Comparative Evaluation of Proton Therapy and Volumetric Modulated Arc Therapy for Brachial Plexus Sparing in the Comprehensive Reirradiation of High-Risk Recurrent Breast Cancer

• Published in: Advances in radiation oncology 2024-02, Vol.9 (2), p.101355-101355, Article 101355
• Main Authors: Choi, J. Isabelle, McCormick, Beryl, Park, Peter, Millar, Mark, Walker, Katherine, Tung, Chih Chun, Huang, Sheng, Florio, Peter, Chen, Chin-Cheng, Lozano, Alicia, Hanlon, Alexandra L., Fox, Jana, Xu, Amy J., Zinovoy, Melissa, Mueller, Boris, Bakst, Richard, LaPlant, Quincey, Braunstein, Lior Z., Khan, Atif J., Powell, Simon N., Cahlon, Oren
• Format: Article
• Language: English
• ISSN: 2452-1094; 2452-1094
• DOI: 10.1016/j.adro.2023.101355

Recurrent or new primary breast cancer requiring comprehensive regional nodal irradiation after prior radiation therapy (RT) to the supraclavicular area and upper axilla is challenging due to cumulative brachial plexus (BP) dose tolerance. We assessed BP dose sparing achieved with pencil beam scanning proton therapy (PBS-PT) and photon volumetric modulated arc therapy (VMAT). In an institutional review board–approved planning study, all patients with ipsilateral recurrent breast cancer treated with PBS-PT re-RT (PBT1) with at least partial BP overlap from prior photon RT were identified. Comparative VMAT plans (XRT1) using matched BP dose constraints were developed. A second pair of proton (PBT2) and VMAT (XRT2) plans using standardized target volumes were created, applying uniform prescription dose of 50.4 per 1.8 Gy and a maximum BP constraint