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Hypofractionated proton therapy in breast cancer: where are we? A critical review of the literature

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Abstract

Purpose

To critically review available literature on hypofractionated (≥ 3 Gy/fraction) proton therapy (PT) for breast cancer (BCa).

Methods

A systematic screening of the literature was performed in April 2021 in compliance with the preferred reporting items for systematic reviews and meta-analyses recommendations. All full-text publication written in English were considered eligible. Acute and late toxicities, oncological outcomes and dosimetric features were considered for the analysis.

Results

Twelve publications met the inclusion criteria; all studies but one focused on accelerated partial breast irradiation (APBI). Eleven works considered post-operative patients, one referred to ABPI as a curative-intent modality. The dosimetric profile of PT compared favorably with both photon-based 3D conformal and intensity-modulated techniques, while a more extended follow-up is warranted to fully assess both the long-term toxicities and the non-inferiority of oncological outcomes.

Conclusion

Our work shows that results on PT for BCa are currently only available for APBI applications, with dosimetric analyses demonstrating a clear advantage over both 3D conformal and intensity modulated X-rays techniques, especially when ≥ 2 treatment fields were used. However, further evidence is needed to define whether such theoretical benefit translates into clinical improvements, especially in the long-term.

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Acknowledgements

The Institution of some authors (IEO IRCCS) was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5 × 1,000 funds. The IEO IRCSS is supported by a research grant from IBA, Louvain-La-Neuve, Belgium. Stefania Volpe was supported by the Department of Oncology and Hemato-Oncology (DIPO) of the University of Milan with “Progetto di Eccellenza”; Stefania Volpe is a PhD student within the European School of Molecular Medicine (SEMM), Milan.

Funding

The research was conducted without any dedicated funding.

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Author notes

  1. Daniela Alterio and Eliana La Rocca have contributed equally to the manuscript and should be considered as co-first authors.

  2. Maria Cristina Leonardi and Barbara Alicja Jereczek-Fossa have contributed equally to the manuscript and should be considered as co-last authors.

Authors and Affiliations

  1. Department of Radiation Oncology, European Institute of Oncology (IEO) IRCSS, Milan, Italy

    Daniela Alterio, Eliana La Rocca, Stefania Volpe, Anna Maria Camarda, Alessia Casbarra, Maria Alessia Zerella, Maria Cristina Leonardi & Barbara Alicja Jereczek-Fossa

  2. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

    Eliana La Rocca, Stefania Volpe, Anna Maria Camarda, Alessia Casbarra & Barbara Alicja Jereczek-Fossa

  3. Library, European Institute of Oncology (IEO) IRCCS, Milan, Italy

    William Russell-Edu

  4. Scientific Directorate, European Institute of Oncology (IEO) IRCSS, Milan, Italy

    Roberto Orecchia

  5. Division of Breast Surgery, European Institute of Oncology (IEO) IRCSS, Milan, Italy

    Viviana Galimberti & Paolo Veronesi

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  1. Daniela Alterio
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Correspondence to Stefania Volpe.

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Alterio, D., La Rocca, E., Volpe, S. et al. Hypofractionated proton therapy in breast cancer: where are we? A critical review of the literature. Breast Cancer Res Treat 192, 249–263 (2022). https://doi.org/10.1007/s10549-022-06516-4

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