Dose to the Left Anterior Descending Artery Correlates With Cardiac Events After Irradiation for Breast Cancer

Zureick, Andrew H.; Grzywacz, V.P.; Almahariq, Muayad; Silverman, Brittany R.; Vayntraub, Aleksander; Chen, Peter Y.; Gustafson, G.; Jawad, M.S.; Dilworth, J.T.

doi:10.1016/j.ijrobp.2022.04.019

Cited by 41 publications

(32 citation statements)

References 25 publications

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“…Jang et al reported that more than 60 Gy of dose to the left ventricle was associated with an increase in the cumulative incidence of ACE in patients who received concurrent chemoradiotherapy for non-small cell lung cancer (sub-distribution HR 10.06, 95% CI 1.46–69.46, p = 0.019) [ 24 ]. In the aspect of radiation to the coronary artery, one of the most recent literatures demonstrated that mean and maximum radiation doses to the left anterior descending artery were correlated with the development of major cardiac events in breast cancer patients [ 6 ]. Atkins et al reported that LAD V15 Gy greater than or equal to 10% was associated with an increased risk of ACE in patients with non-small cell lung cancer (adjusted HR 13.9, 95% CI, 1.23–157.21, p = 0.03) [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the modern treatment era, the risk of radiation-induced heart disease (RIHD) is of increasing concern among breast cancer survivors [ 2 , 3 ]. Among RIHD, acute coronary events (ACEs) have drawn much attention, and well-known dosimetric risk factors for ACEs are the mean heart dose (MHD), the left ventricle volume receiving 5 Gy radiation (LV-5) and dose to the left anterior descending coronary artery [ [4] , [5] , [6] , [7] ].…”

Section: Introductionmentioning

confidence: 99%

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Automated coronary artery calcium scoring in patients with breast cancer to assess the risk of heart disease following adjuvant radiation therapy

Kim

Chung

et al. 2022

The Breast

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Automated coronary artery calcium scoring in patients with breast cancer to assess the risk of heart disease following adjuvant radiation therapy

Kim

Chung

et al. 2022

The Breast

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“…Recently, analyses on cardiac substructures dose, including the LAD, have been published ( 19 , 20 ). Zureick et al.…”

Section: Discussionmentioning

confidence: 99%

“…Zureick et al. found that the dose to the LAD was correlated to adverse cardiac events ( 19 ). Additionally, a variation in mean LAD doses was found even among patients with equivalent MHD ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

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Inter-fraction heart displacement during voluntary deep inspiration breath hold radiation therapy without visual feedback measured by daily CBCT

et al. 2022

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Purpose/ObjectiveDeep Inspiration Breath Hold (DIBH) is now considered as the standard of care for many breast cancer patients. However, there are still uncertainties about the dose given to the heart, and it is unknown if patients may improve voluntary DIBH depth by gaining experience during treatment. In this study, we will examine the interfractional three-dimensional (3D) heart displacement throughout voluntary DIBH (vDIBH) radiotherapy by means of daily cone-beam computed tomography (CBCT).Material and methodsTwo hundred twenty-five unique CBCTs from 15 patients treated in 15 fractions were analyzed. During CBCT, a vDIBH was conducted without any visual feedback. Patients performed their DIBH freely after receiving explanations and training. After daily CBCT matching to the chest wall (CW), surface-guided radiation therapy (SGRT) tracked DIBH depth to ensure that the CW position was the same as the daily acquired CBCT. The CBCTs were retrospectively registered to the DIBH planning-CT to calculate daily changes in heart displacement relative to the CW.ResultsThe mean displacement of the heart during DIBH treatment relative to the DIBH planning-CT was as follows: 1.1 mm to the right, interquartile range (IQR) 8.0; 0.5 mm superiorly, IQR 4.8; and 0 mm posteriorly, IQR 6.4. The Spearman correlation coefficients (rs) were -0.15 (p=0.025), 0.04 (p=0.549), and 0.03 (p=0.612) for the X, Y, and Z directions, respectively. The differences in median heart displacement were significant: Friedmann rank sum test p=0.031 and pairwise comparison using the Wilcoxon rank-sum test were p=0.008 for X and Y; p=0.33 for X and Z; and p=0.07 for Y and Z. The total median heart motion was δtot median= 7.26 mm, IQR= 6.86 mm.ConclusionDuring DIBH, clinicians must be aware of the wide range of intra- and inter-individual heart position variations. The inter-individual heterogeneity shown in our study should be investigated further in order to avoid unexpected cardiac overexposure and to develop a more accurate heart dose-volume model.

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Radiation-Induced Cardiovascular Toxicities

Badiyan¹,

Puckett

Vlacich³

et al. 2022

Curr. Treat. Options in Oncol.

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Dose to the Left Anterior Descending Artery Correlates With Cardiac Events After Irradiation for Breast Cancer

Cited by 41 publications

References 25 publications

Automated coronary artery calcium scoring in patients with breast cancer to assess the risk of heart disease following adjuvant radiation therapy

Automated coronary artery calcium scoring in patients with breast cancer to assess the risk of heart disease following adjuvant radiation therapy

Inter-fraction heart displacement during voluntary deep inspiration breath hold radiation therapy without visual feedback measured by daily CBCT

Radiation-Induced Cardiovascular Toxicities

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