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Herr DJ, Moncion A, Griffith K, Marsh R, Grubb M, Bhatt AK, Dominello MM, Walker EM, Narayana V, Abu-Isa EI, Vicini FA, Hayman JA, Pierce LJ. Factors Associated with Cardiac Radiation Dose Reduction Following Hypofractionated Radiation Therapy for Localized, Left-Sided Breast Cancer in a Large Statewide Quality Consortium. Int J Radiat Oncol Biol Phys 2023; 117:S138. [PMID: 37784352 DOI: 10.1016/j.ijrobp.2023.06.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Limiting radiation dose to the heart is important for minimizing the risk of long-term cardiac toxicity in patients with left-sided early-stage breast cancer. MATERIALS/METHODS Prospectively collected dosimetric data were analyzed for patients undergoing hypofractionated radiation therapy to the left breast for localized node-negative breast cancer within the Michigan Radiation Oncology Quality Consortium (MROQC) from 2016-2022. Goals for limiting cardiac dose were adjusted over time. From 2016-2020, the cardiac quality metric focused on total mean heart dose (MHD) from the composite whole breast and boost plans, tightening from a goal of MHD ≤2 Gy to MHD ≤1.2 Gy by 2020. In 2021-2022, the cardiac metric transitioned to a combined goal of MHD ≤1.0 Gy from the whole breast plan and ≥95% lumpectomy cavity planning target volume (PTV) receiving 95% of the prescription dose. Separate multivariate logistic regression models were developed to assess for covariates associated with meeting the MHD goal in 2016-2020 and combined MHD/PTV coverage goal in 2021-2022. RESULTS In total, 4,165 patients were analyzed with a median age of 64 years. Most patients (86%) had either Tis or T1 disease, and 66% received hormone therapy. Baseline demographic and disease characteristics did not change substantially between treatment periods. Use of breath-hold or motion gating increased from 42% in 2016-2020 to 46% in 2021-2022. Similarly, use of prone positioning increased from 12% to 20%. From 2016-2020, 90.9% of plans achieved the MHD goal, compared to 93.6% of plans achieving the composite MHD/PTV goal from 2021-2022. On multivariate analysis in the 2016-2020 cohort, treatment with motion management (OR 5.20, 95% CI [3.59-7.54], p<0.0001) or prone positioning (OR 3.21, 95% CI [1.85-5.57], p < 0.0001) were associated with meeting the MHD goal, while receipt of boost (OR 0.25, 95% CI [0.17-0.39], p<0.0001) and omission of hormone therapy (OR 0.65, 95% CI [0.49-0.88], p = 0.0047), were associated with not meeting the MHD goal. During the era including composite heart dose and PTV coverage goals (2021-2022), treatment with motion management (OR 1.89, 95% CI [1.12-3.21], p = 0.018) or prone positioning (OR 3.71, 95% CI [1.73-7.95], p = 0.0008) were associated with meeting the combined goal, while larger breast volume (≥1440 cc, OR 0.34, 95% CI [0.13 - 0.91], p = 0.031) and treatment at an academic center (OR 0.36, 95% CI [0.22-0.67], p = 0.0009) were associated with not meeting the combined goal. CONCLUSION In our statewide consortium, rates of compliance with aggressive targets for limiting cardiac dose remain high, despite tightening of these goals to include lower mean heart doses and inclusion of a concurrent PTV coverage goal. Treatment using motion management or prone positioning is associated with achieving the cardiac dose goals.
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Affiliation(s)
- D J Herr
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - A Moncion
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - K Griffith
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - R Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - M Grubb
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - A K Bhatt
- Karmanos Cancer Institute at McLaren Greater Lansing, Lansing, MI
| | - M M Dominello
- Department of Radiation Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI
| | - E M Walker
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
| | - V Narayana
- Ascension Providence Hospital, Southfield, MI
| | - E I Abu-Isa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI; Ascension Providence Hospital, Southfield, MI
| | - F A Vicini
- MHP Radiation Oncology Institute/GenesisCare, Farmington Hills, MI
| | - J A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - L J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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