Reirradiation of recurrent breast cancer with proton beam therapy: A case report and literature review

Proton beam therapy causing pericarditis – a rare case of radiation induced cardiotoxicity

Acute pericarditis is caused by the inflammation of the pericardium which can result in an effusion around the heart. Proton beam therapy causing radiation-induced pericarditis is not a well-known cause of pericarditis. We present a case of a patient with Li-Fraumeni Syndrome who developed acute onset pericarditis, presumed to be secondary to proton beam therapy.

Target motion management in breast cancer radiation therapy

Background

Over the last two decades, breast cancer remains the main cause of cancer deaths in women. To treat this type of cancer, radiation therapy (RT) has proved to be efficient. RT for breast cancer is, however, challenged by intrafractional motion caused by respiration. The problem is more severe for the left-sided breast cancer due to the proximity to the heart as an organ-at-risk. While particle therapy results in superior dose characteristics than conventional RT, due to the physics of particle interactions in the body, particle therapy is more sensitive to target motion.

Conclusions

This review highlights current and emerging strategies for the management of intrafractional target motion in breast cancer treatment with an emphasis on particle therapy, as a modern RT technique. There are major challenges associated with transferring real-time motion monitoring technologies from photon to particles beams. Surface imaging would be the dominant imaging modality for real-time intrafractional motion monitoring for breast cancer. The magnetic resonance imaging (MRI) guidance and ultra high dose rate (FLASH)-RT seem to be state-of-the-art approaches to deal with 4D RT for breast cancer.

Concomitant fulvestrant with reirradiation for unresectable locoregional recurrent estrogen receptor positive (ER+) breast cancer: A case report and narrative review

RATIONALE

Locoregional recurrence of breast cancer is a challenging issue for clinicians. Treatment options for unresectable recurrent estrogen receptor positive (ER+) breast cancer in previously irradiated area are limited. Some studies showed concomitant fulvestrant with radiation therapy might increase radiosensitivity compared with radiation alone in vitro, no in vivo reports yet.

PATIENT CONCERN

Here, we present a case report and make a narrative review of concomitant fulvestrant with radiation therapy for unresectable locoregional recurrent ER+ breast cancer. The patient was treated with modified radical mastectomy in 2015, adjuvant chemotherapy, radiotherapy, followed by exemestane until November 2018, relapsed in internal mammary lymph nodes with sternum involved.

DIAGNOSIS

The final diagnosis was breast cancer internal mammary lymph nodes metastasis with sternum involved.

INTERVENTIONS

After diagnosis was made, concurrent fulvestrant with reirradiation as a palliative treatment were proposed under multiple disciplinary team.

OUTCOMES

There was a good clinical response, enabling curative chance with radiation therapy to a total dose of 60 Gy. Computed tomography scan revealed no evidence of residual tumor.

LESSONS

As far as we know, this is the first report concerning concomitant fulvestrant with reirradiation for unresectable locoregional recurrent ER+ breast cancer. Since no severe adverse events were observed, this strategy could be a suitable "loco-regional rescue therapy" to further reduce tumor progression or even reach a curative effect. Studies of this treatment strategy in randomized clinical trials are warranted to further assess its safety and effectiveness.

The Medical Physics Management of Reirradiation Patients

Medical physics consultation is critical to the safe and appropriate management of patients undergoing reirradiation. A rigorous and efficient workflow in radiation oncology departments is crucial to ensure the safety and quality of treatment. The need for this service is steadily increasing year after year with the increasing complexity of treatment. This article provides an overview of how the Retreatment Special Medical Physics Consult is performed at the University of Michigan, along with a detailed patient-specific example, the results of a survey of how other institutions approach this workflow, and recommendations for future work to improve this process.