The relationship between cardiac dosimetry and tumour quadrant location in left sided whole breast and chest wall adjuvant radiotherapy

2021 ◽  
pp. 1-8
Author(s):  
Yazan A. Masannat ◽  
Gabija Lazaraviciute ◽  
Ian K. Garbett ◽  
Natesh Shivakumar ◽  
Brittany V. Brownlee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Exposure ◽  
Maximum Dose ◽  
Statistical Significance ◽  
Breast Cancer Surgery ◽  
Radiotherapy Planning ◽  
Median Percentage ◽  
Cardiac Dose ◽  
Tumour Location ◽  
The Mean

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.

scholarly journals Dose Volume Relationship in Estimating Cardiac Doses in Breast Cancer Radiotherapy

2020 ◽  
Author(s):  
Lucy Pattanayak ◽  
Swodeep Mohanty ◽  
Deepak Kumar Sahu ◽  
Tapas Kumar Dash ◽  
Itishree Priyadarsini
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Conformal Radiotherapy ◽  
Free Breathing ◽  
P Value ◽  
Carcinoma Breast ◽  
Heart Dose ◽  
Cardiac Dose ◽  
The Mean ◽  
Mean Heart Dose

Introduction: Radiation therapy is an integral part of adjuvant treatment for breast cancer which reduces local recurrence and significantly increases survival. But, radiation therapy also has the propensity to increase cardiac morbidity and mortality due to dose received by the heart which is more in left-sided breast cancer. Mean Heart dose and Maximum Heart Distance (MHD) are two parameters to study dose received by the heart. Aim: The purpose of this study was to determine individual doses received by the heart and to correlate MHD with the mean heart dose received by heart in carcinoma breast patients receiving radiotherapy. Materials and Methods: Ninety patients of histologically proven carcinoma breast who attended the Department of Radiotherapy, Acharya Harihar Regional Cancer, Cuttack from January 2017 to January 2019 were selected for a prospective observational study. All patients were treated with 3D Conformal Radiotherapy technique using free breathing multi slice Computed Tomography (CT) scans to contour target and vital organs. Parallel opposed tangential treatment plans were generated for each patient. Individual dose received by the heart and MHD was assessed for each case. SPSS version 21 used for statistical analysis. The Spearman’s Rho test was used for correlation of MHD with Mean heart dose. The Mann-Whitney U test was used for comparing mean of MHD in left-sided and right-sided breast cancer. The Independent t-test was used for comparing means of Mean heart dose in left-sided and right-sided breast cancer. A p-value <0.05 was considered as statistically significant. Results: The Mean Heart Dose was 4.63 Gy for left-sided breast carcinoma patients and 0.846 Gy for right-sided breast cancer and there was a significant difference (p<0.001). Mean MHD for left-sided breast cancer was 2.974 cm while for right-sided it was 0.017 cm, the difference was statistically significant (p-value <0.001). MHD also correlated positively with Mean Heart Dose with correlation coefficient of 0.849 and p-value <0.001. Conclusion: MHD and Mean Heart dose were significantly higher in left-sided breast cancer receiving radiotherapy. MHD was also found to be positively related to Mean Heart dose and therefore found to be an important predictor of cardiac dose. For right-sided breast carcinoma receiving radiotherapy, free breathing technique using 3-Dimensional Conformal Radiotherapy (3DCRT) will suffice in terms of cardiac dose.

Abstract 11655: Long Term Cardiovascular Mortality After Radiotherapy for Breast Cancer: A Meta-Analysis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Partha Sardar ◽  
Saurav Chatterjee ◽  
Anju Nohria ◽  
Ramez Nairooz ◽  
Pascal Meier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Observational Studies ◽  
Meta Analysis ◽  
Late Complication ◽  
Breast Cancer Radiotherapy ◽  
Cardiac Dose ◽  
The Mean ◽  
Cvd Mortality

Introduction: Cardiovascular disease (CVD) is a late complication of radiotherapy (RT); the mean cardiac dose from irradiation of a left-sided breast cancer is much higher than that for a right-sided breast cancer. However, there is limited knowledge regarding the long-term risk of RT on CVD mortality. This study sought to investigate the use of RT for breast cancer and its association with CVD mortality, in the context of the laterality of breast cancer. Hypothesis: Long term cardiac mortalty with left-sided breast cancer radiotherapy is much higher than that for a right-sided breast cancer. Methods: Databases were searched from their inception through December 2013. Studies reporting CVD mortality with left versus right sided breast RT were included. Two authors reviewed the studies, abstracted the data and checked for accuracy, quality and strength of evidence. The outcome of interest was CVD mortality. We calculated summary risk ratio (RR) and 95% confidence intervals (CI) with the random effects model. Results: The analysis included 289,109 patients from 13 observational studies. Women, who had received RT for left-sided breast cancer, had a higher risk of CVD death than those who received RT for a right-sided breast cancer (RR 1.12, 95% CI: 1.07 to 1.18). Difference in CVD mortality between left versus right breast RT was more apparent after 15 years of follow up (RR 1.23, 95% CI: 1.08 to 1.41). Conclusions: Mortality from CVD with left sided RT was significantly higher compared to right sided RT for breast cancer; this difference was more apparent after at least 15 years of follow up.

scholarly journals Free Breathing versus Breath-Hold Scanning Beam Proton Therapy and Cardiac Sparing in Breast Cancer

2016 ◽  
Vol 3 (3) ◽  
pp. 407-413 ◽  
Author(s):  
Jen Yu ◽  
Sean S. Park ◽  
Michael G. Herman ◽  
Katja Langen ◽  
Minesh Mehta ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Computed Tomography ◽  
Proton Therapy ◽  
Free Breathing ◽  
Breath Hold ◽  
Cardiac Dose ◽  
En Face ◽  
Beam Proton ◽  
Internal Mammary ◽  
The Mean

Purpose: To assess dose errors caused by the interplay effects of free-breathing (FB) motion and to assess the value of breath-hold (BH) in terms of cardiac dose reduction for scanning beam proton therapy (SBPT). Materials and Methods: Three patients with left-sided breast cancer previously treated with photon therapy were included in this dosimetric study: 2 following breast-conserving surgery with 2 hypothetical target volumes (whole breast alone and whole breast plus regional nodes, including supraclavicular, axillary, and internal mammary lymph nodes); and 1 postmastectomy, with the target volume including the chest wall plus regional nodes. SBPT plans were generated with various beam angles that ranged between 2 tangential directions. For treatment with FB, nominal dose and dose with interplay effects considered were calculated based on FB 4-dimensional computed tomography scans. SBPT plans on the BH computed tomography were also calculated for one of the patients, who was selected to be treated with photon therapy with BH. Results: Dosimetric differences between nominal and interplay dose were small (average target mean dose, −0.06 Gy; range, −0.23 to 0.06 Gy; average heart mean dose, 0.001 Gy; range, −0.12 to 0.05 Gy). The largest dose deviations occurred in plans calculated with tangential beam arrangements; the smallest was noted with the en face beam. The average value of the mean heart dose with FB was <1 Gy. For the selected patient, the mean heart doses were 0.5 and 0.2 Gy for FB and BH, respectively. Conclusion: Dose deviations caused by the interplay effects of respiratory motion during FB do not have a significant impact in SBPT with en face beam arrangement. BH does not significantly reduce cardiac dose. SBPT delivery is feasible with FB and can provide optimal target coverage and maximal sparing of the cardiopulmonary system, which can translate into improved clinical outcomes and a decrease in treatment-related morbidity in left-sided breast cancer patients or those who require internal mammary node coverage.

scholarly journals Surgical Management of Breast Cancer under Local Anaesthesia: A Surgeon's Perspective

2017 ◽  
Vol 5 (2) ◽  
pp. 63-67
Author(s):  
Tapesh Kumar Paul ◽  
AR Chowdhury ◽  
Russel Ahmed Khan Lodi ◽  
Shayda Ali ◽  
Mohammad Arman Zahed Basunia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Elderly Patients ◽  
Surgical Management ◽  
Local Anaesthesia ◽  
Local Anaesthetics ◽  
Breast Cancer Surgery ◽  
Medical Conditions ◽  
College Hospital ◽  
Medical College ◽  
The Mean

Background: Treatment of breast cancer without surgery may not be effective. But in elderly patients with lots of co-morbidities, surgical management often cannot be done due to the significant risks of general anesthesia. The need for a safe, easy and effective alternative anaesthetic technique that can provide adequate peroperative analgesia as well as reduced anxiety in such group of patients was the main indication for this study.Materials and method: This prospective study was done on eleven patients, with coexisting medical conditions and who were not at all fit for general anaesthesia, and underwent breast cancer surgery under local anaesthesia. The patients were studied with regard to intraoperative analgesia, haemodynamic stability and complications related to technique. The study was done in Delta Medical College Hospital, Dhaka, Bangladesh.Results: Mean±SD of study patients were 64.7±7 years old and all were suffering from coexisting medical conditions. Following local anaesthesia, mean intraoperative heart rate was 81.5±11.8 beats/min and the mean blood pressure was 127.3/79±9.6/7.0 mmHg. Patients felt no pain after infiltration of local anaesthetics, but experienced it if any place was missed before dissection. No complication occurred due to this procedure. All the candidates were fully satisfied with the procedure.Conclusion: Local anaesthesia provides satisfactory pain control along with keeping haemodynamics stable for surgical treatment of breast cancer among elderly patients having co-morbid conditions.Delta Med Col J. Jul 2017 5(2): 63-67

scholarly journals Elastographic Evaluation of Indeterminate Breast Masses on Ultrasound

2016 ◽  
Vol 39 (02) ◽  
pp. 072-079 ◽  
Author(s):  
Luciana Graziano ◽  
Almir Bitencourt ◽  
Marcela Cohen ◽  
Camila Guatelli ◽  
Miriam Poli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Diagnostic Accuracy ◽  
Qualitative Analysis ◽  
Subcutaneous Tissue ◽  
Statistical Significance ◽  
Breast Lesions ◽  
Surgical Biopsy ◽  
Mean Values ◽  
Conventional Ultrasound ◽  
The Mean

Objective To evaluate the diagnostic accuracy of elastography for breast cancer identification in patients with indeterminate lesions on ultrasound. Methods This prospective, descriptive study included patients with indeterminate breast lesions in the ultrasound and with indication for percutaneous or surgical biopsy. The elastography was evaluated by qualitative analysis and by two methods for the semi quantitative analysis. Results We evaluated 125 female patients with 159 lesions, with a mean age of 47 years, and a range of 20–85 years. Ultrasound has shown to be a method with good sensitivity (98.1%), but with a lower specificity (40.6%). On the elastography qualitative analysis, the specificity and accuracy were of 80.2% and 81.8% respectively. The mean size of the lesions showed no difference in classification by elastography. For the semiquantitative elastography, the mean values ​​of the malignant lesions were statistically higher when compared with the subcutaneous tissue or the adjacent fibroglandular tissue. The analysis of the receiver operating characteristic (ROC) curves for these two semiquantitative methods showed that both are considered satisfactory, with an area under the curve above 0.75 and statistical significance (p < 0.0001). The best results were obtained when using the findings of combined conventional ultrasound and qualitative elastography, with 100% sensitivity and 63.2% specificity. Conclusions Elastography can be a useful complementary method, increasing the specificity and diagnostic accuracy of conventional ultrasound for the diagnosis of breast cancer in patients with indeterminate breast lesions.

scholarly journals Myocardial functional and structural abnormalities after adjuvant radiotherapy for breast cancer. Relation to cardiac radiation exposure

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
P Krug ◽  
M Berliere ◽  
C Kirkove ◽  
B Ledoux ◽  
A Pasquet ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Dose ◽  
Radiation Exposure ◽  
Extracellular Volume ◽  
Healthy Controls ◽  
Cardiac Side Effects ◽  
Cardiac Dose ◽  
Structural Abnormalities ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Funds Pierre Masure, Alphonse and Marie Walckiers & De Winter-Vermant, by King Baudouin Foundation Background Radiation therapy (RXT) is a keystone in breast cancer (BC) treatment which allows to reduce risk of local recurrence and cancer related mortality. Yet these benefits may be offset by increases in cardiovascular mortality due to late radiation induced cardiotoxicity. Indeed, prior works in patients exposed to high cardiac radiation dose demonstrated development of diffuse and focal myocardial fibrosis by cMR. However, whether such effects may also occur after contemporary BC-RXT with lower cardiac dose exposure, has not yet been evaluated. Purpose To evaluate the long-term cardiac safety of contemporary RXT for BC, we sought to estimate the prevalence of cardiac functional and structural focal and myocardial abnormalities in BC survivors treated by RXT 10 years earlier, in direct relation to measured local radiation dose exposure. Methods In a prospective cross-sectional study, we studied 27 women (mean age 62 ± 7 years) treated with adjuvant RXT but without chemotherapy for a first left (n= 12) or right sided (n= 15) BC between 2009 and 2011, which had no history of coronary artery or cardiac disease and compared them to 20 age matched (64 ± 10 years) healthy female controls (without history of BC or RXT). All subjects underwent 3T cMR to measure LV volumes, function, global longitudinal (GLS), circumferential (GRS) and radial strains (GRS) as well as extracellular volume (ECV) and late gadolinium enhancement (LGE). Functional and structural abnormalities in women with BC were compared to healthy controls. We also compared abnormalities among patients with left vs right BC and related them to mean heart radiation dose measured at the time of RXT (Figure). Results Mean cardiac radiation exposure in BC survivors was 1.87 ± 1.7 Gy (range 0-7.9 Gy). Exposure was significantly (p &lt; 0.001) higher in left (3.3 ± 0.66 Gy) than in right (0.84 ± 0.65 Gy) sided BC. Indexed LV mass was slightly lower in BC patients than in controls (46 ± 6 vs 51 ± 9 g/m2, p = 0.03), whereas indexed end-diastolic (66 ± 11 vs 66 ± 12 ml/m2, p = NS) and end-systolic volumes (25 ± 8 vs 24 ± 7 ml/m2, p = NS) were similar. Also, LV ejection fraction (63 ± 6 vs 64 ± 6, p = NS), GLS (-14.7 ± 1.9 vs -15.5 ± 1.8, p = NS), GCS (-20.0 ± 3.6 vs -19.3 ± 5.9, p = NS) and GRS (40.9 ± 10.7 vs 37.0 ± 9.0, p = NS) were not statistically different in BC survivors than in controls. No patient presented LGE, and ECV was similar in BC patients exposed to RXT (28.3 ± 2.8) than in controls (29.3 ± 2.4, p = 0.58). Also, no differences in ECV between left and right sided BC and no statistical correlation between ECV and mean heart dose (r = 0.01, p = NS) was observed. Conclusions In this preliminary work, patients with BC treated by adjuvant RXT 10 years ago, presented no significant structural or functional abnormalities in relation to cardiac dose exposure nor in comparison to healthy controls. This suggests that current RXT protocols for BC are safe without long-term functional or morphological cardiac side effects.

Comparison of the efficacy of adjuvant letrozole and anastrozole in hormone-receptor positive postmenopausal breast cancer patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11554-e11554
Author(s):  
Mehmet Ali Nahit Sendur ◽  
Sercan Aksoy ◽  
Kadri Altundag
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Aromatase Inhibitors ◽  
Hormone Receptor ◽  
Statistical Significance ◽  
Disease Free Survival ◽  
Postmenopausal Breast Cancer ◽  
Breast Cancer Patients ◽  
Hormone Receptor Positive ◽  
The Mean

e11554 Background: In the adjuvant hormonal treatment of postmenopausal breast cancer patients, most of the trials have showed the superiority of aromatase inhibitors over tamoxifen. However, there are limited data in the literature comparing the efficacy of aromatase inhibitors in postmenopausal women. Thus, the aim of this study is to compare the efficacy of letrozole and anastrozole in hormone-receptor positive postmenopausal breast cancer patients. Methods: Newly diagnosed breast cancer patients from 2001 to 2012 in our clinic were retrospectively analyzed. A total 566 hormone receptor-positive postmenopausal breast cancer patients were analyzed. The patients were divided into two group; anastrozole group (n=235) and letrozole patients (n=331). Kaplan–Meier survival analysis was carried out for disease free survival (DFS) and overall survival (OS). The log-rank test was used to examine the statistical significance of the differences observed between the groups. Results: The mean age was 59.2±8.5 in anastrozole group, and 60.1±8.4 in letrozole arm (P = 0.19). The mean BMI was 29.4±5.1 kg/m2 and 29.3±5.3 kg/m2 of anastrozole and letrozole arm, respectively (P =0.84). The median follow-up time for this analysis was 25.1 months. The histology of the primary tumor and type of surgery was similar and not statistically significant in both groups. Also in both arms the incidence of lymphovascular invasion, perineural invasion, HER2 positivity and histological grade were similar and not statistically significant. There were no apparent differences in baseline nodal status (P = 0.43), tumor size (P = 0.58) and tumor stage (P = 0.15) between two treatment arms. In anastrozole arm DFS rate was 93.7%, 81.3% and 66.0% whereas in letrozole arm DFS rate was 90.6%, 78.7% and 68.5% in the first, third and fifth years respectively. Median OS could not be obtained due to low events in both groups. Three year survival rate in anastrozole group was 98.8%, whereas in letrozole arm was 96.7% (P=0.84). Conclusions: In this retrospective study, the efficacy of letrozole and anastrozole was similar in hormone-receptor positive postmenopausal breast cancer patients.

Brachial plexopathy in breast cancer: is it radiation related? An analysis technique and dose volume parameters to brachial plexus in breast cancer radiotherapy

2017 ◽  
Vol 5 (2) ◽  
pp. 469
Author(s):  
Beena Kunheri ◽  
Anand Radhakrishnan ◽  
Toyce Stephen ◽  
Renil Mon ◽  
Anjali Menon
Keyword(s):  
Breast Cancer ◽  
Brachial Plexus ◽  
Maximum Dose ◽  
Mean Value ◽  
Brachial Plexopathy ◽  
Dose Volume Histograms ◽  
Dose Volume ◽  
Supraclavicular Fossa ◽  
Patient Reported ◽  
The Mean

Background: Brachial plexus dysfunction is a rare but well-recognized complication of breast cancer surgery and radiotherapy. Most of the time it presents as paraesthesia of the arm. In an earlier publication Dan Lundstedt et al from Sweden, quantitatively assessed the radiation related brachial plexopathy (mainly paraesthesia) with the help of dose volume histograms and its co relation between patient reported paraesthesia. Paraesthesia was reported by 25% after radiation therapy to the supraclavicular fossa, with a V40 Gy 13.5 cm3 and maximum dose to brachial plexus (Dmax) was not found to correlate with paraesthesia. In order to predict the risk brachial plexopathy in our patients we decided to analyze the dose volume parameters for brachial plexus in carcinoma breast patients treated at our institution with modern radiotherapy techniques.Methods: Twenty five consecutive patients who received post mastectomy radiation during the period September 2015 to January 2016 with a dose of 50Gy in 25 fractions were included for this analysis. Brachial plexus contoured using RTOG guidelines, and dose volume parameters for brachial plexus were documented from the existing treatment plans.Results: The maximum dose to the brachial plexus ranged from 5045cGy to 5679cGy with a mean value of 5312.8cGy. The mean dose received by the brachial plexus ranged from 3093cGy to 4714cGy and the mean value was 4137.28cGy. Volume receiving 40Gy, that is V40, ranged from 2.0078cc to 11.56cc with a mean value of 7.57cc.Conclusions: Maximum dose and V40 Gy values were well below the tolerance limit of plexus, and hence post mastectomy irradiation with modern techniques is unlikely to produce significant brachial plexus neuropathy.

scholarly journals Dosimetric Comparison of Different 3DCRT Techniques in Left Breast Cancer Radiotherapy Planning

2016 ◽  
Vol 17 (2) ◽  
pp. 108-113
Author(s):  
Abdus Sattar Mollah ◽  
Meher Niger Sharmin
Keyword(s):  
Breast Cancer ◽  
Treatment Plan ◽  
Three Dimensional ◽  
Dose Calculation ◽  
Conformal Radiotherapy ◽  
Radiotherapy Planning ◽  
Conformity Index ◽  
Calculation Algorithm ◽  
Breast Cancer Radiotherapy ◽  
The Mean

Treatment plan of 10 patients with left-sided breast cancer treated to a prescribed dose of 50 Gy in 25 fractions were selected. The treatment plans were generated by using an Elekta Precise PLAN treatment plan system (TPS) in three different ways namely M1 method, M2 method and M3 method for evaluation of dosimetric parameters based on three dimensional conformal radiotherapy (3DCRT) technique. Pencil beam calculation algorithm was used for dose calculation of Planning Treatment Volume (PTV) as well as Organ At Risk (OAR), with heterogeneity corrections. Plans were compared according to dose-volume histogram (DVH) analysis in terms of PTV homogeneity and conformity indices (HI and CI) as well as OARs dose and volume parameters. All the three treatment methods achieved comparable radiation dose delivery to PTV-95% of the prescribed dose covering > 95% of the breast PTV. The mean volume of PTV receiving 105% (V105) of the prescribed dose was 2.12% (range 0 - 5.7%) for M1 plan, 1.9% for M2 plan, and 3.08% for M3 plan. The homogeneity and conformity indices (HI and CI) were similar for M1 plan and M2 plan, whereas the M3 plan had better conformity index at the cost of less homogeneity. The low-dose volumes (V5Gy) in the heart and lungs were larger in M1 plan than in the other methods. The value of the mean dose to the ipsilateral lung was higher for M2 plan than the values for with M1 plan and M3 plan. Compared with M1 and M3 plan, M2 plan proved to be a simple planning method for 3DCRT breast irradiation.Bangladesh J. Nuclear Med. 17(2): 108-113, July 2014

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