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Abstract：
To investigate adverse events (AEs, CTCAE v4.0) and clinical outcomes for proton beam therapy (PBT) reirradiation (reRT) for breast cancer. From 2011 to 2016, 50 patients received PBT reRT for breast cancer in the prospective Proton Collaborative Group (PCG) registry. Acute AEs occurred within 180 days from start of reRT. Late AEs began or persisted beyond 180 days. Fisher\'s exact and Mann-Whitney rank-sum tests were utilized. Kaplan-Meier methods were used to estimate overall survival (OS) and local recurrence-free survival (LFRS). Median follow-up was 12.7 months (0-41.8). Median prior RT dose was 60 Gy (10-96.7). Median reRT dose was 55.1 Gy (45.1-76.3). Median cumulative dose was 110.6 Gy (70.6-156.8). Median interval between RT courses was 103.8 months (5.5-430.8). ReRT included regional nodes in 84% (66% internal mammary node [IMN]). Surgery included the following: 44% mastectomy, 22% wide local excision, 6% lumpectomy, 2% reduction mammoplasty, and 26% no surgery. Grade 3 AEs were experienced by 16% of patients (10% acute, 8% late) and were associated with body mass index (BMI) > 30 kg/m2 (P = 0.04), bilateral recurrence (P = 0.02), and bilateral reRT (P = 0.004). All grade 3 AEs occurred in patients receiving IMN reRT (P = 0.08). At 1 year, LRFS was 93%, and OS was 97%. Patients with gross disease at time of PBT trended toward worse 1-year LRFS (100% without vs. 84% with, P = 0.06). PBT reRT is well tolerated with favorable local control. BMI > 30, bilateral disease, and IMN reRT were associated with grade 3 AEs. Toxicity was acceptable despite median cumulative dose > 110 Gy.
摘要：
调查不良事件(AE，CTCAEv4.0）和质子束治疗（PBT）再照射（reRT）治疗乳腺癌的临床结果。从2011年到2016年，有50例患者在前瞻性质子合作组织（PCG）注册中接受了PBTreRT治疗乳腺癌。急性AE发生在reRT开始后180天内。晚期AE开始或持续超过180天。采用Fisher精确检验和Mann-Whitney秩和检验。使用Kaplan-Meier方法估计总生存期（OS）和无局部复发生存期（LFRS）。中位随访时间为12.7个月(0-41.8)。前RT剂量的中位数为60Gy(10-96.7)。中位reRT剂量为55.1Gy（45.1-76.3）。中位累积剂量为110.6Gy(70.6-156.8)。RT课程之间的中位间隔为103.8个月（5.5-430.8）。ReRT包括84%的区域节点(66%的内部乳腺节点[IMN])。手术包括以下：44％的乳房切除术，22%广泛的局部切除，6%肿块切除术,减少2%乳房成形术，26%没有手术。16%的患者经历了3级AE(10%急性，晚8％），并且与体重指数（BMI）>30kg/m2（P=0.04）有关，双侧复发（P=0.02），和双侧reRT（P=0.004）。所有3级AE均发生在接受IMNreRT的患者中（P=0.08）。在1年,LRFS为93%,OS为97%。PBT时患有严重疾病的患者1年LRFS趋于恶化（100％无vs.84%，P=0.06)。PBTreRT耐受性良好，局部控制良好。BMI>30，双侧疾病，IMNreRT与3级AE相关。尽管中位累积剂量>110Gy,但毒性是可接受的。
