Surface-based deep inspiration breath-hold radiotherapy in left-sided breast cancer: final results from the SAVE-HEART study

被引:0
作者
Schoenecker, S. [1 ,2 ]
Angelini, L. [1 ,3 ]
Gaasch, A. [1 ]
Zinn, A. [1 ]
Konnerth, D. [1 ]
Heinz, C. [1 ]
Xiong, Y. [1 ]
Unger, K. [1 ,2 ]
Landry, G. [1 ]
Meattini, I. [3 ]
Braun, M. [4 ]
Poelcher, M. [4 ]
Harbeck, N. [5 ,6 ]
Wuerstlein, R. [5 ,6 ]
Niyazi, M. [1 ,7 ]
Belka, C. [1 ,2 ]
Pazos, M. [1 ]
Corradini, S. [1 ]
机构
[1] Univ Hosp LMU Munich, Dept Radiat Oncol, Munich, Germany
[2] Bavarian Canc Res Ctr BZKF, Munich, Germany
[3] Univ Florence, Dept Expt & Clin Biomed Sci Mario Serio, Largo Brambilla 3, I-50134 Florence, Italy
[4] Red Cross Hosp, Breast Ctr, Dept Gynecol, Munich, Germany
[5] Univ Hosp LMU Munich, Breast Ctr, Dept Obstet & Gynecol, Munich, Germany
[6] Univ Hosp LMU Munich, CCC Munich, Munich, Germany
[7] Univ Hosp Tubingen, Dept Radiat Oncol, Tubingen, Germany
关键词
prospective studies; breast neoplasms; radiotherapy; adjuvant; radiation dosage; organs at risk; coronary vessels; heart disease risk factors; TARGET VOLUME DELINEATION; RADIATION-THERAPY; MYOCARDIAL-INFARCTION; CONSENSUS GUIDELINE; RISK; IRRADIATION; SELECTION; DISEASE; WOMEN;
D O I
10.1016/j.esmoop.2024.103993
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Adjuvant radiotherapy (RT) plays an essential role in the management of early breast cancer (BC), but can lead to cardiovascular and lung toxicities. RT in deep inspiration breath hold (DIBH) often allows better protection of organs at risk. This prospective study compares surface-guided DIBH with free breathing (FB) in patients with left-sided BC, by evaluating individual cardiovascular risks and treatment plan dosimetry. Patients and methods: The study enrolled 585 patients from October 2016 to January 2021 with left-sided invasive breast carcinoma with indicated adjuvant RT of the breast/thoracic wall with or without regional lymph nodes. The ability to hold breath for 20 s was a prerequisite. The treatments were either hypofractionated (HF; 40.05 Gy/15Fx) or normofractionated (NF; 50.00 Gy/25Fx). DIBH was applied using the automatically triggered surface guidance system Catalyst with audio-video feedback. Computed tomography and surface data were acquired during both DIBH and FB. The primary endpoint of the study was the comparative evaluation of heart dose reduction using DIBH. Results: Plan dosimetry was significantly improved by DIBH. The mean and maximum doses to the heart and the left coronary artery were significantly reduced by 36%-42% in HF and NF plans (P < 0.001), while the mean ipsilateral lung dose was reduced by 12%-14% (P < 0.001). Furthermore, DIBH resulted in a 5% reduction in the cumulative 10-year cardiovascular disease risk (10-year cardiovascular disease risk) compared with FB (3.59% to 3.41%; P < 0.001). Conclusion: To the best of our knowledge, this is the largest prospective study showing better sparing for cardiac and ipsilateral lung doses with surface-guided DIBH compared with FB in patients with left-sided BC.
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页数:9
相关论文
共 48 条
[1]   Assessing risk of myocardial infarction and stroke: new data from the Prospective Cardiovascular Munster (PROCAM) study [J].
Assmann, G. ;
Schulte, H. ;
Cullen, P. ;
Seedorf, U. .
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, 2007, 37 (12) :925-932
[2]   Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines [J].
Beaton, Laura ;
Bergman, Alanah ;
Nichol, Alan ;
Aparicio, Maria ;
Wong, Graham ;
Gondara, Lovedeep ;
Speers, Caroline ;
Weir, Lorna ;
Davis, Margot ;
Tyldesley, Scott .
CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY, 2019, 19 :39-45
[3]   Deep Inspiration Breath Hold-Based Radiation Therapy: A Clinical Review [J].
Boda-Heggemann, Judit ;
Knopf, Antje-Christin ;
Simeonova-Chergou, Anna ;
Wertz, Hansjoerg ;
Stieler, Florian ;
Jahnke, Anika ;
Jahnke, Lennart ;
Fleckenstein, Jens ;
Vogel, Lena ;
Arns, Anna ;
Blessing, Manuel ;
Wenz, Frederik ;
Lohr, Frank .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2016, 94 (03) :478-492
[4]   Predictors of cardiac and lung dose sparing in DIBH for left breast treatment [J].
Cao, Ning ;
Kalet, Alan M. ;
Young, Lori A. ;
Fang, L. Christine ;
Kim, Janice N. ;
Mayr, Nina A. ;
Meyer, Juergen .
PHYSICA MEDICA-EUROPEAN JOURNAL OF MEDICAL PHYSICS, 2019, 67 :27-33
[5]  
Corradini S, 2018, STRAHLENTHER ONKOL, V194, P196, DOI 10.1007/s00066-017-1213-y
[6]   Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer [J].
Correa, Candace R. ;
Litt, Harold I. ;
Hwang, Wei-Ting ;
Ferrari, Victor A. ;
Solin, Lawrence J. ;
Harris, Eleanor E. .
JOURNAL OF CLINICAL ONCOLOGY, 2007, 25 (21) :3031-3037
[7]   Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer [J].
Darby, Sarah C. ;
Ewertz, Marianne ;
McGale, Paul ;
Bennet, Anna M. ;
Blom-Goldman, Ulla ;
Bronnum, Dorthe ;
Correa, Candace ;
Cutter, David ;
Gagliardi, Giovanna ;
Gigante, Bruna ;
Jensen, Maj-Britt ;
Nisbet, Andrew ;
Peto, Richard ;
Rahimi, Kazem ;
Taylor, Carolyn ;
Hall, Per .
NEW ENGLAND JOURNAL OF MEDICINE, 2013, 368 (11) :987-998
[8]   Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO) [J].
Duma, Marciana-Nona ;
Baumann, Rene ;
Budach, Wilfried ;
Dunst, Juergen ;
Feyer, Petra ;
Fietkau, Rainer ;
Haase, Wulf ;
Harms, Wolfgang ;
Hehr, Thomas ;
Krug, David ;
Piroth, Marc D. ;
Sedlmayer, Felix ;
Souchon, Rainer ;
Sauer, Rolf .
STRAHLENTHERAPIE UND ONKOLOGIE, 2019, 195 (10) :861-871
[9]   Analysis of coronary artery dosimetry in the 3-dimensional era: Implications for organ-at-risk segmentation and dose tolerances in left-sided tangential breast radiation [J].
Evans, Suzanne B. ;
Panigrahi, Babita ;
Northrup, Veronika ;
Patterson, Joseph ;
Baldwin, Drew E. ;
Higgins, Susan A. ;
Moran, Meena S. .
PRACTICAL RADIATION ONCOLOGY, 2013, 3 (02) :E55-E60
[10]   DEVELOPMENT AND VALIDATION OF A HEART ATLAS TO STUDY CARDIAC EXPOSURE TO RADIATION FOLLOWING TREATMENT FOR BREAST CANCER [J].
Feng, Mary ;
Moran, Jean M. ;
Koelling, Todd ;
Chughtai, Aamer ;
Chan, June L. ;
Freedman, Laura ;
Hayman, James A. ;
Jagsi, Reshma ;
Jolly, Shruti ;
Larouere, Janice ;
Soriano, Julie ;
Marsh, Robin ;
Pierce, Lori J. .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2011, 79 (01) :10-18