E. Hug

Proton Therapy for Local-regionally Advanced Breast Cancer Maximizes Cardiac Sparing

Abstract Purpose: To evaluate the potential of proton therapy in sparing cardiac/coronary structures when compared with 3-dimensional conformal radiation therapy (3DCRT), helical tomotherapy (HT), and intensity-modulated radiation therapy using volumetric modulated arc therapy (VMAT). Materials and Methods: Comparative treatment planning was performed using computed tomography scans of 10 patients with left-sided stage III breast cancer after mastectomy, targeting the chest wall, axilla levels I to III, and the supraclavicular and internal mammary nodes (IMN) to 50.4 Gy (radiobiologic equivalent [RBE]) in 28 fractions. Organs at risk were heart, lungs, contralateral breast, unspecified healthy tissues, and coronary arteries. Plans were also compared that included IMNs for protons, but not for photons. Results: Mean heart dose of 1.2 Gy (RBE) was lowest with protons when compared with 6.8, 10.2, and 8.2 Gy for 3DCRT, HT, and VMAT, respectively (P < .05). The mean left anterior descending artery (LAD) dose ...

Patient-reported Quality of Life After Proton Beam Therapy for Prostate Cancer: The Effect of Prostate Size

Micro‐Abstract The present study assessed the effect of prostate gland size on patient‐assessed quality of life (QOL) after definitive treatment of prostate adenocarcinoma with proton beam therapy. A larger prostate size, despite receiving a greater radiation dose, did not affect QOL at 6 months, providing further support that neoadjuvant cytoreductive treatments are unnecessary. Background: In the present study, we assessed the effect of prostate gland size on patient‐assessed genitourinary and gastrointestinal (GI) quality of life (QOL) after definitive treatment of prostate adenocarcinoma with proton beam therapy. Patients and Methods: As a part of a prospective outcome tracking protocol, 81 patients treated at a single center between with proton beam therapy completed the Expanded Prostate Cancer Index Composite (EPIC) questionnaire before treatment and at the follow‐up examinations. We reviewed the dosimetric data, reported as Vx (volume of organ receiving x Gy), and patient‐reported QOL at 6 months. Genitourinary QOL was assessed using the American Urological Association symptom score and EPIC urinary domain score. GI QOL was assessed using the EPIC GI domain score. Results: Larger prostate glands were associated with greater bladder V70 (P < .01) and rectal V70 (P < .01). The rectal V70 was < 15% for all patients (range, 4%‐13.8%) with the planned treatment volume coverage (percentage of the prescription dose covering 95% of the volume > 95%) maintained. Patients with larger prostates did not have a greater change in their American Urological Association symptom index scores (< 30 cm3, +2.3; 30‐49 cm3, +3.2; ≥ 50 cm3, 0.2; P = .06) or urinary domain score (< 30 cm3, −3.6; 30‐49 cm3, −3.1; ≥ 50 cm3, +3.8; P = .76) at 6 months after treatment. Also, prostate size was not associated with a change in the EPIC GI domain score at 6 months after treatment (< 30 cm3, −3.7; 30‐49 cm3, −1.1; ≥ 50 cm3, −0.55; P = .67). Conclusion: Definitive proton beam therapy for prostate cancer to a dose of 79.2 Gy resulted in excellent patient‐reported urinary and GI QOL, independently of the baseline prostate size. This single‐institution finding should be tested further in a multi‐institutional study to confirm the potential limited role of androgen deprivation therapy.