Dosimetric Comparison of the Heart and Left Anterior Descending Artery in Patients With Left Breast Cancer Treated With Three-Dimensional Conformal and Intensity-Modulated Radiotherapy

Garg, A.K.; Kumar, Piyush

doi:10.7759/cureus.21108

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…Several dosimetric studies have investigated the dosimetric implications of breast radiation on cardiac risk, especially for left-sided tumor and internal mammary chain radiation [10,11]. A study done by Garg and Kumar has shown that V 25 to the heart with 3D-CRT was 14.13 and IMRT 27.74 Gy [12]. In a dosimetric study comparing post-mastectomy IMRT and 3D-CRT, Khullar et al showed that except for the mean dose to the opposite breast, the compliance to DVH constraints for PTV and OARs was significantly improved with IMRT [13].…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Study Comparing 3D Conformal Radiotherapy (3D-CRT), Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) in Hypofractionated One-Week Radiotherapy Regimen in Breast Cancer

Ahmad¹,

Das²,

Kharade³

et al. 2022

Cureus

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IntroductionRecently, the one-week hypofractionated radiotherapy regimen (26 Gy in 5 fractions) for adjuvant breast radiotherapy has been shown to be non-inferior to other hypofractionated regimens (15-16 fractions). The aim of the present dosimetric study is to compare Intensity Modulated Radiotherapy (IMRT), Volumetric Modulated Arc Therapy (VMAT) and 3D Conformal Radiotherapy (3D-CRT) for a one-week hypofractionated radiotherapy regimen (26 Gy in 5 fractions) for adjuvant breast radiotherapy. MethodsA total of 30 patients with histologically proven invasive carcinoma of the breast after breast conservation surgery (BCS) or modified radical mastectomy (MRM) were considered for in silico planning study. The dose prescription used was 26 Gy in 5 fractions as used in the FAST Forward protocol. Targets were contoured according to standard guidelines. The heart, ipsilateral lung, and contralateral breast were contoured as organs at risk. ResultsPlanning Target Volume (PTV) coverage: For IMRT, VMAT and 3D-CRT, respectively, the volumes that received at least 95% of the prescription dose (V 95 ) were 95.7 ± 2.12, 92.47 ± 3.83, 90.87 ± 5.13; mean PTV doses (D mean ) were 26.1 ± 0.6, 25.7 ± 0.7, and 28 ± 4.39 (3D-CRT has higher D mean compared to other techniques). Maximum PTV doses (D max ) were 28.23 ± 0.72, 28.73 ± 0.64, and 29.8 ± 1.03. IMRT had a better V 95 coverage and conformity index.Organs At Risk (OARs): The volumes that received at least 25% of the prescription dose (V 25 ) of the heart were 3.41 ± 4.7, 1.8 ± 2.02 and 4.3 ± 6.98 in IMRT, VMAT and 3D-CRT, respectively. The volumetric (V 25 ) comparison of heart dose in left-sided breast cancer was significantly different between VMAT and 3D-CRT (p=0.04, Wilcoxon signed-rank test). The volume that received at least 5% of the prescription dose (V 5 ) was less than 25% in the 3D-CRT plan (12.55).

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Section: Discussionmentioning

confidence: 99%

Dosimetric Study Comparing 3D Conformal Radiotherapy (3D-CRT), Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) in Hypofractionated One-Week Radiotherapy Regimen in Breast Cancer

Ahmad¹,

Das²,

Kharade³

et al. 2022

Cureus

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Correlations between patient-specific parameters and dosimetric indices for personalized breast cancer radiotherapy

Costin,

Marcu

2024

Sci Rep

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Treatment planning parameters in radiotherapy are key elements that dictate the success of treatment outcome. While some parameters are commonly evaluated irrespective of cancer type, others are site-dependent and strongly patient specific. Given the critical influence of planning parameters on personalized therapy, the aim of this study was to evaluate the correlations between the dosimetric indices (conformity, homogeneity and mismatch indices) related to tumor coverage and the patient-specific parameters which encompass parameters pertaining to organs at risk (widths and lengths of heart and ipsilateral lung included in treatment fields, mean/maximum doses to heart, ipsilateral lung, left anterior descending aorta and contralateral breast) and tumor volume. Forty breast cancer patients were divided into two groups according to tumor location: twenty with left-sided (group A) and twenty with right-sided breast cancer (group B). Conformal (3DCRT), intensity modulated (IMRT) and volumetric arc modulated (VMAT) radiotherapy techniques were used for plan creation. Moderate to strong correlations were found for ipsilateral lung parameters for both groups of patients regardless of the treatment technique. Moderate to strong correlations were found for heart parameters in group A patients, while no correlations were observed in group B. The mismatch index presented moderate to strong correlations with tumor volume for all treatment techniques (r = -0.861 3DCRT, r = -0.556 IMRT, r = -0.533 VMAT) particularly in group A. The evaluated correlations indicate the role of dosimetric indices in personalized treatment planning.

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Left breast radiotherapy – the impact of heart and left anterior descending artery doses to cardiovascular diseases developed eight years after treatment

Petrović

Djuran

et al. 2022

Srp Arh Celok Lek

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Introduction/Objective. Left breast cancer patients undergoing radiotherapy are at higher risk of cardiovascular diseases (CVD), as a partial volume of the heart is anatomically close to target volume. This may cause cardiovascular diseases in the years following cancer treatment. The aim of this work was to develop a scoring system which identifies patients with increased risk of development of cardiovascular diseases, as consequence of left breast irradiation. Methods. The patients followed up in this study were treated during 2009. Eight years later, they were invited to participate in a study where they underwent a cardiology evaluation. Their current condition was statistically correlated to the doses received by their heart and left anterior descendant (LAD) artery. Results. Out of 114 patients, thirty-one women were evaluable for cardiology assessment. Out of these 31 subjects, six women were with a history of CVD before cancer treatment. Four women never developed any kind of heart associated disease, while in the other 27, newly onset CVD were diagnosed ranging from hypertension to myocardial infarction, strongly positively correlated to doses to heart and LAD (p = 0.003). Severity of developed cardiovascular toxicity was formulated through the correlation of mean heart and mean LAD doses with cardiovascular diseases developed in form of the scoring system. Conclusion. The doses to critical organs depend on patient anatomy and technique of irradiation. The cardiovascular complications are proven as consequence of radiotherapy. Scoring system based on doses received by heart and LAD is reliable tool in predicting CVD.

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Dosimetric Comparison of the Heart and Left Anterior Descending Artery in Patients With Left Breast Cancer Treated With Three-Dimensional Conformal and Intensity-Modulated Radiotherapy

Cited by 3 publications

References 23 publications

Dosimetric Study Comparing 3D Conformal Radiotherapy (3D-CRT), Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) in Hypofractionated One-Week Radiotherapy Regimen in Breast Cancer

Dosimetric Study Comparing 3D Conformal Radiotherapy (3D-CRT), Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) in Hypofractionated One-Week Radiotherapy Regimen in Breast Cancer

Correlations between patient-specific parameters and dosimetric indices for personalized breast cancer radiotherapy

Left breast radiotherapy – the impact of heart and left anterior descending artery doses to cardiovascular diseases developed eight years after treatment

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