以体积为基础的保皮计划技术对接受铅笔束扫描质子治疗的乳房和胸壁患者的剂量学和治疗中的临床结果。

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology Pub Date : 2025-02-01 DOI:10.1016/j.adro.2024.101653

Avani D. Rao MD , Alexander Goughenour CS, CMD , Betelehem Kebede BS , Caroline Bamberger BS , Grayden MacLennan MS, CMD , Jackeline Castro BS, CMD , Lisa Stephenson MS, CMD , Amanuel Negussie MS, CMD , Sydney Seracino CMD , Hongkun Wang PhD , Stella Hetelekidis MD , Sarah J. Gao MD , Lonika Majithia MS, MD , Ashish Chawla MD , Ashkan Parniani MBA, CMD , Peng Wang PhD, DABR , Jiajin Fan PhD, DABR

{"title":"以体积为基础的保皮计划技术对接受铅笔束扫描质子治疗的乳房和胸壁患者的剂量学和治疗中的临床结果。","authors":"Avani D. Rao MD , Alexander Goughenour CS, CMD , Betelehem Kebede BS , Caroline Bamberger BS , Grayden MacLennan MS, CMD , Jackeline Castro BS, CMD , Lisa Stephenson MS, CMD , Amanuel Negussie MS, CMD , Sydney Seracino CMD , Hongkun Wang PhD , Stella Hetelekidis MD , Sarah J. Gao MD , Lonika Majithia MS, MD , Ashish Chawla MD , Ashkan Parniani MBA, CMD , Peng Wang PhD, DABR , Jiajin Fan PhD, DABR","doi":"10.1016/j.adro.2024.101653","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the hypothesis that a volumetric skin-sparing planning technique (SSPT) will reduce acute dermatitis in patients treated to the breast or chest wall (CW) with proton pencil-beam scanning (PBS).</div></div><div><h3>Methods and Materials</h3><div>In January 2022, our center incorporated volumetric-based skin-sparing objectives in addition to skin hot spot evaluation as an SSPT. The SSPT incorporated an objective to limit the volume of a skin evaluation structure (skin-eval) receiving 95% of the prescription dose or more (V95%Rx) to ideally < 50%. We compared target coverage, robustness, skin-eval dosimetry, and acute on-treatment skin toxicity in patients treated with and without incorporation of this SSPT. Patients with skin/dermal lymphatic invasion or inflammatory breast cancer were excluded.</div></div><div><h3>Results</h3><div>A total of 84 patients who received breast/CW PBS were included (43 planned without and 41 with the SSPT). There was no difference in percentages of patients treated with intact breast/CW/immediate CW reconstruction between groups. Mean skin-evalV95%Rx was 72% vs 30%, <em>P</em> < .0001, for those treated without versus with an SSPT. Maximum %Rx to the skin-eval volume of 0.03, 0.3, and 1 cc was higher in patients treated without versus with an SSPT (103.1% vs 101.5%; 101.3% vs 100.4%; and 101.8% vs 99.7% [all <em>P</em> ≤ .0001]), respectively. There was a small difference in the mean clinical target volume V97.5%Rx in patients treated without versus with the SSPT (97.8% vs 96.5%, <em>P</em> = .0003). Patients planned using the SSPT demonstrated reduced rates of grade 1 breast pain at week 2 (12% vs 33%, <em>P</em> = .0424) and grades 2 and 3 dermatitis at weeks 4 and 5 (week 4 dermatitis ≥ grade 2, 18% vs 43%, <em>P</em> = .0224; week 5 dermatitis ≥ grade 2, 45% vs 69%, <em>P</em> = .0006). There were numerically more patients requiring a treatment break or not completing the full intended prescription (4 vs 1) in the pre-SSPT cohort.</div></div><div><h3>Conclusions</h3><div>The use of an SSPT may reduce acute skin toxicity in patients with breast cancer treated with PBS.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101653"},"PeriodicalIF":2.2000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719829/pdf/","citationCount":"0","resultStr":"{\"title\":\"Dosimetric and On-treatment Clinical Results of a Volumetric-based Skin-sparing Planning Technique for Patients Treated to the Breast and Chest Wall With Pencil-Beam Scanning Proton Therapy\",\"authors\":\"Avani D. Rao MD , Alexander Goughenour CS, CMD , Betelehem Kebede BS , Caroline Bamberger BS , Grayden MacLennan MS, CMD , Jackeline Castro BS, CMD , Lisa Stephenson MS, CMD , Amanuel Negussie MS, CMD , Sydney Seracino CMD , Hongkun Wang PhD , Stella Hetelekidis MD , Sarah J. Gao MD , Lonika Majithia MS, MD , Ashish Chawla MD , Ashkan Parniani MBA, CMD , Peng Wang PhD, DABR , Jiajin Fan PhD, DABR\",\"doi\":\"10.1016/j.adro.2024.101653\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>This study evaluates the hypothesis that a volumetric skin-sparing planning technique (SSPT) will reduce acute dermatitis in patients treated to the breast or chest wall (CW) with proton pencil-beam scanning (PBS).</div></div><div><h3>Methods and Materials</h3><div>In January 2022, our center incorporated volumetric-based skin-sparing objectives in addition to skin hot spot evaluation as an SSPT. The SSPT incorporated an objective to limit the volume of a skin evaluation structure (skin-eval) receiving 95% of the prescription dose or more (V95%Rx) to ideally < 50%. We compared target coverage, robustness, skin-eval dosimetry, and acute on-treatment skin toxicity in patients treated with and without incorporation of this SSPT. Patients with skin/dermal lymphatic invasion or inflammatory breast cancer were excluded.</div></div><div><h3>Results</h3><div>A total of 84 patients who received breast/CW PBS were included (43 planned without and 41 with the SSPT). There was no difference in percentages of patients treated with intact breast/CW/immediate CW reconstruction between groups. Mean skin-evalV95%Rx was 72% vs 30%, <em>P</em> < .0001, for those treated without versus with an SSPT. Maximum %Rx to the skin-eval volume of 0.03, 0.3, and 1 cc was higher in patients treated without versus with an SSPT (103.1% vs 101.5%; 101.3% vs 100.4%; and 101.8% vs 99.7% [all <em>P</em> ≤ .0001]), respectively. There was a small difference in the mean clinical target volume V97.5%Rx in patients treated without versus with the SSPT (97.8% vs 96.5%, <em>P</em> = .0003). Patients planned using the SSPT demonstrated reduced rates of grade 1 breast pain at week 2 (12% vs 33%, <em>P</em> = .0424) and grades 2 and 3 dermatitis at weeks 4 and 5 (week 4 dermatitis ≥ grade 2, 18% vs 43%, <em>P</em> = .0224; week 5 dermatitis ≥ grade 2, 45% vs 69%, <em>P</em> = .0006). There were numerically more patients requiring a treatment break or not completing the full intended prescription (4 vs 1) in the pre-SSPT cohort.</div></div><div><h3>Conclusions</h3><div>The use of an SSPT may reduce acute skin toxicity in patients with breast cancer treated with PBS.</div></div>\",\"PeriodicalId\":7390,\"journal\":{\"name\":\"Advances in Radiation Oncology\",\"volume\":\"10 2\",\"pages\":\"Article 101653\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719829/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Advances in Radiation Oncology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2452109424002161\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Advances in Radiation Oncology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2452109424002161","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

目的：本研究评估了体积皮肤保留计划技术（SSPT）可以减少质子铅笔束扫描（PBS）治疗乳房或胸壁（CW）患者的急性皮炎的假设。方法和材料：2022年1月，我们中心将基于体积的皮肤保留目标纳入皮肤热点评估作为SSPT。SSPT纳入了一个目标，将接受处方剂量95%或以上（V95%Rx）的皮肤评估结构（皮肤评估）的体积限制在理想的< 50%。我们比较了使用和不使用该SSPT治疗的患者的靶覆盖率、稳健性、皮肤评估剂量学和急性治疗时皮肤毒性。排除皮肤/真皮淋巴浸润或炎性乳腺癌患者。结果：共纳入84例接受乳腺/CW PBS的患者（43例计划不接受SSPT， 41例接受SSPT）。两组间接受完整乳房/连续乳房重建/立即连续乳房重建的患者百分比无差异。无SSPT组和接受SSPT组的平均皮肤评价（95% rx）分别为72%和30%，P < 0.0001。未接受SSPT治疗的患者皮肤评估体积的最大%Rx值为0.03、0.3和1cc，高于接受SSPT治疗的患者(103.1% vs 101.5%；101.3% vs 100.4%；101.8% vs 99.7%[均P≤0.0001])。未接受SSPT治疗的患者与接受SSPT治疗的患者的平均临床靶体积V97.5%Rx有微小差异（97.8% vs 96.5%, P = 0.0003）。计划使用SSPT的患者在第2周表现出1级乳房疼痛（12%对33%，P = 0.0424）和2级和3级皮炎(第4周皮炎≥2级，18%对43%，P = 0.0224；第5周皮炎≥2级（45% vs 69%, P = 0.0006）。在sspt前队列中，需要中断治疗或未完成全部预定处方的患者数量更多（4比1）。结论：使用SSPT可以降低接受PBS治疗的乳腺癌患者的急性皮肤毒性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Dosimetric and On-treatment Clinical Results of a Volumetric-based Skin-sparing Planning Technique for Patients Treated to the Breast and Chest Wall With Pencil-Beam Scanning Proton Therapy

Purpose

This study evaluates the hypothesis that a volumetric skin-sparing planning technique (SSPT) will reduce acute dermatitis in patients treated to the breast or chest wall (CW) with proton pencil-beam scanning (PBS).

Methods and Materials

In January 2022, our center incorporated volumetric-based skin-sparing objectives in addition to skin hot spot evaluation as an SSPT. The SSPT incorporated an objective to limit the volume of a skin evaluation structure (skin-eval) receiving 95% of the prescription dose or more (V95%Rx) to ideally < 50%. We compared target coverage, robustness, skin-eval dosimetry, and acute on-treatment skin toxicity in patients treated with and without incorporation of this SSPT. Patients with skin/dermal lymphatic invasion or inflammatory breast cancer were excluded.

Results

A total of 84 patients who received breast/CW PBS were included (43 planned without and 41 with the SSPT). There was no difference in percentages of patients treated with intact breast/CW/immediate CW reconstruction between groups. Mean skin-evalV95%Rx was 72% vs 30%, P < .0001, for those treated without versus with an SSPT. Maximum %Rx to the skin-eval volume of 0.03, 0.3, and 1 cc was higher in patients treated without versus with an SSPT (103.1% vs 101.5%; 101.3% vs 100.4%; and 101.8% vs 99.7% [all P ≤ .0001]), respectively. There was a small difference in the mean clinical target volume V97.5%Rx in patients treated without versus with the SSPT (97.8% vs 96.5%, P = .0003). Patients planned using the SSPT demonstrated reduced rates of grade 1 breast pain at week 2 (12% vs 33%, P = .0424) and grades 2 and 3 dermatitis at weeks 4 and 5 (week 4 dermatitis ≥ grade 2, 18% vs 43%, P = .0224; week 5 dermatitis ≥ grade 2, 45% vs 69%, P = .0006). There were numerically more patients requiring a treatment break or not completing the full intended prescription (4 vs 1) in the pre-SSPT cohort.

Conclusions

The use of an SSPT may reduce acute skin toxicity in patients with breast cancer treated with PBS.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.