Coronary Event Analysis in Breast Cancer Patients Who Received Breast-Conserving Surgery and Post-Operative Radiotherapy: a Korean Nationwide Cohort Study

Sung, Soo-Yoon; Lee, Jong Hoon; Yang, Ki Hwa; Seo, Yunye; Kang, Myounggon

doi:10.4048/jbc.2020.23.e30

Cited by 3 publications

(7 citation statements)

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“…Al fine di minimizzare il rischio di CAD, per quanto non si possa definire una dose soglia, è consigliato mantenere la dose media cardiaca al di sotto dei 5 Gy, la V25Gy del cuore inferiore al 5% e la dose alla regione coronarica al di sotto di 20 Gy in frazionamento convenzionale. In relazione alla più recente introduzione di schedule di trattamento ipofrazionato, vi sono pochi dati dosimetrici definitivi che possano essere utilizzati come riferimenti certi; si consiglia pertanto l'utilizzo di dosi-soglia biologicamente equivalenti a quelle sopra riportate 91,[94][95][96][97][98][99][100] .…”

Section: (A) Aspetti Generali E Fattori DI Rischiounclassified

“…Infine una recente metanalisi 91 ha confermato come l'omissione della radioterapia in pazienti di età ⩾70 anni con neoplasie in stadio iniziale, sottoposte a terapia con tamoxifene, comporti uno svantaggio in termini di recidiva locale e locoregionale, ma non in termini di sopravvivenza globale. In conclusione, in base ai dati attualmente disponibili in letteratura [89][90][91][92][93][94][95][96][97][98][99][100] , è possibile che l'integrazione di specifici fattori prognostici associati alle pazienti e alla neoplasia possano consentire di individuare una classe di pazienti a basso rischio nelle quali omettere la radioterapia adiuvante 101,102 .…”

Section: Quesito Clinico Nunclassified

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AIRO Breast Cancer Group Best Clinical Practice 2022 Update

Ciabattoni

Gregucci

Rose

et al. 2022

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Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice. Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group. We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology ( www.sign.ac.uk ). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations. Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered. Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation). Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders. Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine.

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Section: (A) Aspetti Generali E Fattori DI Rischiounclassified

Section: Quesito Clinico Nunclassified

AIRO Breast Cancer Group Best Clinical Practice 2022 Update

Ciabattoni

Gregucci

Rose

et al. 2022

Tumori

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“…Therefore, long-term observation is needed [ 2 , 3 ]. Third, pre-existing risk factors such as smoking, old age, obesity, cardio-metabolic risk factors of hypertension and diabetes, and other cardiovascular or cerebrovascular disease can affect cardiac toxicity [ 4 – 6 ]. Most importantly, cardiac toxicity increases gradually per mean heart dose without a clear threshold [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Variation of heart and lung radiation doses according to setup uncertainty in left breast cancer

2021

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Purpose Breast radiotherapy set-up is often uncertain. Actual dose distribution to normal tissues could be different from planned dose distribution. The objective of this study was to investigate such difference in dose distribution according to the extent of set-up error in breast radiotherapy. Materials and methods A total of 50 Gy with fraction size of 2 Gy was given to 30 left breasts with different set-ups applying a deep inspiration breath holding (DIBH) or a free breathing (FB) technique. Under the assumption that errors might come from translational axes of deep or caudal directions, the isocenter was shifted from the original tangential alignment every 2.5 mm to simulate uncertainty of deep and caudal tangential set-up in DIBH and FB. Changes were evaluated for dosimetric parameters for the heart, the left ventricle (LV), the left anterior descending coronary artery (LAD), and the ipsilateral lung. Results On the original plan, mean doses of heart and ipsilateral lung were 2.0 ± 1.1 Gy and 3.7 ± 1.4 Gy in DIBH and 8.4 ± 1.3 Gy and 7.8 ± 1.5 Gy in FB, respectively. The change of dose distribution for the heart in DIBH was milder than that in FB. The deeper the tangential set-up, the worse the heart, LV, LAD, and ipsilateral lung doses, showing as much as 49.4%, 56.4%, 90.3%, and 26.1% shifts, respectively, in 5 mm DIBH setup. The caudal set-up did not show significant dose difference. In multiple comparison of DIBH, differences of mean dose occurred in all 7.5 mm deep set-ups for the heart (p = 0.025), the LV (p = 0.049), and LAD (p = 0.025) in DIBH. Conclusions To correct set-up error over indicated limitation for deep tangential set-up in DIBH at 5 mm action level, mean heart and ipsilateral lung doses are expected to increase approximately 50% and 25%, respectively.

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“…A recent study reported a 5.3% rate of major coronary events (MACE) after RT in breast cancer patients. Moreover, patients with high blood pressure, diabetes mellitus, and cerebrovascular accidents had 3-year coronary event-free survival rates that were inferior to those of the patients without such comorbidities [ 4 ] The increase in the rate of MACE was proportional to the radiation dose; MACE manifested within up to at least 20 years [ 5 ].…”

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confidence: 99%

“…A meta-analysis showed that significant cardiovascular mortality after RT of the left breast, compared with that of the right breast, was more obvious after a long follow-up of over 15 years [ 6 ]. Thus, in breast cancer patients with cardiovascular risk factors, RT should include heart-sparing methods, or it may be performed via intensity-modulated technology to avoid significant cardiotoxicity [ 4 ].…”

mentioning

confidence: 99%