Cardiac and lung complication probabilities after breast cancer irradiation

The Netherlands Cancer Institute/Antonie van Leeuwenhoek Huis, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Radiotherapy and Oncology (Impact Factor: 4.36). 05/2000; 55(2):145-51. DOI: 10.1016/S0167-8140(00)00152-3
Source: PubMed


To assess for locoregional irradiation of breast cancer patients, the dependence of cardiac (cardiac mortality) and lung (radiation pneumonitis) complications on treatment technique and individual patient anatomy.
Three-dimensional treatment planning was performed for 30 patients with left-sided breast cancer and various breast sizes. Two locoregional techniques (Techniques A and B) and a tangential field technique, including only the breast in the target volume, were planned and evaluated for each patient. In both locoregional techniques tangential photon fields were used to irradiate the breast. The internal mammary (IM)-medial supraclavicular (MS) lymph nodes were treated with an anterior mixed electron/photon field (Technique A) or with an obliquely incident mixed electron/photon IM field and an anterior electron/photon MS field (Technique B). The optimal IM and MS electron field dimensions and energies were chosen on the basis of the IM-MS lymph node target volume as delineated on CT-slices. The position of the tangential fields was adapted to match the IM-MS fields. Dose-volume histograms (DVHs) and normal tissue complication probabilities (NTCPs) for the heart and lung were compared for the three techniques. In the beam's eye view of the medial tangential fields the maximum distance of the heart contour to the posterior field border was measured; this value was scored as the Maximum Heart Distance.
The lymph node target volume receiving more than 85% of the prescribed dose was on average 99% for both locoregional irradiation techniques. The breast PTV receiving more than 95% of the prescribed dose was generally smaller using Technique A (mean: 90%, range: 69-99%) than using Technique B (mean: 98%, range: 82-100%) or for the tangential field technique (mean: 98%, range: 91-100%). NTCP values for excess cardiac mortality due to acute myocardial ischemia varied considerably between patients, with minimum and maximum values of 0.1 and 7.5% (Technique A), 0.1 and 5.8% (Technique B) and 0.0 and 6.1% (tangential tech.). The NTCP values were on average significantly higher (P<0.001) by 1.7% (Technique A) and 1.0% (Technique B) when locoregional breast irradiation was given, compared with irradiation of the left breast only. The NTCP values for the tangential field technique could be estimated using the Maximum Heart Distance. NTCP values for radiation pneumonitis were very low for all techniques; between 0.0 and 1.0%.
Technique B results in a good coverage of the breast and locoregional lymph nodes, while Technique A sometimes results in an underdosage of part of the target volume. Both techniques result in a higher probability of heart complications compared with tangential irradiation of the breast only. Irradiation toxicity for the lung is low in all techniques. The Maximum Heart Distance is a simple and useful parameter to estimate the NTCP values for cardiac mortality for tangential breast irradiation.

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    • "Adjuvant radiation therapy after breast-conserving surgery is an essential treatment for early breast cancer [1]. Previous studies, however, have reported increased risk of radiation related toxicity resulting in non-breast cancer related deaths, which are mainly caused by cardiovascular disease and lung cancer [2,3,4]. Recently published study has reported that the cardiac mortality ratio for left sided (vs. "
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    06/2014; 32(2):84-94. DOI:10.3857/roj.2014.32.2.84
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    • "The development of RP depends on the treatment-related factors [22,23], such as radiation dose, fractionation schedule, volume and region of lung irradiated, use of concurrent chemotherapy, and patient-related factors [6,9], such as pre-existing lung disease, poor pulmonary function, being a smoker, and genetic predisposition. It has been previously reported that radiation-induced lung sequelae affect as many as 9% of patients with breast cancer being treated with RT [24]. However, using computer-based radiation treatment planning systems dramatically decreased the incidence of these lung sequelae [25,26]. "
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    09/2012; 15(3):320-8. DOI:10.4048/jbc.2012.15.3.320
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    • "L'un des principaux enseignements tiré des séries de la littérature concerne l'importance de la définition des volumes cibles et des organes à risque. En effet, la prise en compte de toutes les incertitudes, notamment celles dues aux mouvements respiratoires , et la détermination rigoureuse de l'amplitude des marges de sécurité conditionnent étroitement la précision du traitement, son efficacité et sa toxicité potentielle [5] [6] [7] [8] [9] [10] [11] [12] [13] [14]. La diffusion des techniques de contrôle de la respiration constitue donc une priorité afin d'améliorer la qualité et les résultats de la radiothérapie. "
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    Cancer/Radiothérapie 06/2012; 16(4):272-81. DOI:10.1016/j.canrad.2012.03.005 · 1.41 Impact Factor
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