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Li Q, Tong Y, Gong G, Yin Y, Xu Y. The margin of internal risk volume on atrial septal and ventricular septal based on electrocardiograph gating 4DCT. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:842. [PMID: 34164476 PMCID: PMC8184443 DOI: 10.21037/atm-21-1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of this study was to quantify the margin of internal risk volume (IRV) on the atrial septum (AS) and ventricular septum (VS) based on electrocardiograph gating (ECG-gating) 4DCT. Methods Twenty patients were enrolled and received an ECG-gating 4DCT scan performed in breath-hold, and CT images were reconstructed at 5% intervals of the cardiac cycle for a total of 20 phases (0-95%). The contouring of the AS and VS were delineated in each phase, and the displacements and margin of the AS and VS were calculated. We fused the total of the AS and VS (0-95% phase), which were recorded as AS20 and VS20. The margins were applied to the AS and VS in every phase and revised according to the cover rate of AS20 and VS20. Results (I) The margins of the AS and VS according to displacements in the left-right, cranio-caudal, and antero-posterior direction were 3 mm, 3 mm, and 3 mm; and 3 mm, 3 mm, and 2 mm, respectively. (II) The volume of AS20 was (11.80±3.72) cm3, which was 2.9 times larger than the maximum volume of the AS. The volume of VS20 was (60.45±12.92) cm3, which was 1.6 times larger than the maximum volume of the VS. (III) The emendatory margins of the AS and VS in the left-right, cranio-caudal, and antero-posterior direction were 7 mm, 10 mm, and 7 mm; and 5 mm, 3 mm, and 4 mm, respectively. The emendatory margins were added to the AS and VS, and the coverage rates were (95.88±3.29)% and (95.24±2.54)%, respectively. Conclusions The margin of IRV on the AS and VS could cover the movement of AS and VS induced by heartbeat in the left-right, cranio-caudal, and antero-posterior direction respectively during thoracic radiotherapy.
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Affiliation(s)
- Qian Li
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Tong
- Department of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Guanzhong Gong
- Department of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Department of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yaping Xu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Hedden N, Xu H. Radiation therapy dose prediction for left-sided breast cancers using two-dimensional and three-dimensional deep learning models. Phys Med 2021; 83:101-107. [DOI: 10.1016/j.ejmp.2021.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022] Open
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Liu YC, Chang HM, Lin HH, Lu CC, Lai LH. Dosimetric Comparison of Intensity-Modulated Radiotherapy, Volumetric Modulated Arc Therapy and Hybrid Three-Dimensional Conformal Radiotherapy/Intensity-Modulated Radiotherapy Techniques for Right Breast Cancer. J Clin Med 2020; 9:E3884. [PMID: 33260404 PMCID: PMC7760558 DOI: 10.3390/jcm9123884] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 12/21/2022] Open
Abstract
This study aimed to compare different types of right breast cancer radiotherapy planning techniques and to estimate the whole-body effective doses and the critical organ absorbed doses. The three planning techniques are intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT; two methods) and hybrid 3D-CRT/IMRT (three-dimensional conformal radiotherapy/intensity-modulated radiotherapy). The VMAT technique includes two methods to deliver a dose: non-continuous partial arc and continuous partial arc. A thermoluminescent dosimeter (TLD) is placed in the RANDO phantom to estimate the organ absorbed dose. Each planning technique applies 50.4 Gy prescription dose and treats critical organs, including the lung and heart. Dose-volume histogram was used to show the planning target volume (V95%), homogeneity index (HI), conformity index (CI), and other optimized indices. The estimation of whole-body effective dose was based on the International Commission on Radiation Protection (ICRP) Publication 60 and 103. The results were as follows: Continuous partial arc and non-continuous partial arc showed the best CI and HI. The heart absorbed doses in the continuous partial arc and hybrid 3D-CRT/IMRT were 0.07 ± 0.01% and 0% (V5% and V10%, respectively). The mean dose of the heart was lowest in hybrid 3D-CRT/IMRT (1.47 Gy ± 0.02). The dose in the left contralateral lung (V5%) was lowest in continuous partial arc (0%). The right ipsilateral lung average dose and V20% are lowest in continuous partial arc. Hybrid 3D-CRT/IMRT has the lowest mean dose to contralateral breast (organs at risk). The whole-body effective doses for ICRP-60 and ICRP-103 were highest in continuous partial arc (2.01 Sv ± 0.23 and 2.89 Sv ± 0.15, respectively). In conclusion, the use of VMAT with continuous arc has a lower risk of radiation pneumonia, while hybrid 3D-CRT/IMRT attain lower secondary malignancy risk and cardiovascular complications.
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Affiliation(s)
- Yi-Chi Liu
- Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu 30015 Taiwan;
- Department of Radiation Oncology, Wei Gong Memorial Hospital, Miaoli 35148, Taiwan
| | - Hung-Ming Chang
- Department of General Surgery, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan;
| | - Hsin-Hon Lin
- Medical Physics Research Center, Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan;
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Chia-Chun Lu
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan;
| | - Lu-Han Lai
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan
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Poulsen PR, Thomsen MS, Hansen R, Worm E, Spejlborg H, Offersen B. Fully automated detection of heart irradiation in cine MV images acquired during breast cancer radiotherapy. Radiother Oncol 2019; 152:189-195. [PMID: 31787350 DOI: 10.1016/j.radonc.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/31/2019] [Accepted: 11/06/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To develop robust automated detection of heart irradiation in continuous portal images (cine MV images) of tangential breast cancer treatments. METHODS Cine MV images of 302 tangential field deliveries were recorded for ten left-sided breast cancer patients receiving deep-inspiration breath-hold radiotherapy. An algorithm for fully automated heart edge detection in cine MV images was developed and tested for all images. The algorithm first enhances the heart edge contrast greatly by exploiting that pixels on the heart edge change their intensity cyclically, and highly correlated, at 1-3 Hz due to heartbeat. The algorithm then detects the heart edge in the enhanced image and calculates the exposed heart area within the field aperture. RESULTS The algorithm correctly identified the heart edge in all cine MV series with heart exposure (169 of 302 field deliveries). With conservative selection criteria the algorithm on average identified 70 heart edge pixels in the heart-including field deliveries (range: 10-230) without false positives. With less strict criteria 106 heart edge pixels were identified on average (range: 13-262) with 0.6% being false positives. The heart edge bordering the lung was segmented highly reliably even a few millimeters outside the field edge. For six patients with frequent heart irradiation, the exposed heart area showed large interfraction variations and smaller intrafraction variations. CONCLUSIONS Automated heart edge detection in cine MV images was proposed, developed and shown to be highly efficient for heart exposure detection in tangential breast fields. It may allow unsupervised surveillance of heart exposure at all tangential breast cancer treatments in a clinic.
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Affiliation(s)
- Per Rugaard Poulsen
- Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark.
| | | | - Rune Hansen
- Department of Medical Physics, Aarhus University Hospital, Denmark
| | - Esben Worm
- Department of Medical Physics, Aarhus University Hospital, Denmark
| | - Harald Spejlborg
- Department of Medical Physics, Aarhus University Hospital, Denmark
| | - Birgitte Offersen
- Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
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5
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Ueda Y, Gerber NK, Das IJ. Model-based cardiac dose estimation in radiation treatment of left breast cancer. Br J Radiol 2018; 91:20180287. [PMID: 30044144 DOI: 10.1259/bjr.20180287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To develop a mathematical model for cardiac dose estimation for patients who have been treated for left-sided breast cancer without CT data. METHODS: After obtaining institutional review board approvals, 147 patients with left-sided breast cancer were selected that were treated supine with opposed tangents. The heart blocks from the tangential fields were removed and dose calculations were performed with 6 MV beams using an advanced algorithm. This study was performed with CT data with DRR to represent a radiographic simulator image of yesteryear treatments. The beam's eye-view images showing delineated breast, lung and heart were created to represent views on radiograph. The maximum heart distance (MHD) was recorded and irradiated heart area (AREA) was computed by combination of triangles and rectangles. Based on accurate 3D dose calculation, mean dose (Dmean) and V10 to V50 of heart were analyzed with respect to MHD and AREA for dosimetric parameters using linear and quadratic fit. RESULTS: The treatment parameters calculated by MHD and segments using 2D radiographs were within 2% of the actual dosimetric parameters computed from the 3D planning system. The MHD and AREA vs Dmean, V10, V20, V30 and V50 showed very good correlation with linear model (R2 > 0.91); however the correlation was significantly better with quadratic model (R2 > 0.92). The analysis of the dosimetric error with our linear and quadratic model is remarkable within <3% error for most cases. CONCLUSION: The proposed mathematical model for the cardiac dose estimation is accurate within ±3% using a radiograph without CT data. This provides avenues for patient pooling in future studies related to radiation dose and cardiac toxicity. These results will help in estimating cardiac dose analysis accurately from previous studies as well as in centers still using 2D planning. ADVANCES IN KNOWLEDGE: The evidence of cardiac risk following radiotherapy continues to be one of the important considerations for the management of left-sided breast cancer patients. One of the problem in the estimation of dose-risk effects is the reconstruction of heart dose for pre-CT treatments. In this study, a simple mathematical model is presented that could estimate cardiac dose within ±3% in left breast cancer treatment from 2D radiograph where CT data do not exist.
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Affiliation(s)
- Yoshihiro Ueda
- 1 Department of Radiation Oncology, Osaka International Cancer Institute , Osaka , Japan
| | - Naamit K Gerber
- 2 Department of Radiation Oncology, New York University Health & Laura and Isaac Perlmutter Cancer Center , New York, NY , USA
| | - Indra J Das
- 2 Department of Radiation Oncology, New York University Health & Laura and Isaac Perlmutter Cancer Center , New York, NY , USA
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Walls GM, Lyon AR, Harbinson MT, Hanna GG. Cardiotoxicity Following Cancer Treatment. THE ULSTER MEDICAL JOURNAL 2017; 86:3-9. [PMID: 28298705 PMCID: PMC5324172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
More than half of those born after 1960 will develop cancer during their lifetime. Fortunately, owing to improved diagnosis and treatment, cure rates have risen steadily over the last three decades. With an increased survivorship, more will experience adverse effects of cancer therapeutics on the heart. As the oncologist's focus begins to encompass the issues of cancer survivorship, awareness of the management of cardiac toxicity would be prudent for all physicians looking after patients with cancer.
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Affiliation(s)
- GM Walls
- The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London
| | - AR Lyon
- National Heart and Lung Institute, Imperial College London,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London
| | - MT Harbinson
- Centre for Experimental Medicine, Queen’s University Belfast
| | - GG Hanna
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast
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7
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Conroy L, Yeung R, Watt E, Quirk S, Long K, Hudson A, Phan T, Smith WL. Evaluation of target and cardiac position during visually monitored deep inspiration breath-hold for breast radiotherapy. J Appl Clin Med Phys 2016; 17:25-36. [PMID: 27455494 PMCID: PMC5690055 DOI: 10.1120/jacmp.v17i4.6188] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/18/2016] [Accepted: 02/10/2016] [Indexed: 12/25/2022] Open
Abstract
A low‐resource visually monitored deep inspiration breath‐hold (VM‐DIBH) technique was successfully implemented in our clinic to reduce cardiac dose in left‐sided breast radiotherapy. In this study, we retrospectively characterized the chest wall and heart positioning accuracy of VM‐DIBH using cine portal images from 42 patients. Central chest wall position from field edge and in‐field maximum heart distance (MHD) were manually measured on cine images and compared to the planned positions based on the digitally reconstructed radiographs (DRRs). An in‐house program was designed to measure left anterior descending artery (LAD) and chest wall separation on the planning DIBH CT scan with respect to breath‐hold level (BHL) during simulation to determine a minimum BHL for VM‐DIBH eligibility. Systematic and random setup uncertainties of 3.0 mm and 2.6 mm, respectively, were found for VM‐DIBH treatment from the chest wall measurements. Intrabeam breath‐hold stability was found to be good, with over 96% of delivered fields within 3 mm. Average treatment MHD was significantly larger for those patients where some of the heart was planned in the field compared to patients whose heart was completely shielded in the plan (p < 0.001). No evidence for a minimum BHL was found, suggesting that all patients who can tolerate DIBH may yield a benefit from it. PACS number(s): 87.53.Jw, 87.53.Kn, 87.55.D‐
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Abstract
Cancer survivorship should be defined starting not from completion of treatment, but from the time of diagnosis. Assessing and controlling the cancer patient's cardiovascular risk before, during, and after treatment is crucial to improving their overall outcome. There are many cancer therapies, including but not limited to anthracyclines, radiation, and vascular signaling pathway inhibitors which should be considered nontraditional cardiovascular risk factors with significant morbidity. Monitoring novel populations, such as a younger age group, for ischemic coronary disease or congestive heart failure (CHF) is not intuitive to many clinicians. Symptoms of CHF and coronary artery disease overlap with common side effects of cancer and cancer treatment. Cancer survivors may also have fewer typical symptoms of cardiovascular disease. Increased surveillance and aggressive control of cardiovascular disease is important in cancer patients both while undergoing active treatment and in the long term. Despite the increasing interest in cardio-oncology, data-driven guidelines are lacking due to small study sizes and low event rates over a short period of time. Most practice guidelines have been based on clinical practice and expert opinion. The list of cardiotoxic cancer therapies continues to grow each year. This review is not intended to be a comprehensive review of all cancer therapy toxicity, but will focus on recent literature regarding prevention of CHF and coronary artery disease (CAD) during active cancer therapy as well as current screening guidelines for long-term survivors.
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9
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Merino Lara TR, Fleury E, Mashouf S, Helou J, McCann C, Ruschin M, Kim A, Makhani N, Ravi A, Pignol JP. Measurement of mean cardiac dose for various breast irradiation techniques and corresponding risk of major cardiovascular event. Front Oncol 2014; 4:284. [PMID: 25374841 PMCID: PMC4205812 DOI: 10.3389/fonc.2014.00284] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/30/2014] [Indexed: 12/04/2022] Open
Abstract
After breast conserving surgery, early stage breast cancer patients are currently treated with a wide range of radiation techniques including whole breast irradiation (WBI), accelerated partial breast irradiation (APBI) using high-dose rate (HDR) brachytherapy, or 3D-conformal radiotherapy (3D-CRT). This study compares the mean heart’s doses for a left breast irradiated with different breast techniques. An anthropomorphic Rando phantom was modified with gelatin-based breast of different sizes and tumors located medially or laterally. The breasts were treated with WBI, 3D-CRT, or HDR APBI. The heart’s mean doses were measured with Gafchromic films and controlled with optically stimulated luminescent dosimeters. Following the model reported by Darby (1), major cardiac were estimated assuming a linear risk increase with the mean dose to the heart of 7.4% per gray. WBI lead to the highest mean heart dose (2.99 Gy) compared to 3D-CRT APBI (0.51 Gy), multicatheter (1.58 Gy), and balloon HDR (2.17 Gy) for a medially located tumor. This translated into long-term coronary event increases of 22, 3.8, 11.7, and 16% respectively. The sensitivity analysis showed that the tumor location had almost no effect on the mean heart dose for 3D-CRT APBI and a minimal impact for HDR APBI. In case of WBI large breast size and set-up errors lead to sharp increases of the mean heart dose. Its value reached 10.79 Gy for women with large breast and a set-up error of 1.5 cm. Such a high value could increase the risk of having long-term coronary events by 80%. Comparison among different irradiation techniques demonstrates that 3D-CRT APBI appears to be the safest one with less probability of having cardiovascular events in the future. A sensitivity analysis showed that WBI is the most challenging technique for patients with large breasts or when significant set-up errors are anticipated. In those cases, additional heart shielding techniques are required.
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Affiliation(s)
- Tomas Rodrigo Merino Lara
- Radiotherapy Unit, School of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile ; Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Emmanuelle Fleury
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Shahram Mashouf
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Joelle Helou
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Claire McCann
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Anthony Kim
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Nadiya Makhani
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Ananth Ravi
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Jean-Philippe Pignol
- Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada ; Department of Radiation Oncology, Erasmus MC , Rotterdam , Netherlands
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Lemanski C, Thariat J, Ampil FL, Bose S, Vock J, Davis R, Chi A, Dutta S, Woods W, Desai A, Godinez J, Karlsson U, Mills M, Nguyen NP, Vinh-Hung V. Image-guided radiotherapy for cardiac sparing in patients with left-sided breast cancer. Front Oncol 2014; 4:257. [PMID: 25295227 PMCID: PMC4172060 DOI: 10.3389/fonc.2014.00257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/05/2014] [Indexed: 11/30/2022] Open
Abstract
Patients with left-sided breast cancer are at risk of cardiac toxicity because of cardiac irradiation during radiotherapy with the conventional 3-dimensional conformal radiotherapy technique. In addition, many patients may receive chemotherapy prior to radiation, which may damage the myocardium and may increase the potential for late cardiac complications. New radiotherapy techniques such as intensity-modulated radiotherapy (IMRT) may decrease the risk of cardiac toxicity because of the steep dose gradient limiting the volume of the heart irradiated to a high dose. Image-guided radiotherapy (IGRT) is a new technique of IMRT delivery with daily imaging, which may further reduce excessive cardiac irradiation. Preliminary results of IGRT for cardiac sparing in patients with left-sided breast cancer are promising and need to be investigated in future prospective clinical studies.
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Affiliation(s)
- Claire Lemanski
- Department of Radiation Oncology, Centre Val d'Aurelle , Montpellier , France
| | - Juliette Thariat
- Department of Radiation Oncology, University of Nice , Nice , France
| | - Federico L Ampil
- Department of Radiation Oncology, Louisiana State University , Shreveport, LA , USA
| | - Satya Bose
- Department of Radiation Oncology, Howard University , Washington, DC , USA
| | - Jacqueline Vock
- Department of Radiation Oncology, Lindenhofspital , Bern , Switzerland
| | - Rick Davis
- Michael D. Watchtel Cancer Center , Oshkosh, WI , USA
| | - Alexander Chi
- Department of Radiation Oncology, University of West Virginia , Morgantown, WV , USA
| | - Suresh Dutta
- Department of Radiation Oncology, Medicine and Radiation Oncology PA , San Antonio, TX , USA
| | - William Woods
- Department of Radiation Oncology, Richard A. Henson Institute , Salisbury, MD , USA
| | - Anand Desai
- Department of Radiation Oncology, Akron City Hospital , Akron, OH , USA
| | - Juan Godinez
- Florida Radiation Oncology Group, Department of Radiation Oncology , Jacksonville, FL , USA
| | - Ulf Karlsson
- Department of Radiation Oncology, Marshfield Clinic , Marshfield, WI , USA
| | - Melissa Mills
- Department of Radiation Oncology, University of Arizona , Tucson, AZ , USA
| | - Nam Phong Nguyen
- Department of Radiation Oncology, Howard University , Washington, DC , USA
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, University of Martinique Hospital , Martinique , France
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Thomsen MS, Harrov U, Fledelius W, Poulsen PR. Inter- and intra-fraction geometric errors in daily image-guided radiotherapy of free-breathing breast cancer patients measured with continuous portal imaging. Acta Oncol 2014; 53:802-8. [PMID: 24739061 DOI: 10.3109/0284186x.2014.905700] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Daily image-guided radiotherapy (IGRT) using two orthogonal setup images may be inaccurate for breast cancer patients treated in free breathing because the setup images may capture the patient in a breathing phase that is not representative of the mean anatomy. The aim of this study was to quantify the setup errors in breast radiotherapy after image-guided setup correction based on two orthogonal setup images acquired in free breathing. METHODS AND MATERIALS For 16 breast cancer patients with daily image-pair based IGRT, continuous portal imaging (7.5 Hz) were acquired at each treatment fraction during the delivery of the two tangential fields. For each portal image, the chest wall position relative to the planned position was determined in the imager direction orthogonal to the cranio-caudal direction. It yielded the time resolved setup error in this direction throughout the 16 treatment courses. RESULTS The mean absolute setup error exceeded 5 mm in 0.9% (first field) and 1.8% (last field) of the treatments. The group mean error (M) and the standard deviations of the random (σ) and systematic (Σ) setup errors were M=-0.7 mm, Σ=1.1 mm, σ=1.5 mm (first field) and M=-0.2 mm, Σ=1.4 mm, σ=1.7 mm (last field). The negative sign of M indicates that less lung than planned was included in the treatment fields. Intra-field peak-to-peak chest wall motion amplitudes were patient dependent with patient mean values of 2.0±0.7 mm [range 1.1-3.2 mm]. The largest observed intra-field motion amplitude was 8 mm. CONCLUSION Image-guided setup based on orthogonal planar images acquired in free breathing without synchronization with the respiratory phase was found to result in accurate tangential breast radiotherapy with only few outliers.
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Affiliation(s)
- Mette S Thomsen
- Department of Medical Physics, Aarhus University Hospital , Denmark
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Davis M, Witteles RM. Radiation-induced heart disease: an under-recognized entity? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:317. [PMID: 24756471 DOI: 10.1007/s11936-014-0317-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT Radiation-induced heart disease (RIHD) represents a spectrum of cardiovascular disease in patients who have undergone mediastinal, thoracic, or breast radiotherapy (RT). RIHD may involve any cardiac structure and is a major cause of morbidity and mortality in cancer survivors. While large cohort studies have demonstrated that symptomatic RIHD is a common late finding in this population, the incidence of asymptomatic disease is likely to be even higher. Long-term follow-up with regular screening for RIHD plays an important role in the management of cancer survivors who have undergone RT. Aggressive modification of traditional cardiovascular risk factors such as hypertension, dyslipidemia, and cigarette smoking is essential in patients at risk for RIHD, as these have been shown to potentiate the risks of radiation. In patients with symptomatic RIHD, medical and/or percutaneous therapies are often preferable to surgical interventions in view of the increased surgical risk associated with radiation damage to surrounding tissues. Percutaneous revascularization should generally be favored over surgical revascularization. Transcatheter valve replacements have not been widely used in this population but may offer an alternative to high-risk surgical valve procedures. Pericardiectomy is usually associated with extremely poor short-term and long-term outcomes in patients with RIHD and should be avoided in most cases. Heart transplantation is also higher risk in patients with RIHD than in patients with other etiologies of heart failure, but may be considered in young patients without other comorbidities.
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Affiliation(s)
- Margot Davis
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Falk Cardiovascular Research Center #273, Stanford, CA, 94305-5406, USA
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