Supraventricular cardiac conduction system exposure in breast cancer patients treated with radiotherapy and association with heart and cardiac chambers doses

Errahmani, M.Y.; Locquet, Médéa; Broggio, David; Spoor, Daan; Jimenez, G.; Camilleri, J.; Langendijk, Johannes A.; Crijns, A.P.G.; Bernier, Marie Odile; Ferrières, Jean; Thariat, Juliette; Boveda, Serge; Kirova, Youlia; Loap, Pierre; Monceau, Virginie; Jacob, Sophie

doi:10.1016/j.ctro.2022.10.015

Cited by 3 publications

(1 citation statement)

References 30 publications

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“…An exploratory case-control epidemiologic study found a slightly higher risk of arrhythmia for right-sided breast cancer irradiation than left-sided irradiation [ 16 ], which might be related to a higher dose distribution to right-sided cardiac substructures, in particular the SAN; however, larger studies are needed to confirm this hypothesis. Currently, dose constraints to the conduction nodes, which may allow active avoidance with VMAT, are yet to be precisely defined for breast cancer radiation therapy [ 16 , 17 ]. Non-coplanar VMAT planning with partial arcs may potentially lead to a better sparing of the conduction nodes compared with the standard coplanar approach used in this study [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy

Loap

Goudjil

Servois

et al. 2023

International Journal of Particle Therapy

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Purpose The exposition of cardiac conduction system during breast radiation therapy has never been studied, despite the increasing use of intensity-modulated radiation therapy, which exposes larger volume to low-dose bath. We evaluated conduction node exposure during breast irradiation with volumetric modulated arc therapy and estimated the potential dosimetric benefit with intensity-modulated proton therapy. Materials and Methods Atrioventricular (AVN) and sinoatrial (SAN) nodes were retrospectively delineated according to published guidelines on the simulation computed tomography scans of 12 breast cancer patients having undergone conserving surgery and adjuvant locoregional volumetric modulated arc therapy. Intensity-modulated proton therapy treatment was replanned on the simulation computed tomography scans for all breast cancer patients. Mean and maximum doses delivered to the SAN and the AVN were retrieved and compared. Correlation coefficients were calculated between doses to the SAN or the AVN and the whole heart. Results Average mean doses delivered to the SAN and AVN were 2.8 and 2.3 Gy, respectively, for left-sided irradiation and 9.6 and 3.6 Gy, respectively, for right-sided irradiation. Average maximum doses to the SAN and AVN were 3.5 Gy and 2.8 Gy, respectively, for left-sided irradiation and 13.1 and 4.6 Gy, respectively, for right-sided irradiation. Intensity-modulated proton therapy significantly reduced mean and maximum doses to the SAN and AVN. Correlations between doses to the SAN or AVN and whole heart were usually significant. Conclusion SAN and AVN can be substantially exposed during breast volumetric modulated arc therapy, especially for right-sided irradiation. Cardiotoxicity studies evaluating conduction node exposure might define dose constraints and criteria for additional cardiac-sparing techniques, such as respiratory techniques or proton therapy, which could benefit patients with underlying rhythmic or conduction disorders.

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Section: Discussionmentioning

confidence: 99%

Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy

Loap

Goudjil

Servois

et al. 2023

International Journal of Particle Therapy

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Determinants of radiation dose to immune cells during breast radiotherapy

Loap,

Vu Bezin,

De Marzi

et al. 2024

Strahlenther Onkol

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Cardiac substructure delineation in radiation therapy – A state‐of‐the‐art review

Finnegan,

Quinn,

Booth

et al. 2024

J Med Imag Rad Onc

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SummaryDelineation of cardiac substructures is crucial for a better understanding of radiation‐related cardiotoxicities and to facilitate accurate and precise cardiac dose calculation for developing and applying risk models. This review examines recent advancements in cardiac substructure delineation in the radiation therapy (RT) context, aiming to provide a comprehensive overview of the current level of knowledge, challenges and future directions in this evolving field. Imaging used for RT planning presents challenges in reliably visualising cardiac anatomy. Although cardiac atlases and contouring guidelines aid in standardisation and reduction of variability, significant uncertainties remain in defining cardiac anatomy. Coupled with the inherent complexity of the heart, this necessitates auto‐contouring for consistent large‐scale data analysis and improved efficiency in prospective applications. Auto‐contouring models, developed primarily for breast and lung cancer RT, have demonstrated performance comparable to manual contouring, marking a significant milestone in the evolution of cardiac delineation practices. Nevertheless, several key concerns require further investigation. There is an unmet need for expanding cardiac auto‐contouring models to encompass a broader range of cancer sites. A shift in focus is needed from ensuring accuracy to enhancing the robustness and accessibility of auto‐contouring models. Addressing these challenges is paramount for the integration of cardiac substructure delineation and associated risk models into routine clinical practice, thereby improving the safety of RT for future cancer patients.

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Supraventricular cardiac conduction system exposure in breast cancer patients treated with radiotherapy and association with heart and cardiac chambers doses

Cited by 3 publications

References 30 publications

Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy

Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy

Determinants of radiation dose to immune cells during breast radiotherapy

Cardiac substructure delineation in radiation therapy – A state‐of‐the‐art review

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