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Cardiac substructures exposure in left-sided breast cancer radiotherapy: Is the mean heart dose a reliable predictor of cardiac toxicity?
- Source :
-
Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique [Cancer Radiother] 2021 May; Vol. 25 (3), pp. 229-236. Date of Electronic Publication: 2021 Jan 07. - Publication Year :
- 2021
-
Abstract
- Purpose: This study aimed to assess radiation dose distribution to cardiac subvolumes in left-sided breast cancer radiotherapy (LBCRT) and to clarify whether the mean heart dose (MHD) reliably reflects cardiac substructures exposure.<br />Materials and Methods: Fifty women referred for adjuvant LBCRT were prospectively evaluated. All patients received 3D-conformal hypofractionated radiotherapy (40Gy delivered in 15 fractions of 2.67Gy±boost of 13.35Gy). Cardiac substructures were contoured using the F. Duane's cardiac atlas. Dose distribution to cardiac chambers, left main (LM), left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA)) was assessed. Dosimetric associations were analysed.<br />Results: The mean MHD was 3.08Gy (EQD2=3.67Gy). The mean Dmean/Dmax LAD was 11.45Gy (EQD2=13.64Gy)/29.5Gy (EQD2=35.15Gy). Low doses were delivered to LM, LCx, and RCA (Dmean≤1.3Gy). The left ventricle (LV) was the most exposed cardiac chamber with Dmean/Dmax of 4.78Gy/37Gy. The strongest correlation with MHD was found for Dmean LAD (r=0.81). For every 1Gy increase in MHD, Dmean LAD rose by 3.4Gy. However, the proportion of variance in Dmean LAD predictable from MHD was moderate (R <superscript>2</superscript> =0.65). For all other cardiac substructures, R <superscript>2</superscript> values were<0.7.<br />Conclusion: Our study showed high exposure of LAD and LV in LBCRT. With poor predictive value, MHD may underestimate doses to cardiac substructures. For optimal heart sparing radiotherapy, we recommend to consider LV and LAD as separate organ at risk.<br /> (Copyright © 2020 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Carcinoma, Ductal, Breast drug therapy
Carcinoma, Ductal, Breast radiotherapy
Carcinoma, Lobular drug therapy
Carcinoma, Lobular radiotherapy
Coronary Vessels radiation effects
Female
Heart Atria radiation effects
Heart Ventricles radiation effects
Humans
Lymphatic Irradiation
Middle Aged
Organs at Risk radiation effects
Prospective Studies
Radiation Dosage
Radiation Dose Hypofractionation
Re-Irradiation
Unilateral Breast Neoplasms drug therapy
Cardiotoxicity etiology
Heart radiation effects
Radiotherapy, Conformal adverse effects
Unilateral Breast Neoplasms radiotherapy
Subjects
Details
- Language :
- English
- ISSN :
- 1769-6658
- Volume :
- 25
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique
- Publication Type :
- Academic Journal
- Accession number :
- 33423965
- Full Text :
- https://doi.org/10.1016/j.canrad.2020.09.003