Cancer
Radiation therapy

Diagnosis: breast cancer
Treatment: proton beam therapy
The insurer denied the proton beam therapy
The health plan's determination is overturned.

This is the case of a female patient with L (left) breast cancer who was treated with chemotherapy followed by lumpectomy for breast cancer. She is being planned for adjuvant RT (radiation therapy) to the breast and nodal basin using Proton beam therapy.

The requested Proton Beam Radiation Therapy (PBRT) is medically necessary for this patient. The superior power of proton beam therapy may provide improvement in cardiac sparing especially in L (left) breast cancer.
This is young patient with curative disease with expected longevity and excellent performance status. We should try to avoid increased incidence of cardiac events using proton beam. The risk is linearly related to mean heart dose at a rate of 7.4% per Gy (gray unit) of mean heart dose. Proton beam therapy can keep the mean heart dose well below 5 Gy.
With photon beam therapy, this will result in significantly increased cardiac dose with the most sophisticated technology and treatment set up. The patient's tumor is located directly above her heart which requires significant planning to keep her mean heart dose below 5 GY.
Proton beam therapy is the only option to achieve full dose to the L breast and nodes and still stay within the Quantec dose threshold of heart less than 5 Gy.