Abstract
Introduction
We evaluated the dosimetric results of the identification of the left ventricle (LV) and left anterior descending artery (LAD) as organs at risk (OARs) in adjuvant radiotherapy (RT) after breast-conserving surgery (BCS).
Materials and Methods
Twenty-two patients who had previously received RT in our center were evaluated retrospectively. All patients had undergone BCS operation for left breast cancer. LV and LAD were contoured as OARs on the same simulation CTs for these patients whose treatment was previously completed in which LV and LAD were not defined as OARs. Complying with the initial plans, intensity-modulated RT plans with 7–9 fields were made on the computer. Planning target volume (PTV), homogeneity index (HI), conformity index (CI), monitor unit (MU) values, and doses of OARs were compared using the Wilcoxon signed-rank test (p < 0.05).
Results
There were no significant differences in PTV 50 (D 50% and D 98%), PTV 60 (D 2% and D 50%), HI, CI, and MU values when treatment plans and control plans were compared (p > 0.05). While it was possible to protect the heart, LAD, and LV better, LAD and LV were not contoured in the treatment plans, and they received higher doses compared to the control plans (p < 0.05). There was no significant difference in the other OARs.
Conclusion
In conclusion, it is essential to define the lower anatomical regions of the heart as OARs. Otherwise, the doses taken by these regions are ignored and may be maintained less than possible. In our study, it was shown that LV and LAD doses were significantly reduced even in the same center and planning by the same team.
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References
Litiere S, Werutsky G, Fentiman IS (2012) Breast conserving therapy versus mastectomy for stage I–II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol 13:412–419
Darby S, McGale P, Correa C, Taylor C, Arriagada R et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet (London, England) 378:1707–1716
Early Breast Cancer Trialists’ Collaborative G (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383:2127–2135
Clarke M, Collins R, Darby S et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106
Clark RM, Whelan T, Levine M et al (1996) Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: an update. Ontario Clinical Oncology Group. J Natl Cancer Inst 88(22):1659–1664
Fisher B, Anderson S, Redmond CK et al (1995) Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 333(22):1456–1461
Group EBCTC (2010) Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr 41(41):162–177
Darby S, McGale P, Taylor C, Peto R (2005) Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer. Prospective cohort study of about 300,000 women in US SEER cancer registries. Lancet Oncol 6(8):557–565
Sardaro A, Petruzzelli MF, D’Errico MP, Grimaldi L, Pili G, Portaluri M (2012) Radiation-induced cardiac damage in early left breast cancer patients. Risk factors, biological mechanisms, radiobiology, and dosimetric constraints. Radiother Oncol 103(2):133–142
Taylor C, Correa C, Duane FK, Aznar MC, Anderson SJ et al (2017) Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart and from previous randomized trials. J Clin Oncol 35:1641–1649
Darby SC, Ewertz M, McGale P et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368:987–998
Roychoudhuri R, Robinson D, Putcha V et al (2007) Increased cardiovascular mortality more than fifteen years after radiotherapy for breast cancer: a population-based study. BMC Cancer 7:9
van den Bogaard VA, Ta BD, van der Schaaf A, Bouma AB et al (2017) Validation and modification of a prediction model for acute cardiac events in patients with breast Cancer treated with radiotherapy based on three-dimensional dose distributions to cardiac substructures. J Clin Oncol Off J Am Soc Clin Oncol 35(11):1171–1178
Karpf Daniel, Sakka Mazen, Metzger Martin, Grabenbauer Gerhard G (2019) Left breast irradiation with tangential intensity modulated radiotherapy (t-IMRT) versus tangential volumetric modulated arc therapy (t-VMAT): trade-offs between secondary cancer induction risk and optimal target coverage. Radiat Oncol 14:156
Mansouri S, Naim A, Glaria L, Marsiglia H (2014) Dosimetric evaluation of 3-D conformal and intensity-modulated radiotherapy for breast Cancer after conservative surgery. Asian Pac J Cancer Prev 15(11):4727–4732
Rudat V, Alaradi AA, Mohamed A, Ai-Yahya K, Altuwaijri S (2011) Tangential beam IMRT versus tangential beam 3D-CRT of the chest wall in postmastectomy breast cancer patients. A dosimetric comparison. Radiat Oncol (London, England) 6:26
Feng Mary, Moran Jean M, Koelling Todd, Chughtai Aamer, Chan June L et al (2011) Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys 79(1):10–18
Nilsson G, Holmberg L, Garmo H et al (2012) Distribution of coronary artery stenosis after radiation for breast cancer. J Clin Oncol 30:380–386
Cuzick J, Stewart H, Peto R et al (1987) Overview of randomized trials of postoperative adjuvant radiotherapy in breast cancer. Cancer Treat Rep 71(1):15–29
Fowble B (1999) Postmastectomy radiation in patients with one to three positive axillary nodes receiving adjuvant chemotherapy: an unresolved issue. Semin Radiat Oncol 9(3):230–240
Gyenes G, Fornander T, Carlens P et al (1994) Morbidity of ischemic heart disease in early breast cancer 15–20 years after adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 28(5):1235–1241
Harris EER, Correa C, Hwang W-T et al (2006) Late cardiac morbidity and mortality in early stage breast cancer patients after breast conservation treatment. J Clin Oncol 24:4100–4106
Paszat LF, Mackillop WJ, Groome PA et al (1999) Mortality from myocardial infarction following postlumpectomy radiotherapy for breast cancer: a population-based study in Ontario, Canada. Int J Radiat Oncol Biol Phys 43(4):755–762
Saini AS, Das IJ, Hwang CS, Biagioli MC et al (2019) Biological indices evaluation of various treatment techniques for left-sided breast treatment. Pract Radiat Oncol 9(6):e579–e590
Testolin A, Ciccarelli S, Vidano G, Avitabile R et al (2019) Deep inspiration breath-hold intensity modulated radiation therapy in a large clinical series of 239 left-sided breast cancer patients: a dosimetric analysis of organs at risk doses and clinical feasibility from a single center experience. Br J Radiol 92(1101):20190150
Xu Y, Wang J, Hu Z, Tian Y et al (2019) Locoregional irradiation including internal mammary nodal region for left-sided breast cancer after breast conserving surgery: dosimetric evaluation of 4 techniques. Med Dosim 44(4):e13–e18
Lai Junming, Shuang Hu, Luo Yongbiao (2019) Meta-analysis of deep inspiration breath hold (DIBH) versus free breathing (FB) in postoperative radiotherapy for left-side breast cancer. Breast Cancer. https://doi.org/10.1007/s12282-019-01023-9
Schönecker S, Heinz C, Söhn M, Haimerl W, Corradini S et al (2016) Reduction of cardiac and coronary artery doses in irradiation of left-sided breast cancer during inspiration breath hold: a planning study. Strahlenther Onkol 192(11):750–758
Beaton L, Bergman A, Nichol A, Aparicio M, Wong G et al (2019) Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines. Clin Transl Radiat Oncol 19:39–45
Poitevin-Chacón A, Chávez-Nogueda J, Prudencio RR, Fernández AC, Laguna AR et al (2018) Dosimetry of the left anterior descending coronary artery in left breast cancer patients treated with postoperative external radiotherapy. Rep Pract Oncol Radiother 23(2):91–96
Piroth MD, Baumann R, Budach W, Dunst J, Feyer P et al (2019) Heart toxicity from breast cancer radiotherapy. Strahlenther Onkol 195:1–12
Wennstig AK, Garmo H, Isacsson U, Gagliardi G, Rintelä N et al (2019) The relationship between radiation doses to coronary arteries and location of coronary stenosis requiring intervention in breast cancer survivors. Radiat Oncol 14:40
Duma MN, Herr AC, Borm KJ, Trott KR, Molls M et al (2017) Tangential field radiotherapy for breast cancer—the dose to the heart and heart subvolumes: what structures must be contoured in future clinical trials? Front Oncol 7:130
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All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. AA and BS were involved in conceptualization and methodology. AA, EA, and BS contributed to investigation and formal analysis. AA and BT were involved in writing—original draft, review, and editing and visualization.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Institutional review board approval was obtained for this study. The study was conducted with the approval of the Non-Interventional Clinical Research Ethics Committee of Kayseri City Hospital. Ethics Committee convened on 12.03.2020 and received the protocol number 2020/15.
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Arslan, A., Aktas, E., Sengul, B. et al. Dosimetric evaluation of left ventricle and left anterior descending artery in left breast radiotherapy. Radiol med 126, 14–21 (2021). https://doi.org/10.1007/s11547-020-01201-2
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DOI: https://doi.org/10.1007/s11547-020-01201-2