Modern Radiation Therapy and Cardiac Outcomes in Breast Cancer

Boero, Isabel J.; Paravati, Anthony J.; Triplett, Daniel P.; Hwang, Larn; Matsuno, Rayna K.; Gillespie, Erin F.; Yashar, C.M.; Moiseenko, Vitali; Einck, John; Mell, Loren K.; Parikh, Sahil A.; Murphy, James D.

doi:10.1016/j.ijrobp.2015.07.257

Cited by 20 publications

(28 citation statements)

References 26 publications

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“…Adjuvant radiotherapy for breast cancer reduces the risk of locoregional recurrence as well as breast cancer death . However, some radiation is inevitably delivered to normal tissue, such as the heart and lungs, which has been shown to increase the risk of cardiovascular and pulmonary disease . Darby et al have shown that the relative risk of ischemic heart disease increases with 7.4% per Gy increased mean heart dose, with no apparent threshold.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric effects of intrafractional isocenter variation during deep inspiration breath‐hold for breast cancer patients using surface‐guided radiotherapy

Kügele

Edvardsson

Berg

et al. 2017

J Applied Clin Med Phys

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The aim of this study was to investigate potential dose reductions to the heart, left anterior descending coronary artery (LAD), and ipsilateral lung for left‐sided breast cancer using visually guided deep inspiration breath‐hold (DIBH) with the optical surface scanning system Catalyst™, and how these potential dosimetric benefits are affected by intrafractional motion in between breath holds. For both DIBH and free breathing (FB), treatment plans were created for 20 tangential and 20 locoregional left‐sided breast cancer patients. During DIBH treatment, beam‐on was triggered by a region of interest on the xiphoid process using a 3 mm gating window. Using a novel nonrigid algorithm, the Catalyst™ system allows for simultaneous real‐time tracking of the isocenter position, which was used to calculate the intrafractional DIBH isocenter reproducibility. The 50% and 90% cumulative probabilities and maximum values of the intrafractional DIBH isocenter reproducibility were calculated and to obtain the dosimetric effect isocenter shifts corresponding to these values were performed in the treatment planning system. For both tangential and locoregional treatment, the dose to the heart, LAD and ipsilateral lung was significantly reduced for DIBH compared to FB. The intrafractional DIBH isocenter reproducibility was very good for the majority of the treatment sessions, with median values of approximately 1 mm in all three translational directions. However, for a few treatment sessions, intrafractional DIBH isocenter reproducibility of up to 5 mm was observed, which resulted in large dosimetric effects on the target volume and organs at risk. Hence, it is of importance to set tolerance levels on the intrafractional isocenter motion and not only perform DIBH based on the xiphoid process.

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Section: Introductionmentioning

confidence: 99%

Dosimetric effects of intrafractional isocenter variation during deep inspiration breath‐hold for breast cancer patients using surface‐guided radiotherapy

Kügele

Edvardsson

Berg

et al. 2017

J Applied Clin Med Phys

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“…Nonetheless, a Surveillance, Epidemiology and End Results Program (SEER) database study of 29 102 patients diagnosed with breast cancer from 2000 to 2009 showed a small increase in the risk of percutaneous coronary intervention (PCI) after radiation therapy: 5.5% versus 4.5% for left-sided breast cancer versus right-sided breast cancer. In those who underwent PCI, left-sided breast cancer carried significantly increased risk of cardiac mortality with a subdistribution HR of 2.02 (95% CI 1.23 to 3.34), compared with right-sided breast cancer 62. Of note, prior studies have shown right-sided breast cancer also carries significantly increased but smaller risk of cardiovascular events compared with left-sided breast cancer 57.…”

Section: Discussionmentioning

confidence: 92%

Cardiovascular disease in cancer survivors

Okwuosa

Anzevino

Rao

2016

Postgraduate Medical Journal

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Certain cancer therapies, including radiation therapy and some types of chemotherapies, are associated with increased risk of cardiovascular disease (CVD) and events. Some of these effects such as those presented by anthracyclines, radiation therapy, cisplatin, as well as those presented by hormone therapy for breast cancerusually taken for many years for some breast and prostate cancers-are long-lasting and associated with cardiovascular events risk more than 20 years after cancer treatment. Cardiovascular testing, diagnostic assessment of suspected cardiovascular symptomatology, as well as laboratory tests for CVD risk factors are imperative. The early recognition and treatment of CVD processes that arise in survivorship years is pivotal, with specific attention to some CVD processes with specific suggested treatment modalities. Preventive measures include adequate screening, the use of medications such as ACE inhibitors/angiotensin receptor blockers and/or beta blockers, statin therapy and aspirin in persons who warrant these medications, as well as therapeutic lifestyle modifications such as exercise/physical activity, weight loss and appropriate diet for a healthy lifestyle. Periodic follow-up with a good primary care physician who understands the risks associated with cancer therapy is important, and referral to onco-cardiology for further management of cardiovascular risk in these survivors is based on a patient's cardiovascular risk level and the type, amount and duration of cancer therapies received during the patient's lifetime.

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“…They found that the rate of major coronary events increased by 7.4% per Gy without an apparent threshold, and the major coronary events included myocardial infarction, coronary revascularization, and death from ischemic heart disease [13,19]. Even in the era of modern RT, in comparison with patients with right-sided breast cancer, those with left-sided breast cancer experienced a small increase in the risk of percutaneous coronary intervention (PCI) following RT, and the 10-year cumulative incidences in patients with leftsided and right-sided disease were 5.5 and 4.5%, respectively [20].…”

Section: Epidemiological Data For Radiation-related Heart Diseasementioning

confidence: 99%

Radiation-Related Heart Disease: Up-to-Date Developments

Tan¹,

Li²,

Dai³

2017

Radiotherapy

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Approximately 25-30% of patients with cancer undergo thoracic radiation therapy (RT). RT might inadvertently induce heart injury and result in various forms of radiationrelated heart disease (RRHD). The main endpoints of RRHD include cardiac death from RT, clinical heart disease (congestive heart disease, ischemic heart disease, and myocardial infarction), and subclinical heart disease (cardiac perfusion defects). Advanced RT techniques, such as breath control, intensity-modulated RT, and image-guided RT, as well as limited target volume definition might spare or avoid cardiac doses and/or volume, which may translate into decreased incidence of RRHD. The total delivered radiation dose to cardiac implantable electronic devices was strongly recommended not to exceed 2 Gy. The treatment strategies of RRHD were based on the various recommended consensus of related heart diseases in cardiology. However, the standardized definitions of the cardiac structures, dose-volume limits during radiation planning design, the optimal dose-volume parameters, and the dose-volume effects of various cardiac substructures warrant further investigation. The recognition, prediction, prevention, and management of RRHD require close collaboration between oncologists and cardiologists.

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Modern Radiation Therapy and Cardiac Outcomes in Breast Cancer

Cited by 20 publications

References 26 publications

Dosimetric effects of intrafractional isocenter variation during deep inspiration breath‐hold for breast cancer patients using surface‐guided radiotherapy

Dosimetric effects of intrafractional isocenter variation during deep inspiration breath‐hold for breast cancer patients using surface‐guided radiotherapy

Cardiovascular disease in cancer survivors

Radiation-Related Heart Disease: Up-to-Date Developments

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