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Matched-pair dosimetric comparison of cardiac radiation exposure between deep-inspiration breath-hold whole-breast radiation therapy with Active Breathing Coordinator and interstitial multicatheter high-dose-rate brachytherapy as accelerated partial breast irradiation in adjuvant treatment of left-sided breast cancer after breast-conserving surgery

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Abstract

Background and purpose

To compare dosimetrically the radiation exposure to heart, left ventricle (LV), and left anterior descending artery (LAD) between whole-breast radiotherapy (WBRT) with Active Breathing Coordinator (ABC; ABC-WBRT) and interstitial multicatheter high-dose-rate (HDR) brachytherapy as accelerated partial breast irradiation (ABPI; imHDR-APBI) for left-sided breast cancer (BCA) after breast-conserving surgery (BCS).

Materials and methods

Between January 2016 and December 2019, 32 and 20 patients were treated with ABC-WBRT (63 Gy/2.25 Gy) and imHDR-APBI (32 Gy/4 Gy), respectively. Among them a matched-pair analysis was performed according to tumor location (clock position) before BCS as well as planning target volume of imHDR-APBI and boost volume of ABC-WBRT. This yielded 17 pairs of patients for whom dosimetric parameters for heart, LV, and LAD were evaluated. The Mann–Whitney test was used for comparison after adjusting for equivalent dose in 2‑Gy fractions (EQD2). In addition, a second analysis of ABC-WBRT to 40.05 Gy in 15 fractions was performed in order to account for the EQD2 difference between the 63-Gy ABC-WBRT and the imHDR-APBI protocol.

Results

Tumor location for the 17 pairs of patients relative to breast quadrant was as follows: upper outer 8, lower outer 5, upper inner 3, and lower inner 1. There was no difference regarding mean heart dose (MHD) and V5, whereas D25%, D45%, V10, and V25 significantly favored imHDR-APBI. Likewise, mean dose- and V5-LV did not differ, while Dmax- and V23-LV were significantly higher for ABC-WBRT. For LAD, Dmax, D25%, and V30 significantly favored imHDR-APBI without differences for mean dose and V40. When comparing imHDR-APBI with the 40.05 Gy ABC-WBRT schedule, MHD and mean dose LV were significantly lower in favor of ABC-WBRT.

Conclusion

ABC-WBRT and imHDR-APBI yield similar low heart and LV exposure for left-sided BCA after BCS, whereas LAD can be better spared with imHDR-APBI.

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Authors and Affiliations

  1. Department of Radiotherapy and Oncology, Goethe University, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Georgios Chatzikonstantinou, Christian Scherf, Janett Köhn, Ulla Ramm & Nikolaos Tselis

  2. Institute of Biostatistic and Mathematical Modeling, Goethe University Frankfurt, Frankfurt am Main, Germany

    Hans Ackermann

Authors
  1. Georgios Chatzikonstantinou
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  2. Christian Scherf
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  3. Janett Köhn
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Correspondence to Georgios Chatzikonstantinou.

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G. Chatzikonstantinou, C. Scherf, J. Köhn, H. Ackermann, U. Ramm, and N. Tselis declare that they have no competing interests.

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Chatzikonstantinou, G., Scherf, C., Köhn, J. et al. Matched-pair dosimetric comparison of cardiac radiation exposure between deep-inspiration breath-hold whole-breast radiation therapy with Active Breathing Coordinator and interstitial multicatheter high-dose-rate brachytherapy as accelerated partial breast irradiation in adjuvant treatment of left-sided breast cancer after breast-conserving surgery. Strahlenther Onkol 197, 308–316 (2021). https://doi.org/10.1007/s00066-020-01702-z

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