Radiation dose distribution in functional heart regions from tangential breast cancer radiotherapy

Wollschläger, Daniel; Karle, Heiko; Stockinger, Marcus; Bartkowiak, Detlef; Bührdel, Sandra; Merzenich, Hiltrud; Wiegel, Thomas; Blettner, Maria; Schmidberger, Heinz

doi:10.1016/j.radonc.2016.01.020

Cited by 26 publications

(19 citation statements)

References 22 publications

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“…RIHD following chest RT has been recognized fact and demonstrated in numerous clinical trials. The choice of treatment and tumor location has significant influence on RIHD16, 17. At the present stage, chemotherapy is a risk factor for RIHD, anthracycline had evident effects on RIHD18.…”

Section: The Common Types Of Rihdmentioning

confidence: 96%

Radiation-induced heart disease: a review of classification, mechanism and prevention

et al. 2019

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With the increasing incidence of thoracic tumors, radiation therapy (RT) has become an important component of comprehensive treatment. RT improves survival in many cancers, but it involves some inevitable complications. Radiation-induced heart disease (RIHD) is one of the most serious complications. RIHD comprises a spectrum of heart disease including cardiomyopathy, pericarditis, coronary artery disease, valvular heart disease and conduction system abnormalities. There are numerous clinical manifestations of RIHD, such as chest pain, palpitation, and dyspnea, even without obvious symptoms. Based on previous studies, the pathogenesis of RIHD is related to the production and effects of various cytokines caused by endothelial injury, inflammatory response, and oxidative stress (OS). Therefore, it is of great importance for clinicians to identify the mechanism and propose interventions for the prevention of RIHD.

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Section: The Common Types Of Rihdmentioning

confidence: 96%

Radiation-induced heart disease: a review of classification, mechanism and prevention

et al. 2019

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“…Because of this, exploring the dose to individual cardiac substructures is important (6,9). Indeed, it is currently unknown how much radiation dose is safe to administer to the heart under these circumstances (25).…”

Section: Radiotherapy-induced Cardiac Toxicitymentioning

confidence: 99%

“…Radiation therapy dose to various cardiac substructures has been associated with coronary artery, pericardial, and conduction system diseases as well as cardiomyopathy (8). For breast cancer, the radiation dose distribution to various heart regions has been well-described (9). In addition, a recent study demonstrated a clinically-relevant dose-effect relationship between mean heart dose (MHD), left ventricle volume receiving 5 Gy and acute coronary events (6).…”

Section: Introductionmentioning

confidence: 99%

Cardiac radiation dose distribution, cardiac events and mortality in early-stage lung cancer treated with stereotactic body radiation therapy (SBRT)

Reshko¹,

Kalman²,

Hugo³

et al. 2018

J. Thorac. Dis.

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“…The differences may arise from the discrepancy in the total dose prescription and the size of the radiation field, CTV definition and size, OAR contouring, including diameter of the coronary arteries and LV thickness, the lack of detailed heart contouring atlases, individual coronary topology, heart size, body mass index, CWS distance, and finally radiotherapy technique used. 9,33,[49][50][51][52] The use of contrast agent 53 or automatic substructures' segmentation without 54 or with cardiac magnetic resonance imaging 55 could improve contouring consistency, but these technical solutions are unlikely to be widely adopted in the near future. Non-automatic contouring is feasible as showed in a study by Francolini et al Authors made multiple comparisons of delineated cardiac chambers and 5 left LV wall segments according to aforementioned cardiac atlas 24 and confirmed high interobserver delineation consistency.…”

Section: Discussionmentioning

confidence: 99%

Breast size and dose to cardiac substructures in adjuvant three-dimensional conformal radiotherapy compared to tangential intensity modulated radiotherapy

Ratoša

Jenko

Šljivić

et al. 2020

Radiology and Oncology

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BackgroundThe aim of the study was to quantify planned doses to the heart and specific cardiac substructures in free-breathing adjuvant three-dimensional radiation therapy (3D-CRT) and tangential intensity modulated radiotherapy (t-IMRT) for left-sided node-negative breast cancer, and to assess the differences in planned doses to organs at risk according to patients’ individual anatomy, including breast volume.Patients and methodsIn the study, the whole heart and cardiac substructures were delineated for 60 patients using cardiac atlas. For each patient, 3D-CRT and t-IMRT plans were generated. The prescribed dose was 42.72 Gy in 16 fractions. Patients were divided into groups with small, medium, and large clinical target volume (CTV). Calculated dose distributions were compared amongst the two techniques and the three different groups of CTV.ResultsMean absorbed dose to the whole heart (MWHD) (1.9 vs. 2.1 Gy, P < 0.005), left anterior descending coronary artery mean dose (8.2 vs. 8.4 Gy, P < 0.005) and left ventricle (LV) mean dose (3.0 vs. 3.2, P < 0.005) were all significantly lower with 3D-CRT technique compared to t-IMRT. Apical (8.5 vs. 9.0, P < 0.005) and anterior LV walls (5.0 vs. 5.4 Gy, P < 0.005) received the highest mean dose (Dmean). MWHD and LV-Dmean increased with increasing CTV size regardless of the technique. Low MWHD values (< 2.5 Gy) were achieved in 44 (73.3%) and 41 (68.3%) patients for 3D-CRT and t-IMRT techniques, correspondingly.ConclusionsOur study confirms a considerable range of the planned doses within the heart for adjuvant 3D-CRT or t-IMRT in node-negative breast cancer. We observed differences in heart dosimetric metrics between the three groups of CTV size, regardless of the radiotherapy planning technique.

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Radiation dose distribution in functional heart regions from tangential breast cancer radiotherapy

Cited by 26 publications

References 22 publications

Radiation-induced heart disease: a review of classification, mechanism and prevention

Radiation-induced heart disease: a review of classification, mechanism and prevention

Cardiac radiation dose distribution, cardiac events and mortality in early-stage lung cancer treated with stereotactic body radiation therapy (SBRT)

Breast size and dose to cardiac substructures in adjuvant three-dimensional conformal radiotherapy compared to tangential intensity modulated radiotherapy

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