Mammary Tumors

Breast cancer is the most common malignancy in women. In 2017, 7209 women have been diagnosed with breast cancer in the Czech Republic. The high incidence is observed in the developed countries of the world and increases by 1-2% every year. The incidence of breast cancer increases with age, doubling every 10 years until menopause, after which the increase is dramatic every year. The sharpest rise is after the age of 50. In the period 2012-2016, the median age of women with breast cancer was 54-73 years. Although the incidence is still rising, a favorable indicator is the development of mortality, which is the same or even slightly declining in the long run (average year-on-year decrease of 1%). This is a consequence of nationwide screenings and also thanks to more successful oncological treatments. Mammography screening has been introduced in the Czech Republic in 2002 and is helping to detect cancer at lower stages. Up to 83% mammary tumors are detected at early stages, which is why the chances of curing the patients and their long-term survival increases.

The goal of modern radiotherapy is to ensure quality coverage of the target volume while reducing doses to critical organs and thus reduce the risk of late side effects of treatment as much as possible. Proton radiotherapy enables dose reduction to the heart muscle, coronary arteries, lungs and contralateral breast, as evidenced by dosimetric studies. Proton therapy makes it possible to reduce the existing risk of very late complications of conventional radiotherapy, especially late cardiotoxicity and secondary malignancies.

Currently there are not many clinical data and no randomized trials comparing photon and proton radiotherapy. However, due to the latency of very late toxicity, successful realization of such randomized studies cannot be expected. Dosimetric data and radiobiological models show that a certain subgroup of women with breast cancer will benefit from the application of proton radiotherapy. The application of ionizing radiation in patients with a very high probability of survival should emphasize the principles of radiation protection. From the point of view of healthy tissues, such as the heart, even relatively low doses between 2-5 Gy cannot be considered completely safe in the long run. It is necessary to define the subgroup of patients who will benefit most from the application of proton radiotherapy.

Advantages of proton therapy in breast cancer irradiation:

• Minimizes the risk of adverse effects on the heart, lungs and spinal cord.
• Guarantees precise coverage of the irradiated area.
• Reduces the risk of developing secondary tumors.
• Reduces the risk of complications after the treatment.
• Offers patient-friendly, effective, and painless treatment.