Key result
Cardiac substructure-avoidance planning lowers cardiac dose and risks of CAD and CHF versus clinical plans.
Why the study?
Dose to heart substructures is a better predictor for major adverse cardiac events than mean heart dose, motivating an avoidance planning strategy for these substructures.
Does a cardiac substructure-avoidance planning strategy reduce radiation dose to heart substructures and predicted risk of cardiac events in patients undergoing radiation therapy?
Does a cardiac substructure-avoidance planning strategy reduce radiation dose to heart substructures and predicted risk of cardiac events in patients undergoing radiation therapy?
Incorporating cardiac substructures into radiation therapy optimization can significantly reduce the dose to sensitive heart structures and potentially lower the risk of radiation-induced heart disease.
Answers are grounded in this paper and cite their sources.
Substructure avoidance planning may lower MACE risk; leaves open prospective outcome data versus MHD-based planning.
BACKGROUND: Dose to heart substructures is a better predictor for major adverse cardiac events (MACE) than mean heart dose (MHD). We propose an avoidance planning strategy for important cardiac substructures. MATERIAL AND METHODS: Two plans, clinical and cardiac substructure-avoidance plan, were generated for twenty patients. Five dose-sensitive substructures, including left ventricle, pulmonary artery, left anterior descending branch, left circumflex branch and the coronary artery were chosen. The avoidance plan aims to meet the target criteria and organ-at-risk (OARs) constraints while minimizing the dose parameters of the above five substructures. The dosimetric assessments included the mean dose and the maximum dose of cardiac substructures and several volume parameters. In addition, we also evaluated the relative risk of coronary artery disease (CAD), chronic heart failure (CHF), and radiation pneumonia (RP). RESULTS: value of linear regression fitting demonstrated that MHD had poor prediction ability for the mean dose of the cardiac substructures. Compared to clinical plans, an avoidance plan is able to statistically significantly decrease the dose to key substructures. Meanwhile, the dose to OARs and the coverage of the target are comparable in the two plans. In addition, it can be observed that the avoidance plan statistically decreases the relative risks of CAD, CHF, and RP. CONCLUSIONS: The substructure-avoidance planning strategy that incorporates the cardiac substructures into optimization process, can protect the important heart substructures, such as left ventricle, left anterior descending branch and pulmonary artery, achieving the substantive sparing of dose-sensitive cardiac structures, and have the potential to decrease the relative risks of CAD, CHF, and RP.
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Feng et al. (2023) studied Patients requiring radiotherapy (n=20). Cardiac substructure-avoidance plan vs. Clinical plan was evaluated on Dose to cardiac substructures and relative risk of CAD, CHF, and radiation pneumonia. A cardiac substructure-avoidance planning strategy significantly decreased the dose to key cardiac substructures and relative risks of CAD, CHF, and radiation pneumonia compared to clinical plans.
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