Modeled risk of ischemic heart disease following left breast irradiation with deep inspiration breath hold

Eldredge-Hindy, Harriet; Duffy, Danielle; Yamoah, Kosj; Simone, Nicole L.; Skowronski, Jenna; Dicker, Adam P.; Anné, Pramila R.

doi:10.1016/j.prro.2014.10.002

Cited by 15 publications

(14 citation statements)

References 30 publications

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“…Although the absolute risk reduction was relatively small (1.48 %), our current findings may be clinically significant given the high incidence of breast cancer and the high prevalence of long-term survivors. The estimated clinical benefit of DIBH was also studied previously by Eldredge-Hindy et al [ 10 ]. The risk of ischemic heart disease was reduced with DIBH in that study, regardless of the baseline cardiac risk, although the largest benefit was observed in the high-risk group.…”

Section: Discussionmentioning

confidence: 94%

“…According to the Darby model, the excess risk of major coronary events is linearly dependent on the mean heart dose at a rate of 16.3 % during years 0–4 and 15.5 % during years 5–9 following breast RT. To estimate the risk at 10 years, we used the more conservative estimate of 15.5 % per gray because this likely approximates the excess relative risk during years 0–9 [ 10 ]. To group our current study patients according to their baseline risk, American Heart Association (AHA) risk groups were used.…”

Section: Methodsmentioning

confidence: 99%

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Cardiac dose reduction during tangential breast irradiation using deep inspiration breath hold: a dose comparison study based on deformable image registration

et al. 2015

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BackgroundRadiation therapy (RT) for a left-sided breast cancer often involves some incidental exposure of the heart and increase in the rate of major coronary events. One method to reduce the dose to the heart during a tangential breast irradiation is the deep inspiration breath hold (DIBH) technique. Our department adopted DIBH for selected left breast cancer patients with a maximum cardiac distance ≥ 10 mm. We evaluated the effect of the DIBH on cardiac dose compared to normal free breathing (FB). The secondary objective of our present study was to use modeled risk estimates to quantify the risk of coronary events after RT with DIBH.Methods and materialsThirty-two patients who underwent RT with DIBH at our hospital were retrospectively analyzed. For each patient, two computed tomography (CT) scans were acquired, FB-CT and DIBH-CT. Using a deformable image registration tool, the target volume was deformed from DIBH-CT to FB-CT, and conventional tangential treatment planning was performed, focusing on the equality of target coverage between the two plans. Doses to the heart, left anterior descending (LAD) artery, and ipsilateral lung were assessed.ResultsBy using DIBH, the average mean heart dose was reduced from 724.1 cGy to 279.3 (p < 0.001). The relative heart volume irradiated with 10 Gy–50 Gy was consistently reduced. The mean dose to the LAD coronary artery was reduced from 4079.1 cGy to 2368.9 cGy (p < 0.001). The ipsilateral lung volume receiving 20 Gy or more and 40 Gy or more was reduced by 2.2 % in both cases. Estimated risks of coronary events at 10 years were 4.03 and 2.55 % for RT with FB and DIBH, respectively (p < 0.001).ConclusionsThe use of DIBH during RT of the left-sided breast considerably reduces the doses delivered to the heart and LAD artery with similar target coverage. For the current study patients, the probability of major coronary events was reduced with DIBH.

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Section: Discussionmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Cardiac dose reduction during tangential breast irradiation using deep inspiration breath hold: a dose comparison study based on deformable image registration

et al. 2015

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“…Other studies have also quantified cardiopulmonary risks based on established dose‐effect models. Eldredge‐Hindy estimated the risk of IHD following left breast radiation with DIBH using the ERRs proposed by Darby et al and baseline estimated risks obtained from the Atherosclerosis Risk in Communities Study . Similarly, the SAVE‐HEART study quantified the risk of IHD with free breathing and DIBH techniques by applying baseline German population data to Darby's model .…”

Section: Resultsmentioning

confidence: 99%

Radiation effect on late cardiopulmonary toxicity: An analysis comparing supine DIBH versus prone techniques for breast treatment

et al. 2020

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“…Left‐sided breast RT will to some extent irradiate the heart and increase the risk of heart disease 29. Darby et al.…”

Section: Discussionmentioning

confidence: 99%

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Jensen

Абрамова

Frengen

et al. 2017

J Applied Clin Med Phys

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Deep inspiration breath hold (DIBH) in left‐sided breast cancer radiotherapy is a technique to reduce cardiac and pulmonary doses while maintaining target coverage. This study aims at evaluating an in‐house developed DIBH system. Free‐breathing (FB) and DIBH plans were generated for 22 left‐sided localized breast cancer patients who had radiation therapy (RT) after breast‐conserving surgery. All patients were treated utilizing an in‐house laser distance measuring system. 50 Gy was prescribed, and parameters of interest were target coverage, left anterior descending coronary artery, (LAD) and heart doses. Portal images were acquired and the reproducibility and stability of DIBH treatment were compared to FB. The comparing result shows there is a significant reduction in all LAD and heart dose statistics for DIBH compared to FB plans without compromising the target coverage. The maximum LAD dose was reduced from 43.7 Gy to 29.0 Gy and the volume of the heart receiving >25 Gy was reduced from 3.3% to 1.0% using the in‐house system, both statistically significant. The in‐house system gave a reproducible and stable DIBH treatment where the systematic error ∑, and random error σ, were less than 2.2 mm in all directions, but were not significantly better than at FB. The system was well tolerated and all patients completed their treatment sessions with DIBH.

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Modeled risk of ischemic heart disease following left breast irradiation with deep inspiration breath hold

Cited by 15 publications

References 30 publications

Cardiac dose reduction during tangential breast irradiation using deep inspiration breath hold: a dose comparison study based on deformable image registration

Cardiac dose reduction during tangential breast irradiation using deep inspiration breath hold: a dose comparison study based on deformable image registration

Radiation effect on late cardiopulmonary toxicity: An analysis comparing supine DIBH versus prone techniques for breast treatment

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

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