Key result
Respiration-adapted radiotherapy exposes ~29% of patients to high LAD doses despite acceptable whole-heart radiation.
Why the study?
Adjuvant radiotherapy for left-sided breast cancer can lead to late cardiac complications, and the highest radiation doses are likely to the anterior heart including the LAD, necessitating assessment of doses to these structures.
Does respiration-adapted radiotherapy deliver acceptable radiation doses to the whole heart and LAD in patients with left-sided breast cancer?
Observational (n=24)
Does respiration-adapted radiotherapy deliver acceptable radiation doses to the whole heart and LAD in patients with left-sided breast cancer?
Assessing radiation dose to both the whole heart and the entire LAD is necessary during left-sided breast irradiation to prevent excessive cardiac exposure and potential late cardiotoxicity.
Respiration-adapted radiotherapy may lower heart and LAD doses in left-sided breast cancer; leaves open optimal protocols before routine adoption.
OBJECTIVE: Adjuvant radiotherapy for breast cancer can lead to late cardiac complications. The highest radiation doses are likely to be to the anterior portion of the heart, including the left anterior descending coronary artery (LAD). The purpose of this work was to assess the radiation doses delivered to the heart and the LAD in respiration-adapted radiotherapy of patients with left-sided breast cancer. METHODS: 24 patients referred for adjuvant radiotherapy after breast-conserving surgery for left-sided lymph node positive breast cancer were evaluated. The whole heart, the arch of the LAD and the whole LAD were contoured. The radiation doses to all three cardiac structures were evaluated. RESULTS: For 13 patients, the plans were acceptable based on the criteria set for all 3 contours. For seven patients, the volume of heart irradiated was well below the set clinical threshold whereas a high dose was still being delivered to the LAD. In 1 case, the dose to the LAD was low while 19% of the contoured heart volume received over 20 Gy. In five patients, the dose to the arch LAD was relatively low while the dose to the whole LAD was considerably higher. CONCLUSION: This study indicates that it is necessary to assess the dose delivered to the whole heart as well as to the whole LAD when investigating the acceptability of a breast irradiation treatment. Assessing the dose to only one of these structures could lead to excessive heart irradiation and thereby increased risk of cardiac complications for breast cancer radiotherapy patients.
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Aznar et al. (2011) conducted an observational in Left-sided lymph node positive breast cancer (n=24). Respiration-adapted radiotherapy was evaluated on Radiation doses delivered to the whole heart, the arch of the LAD, and the whole LAD. Among 24 patients receiving respiration-adapted radiotherapy for left-sided breast cancer, 7 had acceptable whole heart doses but high LAD doses, highlighting the need to assess both structures.
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