3 fraction pencil-beam scanning proton accelerated partial breast irradiation: Early provider and patient reported outcomes of a novel regimen

Robert W. Mutter, Krishan R. Jethwa, Karthik Gonuguntla, Nicholas B. Remmes, Thomas J. Whitaker, Tina J. Hieken, Kathryn J. Ruddy, Lisa A. McGee, Kimberly S. Corbin, Sean S. Park

Research output: Contribution to journalArticle

Abstract

Background and purpose: To report dosimetry and early adverse effects, aesthetic, and patient-reported outcomes of a prospective study of 3-fraction pencil-beam scanning (PBS) proton accelerated partial irradiation (APBI). Materials and methods: Eligibility included women age ≥ 50 years with estrogen receptor positive (ER+), sentinel lymph node negative invasive or in-situ breast cancer measuring ≤2.5 cm. The prescription was 21.9 Gy (RBE 1.1) in 3 daily fractions to the post-operative tumor bed with a 1 cm expansion. Toxicities were collected using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, 10-point Linear Analog Scale Assessment, Patient-Reported Outcomes Version of the CTCAE, and the Harvard Breast Cosmesis Scale. Results: Seventy-six women were treated between 2015 and 2017. The median breast volume receiving 50% of prescription or more was 28%. Median mean heart, mean ipsilateral lung, and maximum skin dose were 0 Gy, 0.1 Gy, and 20.6 Gy, respectively. With a median follow-up of 12 months, no treatment-related toxicity grade ≥ 2 has been observed. Most common grade 1 adverse events were dermatitis (68%) and skin hyperpigmentation (18%). At 12 months, the only persistent toxicities were one patient with grade 1 breast edema and one patient with a grade 1 seroma. 90% of patients reported quality of life as ≥7 out of 10 (0 indicating "as bad as it can be" and 10 indicating "as good as it can be") and 98% of patients reported excellent or good cosmesis. Conclusion: 3-fraction PBS proton APBI is well tolerated with low rates of physician and patient reported early adverse effects. Follow-up is ongoing to assess late toxicities and disease control outcomes. Further investigation of this novel adjuvant treatment strategy is warranted.

Original languageEnglish (US)
Article number211
JournalRadiation Oncology
Volume14
Issue number1
DOIs
StatePublished - Nov 21 2019

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Protons
Breast
Terminology
Prescriptions
Seroma
Skin
Hyperpigmentation
Dermatitis
Esthetics
Estrogen Receptors
Edema
Quality of Life
Patient Reported Outcome Measures
Prospective Studies
Breast Neoplasms
Physicians
Lung
Therapeutics
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

3 fraction pencil-beam scanning proton accelerated partial breast irradiation : Early provider and patient reported outcomes of a novel regimen. / Mutter, Robert W.; Jethwa, Krishan R.; Gonuguntla, Karthik; Remmes, Nicholas B.; Whitaker, Thomas J.; Hieken, Tina J.; Ruddy, Kathryn J.; McGee, Lisa A.; Corbin, Kimberly S.; Park, Sean S.

In: Radiation Oncology, Vol. 14, No. 1, 211, 21.11.2019.

Research output: Contribution to journalArticle

Mutter, RW, Jethwa, KR, Gonuguntla, K, Remmes, NB, Whitaker, TJ, Hieken, TJ, Ruddy, KJ, McGee, LA, Corbin, KS & Park, SS 2019, '3 fraction pencil-beam scanning proton accelerated partial breast irradiation: Early provider and patient reported outcomes of a novel regimen', Radiation Oncology, vol. 14, no. 1, 211. https://doi.org/10.1186/s13014-019-1417-7
Mutter, Robert W. ; Jethwa, Krishan R. ; Gonuguntla, Karthik ; Remmes, Nicholas B. ; Whitaker, Thomas J. ; Hieken, Tina J. ; Ruddy, Kathryn J. ; McGee, Lisa A. ; Corbin, Kimberly S. ; Park, Sean S. / 3 fraction pencil-beam scanning proton accelerated partial breast irradiation : Early provider and patient reported outcomes of a novel regimen. In: Radiation Oncology. 2019 ; Vol. 14, No. 1.
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abstract = "Background and purpose: To report dosimetry and early adverse effects, aesthetic, and patient-reported outcomes of a prospective study of 3-fraction pencil-beam scanning (PBS) proton accelerated partial irradiation (APBI). Materials and methods: Eligibility included women age ≥ 50 years with estrogen receptor positive (ER+), sentinel lymph node negative invasive or in-situ breast cancer measuring ≤2.5 cm. The prescription was 21.9 Gy (RBE 1.1) in 3 daily fractions to the post-operative tumor bed with a 1 cm expansion. Toxicities were collected using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, 10-point Linear Analog Scale Assessment, Patient-Reported Outcomes Version of the CTCAE, and the Harvard Breast Cosmesis Scale. Results: Seventy-six women were treated between 2015 and 2017. The median breast volume receiving 50{\%} of prescription or more was 28{\%}. Median mean heart, mean ipsilateral lung, and maximum skin dose were 0 Gy, 0.1 Gy, and 20.6 Gy, respectively. With a median follow-up of 12 months, no treatment-related toxicity grade ≥ 2 has been observed. Most common grade 1 adverse events were dermatitis (68{\%}) and skin hyperpigmentation (18{\%}). At 12 months, the only persistent toxicities were one patient with grade 1 breast edema and one patient with a grade 1 seroma. 90{\%} of patients reported quality of life as ≥7 out of 10 (0 indicating {"}as bad as it can be{"} and 10 indicating {"}as good as it can be{"}) and 98{\%} of patients reported excellent or good cosmesis. Conclusion: 3-fraction PBS proton APBI is well tolerated with low rates of physician and patient reported early adverse effects. Follow-up is ongoing to assess late toxicities and disease control outcomes. Further investigation of this novel adjuvant treatment strategy is warranted.",
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AU - Gonuguntla, Karthik

AU - Remmes, Nicholas B.

AU - Whitaker, Thomas J.

AU - Hieken, Tina J.

AU - Ruddy, Kathryn J.

AU - McGee, Lisa A.

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AU - Park, Sean S.

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