Key result
Partial breast irradiation significantly reduced the mean cumulative radiation dose to the left anterior descending artery compared to whole breast irradiation in patients with left-sided breast cancer located in outer quadrants (1.12 Gy vs 2.13 Gy, p=0.0001).
Why the study?
Does partial breast irradiation reduce radiation dose to the left anterior descending artery compared to whole breast irradiation in breast cancer patients?
Observational (n=182)
Does partial breast irradiation reduce radiation dose to the left anterior descending artery compared to whole breast irradiation in breast cancer patients?
Absolute Event Rate: 1.12% vs 2.13%
p-value: p=0.0001
Partial breast irradiation significantly reduces radiation exposure to the left anterior descending artery in patients with left-sided, outer quadrant breast tumors, potentially lowering the risk of radiation-induced coronary artery disease.
May reduce radiation-induced coronary risk in left-sided outer quadrant tumors; hypothesis-generating and should not yet change practice.
PURPOSE: Breast conserving surgery (BCS) followed by whole breast irradiation (WBI) is the standard of care for breast cancer patients. However, there is a risk of coronary events with WBI therapy. In this study, we compared the radiation dose in the left anterior descending artery (LAD) in patients receiving partial breast irradiation (PBI) with WBI. MATERIAL AND METHODS: We evaluated consecutive patients who underwent adjuvant radiotherapy after BCS between October 2008 and July 2014. Whole breast irradiation patients received 50 Gy in fractions of 2 Gy to the entire breast. Partial breast irradiation was performed using multicatheter brachytherapy at a dose of 32 Gy in eight fractions. The mean and maximal cumulative doses to LAD were calculated. The radiotherapeutic biologically effective dose of PBI was adjusted to WBI, and radiation techniques were compared. RESULTS: Of 379 consecutive patients with 383 lesions receiving radiotherapy (151 WBI and 232 PBI lesions), 82 WBI and 100 PBI patients were analyzed. In WBI patients, the mean and maximal cumulative doses for left-sided breast cancer (2.13 ± 0.11 and 8.19 ± 1.21 Gy, respectively) were significantly higher than those for right-sided (0.37 ± 0.02 and 0.56 ± 0.03 Gy, respectively; p < 0.0001). In PBI patients with left-sided breast cancer, the doses for tumors in inner quadrants or central location (2.54 ± 0.21 and 4.43 ± 0.38 Gy, respectively) were significantly elevated compared to outer quadrants (1.02 ± 0.17 and 2.10 ± 0.29 Gy, respectively; p < 0.0001). After the adjustment, the doses in PBI patients were significantly reduced in patients with tumors only in outer quadrants (1.12 ± 0.20 and 2.43 ± 0.37 Gy, respectively; p = 0.0001). CONCLUSIONS: Tumor control and dose to LAD should be considered during treatment since PBI may reduce the risk of coronary artery disease especially in patients with lateral tumors in the left breast.
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Sato et al. (2015) conducted an observational in Breast cancer (n=182). Partial breast irradiation (PBI) vs. Whole breast irradiation (WBI) was evaluated on Mean cumulative radiation dose to the left anterior descending artery (LAD) in left-sided breast cancer (PBI outer quadrants vs WBI) (p=0.0001). Partial breast irradiation significantly reduced the mean cumulative radiation dose to the left anterior descending artery compared to whole breast irradiation in patients with left-sided breast cancer located in outer quadrants (1.12 Gy vs 2.13 Gy, p=0.0001).
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