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Japanese Journal of Radiology

, Volume 37, Issue 5, pp 420–430 | Cite as

A heart atlas for breast radiation therapy and the influence of delination education on both intra and interobserver variability

  • Meltem KırlıEmail author
  • Doğukan Akçay
  • Mustafa Mahmut Barış
  • İlknur Bilkay Görken
Original Article

Abstract

Purpose

We developed a heart atlas for breast radiation therapy and evaluated the influence of education on intra and inter-observer similarity, and cardiac dose reporting.

Materials and methods

The data of 16 left breast cancer patients were analyzed. Eight observers delineated heart and cardiac subunits [left (LCA) and right (RCA) coronary arteries, left anterior descending artery (LAD), bilateral atrium and ventricles] before the education. A radiologist and radiation oncologist developed the atlas and delineated the gold standard (GS) volumes. Observers repeated the delineation after education. RT plans were made for pre/post-atlas contours. The similarity was assessed by Dice (DSC) and Jaccard (JSC) similarity coefficient indices. The absolute difference rate was calculated for the dose analysis.

Results

The inter-observer similarity increased in heart and all subunits. The intra-observer similarity showed a heterogeneous distribution. The absolute difference rate in dose reporting was statistically significant for the bilateral atrium, right ventricle, LAD, LCA + LAD, RCA’s maximum doses (p < 0.05). The maximum dose reporting differences from the GS decreased from 16.9 to 8.9% for LAD (p = 0.011); from 14.8 to 9.3% for LCA + LAD (p = 0.010).

Conclusion

The cardiac atlas reduces the intra-interobserver differences and improves dose reporting consistency. The first intra-observer similarity analysis was made in our study and revealed the need for repeated education to increase the consistency.

Keywords

Breast radiotherapy Heart atlas Cardiac subunit delineation 

Notes

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Female Breast Cancer—Cancer Stat Facts n.d. https://seer.cancer.gov/statfacts/html/breast.html. Accessed 5 June 2018).
  2. 2.
    Early Breast Cancer Trialists' Collaborative Group. Favourable and unfavorable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomized trials. Lancet (London, England). 2000;355:1757–70.CrossRefGoogle Scholar
  3. 3.
    Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, McGale P, Correa C, Taylor C, Arriagada R, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: a meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet (London, England). 2011;378:1707–16.  https://doi.org/10.1016/S0140-6736(11)61629-2.CrossRefGoogle Scholar
  4. 4.
    Sedlmayer F, Sautter-Bihl ML, Budach W, Dunst J, Fastner G, Feyer P, et al. DEGRO practical guidelines: Radiotherapy of breast cancer I: radiotherapy following breast-conserving therapy for invasive breast cancer. Strahlenther Und Onkol. 2013;189:825–33.  https://doi.org/10.1007/s00066-013-0437-8.CrossRefGoogle Scholar
  5. 5.
    Buzdar AU, McNeese MD, Hortobagyi GN, Smith TL, Kau S, Fraschini G, et al. Is chemotherapy effective in reducing the local failure rate in patients with operable breast cancer? Cancer. 1990;65:394–9.CrossRefGoogle Scholar
  6. 6.
    Tennvall-Nittby L, Tengrup I, Landberg T. The total incidence of loco-regional recurrence in a randomized trial of breast cancer TNM stage II. The South Sweden Breast Cancer Trial. Acta Oncol. 1993;32:641–6.CrossRefGoogle Scholar
  7. 7.
    Group EBCTC. An overview of the randomized trials. N Engl J Med. 1995;333:1444–555.  https://doi.org/10.1056/NEJM199511303332202.CrossRefGoogle Scholar
  8. 8.
    van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;92:1143–50.CrossRefGoogle Scholar
  9. 9.
    Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.  https://doi.org/10.1056/NEJMoa022152.CrossRefGoogle Scholar
  10. 10.
    Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–322.  https://doi.org/10.1056/NEJMoa020989.CrossRefGoogle Scholar
  11. 11.
    Abe O, Abe R, Enomoto K, Kikuchi K, Koyama H, Masuda H, et al. 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. 2005;366:2087–106.  https://doi.org/10.1016/S0140-6736(05)67887-7.CrossRefGoogle Scholar
  12. 12.
    Castro Pena P, Kirova YM, Campana F, Dendale R, Bollet MA, Fournier-Bidoz N, et al. Anatomical, clinical and radiological delineation of target volumes in breast cancer radiotherapy planning: Individual variability, questions and answers. Br J Radiol. 2009;82:595–9.  https://doi.org/10.1259/bjr/96865511.CrossRefGoogle Scholar
  13. 13.
    Lorenzen EL, Taylor CW, Maraldo M, Nielsen MH, Offersen BV, Andersen MR, et al. Inter-observer variation in delineation of the heart and left anterior descending coronary artery in radiotherapy for breast cancer: a multi-centre study from Denmark and the UK. Radiother Oncol. 2013;108:254–8.  https://doi.org/10.1016/j.radonc.2013.06.025.CrossRefGoogle Scholar
  14. 14.
    Preston DL, Shimizu Y, Pierce DA, Suyama A, Mabuchi K. Studies of mortality of atomic bomb survivors. Report 13: Solid cancer and noncancer disease mortality: 1950–1997. Radiat Res. 2003;160:381–407.CrossRefGoogle Scholar
  15. 15.
    Rutqvist LE, Lax I, Fornander T, Johansson H. Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys. 1992;22:887–96.CrossRefGoogle Scholar
  16. 16.
    Gagliardi G, Lax I, Söderström S, Gyenes G, Rutqvist LE. Prediction of excess risk of long-term cardiac mortality after radiotherapy of stage I breast cancer. Radiother Oncol. 1998;46:63–71.CrossRefGoogle Scholar
  17. 17.
    Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bogaert J, Davin L, et al. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging. 2013;14:721–40.  https://doi.org/10.1093/ehjci/jet123.CrossRefGoogle Scholar
  18. 18.
    Gagliardi G, Lax I, Ottolenghi A, Rutqvist LE. Long-term cardiac mortality after radiotherapy of breast cancer—application of the relative seriality model. Br J Radiol. 1996;69:839–46.  https://doi.org/10.1259/0007-1285-69-825-839.CrossRefGoogle Scholar
  19. 19.
    Paszat LF, Vallis KA, Benk VMA, Groome PA, Mackillop WJ, Wielgosz A. A population-based case-cohort study of the risk of myocardial infarction following radiation therapy for breast cancer. Radiother Oncol. 2007;82:294–300.  https://doi.org/10.1016/j.radonc.2007.01.004.CrossRefGoogle Scholar
  20. 20.
    Chargari C, Kirov KM, Bollet MA, Magné N, Védrine L, Cremades S, et al. Cardiac toxicity in breast cancer patients: from a fractional point of view to a global assessment. Cancer Treat Rev. 2011;37:321–30.  https://doi.org/10.1016/j.ctrv.2010.08.007.CrossRefGoogle Scholar
  21. 21.
    Giordano SH, Kuo Y-F, Freeman JL, Buchholz TA, Hortobagyi GN, Goodwin JS. Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst. 2005;97:419–24.  https://doi.org/10.1093/jnci/dji067.CrossRefGoogle Scholar
  22. 22.
    Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Brønnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368:987–98.  https://doi.org/10.1056/NEJMoa1209825.CrossRefGoogle Scholar
  23. 23.
    Duma MN, Herr A-C, Borm KJ, Trott KR, Molls M, Oechsner M, et al. 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. 2017;7:1–6.  https://doi.org/10.3389/fonc.2017.00130.CrossRefGoogle Scholar
  24. 24.
    White J, Tai A, Arthur D, Buchholz T. Breast cancer atlas for radiation therapy planning : consensus definitions. Radiat Ther Plan 2011;1–71.Google Scholar
  25. 25.
    Feng M, Moran JM, Koelling T, Chughtai A, Chan JL, Freedman L, et al. Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol. 2011;79:10–8.  https://doi.org/10.1016/j.ijrobp.2009.10.058.CrossRefGoogle Scholar
  26. 26.
    Dice LR. Measures of the amount of ecologic association between species. Ecology. 1945;26:297–302.  https://doi.org/10.2307/1932409.CrossRefGoogle Scholar
  27. 27.
    Jaccard P. The distribution of the flora in the alphine zone. New Phytol. 1912;XI:37–50.  https://doi.org/10.1111/j.1469-8137.1912.tb05611.x.CrossRefGoogle Scholar
  28. 28.
    Deasy JO, Blanco AI, Clark VH. CERR: a computational environment for radiotherapy research. Med Phys. 2003;30:979–85.  https://doi.org/10.1118/1.1568978.CrossRefGoogle Scholar
  29. 29.
    Borst GR, Sonke J-J, den Hollander S, Betgen A, Remeijer P, van Giersbergen A, et al. Clinical results of image-guided deep inspiration breath hold breast irradiation. Int J Radiat Oncol Biol Phys. 2010;78:1345–51.  https://doi.org/10.1016/j.ijrobp.2009.10.006.CrossRefGoogle Scholar
  30. 30.
    Mast ME, van Kempen-Harteveld L, Heijenbrok MW, Kalidien Y, Rozema H, Jansen WPA, et al. Left-sided breast cancer radiotherapy with and without breath-hold: does IMRT reduce the cardiac dose even further? Radiother Oncol. 2013;108:248–53.  https://doi.org/10.1016/j.radonc.2013.07.017.CrossRefGoogle Scholar
  31. 31.
    Mast ME, Vredeveld EJ, Credoe HM, van Egmond J, Heijenbrok MW, Hug EB, et al. Whole breast proton irradiation for maximal reduction of heart dose in breast cancer patients. Breast Cancer Res Treat. 2014;148:33–9.  https://doi.org/10.1007/s10549-014-3149-6.CrossRefGoogle Scholar
  32. 32.
    Osman SOS, Hol S, Poortmans PM, Essers M. Volumetric modulated arc therapy and breath-hold in image-guided locoregional left-sided breast irradiation. Radiother Oncol. 2014;112:17–22.  https://doi.org/10.1016/j.radonc.2014.04.004.CrossRefGoogle Scholar
  33. 33.
    Li XA, Ph D, Tai A, Ph D, Arthur DW, Buchholz TA, et al. NIH Public Access. 2010;73:944–51.  https://doi.org/10.1016/j.ijrobp.2008.10.034.Variability.Google Scholar
  34. 34.
    Nielsen MH, Berg M, Pedersen AN, Andersen K, Glavicic V, Jakobsen EH, et al. Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: national guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group. Acta Oncol (Madr). 2013;52:703–10.  https://doi.org/10.3109/0284186X.2013.765064.CrossRefGoogle Scholar
  35. 35.
    Duane F, Aznar MC, Bartlett F, Cutter DJ, Darby SC, Jagsi R, et al. A cardiac contouring atlas for radiotherapy. Radiother Oncol. 2017;122:416–22.  https://doi.org/10.1016/j.radonc.2017.01.008.CrossRefGoogle Scholar
  36. 36.
    Lee J, Hua KL, Hsu SM, Lin JB, Lee CH, Lu KW, et al. Development of delineation for the left anterior descending coronary artery region in left breast cancer radiotherapy: an optimized organ at risk. Radiother Oncol. 2017;122:423–30.  https://doi.org/10.1016/j.radonc.2016.12.029.CrossRefGoogle Scholar
  37. 37.
    Vennarini S, Fournier-Bidoz N, Aristei C, De Almeida CE, Servois V, Campana F, et al. Visualisation of the left anterior descending coronary artery on CT images used for breast radiotherapy planning. Br J Radiol. 2013. https://doi.org/10.1259/bjr.20120643.
  38. 38.
    Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med. 1997;337:949–55.  https://doi.org/10.1056/NEJM199710023371401.CrossRefGoogle Scholar

Copyright information

© Japan Radiological Society 2019

Authors and Affiliations

  1. 1.Departmant of Radiation OncologyDokuz Eylül University Faculty of MedicineİzmirTurkey
  2. 2.Departmant of RadiologyDokuz Eylül University Faculty of MedicineİzmirTurkey
  3. 3.Department of Radiation OncologyHealth Sciences University Erzurum Regional Training and Research HospitalErzurumTurkey

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