دورية أكاديمية
Postmastectomy Intensity Modulated Proton Therapy: 5-Year Oncologic and Patient-Reported Outcomes.
| العنوان: | Postmastectomy Intensity Modulated Proton Therapy: 5-Year Oncologic and Patient-Reported Outcomes. |
|---|---|
| المؤلفون: | Gao RW; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Mullikin TC; Department of Radiation Oncology, Duke Cancer Center, Durham, North Carolina., Aziz KA; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Afzal A; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Smith NL; Sanford Cancer Center, Sioux Falls, South Dakota., Routman DM; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Gergelis KR; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Harmsen WS; Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota., Remmes NB; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Tseung HSWC; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Shiraishi SS; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Boughey JC; Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota., Ruddy KJ; Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota., Harless CA; Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota., Garda AE; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Waddle MR; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Park SS; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Shumway DA; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Corbin KS; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Mutter RW; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. Electronic address: mutter.robert@mayo.edu. |
| المصدر: | International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2023 Nov 15; Vol. 117 (4), pp. 846-856. Date of Electronic Publication: 2023 May 26. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier, Inc Country of Publication: United States NLM ID: 7603616 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-355X (Electronic) Linking ISSN: 03603016 NLM ISO Abbreviation: Int J Radiat Oncol Biol Phys Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: New York, NY : Elsevier, Inc Original Publication: Elmsford, N. Y., Pergamon Press. |
| مستخلص: | Purpose: To report oncologic, physician-assessed, and patient-reported outcomes (PROs) for a group of women homogeneously treated with modern, skin-sparing multifield optimized pencil-beam scanning proton (intensity modulated proton therapy [IMPT]) postmastectomy radiation therapy (PMRT). Methods and Materials: We reviewed consecutive patients who received unilateral, curative-intent, conventionally fractionated IMPT PMRT between 2015 and 2019. Strict constraints were applied to limit the dose to the skin and other organs at risk. Five-year oncologic outcomes were analyzed. Patient-reported outcomes were evaluated as part of a prospective registry at baseline, completion of PMRT, and 3 and 12 months after PMRT. Results: A total of 127 patients were included. One hundred nine (86%) received chemotherapy, among whom 82 (65%) received neoadjuvant chemotherapy. The median follow-up was 4.1 years. Five-year locoregional control was 98.4% (95% CI, 93.6-99.6), and overall survival was 87.9% (95% CI, 78.7-96.5). Acute grade 2 and 3 dermatitis was seen in 45% and 4% of patients, respectively. Three patients (2%) experienced acute grade 3 infection, all of whom had breast reconstruction. Three late grade 3 adverse events occurred: morphea (n = 1), infection (n = 1), and seroma (n = 1). There were no cardiac or pulmonary adverse events. Among the 73 patients at risk for PMRT-associated reconstruction complications, 7 (10%) experienced reconstruction failure. Ninety-five patients (75%) enrolled in the prospective PRO registry. The only metrics to increase by >1 point were skin color (mean change: 5) and itchiness (2) at treatment completion and tightness/pulling/stretching (2) and skin color (2) at 12 months. There was no significant change in the following PROs: bleeding/leaking fluid, blistering, telangiectasia, lifting, arm extension, or bending/straightening the arm. Conclusions: With strict dose constraints to skin and organs at risk, postmastectomy IMPT was associated with excellent oncologic outcomes and PROs. Rates of skin, chest wall, and reconstruction complications compared favorably to previous proton and photon series. Postmastectomy IMPT warrants further investigation in a multi-institutional setting with careful attention to planning techniques. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.) |
| تواريخ الأحداث: | Date Created: 20230527 Latest Revision: 20231015 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1016/j.ijrobp.2023.05.036 |
| PMID: | 37244627 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1879-355X |
|---|---|
| DOI: | 10.1016/j.ijrobp.2023.05.036 |