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Nikovia V, Chinis E, Gkantaifi A, Marketou M, Mazonakis M, Charalampakis N, Mavroudis D, Orfanidou KV, Varveris A, Antoniadis C, Tolia M. Current Cardioprotective Strategies for the Prevention of Radiation-Induced Cardiotoxicity in Left-Sided Breast Cancer Patients. J Pers Med 2023; 13:1038. [PMID: 37511651 PMCID: PMC10381791 DOI: 10.3390/jpm13071038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/11/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common malignancy in females, accounting for the majority of cancer-related deaths worldwide. There is well-established understanding about the effective role of radiotherapy (RT) in BC therapeutic strategies, offering a better local-regional control, prolonged survival, and improved quality of life for patients. However, it has been proven that conventional RT modalities, especially in left-sided BC cases, are unable to avoid the administration of high RT doses to the heart, thus resulting in cardiotoxicity and promoting long-term cardiovascular diseases (CVD). Recent radiotherapeutic techniques, characterized by dosimetric dose restrictions, target volume revision/modifications, an increased awareness of risk factors, and consistent follow-ups, have created an advantageous context for a significant decrease inpost-RT CVD incidence. AIM This review presents the fundamental role of current cardioprotective strategies in the prevention of cardiotoxic effects in left-BCRT. MATERIAL AND METHODS A literature search was conducted up to January 2023 using the Cochrane Central Register of Controlled Trials and PubMed Central databases. Our review refers to new radiotherapeutic techniques carried out on patients after BC surgery. Specifically, a dose evaluation of the heart and left anterior descending coronary artery (LADCA) was pointed out for all the included studies, depending on the implemented RT modality, bed positioning, and internal mammary lymph nodes radiation. RESULTS Several studies reporting improved heart sparing with new RT techniques in BC patients were searched. In addition to the RT modality, which definitely determines the feasibility of achieving lower doses for the organs at risk (OARs), better target coverage, dose conformity and homogeneity, and the patient's position, characteristics, and anatomy may also affect the evaluated RT dose to the whole heart and its substructures. CONCLUSIONS Modern BC RT techniques seem to enable the administration of lower doses to the OARs without compromising on the target coverage. The analysis of several anatomical parameters and the assessment of cardiac biomarkers potentiate the protective effect of these new irradiation modalities, providing a holistic approach to the radiation-associated risks of cardiac disease for BC patients. Despite technological advances, an inevitable cardiac radiation risk still exists, while adverse cardiac events may be observed even many years after RT. Studies with longer follow-ups are required in order to determine the effectiveness of modern breast RT techniques.
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Affiliation(s)
- Vasiliki Nikovia
- Medical School, University of Crete, Vassilika, 71110 Heraklion, Greece
| | - Evangelos Chinis
- Medical School, University of Crete, Vassilika, 71110 Heraklion, Greece
| | - Areti Gkantaifi
- Radiotherapy Department, Theagenio Anticancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece
| | - Maria Marketou
- Cardiology Department, University General Hospital of Heraklion, Heraklion, 71110 Heraklion, Greece
| | - Michalis Mazonakis
- Department of Medical Physics, Faculty of Medicine, University of Cret, Iraklion, P.O. Box 2208, 71003 Heraklion, Greece
| | | | - Dimitrios Mavroudis
- Department of Medical Oncology, University General Hospital of Heraklion, 71500 Heraklion, Greece
| | | | - Antonios Varveris
- Department of Radiotherapy, University Hospital/Medical School, University of Crete, Vassilika, 71110 Heraklion, Greece
| | - Chrysostomos Antoniadis
- Department of Radiotherapy, University Hospital/Medical School, University of Crete, Vassilika, 71110 Heraklion, Greece
| | - Maria Tolia
- Department of Radiotherapy, University Hospital/Medical School, University of Crete, Vassilika, 71110 Heraklion, Greece
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Sindhu M, Malik M, Ahmed SF, Valiyaveettil D. Assessment of toxicities and outcomes in patients with breast cancer treated with hypofractionated radiotherapy. Indian J Cancer 2021; 57:423-427. [PMID: 33078749 DOI: 10.4103/ijc.ijc_670_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Background Hypofractionation is now becoming the standard of care in breast irradiation. The aim of this study was to assess the toxicities and outcomes in patients with breast cancer treated with hypofractionated radiotherapy (HFRT). Methods Patients with localized breast cancer who received adjuvant HFRT between 2013 and 2015 with a minimum follow-up of 6 months following radiation were included in this prospective study. Late toxicities were assessed using CTCAE v 4 and included chest/breast pain, limb pain, limb edema, skin pigmentation, skin fibrosis, and shoulder movement restriction. Outcomes assessed included locoregional control, disease-free survival, and overall survival. Statistical analysis was done using Microsoft Excel and SPSS v22. Results A total of 81 patients fulfilled the inclusion criteria, of which 19 patients had died during follow-up. Regional nodal irradiation was done in 63 (77.8%) patients using the same hypofractionated schedule of 40 Gy in 15 fractions. Late toxicities were assessed for 62 patients. The median follow-up following the course of hypofractionated radiation was 45 months (range 14 - 65 months). Late toxicities were assessed for 62 patients. Grade 1/2 chest/breast pain, limb pain, limb edema, skin pigmentation, skin fibrosis, and shoulder movement restriction were seen in 11%, 12%, 7%, 6%, 8%, and 11% of cases, respectively. Distant recurrences were seen in 8% of cases, and there were no locoregional recurrences. Five-year overall survival was 76.5%. Conclusion HFRT to whole breast or chest wall and the regional nodal areas was well-tolerated with acceptable rates of late toxicities on follow-up.
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Affiliation(s)
- M Sindhu
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Monica Malik
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Syed F Ahmed
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Deepthi Valiyaveettil
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Anastasov N, Hirmer E, Klenner M, Ott J, Falkenberg N, Bao X, Mutschelknaus L, Moertl S, Combs S, Atkinson MJ, Schmid T. MEK1 Inhibitor Combined with Irradiation Reduces Migration of Breast Cancer Cells Including miR-221 and ZEB1 EMT Marker Expression. Cancers (Basel) 2020; 12:cancers12123760. [PMID: 33327491 PMCID: PMC7764972 DOI: 10.3390/cancers12123760] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Combined chemotherapy and radiotherapy are an effective treatment for invasive breast cancer. However, some studies suggest that such interventions may increase the risk of metastasis. Cell metastatic behavior is highly dependent on RAS-RAF-MEK pathway and its downstream target activation, including miR-221 overexpression and epithelial-to-mesenchymal transition (EMT). By using MEK1 inhibitor (TAK-733) in combination with radiation therapy for breast cancer cells, significant decrease in migration capacity, including reduction of miR-221 and EMT (ZEB1) marker expression was observed. miR-221 holds great potential as therapeutic biomarker and target for new drug developments, however more insight into efficiency of miR-221 inhibition needs to be followed in the future. Abstract The miR-221 expression is dependent on the oncogenic RAS-RAF-MEK pathway activation and influences epithelial-to-mesenchymal transition (EMT). The Cancer Genome Atlas (TCGA) database analysis showed high gene significance for ZEB1 with EMT module analysis and miR-221 overexpression within the triple-negative breast cancer (TNBC) and HER2+ subgroups when compared to luminal A/B subgroups. EMT marker expression analysis after MEK1 (TAK-733) inhibitor treatment and irradiation was combined with miR-221 and ZEB1 expression analysis. The interaction of miR-221 overexpression with irradiation and its influence on migration, proliferation, colony formation and subsequent EMT target activation were investigated. The results revealed that MEK1 inhibitor treatment combined with irradiation could decrease the migratory potential of breast cancer cells including reduction of miR-221 and corresponding downstream ZEB1 (EMT) marker expression. The clonogenic survival assays revealed that miR-221 overexpressing SKBR3 cells were more radioresistant when compared to the control. Remarkably, the effect of miR-221 overexpression on migration in highly proliferative and highly HER2-positive SKBR3 cells remained constant even upon 8 Gy irradiation. Further, in naturally miR-221-overexpressing MDA-MB-231 cells, the proliferation and migration significantly decrease after miR-221 knockdown. This leads to the assumption that radiation alone is not reducing migration capacity of miR-221-overexpressing cells and that additional factors play an important role in this context. The miR-221/ZEB1 activity is efficiently targeted upon MEK1 inhibitor (TAK-733) treatment and when combined with irradiation treatment, significant reduction in migration of breast cancer cells was shown.
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Affiliation(s)
- Nataša Anastasov
- Institute of Radiation Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany; (E.H.); (M.K.); (J.O.); (X.B.); (L.M.); (S.M.); (M.J.A.)
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany
- Correspondence: ; Tel.: +49-893-187-3798; Fax: +49-893-187-3017
| | - Elisabeth Hirmer
- Institute of Radiation Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany; (E.H.); (M.K.); (J.O.); (X.B.); (L.M.); (S.M.); (M.J.A.)
- Institute of Radiation Medicine, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany; (S.C.); (T.S.)
| | - Marbod Klenner
- Institute of Radiation Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany; (E.H.); (M.K.); (J.O.); (X.B.); (L.M.); (S.M.); (M.J.A.)
| | - Jessica Ott
- Institute of Radiation Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany; (E.H.); (M.K.); (J.O.); (X.B.); (L.M.); (S.M.); (M.J.A.)
- Institute of Radiation Medicine, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany; (S.C.); (T.S.)
| | - Natalie Falkenberg
- Institute of Pathology, Technical University of Munich (TUM), 81675 Munich, Germany;
- Clinical Research Unit, Department of Obstetrics and Gynecology, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Xuanwen Bao
- Institute of Radiation Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany; (E.H.); (M.K.); (J.O.); (X.B.); (L.M.); (S.M.); (M.J.A.)
| | - Lisa Mutschelknaus
- Institute of Radiation Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany; (E.H.); (M.K.); (J.O.); (X.B.); (L.M.); (S.M.); (M.J.A.)
| | - Simone Moertl
- Institute of Radiation Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany; (E.H.); (M.K.); (J.O.); (X.B.); (L.M.); (S.M.); (M.J.A.)
- Federal Office of Radiation Protection, 85764 Oberschleissheim, Germany
| | - Stephanie Combs
- Institute of Radiation Medicine, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany; (S.C.); (T.S.)
- Department of Radiation Oncology, School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Michael J. Atkinson
- Institute of Radiation Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany; (E.H.); (M.K.); (J.O.); (X.B.); (L.M.); (S.M.); (M.J.A.)
- Radiation Biology, Technical University of Munich, 81675 Munich, Germany
| | - Thomas Schmid
- Institute of Radiation Medicine, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764 Neuherberg, Germany; (S.C.); (T.S.)
- Department of Radiation Oncology, School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany
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Tang B, Ma J, Xu J, Li J, Kang S, Wang P, Wu F, Orlandini LC. Feasibility of using calibrated cone-beam computed tomography scans to validate the heart dose in left breast post-mastectomy radiotherapy. J Int Med Res 2020; 48:300060520929168. [PMID: 32567427 PMCID: PMC7309397 DOI: 10.1177/0300060520929168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective In post-mastectomy radiotherapy, high-conformal techniques are a valid method for determining the dose distribution around a target. However, the proximity of critical structures is a reason for concern. This study aims to evaluate the feasibility of using calibrated cone-beam computed tomography (CBCT) scans as a valid tool for a timely heart dose evaluation. Methods A retrospective analysis was conducted on 170 retrospective CBCT scans of 17 patients who underwent high-conformal post-mastectomy irradiation. The delivered doses that were calculated using personalized calibrated CBCT were compared with the doses planned, using the dose–volume histogram dosimetric parameters. Results The heart volume that was evaluated using CBCT presented a mean increase of 6%; this discrepancy impacted the heart dose in 4 of 17 patients, with an absolute increase of V25 Gy (range, 2.5%–7.6%) and an increase in the mean dose (range, 1.1–3.4 Gy). The dose for the target, ipsilateral lung, and contralateral breast remained unchanged. Conclusion Using CBCT to monitor the dose that is delivered to the heart is feasible, allowing for a timely shift to an adaptive plan if clinically necessary.
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Affiliation(s)
- Bin Tang
- Key Laboratory of Radiation Physics, Institute of Nuclear Science and Technology, Sichuan University, No. 24, South Section 1, Yihuar, Chengdu, 610065, China.,Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Jiabao Ma
- Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Jinghui Xu
- Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Jie Li
- Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Shengwei Kang
- Key Laboratory of Radiation Physics, Institute of Nuclear Science and Technology, Sichuan University, No. 24, South Section 1, Yihuar, Chengdu, 610065, China.,Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Pei Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Fan Wu
- Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Lucia Clara Orlandini
- Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
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Haussmann J, Corradini S, Nestle-Kraemling C, Bölke E, Njanang FJD, Tamaskovics B, Orth K, Ruckhaeberle E, Fehm T, Mohrmann S, Simiantonakis I, Budach W, Matuschek C. Recent advances in radiotherapy of breast cancer. Radiat Oncol 2020; 15:71. [PMID: 32228654 PMCID: PMC7106718 DOI: 10.1186/s13014-020-01501-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/18/2020] [Indexed: 01/08/2023] Open
Abstract
Radiation therapy is an integral part of the multidisciplinary management of breast cancer. Regional lymph node irradiation in younger trials seems to provide superior target coverage as well as a reduction in long-term toxicity resulting in a small benefit in the overall survival rate. For partial breast irradiation there are now two large trials available which support the role of partial breast irradiation in low risk breast cancer patients. Multiple randomized trials have established that a sequentially applied dose to the tumor bed improves local control with the cost of worse cosmetic results.
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Affiliation(s)
- Jan Haussmann
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Carolin Nestle-Kraemling
- Department of Gynecologic and Obstetrics, Evanglisches Krankenhaus Dusseldorf, Dusseldorf, Germany
| | - Edwin Bölke
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany.
| | | | - Bálint Tamaskovics
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Klaus Orth
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Eugen Ruckhaeberle
- Department of Gynecology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Tanja Fehm
- Department of Gynecology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Svjetlana Mohrmann
- Department of Gynecology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Ioannis Simiantonakis
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Wilfried Budach
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Christiane Matuschek
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
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Xi D, Ding Y, Hu R, Gu W, Mu J, Li Q. Advantages of a technique using two 50 degree arcs in simultaneous integrated boost radiotherapy for left-sidebreast cancer. Sci Rep 2017; 7:14748. [PMID: 29116237 PMCID: PMC5677093 DOI: 10.1038/s41598-017-15307-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/25/2017] [Indexed: 11/26/2022] Open
Abstract
This study evaluated radiotherapy techniques with 15 cases for simultaneous integrated boost to treat whole left breast and tumor bed following breast conserving surgery. Treatment plans were generated using three techniques: volumetric modulated arc therapy (VMAT) with a partial arc of 190° (1ARC), VMAT with two tangential mini-arcs of 50° each (2TARC) and intensity modulated radiation therapy with four fixed angle fields (4IMRT). Dosimetric parameters for the whole breast (Target), the boost tumor bed (Boost), and surrounding normal organs were compared. Chair Index (CHI) was introduced to evaluate the dose homogeneity in Target given the two levels of prescription dose. The dose coverage in Target was better in 1ARC and 2TARC than that in 4IMRT. The mean CHI in 1ARC (2.47) and 2TARC (2.62) were higher than that in 4IMRT (1.71, p < 0.05), and this indicated the dose homogeneity of Target was better in 1ARC and 2TARC than that in 4IMRT. The mean doses to right lung, and contralateral breast in 4IMRT were lower than those in 2TARC but the differences between them were small. 2TARC was better than 4IMRT with respect to the dose to ipsilateral lung and heart. Overall, 2TARC was optimal among three techniques.
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Affiliation(s)
- Dan Xi
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, The First Peoples' Hospital of Changzhou, Changzhou, 213003, China
| | - Yun Ding
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, The First Peoples' Hospital of Changzhou, Changzhou, 213003, China
| | - Rui Hu
- Department of Radiation Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 213003, China
| | - Wendong Gu
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, The First Peoples' Hospital of Changzhou, Changzhou, 213003, China
| | - Jinming Mu
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, The First Peoples' Hospital of Changzhou, Changzhou, 213003, China
| | - Qilin Li
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, The First Peoples' Hospital of Changzhou, Changzhou, 213003, China.
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Rahimy E, Hong JC, Gross CP, Hu X, Soulos PR, Shafman T, Connor HJ, Ross R, Yu JB, Dosoretz A, Evans SB. Increased Number of Beam Angles Is Associated With Higher Cardiac Dose in Adjuvant Fixed Gantry Intensity Modulated Radiation Therapy of Left-Sided Breast Cancer. Int J Radiat Oncol Biol Phys 2017; 99:1137-1145. [PMID: 28864402 DOI: 10.1016/j.ijrobp.2017.06.2451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/09/2017] [Accepted: 06/19/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE To analyze the relationship between angle number and mean heart dose (MHD) in adjuvant fixed gantry intensity modulated radiation therapy (FG-IMRT) treatment of left-sided breast cancer as is currently practiced in the community. METHODS AND MATERIALS We performed a retrospective, multi-institutional review of women with left-sided breast cancer receiving adjuvant FG-IMRT between 2012 and 2014, encompassing 85 centers in 15 states. Bivariate and multivariate regression analyses were done to identify factors associated with MHD. Long-term cardiac risk was estimated according to a previously published model. RESULTS Of the 538 women included, 284 had >2 gantry angle treatment plans (multi-angle), and 254 had 2 gantry angle (standard) plans. Median MHD was higher in patients with multi-angle plans compared with standard (median 475 vs 203 cGy). Number of gantry angles was significantly associated with MHD, with multi-angle plans independently increasing MHD by 229 cGy. Absolute risk of acute coronary events 20 years after treatment was estimated as 7 excess events per 1000 women for standard plans, compared with 12 excess events for multi-angle plans. CONCLUSIONS Fixed gantry IMRT breast treatment plans with >2 gantry angles were associated with increased MHD, which translated to an increased cardiac risk. Clinicians should account for this potential drawback in treatment technique when assessing overall plan quality.
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Affiliation(s)
- Elham Rahimy
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
| | - Julian C Hong
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Cary P Gross
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut; Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xin Hu
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Timothy Shafman
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut; 21st Century Oncology, Fort Myers, Florida
| | - Henry J Connor
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut; Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rudi Ross
- 21st Century Oncology, Fort Myers, Florida
| | - James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Arie Dosoretz
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; 21st Century Oncology, Fort Myers, Florida
| | - Suzanne B Evans
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
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Nitsche M, Dunst J, Carl UM, Hermann RM. Emerging Role of Hypofractionated Radiotherapy with Simultaneous Integrated Boost in Modern Radiotherapy of Breast Cancer. Breast Care (Basel) 2015; 10:320-4. [PMID: 26688679 DOI: 10.1159/000436951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Hypofractionated radiotherapy for breast cancer is becoming increasingly important. The scientific background of this development as well as the introduction of the simultaneous integrated boost to the primary tumor region in this context are discussed here.
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Affiliation(s)
- Mirko Nitsche
- Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede, Germany ; Klinik für Strahlentherapie, Karl-Lennert-Krebscentrum, Universität Kiel, Germany
| | - Juergen Dunst
- Klinik für Strahlentherapie, Karl-Lennert-Krebscentrum, Universität Kiel, Germany
| | - Ulrich M Carl
- Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede, Germany
| | - Robert M Hermann
- Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede, Germany ; Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Germany
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