Abstract
Simple SummaryApproximately 60% of patients with breast cancer require radiotherapy. With significant advances in breast cancer outcomes, an increasing focus is being placed on cancer survivorship, including the reduction of the late effects from radiotherapy. The aim of this review article is to highlight the potential of particle therapy in ensuring comprehensive radiotherapy for patients with breast cancer while reducing normal tissue exposure that can lead to subsequent impairments in quality of life. We review the latest literature in this space for both proton and carbon therapy and highlight opportunities for future study.Particle therapy has received increasing attention in the treatment of breast cancer due to its unique physical properties that may enhance patient quality of life and reduce the late effects of therapy. In this review, we will examine the rationale for the use of proton and carbon therapy in the treatment of breast cancer and highlight their potential for sparing normal tissue injury. We will discuss the early dosimetric and clinical studies that have been pursued to date in this domain before focusing on the remaining open questions limiting the widespread adoption of particle therapy.
Highlights
Advances in multi-disciplinary care have led to improvement in overall outcomes for women diagnosed with breast cancer, with a 40% decline in breast cancer mortality seen over the last 28 years [1]
Particle therapy has emerged as a attractive therapeutic option, largely based on its unique physical properties which result in very little dose beyond the target
Among cancer cells with defects in homologous recombination, including BRCA-related malignancies, and Fanconi Anemia pathways, observed relative biological effectiveness (RBE) values can be high as 1.3–1.5 in-vitro, suggesting that these malignancies may be more sensitive to proton therapy than conventional radiation [84–87]
Summary
Advances in multi-disciplinary care have led to improvement in overall outcomes for women diagnosed with breast cancer, with a 40% decline in breast cancer mortality seen over the last 28 years [1]. Compared with conventional or photonbased approaches, particle therapy results in lower radiation dose exposure to non-target tissue, often while offering improved target coverage. Dose modeling studies of secondary lung cancer after radiation for breast cancer have shown significantly lower risks of radiation-induced pulmonary malignancy with the use of proton beam therapy compared to conventional three-dimensional or intensity-modulated radiation therapy [25,26]. This may be important among patients who are current and former smokers, given their relatively higher risk of developing a secondary lung cancer (4% absolute risk for active smokers compared with 0.3% for non-smokers) [27,28]
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