Left-sided breast cancer and risks of secondary lung cancer and ischemic heart disease

Corradini, Stefanie; Ballhausen, Hendrik; Weingandt, Helmut; Freislederer, P.; Schönecker, S.; Niyazi, Maximilian; Simonetto, Cristoforo; Eidemüller, Markus; Ganswindt, Ute; Belka, Claus

doi:10.1007/s00066-017-1213-y

Cited by 68 publications

(56 citation statements)

References 63 publications

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“…Even though clinicians have to give particular attention to these complications, anthracycline treatment [60][61][62]) is an additional major risk factor for additional cardiotoxicity during radiotherapy with a synergistic effect. However, the use of anthracycline, other cardiotoxic chemotherapies, immunotherapy [63][64][65] and targeted therapies [66,67] should only be used with great caution and only after carrying out a careful treatment plan and optimization [1,30,40]. There is a wealth of evidence from retrospective and planning studies demonstrating reduction in dose to the heart and coronary arteries with DIBH treatment of left-sided breast cancers [10,14,15].…”

Section: Discussionmentioning

confidence: 99%

“…Darby et al [16] found after retrospectively analyzing 2168 patients from the Nordic cancer registry that the relative risk for ischemic heart disease increased by 7.4 % for every 1 Gray (Gy) in mean heart dose. However especially the Ramus interventricularis anterior (RIVA; left anterior descending coronary artery-LAD-CA) has a high risk of obtaining significant higher doses and is responsible for the development of pathologic blood vessel disorder and myocardial or coronary artery disease [1,[20][21][22].…”

Section: Introductionmentioning

confidence: 99%

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5 years of experience with DIBH (Deep inspiration breath-hold) combined with SGRT (Surface-Guided Radiation Therapy) in left-sided breast cancer

Steffal

Schratter-Sehn

Brinda-Raitmayr

et al. 2020

Senologie - Zeitschrift für Mammadiagnostik und -therapie

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Background Radiation treatment to the left breast is associated with increased cardiac morbidity as well as mortality. Deep inspiration breath-hold (DIBH) technique with Surface Guided Radiation Therapy (SGRT) could have dosimetric advantages over the free breathing technique (NB, normal breathing) in cardiac (heart and LAD) and ipsilateral lung sparing in patients with left-sided breast cancer after surgery. Therefore this technique was implemented in 2013 at the institute of radiooncology at the KFJ/SMZ-South – Hospital Vienna. Methods From Oct 2013 – December 2018 548 patients were referred to radiotherapy following conservative operation of left-sided invasive breast cancer. All patients gave their informed consent and underwent training sessions for the DIBH-technique independent of age or breathing activity or respiratory disorders. Patients who turned out to be unfit for DIBH were enrolled for NB. The relative reduction in Dmean heart and left lung dose was compared between the two cohorts. Acute radiation induced side effects were classified according to the Radiation Therapy Oncology Group/The European Organisation for Research (RTOG) 37; late toxicity rates according to the Common Terminology Criteria for Adverse Events (CTCAE Version 4.03) Results The median age of the DIBH-patients was 58 years (27–90), of the NB-patients 65 (30–80) years. Follow-up was obtained until June 2019. The median follow-up was 52 months (range 7–73 m). The average coverage of Dmean left lung was 6.91 Gy (1.44 Gy – 12.4 Gy). The average coverage of Dmean heart was 1.17 Gy (0.12 Gy – 3.19 Gy) in the DIBH-cohort. The NB – plans had a Dmean of 8.92 Gy (5.23–16.9 Gy) at the ipsilateral lung and a Dmean of 2.31 Gy (0.71–4.21 Gy) at the heart. This shows that the DIBH-technique halved the Dmean of the heart. The amount of acute side effects was comparable between the two groups: RTOG 1: 70.8 % vs. 64 %, RTOG 3 6.6 % vs. 5.6 %, no reaction 3.2 % vs. 1.4 %. There were more CTCAE 1-late events in the NB-group (51.6 % vs. 12.67 %). Conclusion Deep inspiration breath-hold (DIBH) technique with Surface Guided Radiation Therapy (SGRT) is a rather simple, reproducable method with a high acceptance of the patients who can actively participate in the whole treatment process. The mean dose at the heart and the left lung can be reduced, at the heart even by as much as 50 %.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

5 years of experience with DIBH (Deep inspiration breath-hold) combined with SGRT (Surface-Guided Radiation Therapy) in left-sided breast cancer

Steffal

Schratter-Sehn

Brinda-Raitmayr

et al. 2020

Senologie - Zeitschrift für Mammadiagnostik und -therapie

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“…Radiation oncologists implement several methods to decrease IR dose to the heart for minimizing the risk of RACVD (76), such as prone positioning (77), heart block with electronic compensation (57), heart-sparing three-dimensional printing technique (78), continuous positive airway pressure (CPAP) (79), real-time position management (RPM) inspiration gating (80,81), proton-beam irradiation (82)(83)(84)(85), and deep-inspiration breath-hold technique (DIBH) (86)(87)(88)(89)(90). However, even with the highly recommended visual-guided DIBH technique, residual variations of the heart position are still noticeable (91).…”

Section: Clinical Challenges Of Decreasing the Risk Of Racvd In Modermentioning

confidence: 99%

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

Lee

Liu

Hung

et al. 2020

Front. Cardiovasc. Med.

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Radiotherapy (RT) is a crucial treatment modality in managing cancer patients. However, irradiation dose sprinkling to tumor-adjacent normal tissues is unavoidable, generating treatment toxicities, such as radiation-associated cardiovascular dysfunction (RACVD), particularly for those patients with combined therapies or pre-existing adverse features/comorbidities. Radiation oncologists implement several efforts to decrease heart dose for reducing the risk of RACVD. Even applying the deep-inspiration breath-hold (DIBH) technique, the risk of RACVD is though reduced but still substantial. Besides, available clinical methods are limited for early detecting and managing RACVD. The present study reviewed emerging challenges of RACVD in modern radiation oncology, in terms of clinical practice, bench investigation, and multidisciplinary care. Several molecules are potential for serving as biomarkers and therapeutic targets. Of these, miRNAs, endogenous small non-coding RNAs that function in regulating gene expression, are of particular interest because low-dose irradiation, i.e., 200 mGy (one-tenth of conventional RT daily dose) induces early changes of pro-RACVD miRNA expression. Moreover, several miRNAs, e.g., miR-15b and miR21, involve in the development of RACVD, further demonstrating the potential bio-application in RACVD. Remarkably, many RACVDs are late RT sequelae, characterizing highly irreversible and progressively worse. Thus, multidisciplinary care from oncologists and cardiologists is crucial. Combined managements with commodities control (such as hypertension, hypercholesterolemia, and diabetes), smoking cessation, and close monitoring are recommended. Some agents show abilities for preventing and managing RACVD, such as statins and angiotensin-converting enzyme inhibitors (ACEIs); however, their real roles should be confirmed by further prospective trials.

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“…Recent data show that even low radiation doses to the heart can play a relevant role in the development of late cardiac toxicity after BC treatment [51,52]. However, neither the exact pathomechanisms nor the exact dose-response relationships or the critical regions within the heart are well defined.…”

Section: Role Of Modern Techniques: Imrt Vmat and Dibhmentioning

confidence: 99%

Recent Developments in Radiation Oncology: An Overview of Individualised Treatment Strategies in Breast Cancer

et al. 2018

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Radiation therapy (RT) for breast cancer has dramatically changed over the past years, leading to individualized risk-adapted treatment strategies. Historically, the choice of RT regimen was limited to conventional fractionation protocols using standard tangential fields. Nowadays, technological and technical improvements in modern RT have added a variety of other RT modalities, different fractionation schedules, and individualised treatment volumes to the portfolio of breast RT. This review aims to give a short overview on the main topics which have recently found their way into clinical practice: hypofractionated treatment protocols, accelerated partial breast irradiation (APBI) for low-risk patients, deep inspiration breath hold (DIBH) for maximal heart protection, extent of regional nodal irradiation for high-risk patients, and the implementation of new radiation techniques such as intensity modulated RT (IMRT) and volumetric modulated RT (VMAT).

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Left-sided breast cancer and risks of secondary lung cancer and ischemic heart disease

Abstract: The results indicate that 3D-CRT plans in DIBH pose the lowest risk for both major coronary events and secondary lung cancer.

Cited by 68 publications

References 63 publications

5 years of experience with DIBH (Deep inspiration breath-hold) combined with SGRT (Surface-Guided Radiation Therapy) in left-sided breast cancer

5 years of experience with DIBH (Deep inspiration breath-hold) combined with SGRT (Surface-Guided Radiation Therapy) in left-sided breast cancer

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

Recent Developments in Radiation Oncology: An Overview of Individualised Treatment Strategies in Breast Cancer

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