Spatial orientation of coronary arteries and its implication for breast and thoracic radiotherapy—proposing “coronary strip” as a new organ at risk

Munshi, Anusheel; Khataniar, Nilaxi; Sarkar, Biplab; Bera, M.L.; Mohanti, Bidhu Kalyan

doi:10.1007/s00066-018-1299-x

Cited by 16 publications

(8 citation statements)

References 32 publications

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“…Despite such low mean heart doses, subvolumes such as the heart apex or parts of the LAD can be exposed to much higher doses (Figs. 1 and 2; [41]). In a study conducted by the authors using a modern 3D technique with tangential beams to treat left-sided breast cancer, the mean heart dose amounted 2.1 (0.98–8.3) Gy [42].…”

Section: Value Of Mean Heart Dosementioning

confidence: 99%

Heart toxicity from breast cancer radiotherapy

et al. 2018

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BackgroundLate cardiac toxicities caused by (particularly left-sided) breast radiotherapy (RT) are now recognized as rare but relevant sequelae, which has prompted research on risk structure identification and definition of threshold doses to heart subvolumes. The aim of the present review was to critically discuss the clinical evidence on late cardiac reactions based on dose-dependent outcome reports for mean heart doses as well as doses to cardiac substructures.MethodsA literature review was performed to examine clinical evidence on radiation-induced heart toxicities. Mean heart doses and doses to cardiac substructures were focused upon based on dose-dependent outcome reports. Furthermore, an overview of radiation techniques for heart protection is given and non-radiotherapeutic aspects of cardiotoxicity in the multimodal setting of breast cancer treatment are discussed.ResultsBased on available findings, the DEGRO breast cancer expert panel recommends the following constraints: mean heart dose <2.5 Gy; DmeanLV (mean dose left ventricle) < 3 Gy; V5LV (volume of LV receiving ≥5 Gy) < 17%; V23LV (volume of LV receiving ≥23 Gy) < 5%; DmeanLAD (mean dose left descending artery) < 10 Gy; V30LAD (volume of LAD receiving ≥30 Gy) < 2%; V40LAD (volume of LAD receiving ≥40 Gy) < 1%.ConclusionIn addition to mean heart dose, breast cancer RT treatment planning should also include constraints for cardiac subvolumes such as LV and LAD. The given constraints serve as a clinicians’ aid for ensuring adequate heart protection. The individual decision between sufficient protection of cardiac structures versus optimal target volume coverage remains in the physician’s hand. The risk of breast cancer-specific mortality and a patient’s cardiac risk factors must be individually weighed up against the risk of radiation-induced cardiotoxicity.

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Section: Value Of Mean Heart Dosementioning

confidence: 99%

Heart toxicity from breast cancer radiotherapy

et al. 2018

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“…Because of changes in dose fractionation (from conventional to hypofractionation) and techniques of RT for breast cancer (from 2D to 3D-CRT/FIF IMRT); dose constraints to be placed for the heart, LAD and lungs and its impact on the cardiac related morbidity and mortality still remains unclear. Although MHD has been the gold standard for prediction of late cardiac effects in the past but recent studies have suggested that reporting doses to the heart substructures such as apical part of left ventricle and LAD may be more relevant [35,36]. Hypofractionation have been reported to result in [37,38].…”

Section: Discussionmentioning

confidence: 99%

Accelerated hypofractionated breast radiotherapy with simultaneous integrated boost: a feasibility study

et al. 2022

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Purpose: To assess the feasibility of accelerated hypofractionated radiotherapy with simultaneous integrated boost (SIB) in patients with breast cancer.Materials and Methods: A total of 27 patients after breast-conserving surgery were included in this study. Patients were planned on a four-dimensional computerized tomogram, and contouring was done using RTOG guidelines. The dose was 34 Gy/10#/2 week to the breast and 40 Gy/10#/2 week to the tumor bed as SIB with volumetric modulated arc technique. The primary endpoint was grade 2 acute skin toxicity. Doses to the organs-at-risk were calculated. Toxicities and cosmesis were assessed using RTOG/LENT/SOMA and HARVARD/NSABP/RTOG grading scales, respectively. Disease-free survival (DFS) and overall survival (OS) were calculated with Kaplan-Meier curves.Results: The mean age of the patients was 42 years. Left and right breast cancers were seen in 17 (63%) and 10 (37%) patients, respectively. The mean values of ipsilateral lung V16 and contralateral lung V5 were 16.01% and 3.74%, respectively. The mean heart doses from the left and right breast were 7.25 Gy and 4.37 Gy, respectively. The mean doses to the contralateral breast, oesophagus, and Dmax to brachial plexus were 2.64 Gy, 3.69 Gy, and 26.95 Gy, respectively. The mean value of thyroid V25 was 19.69%. Grade 1 and 2 acute skin toxicities were observed in 9 (33%) and 5 (18.5%) patients, respectively. Grade 2 hyperpigmentation, edema, and induration were observed in 1 (3.7%), 2 (7.4%), and 4 (14.8%) patients, respectively. Mild breast pain and arm/shoulder discomfort were reported by 1 (3.4%) patient. The median follow-up was 51 months (range, 12 to 61 months). At four years, breast induration, edema, and fibrosis were observed in 1 (3.7%) patient. Cosmesis was excellent and good in 21 (78%) and 6 (22%) patients, respectively. Local recurrence and distant metastases occurred in 1 (3.7%) and 2 (7.4%) patients, respectively. DFS and OS at four years were 88% and 92%, respectively.Conclusion: With this radiotherapy schedule, acute and late toxicity rates were acceptable with no adverse cosmesis. Local control, DFS, and OS were good.

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“…Based on contrast-enhanced CT-angiographies, Munshi et al [ 52 ] proposed a “coronary strip” as a new organ at risk representing the left and the right coronary artery. However, there was considerable variation among the 51 analyzed hearts.…”

Section: Discussionmentioning

confidence: 99%

Heart atlas for retrospective cardiac dosimetry: a multi-institutional study on interobserver contouring variations and their dosimetric impact

et al. 2021

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Purpose Cardiac effects after breast cancer radiation therapy potentially affect more patients as survival improves. The heart’s heterogeneous radiation exposure and composition of functional structures call for establishing individual relationships between structure dose and specific late effects. However, valid dosimetry requires reliable contouring which is challenging for small volumes based on older, lower-quality computed tomography imaging. We developed a heart atlas for robust heart contouring in retrospective epidemiologic studies. Methods and materials The atlas defined the complete heart and geometric surrogate volumes for six cardiac structures: aortic valve, pulmonary valve, all deeper structures combined, myocardium, left anterior myocardium, and right anterior myocardium. We collected treatment planning records from 16 patients from 4 hospitals including dose calculations for 3D conformal tangential field radiation therapy for left-sided breast cancer. Six observers each contoured all patients. We assessed spatial contouring agreement and corresponding dosimetric variability. Results Contouring agreement for the complete heart was high with a mean Jaccard similarity coefficient (JSC) of 89%, a volume coefficient of variation (CV) of 5.2%, and a mean dose CV of 4.2%. The left (right) anterior myocardium had acceptable agreement with 63% (58%) JSC, 9.8% (11.5%) volume CV, and 11.9% (8.0%) mean dose CV. Dosimetric agreement for the deep structures and aortic valve was good despite higher spatial variation. Low spatial agreement for the pulmonary valve translated to poor dosimetric agreement. Conclusions For the purpose of retrospective dosimetry based on older imaging, geometric surrogate volumes for cardiac organs at risk can yield better contouring agreement than anatomical definitions, but retain limitations for small structures like the pulmonary valve.

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Spatial orientation of coronary arteries and its implication for breast and thoracic radiotherapy—proposing “coronary strip” as a new organ at risk

Cited by 16 publications

References 32 publications

Heart toxicity from breast cancer radiotherapy

Heart toxicity from breast cancer radiotherapy

Accelerated hypofractionated breast radiotherapy with simultaneous integrated boost: a feasibility study

Heart atlas for retrospective cardiac dosimetry: a multi-institutional study on interobserver contouring variations and their dosimetric impact

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