title: Long-term cosmetic outcomes and toxicities of proton beam therapy compared with photon-based 3-dimensional conformal accelerated partial-breast irradiation: a phase 1 trial.
abstract: OBJECTIVE
  To present long-term outcomes of a prospective feasibility trial using either protons or 3-dimensional conformal photon-based (accelerated partial-breast irradiation [APBI]) techniques.
  
  
  METHODS
  From October 2003 to April 2006, 98 evaluable patients with stage I breast cancer were treated with APBI (32 Gy in 8 fractions given twice daily) on a prospective clinical trial: 19 with proton beam therapy (PBT) and 79 with photons or mixed photons/electrons. Median follow-up was 82.5 months (range, 2-104 months). Toxicity and patient satisfaction evaluations were performed at each visit.
  
  
  RESULTS
  At 7 years, the physician rating of overall cosmesis was good or excellent for 62% of PBT patients, compared with 94% for photon patients (P=.03). Skin toxicities were more common for the PBT group: telangiectasia, 69% and 16% (P=.0013); pigmentation changes, 54% and 22% (P=.02); and other late skin toxicities, 62% and 18% (P=.029) for PBT and photons, respectively. There were no significant differences between the groups in the incidences of breast pain, edema, fibrosis, fat necrosis, skin desquamation, and rib pain or fracture. Patient-reported cosmetic outcomes at 7 years were good or excellent for 92% and 96% of PBT and photon patients, respectively (P=.95). Overall patient satisfaction was 93% for the entire cohort. The 7-year local failure rate for all patients was 6%, with 3 local recurrences in the PBT group (7-year rate, 11%) and 2 in photon-treated patients (4%) (P=.22).
  
  
  CONCLUSIONS
  Local failure rates of 3-dimensional APBI and PBT were similar in this study. However, PBT, as delivered in this study, led to higher rates of long-term telangiectasia, skin color changes, and skin toxicities. We recommend the use of multiple fields and treatment of all fields per treatment session or the use of scanning techniques to minimize skin toxicity.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Sigolène
authors.initials: S
authors.lastname: Galland-Girodet
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Itai
authors.initials: I
authors.lastname: Pashtan
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: MacDonald
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Marek
authors.initials: M
authors.lastname: Ancukiewicz
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Ariel E
authors.initials: AE
authors.lastname: Hirsch
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kachnic
authors.affiliation: Department of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Michelle
authors.initials: M
authors.lastname: Specht
authors.affiliation: Department of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Michele
authors.initials: M
authors.lastname: Gadd
authors.affiliation: Department of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Simon N
authors.initials: SN
authors.lastname: Powell
authors.affiliation: Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Abram
authors.initials: A
authors.lastname: Recht
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: ataghian@partners.org.
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D005218:Fat Necrosis / Q000209:etiology / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D017785:Photons / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D061766:Proton Therapy / Q000009:adverse effects / Q000379:methods*; D011855:Radiodermatitis / Q000473:pathology / Q000517:prevention & control; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D012867:Skin / Q000528:radiation effects*; D012880:Skin Pigmentation / Q000528:radiation effects; D013684:Telangiectasis / Q000209:etiology; D016896:Treatment Outcome; D047368:Tumor Burden