welela Tereffe Benjamin D. Smith Michael Stauder Wendy Woodward |
spellingShingle |
Valentina Ovalle Eric A. Strom Simona Shaitelman Karen Hoffman Richard Amos George Perkins Welela Tereffe Benjamin D. Smith Michael Stauder Wendy Woodward Proton Partial Breast Irradiation: Detailed Description of Acute Clinico-Radiologic Effects Cancers breast conservation breast cancer proton radiation proton APBI |
author_facet |
Valentina Ovalle Eric A. Strom Simona Shaitelman Karen Hoffman Richard Amos George Perkins Welela Tereffe Benjamin D. Smith Michael Stauder Wendy Woodward |
author_sort |
Valentina Ovalle |
title |
Proton Partial Breast Irradiation: Detailed Description of Acute Clinico-Radiologic Effects |
title_short |
Proton Partial Breast Irradiation: Detailed Description of Acute Clinico-Radiologic Effects |
title_full |
Proton Partial Breast Irradiation: Detailed Description of Acute Clinico-Radiologic Effects |
title_fullStr |
Proton Partial Breast Irradiation: Detailed Description of Acute Clinico-Radiologic Effects |
title_full_unstemmed |
Proton Partial Breast Irradiation: Detailed Description of Acute Clinico-Radiologic Effects |
title_sort |
proton partial breast irradiation: detailed description of acute clinico-radiologic effects |
publisher |
MDPI AG |
series |
Cancers |
issn |
2072-6694 |
publishDate |
2018-04-01 |
description |
Introduction: Accelerated partial breast irradiation (APBI) with protons results in a very different acute effect profile than standard whole breast irradiation. We reviewed our initial experience with proton APBI and felt that a detailed description of these effects were needed to permit a common tool to compare experience with this developing technology. Methods: Sixty sequential patients treated with proton APBI on a prospective protocol were evaluated and 43 patients with a minimum six-month follow-up underwent detailed photographic and radiologic analysis. The tumorectomy cavity plus an additional 1.5 cm clinical target volume (CTV) was treated with two or three passively-scattered proton beams to a dose of 34 Gy in 10 fractions in one week. Photographs were taken at the end of radiation, at two weeks, six weeks, and every six months thereafter. Mammography was obtained at six months after radiation and annually thereafter. All visual changes were categorized using the smallest meaningful gradations in findings and are demonstrated herein. All treatment-related mammographic findings are reported. Findings: Visual and mammographic findings showed a clear time-dependent relationship and significant variation between individuals. Peak skin reaction occurred at two to six weeks after completion of therapy. At two weeks most patients had either no visible effects and patchy erythema involving <50% of the treated skin (60%). At six weeks most patients had either patchy erythema involving <50% of the overlying skin (33%) or patchy erythema involving >50% of the treated skin (28%). Only one patient developed any moist desquamation. At six months most patients had no visible skin changes (57%) or a small, circular area of mild hyperpigmentation (33%). Mammographic changes seen at six months were regional skin thickening (40%), residual seroma (14%), localized retraction (26%), and fat necrosis (2%). A subcategorized variant on the CTCAE 4.0 was developed to foster granular recording of these findings. |
topic |
breast conservation breast cancer proton radiation proton APBI |
url |
http://www.mdpi.com/2072-6694/10/4/111 |
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