Cardiac risk index as a simple geometric indicator to select patients for the heart‐sparing radiotherapy of left‐sided breast cancer

Abstract

Cardiac risk index proposed as a simple geometric indicator to select high-risk patients provides useful guidance for clinicians considering optimal implementation of heart-sparing RT.

Identifying breast cancer patients who gain the most dosimetric benefit from deep inspiration breath hold radiotherapy

“…It should be noted that, despite variations in the actual measurement taken, the majority of studies that have suggested potential predictive factors have identified these as being related to the amount of heart in the field at FB indicating this area warrants further investigation. 6,[12][13][14] Although this is a factor that would most often be assessed after CT simulation, if a patient had diagnostic CT scans performed during the diagnosis phase, the radiation oncologist may be able to use these to assess the potential amount of heart in treatment field. This information could inform their decision regarding whether the patient would benefit from DIBH prior to CT simulation.…”

“…stage, smoking status, co-morbidities and radiation prescription. DIBH technique-specific factors investigated in previous studies as potential factors associated with reduction in heart and lung dose were also collected, 6,[8][9][10][11][12][13][14][15][16][17][18] and are provided in Table 2. Multiple heart, lung and LAD doses were recorded from both the FB and DIBH plans ( Table 2).…”

“…To date, various potential patient and radiation therapy technique-specific factors have been investigated as potential predictors of mean heart dose reduction. 6,[8][9][10][11][12][13][14][15][16][17][18] While these studies have all compared heart doses on free breathing (FB) versus DIBH planning computed tomography (CT) scans of left-sided breast cancer patients receiving radiation therapy to their whole breast or chest wall, predictive factors identified have varied. The aim of this study was to investigate if any factors existed that could identify breast cancer patients who may benefit most from DIBH, to develop a cardiac dose risk profile approach to facilitate appropriate utilisation of departmental resources.…”

“…To date, various potential patient and radiation therapy technique‐specific factors have been investigated as potential predictors of mean heart dose reduction 6,8–18 . While these studies have all compared heart doses on free breathing (FB) versus DIBH planning computed tomography (CT) scans of left‐sided breast cancer patients receiving radiation therapy to their whole breast or chest wall, predictive factors identified have varied.…”

Radiation-Induced Cardiovascular Toxicity: Mechanisms, Prevention, and Treatment

“…For conventional RT, various heart-sparing techniques have been developed to reduce unwanted absorbed dose to the heart, including prone position RT, deep inspiration breath hold, and dynamic breathing guidance [41,42]. These techniques, however, require extra resources and workload, and methods to evaluate their benefit on an individual patient basis as well as simplify the treatment planning are being developed [43,44]. Efforts are also being made to further improve the accuracy in dosimetry and treatment planning [44,45].…”