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

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

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

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.

Mono versus dual isocentric technique for breast cancer radiotherapy: evaluation of planning, dosimetry and treatment delivery

2020 ◽  
pp. 1-6
Author(s):  
Tabassum Wadasadawala ◽  
Shirley Lewis ◽  
Utpal Gaikwad ◽  
Umesh Gayake ◽  
Reena Phurailatpam ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Total Error ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Imaging Device ◽  
Heart Dose ◽  
Breast Cancer Radiotherapy ◽  
Field Junction ◽  
Set Up ◽  
Mean Heart Dose

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.

scholarly journals PO-0762 Low predictive value of mean heart dose for coronary artery dosimetry in breast cancer radiotherapy

2019 ◽  
Vol 133 ◽  
pp. S391-S392
Author(s):  
S. JACOB ◽  
J. Camilleri ◽  
S. Derreumaux ◽  
V. Walker ◽  
O. Lairez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Coronary Artery ◽  
Predictive Value ◽  
Cancer Radiotherapy ◽  
Heart Dose ◽  
Breast Cancer Radiotherapy ◽  
Mean Heart Dose

Establishing Mean Heart Dose Thresholds for Cost-effective Allocation of Proton Regional Nodal Irradiation

2020 ◽  
Vol 108 (3) ◽  
pp. S144
Author(s):  
R. Mailhot Vega ◽  
J.A. Bradley ◽  
N.A. Lockney ◽  
N.P. Mendenhall ◽  
S. MacDonald ◽  
...  
Keyword(s):  
Cost Effective ◽  
Regional Nodal Irradiation ◽  
Heart Dose ◽  
Mean Heart Dose

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

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

scholarly journals Identifying Mean Heart Dose Thresholds for Proton Therapy Acceptability in Mediastinal Unfavorable Early-Stage Hodgkin Disease

2020 ◽  
Vol 108 (3) ◽  
pp. e401-e402
Author(s):  
R. Mailhot Vega ◽  
S. Patel ◽  
A.L. Holtzman ◽  
N.A. Lockney ◽  
J.W. Lynch ◽  
...  
Keyword(s):  
Proton Therapy ◽  
Early Stage ◽  
Hodgkin Disease ◽  
Heart Dose ◽  
Mean Heart Dose

scholarly journals OC-0384: Relationship of mean heart dose and cardiac substructure dose over evolving radiation techniques in Hodgkin lymphoma

2018 ◽  
Vol 127 ◽  
pp. S196-S197
Author(s):  
B. Hoppe ◽  
N.P. Mendenhall ◽  
J.E. Bates ◽  
C.G. Morris ◽  
S. Flampouri
Keyword(s):  
Hodgkin Lymphoma ◽  
Heart Dose ◽  
Mean Heart Dose ◽  
Relationship Of

An update on the dosimetric analysis of concurrent radiation therapy and trastuzumab on early cardiac events.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 121-121
Author(s):  
K. S. Keene ◽  
L. C. Klepczyk ◽  
R. Meredith ◽  
A. Forero-Torres ◽  
J. T. Carpenter ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Heart Disease ◽  
Breath Hold ◽  
Cardiac Events ◽  
Cardiac Morbidity ◽  
Heart Dose ◽  
Dosimetric Analysis ◽  
Mean Heart Dose ◽  
The Impact

121 Background: The impact of radiation therapy (RT) with concurrent trastuzumab on early cardiac morbidity is relatively unknown. Trastuzumab’s radiosensitizing properties may augment both early and late effects of RT. This retrospective review update provides an analysis of cardiac event (CE) development in patients treated with concurrent RT and trastuzumab with a focus on RT heart dose. Methods: Sixty-five patients treated with concurrent RT (30 left, 33 right, 2 bilateral) and trastuzumab at the University of Alabama at Birmingham were identified. Patient data for pre-existing heart disease, cardiac risk factors, drug regimen, and CEs were recorded. Dosimetric parameters of maximum heart dose, mean heart dose, heart volume receiving 5, 10, 15, 20 and 30Gy (V5, V10, V15, V20, V30) were also analyzed. Endpoints include the occurrence of CEs at any time in relation to RT and those specifically after the start of RT. Results: In addition to receiving trastuzumab, 80% of patients received doxorubicin. 15.4% had preexisting heart disease. The mean heart dose for all patients was 248cGy. With a median follow-up of 24.5 months, six patients developed CEs (9.2%), and three of these cases occurred after RT initiation (4, 4, and 0.5 months post-RT). All six CEs occurred during treatment with trastuzumab and consisted of congestive heart failure. Analysis of the heart dose maximum, mean, V5, V10, V15, and V20, V30 were similar in patients with and without CEs, and small differences between groups did not reach statistical significance. CE incidence was significantly associated with smoking (p=0.0037) but not hypertension, diabetes or pre-existing heart disease. Conclusions: This updated retrospective dosimetric analysis did not find a correlation between concurrent trastuzumab and RT on the development of early cardiac events. Modern era RT with 3D conformal planning, the use of heart blocks, and breath hold techniques will continue to decrease the dose to the heart. Longer follow-up will be needed for analysis of the impact of modern technologic advances and late cardiac morbidity.

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

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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