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16 januari 2021: Bron: International Journal of radiation Oncology

Protonenbestraling na operatie van beginnende borstkanker blijkt een uitstekende behandelingsoptie met een 100 procent lokale controle, gunstige cosmetische effecten op middellange termijn, hoge tevredenheid over de behandeling van de patiënten zelf en van de artsen, lage behandelingsbelasting omdat er weinig tot geen bijwerkingen werden gemeld en niet onbelangrijk een uitzonderlijk goede hart- en longbescherming.

In totaal werden 100 borstkankerpatiënten met pTis of pT1-2 N0 (≤3 cm) status na plaatselijke en gedeeltelijke mastectomie - operatie opgenomen in een fase 2-studie van 1 groep patiënten van 2010 tot 2019.

De mediane follow-up was 24 maanden ((interquartile range , 12-43 months), Lokale controle en algehele overleving waren 100% na 12 en 24 maanden. Er waren geen acute of late bijwerkingen van graad 3 of hoger; geen enkele patiënt ondervond vetnecrose, fibrose, infectie of kleiner worden van de borst. Uitstekende of goede cosmetische effecten na 12 maanden werd gemeld door 91% van de patiënten en 94% van de artsen; bij de meest recente follow-up waren dit respectievelijk 94% en 87%.

Het meest gerapporteerde late cosmetische effect was telangiectasia - blijvend verwijde bloedvaatjes vlak onder het oppervlak van de huid, zichtbaar als rode vaattekening met maximaal zo'n 1 millimeter doorsnede(17%).
Het totale patiënttevredenheidspercentage voor behandeling en resultaten na 12 en 24 maanden was respectievelijk 96% en 100%. De gemiddelde tijd weg van het werk van de patiënt was 5 dagen (IQR, 2-5 dagen).

Lees ook deze informatie verstrekt vanuit het Zorginstituut over protonenbestraling in Nederland:

Protonentherapie is een nieuwe vorm van radiotherapie (bestraling). De wijze waarop de straling wordt opgewekt is bij protonentherapie anders dan het geval is bij de conventionele technieken (zoals fotonenbestraling). Dit maakt het mogelijk een hogere dosis op de tumor en een lagere dosis op de omliggende organen en weefsels te geven. Voordeel van dit laatste is dat de schade aan omringende organen en weefsels kan worden beperkt. Als gevolg daarvan kunnen ernstige bijwerkingen, die vaak pas jaren laten optreden, worden verminderd.

Protonentherapie beschikbaar in Nederland

Vanaf begin 2018 is protonentherapie in Nederland beschikbaar. Het Protonen Therapie Centrum Groningen (PTCG) heeft als eerste een start gemaakt met het toepassen van protonentherapie bij daarvoor in aanmerking komende patiënten. Ook het in Delft gevestigde protonencentrum, Holland Particle Therapy Centre (HPTC), en het in Maastricht gevestigde centrum, Zuidoost Nederland Proton Therapy Centre (ZON-PTC), zijn inmiddels begonnen met de behandeling van patiënten met protonentherapie.

>>>>>lees verder

Zie ook deze informatie uit MAASTRO - Maastricht:

Lage dosis op gezond weefsel, hoge dosis in de tumor

Maastricht, 20 maart 2019 – Onlangs is bij Maastro in Maastricht de eerste borstkanker patiënt bestraald met protonen. “Dat is met name winst voor patiënten met een tumor in de linkerborst waarvan ook de klieren langs het borstbeen worden bestraald te worden,” vertelt Karolien Verhoeven, radiotherapeut-oncoloog. “Deze therapie kan de kans immers verminderen op het risico van het nadien ontwikkelen van een hartinfarct.” In Zuidoost Nederland is Maastro het enige radiotherapeutisch instituut met protonentherapie. Ze werkt hiervoor samen met diverse ziekenhuizen.>>>>>>>lees verder

Het volledige studierapport is tegen betaling in te zien of te downloaden. Hier het abstract:

CLINICAL INVESTIGATION| VOLUME 109, ISSUE 2, P441-448, FEBRUARY 01, 2021

Proton Accelerated Partial Breast Irradiation: Clinical Outcomes at a Planned Interim Analysis of a Prospective Phase 2 Trial

Published:September 15, 2020DOI:https://doi.org/10.1016/j.ijrobp.2020.09.009

Purpose

To perform a planned interim analysis of acute (within 12 months) and late (after 12 months) toxicities and cosmetic outcomes after proton accelerated partial breast irradiation (APBI).

Methods and Materials

A total of 100 patients with pTis or pT1-2 N0 (≤3cm) breast cancer status after segmental mastectomy were enrolled in a single-arm phase 2 study from 2010 to 2019. The clinically determined postlumpectomy target volume, including tumor bed surgical clips and operative-cavity soft-tissue changes seen on imaging plus a radial clinical expansion, was irradiated with passively scattered proton APBI (34 Gy in 10 fractions delivered twice daily with a minimum 6-hour interfraction interval). Patients were evaluated at protocol-specific time intervals for recurrence, physician reports of cosmetic outcomes and toxicities, and patient reports of cosmetic outcomes and satisfaction with the treatment or experience.

Results

Median follow-up was 24 months (interquartile range , 12-43 months). Local control and overall survival were 100% at 12 and 24 months. There were no acute or late toxicities of grade 3 or higher; no patients experienced fat necrosis, fibrosis, infection, or breast shrinkage. Excellent or good cosmesis at 12 months was reported by 91% of patients and 94% of physicians; at the most recent follow-up, these were 94% and 87%, respectively. The most commonly reported late cosmetic effect was telangiectasis (17%). The total patient satisfaction rate for treatment and results at 12 and 24 months was 96% and 100%, respectively. Patients’ mean time away from work was 5 days (IQR, 2-5 days), and the median out-of-pocket cost was $700 (IQR, $100-$1600). The mean left-sided heart dose was 2 cGy (range, 0.2-75 cGy), and the mean ipsilateral lung dose was 19 cGy (range, 0.2-164 cGy).

Conclusions

Proton APBI is a maturing treatment option with high local control, favorable intermediate-term cosmesis, high treatment satisfaction, low treatment burden, and exceptional heart and lung sparing.

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Article Info

Publication History

Published online: September 15, 2020

Accepted: September 9, 2020

Received: May 14, 2020

Footnotes

This work had no specific funding.

Disclosures: D.A.W. reports personal fees from Genomic Health Inc and a one-time advisory fee from Merck, outside of the submitted work. B.D.S. reports past grant funding from Varian Medical Systems and intellectual property interests with Oncora Medical, outside of the submitted work. S.F.S. reports grant funding from Varian Medical Systems, outside of the submitted work. Dr Amos reports grants from Varian Medical Systems, personal fees from TAE Life Sciences, personal fees from the University of London, and personal fees from London South Bank University, outside of the submitted work. The remaining authors reported no disclosures or conflicts of interest.

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