Is Radiation-Induced Cardiac Toxicity Reversible? Prospective Evaluation of Patients With Breast Cancer Enrolled in a Phase 3 Randomized Controlled Trial

Abraham, Aswin George; Sanghera, Karan Paul; Gheisari, Farshid; Koumna, Stella; Riauka, Terence; Ghosh, Sunita; Warkentin, Heather; Gabos, Zsolt; Chafe, Susan; Tankel, Keith; Huang, Fleur; Sabri, Siham; Paterson, D. Ian; Abdulkarim, Bassam; Joseph, Kurian

doi:10.1016/j.ijrobp.2022.01.020

Cited by 15 publications

(13 citation statements)

References 36 publications

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“…One of the distinct advantages of proton therapy is a reduction in dose to the LAD by as much as 90% compared to photon therapy (Table 4). The mean LAD dose achieved in our left-sided patients was 2.21 GyE, comparable with 2.8-5 Gy reported in various studies [14,36]. In our cohort, the mean and max LAD EQD 2 were less than the dose threshold identified by Zureick et al [36] in 13 of 15 left-sided patients.…”

Section: Cardiac Substructure Dosesupporting

confidence: 85%

“…This parameter has only recently been addressed in published literature and was documented to range from 0 to 3.37% in this series. Abraham et al [14], prospectively analyzed 181 breast patients, with a median follow-up of 127 months and recorded any cardiac events, viz., any ischemic event, conduction abnormality, congestive heart failure, pericarditis and valvular disease. The authors noted that mean left ventricular dose < 5.85 Gy (p = 0.035), V 5 < 42 cc (p = 0.024) and V 10 < 38 cc (p = 0.081) reduces additional risk of radiation-related cardiac events to < 5% at 10 years.…”

Section: Cardiac Substructure Dosementioning

confidence: 99%

“…Subsequent to Darby's landmark study [12], there has been a further analysis on the dose-volume relationship of cardiac toxicity and the dose received by cardiac substructures; coronary arteries and the left ventricle have emerged as organs-at-risk (OARs) [13,14]. In a prospective study by Abraham et al [14], 17% of left-sided breast cancer patients, with only a small fraction receiving adriamycin and trastuzumab, had some form of cardiac ailment.…”

Section: Introductionmentioning

confidence: 99%

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Proton therapy for reducing heart and cardiac substructure doses in Indian breast cancer patients

et al. 2023

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Purpose: Indians have a higher incidence of cardiovascular diseases, often at a younger age, than other ethnic groups. This higher baseline risk requires consideration when assessing additional cardiac morbidity of breast cancer treatment. Superior cardiac sparing is a critical dosimetric advantage of proton therapy in breast cancer radiotherapy. We report here the heart and cardiac-substructure doses and early toxicities in breast cancer patients treated post-operatively with proton therapy in India’s first proton therapy center. Materials and Methods: We treated twenty breast cancer patients with intensity-modulated proton therapy (IMPT) from October 2019 to September 2022, eleven after breast conservation, nine following mastectomy, and appropriate systemic therapy, when indicated. The most prescribed dose was 40 GyE to the whole breast/chest wall and 48 GyE by simultaneous integrated boost to the tumor bed and 37.5 GyE to appropriate nodal volumes, delivered in 15 fractions. Results: Adequate coverage was achieved for clinical target volume (breast/chest wall), i.e., CTV40, and regional nodes, with 99% of the targets receiving 95% of the prescribed dose (V95% > 99%). The mean heart dose was 0.78 GyE and 0.87 GyE for all and left breast cancer patients, respectively. The mean left anterior descending artery (LAD) dose, LAD D0.02cc, and left ventricle dose were 2.76, 6.46, and 0.2 GyE, respectively. Mean ipsilateral lung dose, V20Gy, V5Gy, and contralateral breast dose (Dmean) were 6.87 GyE, 14.6%, 36.4%, and 0.38 GyE, respectively. Conclusion: The dose to heart and cardiac substructures is lower with IMPT than published photon therapy data. Despite the limited access to proton therapy at present, given the higher cardiovascular risk and coronary artery disease prevalence in India, the cardiac sparing achieved using this technique merits consideration for wider adoption in breast cancer treatment.

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Section: Cardiac Substructure Dosesupporting

confidence: 85%

Section: Cardiac Substructure Dosementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Proton therapy for reducing heart and cardiac substructure doses in Indian breast cancer patients

et al. 2023

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“…Five studies used [ 99m Tc]-sestamibi ( 23 – 27 ), with varied SPECT acquisition methods: four used rest acquisition ( 23 , 24 , 26 , 28 ), one used adenosine stress ( 27 ), and one used rest and stress protocols ( 25 ). Perfusion assessments were conducted at different time points: one at six months post-RT without baseline SPECT ( 25 ), two at baseline and six months post-RT ( 26 , 28 ) one at one year post-RT ( 27 ), one before and during irradiation ( 23 ), and one at multiple time points up to five years post-RT ( 24 ).…”

Section: Resultsmentioning

confidence: 99%

Nuclear medicine imaging methods of early radiation-induced cardiotoxicity: a ten-year systematic review

Eber,

Blondet,

Le Fevre

et al. 2023

Front. Oncol.

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IntroductionRadiotherapy has significantly improved cancer survival rates, but it also comes with certain unavoidable complications. Breast and thoracic irradiation, for instance, can unintentionally expose the heart to radiation, leading to damage at the cellular level within the myocardial structures. Detecting and monitoring radiation-induced heart disease early on is crucial, and several radionuclide imaging techniques have shown promise in this regard. MethodIn this 10-year review, we aimed to identify nuclear medicine imaging modalities that can effectively detect early cardiotoxicity following radiation therapy. Through a systematic search on PubMed, we selected nineteen relevant studies based on predefined criteria. ResultsThe data suggest that incidental irradiation of the heart during breast or thoracic radiotherapy can cause early metabolic and perfusion changes. Nuclear imaging plays a prominent role in detecting these subclinical effects, which could potentially serve as predictors of late cardiac complications.DiscussionHowever, further studies with larger populations, longer follow-up periods, and specific heart dosimetric data are needed to better understand the relationship between early detection of cardiac abnormalities and radiation-induced heart disease.

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“…In a landmark paper by Darby et al, the risk of acute coronary events, comprising coronary revascularisation, myocardial infarction and death, was noted to increase by 7.4 % for every 1 Gy increase in the mean heart dose (MHD) in patients undergoing radiotherapy for breast cancer [2] . In a recent prospectively assessed cohort, the risk of any cardiac event was 17.5 % in left-sided breast cancer patients at a median follow-up of >10 years [3] .…”

Section: Introductionmentioning

confidence: 99%

Deep inspiratory breath-hold radiotherapy on a Helical Tomotherapy unit: Workflow and early outcomes in patients with left-sided breast cancer

Nangia,

Burela,

Sawant

et al. 2024

Technical Innovations & Patient Support in Radiation Oncolo

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Is Radiation-Induced Cardiac Toxicity Reversible? Prospective Evaluation of Patients With Breast Cancer Enrolled in a Phase 3 Randomized Controlled Trial

Cited by 15 publications

References 36 publications

Proton therapy for reducing heart and cardiac substructure doses in Indian breast cancer patients

Proton therapy for reducing heart and cardiac substructure doses in Indian breast cancer patients

Nuclear medicine imaging methods of early radiation-induced cardiotoxicity: a ten-year systematic review

Deep inspiratory breath-hold radiotherapy on a Helical Tomotherapy unit: Workflow and early outcomes in patients with left-sided breast cancer

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