Factors Affecting Mean Heart Dose in Patients Receiving Breast Radiotherapy from 2011-2018 in a Single Institution

Abstract Aim: To compare the dosimetry and reproducibility of set-up with monoisocentric technique (MIT) and dual isocentric technique (DIT) in adjuvant breast radiotherapy (RT). Material and methods: Breast cancer patients treated with MIT or DIT were retrospectively studied. The organ-at-risk dose was compared between two groups. All patients underwent set-up verification with an electronic portal imaging device, and set-up time was recorded for each fraction. Treatment reproducibility was assessed in terms of systematic and random error. Results: Twenty patients were included (11 right and 9 left-sided tumours) and ten received whole breast RT, while the rest received chest wall RT. Overall, the mean heart dose was less with MIT (0.40 versus 0.79, p = <0.001) as well as in left-sided tumours (0.37 versus 0.98, p = 0.003). The maximum dose at the field junction was significantly higher with DIT (43 Gy, 107%, p = 0.003). The maximum total error was 1 cm in lateral for supraclavicular field and 8 mm in superior–inferior in tangents for both techniques. There was no difference in set-up errors between the two techniques. Findings: MIT resulted in better dose homogeneity at the field junctions and reduced mean heart dose as compared to DIT. MIT is safe for implementation in clinical practice for breast cancer treatment. Conclusion: This study is one of the few studies comparing MIT with DIT in terms of the dosimetry and the first one to compare set-up errors between the two techniques. The ease of set-up and better dosimetry with MIT was achieved.

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EP-1314 Cardiac structures doses and correlation with mean heart dose in breast radiotherapy treatment

Radiotherapy and Oncology ◽

10.1016/s0167-8140(19)31734-7 ◽

2019 ◽

Vol 133 ◽

pp. S720-S721

Author(s):

M. Vázquez ◽

A. Giraldo ◽

S. Micó ◽

M. Altabas ◽

D. Sánchez ◽

...

Keyword(s):

Breast Radiotherapy ◽

Heart Dose ◽

Mean Heart Dose ◽

Radiotherapy Treatment

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Cardiac dose evaluation in patients undergoing breast radiotherapy in the modern era.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.26_suppl.78 ◽

2014 ◽

Vol 32 (26_suppl) ◽

pp. 78-78

Author(s):

Christopher A. Peters ◽

Andrew Kaleda ◽

Anthony Manfredo ◽

Elizabeth Tapen ◽

Lawrence Koutcher

Keyword(s):

Breast Cancer ◽

Multivariate Analysis ◽

Critical Role ◽

Univariate Analysis ◽

Metastatic Breast ◽

Planning System ◽

Treatment Planning System ◽

Breast Radiotherapy ◽

Heart Dose ◽

Mean Heart Dose

78 Background: Breast radiotherapy (RT) after conservative surgery improves overall survival and minimizes locoregional recurrence. The therapeutic ratio of adjuvant RT continues to improve with time. Cardiac toxicity from breast cancer treatment remains a concern, and can result from chemotherapy, biologic therapy, or RT in a dose-dependent fashion. Dose to avoidance structures can be minimized as technological improvements in radiotherapy evolve. We sought to investigate heart and coronary artery dose using modern RT techniques. Methods: We reviewed 164 consecutive non-metastatic breast cancer patients treated with adjuvant breast RT, from 3/2011 to 12/2013. 8 patients were excluded because they did not complete the prescribed dose. Patients were treated on 3 different machines, at 2 centers. Data was extracted using both the treatment planning system and electronic medical records. Univariate analysis was done using t-test and one way ANOVA for variables predicting higher mean heart dose (MHD). Multivariate analysis was performed using multiple linear regression. p values ≤0.05 were considered significant. Results: The median age of our cohort was 63 (range 33-85), and 90% had ≤ stage 2 disease. 53% had left sided RT, 45% right, and 2% had bilateral RT. 18% had breast/chest wall and nodal RT, with 2% dedicated IMN targeting. 22% of patients were treated prone. The median dose, including boost, was 60.4 Gy (range 42.4-66.4). 35% received cytotoxic chemotherapy and 10% received trastuzumab. Mean heart dose was 1.4Gy (SD 2.2), and mean LAD dose was 4.9Gy (SD 4.4). MHD were lower in the prone position compared to supine, but did not reach statistical significance p=0.3. Advanced AJCC stage grouping, left sided or bilateral treatment, breast/nodal target volume, and helical treatment were associated with significantly higher MHD on univariate analysis. On multivariate analysis, only breast/nodal volume and helical technique remained significant, both p<0.001. Conclusions: Modern techniques result in low heart and LAD doses in our series. Because adjuvant breast RT plays a critical role in the definitive management of breast cancer, these data are reassuring to patients, physicians, and payers.

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Deep inspirational breath hold to reduce cardiac dose in left-sided breast radiotherapy

Journal of Radiotherapy in Practice ◽

10.1017/s1460396917000152 ◽

2017 ◽

Vol 16 (3) ◽

pp. 251-257 ◽

Cited By ~ 1

Author(s):

Camarie Welgemoed ◽

Jonathan Rogers ◽

Patti McNaught ◽

Susan Cleator ◽

Pippa Riddle ◽

...

Keyword(s):

Radiation Dose ◽

Free Breathing ◽

Good Method ◽

Breath Hold ◽

Treatment Area ◽

Breast Radiotherapy ◽

Deep Inspiration Breath Hold ◽

Heart Dose ◽

Set Up ◽

Mean Heart Dose

AbstractBackgroundDuring left-sided breast radiotherapy, the heart is often exposed to radiation dose. Shielding can be utilised to reduce heart exposure, but compromises the dose delivered to the breast tissue and, in a proportion of patients, to the tumour bed. Deep inspiration breath hold (DIBH) can be used as a technique to move the heart away from the treatment area and thus reduce heart dose. This study examines the efficacy of the Elekta Active Breathing Coordinator (ABC), a DIBH method, in reducing heart dose.Materials and methodsIn total, 12 patients receiving radiotherapy to the left breast were planned for treatment with both a free-breathing (FB) and an ABC scan. The dose volume histogram data for the plans was analysed with respect to heart V13, V5 Gy, mean heart dose and ipsilateral lung V18 Gy. Tumour bed D98%, threshold lung volume in breath hold (BH) and the maximum BH time for each patient was also measured. Patients then received their radiotherapy treatment using the ABC plan and the systematic error in the craniocaudal, lateral and vertical axes was assessed using orthogonal imaging.ResultsThe median heart V13 Gy for FB and DIBH patients was 3% (range, 0·85–11·28) and 0% (range, 0–1·56), respectively, with a mean heart dose of 2·62 Gy (range, 1·21–4·93) in FB and 1·51 Gy (range, 1·17–2·22) in ABC. The median lung V18 Gy was 8·7% (3·08–14·87) in FB plans and 9% (4·88–12·82) in ABC plans. The mean systematic set-up errors in all three planes were within the departmental set-up tolerance of 5 mm for both techniques. Median FB tumour bed D98% was 97·4% (92·8–99·5) and 97·5% (97·3–98·5) for ABC.ConclusionABC represents a good method of reducing radiation dose to the heart while not compromising on dose to the tumour bed, and it has a clear advantage over FB radiotherapy in reducing the risk of cardiac toxicity. It is tolerated well by patients and does not produce any difficulties in patient positioning.

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Mean Heart Dose Is an Inadequate Surrogate for Left Anterior Descending Coronary Artery Dose and the Risk of Major Adverse Cardiac Events in Lung Cancer Radiation Therapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2021.03.005 ◽

2021 ◽

Author(s):

Katelyn M. Atkins ◽

Danielle S. Bitterman ◽

Tafadzwa L. Chaunzwa ◽

David E. Kozono ◽

Elizabeth H. Baldini ◽

...

Keyword(s):

Lung Cancer ◽

Radiation Therapy ◽

Coronary Artery ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Heart Dose ◽

Adverse Cardiac Events ◽

Mean Heart Dose

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PO-1183 Mean heart dose predicts survival of NSCLC patients treated with chemoradiotherapy and durvalumab

Radiotherapy and Oncology ◽

10.1016/s0167-8140(21)07634-9 ◽

2021 ◽

Vol 161 ◽

pp. S981

Author(s):

E. Ćirić ◽

S. Jelerčič ◽

M. Vrankar ◽

J. But Hadžić ◽

K. Stanič ◽

...

Keyword(s):

Heart Dose ◽

Mean Heart Dose ◽

Nsclc Patients

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Predictors of early hospice or death in patients with inoperable lung cancer treated with curative intent.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e20525 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e20525-e20525

Author(s):

Anna Mary Brown Laucis ◽

Kimberly A. Hochstedler ◽

Thomas Pence Boike ◽

Benjamin Movsas ◽

Craig William Stevens ◽

...

Keyword(s):

Lung Cancer ◽

Logistic Regression ◽

Predictive Model ◽

Performance Status ◽

Ecog Performance Status ◽

Curative Intent ◽

Heart Dose ◽

Patient Reported ◽

Mean Heart Dose ◽

Nsclc Patients

e20525 Background: Treatment for inoperable stage II-III non-small cell lung cancer (NSCLC) involves aggressive chemo-radiotherapy (CRT). While outcomes have improved with immunotherapy, some patients transition to hospice or die early in their treatment course. To help identify these patients, we developed a predictive model for early poor outcomes in NSCLC patients treated with curative intent. Methods: In a statewide consortium involving 27 sites, information was collected prospectively on stage II-III NSCLC patients who received curative CRT from April 2012 to November 2019. We defined an early poor outcome as termination of treatment due to hospice enrollment or death within 5 months of initiating radiation therapy. Potential predictors included clinical characteristics and patient reported outcomes (PROs) from validated questionnaires. Logistic regression models were used to assess potential predictors and build predictive models. Multiple imputation was used to handle missing data. We used Lasso regularized logistic regression to build a predictive model with multiple predictor variables. Results: Of the total of 2267 included patients, 128 patients discontinued treatment early due to hospice enrollment or death. The mean age of the 128 patients was 71 years old (range 48-91) and 59% received concurrent chemotherapy. Significant uni-variable predictors of early hospice or death were advanced age, worse ECOG performance status, high PTV volume, short distance to normal tissue critical structures, high mean heart dose, uninsured status, lower scores on the Functional and Physical Well-Being scale and the Lung Cancer Symptoms sub-scale of the FACT-L quality of life instrument, as well as higher levels of patient-reported lack of energy, cough, and shortness of breath. The best predictive model included age, ECOG performance status, PTV volume, mean heart dose, patient insurance status, and patient-reported lack of energy and cough. The pooled estimate of area under the curve (AUC) for this multivariable model was 0.71, with a negative predictive value of 95%, specificity of 97%, positive predictive value of 23%, and sensitivity of 16% at a predicted risk threshold of 20%. Conclusions: Our models identified a combination of clinical variables and PROs that may help identify individuals with inoperable NSCLC undergoing curative intent chemo-radiotherapy who are at a high risk of early hospice enrollment or death. These preliminary results are encouraging and warrant further evaluation in a larger cohort of patients.

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