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Wittmann A, Bartels A, Alkotub B, Bauer L, Kafshgari MH, Multhoff G. Chronic inflammatory effects of in vivo irradiation of the murine heart on endothelial cells mimic mechanisms involved in atherosclerosis. Strahlenther Onkol 2023; 199:1214-1224. [PMID: 37658922 PMCID: PMC10673733 DOI: 10.1007/s00066-023-02130-5] [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: 05/12/2023] [Accepted: 07/16/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Radiotherapy is a major pillar in the treatment of solid tumors including breast cancer. However, epidemiological studies have revealed an increase in cardiac diseases approximately a decade after exposure of the thorax to ionizing irradiation, which might be related to vascular inflammation. Therefore, chronic inflammatory effects were examined in primary heart and lung endothelial cells (ECs) of mice after local heart irradiation. METHODS Long-lasting effects on primary ECs of the heart and lung were studied 20-50 weeks after local irradiation of the heart of mice (8 and 16 Gy) in vivo by multiparameter flow cytometry using antibodies directed against cell surface markers related to proliferation, stemness, lipid metabolism, and inflammation, and compared to those induced by occlusion of the left anterior descending coronary artery. RESULTS In vivo irradiation of the complete heart caused long-lasting persistent upregulation of inflammatory (HCAM, ICAM‑1, VCAM-1), proliferation (CD105), and lipid (CD36) markers on primary heart ECs and an upregulation of ICAM‑1 and VCAM‑1 on primary ECs of the partially irradiated lung lobe. An artificially induced heart infarction induces similar effects with respect to inflammatory markers, albeit in a shorter time period. CONCLUSION The long-lasting upregulation of prominent inflammatory markers on primary heart and lung ECs suggests that local heart irradiation induces chronic inflammation in the microvasculature of the heart and partially irradiated lung that leads to cardiac injury which might be related to altered lipid metabolism in the heart.
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Affiliation(s)
- Andrea Wittmann
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Center for Translational Cancer Research (TranslaTUM), School of Medicine Radiation Immuno-Oncology Group, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Anna Bartels
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Bayan Alkotub
- Institute of Biological Medical Imaging, Helmholtz-Zentrum München (HMGU), Neuherberg, Munich, Germany
| | - Lisa Bauer
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Center for Translational Cancer Research (TranslaTUM), School of Medicine Radiation Immuno-Oncology Group, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Morteza Hasanzadeh Kafshgari
- Center for Translational Cancer Research (TranslaTUM), Heinz-Nixdorf-Chair for Biomedical Electronics, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Gabriele Multhoff
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany.
- Center for Translational Cancer Research (TranslaTUM), School of Medicine Radiation Immuno-Oncology Group, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaningerstr. 22, 81675, Munich, Germany.
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Van Parijs H, Cecilia-Joseph E, Gorobets O, Storme G, Adriaenssens N, Heyndrickx B, Verschraegen C, Nguyen NP, De Ridder M, Vinh-Hung V. Lung-heart toxicity in a randomized clinical trial of hypofractionated image guided radiation therapy for breast cancer. Front Oncol 2023; 13:1211544. [PMID: 38053657 PMCID: PMC10694354 DOI: 10.3389/fonc.2023.1211544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
Background TomoBreast hypothesized that hypofractionated 15 fractions/3 weeks image-guided radiation therapy (H-IGRT) can reduce lung-heart toxicity, as compared with normofractionated 25-33 fractions/5-7 weeks conventional radiation therapy (CRT). Methods In a single center 123 women with stage I-II operated breast cancer were randomized to receive CRT (N=64) or H-IGRT (N=59). The primary endpoint used a composite four-items measure of the time to 10% alteration in any of patient-reported outcomes, physician clinical evaluation, echocardiography or lung function tests, analyzed by intention-to-treat. Results At 12 years median follow-up, overall and disease-free survivals between randomized arms were comparable, while survival time free from alteration significantly improved with H-IGRT which showed a gain of restricted mean survival time of 1.46 years over CRT, P=0.041. Discussion The finding establishes TomoBreast as a proof-of-concept that hypofractionated image-guided radiation-therapy can improve the sparing of lung-heart function in breast cancer adjuvant therapy without loss in disease-free survival. Hypofractionation is advantageous, conditional on using an advanced radiation technique. Multicenter validation may be warranted. Trial registration https://clinicaltrials.gov/ct2/show/NCT00459628. Registered 12 April 2007.
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Affiliation(s)
- Hilde Van Parijs
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Elsa Cecilia-Joseph
- Department of Oral Surgery, University Hospital of Martinique, Fort-de-France, France
| | - Olena Gorobets
- Department of Oral Surgery, University Hospital of Martinique, Fort-de-France, France
| | - Guy Storme
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Adriaenssens
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Claire Verschraegen
- Department of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC, United States
- Department of Clinical Research, International Geriatric Radiotherapy Group, Washington, DC, United States
| | - Mark De Ridder
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Vincent Vinh-Hung
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Clinical Research, International Geriatric Radiotherapy Group, Washington, DC, United States
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
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Ippolito E, Greco C, Marrocco M, Rinaldi CG, Fiore M, Trodella LE, D’Angelillo RM, Ramella S. Preventing Cardiotoxicity in Personalized Breast Irradiation. Cancers (Basel) 2023; 15:5153. [PMID: 37958327 PMCID: PMC10650895 DOI: 10.3390/cancers15215153] [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: 09/25/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND This study aims to assess the benefit of a deep inspiration breath hold (DIBH) over the standard irradiation technique, and eventually to identify anatomical and/or treatment preplanning characteristics correlated with the LAD dose. METHODS Patients with left-sided breast cancer undergoing whole breast radiotherapy with DIBH were analyzed. All patients included in the analysis had plans in DIBH and free-breathing (FB). Receiving operating characteristics (ROC analysis) were used to identify the cut-off point of parameters to predict the LAD maximum dose > 10 Gy and LAD mean dose > 4 Gy, and the areas under the curve (AUCs) were computed. Post-test probability has been performed to evaluate the effect of parameters' combination. RESULTS One hundred ninety-seven patients were analyzed. The LAD dose was significantly reduced in DIBH plans with the maximum and mean dose reduced by 31.7% (mean value 3.5 Gy vs. 4.8 Gy, p ≤ 0.001) and 28.1% (mean value 8.2 Gy vs. 12.8 Gy, p ≤ 0.001) in DIBH plans compared to FB plans. The strongest predictor of the LAD dose (maximum > 10 Gy and mean > 4 Gy) was the minimum distance of LAD from tangent open fields. Other parameters were lung volume and heart volume (LAD Dmax > 10 Gy) and lung volume, heart volume, and breast separation (LAD Dmean > 4 Gy). CONCLUSION The dosimetric advantage of DIBH is clear in all patients and DIBH should always be preferred.
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Affiliation(s)
- Edy Ippolito
- Radiation Oncology, Campus Bio-Medico University Rome, 00128 Rome, Italy; (E.I.); (C.G.); (M.M.); (M.F.); (L.E.T.); (S.R.)
| | - Carlo Greco
- Radiation Oncology, Campus Bio-Medico University Rome, 00128 Rome, Italy; (E.I.); (C.G.); (M.M.); (M.F.); (L.E.T.); (S.R.)
| | - Maristella Marrocco
- Radiation Oncology, Campus Bio-Medico University Rome, 00128 Rome, Italy; (E.I.); (C.G.); (M.M.); (M.F.); (L.E.T.); (S.R.)
| | - Carla Germana Rinaldi
- Radiotherapy, Department of Oncoematology, Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University Rome, 00128 Rome, Italy; (E.I.); (C.G.); (M.M.); (M.F.); (L.E.T.); (S.R.)
| | - Luca Eolo Trodella
- Radiation Oncology, Campus Bio-Medico University Rome, 00128 Rome, Italy; (E.I.); (C.G.); (M.M.); (M.F.); (L.E.T.); (S.R.)
| | - Rolando Maria D’Angelillo
- Radiotherapy, Department of Oncoematology, Policlinico Tor Vergata, 00133 Rome, Italy;
- Radiation Oncology, Università degli Studi di Roma Tor Vergata, 00133 Rome, Italy
| | - Sara Ramella
- Radiation Oncology, Campus Bio-Medico University Rome, 00128 Rome, Italy; (E.I.); (C.G.); (M.M.); (M.F.); (L.E.T.); (S.R.)
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Chau OW, El-Sherif O, Mouawad M, Sykes JM, Butler J, Biernaski H, deKemp R, Renaud J, Wisenberg G, Prato FS, Gaede S. Changes in myocardial blood flow in a canine model of left sided breast cancer radiotherapy. PLoS One 2023; 18:e0291854. [PMID: 37768966 PMCID: PMC10538714 DOI: 10.1371/journal.pone.0291854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Left-sided breast cancer patients receiving adjuvant radiotherapy are at risk for coronary artery disease, and/or radiation mediated effects on the microvasculature. Previously our laboratory demonstrated in canines with hybrid 18FDG/PET a progressive global inflammatory response during the initial one year following treatment. In this study, the objective is to evaluate corresponding changes in perfusion, in the same cohort, where resting myocardial blood flow (MBF) was quantitatively measured. METHOD In five canines, Ammonia PET (13NH3) derived MBF was measured at baseline, 1-week, 1, 3, 6 and 12-months after cardiac external beam irradiation. MBF measurements were correlated with concurrent 18FDG uptake. Simultaneously MBF was measured using the dual bolus MRI method. RESULTS MBF was significantly increased at all time points, in comparison to baseline, except at 3-months. This was seen globally throughout the entire myocardium independent of the coronary artery territories. MBF showed a modest significant correlation with 18FDG activity for the entire myocardium (r = 0.51, p = 0.005) including the LAD (r = 0.49, p = 0.008) and LCX (r = 0.47, p = 0.013) coronary artery territories. CONCLUSION In this canine model of radiotherapy for left-sided breast cancer, resting MBF increases as early as 1-week and persists for up to one year except at 3-months. This pattern is similar to that of 18FDG uptake. A possible interpretation is that the increase in resting MBF is a response to myocardial inflammation.
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Affiliation(s)
- Oi-Wai Chau
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Omar El-Sherif
- Mayo Clinic, Rochester, Minnesota, United States of America
| | - Matthew Mouawad
- Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Jane M. Sykes
- Thames Valley Veterinary Services, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - John Butler
- Lawson Health Research Institute, London, Ontario, Canada
| | | | - Robert deKemp
- National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jennifer Renaud
- Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada
| | - Gerald Wisenberg
- Lawson Health Research Institute, London, Ontario, Canada
- Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada
| | - Frank S. Prato
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Stewart Gaede
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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Wang S, Tsai W, Lin K, Yu C, Yang S, Shueng P, Wu Y, Hsu C, Wu T. Integrating subvolume dose and myocardial perfusion imaging parameters to assess the impact of radiation therapy on heart function in breast cancer patients: A comparative analysis between left- and right-sided breast cancer. Thorac Cancer 2023; 14:2696-2706. [PMID: 37553772 PMCID: PMC10493477 DOI: 10.1111/1759-7714.15056] [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: 04/14/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND This study aimed to utilize an innovative method of integrating the 20 subvolume dose of left ventricle and the Tl-201 single photon emission computed tomography (SPECT) with myocardial perfusion imaging (MPI) parameters in patients with left- and right-sided breast cancer after radiation therapy. METHODS Female patients with breast cancer underwent SPECT MPI before commencing radiotherapy and 12 months later were enrolled from January 2014 to December 2018. The images of CT simulation and SPECT MPI were integrated into the treatment planning system. The differences of doses and parameters of MPI in all cardiac subvolumes between left- and right-sided breast cancer patients were analyzed. RESULTS Patients with left-sided breast cancer (n = 61) received a higher radiation dose to the heart, left ventricular, and its territories and subvolumes, compared to patients with right-sided breast cancer (n = 19). The 20-segment analysis also showed statistically significant disparities in the average radiation doses received by the two groups. In different coronary artery territories, the end-diastolic perfusion and end-systolic perfusion showed a decrease in both sides, with no significant differences. However, the wall motion and wall thickening showed a significant decline in subregions within the left- and right-sided coronary artery territories. CONCLUSION This study demonstrates an innovative integrated method combining the left ventricular 20 regional doses with SPECT MPI which shows that left-sided breast cancer patients receive a higher subvolume dose than right-sided breast cancer patients. Further research is needed to confirm the potential impact on heart function after radiotherapy on both sides.
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Affiliation(s)
- Shan‐Ying Wang
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Nuclear MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Wei‐Ta Tsai
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Radiation Oncology, Dalin Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationChiayiTaiwan
| | - Kuan‐Heng Lin
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Division of Radiation Oncology, Department of RadiologyFar Eastern Memorial HospitalNew Taipei CityTaiwan
- Industrial Ph.D. Program of Biomedical Science and EngineeringNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chih‐Wei Yu
- Department of Radiation OncologyChina Medical University Hsinchu HospitalZhubei CityTaiwan
- Institute of Nuclear Engineering and ScienceNational Tsing Hua UniversityHsinchu CityTaiwan
| | - Shu‐Ya Yang
- Department of Nuclear MedicineCheng Hsin General HospitalTaipeiTaiwan
| | - Pei‐Wei Shueng
- Division of Radiation Oncology, Department of RadiologyFar Eastern Memorial HospitalNew Taipei CityTaiwan
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Yen‐Wen Wu
- Department of Nuclear MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Division of Cardiology, Cardiovascular Medical CenterFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Chen‐Xiong Hsu
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Division of Radiation Oncology, Department of RadiologyFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Tung‐Hsin Wu
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
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Leo I, Vidula M, Bisaccia G, Procopio MC, Licordari R, Perotto M, La Vecchia G, Miaris N, Bravo PE, Bucciarelli-Ducci C. The Role of Advanced Cardiovascular Imaging Modalities in Cardio-Oncology: From Early Detection to Unravelling Mechanisms of Cardiotoxicity. J Clin Med 2023; 12:4945. [PMID: 37568347 PMCID: PMC10419705 DOI: 10.3390/jcm12154945] [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: 05/15/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Advances in cancer therapies have led to a global improvement in patient survival rates. Nevertheless, the price to pay is a concomitant increase in cardiovascular (CV) morbidity and mortality in this population. Increased inflammation and disturbances of the immune system are shared by both cancer and CV diseases. Immunological effects of anti-cancer treatments occur with both conventional chemotherapy and, to a greater extent, with novel biological therapies such as immunotherapy. For these reasons, there is growing interest in the immune system and its potential role at the molecular level in determining cardiotoxicity. Early recognition of these detrimental effects could help in identifying patients at risk and improve their oncological management. Non-invasive imaging already plays a key role in evaluating baseline CV risk and in detecting even subclinical cardiac dysfunction during surveillance. The aim of this review is to highlight the role of advanced cardiovascular imaging techniques in the detection and management of cardiovascular complications related to cancer treatment.
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Affiliation(s)
- Isabella Leo
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; (I.L.)
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Mahesh Vidula
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA (P.E.B.)
- Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Giandomenico Bisaccia
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; (I.L.)
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Maria Cristina Procopio
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; (I.L.)
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Roberto Licordari
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; (I.L.)
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy
| | - Maria Perotto
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; (I.L.)
| | - Giulia La Vecchia
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; (I.L.)
- Department of Cardiovascular and Pulmonary Science, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Nikolaos Miaris
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; (I.L.)
| | - Paco E. Bravo
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA (P.E.B.)
- Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; (I.L.)
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK
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Vaidya JS, Bulsara M, Wenz F, Sperk E, Massarut S, Alvarado M, Williams NR, Brew-Graves C, Bernstein M, Holmes D, Vinante L, Pigorsch S, Lundgren S, Uhl V, Joseph D, Tobias JS. The TARGIT-A Randomized Trial: TARGIT-IORT Versus Whole Breast Radiation Therapy: Long-Term Local Control and Survival. Int J Radiat Oncol Biol Phys 2023; 115:77-82. [PMID: 35998867 DOI: 10.1016/j.ijrobp.2022.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Jayant S Vaidya
- Division of Surgery and Interventional Science, University College London, London, United Kingdom.
| | - Max Bulsara
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Biostatistics, University of Notre Dame, Fremantle, WA, Australia
| | - Frederik Wenz
- University Medical Centre Freiburg, University of Frieberg, Frieberg, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Samuele Massarut
- Department of Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Michael Alvarado
- Department of Surgery, University of California, San Francisco, California
| | | | | | | | - Dennis Holmes
- University of Southern California, John Wayne Cancer Institute & Helen Rey Breast Cancer Foundation, Los Angeles, California
| | - Lorenzo Vinante
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Steffi Pigorsch
- Department of RadioOncology and Radiotherapy, Technical University of Munich, Munich, Germany
| | - Steinar Lundgren
- Department of Oncology, St Olav's University Hospital, Trondheim, Norway
| | - Valery Uhl
- Radiation Oncology, Summit Medical Center, Oakland, California
| | - David Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Jeffrey S Tobias
- Department of Clinical Oncology, University College London Hospitals, London, United Kingdom
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8
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Retrospective Analysis for Dose Reduction to Organs at Risk with New Personalized Breast Holder (PERSBRA) in Left Breast IMRT. J Pers Med 2022; 12:jpm12091368. [PMID: 36143153 PMCID: PMC9505458 DOI: 10.3390/jpm12091368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
This study evaluated dose differences in normal organs at risk, such as the lungs, heart, left anterior descending artery (LAD), right coronary artery, left ventricle, and right breast under personalized breast holder (PERSBRA), when using intensity-modulated radiation therapy (IMRT). This study evaluated the radiation protection offered by PERSBRA in left breast cancer radiation therapy. Here, we retrospectively collected data from 24 patients with left breast cancer who underwent breast-conserving surgery as well as IMRT radiotherapy. We compared the dose differences in target coverage and organs at risk with and without PERSBRA. For target coverage, tumor prescribed dose 95% coverage, conformity index, and homogeneity index were evaluated. For organs at risk, we compared the mean heart dose, mean left ventricle dose, LAD maximum and mean dose, mean left lung receiving 20 Gy, 10 Gy, and 5 Gy of left lung volume, maximum and mean coronary artery of the right, maximum of right breast, and mean dose. Good target coverage was achieved with and without PERSBRA. When PERSBRA was used with IMRT, the mean dose of the heart decreased by 42%, the maximum dose of LAD decreased by 26.4%, and the mean dose of LAD decreased by 47.0%. The mean dose of the left ventricle decreased by 54.1%, the volume (V20) of the left lung that received 20 Gy decreased by 22.8%, the volume (V10) of the left lung that received 10 Gy decreased by 19.8%, the volume (V5) of the left lung that received 5 Gy decreased by 15.7%, and the mean dose of the left lung decreased by 23.3%. Using PERSBRA with IMRT greatly decreases the dose to organs at risk (left lung, heart, left ventricle, and LAD). This study found that PERSBRA with IMRT can achieve results similar to deep inspiration breath-hold radiotherapy (DIBH) in terms of reducing the heart radiation dose and the risk of developing heart disease in patients with left breast cancer who cannot undergo DIBH.
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9
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Stowe HB, Andruska ND, Reynoso F, Thomas M, Bergom C. Heart Sparing Radiotherapy Techniques in Breast Cancer: A Focus on Deep Inspiration Breath Hold. BREAST CANCER: TARGETS AND THERAPY 2022; 14:175-186. [PMID: 35899145 PMCID: PMC9309321 DOI: 10.2147/bctt.s282799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/04/2022] [Indexed: 11/23/2022]
Abstract
Adjuvant radiation therapy is a critical component of breast cancer management. However, when breast cancer patients receive incidental radiation to the heart, there is an increased risk of cardiac disease and mortality. This is most common for patients with left-sided breast cancers and those receiving nodal irradiation as part of treatment. The overall risk of cardiac toxicity increases 4–16% with each Gray increase in mean heart radiation dose, with data suggesting that no lower limit exists which would eliminate cardiac risk entirely. Radiation techniques have improved over time, leading to lower cardiac radiation exposure than in the past. This decline is expected to reduce the incidence of radiation-induced heart dysfunction in patients. Deep inspiration breath hold (DIBH) is one such technique that was developed to reduce the risk of cardiac death and coronary events. DIBH is a non-invasive approach that capitalizes on the natural physiology of the respiratory cycle to increase the distance between the heart and the therapeutic target throughout the course of radiation therapy. DIBH has been shown to decrease the mean incidental radiation doses to the heart and left anterior descending coronary artery by approximately 20–70%. In this review, we summarize different techniques for DIBH and discuss recent data on this technique.
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Affiliation(s)
- Hayley B Stowe
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Neal D Andruska
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Francisco Reynoso
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Maria Thomas
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardio-Oncology Center of Excellence, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Alvin J. Siteman Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Correspondence: Carmen Bergom, Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA, Email
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Polomski EAS, Antoni ML, Jukema JW, Kroep JR, Dibbets-Schneider P, Sattler MGA, de Geus-Oei LF. Nuclear medicine imaging methods of radiation-induced cardiotoxicity. Semin Nucl Med 2022; 52:597-610. [PMID: 35246310 DOI: 10.1053/j.semnuclmed.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 12/21/2022]
Abstract
Breast cancer survival is significantly improved over the past decades due to major improvements in anti-tumor therapies and the implementation of regular screening, which leads to early detection of breast cancer. Therefore, it is of utmost importance to prevent patients from long-term side effects, including radiotherapy-induced cardiotoxicity. Radiotherapy may contribute to damage of myocardial structures on the cellular level, which eventually could result in various types of cardiovascular problems, including coronary artery disease and (non-)ischemic cardiomyopathy, leading to heart failure. These cardiac complications of radiotherapy are preceded by alterations in myocardial perfusion and blood flow. Therefore, early detection of these alterations is important to prevent the progression of these pathophysiological processes. Several radionuclide imaging techniques may contribute to the early detection of these changes. Single-Photon Emission Computed Tomography (SPECT) cameras can be used to create Multigated Acquisition scans in order to assess the left ventricular systolic and diastolic function. Furthermore, SPECT cameras are used for myocardial perfusion imaging with radiopharmaceuticals such as 99mTc-sestamibi and 99mTc-tetrofosmin. Accurate quantitative measurement of myocardial blood flow (MBF), can be performed by Positron Emission Tomography (PET), as the uptake of some of the tracers used for PET-based MBF measurement almost creates a linear relationship with MBF, resulting in very accurate blood flow quantification. Furthermore, there are PET and SPECT tracers that can assess inflammation and denervation of the cardiac sympathetic nervous system. Research over the past decades has mainly focused on the long-term development of left ventricular impairment and perfusion defects. Considering laterality of the breast cancer, some early studies have shown that women irradiated for left-sided breast cancer are more prone to cardiotoxic side effects than women irradiated for right-sided breast cancer. The left-sided radiation field in these trials, which predominantly used older radiotherapy techniques without heart-sparing techniques, included a larger volume of the heart and left ventricle, leading to increased unavoidable radiation exposure to the heart due to the close proximity of the radiation treatment volume. Although radiotherapy for breast cancer exposes the heart to incidental radiation, several improvements and technical developments over the last decades resulted in continuous reduction of radiation dose and volume exposure to the heart. In addition, radiotherapy reduces loco-regional tumor recurrences and death from breast cancer and improves survival. Therefore, in the majority of patients, the benefits of radiotherapy outweigh the potential very low risk of cardiovascular adverse events after radiotherapy. This review addresses existing nuclear imaging techniques, which can be used to evaluate (long-term) effects of radiotherapy-induced mechanical cardiac dysfunction and discusses the potential use of more novel nuclear imaging techniques, which are promising in the assessment of early signs of cardiac dysfunction in selected irradiated breast cancer patients.
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Affiliation(s)
| | - Maria Louisa Antoni
- Department of Cardiology, Heart and Lung Centre, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan Wouter Jukema
- Department of Cardiology, Heart and Lung Centre, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith Rian Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Petra Dibbets-Schneider
- Department of Radiology, section Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Margriet G A Sattler
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, section Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
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11
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Verbanck S, Van Parijs H, Schuermans D, Vinh-Hung V, Storme G, Fontaine C, De Ridder M, Verellen D, Vanderhelst E, Hanon S. Lung Restriction in Breast Cancer Patients after Hypofractionated Tomotherapy and Conventional 3D Conformal Radiotherapy: a 10-year Follow-up. Int J Radiat Oncol Biol Phys 2022; 113:561-569. [DOI: 10.1016/j.ijrobp.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
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12
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Bachir B, Anouti S, Abi Jaoude J, Kayali M, Tfayli A, de Azambuja E, Poortmans P, Zeidan YH. Evaluation of Cardiotoxicity in HER-2-Positive Breast Cancer Patients Treated With Radiation Therapy and Trastuzumab. Int J Radiat Oncol Biol Phys 2022; 113:135-142. [PMID: 34986381 DOI: 10.1016/j.ijrobp.2021.12.159] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Trastuzumab is associated with cardiac dysfunction in patients with human epidermal growth factor receptor 2 (HER-2)-positive breast cancer. The current study examines the effect of radiation therapy (RT) on cardiotoxicity in this patient population. METHODS AND MATERIALS The Herceptin Adjuvant (HERA) trial is a phase 3 prospective, randomized clinical trial that established the efficacy of trastuzumab in HER-2-positive breast cancer. The current study is a retrospective analysis of 3321 trial patients treated with trastuzumab, with or without RT. Cardiac function was closely monitored over a median follow-up period of 11 years. The primary endpoint of the current study was to determine the effect of RT on left ventricular ejection fraction (LVEF) and the occurrence of cardiovascular events. RESULTS Patients were divided into 3 groups: 1270 patients received trastuzumab and left-sided RT (group 1); 1271 patients received trastuzumab and right-sided RT (group 2); and 780 patients received trastuzumab with no RT (group 3). The incidence of decline in LVEF documented by echocardiography was 9.18%, 8.99%, and 8.80%, respectively, with no significant differences among the 3 groups (P = .073). The incidence of cardiovascular events was low in all groups, with the lowest incidence noted in group 3 (0.62%) followed by group 2 (0.92%) and group 1 (1.08%) (P = .619). Univariate and multivariate competing-risks regression showed that left-sided and right-sided RT delivery did not significantly increase the risk of LVEF decline or cardiovascular events. CONCLUSIONS Our analysis of the HERA trial suggests that RT does not significantly increase the risk of cardiotoxicity in HER-2-positive breast cancer patients treated with trastuzumab. Continued monitoring of patients is needed to investigate late effects of contemporary treatments for breast cancer patients.
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Affiliation(s)
- Bachir Bachir
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Sirine Anouti
- American University of Beirut, Faculty of Health Sciences, Beirut, Lebanon
| | | | - Majd Kayali
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Arafat Tfayli
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Evandro de Azambuja
- Institut Jules Bordet and l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philip Poortmans
- Iridium Netwerk, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
| | - Youssef H Zeidan
- Lynn Cancer Institute, Baptist Health South Florida, Boca Raton, FL.
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13
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Olacak N, Hazeral Y, Hazeral B, Duran O, Güray G, Alanyali S, Haydaroğlu A. Dosimetric evaluation of different radiotherapy techniques in mastectomized left-sided breast cancer. J Cancer Res Ther 2022. [DOI: 10.4103/jcrt.jcrt_1018_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Abraham A, Sanghera KP, Gheisari F, Koumna S, Riauka T, Ghosh S, Warkentin H, Gabos Z, Chafe S, Tankel K, Huang F, Sabri S, Paterson DI, Abdulkarim B, Joseph K. Is radiation-induced cardiac toxicity reversible? Prospective evaluation of breast cancer patients enrolled in a phase-III randomized controlled trial. Int J Radiat Oncol Biol Phys 2022; 113:125-134. [DOI: 10.1016/j.ijrobp.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 12/24/2022]
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15
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Aimo A, Gimelli A. Myocardial perfusion years after radiation therapy for left-sided breast cancer: Normal or abnormal? This is the question. J Nucl Cardiol 2021; 28:1933-1935. [PMID: 31745863 DOI: 10.1007/s12350-019-01959-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, University Hospital of Pisa, Pisa, Italy
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16
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Melo MDTD, Paiva MG, Santos MVC, Rochitte CE, Moreira VDM, Saleh MH, Brandão SCS, Gallafrio CC, Goldwasser D, Gripp EDA, Piveta RB, Silva TO, Santo THCE, Ferreira WP, Salemi VMC, Cauduro SA, Barberato SH, Lopes HMC, Pena JLB, Rached HRS, Miglioranza MH, Pinheiro AC, Vrandecic BALM, Cruz CBBV, Nomura CH, Cerbino FME, Costa IBSDS, Coelho Filho OR, Carneiro ACDC, Burgos UMMC, Fernandes JL, Uellendahl M, Calado EB, Senra T, Assunção BL, Freire CMV, Martins CN, Sawamura KSS, Brito MM, Jardim MFS, Bernardes RJM, Diógenes TC, Vieira LDO, Mesquita CT, Lopes RW, Segundo Neto EMV, Rigo L, Marin VLS, Santos MJ, Grossman GB, Quagliato PC, Alcantara MLD, Teodoro JAR, Albricker ACL, Barros FS, Amaral SID, Porto CLL, Barros MVL, Santos SND, Cantisano AL, Petisco ACGP, Barbosa JEM, Veloso OCG, Spina S, Pignatelli R, Hajjar LA, Kalil Filho R, Lopes MACQ, Vieira MLC, Almeida ALC. Brazilian Position Statement on the Use Of Multimodality Imaging in Cardio-Oncology - 2021. Arq Bras Cardiol 2021; 117:845-909. [PMID: 34709307 PMCID: PMC8528353 DOI: 10.36660/abc.20200266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
| | | | | | - Carlos Eduardo Rochitte
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | | | - Mohamed Hassan Saleh
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Daniel Goldwasser
- Hospital Federal de Ipanema, Rio de Janeiro, RJ - Brasil
- Hospital Copa D'Or, Rio de Janeiro, RJ - Brasil
- Casa de Saúde São José, Rio de Janeiro, RJ - Brasil
| | - Eliza de Almeida Gripp
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro, Rio de Janeiro, RJ - Brasil
| | | | - Tonnison Oliveira Silva
- Hospital Cardio Pulmonar - Centro de Estudos em Cardiologia, Salvador, BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
| | | | | | - Vera Maria Cury Salemi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Silvio Henrique Barberato
- CardioEco Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brasil
- Quanta Diagnóstico, Curitiba, PR - Brasil
| | | | | | | | - Marcelo Haertel Miglioranza
- Instituto de Cardiologia do Rio Grande do Sul - Laboratório de Pesquisa e Inovação em Imagem Cardiovascular, Porto Alegre, RS - Brasil
- Hospital Mãe de Deus, Porto Alegre, RS - Brasil
| | | | | | | | - César Higa Nomura
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Fernanda Mello Erthal Cerbino
- Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ - Brasil
- Diagnósticos da América AS, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Juliano Lara Fernandes
- Radiologia Clínica de Campinas, Campinas, SP - Brasil
- Instituto de Ensino e Pesquisa José Michel Kalaf, Campinas, SP - Brasil
| | - Marly Uellendahl
- Diagnósticos da América AS, Rio de Janeiro, RJ - Brasil
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | - Tiago Senra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
- Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Bruna Leal Assunção
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Claudia Maria Vilas Freire
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- ECOCENTER, Belo Horizonte, MG - Brasil
| | | | - Karen Saori Shiraishi Sawamura
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
- Hospital Universitário Antônio Pedro, Rio de Janeiro, RJ - Brasil
- Instituto da Criança da Universidade de São Paulo (USP), São Paulo, SP - Brasil
| | - Márcio Miranda Brito
- Universidade Federal do Tocantins - Campus de Araguaina, Araguaina, TO - Brasil
- Hospital Municipal de Araguaina, Araguaina, TO - Brasil
| | | | | | | | | | - Claudio Tinoco Mesquita
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
- Hospital Vitória, Rio de Janeiro, RJ - Brasil
| | | | | | - Letícia Rigo
- Hospital Beneficência Portuguesa, São Paulo, SP - Brasil
| | | | | | - Gabriel Blacher Grossman
- Clínica Cardionuclear, Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | - Monica Luiza de Alcantara
- Americas Medical City, Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Americas Serviços Médicos, Rio de Janeiro, RJ - Brasil
- Rede D'Or, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Simone Nascimento Dos Santos
- Hospital Brasília - Ecocardiografia, Brasília, DF - Brasil
- Eccos Diagnóstico Cardiovascular Avançado, Brasília, DF - Brasil
| | | | | | | | | | | | - Ricardo Pignatelli
- Texas Children's Hospital, Houston, Texas - EUA
- Baylor College of Medicine, Houston, Texas - EUA
| | - Ludhmilla Abrahão Hajjar
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Roberto Kalil Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Marcelo Antônio Cartaxo Queiroga Lopes
- Hospital Alberto Urquiza Wanderley - Hemodinâmica e Cardiologia Intervencionista, João Pessoa, PB - Brasil
- Hospital Metropolitano Dom José Maria Pires, João Pessoa, PB - Brasil
- Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - André Luiz Cerqueira Almeida
- Santa Casa de Misericórdia de Feira de Santana - Cardiologia, Feira de Santana, BA - Brasil
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia, São Paulo, SP - Brasil
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17
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Jordan JH, D'Agostino RB, Ansley K, Douglas E, Melin S, Sorscher S, Vasu S, Park S, Kotak A, Romitti PA, O'Connell NS, Hundley WG, Thomas A. Myocardial Function in Premenopausal Women Treated With Ovarian Function Suppression and an Aromatase Inhibitor. JNCI Cancer Spectr 2021; 5:pkab071. [PMID: 34476341 PMCID: PMC8406435 DOI: 10.1093/jncics/pkab071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/28/2021] [Accepted: 07/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Premenopausal women with high-risk hormone receptor (HR)-positive breast cancer often receive ovarian function suppression (OFS) with aromatase inhibitor therapy; however, abrupt menopause induction, together with further decrements in estrogen exposure through aromatase inhibition, may affect cardiovascular microcirculatory function. We examined adenosine-induced changes in left ventricular (LV) myocardial T1, a potential subclinical marker of LV microcirculatory function in premenopausal women undergoing treatment for breast cancer. Methods Twenty-one premenopausal women (14 with HR-positive breast cancer receiving OFS with an aromatase inhibitor and 7 comparator women with triple-negative breast cancer [TNBC] who had completed primary systemic therapy) underwent serial resting and adenosine cardiovascular magnetic resonance imaging measurements of LV myocardial T1 and LV volumes, mass, and ejection fraction. All statistical tests were 2-sided. Results After a median of 4.0 months (range = 3.1-5.7 months), the stress to resting ratio of LV myocardial T1 declined in women with HR-positive breast cancer (−1.3%, 95% confidence interval [CI] = −3.4% to 0.7%) relative to those with TNBC (3.2%, 95% CI = −1.2% to 7.6%, P = .02). After accounting for age, LV stroke volume, LV ejection fraction, diastolic blood pressure, and breast cancer subtype women with HR-positive breast cancer experienced a blunted T1 response after adenosine relative to women with TNBC (difference = −4.7%, 95% CI = −7.3% to −2.1%, Pdifference = .002). Conclusions Over the brief interval examined, women with HR-positive breast cancer receiving OFS with an aromatase inhibitor experienced reductions in adenosine-associated changes in LV myocardial T1 relative to women who received nonhormonal therapy for TNBC. These findings suggest a possible adverse impact on LV myocardial microcirculatory function in premenopausal women with breast cancer receiving hormone deprivation therapy.
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Affiliation(s)
- Jennifer H Jordan
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Ralph B D'Agostino
- Department of Biostatistics and Data Science, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Katherine Ansley
- Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Emily Douglas
- Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Susan Melin
- Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Steven Sorscher
- Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Sujethra Vasu
- Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Sung Park
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Anuj Kotak
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Nathanial S O'Connell
- Department of Biostatistics and Data Science, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - William G Hundley
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University Health Sciences, Richmond, VA, USA
| | - Alexandra Thomas
- Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
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18
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Masannat YA, Lazaraviciute G, Garbett IK, Shivakumar N, Brownlee BV, Gagliardi T, Bromiley A, Heys SD, Sharma R. The relationship between cardiac dosimetry and tumour quadrant location in left sided whole breast and chest wall adjuvant radiotherapy. Breast Dis 2021; 41:67-74. [PMID: 34420936 DOI: 10.3233/bd-201025] [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: 11/15/2022]
Abstract
BACKGROUND Radiotherapy after breast surgery decreases locoregional recurrence and improves survival. This is not without risks from radiation exposure and could have implications in clinical practice. Our study investigates the correlation between tumour location and radiation dose to the heart. METHODS Left-sided breast cancer patients who had radiotherapy at Aberdeen Royal Infirmary in 2010 were identified. Tumour location was established from notes and imaging. Radiotherapy planning scans were reviewed, and cardiac doses calculated. The mean cardiac dose, maximum dose and volume of the heart in the field, along with V5-V40, were determined. RESULTS 40 patients had mastectomies and 118 breast conserving surgery. The median percentage of the heart in the field and the Interquartile Range was 0.59% (0.03-1.74) for all patients, with the highest for lower inner quadrant (LIQ) tumours 1.20% (0.29-2.40), followed by mastectomy 0.94% (0.02-1.82). The mean heart dose showed a higher median for mastectomies 1.59 Gy (1.00-1.94), followed by LIQ tumours 1.58 Gy (1.31-2.28), with an overall median of 1.42 Gy (1.13-1.95). The median percentage of the heart in the field, the mean cardiac dose and V5-V30 did not reach statistical significance, however, V40 and the maximum dose did. CONCLUSIONS The benefits of radiotherapy after breast cancer surgery are established, but with potential harm from cardiac exposure. Our cohort showed higher radiation exposure to the heart in patients with LIQ tumours and mastectomies but reached significance only for V40 and maximum dose. This highlights tumour location as a potentially important risk factor for cardiac exposure with breast radiotherapy.
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Affiliation(s)
- Yazan A Masannat
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK.,School of Medicine, Medical sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, Scotland, UK
| | | | - Ian K Garbett
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK
| | - Natesh Shivakumar
- School of Medicine, Medical sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, Scotland, UK
| | - Brittany V Brownlee
- School of Medicine, Medical sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, Scotland, UK
| | - Tanja Gagliardi
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK
| | - Andrew Bromiley
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK
| | - Steven D Heys
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK.,School of Medicine, Medical sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, Scotland, UK
| | - Ravi Sharma
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK
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19
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Changes on myocardial perfusion scintigraphy and contrast-enhanced cardiac magnetic resonance imaging after definitive radiotherapy in patients with lung cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim:
To determine whether myocardial perfusion scintigraphy (MPS) changes in lung cancer patients treated with radiotherapy (RT) were detectable with late gadolinium enhancement cardiac magnetic resonance imaging (LGE CMR).
Materials and methods:
Twenty-one patients with lung cancer were evaluated pre-RT and at 2 and 6 months post-RT follow-up (FU) with MPS and LGE CMR. MPS changes in the left ventricle (LV) were analysed using the semi-quantitative summed rest score method (20 segments) and the Bull’s-eye-view technique. The LGE CMR studies were analysed for visual signs of myocardial damage (fibrosis), that is, focal LGE in the LV and cardiac function parameters.
Results:
MPS changes were detected in 7/20 patients at 2 months FU and in 8/13 patients at 6 months FU. Only one patient had a new irreversible defect judged to be caused by direct irradiation. MPS changes in two cases were deemed to be caused by attenuation. All new MPS defects were minor and no corresponding myocardial damage, or any functional changes, were evident on LGE CMR.
Findings:
The extent of MPS changes at 6 months FU appeared less prominent than in previous reports. No visual signs or functional changes corresponding to myocardial damage were detected on LGE CMR. A risk for false-positive MPS changes caused by attenuation is evident.
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Misra S, Mishra A, Lal P, Srivastava R, Verma M, Senthil Kumar SK, Maria Das KJ. Cardiac dose reduction using deep inspiratory breath hold (DIBH) in radiation treatment of left sided breast cancer patients with breast conservation surgery and modified radical mastectomy. J Med Imaging Radiat Sci 2021; 52:57-67. [PMID: 33509700 DOI: 10.1016/j.jmir.2020.12.004] [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: 09/09/2020] [Revised: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Deep inspiration breath hold (DIBH) reduces heart and pulmonary doses during left-sided breast radiation therapy (RT); however, there is limited information whether the reduction in doses is similar in patients with modified radical MRM (MRM) and breast conservation surgery (BCS). The primary objective was to determine whether DIBH offers greater dosimetric reduction in cardiac doses in patients with MRM as compared to BCS with secondary objectives of documenting time consumed in counseling, simulation and planning such techniques. METHODS Thirty patients with diagnosis of left sided breast cancer underwent CT simulation both free breathing (FB) and DIBH. Patients were grouped into two cohorts: MRM (n = 20) and BCS (n = 10). 3D-conformal plans were developed and FB was compared to DIBH for entire group (n = 30) and each cohort using Wilcoxon signed-rank tests for continuous variables and McNemar's test for discrete variables. The percent relative reduction conferred by DIBH in mean heart (Dmean heart) and left anterior descending artery dose (LADmean and LADmax), heart V25,V10, V2 and ipsilateral DmeanLung,V20, V12 were compared between the two cohorts using Wilcox rank-sum testing. A two-tailed p-value ≤ 0.05 was considered statistically significant. Time consumed during FB and DIBH from patient counseling to planning was documented. RESULTS Patients undergoing BCS had comparable boost target coverage on DIBH and FB. For the overall group (n = 30), DIBH reduced Dmean heart and LAD dose, V25, V10 and V2 doses for the heart and Ipsilateral DmeanLung, V20, V12 which was statistically significant. For individual cohorts DIBH did not significantly reduce the lung (Ipsilateral DmeanLung, V20, V12) and LAD (LADmean and LADmax) doses for BCS while significant reduction in all cardiopulmonary doses was seen in MRM cohort. Despite significant reductions with DIBH in MRM, ipsilateral lung constraint of V12 < 15% was less commonly achieved in MRM (n = 11, 55%) requiring nodal radiation as compared to BCS (n = 3, 30%). Percent reduction in all cardiac and pulmonary dosimetric parameters with DIBH was similar in the MRM cohort as compared to BCS cohort. In total 73.1 ± 2.6 min was required for FB as compared to 108.1 ± 4.1 min in DIBH. CONCLUSION DIBH led to significant reduction of cardiac doses in both MRM and BCS. Reduction of lung and LAD doses were significant in MRM cohort. All cardiac constraints were met with DIBH in both cohorts, lung constraints were less frequently met in MRM cohort requiring nodal radiation.
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Affiliation(s)
- Shagun Misra
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ashutosh Mishra
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Punita Lal
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Resham Srivastava
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; Homi Bhabha Cancer Hospital, Varanasi, India
| | - Mrinalani Verma
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; King George's Medical University, Lucknow, India
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Chang S, Liu G, Zhao L, Dilworth JT, Zheng W, Jawad S, Yan D, Chen P, Stevens C, Kabolizadeh P, Li X, Ding X. Feasibility study: spot-scanning proton arc therapy (SPArc) for left-sided whole breast radiotherapy. Radiat Oncol 2020; 15:232. [PMID: 33028378 PMCID: PMC7542109 DOI: 10.1186/s13014-020-01676-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study investigated the feasibility and potential clinical benefit of utilizing a new proton treatment technique: Spot-scanning proton arc (SPArc) therapy for left-sided whole breast radiotherapy (WBRT) to further reduce radiation dose to healthy tissue and mitigate the probability of normal tissue complications compared to conventional intensity modulated proton therapy (IMPT). METHODS Eight patients diagnosed with left-sided breast cancer and treated with breast-preserving surgery followed by whole breast irradiation without regional nodal irradiation were included in this retrospective planning. Two proton treatment plans were generated for each patient: vertical intensity-modulated proton therapy used for clinical treatment (vIMPT, gantry angle 10°-30°) and SPArc for comparison purpose. Both SPArc and vIMPT plans were optimized using the robust optimization of ± 3.5% range and 5 mm setup uncertainties. Root-mean-square deviation dose (RMSD) volume histograms were used for plan robustness evaluation. All dosimetric results were evaluated based on dose-volume histograms (DVH), and the interplay effect was evaluated based on the accumulation of single-fraction 4D dynamic dose on CT50. The treatment beam delivery time was simulated based on a gantry rotation with energy-layer-switching-time (ELST) from 0.2 to 5 s. RESULTS The average D1 to the heart and LAD were reduced to 53.63 cGy and 82.25 cGy compared with vIMPT 110.38 cGy (p = 0.001) and 170.38 cGy (p = 0.001), respectively. The average V5Gy and V20Gy of ipsilateral lung was reduced to 16.77% and 3.07% compared to vIMPT 25.56% (p = 0.001) and 4.68% (p = 0.003). Skin3mm mean and maximum dose were reduced to 3999.38 cGy and 4395.63 cGy compared to vIMPT 4104.25 cGy (p = 0.039) and 4411.63 cGy (p = 0.043), respectively. A significant relative risk reduction (RNTCP = NTCPSPArc/NTCPvIMPT) for organs at risk (OARs) was obtained with SPArc ranging from 0.61 to 0.86 depending on the clinical endpoint. The RMSD volume histogram (RVH) analysis shows SPArc provided better plan robustness in OARs sparing, including the heart, LAD, ipsilateral lung, and skin. The average estimated treatment beam delivery times were comparable to vIMPT plans when the ELST is about 0.5 s. CONCLUSION SPArc technique can further reduce dose delivered to OARs and the probability of normal tissue complications in patients treated for left-sided WBRT.
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Affiliation(s)
- Sheng Chang
- Department of Radiation Oncology, Renmin Hospital, Wuhan University, Wuhan, 430060, Hubei Province, China.,Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Gang Liu
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA.,Cancer Center, Union Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, 430023, China.,School of Physics and Technology, Wuhan University, Wuhan, 430072, Hubei, China
| | - Lewei Zhao
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Joshua T Dilworth
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Weili Zheng
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Saada Jawad
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Di Yan
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Peter Chen
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Peyman Kabolizadeh
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Xiaoqiang Li
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA.
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22
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Breast size and dose to cardiac substructures in adjuvant three-dimensional conformal radiotherapy compared to tangential intensity modulated radiotherapy. Radiol Oncol 2020; 54:470-479. [PMID: 32990650 PMCID: PMC7585338 DOI: 10.2478/raon-2020-0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background The aim of the study was to quantify planned doses to the heart and specific cardiac substructures in free-breathing adjuvant three-dimensional radiation therapy (3D-CRT) and tangential intensity modulated radiotherapy (t-IMRT) for left-sided node-negative breast cancer, and to assess the differences in planned doses to organs at risk according to patients’ individual anatomy, including breast volume. Patients and methods In the study, the whole heart and cardiac substructures were delineated for 60 patients using cardiac atlas. For each patient, 3D-CRT and t-IMRT plans were generated. The prescribed dose was 42.72 Gy in 16 fractions. Patients were divided into groups with small, medium, and large clinical target volume (CTV). Calculated dose distributions were compared amongst the two techniques and the three different groups of CTV. Results Mean absorbed dose to the whole heart (MWHD) (1.9 vs. 2.1 Gy, P < 0.005), left anterior descending coronary artery mean dose (8.2 vs. 8.4 Gy, P < 0.005) and left ventricle (LV) mean dose (3.0 vs. 3.2, P < 0.005) were all significantly lower with 3D-CRT technique compared to t-IMRT. Apical (8.5 vs. 9.0, P < 0.005) and anterior LV walls (5.0 vs. 5.4 Gy, P < 0.005) received the highest mean dose (Dmean). MWHD and LV-Dmean increased with increasing CTV size regardless of the technique. Low MWHD values (< 2.5 Gy) were achieved in 44 (73.3%) and 41 (68.3%) patients for 3D-CRT and t-IMRT techniques, correspondingly. Conclusions Our study confirms a considerable range of the planned doses within the heart for adjuvant 3D-CRT or t-IMRT in node-negative breast cancer. We observed differences in heart dosimetric metrics between the three groups of CTV size, regardless of the radiotherapy planning technique.
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Song J, Tang T, Caudrelier JM, Bélec J, Chan J, Lacasse P, Aldosary G, Nair V. Dose-sparing effect of deep inspiration breath hold technique on coronary artery and left ventricle segments in treatment of breast cancer. Radiother Oncol 2020; 154:101-109. [PMID: 32950530 DOI: 10.1016/j.radonc.2020.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/21/2020] [Accepted: 09/10/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The risk of radiation-induced cardiac injury remains a challenging problem in the treatment of breast cancer. Certain cardiac structures receive higher doses than others, which results in variable frequencies of radiation-induced injuries across these structures. Radiation dose can be reduced using the deep inspiration breath hold (DIBH) technique. We aimed to investigate the dose reductions from DIBH in individual cardiac segments. MATERIALS AND METHODS A dosimetric analysis was performed on left-sided breast cancer patients who underwent breast-conserving surgery and whole breast irradiation. Radiation doses to the cardiac structures were compared between the DIBH and free-breathing (FB) techniques and the dose reductions with DIBH were correlated to the lung expansion. RESULTS For the 75 patients included in our study, DIBH effectively reduced doses to the heart, left lung, left anterior descending coronary artery (LAD) and left ventricle (LV), but the degree of dose reductions was variable across different structures. The absolute dose reductions were greatest in the distal LAD (14.4 Gy) and apical LV (12.1 Gy) segments, compared with the other LAD (middle 9.7 Gy, proximal 1.6 Gy) and LV (anterior 5.3 Gy, lateral 2.9 Gy, septal 2.0 Gy, inferior 0.2 Gy) segments. Left lung expansion was significantly correlated with the dose reductions in the LAD (Spearman's rank correlation coefficient, ρ, 0.304) and LV (ρ, 0.420) segments. CONCLUSIONS Our study demonstrates the dose-sparing effects of DIBH in various cardiac structures, especially the distal LAD and apical LV segments. The large dose reductions seen in the distal LAD and apical LV segments could potentially translate into clinical benefit of reduced cardiac toxicity, as these structures have been previously shown to receive the highest doses and are associated with radiation-induced injury.
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Affiliation(s)
- Jiheon Song
- Division of Radiation Oncology, The Ottawa Hospital, Canada.
| | - Terence Tang
- Faculty of Medicine, University of Ottawa, Canada
| | | | - Jason Bélec
- Department of Medical Physics, The Ottawa Hospital, Canada
| | - Jessica Chan
- Division of Radiation Oncology, The Ottawa Hospital, Canada
| | | | | | - Vimoj Nair
- Division of Radiation Oncology, The Ottawa Hospital, Canada
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Marques C, Schiff J, Momin F, McAllister N, Jennelle RL, Bian SX, Schechter NR, Yoo SK. Technical Challenges of Heart Avoidance for Synchronous Breast and Lung Cancers in a Postmenopausal Female: A Planning Case Report From a Safety-Net Hospital. Adv Radiat Oncol 2020; 5:1076-1082. [PMID: 33083670 PMCID: PMC7557127 DOI: 10.1016/j.adro.2020.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 03/21/2020] [Accepted: 04/20/2020] [Indexed: 11/03/2022] Open
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25
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Bisceglia I, Canale ML, Lestuzzi C, Parrini I, Russo G, Colivicchi F, Gabrielli D, Gulizia MM, Iliescu CA. Acute coronary syndromes in cancer patients. J Cardiovasc Med (Hagerstown) 2020; 21:944-952. [PMID: 32520859 DOI: 10.2459/jcm.0000000000000993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: Cardiovascular disease and cancer are responsible for the majority of deaths in the Western world. These two entities share common risk factors and their intersection will be more and more frequent in future due to general population aging and long-term cancer control. Clinical presentation, management and outcome of acute coronary syndromes (ACS) in cancer patients could differ from noncancer ones. Cancer patients were frequently excluded from clinical trials and so the paucity of data further complicates the scenario. The management of ACS in cancer patients represents a unique setting in which the risk/benefit ratio of invasive treatment should be carefully evaluated. This review focused on the available evidence of all aspects of ACS in cancer patients providing a guide to a multidisciplinary approach.
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Affiliation(s)
- Irma Bisceglia
- Servizi Cardiologici Integrati Cardiology Department, Azienda Ospedaliera San Camillo-Forlanini, Roma
| | - Maria Laura Canale
- Division of Cardiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, Lido di Camaiore
| | - Chiara Lestuzzi
- Cardiology Unit, Oncology Department, CRO National Cancer Institute, Aviano
| | - Iris Parrini
- Divisione di Cardiologia, Ospedale Mauriziano, Torino
| | - Giulia Russo
- SC Centro Cardiovascolare Ospedale Maggiore, Cardiology Department, Trieste
| | - Furio Colivicchi
- Division of Cardiology, San Filippo Neri Hospital, ASL Roma 1, Rome
| | | | | | - Cezar A Iliescu
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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26
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Clinical and Research Tools for the Study of Cardiovascular Effects of Cancer Therapy. J Cardiovasc Transl Res 2020; 13:417-430. [PMID: 32472498 DOI: 10.1007/s12265-020-10030-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/12/2020] [Indexed: 12/16/2022]
Abstract
The expansion of cancer therapeutics has paved the way for improved cancer-related outcomes. Cardiotoxicity from cancer therapy occurs in a small but significant subset of patients, is often poorly understood, and contributes to adverse outcomes at all stages of cancer treatment. Given the often-idiopathic occurrence of cardiotoxicity, novel strategies are needed for risk-stratification and early identification of cancer patients experiencing cardiotoxicity. Clinical and research tools extending from imaging to blood-based biomarkers and pluripotent stem cells are being explored as methods to study the cardiovascular impact of various cancer treatments. Here we provide an overview of tools currently available for evaluation of cardiotoxicity and highlight novel techniques in development aimed at understanding underlying pathophysiologic mechanisms.
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27
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Skyttä T, Tuohinen S, Luukkaala T, Virtanen V, Raatikainen P, Kellokumpu-Lehtinen PL. Adjuvant radiotherapy-induced cardiac changes among patients with early breast cancer: a three-year follow-up study . Acta Oncol 2019; 58:1250-1258. [PMID: 31219359 DOI: 10.1080/0284186x.2019.1630751] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: In this study, we evaluate the evolution of cardiac changes during a three-year follow-up after adjuvant breast radiotherapy (RT). Methods: Sixty patients with left-sided and 20 patients with right-sided early stage breast cancer without chemotherapy were included in this prospective study. Echocardiography and cardiac biomarkers were evaluated before, immediately after and 3 years after RT. Radiation doses to cardiac structures were calculated. Results: In echocardiography, left ventricle (LV) systolic measurements had impaired at 3 years compared to baseline: the mean global longitudinal strain (GLS) worsened from -18 ± 3 to -17 ± 3 (p = .015), LV ejection fraction from 62 ± 5% to 60 ± 4% (p = .003) and the stroke volume from 73 ± 16 mL to 69 ± 15 mL (p = .015). LV diastolic function was also negatively affected: the isovolumetric relaxation time was prolonged (p = .006) and the first peak of diastole decreased (p = .022). Likewise, left atrial (LA) measurements impaired. These changes in echocardiography were more prominent in left-sided than in right-sided patients. The concurrent aromatase inhibitor (AI) use was associated with GLS impairment. In all patients, the N-terminal pro-brain natriuretic peptide (proBNP) values were median (interquartile range) 74 (41-125) ng/L at baseline, 75 (41-125) ng/L at the end of RT and 96 (56-162) ng/L at 3 years (p < .001 from baseline to 3 years). However, proBNP did not increase in right-sided patients. Conclusion: During the 3-year follow-up after RT, negative subclinical changes in cardiac biomarkers and in LV systolic and diastolic function were observed. The measured changes were more pronounced in left-sided patients. In addition, AI use was associated with impaired cardiac systolic function.
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Affiliation(s)
- Tanja Skyttä
- Department of Oncology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Suvi Tuohinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Center, Tampere University Hospital, Tampere, Finland
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Tiina Luukkaala
- Research Innovation and Development Center, Tampere University Hospital and Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Vesa Virtanen
- Heart Center, Tampere University Hospital, Tampere, Finland
| | - Pekka Raatikainen
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Department of Oncology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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28
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Dreyfuss AD, Bravo PE, Koumenis C, Ky B. Precision Cardio-Oncology. J Nucl Med 2019; 60:443-450. [PMID: 30655328 DOI: 10.2967/jnumed.118.220137] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/29/2018] [Indexed: 01/07/2023] Open
Abstract
Modern oncologic therapies and care have resulted in a growing population of cancer survivors with comorbid, chronic health conditions. As an example, many survivors have an increased risk of cardiovascular complications secondary to cardiotoxic systemic and radiation therapies. In response, the field of cardio-oncology has emerged as an integral component of oncologic patient care, committed to the early diagnosis and treatment of adverse cardiac events. However, as current clinical management of cancer therapy-related cardiovascular disease remains limited by a lack of phenotypic data, implementation of precision medicine approaches has become a focal point for deep phenotyping strategies. In particular, -omics approaches (a field of study in biology ending in -omic, such as genomics, proteomics, or metabolomics) have shown enormous potential in identifying sensitive biomarkers of cardiovascular disease, applying sophisticated, pattern-revealing technologies to growing databases of biologic molecules. Moreover, the use of -omics to inform radiologic strategies may add a dimension to future clinical practices. In this review, we present a paradigm for a precision medicine approach to the care of cardiotoxin-exposed cancer patients. We discuss the role of current imaging techniques; demonstrate how -omics can advance our understanding of disease phenotypes; and describe how molecular imaging can be integrated to personalize surveillance and therapeutics, ultimately reducing cardiovascular morbidity and mortality in cancer patients and survivors.
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Affiliation(s)
- Alexandra D Dreyfuss
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paco E Bravo
- Division of Nuclear Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Constantinos Koumenis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and .,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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29
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Demissei BG, Freedman G, Feigenberg SJ, Plastaras JP, Maity A, Smith AM, McDonald C, Sheline K, Simone CB, Lin LL, Carver JR, Liu P, Zhang L, Bekelman JE, Ky B. Early Changes in Cardiovascular Biomarkers with Contemporary Thoracic Radiation Therapy for Breast Cancer, Lung Cancer, and Lymphoma. Int J Radiat Oncol Biol Phys 2018; 103:851-860. [PMID: 30445173 DOI: 10.1016/j.ijrobp.2018.11.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/11/2018] [Accepted: 11/06/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE We characterized the early changes in cardiovascular biomarkers with contemporary thoracic radiation therapy (RT) and evaluated their associations with radiation dose-volume metrics including mean heart dose (MHD), V5, and V30. METHODS AND MATERIALS In a prospective longitudinal study of 87 patients with breast cancer, lung cancer, or mediastinal lymphoma treated with photon or proton thoracic RT, blood samples were obtained pre-RT and after completion of RT (median, 20 days; interquartile range [IQR], 1-35). High-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, placental growth factor (PIGF), and growth differentiation factor 15 (GDF-15) were measured. Associations between MHD, V5 and V30, and biomarker levels and associations between echocardiography-derived measures of cardiac function and biomarker levels were assessed in multivariable linear regression models. Analyses were performed according to the following subgroups: (1) breast cancer alone and (2) lung cancer and lymphoma combined. RESULTS The median (IQR) estimates of MHD ranged from 1.3 Gy (0.9-2.4) in breast cancer (n = 60) to 6.8 Gy (5.4-10.2) in mediastinal lymphoma (n = 14) and 8.4 Gy (6.7-16.1) in lung cancer (n = 13) patients (P < .001). There were no significant increases in biomarker levels from pre-RT to post-RT in breast cancer. In lung cancer/lymphoma, PIGF increased from a median (IQR) of 20 ng/L (16-26) to 22 ng/L (16-30) (P = .005), and GDF-15 increased from 1171 ng/L (755-2493) to 1887 ng/L (903-3763) (P = .006). MHD, V5, and V30 were significantly associated with post-RT PIGF and GDF-15 levels in multivariable models. Changes in biomarkers were not significantly associated with changes in echocardiography-derived measures of cardiac function. CONCLUSION Contemporary thoracic RT induces acute abnormalities in vascular and inflammatory biomarkers that are associated with radiation dose-volume metrics, particularly in lung cancer and mediastinal lymphoma. Long-term follow-up studies are needed to determine the impact of these changes on the development of overt cardiac disease.
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Affiliation(s)
- Biniyam G Demissei
- Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gary Freedman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven J Feigenberg
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Plastaras
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amit Maity
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amanda M Smith
- Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caitlin McDonald
- Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karyn Sheline
- Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles B Simone
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - Lilie L Lin
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph R Carver
- Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter Liu
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Liyong Zhang
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Justin E Bekelman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bonnie Ky
- Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Braunstein LZ, Cahlon O. Potential Morbidity Reduction With Proton Radiation Therapy for Breast Cancer. Semin Radiat Oncol 2018; 28:138-149. [PMID: 29735190 DOI: 10.1016/j.semradonc.2017.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Proton radiotherapy confers significant dosimetric advantages in the treatment of malignancies that arise adjacent to critical radiosensitive structures. To date, these advantages have been most prominent in the treatment of pediatric and central nervous system malignancies, although emerging data support the use of protons among other anatomical sites in which radiotherapy plays an important role. With advances in the overall treatment paradigm for breast cancer, most patients with localized disease now exhibit long-term disease control and, consequently, may manifest the late toxicities of aggressive treatment. As a result, there is increasing emphasis on the mitigation of iatrogenic morbidity, with particular attention to heart and lung exposure in those receiving adjuvant radiotherapy. Indeed, recent landmark analyses have demonstrated an increase in significant cardiac events that is linked directly to low-dose radiation to the heart. Coupled with practice-changing trials that have expanded the indications for comprehensive regional nodal irradiation, there exists significant interest in employing novel technologies to mitigate cardiac dose while improving target volume coverage. Proton radiotherapy enjoys distinct physical advantages over photon-based approaches and, in appropriately selected patients, markedly improves both target coverage and normal tissue sparing. Here, we review the dosimetric evidence that underlies the putative benefits of proton radiotherapy, and further synthesize early clinical evidence that supports the efficacy and feasibility of proton radiation in breast cancer. Landmark, prospective randomized trials are underway and will ultimately define the role for protons in the treatment of this disease.
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Affiliation(s)
- Lior Z Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Taylor C, McGale P, Brønnum D, Correa C, Cutter D, Duane FK, Gigante B, Jensen MB, Lorenzen E, Rahimi K, Wang Z, Darby SC, Hall P, Ewertz M. Cardiac Structure Injury After Radiotherapy for Breast Cancer: Cross-Sectional Study With Individual Patient Data. J Clin Oncol 2018; 36:2288-2296. [PMID: 29791285 PMCID: PMC6067799 DOI: 10.1200/jco.2017.77.6351] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Incidental cardiac irradiation can cause cardiac injury, but little is known about the effect of radiation on specific cardiac segments. Methods For 456 women who received breast cancer radiotherapy between 1958 and 2001 and then later experienced a major coronary event, information was obtained on the radiotherapy regimen they received and on the location of their cardiac injury. For 414 women, all with documented location of left ventricular (LV) injury, doses to five LV segments were estimated. For 133 women, all with documented location of coronary artery disease with ≥ 70% stenosis, doses to six coronary artery segments were estimated. For each segment, numbers of women with left-sided and right-sided breast cancer were compared. Results Of women with LV injury, 243 had left-sided breast cancer and 171 had right-sided breast cancer (ratio of left v right, 1.42; 95% CI, 1.17 to 1.73), reflecting the higher typical LV radiation doses in left-sided cancer (average dose left-sided, 8.3 Gy; average dose right-sided, 0.6 Gy; left minus right dose difference, 7.7 Gy). For individual LV segments, the ratios of women with left- versus right-sided radiotherapy were as follows: inferior, 0.94 (95% CI, 0.70 to 1.25); lateral, 1.42 (95% CI, 1.04 to 1.95); septal, 2.09 (95% CI, 1.37 to 3.19); anterior, 1.85 (95% CI, 1.39 to 2.46); and apex, 4.64 (95% CI, 2.42 to 8.90); corresponding left-minus-right dose differences for these segments were 2.7, 4.9, 7.2, 10.4, and 21.6 Gy, respectively ( Ptrend < .001). For women with coronary artery disease, the ratios of women with left- versus right-radiotherapy for individual coronary artery segments were as follows: right coronary artery proximal, 0.48 (95% CI, 0.26 to 0.91); right coronary artery mid or distal, 1.69 (95% CI, 0.85 to 3.36); circumflex proximal, 1.46 (95% CI, 0.72 to 2.96); circumflex distal, 1.11 (95% CI, 0.45 to 2.73); left anterior descending proximal, 1.89 (95% CI, 1.07 to 3.34); and left anterior descending mid or distal, 2.33 (95% CI, 1.19 to 4.59); corresponding left-minus-right dose differences for these segements were -5.0, -2.5, 1.6, 3.5, 9.5, and 38.8 Gy ( Ptrend = .002). Conclusion For individual LV and coronary artery segments, higher radiation doses were strongly associated with more frequent injury, suggesting that all segments are sensitive to radiation and that doses to all segments should be minimized.
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Affiliation(s)
- Carolyn Taylor
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Paul McGale
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Dorthe Brønnum
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Candace Correa
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - David Cutter
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Frances K. Duane
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Bruna Gigante
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Maj-Britt Jensen
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Ebbe Lorenzen
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Kazem Rahimi
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Zhe Wang
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Sarah C. Darby
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Per Hall
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Marianne Ewertz
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
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Żyromska A, Małkowski B, Wiśniewski T, Majewska K, Reszke J, Makarewicz R. 15O-H 2O PET/CT as a tool for the quantitative assessment of early post-radiotherapy changes of heart perfusion in breast carcinoma patients. Br J Radiol 2018; 91:20170653. [PMID: 29470136 DOI: 10.1259/bjr.20170653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Studies examining radiation-induced heart toxicity in breast cancer patients are inconclusive. The aim of this study was to prospectively and quantitatively asses myocardial blood flow (MBF) with, for the first time, 15O-H2O PET/CT as a marker of heart damage in irradiated breast cancer patients. METHODS 15 breast cancer patients receiving intact breast or chest wall irradiation were included in the analysis (six with right-sided and nine with left-sided breast cancer). They underwent 15O-H2O PET/CT before radiotherapy (RT) and 2 and 8 months after RT. MBF was quantitatively assessed at rest and under stress conditions in 17 heart segments distinguished according to the American Ultrasound Association classification. Regional MBF values were derived in each of the coronary artery territories. RESULTS MBF decreased in 53% and increased in 33% of cases 2 months after RT in both left-sided and right-sided breast cancer patients. Stress testing was more sensitive than at-rest testing, demonstrating decreased perfusion in the segments supplied by the left anterior descending coronary artery (LAD) [5.41 ± 1.74 vs 4.52 ± 1.82 ml (g*min)-1; p = 0.018], which persisted at 6 months [5.41 ± 1.74 vs 4.40 ± 1.38 ml (g*min)-1; p = 0.032] and a decrease in global heart perfusion [5.14 ± 1.49 vs 4.46 ± 1.73 ml (g*min)-1; p = 0.036]. A minimal radiation dose applied to the LAD correlated with MBF changes observed 2 months after RT (r = -0.57; p = 0.032). Radiological findings were not correlated with clinical symptoms of heart toxicity. CONCLUSION 15O-H2O PET/CT is safe and effective for the early detection and quantitative analysis of subclinical post-RT changes in heart perfusion in breast cancer patients. The LV segments supplied by the LAD are the main site of MBF changes. A minimum radiation dose deposited in the LAD may be a predictor of radiation-induced heart toxicity. Advances in knowledge: This is the first time that 15O-H2O PET/CT has been used to assess MBF after RT and the first granular description of the distribution of blood flow changes after breast cancer RT.
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Affiliation(s)
- Agnieszka Żyromska
- 1 Department of Oncology and Brachytherapy, Nicolaus Copernicus University in Toruń Ludwik Rydygier, Collegium Medicum in Bydgoszcz , Bydgoszcz , Poland.,2 Radiology Therapeutic Center in Krakow , Amethyst Radiotherapy Center in Zgorzelec , Poland
| | - Bogdan Małkowski
- 1 Department of Oncology and Brachytherapy, Nicolaus Copernicus University in Toruń Ludwik Rydygier, Collegium Medicum in Bydgoszcz , Bydgoszcz , Poland.,3 Department of Nuclear Medicine, Franciszek Lukaszczyk Oncology Centre , Bydgoszcz , Poland
| | - Tomasz Wiśniewski
- 1 Department of Oncology and Brachytherapy, Nicolaus Copernicus University in Toruń Ludwik Rydygier, Collegium Medicum in Bydgoszcz , Bydgoszcz , Poland.,4 Department of Radiotherapy, Franciszek Lukaszczyk Oncology Centre , Bydgoszcz , Poland
| | - Karolina Majewska
- 1 Department of Oncology and Brachytherapy, Nicolaus Copernicus University in Toruń Ludwik Rydygier, Collegium Medicum in Bydgoszcz , Bydgoszcz , Poland.,5 Department of Medical Physics, Franciszek Lukaszczyk Oncology Centre , Bydgoszcz , Poland
| | - Joanna Reszke
- 4 Department of Radiotherapy, Franciszek Lukaszczyk Oncology Centre , Bydgoszcz , Poland
| | - Roman Makarewicz
- 1 Department of Oncology and Brachytherapy, Nicolaus Copernicus University in Toruń Ludwik Rydygier, Collegium Medicum in Bydgoszcz , Bydgoszcz , Poland
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Gallucci G, Capobianco AM, Coccaro M, Venetucci A, Suriano V, Fusco V. Myocardial Perfusion Defects after Radiation Therapy and Anthracycline Chemotherapy for Left Breast Cancer: A Possible Marker of Microvascular Damage. Three Cases and Review of the Literature. TUMORI JOURNAL 2018; 94:129-33. [DOI: 10.1177/030089160809400124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radiation therapy to the thorax may induce early and late cardiac adverse effects if large parts of the heart have been included in the irradiation field and particularly if anthracycline-containing chemotherapy is concomitantly administered. We describe 3 cases of cardiotoxicity in patients with left breast cancer treated with anthracycline-containing chemotherapy and left thoracic radiotherapy. In 2 cases we observed asymptomatic electrocardiographic abnormalities of ventricular repolarization mimicking anterior myocardial ischemia and SPECT reversible myocardial perfusion defects. In 1 case we observed echocardiographic abnormalities of left ventricular wall motion and reversible myocardial perfusion abnormalities. We recommend close cardiac monitoring of patients treated with anthracycline chemotherapy and left thoracic radiotherapy to better understand the clinical impact of these abnormalities.
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Affiliation(s)
- Giuseppina Gallucci
- Cardiology Unit, CROB Regional Cancer Hospital, Rionero in Vulture (Potenza), Italy
| | | | - Mariarosa Coccaro
- Oncology Unit, CROB Regional Cancer Hospital, Rionero in Vulture (Potenza), Italy
| | - Angela Venetucci
- Nuclear Medicine Unit, CROB Regional Cancer Hospital, Rionero in Vulture (Potenza), Italy
| | - Vincenzo Suriano
- Nuclear Medicine Unit, CROB Regional Cancer Hospital, Rionero in Vulture (Potenza), Italy
| | - Vincenzo Fusco
- Radiotherapy Unit, CROB Regional Cancer Hospital, Rionero in Vulture (Potenza), Italy
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Yusuf SW, Venkatesulu BP, Mahadevan LS, Krishnan S. Radiation-Induced Cardiovascular Disease: A Clinical Perspective. Front Cardiovasc Med 2017; 4:66. [PMID: 29124057 PMCID: PMC5662579 DOI: 10.3389/fcvm.2017.00066] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/09/2017] [Indexed: 01/15/2023] Open
Abstract
Cancer survival has improved dramatically, and this has led to the manifestation of late side effects of multimodality therapy. Radiation (RT) to the thoracic malignancies results in unintentional irradiation of the cardiac chambers. RT-induced microvascular ischemia leads to disruption of capillary endothelial framework, and injury to differentiated myocytes results in deposition of collagen and fibrosis. Coexistence of risk factors of metabolic syndrome and preexisting atherosclerosis in addition to RT exposure results in accelerated occurrence of major coronary events. Hence, it becomes pertinent to understand the underlying pathophysiology and clinical manifestations of RT-induced cardiovascular disease to devise optimal preventive and surveillance strategies.
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Affiliation(s)
- Syed Wamique Yusuf
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Bhanu Prasad Venkatesulu
- Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lakshmi Shree Mahadevan
- Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sunil Krishnan
- Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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35
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Early cardiac perfusion defects after left-sided radiation therapy for breast cancer: is there a volume response? Breast Cancer Res Treat 2017; 164:253-262. [DOI: 10.1007/s10549-017-4248-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 02/04/2023]
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36
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Zagar TM, Kaidar-Person O, Tang X, Jones EE, Matney J, Das SK, Green RL, Sheikh A, Khandani AH, McCartney WH, Oldan JD, Wong TZ, Marks LB. Utility of Deep Inspiration Breath Hold for Left-Sided Breast Radiation Therapy in Preventing Early Cardiac Perfusion Defects: A Prospective Study. Int J Radiat Oncol Biol Phys 2017; 97:903-909. [DOI: 10.1016/j.ijrobp.2016.12.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/14/2016] [Accepted: 12/08/2016] [Indexed: 12/16/2022]
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37
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Matched-Pair Analysis of High Dose Versus Standard Dose Definitive Chemoradiation for Locally Advanced Non–Small-Cell Lung Cancer. Clin Lung Cancer 2017; 18:149-155. [DOI: 10.1016/j.cllc.2016.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 12/25/2022]
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38
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Moreira LAR, Silva EN, Ribeiro ML, Martins WDA. Cardiovascular effects of radiotherapy on the patient with cancer. Rev Assoc Med Bras (1992) 2017; 62:192-6. [PMID: 27167552 DOI: 10.1590/1806-9282.62.02.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 10/21/2014] [Indexed: 12/21/2022] Open
Abstract
The incidence of cancer (CA) has increased globally and radiotherapy (RT) is a vital component in its treatment. Cardiovascular injuries induced by RT in the treatment of thoracic and cervical CA have been causing problems in clinical practice for decades, and are among the most serious adverse effects of radiation experienced by the growing number of cancer survivors. This article presentes a review on the Lilacs, Scielo and Pubmed databases of the main cardiovascular injuries, their mechanisms, clinical presentations, treatments and prevention proposals. Injuries caused by RT include diseases of the pericardium, coronary artery disease, valvular disease, myocardial disease with systolic and diastolic dysfunction, conduction disorders, and carotid artery and great vessels disease. Thoracic and cervical irradiation increases cardiovascular morbidity and mortality. Despite the great progress in the improvement of RT techniques, totally excluding prime areas of the cardiovascular system from the irradiation field is not yet possible. Guidelines must be created for monitoring, diagnosis and treatment of patients with CA treated with RT.
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39
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Whole-Breast Irradiation Following Breast-Conserving Surgery for Invasive Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Le MT, Mothersill CE, Seymour CB, McNeill FE. Is the false-positive rate in mammography in North America too high? Br J Radiol 2016; 89:20160045. [PMID: 27187600 PMCID: PMC5124917 DOI: 10.1259/bjr.20160045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/04/2016] [Accepted: 05/16/2016] [Indexed: 01/23/2023] Open
Abstract
The practice of investigating pathological abnormalities in the breasts of females who are asymptomatic is primarily employed using X-ray mammography. The importance of breast screening is reflected in the mortality-based benefits observed among females who are found to possess invasive breast carcinoma prior to the manifestation of clinical symptoms. It is estimated that population-based screening constitutes a 17% reduction in the breast cancer mortality rate among females affected by invasive breast carcinoma. In spite of the significant utility that screening confers in those affected by invasive cancer, limitations associated with screening manifest as potential harms affecting individuals who are free of invasive disease. Disease-free and benign tumour-bearing individuals who are subjected to diagnostic work-up following a screening examination constitute a population of cases referred to as false positives (FPs). This article discusses factors contributing to the FP rate in mammography and extends the discussion to an assessment of the consequences associated with FP reporting. We conclude that the mammography FP rate in North America is in excess based upon the observation of overtreatment of in situ lesions and the disproportionate distribution of detriment and benefit among the population of individuals recalled for diagnostic work-up subsequent to screening. To address the excessive incidence of FPs in mammography, we investigate solutions that may be employed to remediate the current status of the FP rate. Subsequently, it can be suggested that improvements in the breast-screening protocol, medical litigation risk, image interpretation software and the implementation of image acquisition modalities that overcome superimposition effects are promising solutions.
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Affiliation(s)
- Michelle T Le
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Carmel E Mothersill
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Colin B Seymour
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Fiona E McNeill
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
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Cooper BT, Li X, Shin SM, Modrek AS, Hsu HC, DeWyngaert JK, Jozsef G, Lymberis SC, Goldberg JD, Formenti SC. Preplanning prediction of the left anterior descending artery maximum dose based on patient, dosimetric, and treatment planning parameters. Adv Radiat Oncol 2016; 1:373-381. [PMID: 28740908 PMCID: PMC5514165 DOI: 10.1016/j.adro.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Maximum dose to the left anterior descending artery (LADmax) is an important physical constraint to reduce the risk of cardiovascular toxicity. We generated a simple algorithm to guide the positioning of the tangent fields to reliably maintain LADmax <10 Gy. METHODS AND MATERIALS Dosimetric plans from 146 consecutive women treated prone to the left breast enrolled in prospective protocols of accelerated whole breast radiation therapy, with a concomitant daily boost to the tumor bed (40.5 Gy/15 fraction to the whole breast and 48 Gy to the tumor bed), provided the training set for algorithm development. Scatter plots and correlation coefficients were used to describe the bivariate relationships between LADmax and several parameters: distance from the tumor cavity to the tangent field edge, cavity size, breast separation, field size, and distance from the tangent field. A logistic sigmoid curve was used to model the relationship of LADmax and the distance from the tangent field. Furthermore, we tested this prediction model on a validation data set of 53 consecutive similar patients. RESULTS A lack of linear relationships between LADmax and distance from cavity to LAD (-0.47), cavity size (-0.18), breast separation (-0.02), or field size (-0.28) was observed. In contrast, distance from the tangent field was highly negatively correlated to LADmax (-0.84) and was used in the models to predict LADmax. From a logistic sigmoid model we selected a cut-point of 2.46 mm (95% confidence interval, 2.19-2.74 mm) greater than which LADmax is <10 Gy (95% confidence interval, 9.30-10.72 Gy) and LADmean is <3.3 Gy. CONCLUSIONS Placing the edge of the tangents at least 2.5 mm from the closest point of the contoured LAD is likely to assure LADmax is <10 Gy and LADmean is <3.3 Gy in patients treated with prone accelerated breast radiation therapy.
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Affiliation(s)
- Benjamin T Cooper
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Xiaochun Li
- Division of Biostatistics and Department of Population Health, New York University School of Medicine, New York, New York
| | - Samuel M Shin
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Aram S Modrek
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Howard C Hsu
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - J K DeWyngaert
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Gabor Jozsef
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Stella C Lymberis
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Judith D Goldberg
- Division of Biostatistics and Department of Population Health, New York University School of Medicine, New York, New York
| | - Silvia C Formenti
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
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Becker-Schiebe M, Stockhammer M, Hoffmann W, Wetzel F, Franz H. Does mean heart dose sufficiently reflect coronary artery exposure in left-sided breast cancer radiotherapy? : Influence of respiratory gating. Strahlenther Onkol 2016; 192:624-31. [PMID: 27389036 DOI: 10.1007/s00066-016-1011-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/08/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE With extensive use of systemic treatment, the issue of cardiac mortality after breast cancer radiation (RT) is still important. The aim of our analysis was to clarify whether the dose to one surrogate parameter (e. g., mean heart dose, as used in most studies) reflects the dose to the other cardiovascular structures especially the left anterior descending artery depending on breathing-adapted RT. PATIENTS AND METHODS A total of 130 patients who underwent adjuvant RT (50.4 Gy plus boost 9-16 Gy) were evaluated. In all, 71 patients were treated with free-breathing and 59 patients using respiratory monitoring (gated RT). Dosimetric associations were calculated. RESULTS The mean dose to the heart (Dmean heart) was reduced from 2.7 (0.8-5.2) Gy to 2.4 (1.1-4.6) Gy, the Dmean LAD (left anterior descending artery) decreased from 11.1 (1.3-28.6) Gy to 9.3 (2.2-19.9) Gy with gated RT (p = 0.04). A significant relationship was shown for Dmean heart-Dmean LAD, V25heart-Dmean LAD and Dmax heart-Dmax LAD for gated patients only (p < 0.01). For every 1 Gy increase in Dmean heart, mean LAD doses rose by 3.6 Gy, without gating V25 ≤5 % did not assure a benefit and resulted in Dmean LAD between 1.3 and 28.6 Gy. CONCLUSION A significant reduction and association of heart and coronary artery (LAD) doses using inspiratory gating was shown. However, in free-breathing plans commonly measured dose constraints do not allow precise estimation of the dose to the coronary arteries.
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Affiliation(s)
- Martina Becker-Schiebe
- Department of Radiotherapy and Radio-Oncology, Klinikum Braunschweig, Celler Straße 38, 38114, Braunschweig, Germany. .,Radiation Oncology, Hannover Medical School, Hannover, Germany.
| | - Maxi Stockhammer
- Department of Gynecology and Obstetrics, Klinikum Braunschweig, Braunschweig, Germany
| | - Wolfgang Hoffmann
- Department of Radiotherapy and Radio-Oncology, Klinikum Braunschweig, Celler Straße 38, 38114, Braunschweig, Germany
| | - Fabian Wetzel
- Department of Radiotherapy and Radio-Oncology, Klinikum Braunschweig, Celler Straße 38, 38114, Braunschweig, Germany
| | - Heiko Franz
- Department of Gynecology and Obstetrics, Klinikum Braunschweig, Braunschweig, Germany
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Bablekos GD, Analitis A, Michaelides SA, Charalabopoulos KA, Tzonou A. Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:213. [PMID: 27386487 DOI: 10.21037/atm.2016.06.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Co-morbidity of primary lung cancer (LC) and heart disease (HD), both requiring surgical therapy, characterizes a high risk group of patients necessitating prompt diagnosis and treatment. The aim of this study is the review of available evidence guiding the management of these patients. METHODS Postoperative outcome of patients operated for primary LC (first meta-analysis) and for both primary LC and HD co-morbidity (second meta-analysis), were studied. Parameters examined in both meta-analyses were thirty-day postoperative mortality, postoperative complications, three- and five-year survival probabilities. The last 36 years were reviewed by using the PubMed data base. Thirty-seven studies were qualified for both meta-analyses. RESULTS The pooled 30-day mortality percentages (%) were 4.16% [95% confidence interval (CI): 2.68-5.95] (first meta-analysis) and 5.26% (95% CI: 3.47-7.62) (second meta-analysis). Higher percentages of squamous histology and lobectomy, were significantly associated with increased (P=0.001) and decreased (P<0.001) thirty-day postoperative mortality, respectively (first meta-analysis). The pooled percentages for postoperative complications were 34.32% (95% CI: 24.59-44.75) (first meta-analysis) and 45.59% (95% CI: 35.62-55.74) (second meta-analysis). Higher percentages of squamous histology (P=0.001), lobectomy (P=0.002) and p-T1 or p-T2 (P=0.034) were associated with higher proportions of postoperative complications (second meta-analysis). The pooled three- and five- year survival probabilities were 68.25% (95% CI: 45.93-86.86) and 52.03% (95% CI: 34.71-69.11), respectively. Higher mean age (P=0.046) and percentage lobectomy (P=0.009) significantly reduced the five-year survival probability. CONCLUSIONS Lobectomy and age were both accompanied by reduced five-year survival rate. Also, combined aorto-coronary bypass grafting (CABG) with lobectomy for squamous pT1 or pT2 LC displayed a higher risk of postoperative complications. Moreover, medical decision between combined or staged surgery is suggested to be individualized based on adequacy of coronary arterial perfusion, age, patient's preoperative performance status (taking into account possible co-morbidities per patient), tumor's staging and extent of lung resection.
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Affiliation(s)
- George D Bablekos
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
| | - Antonis Analitis
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
| | - Stylianos A Michaelides
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
| | - Konstantinos A Charalabopoulos
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
| | - Anastasia Tzonou
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
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Clinical Outcomes and Toxicity of Proton Radiotherapy for Breast Cancer. Clin Breast Cancer 2016; 16:145-54. [DOI: 10.1016/j.clbc.2016.02.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/16/2015] [Accepted: 02/03/2016] [Indexed: 12/15/2022]
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Hybrid intensity-modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) technique versus three-dimensional (3D) conformal radiotherapy with SIB for breast radiotherapy: a planning comparison. JOURNAL OF RADIOTHERAPY IN PRACTICE 2016. [DOI: 10.1017/s146039691600008x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractAimThis study aims to compare conventional simultaneous integrated boost (SIB) planning technique with a hybrid SIB intensity-modulated radiation therapy (IMRT) technique with varying open tangent to IMRT field dose ratios. Furthermore, we investigated which of the dose ratios proves the most favourable as a class solution across a sample.MethodsIn total, 15 patients with conventional SIB treatment plans were re-planned with hybrid SIB IMRT technique using three differing open field:IMRT dose ratios, that is, 80:20, 70:30 and 60:40. Plans were compared using dosimetric comparison of organs at risk (OARs) and homogeneity and conformity indexes across target structures.ResultsAll hybrid plans reduced dose maximums and showed a reduction of high doses to both lungs but increased lower doses, that is, V5, with similar results discovered for the heart. Contralateral breast dose was shown to decrease V5 and V1 measures by hybrid arms, whereas increasing the V2. Left anterior descending artery dose and non-irradiated structures were reduced by all hybrid arms. The homogeneity and conformity increased across all hybrid arms. Qualitative assessment of all plans also favoured hybrid plans.FindingsHybrid plans produced superior dose conformity, homogeneity, reduced dose maximums and showed an improvement in most OAR parameters. The 70:30 hybrid technique exhibited greater benefits as a class solution to the sample than conventional plans due to superior dose conformity and homogeneity to target volumes.
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El-Sherif O, Yu E, Xhaferllari I, Gaede S. Assessment of Intrafraction Breathing Motion on Left Anterior Descending Artery Dose During Left-Sided Breast Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 95:1075-1082. [PMID: 27130788 DOI: 10.1016/j.ijrobp.2016.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 01/28/2016] [Accepted: 02/05/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To use 4-dimensional computed tomography (4D-CT) imaging to predict the level of uncertainty in cardiac dose estimates of the left anterior descending artery that arises due to breathing motion during radiation therapy for left-sided breast cancer. METHODS AND MATERIALS The fast helical CT (FH-CT) and 4D-CT of 30 left-sided breast cancer patients were retrospectively analyzed. Treatment plans were created on the FH-CT. The original treatment plan was then superimposed onto all 10 phases of the 4D-CT to quantify the dosimetric impact of respiratory motion through 4D dose accumulation (4D-dose). Dose-volume histograms for the heart, left ventricle (LV), and left anterior descending (LAD) artery obtained from the FH-CT were compared with those obtained from the 4D-dose. RESULTS The 95% confidence interval of 4D-dose and FH-CT differences in mean dose estimates for the heart, LV, and LAD were ±0.5 Gy, ±1.0 Gy, and ±8.7 Gy, respectively. CONCLUSION Fast helical CT is a good approximation for doses to the heart and LV; however, dose estimates for the LAD are susceptible to uncertainties that arise due to intrafraction breathing motion that cannot be ascertained without the additional information obtained from 4D-CT and dose accumulation. For future clinical studies, we suggest the use of 4D-CT-derived dose-volume histograms for estimating the dose to the LAD.
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Affiliation(s)
- Omar El-Sherif
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada; Department of Physics, London Regional Cancer Program, London, Ontario, Canada.
| | - Edward Yu
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Ilma Xhaferllari
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada; Department of Physics, London Regional Cancer Program, London, Ontario, Canada
| | - Stewart Gaede
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada; Department of Physics, London Regional Cancer Program, London, Ontario, Canada; Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
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Verbanck S, Hanon S, Schuermans D, Van Parijs H, Vinh-Hung V, Miedema G, Verellen D, Storme G, Fontaine C, Lamote J, De Ridder M, Vincken W. Mild Lung Restriction in Breast Cancer Patients After Hypofractionated and Conventional Radiation Therapy: A 3-Year Follow-Up. Int J Radiat Oncol Biol Phys 2016; 95:937-945. [PMID: 27302510 DOI: 10.1016/j.ijrobp.2016.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/15/2016] [Accepted: 02/01/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To assess the effect of radiation therapy on lung function over the course of 3 years. METHODS AND MATERIALS Evolution of restrictive and obstructive lung function parameters was investigated in 108 breast cancer participants in a randomized, controlled trial comparing conventional radiation therapy (CR) and hypofractionated tomotherapy (TT) (age at inclusion ranging 32-81 years). Spirometry, plethysmography, and hemoglobin-corrected diffusing capacity were assessed at baseline and after 3 months and 1, 2, and 3 years. Natural aging was accounted for by considering all lung function parameters in terms of percent predicted values using the most recent reference values for women aged up to 80 years. RESULTS In the patients with negligible history of respiratory disease or smoking (n=77), the greatest rate of functional decline was observed during the initial 3 months, this acute decrease being more marked in the CR versus the TT arm. During the remainder of the 3-year follow-up period, values (in terms of percent predicted) were maintained (diffusing capacity) or continued to decline at a slower rate (forced vital capacity). However, the average decline of the restrictive lung function parameters over a 3-year period did not exceed 9% predicted in either the TT or the CR arm. Obstructive lung function parameters remained unaffected throughout. Including also the 31 patients with a history of respiratory disease or more than 10 pack-years showed a very similar restrictive pattern. CONCLUSIONS In women with breast cancer, both conventional radiation therapy and hypofractionated tomotherapy induce small but consistent restrictive lung patterns over the course of a 3-year period, irrespective of baseline respiratory status or smoking history. The fastest rate of lung function decline generally occurred in the first 3 months.
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Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium.
| | - Shane Hanon
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium
| | - Daniel Schuermans
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium
| | - Hilde Van Parijs
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Vincent Vinh-Hung
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Geertje Miedema
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Dirk Verellen
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Guy Storme
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Christel Fontaine
- Department of Senology and Oncologic Surgery, University Hospital UZ Brussel, Brussels, Belgium
| | - Jan Lamote
- Department of Senology and Oncologic Surgery, University Hospital UZ Brussel, Brussels, Belgium
| | - Mark De Ridder
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Walter Vincken
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium
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Joo JH, Kim SS, Ahn SD, Kwak J, Jeong C, Ahn SH, Son BH, Lee JW. Cardiac dose reduction during tangential breast irradiation using deep inspiration breath hold: a dose comparison study based on deformable image registration. Radiat Oncol 2015; 10:264. [PMID: 26715382 PMCID: PMC4696108 DOI: 10.1186/s13014-015-0573-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiation therapy (RT) for a left-sided breast cancer often involves some incidental exposure of the heart and increase in the rate of major coronary events. One method to reduce the dose to the heart during a tangential breast irradiation is the deep inspiration breath hold (DIBH) technique. Our department adopted DIBH for selected left breast cancer patients with a maximum cardiac distance ≥ 10 mm. We evaluated the effect of the DIBH on cardiac dose compared to normal free breathing (FB). The secondary objective of our present study was to use modeled risk estimates to quantify the risk of coronary events after RT with DIBH. METHODS AND MATERIALS Thirty-two patients who underwent RT with DIBH at our hospital were retrospectively analyzed. For each patient, two computed tomography (CT) scans were acquired, FB-CT and DIBH-CT. Using a deformable image registration tool, the target volume was deformed from DIBH-CT to FB-CT, and conventional tangential treatment planning was performed, focusing on the equality of target coverage between the two plans. Doses to the heart, left anterior descending (LAD) artery, and ipsilateral lung were assessed. RESULTS By using DIBH, the average mean heart dose was reduced from 724.1 cGy to 279.3 (p < 0.001). The relative heart volume irradiated with 10 Gy-50 Gy was consistently reduced. The mean dose to the LAD coronary artery was reduced from 4079.1 cGy to 2368.9 cGy (p < 0.001). The ipsilateral lung volume receiving 20 Gy or more and 40 Gy or more was reduced by 2.2 % in both cases. Estimated risks of coronary events at 10 years were 4.03 and 2.55 % for RT with FB and DIBH, respectively (p < 0.001). CONCLUSIONS The use of DIBH during RT of the left-sided breast considerably reduces the doses delivered to the heart and LAD artery with similar target coverage. For the current study patients, the probability of major coronary events was reduced with DIBH.
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Affiliation(s)
- Ji Hyeon Joo
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Jungwon Kwak
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Chiyoung Jeong
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Sei-Hyun Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Byung-Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Palumbo I, Palumbo B, Fravolini ML, Marcantonini M, Perrucci E, Latini ME, Falcinelli L, Sabalich I, Tranfaglia C, Schillaci G, Mannarino E, Aristei C. Brain natriuretic peptide as a cardiac marker of transient radiotherapy-related damage in left-sided breast cancer patients: A prospective study. Breast 2015; 25:45-50. [PMID: 26547836 DOI: 10.1016/j.breast.2015.10.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/04/2015] [Accepted: 10/10/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Our study evaluated brain natriuretic peptide (BNP) changes over time after adjuvant radiotherapy (RT) in women with left-sided breast cancer investigating its correlation with heart dosimetric parameters. METHODS Forty-three patients underwent clinical cardiac examination, electrocardiogram (ECG), echocardiography and BNP measurement before RT (T0) and 1 (T1), 6 (T6) and 12 months (T12) after. After T12 cardiac assessment was performed annually in each patient. Mean values and standard deviation (SD) of BNP, left ventricular ejection fraction (LVEF), V20, V25, V30, V45 and mean dose were calculated. Normalized BNP (BNPn) was calculated as follows: BNPnT1 = BNPT1/BNPT0, BNPnT6 = BNPT6/BNPT0, BNPnT12 = BNPT12/BNPT0. Absolute BNP and BNPn values were used for data analysis. RESULTS Median follow-up from the end of RT to the last check-up was 87 months (range 37-120 months). Minimum follow-up was 74 months except for two patients, who died at respectively 37 and 47 months after RT. In all patients LVEF did not change significantly (p = 0.22) after RT. BNP increased significantly (p < 0.001), particularly 1 and 6 months after RT. It slightly decreased after 12 months. BNP did not correlate with V20, V25, V30, V45, mean dose and MHD. All BNPn correlated significantly (p < 0.05) with V20, V25, V30, V45, mean dose and MHD. Four patients had a cardiac event; in the only subject who developed myocardial infarction, V20, V25, V30 and V45 were the highest and BNP increased from T1 and persisted high even at T12. CONCLUSION Our results confirm that BNP could be a useful minimally invasive marker of early RT related cardiac impairment.
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Affiliation(s)
- I Palumbo
- Radiation Oncology Section, University of Perugia, Perugia General Hospital, Perugia, Italy.
| | - B Palumbo
- Nuclear Medicine and Health Physics Section, University of Perugia, Perugia, Italy
| | - M L Fravolini
- Department of Engineering, University of Perugia, Italy
| | - M Marcantonini
- Medical Physics Unit, Perugia General Hospital, Perugia, Italy
| | - E Perrucci
- Radiation Oncology Division, Perugia General Hospital, Perugia, Italy
| | - M E Latini
- Radiology Division, Perugia General Hospital, Perugia, Italy
| | - L Falcinelli
- Radiation Oncology Division, Perugia General Hospital, Perugia, Italy
| | - I Sabalich
- Nuclear Medicine and Health Physics Section, University of Perugia, Perugia, Italy
| | - C Tranfaglia
- Nuclear Medicine and Health Physics Section, University of Perugia, Perugia, Italy
| | - G Schillaci
- Internal Medicine Unit, Department of Medicine, University of Perugia, Italy
| | - E Mannarino
- Internal Medicine, Angiology and Arteriosclerosis Diseases Unit, Department of Medicine, University of Perugia, Italy
| | - C Aristei
- Radiation Oncology Section, University of Perugia, Perugia General Hospital, Perugia, Italy
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Nitsche M, Pahl R, Huber K, Eilf K, Dunst J. Cardiac Toxicity after Radiotherapy for Breast Cancer: Myths and Facts. Breast Care (Basel) 2015. [PMID: 26195942 DOI: 10.1159/000376560] [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: 11/19/2022] Open
Abstract
Radiotherapy is an important component in the multidisciplinary treatment of breast cancer. In recent years, the cardiac risks of radiation have been discussed several times. This problem has long been known and resolved from the radiotherapeutic point of view. The current data is briefly described 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
| | - René Pahl
- Klinik für Strahlentherapie, Karl-Lennert-Krebscentrum, Universität Kiel, Germany
| | - Karen Huber
- Klinik für Strahlentherapie, Karl-Lennert-Krebscentrum, Universität Kiel, Germany
| | - Kirsten Eilf
- Klinik für Strahlentherapie, Karl-Lennert-Krebscentrum, Universität Kiel, Germany
| | - Juergen Dunst
- Klinik für Strahlentherapie, Karl-Lennert-Krebscentrum, Universität Kiel, Germany
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