1
|
Loap P, Vu Bezin J, De Marzi L, Kirova Y. Determinants of radiation dose to immune cells during breast radiotherapy. Strahlenther Onkol 2024:10.1007/s00066-024-02240-8. [PMID: 38801448 DOI: 10.1007/s00066-024-02240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The immune system has been identified as an organ at risk in esophageal and lung cancers. However, the dosimetric impact of radiotherapy on immune system exposure in patients treated for breast cancer has never been studied. METHODS A monocentric retrospective dosimetric study included 163 patients treated at the Institut Curie (Paris, France) between 2010 and 2016 with locoregional helical tomotherapy after conservative surgery or total mastectomy. The effective dose to the immune system (EDIC) was calculated based on diverse dosimetric parameters. The clinical and volumetric determinants of EDIC in adjuvant radiotherapy of breast cancer were analyzed. RESULTS The median EDIC for the population was 4.23 Gy, ranging from 1.82 to 6.19 Gy. Right-sided radiotherapy and regional lymph node irradiation were associated with significantly higher EDIC in univariate (4.38 Gy vs. 3.94 Gy, p < 0.01, and 4.27 Gy vs. 3.44 Gy, p < 0.01, respectively) and multivariate analyses (p < 0.01 and p < 0.01). Liver overexposure was the main contributor to EDIC increase in right-sided breast cancer patients (+0.38 Gy [95%CI: +0.30; +0.46]), while the integral total dose increase was the main contributor to EDIC increase in cases of regional node irradiation (+0.63 Gy [95%CI: +0.42; +0.85]). CONCLUSION The EDIC score during adjuvant radiotherapy after breast cancer was statistically significantly higher in the case of right-sided radiotherapy and regional lymph node irradiation. Liver irradiation is the main contributor to immune system exposure in adjuvant irradiation of right-sided breast cancer. Populations in which an association between EDIC and survival would exist have yet to be identified but could potentially include patients treated for triple-negative breast cancer with a poor response to neoadjuvant chemoimmunotherapy.
Collapse
Affiliation(s)
- Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France.
| | - Jeremi Vu Bezin
- Department of Radiation Oncology, Institut Curie, Paris, France
| | | | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| |
Collapse
|
2
|
Lu W, Hong LX, Yamada N, Berry SL, Song Y, Choi W, Cerviño LI, Tang X, Mechalakos JG, Romesser PB, Powell S, Li G. Comparison of setup accuracy of optical surface image versus orthogonal x-ray images for VMAT of the left breast using deep-inspiration breath-hold. J Appl Clin Med Phys 2023; 24:e14117. [PMID: 37535396 PMCID: PMC10691624 DOI: 10.1002/acm2.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/25/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023] Open
Abstract
To compare the setup accuracy of optical surface image (OSI) versus orthogonal x-ray images (2DkV) using cone beam computed tomography (CBCT) as ground truth for radiotherapy of left breast cancer in deep-inspiration breath-hold (DIBH). Ten left breast DIBH patients treated with volumetric modulated arc therapy (VMAT) were studied retrospectively. OSI, 2DkV, and CBCT were acquired weekly at treatment setup. OSI, 2DkV, and CBCT were registered to planning CT or planning DRR based on a breast surface region of interest (ROI), bony anatomy (chestwall and sternum), and both bony anatomy and breast surface, respectively. These registrations provided couch shifts for each imaging system. The setup errors, or the difference in couch shifts between OSI and CBCT were compared to those between 2DkV and CBCT. A second OSI was acquired during last beam delivery to evaluate intrafraction motion. The median absolute setup errors were (0.21, 0.27, 0.23 cm, 0.6°, 1.3°, 1.0°) for OSI, and (0.26, 0.24, 0.18 cm, 0.9°, 1.0°, 0.6°) for 2DkV in vertical, longitudinal and lateral translations, and in rotation, roll and pitch, respectively. None of the setup errors was significantly different between OSI and 2DkV. For both systems, the systematic and random setup errors were ≤0.6 cm and ≤1.5° in all directions. Nevertheless, larger setup errors were observed in some sessions in both systems. There was no correlation between OSI and CBCT whereas there was modest correlation between 2DkV and CBCT. The intrafraction motion in DIBH detected by OSI was small with median absolute translations <0.2 cm, and rotations ≤0.4°. Though OSI showed comparable and small setup errors as 2DkV, it showed no correlation with CBCT. We concluded that to achieve accurate setup for both bony anatomy and breast surface, daily 2DkV can't be omitted following OSI for left breast patients treated with DIBH VMAT.
Collapse
Affiliation(s)
- Wei Lu
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Linda X. Hong
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Nelson Yamada
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Sean L. Berry
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Yulin Song
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Wookjin Choi
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Laura I. Cerviño
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Xiaoli Tang
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - James G. Mechalakos
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Paul B. Romesser
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Simon Powell
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Guang Li
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| |
Collapse
|
3
|
Loap P, Vu-Bezin J, Monceau V, Jacob S, Fourquet A, Kirova Y. Dosimetric evaluation of the benefit of deep inspiration breath hold (DIBH) for locoregional irradiation of right breast cancer with volumetric modulated arctherapy (VMAT). Acta Oncol 2023; 62:150-158. [PMID: 36786671 DOI: 10.1080/0284186x.2023.2177976] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Right-lateralized cardiac substructures can be substantially exposed during right breast cancer (R-BC) radiotherapy. The cardiac benefit of deep inspiration breath hold (DIBH) is established in combination with volumetric modulated arctherapy (VMAT) for left breast cancer with regional node irradiation but is unknown for R-BC. This study evaluated the dosimetric benefit of DIBH for locoregional irradiation of R-BC with VMAT. MATERIAL AND METHODS All patients treated for R-BC with adjuvant locoregional DIBH-VMAT in the Department of Radiation Oncology of the Institut Curie (Paris, France) until December 2022 were included, corresponding to 15 patients. FB- and DIBH-VMAT plans were compared both for a normofractionated regimen (50 Gy/25fx) used for treatment and a replanned hypofractionated regimen (40 Gy/15fx). Dose to the heart, cardiac substructures (sinoatrial node (SAN), atrio-ventricular node (AVN), right coronary artery, left anterior descending coronary artery, left ventricle), ipsilateral lung and liver were retrieved and compared. RESULTS Mean heart dose (MHD) was 3.33 Gy with FB vs. 3.10 Gy with DIBH on normofractionated plans (p = 0.489), and 2.58 Gy with FB vs. 2.41 Gy with DIBH on hypofractionated plan (p = 0.489). The benefit of DIBH was not significant for any cardiac substructure. The most exposed cardiac substructure were the SAN (mean dose of 6.62 Gy for FB- and 5.64 Gy for DIBH-VMAT on normofractionated plans) and the RCA (mean dose of 4.21 Gy for FB- and 4.06 Gy for DIBH-VMAT on normofractionated plans). The maximum benefit was observed for the RCA with a median individual dose reduction of 0.84 Gy on normofractionated plans (p = 0.599). No significant dosimetric difference were observed for right lung. Liver mean dose was significantly lower with DIBH with median values decreasing from 2.54 Gy to 0.87 Gy (p = 0.01). CONCLUSION Adding DIBH to efficient cardiac-sparing radiotherapy techniques, such as VMAT, is not justified in the general case for locoregional R-BC irradiation. Specific R-BC patient subpopulations who could benefit from additional DIBH combination with locoregional VMAT are yet to be identified.
Collapse
Affiliation(s)
- Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Jeremi Vu-Bezin
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Virginie Monceau
- Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France
| | - Sophie Jacob
- Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France
| | - Alain Fourquet
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| |
Collapse
|
4
|
Song YQ, Hong J, Wang JY, Peng J, Han JH, Luo HL. Dosimetric comparison of different intensity-modulated radiotherapy techniques for whole-breast irradiation of right-breast cancer. Cancer Radiother 2023; 27:11-16. [PMID: 35879144 DOI: 10.1016/j.canrad.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/02/2022] [Accepted: 04/11/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE This study compared the dosimetric parameters of field-in-field forward intensity-modulated radiotherapy (FIF-IMRT) and fixed-field inversely optimized intensity-modulated radiotherapy (FFIO-IMRT) for the whole-breast irradiation of patients undergoing right-breast lumpectomy. MATERIAL AND METHODS A total of 30 patients with pT1-2N0M0 right-breast invasive ductal carcinoma were enrolled in this study. Two different treatment plans, i.e., FIF-IMRT and FFIO-IMRT, were designed for each patient. The dosimetric parameters of the two treatment plans were compared including ipsilateral lung and heart, conformity index (CI), and the homogeneity index (HI) of the planning target volume (PTV). RESULTS Fixed-field inversely optimized intensity-modulated radiotherapy was found to significantly improve CI (83.302% vs. 60.146%) and HI (11.837% vs. 19.280%), and significantly reduced V25 (18.038% vs. 19.653%) and V30 (15.790% vs. 18.492%) of the ipsilateral lung. It also significantly increased V5 (69.791% vs. 32.615%) of the ipsilateral lung and V5 (61.579% vs. 3.829%), V10 (14.130% vs. 0.381%), V20 (1.843% vs. 0.051%), and Dmean (5.211Gy vs. 1.870Gy) of the heart. CONCLUSION Regardless of improving the conformity and homogeneity of PTV and reducing the ipsilateral lung irradiation volume at high doses, FFIO-IMRT significantly raised the ipsilateral lung irradiated volume at low doses, as well as the irradiation volume and mean radiation doses to the heart. This limits its use in patients with early-stage right breast cancer.
Collapse
Affiliation(s)
- Y-Q Song
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, 223300 Huaian Jiangsu, China
| | - J Hong
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, 223300 Huaian Jiangsu, China
| | - J-Y Wang
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, 223300 Huaian Jiangsu, China
| | - J Peng
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, 223300 Huaian Jiangsu, China
| | - J-H Han
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, 223300 Huaian Jiangsu, China
| | - H-L Luo
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, 223300 Huaian Jiangsu, China.
| |
Collapse
|
5
|
Lu W, Li G, Hong L, Yorke E, Tang X, Mechalakos JG, Zhang P, Cerviño LI, Powell S, Berry SL. Reproducibility of chestwall and heart position using surface-guided versus RPM-guided DIBH radiotherapy for left breast cancer. J Appl Clin Med Phys 2022; 24:e13755. [PMID: 35993318 PMCID: PMC9859984 DOI: 10.1002/acm2.13755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/27/2022] [Accepted: 08/26/2021] [Indexed: 01/27/2023] Open
Abstract
This study compared the reproducibility of chestwall and heart position using surface-guided versus RPM (real-time position management)-guided deep inspiration breath hold (DIBH) radiotherapy for left sided breast cancer. Forty DIBH patients under either surface-guided radiotherapy (SGRT) or RPM guidance were studied. For patients treated with tangential fields, reproducibility was measured as the displacements in central lung distance (CLD) and heart shadow to field edge distance (HFD) between pretreatment MV (megavoltage) images and planning DRRs (digitally reconstructed radiographs). For patients treated with volumetric modulated arc therapy (VMAT), sternum to isocenter (ISO) distance (StID), spine to rib edge distance (SpRD), and heart shadow to central axis (CAX) distance (HCD) between pretreatment kV images and planning DRRs were measured. These displacements were compared between SGRT and RPM-guided DIBH. In tangential patients, the mean absolute displacements of SGRT versus RPM guidance were 0.19 versus 0.23 cm in CLD, and 0.33 versus 0.62 cm in HFD. With respect to planning DRR, heart appeared closer to the field edge by 0.04 cm with surface imaging versus 0.62 cm with RPM. In VMAT patients, the displacements of surface imaging versus RPM guidance were 0.21 versus 0.15 cm in StID, 0.24 versus 0.19 cm in SpRD, and 0.72 versus 0.41 cm in HCD. Heart appeared 0.41 cm further away from CAX with surface imaging, whereas 0.10 cm closer to field CAX with RPM. None of the differences between surface imaging and RPM guidance was statistically significant. In conclusion, the displacements of chestwall were small and were comparable with SGRT- or RPM-guided DIBH. The position deviations of heart were larger than those of chestwall with SGRT or RPM. Although none of the differences between SGRT and RPM guidance were statistically significant, there was a trend that the position deviations of heart were smaller and more favorable with SGRT than with RPM guidance in tangential patients.
Collapse
Affiliation(s)
- Wei Lu
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Guang Li
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Linda Hong
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Ellen Yorke
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Xiaoli Tang
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - James G. Mechalakos
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Pengpeng Zhang
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Laura I. Cerviño
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Simon Powell
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Sean L. Berry
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| |
Collapse
|
6
|
Errahmani MY, Locquet M, Spoor D, Jimenez G, Camilleri J, Bernier MO, Broggio D, Monceau V, Ferrières J, Thariat J, Boveda S, Kirova Y, Loap P, Langendijk JA, Crijns A, Jacob S. Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control Study. Front Oncol 2022; 12:892882. [PMID: 35860581 PMCID: PMC9289188 DOI: 10.3389/fonc.2022.892882] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/02/2022] [Indexed: 12/25/2022] Open
Abstract
Background Previous studies suggested that radiation therapy (RT) for breast cancer (BC) can induce cardiac arrhythmias and conduction disorders. However, the association with mean heart dose and specific cardiac substructures doses was less studied. Materials and Methods We conducted a nested case–control study based on French BC patients, enrolled in the European MEDIRAD-BRACE study (https://clinicaltrials.gov, Identifier: NCT03211442), who underwent three-dimensional conformal radiation therapy (3D-CRT) between 2009 and 2013 and were retrospectively followed until 2019. Cases were incident cases of cardiac arrhythmia. Controls without arrhythmia were selected with propensity-scored matching by age, duration of follow-up, chemotherapy, hypertension, and diabetes (ratio 1:4 or 5). Doses to the whole heart (WH), left and right atria (LA and RA), and left and right ventricles (LV and RV) were obtained after delineation with multi-atlas-based automatic segmentation. Results The study included 116 patients (21 cases and 95 controls). Mean age at RT was 64 ± 10 years, mean follow-up was 7.0 ± 1.3 years, and mean interval from RT to arrhythmia was 4.3 ± 2.1 years. None of the results on association between arrhythmia and cardiac doses reached statistical significance. However, the proportion of right-sided BC was higher among patients with arrhythmia than among controls (57% vs. 51%, OR = 1.18, p = 0.73). Neither mean WH dose, nor LV, RV, and LA doses were associated with an increased risk of arrhythmia (OR = 1.00, p > 0.90). In contrast, the RA dose was slightly higher for cases compared to controls [interquartile range (0.61–1.46 Gy) vs. (0.49–1.31 Gy), p = 0.44], and a non-significant trend toward a potentially higher risk of arrhythmia with increasing RA dose was observed (OR = 1.19, p = 0.60). Subanalysis according to BC laterality showed that the association with RA dose was reinforced specifically for left-sided BC (OR = 1.76, p = 0.75), while for right-sided BC, the ratio of mean RA/WH doses may better predict arrhythmia (OR = 2.39, p = 0.35). Conclusion Despite non-significant results, our exploratory investigation on BC patients treated with RT is the first study to suggest that right-sided BC patients and the right atrium irradiation may require special attention regarding the risk of cardiac arrhythmia and conduction disorders. Further studies are needed to expand on this topic.
Collapse
Affiliation(s)
- Mohamed Yassir Errahmani
- Laboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France
- University Paris-Saclay, Gif-sur-Yvette, France
| | - Médéa Locquet
- Laboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France
| | - Daan Spoor
- Department of Radiation Oncology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
| | - Gaelle Jimenez
- Department of Radiation Oncology (Oncorad), Clinique Pasteur, Toulouse, France
| | - Jérémy Camilleri
- Department of Radiation Oncology (Oncorad), Clinique Pasteur, Toulouse, France
| | - Marie-Odile Bernier
- Laboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France
| | - David Broggio
- Department of Dosimetry, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France
| | - Virginie Monceau
- Laboratory of Radiotoxicology and Radiobiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France
| | - Jean Ferrières
- Department of Cardiology and INSERM UMR 1295, Rangueil University Hospital, Toulouse, France
| | - Juliette Thariat
- Department of Radiotherapy, Centre de Lutte Contre le Cancer A. Baclesse, University of Caen Normandie, Caen, France
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Johannes A. Langendijk
- Department of Radiation Oncology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
| | - Anne Crijns
- Department of Radiation Oncology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
| | - Sophie Jacob
- Laboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France
- *Correspondence: Sophie Jacob,
| |
Collapse
|
7
|
Schröder C, Kirschke S, Blank E, Rohrberg S, Förster R, Buchali A. Deep inspiration breath-hold for patients with left-sided breast cancer - A one-fits-all approach? A prospective analysis of patient selection using dosimetrical and practical aspects. Br J Radiol 2022; 95:20210295. [PMID: 34111954 PMCID: PMC10996328 DOI: 10.1259/bjr.20210295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To prospectively analyze the feasibility of an algorithm for patient preparation, treatment planning, and selection for deep inspiration breath-hold (DIBH) treatment of left-sided breast cancer. METHODS From February 2017 to July 2019, 135 patients with left-sided breast cancer were selected and prepared for radiotherapy in DIBH. 99 received radiotherapy for the breast alone and 36 for the breast including the lymphatic drainage (RNI). Treatment plans DIBH and free breathing (FB) were calculated. Dosimetrical analyses were performed, and criteria were defined to assess whether a patient would dosimetrically profit from DIBH. RESULTS Of the 135 patients, 97 received a DIBH planning CT and 72 were selected for treatment in DIBH according to predefined criteria. When using DIBH, there was a mean reduction of the DmeanHeart of 2.8 Gy and DmeanLAD of 4.2 Gy. seven patients did not benefit from DIBH regarding DmeanHeart, 23 regarding DmeanLAD. For the left lung, the V20Gy was reduced by 4.9%, the V30Gy by 2.7% with 15 and 29 patients not benefiting from DIBH, respectively. In the 25 patients treated in FB, the benefit of DIBH would have been lower than for patients treated with DIBH (ΔDmeanHeart0.7 Gy vs 3.4 Gy). CONCLUSION Dosimetrically, DIBH is no "one-fits-all" approach. However, there is a statistically significant benefit when looking at a larger patient population. DIBH should be used for treatment of left-sided breast cancer in patients fit for DIBH. ADVANCES IN KNOWLEDGE This analysis offers a well-designed dosimetrical analysis in patients treated with DIBH radiotherapy in an "every day" cohort.
Collapse
Affiliation(s)
- Christina Schröder
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
- Institute of Radiation Oncology, Cantonal Hospital Winterthur
(KSW), Brauerstrasse 15, 8401
Winterthur, Switzerland
| | - Sebastian Kirschke
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
| | - Eyck Blank
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
| | - Sophia Rohrberg
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
| | - Robert Förster
- Institute of Radiation Oncology, Cantonal Hospital Winterthur
(KSW), Brauerstrasse 15, 8401
Winterthur, Switzerland
- Medical Faculty, University of Zurich (UZH), Pestalozzistrasse
3/5, 8091 Zurich,
Switzerland
| | - André Buchali
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
- Medizinische Hochschule Theodor Fontane
Brandenburg, Neuruppin,
Germany
| |
Collapse
|
8
|
Loap P, Orlandi E, De Marzi L, Vitolo V, Barcellini A, Iannalfi A, Dendale R, Kirova Y, Mirandola A. Cardiotoxicity model-based patient selection for Hodgkin lymphoma proton therapy. Acta Oncol 2022; 61:979-986. [PMID: 35668710 DOI: 10.1080/0284186x.2022.2084639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Hodgkin lymphoma (HL) is a highly curable hematological malignancy. Consolidation radiation therapy techniques have made significant progresses to improve organ-at-risk sparing in order to reduce late radiation-induced toxicity. Recent technical breakthroughs notably include intensity modulated proton therapy (IMPT), which has demonstrated a major dosimetric benefit at the cardiac level for mediastinal HL patients. However, its implementation in clinical practice is still challenging, notably due to the limited access to proton therapy facilities. In this context, the purpose of this study was to estimate the benefit of IMPT for HL proton therapy for diverse cardiac adverse events and to propose a general frame for mediastinal HL patient selection strategy for IMPT based on cardiotoxicity reduction, patient clinical factors, and IMPT treatment availability. MATERIAL AND METHODS This retrospective dosimetric study included 30 mediastinal HL patients treated with VMAT. IMPT plans were generated on the initial simulation scans. Dose to the heart, to the left ventricle and to the valves were retrieved to calculate the relative risk (RR) of ischemic heart disease (IHD), congestive heart failure (CHF) and valvular disease (VD). Composite relative risk reduction (cRRR) of late cardiotoxicity, between VMAT and IMPT, were calculated as the weighted mean of relative risk reduction for IHD, CHF and VD, calculated across a wide range of cardiovascular risk factor combinations. The proportion of mediastinal HL patients who could benefit from IMPT was estimated in European countries, based on the country population and on the number of active gantries, to propose country-specific cRRR thresholds for patient selection. RESULTS Compared with VMAT, IMPT significantly reduced average mean doses to the heart (2.36 Gy vs 0.99 Gy, p < 0.01), to the left ventricle (0.67 Gy vs 0.03, p < 0.01) and to the valves (1.29 Gy vs. 0.06, p < 0.01). For a HL patient without cardiovascular risk factor other than anthracycline-based chemotherapy, the relative risks of late cardiovascular complications were significantly lower after IMPT compared with VMAT for ischemic heart disease (1.07 vs 1.17, p < 0.01), for congestive heart failure (2.84 vs. 3.00, p < 0.01), and for valvular disease (1.01 vs. 1.06, p < 0.01). The median cRRR of cardiovascular adverse events with IMPT was 4.8%, ranging between 0.1% and 30.5%, depending on the extent of radiation fields and on the considered cardiovascular risk factors. The estimated proportion of HL patients currently treatable with IMPT in European countries with proton therapy facilities ranged between 8.0% and 100% depending on the country, corresponding to cRRR thresholds ranging from 24.0% to 0.0%. CONCLUSION While a statistically significant clinical benefit is theoretically expected for ischemic heart disease, cardiac heart failure and valvular disease for mediastinal HL patients with IMPT, the overall cardiotoxicity risk reduction is notable only for a minority of patients. In the context of limited IMPT availability, this study proposed a general model-based selection approach for mediastinal HL patient based on calculated cardiotoxicity reduction, taking into consideration patient clinical characteristics and IMPT facility availability.
Collapse
Affiliation(s)
- Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France.,Centre de Protonthérapie (CPO), Institut Curie, Orsay, France.,Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Ester Orlandi
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Ludovic De Marzi
- Department of Radiation Oncology, Institut Curie, Paris, France.,Centre de Protonthérapie (CPO), Institut Curie, Orsay, France
| | - Viviana Vitolo
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Amelia Barcellini
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Alberto Iannalfi
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Rémi Dendale
- Department of Radiation Oncology, Institut Curie, Paris, France.,Centre de Protonthérapie (CPO), Institut Curie, Orsay, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France.,Centre de Protonthérapie (CPO), Institut Curie, Orsay, France
| | - Alfredo Mirandola
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| |
Collapse
|
9
|
Increased cardiac uptake of (18F)-fluorodeoxyglucose incidentally detected on positron emission tomography after left breast irradiation: How to interpret? Cancer Radiother 2022; 26:724-729. [DOI: 10.1016/j.canrad.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/13/2021] [Accepted: 10/29/2021] [Indexed: 12/13/2022]
|
10
|
Loap P, De Marzi L, Almeida CE, Barcellini A, Bradley J, de Santis MC, Dendale R, Jimenez R, Orlandi E, Kirova Y. Hadrontherapy techniques for breast cancer. Crit Rev Oncol Hematol 2021; 169:103574. [PMID: 34958916 DOI: 10.1016/j.critrevonc.2021.103574] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 12/31/2022] Open
Abstract
Radiotherapy plays a key role in breast cancer treatment, and recent technical advances have been made to improve the therapeutic window by limiting the risk of radiation-induced toxicity or by increasing tumor control. Hadrontherapy is a form a radiotherapy relying on particle beams; compared with photon beams, particle beams have specific physical, radiobiological and immunological properties, which can be valuable in diverse clinical situations. To date, available hadrontherapy techniques for breast cancer irradiation include proton therapy, carbon ion radiation therapy, fast neutron therapy and boron neutron capture therapy. This review analyzes the current rationale and level of evidence for each hadrontherapy technique for breast cancer.
Collapse
Affiliation(s)
- Pierre Loap
- Proton Therapy Center, Institut Curie, Orsay, France.
| | | | - Carlos Eduardo Almeida
- Department of Radiological Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Julie Bradley
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, United States
| | | | - Remi Dendale
- Proton Therapy Center, Institut Curie, Orsay, France
| | - Rachel Jimenez
- Massachusetts General Hospital, Boston, MA, United States
| | - Ester Orlandi
- National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Youlia Kirova
- Proton Therapy Center, Institut Curie, Orsay, France
| |
Collapse
|
11
|
Mutter RW, Choi JI, Jimenez RB, Kirova YM, Fagundes M, Haffty BG, Amos RA, Bradley JA, Chen PY, Ding X, Carr AM, Taylor LM, Pankuch M, Vega RBM, Ho AY, Nyström PW, McGee LA, Urbanic JJ, Cahlon O, Maduro JH, MacDonald SM. Proton Therapy for Breast Cancer: A Consensus Statement From the Particle Therapy Cooperative Group Breast Cancer Subcommittee. Int J Radiat Oncol Biol Phys 2021; 111:337-359. [PMID: 34048815 PMCID: PMC8416711 DOI: 10.1016/j.ijrobp.2021.05.110] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 12/23/2022]
Abstract
Radiation therapy plays an important role in the multidisciplinary management of breast cancer. Recent years have seen improvements in breast cancer survival and a greater appreciation of potential long-term morbidity associated with the dose and volume of irradiated organs. Proton therapy reduces the dose to nontarget structures while optimizing target coverage. However, there remain additional financial costs associated with proton therapy, despite reductions over time, and studies have yet to demonstrate that protons improve upon the treatment outcomes achieved with photon radiation therapy. There remains considerable heterogeneity in proton patient selection and techniques, and the rapid technological advances in the field have the potential to affect evidence evaluation, given the long latency period for breast cancer radiation therapy recurrence and late effects. In this consensus statement, we assess the data available to the radiation oncology community of proton therapy for breast cancer, provide expert consensus recommendations on indications and technique, and highlight ongoing trials' cost-effectiveness analyses and key areas for future research.
Collapse
Affiliation(s)
- Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - J Isabelle Choi
- Department of Radiation Oncology, New York Proton Center and Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Marcio Fagundes
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - Bruce G Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Richard A Amos
- Proton and Advanced Radiotherapy Group, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida
| | - Peter Y Chen
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Antoinette M Carr
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Leslie M Taylor
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Mark Pankuch
- Department of Radiation Oncology, Northwestern Medicine Proton Center, Warrenville, Illinois
| | | | - Alice Y Ho
- Department of Radiation Oncology, New York Proton Center and Memorial Sloan Kettering Cancer Center, New York, New York
| | - Petra Witt Nyström
- The Skandion Clinic, Uppsala, Sweden and the Danish Centre for Particle Therapy, Aarhus, Denmark
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
| | - James J Urbanic
- Department of Radiation Medicine and Applied Sciences, UC San Diego Health, Encinitas, California
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John H Maduro
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
12
|
Spoor DS, Sijtsema NM, van den Bogaard VAB, van der Schaaf A, Brouwer CL, Ta BDP, Vliegenthart R, Kierkels RGJ, Langendijk JA, Maduro JH, Peters FBJ, Crijns APG. Validation of separate multi-atlases for auto segmentation of cardiac substructures in CT-scans acquired in deep inspiration breath hold and free breathing. Radiother Oncol 2021; 163:46-54. [PMID: 34343547 DOI: 10.1016/j.radonc.2021.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Developing NTCP-models for cardiac complications after breast cancer (BC) radiotherapy requires cardiac dose-volume parameters for many patients. These can be obtained by using multi-atlas based automatic segmentation (MABAS) of cardiac structures in planning CT scans. We investigated the relevance of separate multi-atlases for deep inspiration breath hold (DIBH) and free breathing (FB) CT scans. MATERIALS AND METHODS BC patients scanned in DIBH (n = 10) and in FB (n = 20) were selected to create separate multi-atlases consisting of expert panel delineations of the whole heart, atria and ventricles. The accuracy of atlas-generated contours was validated with expert delineations in independent datasets (n = 10 for DIBH and FB) and reported as Dice coefficients, contour distances and dose-volume differences in relation to interobserver variability of manual contours. Dependency of MABAS contouring accuracy on breathing technique was assessed by validation of a FB atlas in DIBH patients and vice versa (cross-validation). RESULTS For all structures the FB and DIBH atlases resulted in Dice coefficients with their respective reference contours ≥ 0.8 and average contour distances ≤ 2 mm smaller than slice thickness of (CTs). No significant differences were found for dose-volume parameters in volumes receiving relevant dose levels (WH, LV and RV). Accuracy of the DIBH atlas was at least similar to, and for the ventricles better than, the interobserver variation in manual delineation. Cross-validation between breathing techniques showed a reduced MABAS performance. CONCLUSION Multi-atlas accuracy was at least similar to interobserver delineation variation. Separate atlases for scans made in DIBH and FB could benefit atlas performance because accuracy depends on breathing technique.
Collapse
Affiliation(s)
- Daan S Spoor
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
| | - Veerle A B van den Bogaard
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Charlotte L Brouwer
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Bastiaan D P Ta
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Roel G J Kierkels
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - John H Maduro
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Femke B J Peters
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Anne P G Crijns
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| |
Collapse
|
13
|
Loap P, Loirat D, Berger F, Cao K, Ricci F, Jochem A, Raizonville L, Mosseri V, Fourquet A, Kirova Y. Combination of Olaparib with radiotherapy for triple-negative breast cancers: One-year toxicity report of the RADIOPARP Phase I trial. Int J Cancer 2021; 149:1828-1832. [PMID: 34270809 DOI: 10.1002/ijc.33737] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/05/2021] [Accepted: 07/07/2021] [Indexed: 12/16/2022]
Abstract
Triple-negative breast cancer (TNBC) cells are sensitive to PARP1 inhibitors in vitro. The combination of Olaparib and radiotherapy for TNBC is currently evaluated in the Phase I RADIOPARP trial. RADIOPARP is a monocentric prospective open-label Phase I dose-escalation trial evaluating the combination of breast radiotherapy and Olaparib in TNBC patients with inflammatory, locoregionally advanced or metastatic disease, or with residual disease after neoadjuvant chemotherapy. Olaparib was orally given at increasing dose levels (50, 100, 150 or 200 mg twice a day [BID]); radiotherapy consisted of 50 Gy to the breast or chest wall with or without lymph node irradiation. Twenty-four TNBC patients were enrolled between September 2017 and November 2019. Olaparib was escalated to 200 mg BID without dose-limiting toxicities. At 1-year follow-up, no treatment-related grade ≥3 toxicity was observed. One patient (4.2%) had persistent grade 2 adverse events (breast pain, fibrosis and deformity). There was no cardiac, pulmonary or digestive toxicity related to treatment. The 1-year follow-up report of the RADIOPARP Phase I trial, evaluating Olaparib associated with breast radiotherapy in TNBC patients, consequently demonstrated an excellent toxicity profile of this combination with few low-grade adverse events.
Collapse
Affiliation(s)
- Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Delphine Loirat
- Department of Medical Oncology, Institut Curie, Paris, France
| | | | - Kim Cao
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Francesco Ricci
- Department of Clinical Investigations, Institut Curie, Paris, France
| | - Anne Jochem
- Department of Biostatistics, Institut Curie, Paris, France
| | | | | | - Alain Fourquet
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| |
Collapse
|
14
|
Yang EH, Marmagkiolis K, Balanescu DV, Hakeem A, Donisan T, Finch W, Virmani R, Herrman J, Cilingiroglu M, Grines CL, Toutouzas K, Iliescu C. Radiation-Induced Vascular Disease-A State-of-the-Art Review. Front Cardiovasc Med 2021; 8:652761. [PMID: 33860001 PMCID: PMC8042773 DOI: 10.3389/fcvm.2021.652761] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/05/2021] [Indexed: 12/14/2022] Open
Abstract
Since the 1990s, there has been a steady increase in the number of cancer survivors to an estimated 17 million in 2019 in the US alone. Radiation therapy today is applied to a variety of malignancies and over 50% of cancer patients. The effects of ionizing radiation on cardiac structure and function, so-called radiation-induced heart disease (RIHD), have been extensively studied. We review the available published data on the mechanisms and manifestations of RIHD, with a focus on vascular disease, as well as proposed strategies for its prevention, screening, diagnosis, and management.
Collapse
Affiliation(s)
- Eric H Yang
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Dinu V Balanescu
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States
| | - Abdul Hakeem
- Division of Cardiovascular Diseases & Hypertension, Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Teodora Donisan
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States
| | - William Finch
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Renu Virmani
- CVPath Institute, Gaithersburg, MD, United States
| | - Joerg Herrman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,University of Hawaii John Burns School of Medicine, Honolulu, HI, United States
| | - Cindy L Grines
- Cardiovascular Institute, Northside Hospital, Atlanta, GA, United States
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| |
Collapse
|
15
|
Loap P, Tkatchenko N, Nicolas E, Fourquet A, Kirova Y. Optimization and auto-segmentation of a high risk cardiac zone for heart sparing in breast cancer radiotherapy. Radiother Oncol 2020; 153:146-154. [DOI: 10.1016/j.radonc.2020.09.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 01/06/2023]
|