What Can Proton Beam Therapy Achieve for Patients with Pectus Excavatum Requiring Left Breast, Axilla and Internal Mammary Nodal Radiotherapy?

Executive Summary of the American Radium Society Appropriate Use Criteria: Regional Nodal Irradiation for Breast Cancer

OBJECTIVES

Recent literature has provided additional data to further individualize treatment recommendations on regional nodal irradiation (RNI) patient selection and delivery techniques, but controversies surrounding optimal RNI utilization remain, including radiation technique, modality selection, and internal mammary lymph node (IMN) inclusion. The American Radium Society (ARS) Breast Appropriate Use Criteria (AUC) Committee performed a systematic review and developed a consensus guideline to summarize recent data and provide evidence-based recommendations.

METHODS

A multidisciplinary panel comprised of 15 members representing radiation oncologists, medical oncologists, and surgical oncologists specializing in the treatment of breast cancer conducted an analysis of the medical literature from January 1, 2011 to April 1, 2024. Modified Delphi methodology was used to rate the appropriateness of treatments for variants across 3 key questions.

RESULTS

Patients with intermediate-risk breast cancer, such as limited nodal involvement or large primary tumor size, are reasonable candidates for RNI, although a subset of patients with overall favorable clinicopathologic features may be considered for treatment de-escalation. Data on the use of advanced radiation techniques for RNI were limited in scope and strength, and the panel agreed that careful patient selection is needed when using these tools. Evidence suggests that the IMN should be included when delivering RNI given the absolute benefit demonstrated in multiple randomized trials.

CONCLUSION

A systematic review and evidence-based summary of recommendations are provided in these consensus guidelines from the ARS Breast AUC Committee to provide current comprehensive guidance on the optimal management of non-metastatic breast cancer patients being considered for RNI.

Proton therapy for breast cancer: Reducing toxicity

Radiotherapy is a crucial component in the holistic management of breast cancer, with approximately 60% of individuals diagnosed with breast cancer requiring this treatment. As the survival rate of individuals with breast cancer has significantly increased, there is a growing focus on the long-term well-being of patients. Proton therapy (PT) is a new and rapidly developing radiotherapy method. In comparison with conventional photon therapy, PT offers the benefits of decreased radiation toxicity and increased dosage in the designated region. This can extend patients' lifespan and enhance their overall well-being. The present analysis examines the function of PT in diminishing the harmful effects of radiation in cases of breast cancer, while also providing a brief overview of the future potential and obstacles associated with PT for breast cancer.

A Case of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer in a Patient With Fabry Disease

Fabry disease is a metabolic disorder caused by a deficiency in lysosomal enzymes and is inherited as an X-chromosomal disorder. Patients with Fabry disease have a low incidence of cancer, and reports of malignant tumors, especially in the thoracic region, are rare. In this case report, we describe our experience with radiation therapy following breast-conserving surgery in a patient with left breast cancer and Fabry disease, and we review the existing literature. The patient, a woman in her 40s, required postoperative irradiation for left breast cancer (pT1N0M0). There were several patients with Fabry disease in her family, and the diagnosis of Fabry disease was made five years ago. Cardiac function evaluation revealed no significant abnormalities, but a myocardial biopsy had suggested the presence of Fabry disease. Due to the relatively preserved distance between the heart and the chest wall, the patient received heart-shielded three-dimensional conformal radiation therapy at a dose of 53.2 Gy in 20 fractions, without the use of deep-inspiration breath-hold or intensity-modulated radiotherapy. After treatment was completed, only mild radiation dermatitis was observed. Six months have passed since treatment, and there have been no serious adverse events.

Particle Therapy for Breast Cancer

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.