Key result
Provided text contains no clinical data comparing field-in-field to 3D radiotherapy.
Why the study?
Breast radiotherapy may cause cardiac toxicity linked to radiation dose and volume, prompting comparison of dose distribution to individual heart structures between two treatment techniques.
Does the Field-in-Field radiotherapy technique reduce radiation dose to heart structures compared to 3D radiotherapy in patients with left breast cancer?
Does the Field-in-Field radiotherapy technique reduce radiation dose to heart structures compared to 3D radiotherapy in patients with left breast cancer?
The Field-in-Field radiotherapy technique significantly reduces the radiation dose to the heart and its substructures, particularly the LAD, compared to the 3D technique in left breast cancer patients.
The most common type of cancer among women is breast cancer. Due to the anatomical position of the breast, radiotherapy may cause side effects to adjacent normal tissues, especially the heart. The severity of radiation-induced toxicity is closely linked to volume and dose of radiation received by cardiac tissue and its substructures. The aim of this study is to evaluate the dose distribution received by the breast and by organs at risk, with emphasis on individual heart structures, for 2 different radiotherapy treatment techniques (Field-in-Field and 3D) in patients undergoing conservative surgery of left breast. After injection of iodinated contrast medium in 18 patients, tomographic images were acquired on a 64-channel multislice tomograph synchronized to the electrocardiogram. The following contours of the target volumes and heart substructures were outlined: pulmonary trunk, heart, right and left ventricles, right and left atria, left anterior descending artery (LAD), right coronary artery, circumflex artery and aorta. For each patient, treatment plans were performed using the 3D and Field-in-field (FiF) techniques in a treatment planning system. From the dose-volume histogram information, the volumes for different doses (V2, V5, V10, V20, V25 and V30) and the average and maximum doses received for each outlined structure were determined. Means and respective standard deviations were calculated. The FiF technique, in comparison to 3D, showed an 18% percentage reduction in the average dose received by the heart and 11% lower V25. The LAD and left ventricle substructures also presented lower irradiated volumes for the FiF technique. The average dose of LAD was much higher than that of the heart. It was concluded in the study that angiotomography effectively assists in the precise delineation of each heart substructure during the planning process. In addition, for dose distribution, benefits on FiF technique were found when compared to 3D for radiotherapy treatment of patients with left breast cancer. Almost all analyzed substructures were less irradiated with the FiF technique compared to 3D, and all p-values were significant. The average heart dose was not a representative parameter of the average LAD dose, and it is common for this substructure to receive high doses even though the heart dose limits are being respected. Article published online: 23 October 2019 © 2019. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
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Almeida et al. (2019) studied this question.
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