Published in the Red Journal, this study from MGH analyzed 392 patients who underwent mastectomy and reconstruction followed by postmastectomy radiotherapy delivered either with photon (3D-conformal or VMAT, 236 patients, 60.2%), photons + electron (112 patients, 28.6%) or proton therapy (44 patients, 11.2%) mainly with pencil beam scanning in a similar dose fractionation schedule i.e. 50-50.4Gy in 25-28 fractions.

This study found no significant di9erence between protons and photons in terms of infection/necrosis (OR:1.6, p=0.4) and absolute-reconstruction-failure (OR: 1.2, p=0.7), but significantly higher risks for capsular-contracture with protons (OR:4.4, p<0.001) and overall-reconstruction-failure when compared to photon (OR:2.0, p=0.05).