Potential Morbidity Reduction With Proton Radiation Therapy for Breast Cancer.

Abstract:

:Proton radiotherapy confers significant dosimetric advantages in the treatment of malignancies that arise adjacent to critical radiosensitive structures. To date, these advantages have been most prominent in the treatment of pediatric and central nervous system malignancies, although emerging data support the use of protons among other anatomical sites in which radiotherapy plays an important role. With advances in the overall treatment paradigm for breast cancer, most patients with localized disease now exhibit long-term disease control and, consequently, may manifest the late toxicities of aggressive treatment. As a result, there is increasing emphasis on the mitigation of iatrogenic morbidity, with particular attention to heart and lung exposure in those receiving adjuvant radiotherapy. Indeed, recent landmark analyses have demonstrated an increase in significant cardiac events that is linked directly to low-dose radiation to the heart. Coupled with practice-changing trials that have expanded the indications for comprehensive regional nodal irradiation, there exists significant interest in employing novel technologies to mitigate cardiac dose while improving target volume coverage. Proton radiotherapy enjoys distinct physical advantages over photon-based approaches and, in appropriately selected patients, markedly improves both target coverage and normal tissue sparing. Here, we review the dosimetric evidence that underlies the putative benefits of proton radiotherapy, and further synthesize early clinical evidence that supports the efficacy and feasibility of proton radiation in breast cancer. Landmark, prospective randomized trials are underway and will ultimately define the role for protons in the treatment of this disease.

journal_name

Semin Radiat Oncol

authors

Braunstein LZ,Cahlon O

doi

10.1016/j.semradonc.2017.11.009

subject

Has Abstract

pub_date

2018-04-01 00:00:00

pages

138-149

issue

2

eissn

1053-4296

issn

1532-9461

pii

S1053-4296(17)30111-X

journal_volume

28

pub_type

杂志文章,评审
  • Lactate: mirror and motor of tumor malignancy.

    abstract::A number of studies have shown that malignant transformation is associated with an increase in glycolytic flux and in anaerobic and aerobic cellular lactate excretion. Using quantitative bioluminescence imaging in various primary carcinomas in patients (uterine cervix, head and neck, colorectal region) at first diagno...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2004.04.004

    authors: Walenta S,Mueller-Klieser WF

    更新日期:2004-07-01 00:00:00

  • Concurrent twice-weekly paclitaxel and thoracic irradiation for stage III non-small cell lung cancer.

    abstract::Concurrent twice-weekly paclitaxel and thoracic radiation (XRT) for stage III non-small cell lung cancer were studied in a phase I trial. Radiation was delivered in fractions of 1.8 to 2.0 Gy/d to a total dose of 61 Gy. Paclitaxel, at a starting dose of 25 mg/m2/d, was administered intravenously over 1 hour before dai...

    journal_title:Seminars in radiation oncology

    pub_type: 临床试验,杂志文章

    doi:

    authors: Lau D,Ryu J,Gandara D,Morgan R,Doroshow J,Wilder R,Leigh B

    更新日期:1999-04-01 00:00:00

  • Challenges in Reirradiation of Intrahepatic Tumors.

    abstract::Definitive reirradiation using a stereotactic technique is an effective local treatment option for both recurrent liver metastases and recurrent primary liver cancers. The tolerance of the liver, bile ducts, and surrounding gastrointestinal luminal organs must be respected to ensure safe retreatment. The risks associa...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2020.02.004

    authors: Owen D,Lukovic J,Hosni A,Crane CH,Hong TS,Dawson LA,Velec M,Lawrence TS

    更新日期:2020-07-01 00:00:00

  • Magnetic Resonance Imaging and Other Imaging Modalities in Diagnostic and Tumor Response Evaluation.

    abstract::Functional imaging is emerging as a valuable contributor to the clinical management of patients with rectal cancer. Techniques such as diffusion-weighted magnetic resonance imaging, perfusion imaging, and positron emission tomography can offer meaningful insights into tissue architecture, vascularity, and metabolism. ...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2016.02.001

    authors: Lambregts DM,Maas M,Stokkel MP,Beets-Tan RG

    更新日期:2016-07-01 00:00:00

  • Radiation treatment parameters in the adjuvant postoperative therapy of gastric cancer.

    abstract::Radiation therapy will be used much more commonly in the treatment of adenocarcinoma of the stomach because of the results of the Intergroup Trial demonstrating an advantage to adjuvant postoperative chemoradiation therapy. Previous descriptions of radiation fields have not emphasized the variation in local spread pat...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1053/srao.2002.30827

    authors: Tepper JE,Gunderson LL

    更新日期:2002-04-01 00:00:00

  • Radiation therapy for benign disease of the orbit.

    abstract::Benign diseases of the orbit can cause significant impairment of visual function through direct effects on the eye or supporting orbital tissues. Persistent moderate-to-severe inflammatory symptoms, diplopia, and visual loss may prompt therapeutic intervention. Low doses of external-beam irradiation (20 Gy in 2-Gy fra...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/s1053-4296(99)80008-3

    authors: Smitt MC,Donaldson SS

    更新日期:1999-04-01 00:00:00

  • Adaptive management of cervical cancer radiotherapy.

    abstract::Since the breakthrough 10 years ago with concomitant radio-chemotherapy, substantial progress in the treatment of locally advanced cervical cancer has been lacking. Radiotherapy continues to be the cornerstone in the treatment of this disease and now shows much potential for progress, as image guidance of both externa...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2009.11.006

    authors: Tanderup K,Georg D,Pötter R,Kirisits C,Grau C,Lindegaard JC

    更新日期:2010-04-01 00:00:00

  • The linear-quadratic model is inappropriate to model high dose per fraction effects in radiosurgery.

    abstract::The linear-quadratic (LQ) model is widely used to model the effect of total dose and dose per fraction in conventionally fractionated radiotherapy. Much of the data used to generate the model are obtained in vitro at doses well below those used in radiosurgery. Clinically, the LQ model often underestimates tumor contr...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章

    doi:10.1016/j.semradonc.2008.04.005

    authors: Kirkpatrick JP,Meyer JJ,Marks LB

    更新日期:2008-10-01 00:00:00

  • Therapeutic Options for Clinically Localized Carcinoma of the Prostate.

    abstract::Clinically localized carcinoma of the prostate is diagnosed annually in over 50,000 American men. The advent of screening programs using digital rectal examination, transrectal ultrasound, and assays for prostatic specific antigen will increase the magnitude of this public health problem. The range of treatment option...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章

    doi:10.1053/SRAO00300187

    authors: Corn BW,Hanks GE

    更新日期:1993-07-01 00:00:00

  • The role of focal liver ablation in the treatment of unresectable primary and secondary malignant liver tumors.

    abstract::Surgical resection is often the first-line treatment option for primary and select metastatic hepatic malignancies. A minority of patients with hepatocellular carcinoma undergo potentially curative resection. Similarly, patients with liver-only metastasis are candidates for resection less than 15% of the time because ...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2005.04.004

    authors: Gannon CJ,Curley SA

    更新日期:2005-10-01 00:00:00

  • Altered fractionation trials in head and neck cancer.

    abstract::Advancement in radiobiological concepts has led to the development of two classes of new fractionation schedules for the treatment of head and neck cancers. These altered fractionation regimens are referred to as hyperfractionation and accelerated fractionation schedules. Hyperfractionation exploits the difference in ...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,meta分析

    doi:10.1016/s1053-4296(98)80020-9

    authors: Ang KK

    更新日期:1998-10-01 00:00:00

  • Evaluating Commercially Available Three-Dimensional Radiotherapy Treatment Planning Systems.

    abstract::Over the past year we have developed two similar questionnaires on three-dimensional radiotherapy treatment planning (3DRTP) systems and used them to conduct a study of the function and features of commercially available 3DRTP systems. The issues which we reviewed to develop these questionnaires are important to all c...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章

    doi:10.1053/SRAO00700083

    authors: Harms WB Sr,Purdy JA

    更新日期:1997-01-01 00:00:00

  • The treatment of early-stage disease.

    abstract::For medically operable patients with stage I non-small-cell lung cancer (NSCLC), lobectomy or pneumonectomy remains the standard of care. The utility of radiotherapy or chemotherapy after major pulmonary resection remains unproven, though clinical and biological models may identify subgroups most likely to benefit. Li...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2010.01.004

    authors: Robinson CG,Bradley JD

    更新日期:2010-07-01 00:00:00

  • Locoregional failure rates in patients with involved axillary nodes after mastectomy and systemic therapy.

    abstract::Published series vary substantially in describing the incidence of locoregional failure after mastectomy among patients with involved axillary lymph nodes who receive systemic therapy. There are few data on such risks with regards to particular patient subsets (such as those defined by combinations of tumor size and n...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/s1053-4296(99)80013-7

    authors: Recht A

    更新日期:1999-07-01 00:00:00

  • The Role of Surgical Staging for Cervical Cancer.

    abstract::Recent trends in gynecologic oncology have favored surgical staging of disease not only to define local extent, but more importantly nodal involvement. For cervical cancer, surgical staging includes intraperitoneal exploration, cytological washings, direct tumor palpation, and para-aortic with or without pelvic lymph ...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章

    doi:10.1053/SRAO00400046

    authors: Lanciano RM,Corn BW

    更新日期:1994-01-01 00:00:00

  • The Practicality of ICRU and Considerations for Future ICRU Definitions.

    abstract::The International Commission on Radiation Units and Measurements (ICRU) volumes are standardized volume definitions used in radiation oncology practice that have evolved over time to account for advancements in technology and radiation planning. The current definitions have strengths but also practical limitations. Th...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2018.02.005

    authors: Shepherd A,James SS,Rengan R

    更新日期:2018-06-01 00:00:00

  • Chemotherapy for Stage IV Non-Small Cell Lung Cancer: Protocol Versus Nonprotocol? Is Noninvestigational Treatment Worthwhile? Patient Selection? Which Regimen? What's Next?

    abstract::The results of selected chemotherapy trials and philosophical considerations regarding the role of chemotherapy in Non-Small Cell Lung Cancer are discussed in this review. The issue of treating patients within a clinical or with a "standard regimen" is addressed. In addition, the survival results of randomized trials ...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章

    doi:10.1053/SRAO00600110

    authors: Bonomi P

    更新日期:1996-04-01 00:00:00

  • Introduction.

    abstract::Copyright ...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章

    doi:10.1016/s1053-4296(98)80039-8

    authors: Dewhirst MW,Mitchell JB

    更新日期:1998-07-01 00:00:00

  • Three-dimensional conformal radiation treatment planning and delivery for low- and intermediate-grade gliomas.

    abstract::Three-Dimensional conformal radiation treatment (3D-CRT) planning and delivery is an external beam radiation therapy modality that has the general goal of conforming the shape of a prescribed dose volume to the shape of a 3-dimensional target volume, simultaneously limiting dose to critical normal structures. 3-Dimens...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1053/srao.2001.22060

    authors: Morris DE,Bourland JD,Rosenman JG,Shaw EG

    更新日期:2001-04-01 00:00:00

  • Artifacts in computed tomography scanning of moving objects.

    abstract::Target volumes in the thorax and abdomen are commonly computed tomography (CT) scanned during light respiration. In this article, we analyze the distortions introduced in helical scanning of moving objects. Objects of known geometry are placed on a moving sled and scanned in a multirow helical CT scanner. The motion o...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章

    doi:10.1053/j.semradonc.2003.10.004

    authors: Chen GT,Kung JH,Beaudette KP

    更新日期:2004-01-01 00:00:00

  • The systematic application of quality measures and process control in clinical radiation oncology.

    abstract::There has been growing emphasis on quality measures and process analysis techniques that may be implemented in the daily practice of radiation oncology to improve the overall quality of patient care. In this work, quality measures are a form of monitoring that should be actionable and specific to guide process improve...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章

    doi:10.1016/j.semradonc.2011.09.006

    authors: Pawlicki T,Chera B,Ning T,Marks LB

    更新日期:2012-01-01 00:00:00

  • Physical and chemical properties of radionuclide therapy.

    abstract::As more radionuclide therapies move from laboratory feasibility studies into clinical reality, it becomes increasingly important for the labeling chemistry to produce consistently a stable radiopharmaceutical that remains intact under the challenge of human catabolism. Similarly, once proof of principle is established...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/s1053-4296(00)80048-x

    authors: Wessels BW,Meares CF

    更新日期:2000-04-01 00:00:00

  • Clinical Case Panel: Treatment Alternatives for Inoperable Hepatocellular Carcinoma.

    abstract::Surgical resection or liver transplantation offers the best chance of cure for patients with hepatocellular carcinoma (HCC). Unfortunately, most patients are not good candidates for liver resection due to locally advanced disease or compromised liver function. Moreover, liver transplantation waiting lists are long. Fo...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2018.08.001

    authors: Toesca DAS,Barry A,Sapisochin G,Beecroft R,Dawson L,Owen D,Mouli S,Lewandowski R,Salem R,Chang DT

    更新日期:2018-10-01 00:00:00

  • New Directions in Radionuclide Sources for Brachytherapy.

    abstract::Brachytherapy continues to play an important role in the management of cancers of several sites, including the head and neck, brain, uterine cervix, endometrium, and prostate. The physical advantages of brachytherapy result from a superior localization of dose to the tumor volume. In brachytherapy, as radiation is con...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章

    doi:10.1053/SRAO00300278

    authors: Nath R

    更新日期:1993-10-01 00:00:00

  • Meeting the Global Need for Radiation Therapy in Cervical Cancer-An Overview.

    abstract::Cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women. The discrepancy in cervical cancer incidence and mortality between developed and developing nations has become increasingly apparent with 84% of the incidence and 88% of the mortality of cervical cance...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2020.05.004

    authors: Gurram L,Kalra B,Mahantshetty U

    更新日期:2020-10-01 00:00:00

  • Controversies in pathology in early-stage breast cancer.

    abstract::Breast-conserving therapy is a reliable, evidenced-based approach for early-stage breast carcinoma. This article reviews the issues and limitations related to simple margin measurements, data supporting the association between the amount of carcinoma near the margin, and ipsilateral breast failure risk. Additional fac...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2010.08.003

    authors: Goldstein SN

    更新日期:2011-01-01 00:00:00

  • Inflammatory breast cancer.

    abstract::Inflammatory breast cancer (IBC) represents the most virulent form of breast cancer, characterized by involvement of the skin and rapid progression of the disease. Management involves careful coordination of all multidisciplinary modalities, including imaging, systemic chemotherapy, surgery, and radiation therapy. The...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2009.05.008

    authors: Woodward WA,Cristofanilli M

    更新日期:2009-10-01 00:00:00

  • Androgen ablation in addition to radiation therapy for prostate cancer: is there true benefit?

    abstract::Prostate cancer patients may now be identified as having a high risk of failing single-modality treatment based on pretreatment prostate specific antigen (PSA), Gleason score, and palpable stage. In particular, a PSA greater than 20 ng/mL portends a biochemical failure rate of 50% to 80% when radiation therapy, surger...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/s1053-4296(98)80005-2

    authors: Pollack A,Zagars GK

    更新日期:1998-04-01 00:00:00

  • Thoracic Radiation Normal Tissue Injury.

    abstract::Thoracic malignancies are often a difficult group of tumors to treat definitively as the radiation doses needed to achieve a high probability for tumor control are often associated with high rates of radiation-induced toxicities. The lungs are particularly radiosensitive and are susceptible to radiation pneumonitis in...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2017.04.009

    authors: Simone CB 2nd

    更新日期:2017-10-01 00:00:00

  • Poly(ADP-ribose) polymerase inhibition as a model for synthetic lethality in developing radiation oncology targets.

    abstract::DNA double-strand breaks (DSBs) induced during clinical radiotherapy are potent inducers of cell death. Poly(ADP-ribose) polymerase (PARP)-1 is a 113-kD nuclear protein that binds to both single- and double-strand DNA breaks and is actively involved in DNA single-strand break repair and base excision repair. Recently,...

    journal_title:Seminars in radiation oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semradonc.2010.06.001

    authors: Chalmers AJ,Lakshman M,Chan N,Bristow RG

    更新日期:2010-10-01 00:00:00