Simple Method to Estimate Mean Heart Dose From Hodgkin Lymphoma Radiation Therapy According to Simulation X-Rays

Nimwegen, Frederika A. van; Schaapveld, Michael; Rutten, Annemarieke; Kooijman, Karen; Krol, Augustinus D.G.; Janus, Cécile P.M.; Darby, Sarah C.; Leeuwen, Flora E. van; Aleman, Berthe M.P.

doi:10.1016/j.ijrobp.2015.02.019

Cited by 12 publications

(14 citation statements)

References 34 publications

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“…RICC is a late toxicity [24]. Radiotherapy for breast cancer involves exposing the heart to 1–5 Gy [15], [25], [26], [27] levels that cause mainly ischemic heart disease, which tends to occur 10 years or more after the radiation [15], [28], [29].…”

Section: Discussionmentioning

confidence: 99%

Heart and lung doses are independent predictors of overall survival in esophageal cancer after chemoradiotherapy

Cai

Guo

Liao

et al. 2019

Clinical and Translational Radiation Oncology

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Highlights Dosimetric parameters for the heart and lung are associated with overall survival in esophageal cancer patients. Heart and lung doses were associated with cardiac and pulmonary complications. Patients with cardiac and pulmonary complications are strongly correlated with survival outcomes. Dosimetric relationship with clinical outcomes are predictive for surgical and non-surgical patients.

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Section: Discussionmentioning

confidence: 99%

Heart and lung doses are independent predictors of overall survival in esophageal cancer after chemoradiotherapy

Cai

Guo

Liao

et al. 2019

Clinical and Translational Radiation Oncology

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“…To develop these radiation therapy risk models, researchers have relied on data sets of patients treated using historical radiation fields and techniquesdsuch as subtotal lymphoid irradiation, mantle field, and involved-field radiation therapy (IFRT). 8 The simple field arrangements in these historical cases (anterior-posterior and posterior-anterior [AP/PA]) have allowed for the mean heart dose to be retrospectively calculated through complex analyses of port films and 2-dimensional simulation films. 8,9 The studies using these techniques have shown relationships between mean heart dose and cardiac morbidity.…”

Section: Introductionmentioning

confidence: 99%

“…8 The simple field arrangements in these historical cases (anterior-posterior and posterior-anterior [AP/PA]) have allowed for the mean heart dose to be retrospectively calculated through complex analyses of port films and 2-dimensional simulation films. 8,9 The studies using these techniques have shown relationships between mean heart dose and cardiac morbidity. 1,[10][11][12][13] Models relying on mean heart dose likely oversimplify the actual cardiac risk from radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

The Meaningless Meaning of Mean Heart Dose in Mediastinal Lymphoma in the Modern Radiation Therapy Era

Hoppe

Bates

Mendenhall

et al. 2020

Practical Radiation Oncology

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Mean heart dose (MHD) correlates with late cardiac toxicity among survivors of lymphoma receiving involved-field radiation therapy (IFRT). We investigated MHD and cardiac substructure dose across older and newer radiation fields and techniques to understand the value of evaluating MHD alone. Methods and Materials: After institutional review board approval, we developed a database of dosimetry plans for 40 patients with mediastinal lymphoma, which included IFRT (anterior-posterior and posterior-anterior), involved-site radiation therapy (ISRT) þ 3dimensional conformal radiation therapy (3DCRT), ISRT þ intensity modulated radiation therapy, and ISRT þ proton therapy plans for each patient. Each plan was evaluated for dose to the heart and cardiac substructures, including the right and left ventricles (RV, LV) and atria (RA, LA); tricuspid, mitral (MV), and aortic valves; and left anterior descending coronary artery (LAD). Correlation between MHD and cardiac substructure dose was assessed with linear regression. A correlation was considered very strong, strong, moderate, or weak if the r was !0.8, 0.6-0.79, 0.4-0.59, or <0.4, respectively. Results: A very strong correlation was observed between MHD and the mean cardiac substructure dose for each plan as follows: IFRTdLV, RV, LA, MV and LAD; ISRT þ 3DCRTdLV, RV, MV, TV, and LA; ISRT þ intensity modulated radiation therapydLV and RV; ISRT þ proton therapydnone. The following strong correlations were observed: IFRTdRA; ISRT þ 3DCRTdLAD, RA, AV; ISRT þ IMRTdLA, RA, LAD, AV, TV, and MV; ISRT þ proton therapydLV only. Conclusions: In the management of mediastinal lymphoma, more conformal treatment techniques can lead to more heterogeneous dose distributions across the heart, which translate into weaker relationships between mean heart dose and mean cardiac substructure doses. Consequently, models for assessing the risk of cardiac toxicity after radiation therapy that rely on MHD can be misleading when using modern treatment fields and techniques. Contouring the cardiac substructures and evaluating their dose is important when using contemporary RT.

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“…We do not know whether the cancers originate at one point in the centre of mass, or indeed whether there is a field cancerization effect across a larger portion of the breast tissue in general [28] , or mediation through bystander effects of breast stromal elements as suggested from experimental data of Barcellos-Hoff et al [29] . If this were the case, then possibly a mean breast dose would be sufficient to estimate risk, in analogy to the mean heart dose used for analysis of radiation-induced cardiac disease [30] . Further, although some tumours were screen-detected and quite small (5 mm), others were large T3 tumours growing in almost the whole of the breast over multiple quadrants, resulting in a large dose-gradient across the tumour position from the HL radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Retrospective methods to estimate radiation dose at the site of breast cancer development after Hodgkin lymphoma radiotherapy

Russell

Krul

Eggermond

et al. 2017

Clinical and Translational Radiation Oncology

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BackgroundAn increased risk of breast cancer following radiotherapy for Hodgkin lymphoma (HL) has now been robustly established. In order to estimate the dose–response relationship more accurately, and to aid clinical decision making, a retrospective estimation of the radiation dose delivered to the site of the subsequent breast cancer is required.MethodsFor 174 Dutch and 170 UK female patients with breast cancer following HL treatment, the 3-dimensional position of the breast cancer in the affected breast was determined and transferred onto a CT-based anthropomorphic phantom. Using a radiotherapy treatment planning system the dose distribution on the CT-based phantom was calculated for the 46 different radiation treatment field set-ups used in the study population. The estimated dose at the centre of the breast cancer, and a margin to reflect dose uncertainty were determined on the basis of the location of the tumour and the isodose lines from the treatment planning. We assessed inter-observer variation and for 47 patients we compared the results with a previously applied dosimetry method.ResultsThe estimated median point dose at the centre of the breast cancer location was 29.75 Gy (IQR 5.8–37.2), or about 75% of the prescribed radiotherapy dose. The median dose uncertainty range was 5.97 Gy. We observed an excellent inter-observer variation (ICC 0.89 (95% CI: 0.74–0.95)). The absolute agreement intra-class correlation coefficient (ICC) for inter-method variation was 0.59 (95% CI: 0.37–0.75), indicating (nearly) good agreement. There were no systematic differences in the dose estimates between observers or methods.ConclusionEstimates of the dose at the point of a subsequent breast cancer show good correlation between methods, but the retrospective nature of the estimates means that there is always some uncertainty to be accounted for.

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Simple Method to Estimate Mean Heart Dose From Hodgkin Lymphoma Radiation Therapy According to Simulation X-Rays

Cited by 12 publications

References 34 publications

Heart and lung doses are independent predictors of overall survival in esophageal cancer after chemoradiotherapy

Heart and lung doses are independent predictors of overall survival in esophageal cancer after chemoradiotherapy

The Meaningless Meaning of Mean Heart Dose in Mediastinal Lymphoma in the Modern Radiation Therapy Era

Retrospective methods to estimate radiation dose at the site of breast cancer development after Hodgkin lymphoma radiotherapy

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