Dosimetric Comparison of Intensity-Modulated Radiotherapy Plans, With or Without Anterior Myocardial Territory and Left Ventricle as Organs at Risk, in Early-Stage Left-Sided Breast Cancer Patients

Tan, Wenyong; Wang, Xiaohong; Qiu, Dasheng; Dong, Liang; Jia, Shaohui; Zeng, Fang; Chen, Zhengwang; Li, Beihui; Xu, Jinghua; Lai, W. Michael; Hu, Desheng

doi:10.1016/j.ijrobp.2010.09.028

Cited by 25 publications

(20 citation statements)

References 33 publications

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“…Most of the literature analyzed the irradiated dose of heart, but they did not specify the dosimetric parameters of coronary artery when comparing the dose difference of treatment plans for the left-side breast cancer after conserving surgery. There were some studies suggested that coronary heart disease after postoperative radiotherapy for breast cancer was one of the radiation-related complications [27,28]. In this study, the dose-volume (V 5Gy ~V 40Gy ) of heart and coronary artery were detailed and their relationships were described with the quadratic polynomial.…”

Section: Discussionmentioning

confidence: 99%

A comparative dosimetric study for treating left-sided breast cancer for small breast size using five different radiotherapy techniques: conventional tangential field, filed-in-filed, Tangential-IMRT, Multi-beam IMRT and VMAT

et al. 2013

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Background and purposesTo compare the dosimetry for the left-sided breast cancer treatment using five different radiotherapy techniques.Materials and methodsTwenty patients with left sided breast cancer were treated with conservative surgery followed by radiotherapy. They were planned using five different radiotherapy techniques, including: 1) conventional tangential wedge-based fields (TW); 2) field-in-field (FIF) technique; 3) tangential inverse planning intensity-modulated radiation therapy (T-IMRT); 4) multi-field IMRT (M-IMRT); and 5) volumetric modulated arc therapy (VMAT). The CTV, PTV and OARs including the heart, the regions of coronary artery (CA), the contralateral breast, the left and right lung were delineated. The PTV dose was prescribed 50Gy and V47.5≥95%. Same dose constraint was used for all five plans. The planned volumetric dose of PTV and PRV-OARs were compared and analyzed.ResultsExcept VMAT (Average V47.5 was 94.72%±1.2%), all the other four plans were able to meet the V95% (V47.5) requirement. T-IMRT plan improved the PTV dose homogeneity index (HI) by 0.02 and 0.03 when compared to TW plan and VMAT plan, and decreased the V5, V10 and V20 of all PRV-OARs. However, the high dose volume (≥ 30Gy) of the PRV-OARs in T-IMRT plan had no statistically significant difference compared with the other two inverse plans. In all five plans, the dose volume of coronary artery area showed a strong correlation to the dose volume of the heart (the correlation coefficients were 0.993, 0.996, 1.000, 0.995 and 0.986 respectively).ConclusionCompared to other techniques, the T-IMRT technology reduced radiation dose exposure to normal tissues and maintained reasonable target homogeneity, VMAT is not recommended for left-sided breast cancer treatment. In five techniques, the dose-volume histogram (DVH) of the heart can be used to predict the dose-volume histogram (DVH) of the coronary artery.

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Section: Discussionmentioning

confidence: 99%

A comparative dosimetric study for treating left-sided breast cancer for small breast size using five different radiotherapy techniques: conventional tangential field, filed-in-filed, Tangential-IMRT, Multi-beam IMRT and VMAT

et al. 2013

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“…We have previously reported detailed definitions of the heart, AMT, and left ventricle 9,10. Briefly, the heart includes all visible myocardium and excludes large vessels (Figure 1A and B).…”

Section: Methodsmentioning

confidence: 99%

“…The interventricular septum was also included in the left ventricle (Figure 1A and B). The AMT9,10 comprised the myocardium from the anterior surface of the heart up to 1.0 cm posteriorly and the main branches of the coronary arteries at the anterior portion of the heart, such as the left anterior descending artery, left circumflex artery, and right marginal artery as well as the left and right main coronary arteries (Figure 1A–C). The left and right main coronary arteries were defined from their origin in the aortic sinus to the first branches (Figure 1A and C).…”

Section: Methodsmentioning

confidence: 99%

“…Clinically however, the heart is generally considered a whole organ at risk during thoracic RT,4 whereby possible heterogeneity in the radiobiological response of various substructures is not taken into consideration. In previous studies,9,10 we specifically defined the anterior part of the heart as the anterior myocardial territory (AMT). We have shown that the AMT can replace the heart as an independent cardiac substructure, with the aim of decreasing the cardiac radiation dose during breast intensity-modulated RT.…”

Section: Introductionmentioning

confidence: 99%

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Estimation of the displacement of cardiac substructures and the motion of the coronary arteries using electrocardiographic gating

Tan¹,

Xu²,

Wang³

et al. 2013

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PurposeThe aim of this study was to quantify the displacement of cardiac substructures, including the anterior myocardial territory (AMT), left ventricle, and coronary arteries during a normal cardiac cycle.Materials and methodsComputed tomography (CT) images with retrospective electrocardiographic gating of 17 eligible patients were obtained. All images were reconstructed automatically for the end-diastolic and end-systolic phases. CT scanning without contrast at a random phase and a selected vertebral body were used as references to measure three-dimensionaldisplacements of the cardiac substructures.ResultsThe displacement between the end-diastolic and end-systolic phases (Dd-s) was greater than that between the end-systolic and random phases and between the end-diastolic and random cardiac phases. The largest displacements for the heart were in the left, posterior, and inferior directions with an average Dd-s of approximately 4–6 mm. The average Dd-s for the AMT and left ventricle was 1.2–2.7 mm in the anterior and right directions, 4.3–7.8 mm in left and posterior directions, and 4.9–6.3 mm in superior and inferior directions. For the coronary arteries, the average Dd-s was 2.8–5.9 mm in the anterior-posterior direction, 3.5–6.6 mm in left-right direction, and 3.8–5.3 mm in the superior-inferior direction. Inter-observer agreement was excellent for the heart, AMT, and left ventricle (kappa coefficient, >0.75 for all) and good for most coronary arteries in three dimensions (kappa coefficient, 0.511–0.687). The Dd-s did not differ significantly between men and women.ConclusionMost average displacements of the cardiac substructures and coronary arteries were 3–8 mm in three dimensions. These findings will be useful to accurately estimate the radiation dose to cardiac substructures during thoracic radiation and to evaluate the risk of radiation-related heart disease.

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“…For example, in a comparative dosimetric study, Tan et al. demonstrated that using the AMT as an OAR in left-sided breast intensity-modulated RT (IMRT), the radiation dose to the heart could be reduced [43, 44]. …”

Section: Value Of Mean Heart Dosementioning

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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Dosimetric Comparison of Intensity-Modulated Radiotherapy Plans, With or Without Anterior Myocardial Territory and Left Ventricle as Organs at Risk, in Early-Stage Left-Sided Breast Cancer Patients

Cited by 25 publications

References 33 publications

A comparative dosimetric study for treating left-sided breast cancer for small breast size using five different radiotherapy techniques: conventional tangential field, filed-in-filed, Tangential-IMRT, Multi-beam IMRT and VMAT

A comparative dosimetric study for treating left-sided breast cancer for small breast size using five different radiotherapy techniques: conventional tangential field, filed-in-filed, Tangential-IMRT, Multi-beam IMRT and VMAT

Estimation of the displacement of cardiac substructures and the motion of the coronary arteries using electrocardiographic gating

Heart toxicity from breast cancer radiotherapy

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