The degree of hypofractionation and parasternal photon beams contributed to increased cardiac mortality in this patient cohort. Differences emerged after 12 to 15 years, indicating the need of more studies with observation time of 2 decades.
Purpose:To evaluate cardiac doses in breast cancer patients with stage II/III treated with 4-field radiotherapy based on computed tomography (CT) dose planning.Methods and Materials:Based on archived CT images, whole heart and cardiac chamber radiation doses were analyzed in 216 (111 left-sided and 105 right-sided) mastectomized or lumpectomized breast cancer patients treated at a single institution, the Norwegian Radium Hospital, between 2000–2002. Individual dose volume histograms for the whole heart and for the four cardiac chambers were obtained, and mean, median and maximum doses to these structures were calculated. The dose (Gy) delivered to the 5% of the volume of each cardiac structure (D5%), and the volume percentage of each structure receiving ≥ 25 Gy (V25Gy) were reported. Normal tissue complication probability (NTCP) calculations were used to estimate the risk for ischemic heart disease (IHD).Results:Cohort-based medians of the whole heart mean dose (Dmean) for left- and right-sided tumors were 3.2 Gy and 1.3 Gy, respectively, with similar ventricular but lower atrial values. The atrial doses did not differ according to laterality of the breast tumor. In 13 patients with left-sided cancer, 5% of the heart volume was exposed to >25 Gy. The NTCP estimates were generelly low, with a maximum of 2.8%.Conclusions:During adjuvant CT-based locoregional radiotherapy of women with breast cancer, the cardiac radiation doses are, at the group level, below recommended threshold values (D5% < 25 Gy), though individual patients with left-sided disease may exceed these limits.
Hjertemedisinsk avdeling Oslo universitetssykehus, Ullevål og Forskning og innovasjonsavdelingen Akershus universitetssykehus og Universitetet i Oslo Forfa erbidrag: utforming og design av manuskriptet. Geeta Gulati er ph.d. i kardioonkologi, overlege og forsker. Hun er leder for Nordic Cardio-Oncology Society. Forfa eren har fylt ut ICMJE-skjemaet og oppgir følgende interessekonflikter: Hun har mo a honorar fra Roche, Orion Pharma, Novartis, AstraZeneca og Bristol-Myers Squibb. Hjertemedisinsk avdeling Oslo universitetssykehus, Ullevål Forfa erbidrag: utforming og design av manuskriptet. Kristin Holm Tjessem er ph.d. i kardioonkologi og konstituert overlege. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Avdeling for kreftbehandling Oslo universitetssykehus, Ullevål og Avdeling for kreftgenetikk Institu for kreftbehandling Oslo universitetssykehus, Radiumhospitalet Forfa erbidrag: utforming og design av manuskriptet. Henrik Horndalsveen er overlege og ph.d.-stipendiat. Forfa eren har fylt ut ICMJE-skjemaet og oppgir følgende interessekonflikter: Han har mo a honorar for foredrag og møtedeltakelse fra AstraZeneca, Pfizer og Roche. Hjertemedisinsk avdeling Oslo universitetssykehus, Ullevål og Universitetet i Oslo Forfa erbidrag: utforming og design av manuskriptet. Sigrun Halvorsen er spesialist i hjertesykdommer, avdelingsleder og professor. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.
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