Key result
In patients with left-sided breast cancer, the percentage of the left ventricle included in the radiation field was >5% for all plans (8.92% for 3DCRT, 8.30% for IMRT, and 6.84% for VMAT).
Why the study?
Cardiac events have been associated with doses received by heart substructures following radiotherapy, highlighting the need to evaluate the dosimetry of heart and heart substructures in left-sided breast cancer radiotherapy.
What is the dosimetric impact on heart substructures of different radiotherapy techniques for left-sided breast cancer?
Observational (n=20)
What is the dosimetric impact on heart substructures of different radiotherapy techniques for left-sided breast cancer?
Significant portions of the left ventricle are exposed to radiation during left-sided breast cancer radiotherapy across multiple modalities, highlighting the need for substructure-specific dosimetric monitoring to prevent radiation-induced cardiotoxicity.
Left ventricular exposure exceeds 5% across techniques; leaves open whether substructure constraints reduce cardiotoxicity risk.
Background. A group of cardiopathies (ischemic, arrhythmic, and pericardial cardiac events) were shown to be associated with doses received by heart substructures following radiotherapy, alerting about the importance of dosimetric evaluation of cardiac structures besides the heart. The aim of this study was to assess the dosimetry of heart and heart substructures of left-sided breast cancer radiotherapy to evaluate possible radiation-induced complications. Methods and Materials. The study enrolled 20 patients treated with 3D-conformal radiotherapy (3DCRT), while intensity-modulated (IMRT) and volumetric-modulated arc radiotherapy (VMAT) plans were simulated for comparative purposes. The organs at risk (OARs) of interest were the heart, ascending aorta, descending aorta, left ventricle, left atrium, right ventricle, right atrium, superior vena cava, inferior vena cava, and pulmonary artery. Results. The percentage of left ventricle included in the radiation field was >5% for all plans (8.92% 3DCRT, 8.30% IMRT, and 6.84% VMAT). A strong correlation between mean heart dose and the percentage of left ventricle overlapping with the radiation fields was observed in 3DCRT (r = 0.784) and IMRT (r = 0.755) plans, and a moderate correlation was shown between tumor volume and the percentage of left ventricle included in the radiation field for all plans. A moderate correlation was observed between body mass index and cardiac structures for the mean dose to the right ventricle (r = 0.640) in conformal plans and V5 of heart (r = 0.528) and left ventricle (r = 0.669) in volumetric-modulated plans. Additionally, moderate to strong correlations were found between maximum heart distance and heart dose in both conformal and modulated plans. Conclusions. Considering possible occurrences of cardiac events during or postradiotherapy, monitoring the heart and its substructures and setting dosimetric thresholds for healthy tissues must be a priority to achieve a personalized and effective treatment.
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Costin et al. (2024) conducted an observational in left-sided breast cancer (n=20). 3D-conformal radiotherapy (3DCRT) vs. intensity-modulated (IMRT) and volumetric-modulated arc radiotherapy (VMAT) was evaluated on percentage of left ventricle included in the radiation field. In patients with left-sided breast cancer, the percentage of the left ventricle included in the radiation field was >5% for all plans (8.92% for 3DCRT, 8.30% for IMRT, and 6.84% for VMAT).
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