The long-term survival of dialysis-dependent patients after AVR is low (5-year survival: 29.5 %) irrespective of the type of heart valve prosthesis. Therefore, the use of biological AVR is not contraindicated in this group of patients.

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Results: Two hundred thirty-three pts treated with curative intent for BC were enrolled between April 2004 and June 2007. All pts received a CRT with (n = 79; 34%) or without (n = 154; 66%) RG. Median follow-up was 28 months . A majority of left-sided BC was included (64%). There was no difference between the two groups in terms of baseline characteristics except for younger median age in the RG group (53 vs. 58 years old, p \ 0.001). Compliance to RG was 97%. Based on total lung volume and CTV, there was an excellent reproducibility between the two acquisitions obtained with either RG techniques. The CTV and PTV coverage were comparable between the two groups. In RG group, the lung dosimetric parameters were significantly decreased: V37 (3.8% vs. 4.8%, p\ 0.0001) and mean dose (3.9 vs. 4.4 Gy, p\ 0.005) and there was a non-significant trend towards a decrease in V20 (6.8 vs. 7.4%, p = 0.08). The cardiac V40 was significantly decreased in the RG group (0.5 vs. 0.1%, p = 0.01). The decrease observed in Dmax to the heart was more important in the case of left breast irradiation (11 vs. 2 Gy, p \ 0.0001). The Dmax to the contralateral breast was reduced with RGR (2.5 vs. 3.4 Gy, p \ 0.01). In the RG group, benefits were more important with ABC and SDX (92%) than with RPM (8%). No difference was reported in acute and late toxicities. OS and PFS were not different between the two groups. Conclusions: RG techniques allow better lungs and heart protection than classical free-breathing techniques for irradiation in BC pts. Benefits were mostly obtained with BHT and during left breast irradiation.

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