Coronary stenosis risk analysis following Hodgkin lymphoma radiotherapy: A study based on patient specific artery segments dose calculation

Moignier, A.; Broggio, David; Derreumaux, S.; Beaudré, A.; Girinsky, T.; Paul, Jean‐François; Drubay, Damien; Lefkopoulos, D.; Franck, Didier; Aubert, Bernard; Deutsch, Éric; Bourhis, Jean

doi:10.1016/j.radonc.2015.07.043

Cited by 56 publications

(52 citation statements)

References 25 publications

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“…2012 [22]1970–2003Angiography10.3 yearsCoronary arteries within (or near) the tangential radiation field, so called hotspot areas: mid, distal, and distal diagonal branch of LADStenosis in LAD (mid, distal and distal diagonal branch of LAD)Moignier et al. 2015 [23]2000–2008Coronary CT angiographyMedian 6 yearsCoronary artery segments: median 30.3 Gy vs. 26.3 GyCoronary stenosisSkyttä et al. 2015 [28]2011–2013Serum troponin T9 months (mean)Mean heart dose: 4 Gy vs. 2.8 GyIncrease of serum troponin T (hscTNT) > 30%Mean LV dose: 6.7 vs. 4.5 GyMean LAD dose: 23.8 vs. 17.5 GyV20 LAD : 55.4% vs. 36.2%V30 LAD : 45% vs. 29.3%Erven et al.…”

Section: Methodsmentioning

confidence: 99%

Heart toxicity from breast cancer radiotherapy

et al. 2018

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BackgroundLate cardiac toxicities caused by (particularly left-sided) breast radiotherapy (RT) are now recognized as rare but relevant sequelae, which has prompted research on risk structure identification and definition of threshold doses to heart subvolumes. The aim of the present review was to critically discuss the clinical evidence on late cardiac reactions based on dose-dependent outcome reports for mean heart doses as well as doses to cardiac substructures.MethodsA literature review was performed to examine clinical evidence on radiation-induced heart toxicities. Mean heart doses and doses to cardiac substructures were focused upon based on dose-dependent outcome reports. Furthermore, an overview of radiation techniques for heart protection is given and non-radiotherapeutic aspects of cardiotoxicity in the multimodal setting of breast cancer treatment are discussed.ResultsBased on available findings, the DEGRO breast cancer expert panel recommends the following constraints: mean heart dose <2.5 Gy; DmeanLV (mean dose left ventricle) < 3 Gy; V5LV (volume of LV receiving ≥5 Gy) < 17%; V23LV (volume of LV receiving ≥23 Gy) < 5%; DmeanLAD (mean dose left descending artery) < 10 Gy; V30LAD (volume of LAD receiving ≥30 Gy) < 2%; V40LAD (volume of LAD receiving ≥40 Gy) < 1%.ConclusionIn addition to mean heart dose, breast cancer RT treatment planning should also include constraints for cardiac subvolumes such as LV and LAD. The given constraints serve as a clinicians’ aid for ensuring adequate heart protection. The individual decision between sufficient protection of cardiac structures versus optimal target volume coverage remains in the physician’s hand. The risk of breast cancer-specific mortality and a patient’s cardiac risk factors must be individually weighed up against the risk of radiation-induced cardiotoxicity.

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Section: Methodsmentioning

confidence: 99%

Heart toxicity from breast cancer radiotherapy

et al. 2018

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“…Some studies have investigated the relationship between doses to particular cardiac substructures and subsequent damage to those structures. In Hodgkin lymphoma, one study related valve doses to subsequent valvular heart disease and another related coronary artery doses to subsequent coronary artery stenosis [4], [5]. In breast cancer, two studies have related coronary artery doses to subsequent coronary artery stenosis [6], [7] and further studies have related whole left ventricle dose to subsequent subclinical left ventricular abnormalities [8], [9].…”

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confidence: 99%

A cardiac contouring atlas for radiotherapy

Duane

Aznar

Bartlett

et al. 2017

Radiotherapy and Oncology

237

148

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Background and purposeThe heart is a complex anatomical organ and contouring the cardiac substructures is challenging. This study presents a reproducible method for contouring left ventricular and coronary arterial segments on radiotherapy CT-planning scans.Material and methodsSegments were defined from cardiology models and agreed by two cardiologists. Reference atlas contours were delineated and written guidelines prepared. Six radiation oncologists tested the atlas. Spatial variation was assessed using the DICE similarity coefficient (DSC) and the directed Hausdorff average distance (d→H,avg). The effect of spatial variation on doses was assessed using six different breast cancer regimens.ResultsThe atlas enabled contouring of 15 cardiac segments. Inter-observer contour overlap (mean DSC) was 0.60–0.73 for five left ventricular segments and 0.10–0.53 for ten coronary arterial segments. Inter-observer contour separation (mean d→H,avg) was 1.5–2.2 mm for left ventricular segments and 1.3–5.1 mm for coronary artery segments. This spatial variation resulted in <1 Gy dose variation for most regimens and segments, but 1.2–21.8 Gy variation for segments close to a field edge.ConclusionsThis cardiac atlas enables reproducible contouring of segments of the left ventricle and main coronary arteries to facilitate future studies relating cardiac radiation doses to clinical outcomes.

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“…In another study of HL survivors, the prior radiation doses to stenotic segments were compared with those received by normal segments (from cases and controls). In 11 cases out of 12, the highest of the coronary dose distribution was on a damaged segment . The coronary ostia and proximal segments were most often involved …”

Section: Resultsmentioning

confidence: 99%

“…An increased risk of fatal MI of 2.2‐fold to 7.7‐fold (as compared with the general population) have been documented in several studies of HL survivors who had prior treatments with supradiaphragmatic RT . More than 1 classical CAD risk factor further increased the risk of suffering symptomatic MI or angina . The risk of developing CAD increases with time.…”

Section: Resultsmentioning

confidence: 99%

Short and long term radiation induced cardiovascular disease in patients with cancer

Nielsen

Offersen

Nielsen

et al. 2017

Clinical Cardiology

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Radiation‐induced cardiovascular disease is well described as a late effect in cancer patients treated with radiation therapy. Advancements in surgery, radiotherapy, and chemotherapy have led to an increasing number of cancer survivors with resultant long‐term side effects related to their cancer treatments. In this review, we describe the short‐ and long‐term cardiovascular consequences of mediastinal radiotherapy and discuss the optimal cardiovascular assessments and diagnostic tools in asymptomatic and symptomatic patients.

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Coronary stenosis risk analysis following Hodgkin lymphoma radiotherapy: A study based on patient specific artery segments dose calculation

Cited by 56 publications

References 25 publications

Heart toxicity from breast cancer radiotherapy

Heart toxicity from breast cancer radiotherapy

A cardiac contouring atlas for radiotherapy

Short and long term radiation induced cardiovascular disease in patients with cancer

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