title: Proton therapy for breast cancer after mastectomy: early outcomes of a prospective clinical trial.
abstract: OBJECTIVE
  Dosimetric planning studies have described potential benefits for the use of proton radiation therapy (RT) for locally advanced breast cancer. We report acute toxicities and feasibility of proton delivery for 12 women treated with postmastectomy proton radiation with or without reconstruction.
  
  
  METHODS
  Twelve patients were enrolled in an institutional review board-approved prospective clinical trial. The patients were assessed for skin toxicity, fatigue, and radiation pneumonitis during treatment and at 4 and 8 weeks after the completion of therapy. All patients consented to have photographs taken for documentation of skin toxicity.
  
  
  RESULTS
  Eleven of 12 patients had left-sided breast cancer. One patient was treated for right-sided breast cancer with bilateral implants. Five women had permanent implants at the time of RT, and 7 did not have immediate reconstruction. All patients completed proton RT to a dose of 50.4 Gy (relative biological effectiveness [RBE]) to the chest wall and 45 to 50.4 Gy (RBE) to the regional lymphatics. No photon or electron component was used. The maximum skin toxicity during radiation was grade 2, according to the Common Terminology Criteria for Adverse Events (CTCAE). The maximum CTCAE fatigue was grade 3. There have been no cases of RT pneumonitis to date.
  
  
  CONCLUSIONS
  Proton RT for postmastectomy RT is feasible and well tolerated. This treatment may be warranted for selected patients with unfavorable cardiac anatomy, immediate reconstruction, or both that otherwise limits optimal RT delivery using standard methods.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. smacdonald@partners.org
authors.forename: Shannon M
authors.initials: SM
authors.lastname: MacDonald
authors.forename: Sagar A
authors.initials: SA
authors.lastname: Patel
authors.forename: Shea
authors.initials: S
authors.lastname: Hickey
authors.forename: Michelle
authors.initials: M
authors.lastname: Specht
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Isakoff
authors.forename: Michele
authors.initials: M
authors.lastname: Gadd
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.forename: Beow Y
authors.initials: BY
authors.lastname: Yeap
authors.forename: Judith
authors.initials: J
authors.lastname: Adams
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Delaney
authors.forename: Hanne
authors.initials: H
authors.lastname: Kooy
authors.forename: Hsiao-Ming
authors.initials: HM
authors.lastname: Lu
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005221:Fatigue / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D008408:Mastectomy; D008875:Middle Aged; D010781:Photography; D017785:Photons / Q000627:therapeutic use; D061766:Proton Therapy / Q000009:adverse effects*; D017564:Radiation Pneumonitis / Q000209:etiology; D011855:Radiodermatitis / Q000209:etiology* / Q000473:pathology; D011859:Radiography; D011879:Radiotherapy Dosage; D012062:Relative Biological Effectiveness; D013997:Time Factors; D016896:Treatment Outcome