Proton therapy for reducing heart and cardiac substructure doses in Indian breast cancer patients

• 영문명: Proton therapy for reducing heart and cardiac substructure doses in Indian breast cancer patients
• 발행기관: 대한방사선종양학회
• 저자명: Sapna Nangia Nagarjuna Burela M. P. Noufal Kartikeswar Patro Manoj Gulabrao Wakde
• 간행물 정보: 『대한방사선종양학회지』제41권 제2호, 69~80쪽, 전체 12쪽
• 주제분류: 의약학 > 종양학
• 파일형태: PDF
• 발행일자: 2023.06.30

영문 초록

Purpose: Indians have a higher incidence of cardiovascular diseases, often at a younger age, than other ethnic groups. This higher baseline risk requires consideration when assessing additional cardiac morbidity of breast cancer treatment. Superior cardiac sparing is a critical dosimetric advantage of proton therapy in breast cancer radiotherapy. We report here the heart and cardiac-substructure doses and early toxicities in breast cancer patients treated post-operatively with proton therapy in India’s first proton therapy center. Materials and Methods: We treated twenty breast cancer patients with intensity-modulated proton therapy (IMPT) from October 2019 to September 2022, eleven after breast conservation, nine following mastectomy, and appropriate systemic therapy, when indicated. The most prescribed dose was 40 GyE to the whole breast/chest wall and 48 GyE by simultaneous integrated boost to the tumor bed and 37.5 GyE to appropriate nodal volumes, delivered in 15 fractions. Results: Adequate coverage was achieved for clinical target volume (breast/chest wall), i.e., CTV40, and regional nodes, with 99% of the targets receiving 95% of the prescribed dose (V95% > 99%). The mean heart dose was 0.78 GyE and 0.87 GyE for all and left breast cancer patients, respectively. The mean left anterior descending artery (LAD) dose, LAD D0.02cc, and left ventricle dose were 2.76, 6.46, and 0.2 GyE, respectively. Mean ipsilateral lung dose, V20Gy, V5Gy, and contralateral breast dose (Dmean) were 6.87 GyE, 14.6%, 36.4%, and 0.38 GyE, respectively. Conclusion: The dose to heart and cardiac substructures is lower with IMPT than published photon therapy data. Despite the limited access to proton therapy at present, given the higher cardiovascular risk and coronary artery disease prevalence in India, the cardiac sparing achieved using this technique merits consideration for wider adoption in breast cancer treatment.

목차

Introduction

Materials and Methods

Results

Discussion and Conclusion

Acknowledgements

Statement of Ethics

Conflict of Interest

Funding

Author Contributions

Data Availability Statement

References

키워드

Breast cancer Pencil beam scanning Protons Heart Proton beam therapy Toxicity