Potential of Hybrid Computational Phantoms for Retrospective Heart Dosimetry After Breast Radiation Therapy: A Feasibility Study

Moignier, A.; Derreumaux, S.; Broggio, David; Beurrier, J.; Chea, M.; Boisserie, G.; Franck, Didier; Aubert, Bernard; Mazeron, Jean‐Jacques

doi:10.1016/j.ijrobp.2012.03.037

Cited by 11 publications

(7 citation statements)

References 18 publications

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“…The difference between LAD dose and MHD is striking, but it can be explained by the fact that the LAD is located in the anterior region of the heart where it is exposed to the tangential fields used in left sided breast RT. Moreover, we observed a mean ratio Dmean LAD/MHD around 5, confirming prior findings [21]. However, the association between the MHD and delineated substructures, in particular the LAD mean dose, was not precise enough to predict with confidence individual patient dose as shown in Fig.…”

Section: Discussionsupporting

confidence: 89%

Is mean heart dose a relevant surrogate parameter of left ventricle and coronary arteries exposure during breast cancer radiotherapy: a dosimetric evaluation based on individually-determined radiation dose (BACCARAT study)

et al. 2019

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BackgroundIntra-individual heterogeneity of cardiac exposure is an issue in breast cancer (BC) radiotherapy that was poorly considered in previous cardiotoxicity studies mainly based on mean heart dose (MHD). This dosimetric study analyzes the distribution of individually-determined radiation doses to the heart and its substructures including coronary arteries and evaluate whether MHD is a relevant surrogate parameter of dose for these substructures.MethodsData were collected from the BACCARAT prospective study that included left or right unilateral BC patients treated with 3D-Conformal Radiotherapy (RT) between 2015 and 2017 and followed-up for 2 years with repeated cardiac imaging examinations. A coronary computed tomography angiography (CCTA) was performed before RT for all patients. Registration of the planning CT and CCTA images allowed delineation of the coronary arteries on the planning CT images. Using the 3D dose matrix generated during treatment planning and the added coronary contours, dose distributions were generated for whole heart and the following substructures: left ventricle (LV), left main coronary artery (LMCA), left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA). A descriptive analysis of the physical doses in Gray (Gy) was performed, Dmean was the volume-weighted mean dose.ResultsDose distributions were generated for 89 left-sided BC patients (MHD = 2.9 ± 1.5 Gy, Dmean_LAD = 15.7 ± 3.1 Gy) and 15 right-sided BC patients (MHD = 0.5 ± 0.1 Gy; Dmean_RCA = 1.2 ± 0.4 Gy). For left-sided BC patients, the ratio Dmean_LAD/MHD was around 5. Pearson correlation coefficients between MHD and Dmean for delineated substructures were all statistically significant. However, for all substructures, the coefficient of determination R2 indicated that the proportion of the variance in Dmean of the substructure predictable from MHD was moderate to low (in particular R2 = 0.45 for LAD). Among left-sided BC patients with MHD < 3Gy, 56% of patients could nevertheless receive LAD doses above 40Gy (V40 > 0).ConclusionOur study illustrates that MHD is not enough to predict with confidence individual patient dose to the LV and coronary arteries, in particular the LAD. For precise radiotherapy-induced cardiotoxicity studies it would be necessary to consider the distribution of doses within these cardiac substructures rather than just the MHD.Trial registrationClinicalTrials.gov: NCT02605512, Registered 6 November 2015 - Retrospectively registered.

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Section: Discussionsupporting

confidence: 89%

Is mean heart dose a relevant surrogate parameter of left ventricle and coronary arteries exposure during breast cancer radiotherapy: a dosimetric evaluation based on individually-determined radiation dose (BACCARAT study)

et al. 2019

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“…There have also been studies that instead chose to utilize dose measured to a water phantom, along with tumor location details from clinical records, to estimate the doses at the site of secondary tumor development [21]. Hybrid computational phantoms created from CT scans have been shown to be feasible for retrospective heart dosimetry following breast irradiation [26]. By also adding the use of Monte Carlo based dose calculations to pediatric hybrid phantoms, organ doses could be reconstructed to add further accuracy in future secondary cancer risk studies [27].…”

Section: Discussionmentioning

confidence: 99%

Retrospective estimation of heart and lung doses in pediatric patients treated with spinal irradiation

Gasic

Rosenschöld

Vogelius

et al. 2018

Radiotherapy and Oncology

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“…In this case, organ contouring must be redone so as to include all organs of interest. Also, to personalise the phantom to the patient, it is possible to mix the representative patient image with virtual modelled organs [34]. The modelled organ is voxelised and inserted into the representative patient RT-planning CT, hence producing a hybrid phantom.…”

Section: Imaging Of Patient Anatomymentioning

confidence: 99%

A review of uncertainties in radiotherapy dose reconstruction and their impacts on dose–response relationships

et al. 2017

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Proper understanding of the risk of radiation-induced late effects for patients receiving external photon beam radiotherapy requires the determination of reliable dose–response relationships. Although significant efforts have been devoted to improving dose estimates for the study of late effects, the most often questioned explanatory variable is still the dose. In this work, based on a literature review, we provide an in-depth description of the radiotherapy dose reconstruction process for the study of late effects. In particular, we focus on the identification of the main sources of dose uncertainty involved in this process and summarise their impacts on the dose–response relationship for radiotherapy late effects. We provide a number of recommendations for making progress in estimating the uncertainties in current studies of radiotherapy late effects and reducing these uncertainties in future studies.

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Potential of Hybrid Computational Phantoms for Retrospective Heart Dosimetry After Breast Radiation Therapy: A Feasibility Study

Cited by 11 publications

References 18 publications

Is mean heart dose a relevant surrogate parameter of left ventricle and coronary arteries exposure during breast cancer radiotherapy: a dosimetric evaluation based on individually-determined radiation dose (BACCARAT study)

Is mean heart dose a relevant surrogate parameter of left ventricle and coronary arteries exposure during breast cancer radiotherapy: a dosimetric evaluation based on individually-determined radiation dose (BACCARAT study)

Retrospective estimation of heart and lung doses in pediatric patients treated with spinal irradiation

A review of uncertainties in radiotherapy dose reconstruction and their impacts on dose–response relationships

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