Estimating Cardiac Exposure From Breast Cancer Radiotherapy in Clinical Practice

Taylor, C.W.; McGale, Paul; Povall, J.M.; Thomas, Edward L.; Kumar, Sabari; Dodwell, David; Darby, Sarah C.

doi:10.1016/j.ijrobp.2008.05.066

Cited by 113 publications

(86 citation statements)

References 21 publications

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“…It can be perceived from their study that contemporary RT for early breast cancer may be associated with a small, but potentially avoidable, risk of cardiovascular morbidity that is associated with treatment technique. Also strong linear correlations between the MMD and the mean heart dose and LAD dose have been reported by Taylor et al [25]. Similarly designed studies revealed dosimetrical findings inconstant with our findings.…”

Section: Discussionsupporting

confidence: 51%

Indexes of Cardiac and LAD Irradiation in Conventional 2-Dimensional (SAD) and 3-Dimensional Conformal Radiotherapy Techniques: A Dosimetrical Comparison

Emami¹,

Akhavan²,

Sharhani³

et al. 2017

J Nucl Med Radiat Ther

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Radiation therapy in breast cancer patients has been shown to reduce local recurrence and improve survival rates. Nevertheless, recent concerns have been raised regarding an increase in cardiac mortality, especially in patients who had been treated with radiation for left-sided breast tumors. Hence, the aim of this study is to estimate doses of irradiation to the heart, LAD coronary artery, and lungs in 2D (SAD) and 3D conformal radio therapy techniques, and to compare the two.Out of 32, 18 to 75 years old females with a diagnosis of non-metastatic breast cancer, who referred from surgery department, went through irradiation in the conventional 2D (SAD) and then 3DCRT using multi-slice CT scans to contour vital organ. Nearly all of the dosimetrical indexes were higher in 3DCRT method.This shows that 2D technique lacks a decent scale to measure cardiac toxicity since its mid-plane CT slice did not give a reliable assessment of cardiac irradiation.

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Section: Discussionsupporting

confidence: 51%

Indexes of Cardiac and LAD Irradiation in Conventional 2-Dimensional (SAD) and 3-Dimensional Conformal Radiotherapy Techniques: A Dosimetrical Comparison

Emami¹,

Akhavan²,

Sharhani³

et al. 2017

J Nucl Med Radiat Ther

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“…In the treatment of localized malignant disease, for example, Hodgkin's disease and carcinoma of the breast, the dose distribution to the heart is highly nonuniform. For example, in 50 consecutive patients treated for left-sided breast cancer using tangential fields in a single center in the United Kingdom in 2006, 44% (22/50) received a dose of > 20 Gy to up to 5% of the total heart volume (88). The average maximum dose in this series was 30.7 Gy and the minimum *2 Gy.…”

Section: Cancer Treatmentmentioning

confidence: 82%

Radiation as a Risk Factor for Cardiovascular Disease

Baker

Moulder

Hopewell

2011

Antioxidants & Redox Signaling

107

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Humans are continually exposed to ionizing radiation from terrestrial sources. The two major contributors to radiation exposure of the U.S. population are ubiquitous background radiation and medical exposure of patients. From the early 1980s to 2006, the average dose per individual in the United States for all sources of radiation increased by a factor of 1.7-6.2 mSv, with this increase due to the growth of medical imaging procedures. Radiation can place individuals at an increased risk of developing cardiovascular disease. Excess risk of cardiovascular disease occurs a long time after exposure to lower doses of radiation as demonstrated in Japanese atomic bomb survivors. This review examines sources of radiation (atomic bombs, radiation accidents, radiological terrorism, cancer treatment, space exploration, radiosurgery for cardiac arrhythmia, and computed tomography) and the risk for developing cardiovascular disease. The evidence presented suggests an association between cardiovascular disease and exposure to low-to-moderate levels of radiation, as well as the well-known association at high doses. Studies are needed to define the extent that diagnostic and therapeutic radiation results in increased risk factors for cardiovascular disease, to understand the mechanisms involved, and to develop strategies to mitigate or treat radiation-induced cardiovascular disease. Antioxid. Redox Signal. 15, 1945Signal. 15, -1956

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“…18,19 The role of radiation directed to the internal mammary nodes was questioned, particularly since its use was associated with radiation-associated cardiac death, which was probably attributable to outdated radiation techniques. [20][21][22][23][24][25][26][27][28][29] It remains undefined whether this risk is significantly lowered by advances in radiation techniques.…”

Section: Discussionmentioning

confidence: 99%

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

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BACKGROUND The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown. METHODS We randomly assigned women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement to undergo either whole-breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole-breast or thoracicwall irradiation alone (control group). The primary end point was overall survival. Secondary end points were the rates of disease-free survival, survival free from distant disease, and death from breast cancer. RESULTS Between 1996 and 2004, a total of 4004 patients underwent randomization. The majority of patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of the patients in both groups underwent chest-wall irradiation. Nearly all patients with node-positive disease (99.0%) and 66.3% of patients with node-negative disease received adjuvant systemic treatment. At a median followup of 10.9 years, 811 patients had died. At 10 years, overall survival was 82.3% in the nodal-irradiation group and 80.7% in the control group (hazard ratio for death with nodal irradiation, 0.87; 95% confidence interval [CI], 0.76 to 1.00; P=0.06). The rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (hazard ratio for disease progression or death, 0.89; 95% CI, 0.80 to 1.00; P=0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (hazard ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02), and breast-cancer mortality was 12.5% versus 14.4% (hazard ratio, 0.82; 95% CI, 0.70 to 0.97; P=0.02). Acute side effects of regional nodal irradiation were modest. CONCLUSIONS In patients with early-stage breast cancer, irradiation of the regional nodes had a marginal effect on overall survival. Disease-free survival and distant disease-free survival were improved, and breast-cancer mortality was reduced. (Funded by Fonds Cancer; ClinicalTrials.gov number, NCT00002851.).

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Estimating Cardiac Exposure From Breast Cancer Radiotherapy in Clinical Practice

Cited by 113 publications

References 21 publications

Indexes of Cardiac and LAD Irradiation in Conventional 2-Dimensional (SAD) and 3-Dimensional Conformal Radiotherapy Techniques: A Dosimetrical Comparison

Indexes of Cardiac and LAD Irradiation in Conventional 2-Dimensional (SAD) and 3-Dimensional Conformal Radiotherapy Techniques: A Dosimetrical Comparison

Radiation as a Risk Factor for Cardiovascular Disease

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

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