Radiation-induced heart morbidity after adjuvant radiotherapy of early breast cancer - Is it still an issue?

Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.
Radiotherapy and Oncology (Impact Factor: 4.36). 08/2011; 100(2):157-9. DOI: 10.1016/j.radonc.2011.08.007
Source: PubMed
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    • "Postoperative radiotherapy for breast cancer patients has been shown to significantly reduce the risk of local recurrence as well as improving long-term survival [1,2]. However, many studies have demonstrated increased cardiac mortality and morbidity after breast radiotherapy [3-5]. "
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    ABSTRACT: We explored whether the deep inspiration breath hold (DIBH) technique using Abches during left-sided breast irradiation was effective for minimizing the amount of radiation to the heart and lung compared to free breathing (FB). Between February and July 2012, a total of 25 patients with left-sided breast cancer underwent two computed tomography scans each with the DIBH using Abches and using FB after breast-conserving surgery. The scans were retrospectively replanned using standardized criteria for the purpose of this study. The DIBH plans for each patient were compared with FB plans using dosimetric parameters. All patients were successfully treated with the DIBH technique using Abches. Significant differences were found between the DIBH and FB plans for mean heart dose (2.52 vs. 4.53 Gy), heart V30 (16.48 vs. 45.13 cm(3)), V20 (21.35 vs. 54.55 cm(3)), mean left anterior descending coronary artery (LAD) dose (16.01 vs. 26.26 Gy, all p < 0.001), and maximal dose to 0.2 cm(3) of the LAD (41.65 vs. 47.27 Gy, p = 0.017). The mean left lung dose (7.53 vs. 8.03 Gy, p = 0.073) and lung V20 (14.63% vs. 15.72%, p = 0.060) of DIBH using Abches were not different significantly compared with FB. We report that the use of a DIBH technique using Abches in breathing adapted radiotherapy for left-sided breast cancer is easily feasible in daily practice and significantly reduces the radiation doses to the heart and LAD, therefore potentially reducing cardiac risk.
    12/2013; 31(4):239-46. DOI:10.3857/roj.2013.31.4.239
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    • "Systemic therapies of early breast cancer such as anthracyclines , trastuzumab, taxanes, tamoxifen, and letrozole have increased over the last few decades and these may potentiate the radiation's effects on the heart [40]. "
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    ABSTRACT: Today there is general awareness of the potential damage to the heart in left-sided (more than in right-sided) breast cancer radiotherapy (RT). Historical changes in tumor and heart doses are presented here along with the impact of different RT techniques and volumes. Individual and pharmacological risk factors are also examined with respect to radiation damage. The biological mechanisms of harm are only partially understood, such as the radiobiology of heart damage due to the presence of various radiosensitive structures and their topographic heterogeneity. Furthermore, individual variability may expose patients to higher or lower risks of late cardiac damage or death. Damage mechanisms and radiobiological characteristics in heart irradiation are presented in relation to dosimetric and biological parameters.
    Radiotherapy and Oncology 03/2012; 103(2):133-42. DOI:10.1016/j.radonc.2012.02.008 · 4.36 Impact Factor
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    ABSTRACT: Aims: Hypofractionation of postoperative radiotherapy for breast cancer has been evaluated in a number of large randomised clinical trials, but concerns remain over the late cardiac toxicity. In this study, we examined the predictions of the linear quadratic model on the estimated fraction size-corrected dose to the heart for four evidence-based hypofractionation regimens. Materials and methods: Dose plans for 60 left-sided breast cancer patients were analysed. All patients were planned with tangential fields for whole breast irradiation. Dose distributions were corrected to the equivalent dose in 2 Gy fractions (EQD(2)) using the linear quadratic model for five different fractionation schedules (50 Gy/25 fractions and four hypofractionation regimens) and for a range of α/β values (0-5 Gy). The mean EQD(2) to the heart ( [Formula: see text] ) and the volume receiving 40 Gy ( [Formula: see text] ), both as calculated from the EQD(2) dose distributions, were compared between schedules. Results: For α/β = 3 Gy, [Formula: see text] favours hypofractionation for 40 Gy/15 fractions, 39 Gy/13 fractions and 42.5 Gy/16 fractions, but not for 41.6 Gy/13 fractions. All of the hypofractionation schedules result in lower [Formula: see text] compared with normofractionation. These results hold as long as α/β ≳ 1.5 Gy. If the heart is blocked from the treatment beam, the fraction size-corrected dose is lower for the first three hypofractionation schedules, compared with normofractionation, even for α/β = ∼1 Gy. Conclusion: For standard tangential field whole breast irradiation, most of the examined hypofractionation schedules are estimated to spare the heart when compared with normofractionation. The dose to the heart, adjusted for fraction size using the linear quadratic model, will generally be lower after hypofractionated compared with normofractionated schedules, even for very low values of α/β.
    Clinical Oncology 08/2012; 25(3). DOI:10.1016/j.clon.2012.07.012 · 3.40 Impact Factor
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