Abstract

Patients with recurrent breast cancer to chest wall, who had previous irradiation, are difficult to manage and have limited options. Several reports described the use of photon therapy, hyperthermia, and brachytherapy. This is a case report of a 72-year-old female with Stage IIIA (pT3N1M0) invasive ductal carcinoma of the right breast status post modified radical mastectomy. The patient developed recurrence to the chest wall and one internal mammary lymph node one year later. She received 3-D conformal photon radiation therapy for this recurrence. Two years later, she had progression of the recurrence at the right chest wall and axillary and internal mammary lymph nodes. She was treated with intensity modulated proton therapy (IMPT) for a total of 6600 cGy in 33 fractions. However, four months later, she was found to have biopsy-proven isolated metastatic disease at her right bicep, which was again treated with IMPT for a dose of 6000 cGy in 20 fractions. Proton beam therapy was used in this case to spare dose to the brachial plexus, heart and lung while optimally irradiating the recurrent tumors. At last follow up, the patient is alive and has been disease free for 39 months. This report describes the technique and dosimetry for this unique case, which also reviewed recent series of re-irradiation using proton beam.

Highlights

  • Many breast cancer patients receive radiation therapy as part of their initial treatment, either as part of breast conserving therapy or post-mastectomy radiation treatment to the chest wall and regional lymphatics due to high risk features

  • Most re-irradiation for recurrent breast cancer has been done with electron or photon therapy in conjunction with hyperthermia as radio-sensitization [2]-[7]

  • Proton beam therapy (PBT) significantly reduces normal organ dose compared with photon or X-ray radiation therapy (XRT) such as 3-D Conformal Radiation Therapy (3DCRT) and Intensity Modulated (IMRT)

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Summary

Introduction

Many breast cancer patients receive radiation therapy as part of their initial treatment, either as part of breast conserving therapy or post-mastectomy radiation treatment to the chest wall and regional lymphatics due to high risk features. Despite increased local control rate with post-mastectomy radiation therapy when compared to no adjuvant radiation, some patients do experience loco-regional recurrence in the chest wall [1]. Proton beam therapy (PBT) significantly reduces normal organ dose compared with photon or X-ray radiation therapy (XRT) such as 3-D Conformal Radiation Therapy (3DCRT) and Intensity Modulated (IMRT). Pencil beam scanning (PBS), commonly referred to as intensity-modulated proton therapy (IMPT), is a modern PBT technique in which “spots” of protons are directed by steering magnets across multiple dose layers, achieving excellent conformality including proximal to the target

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