How dose sparing of cardiac structures correlates with in-field heart volume and sternal displacement

被引：11

作者：

Kim, Taeho ^{[1
,2
]}

Reardon, Kelli ^{[1
]}

Trifiletti, Daniel M. ^{[1
]}

Geesey, Constance ^{[1
]}

Sukovich, Kaitlyn ^{[1
]}

Crandley, Edwin ^{[1
]}

Read, Paul W. ^{[1
]}

Wijesooriya, Krishni ^{[1
]}

机构：

[1] Univ Virginia Hlth Syst, Radiat Oncol, Charlottesville, VA USA

[2] Virginia Commonwealth Univ, Radiat Oncol, Richmond, VA USA

来源：

JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS | 2016年 / 17卷 / 06期

关键词：

predicting dose to heart; left-breast irradiation; INSPIRATION BREATH-HOLD; CANCER; RADIOTHERAPY; REDUCTION; MORTALITY; SURVIVAL; RISK;

D O I：

10.1120/jacmp.v17i6.6324

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

Cardiac irradiation increases the risk of coronary artery disease in patients with left-sided breast cancer. Techniques exist to reduce cardiac irradiation, but the optimum technique depends on individual patient anatomy and physiology. We investigated the correlation of delta heart volume in field (dHVIF) and sternal excursion with dose sparing in heart and left anterior descending artery (LAD) to develop quantitative predictive models for expected dose to heart and LAD. A treatment planning study was performed on 97 left-breast cancer patients who underwent whole breast radiotherapy (prescription dose = 50 Gy) under deep inspiratory breath hold (DIBH). Two CT datasets, free breathing (FB) and DIBH, were utilized for treatment planning and for determination of the internal anatomy-based DIBH amplitude. The mean heart and LAD dose were compared between FB and DIBH plans and dose to the heart and LAD as a function of dHVIF and sternal excursion were determined. The [Average (STD); Range] mean heart doses from free breathing and DIBH are [120.5(65.2); 28.9 similar to 393.8] cGy and [67.5(25.1); 19.7 similar to 145.6] cGy, respectively. The mean LAD doses from free breathing and DIBH are [571.0(582.2); 42.2 similar to 2332.2] cGy and [185.9(127.0); 41.2 similar to 898.4] cGy, respectively. The mean dose reductions with DIBH are [53.1(50.6); -15.4 similar to 295.1] cGy for the heart and [385.1(513.4); -0.6 similar to 2105.8] cGy for LAD. Percent mean dose reductions to the heart and LAD with DIBH are 44% (p < 0.0001) and 67% (p < 0.0001), respectively, compared to FB. The dHVIF mean dose reduction correlation is 8.1 cGy/cc for the heart and 81.6 cGy/cc for LAD (with linear trend and y intercept: 26.0 cGy for the heart, 109.1 cGy for LAD). DIBH amplitude using sternal position was [1.3(.48);.38 similar to 2.5] cm. The DIBH amplitude mean dose reduction correlation is 14 cGy/cm for the heart and 212cGy/cm for LAD (with linear trend with y intercept: 35.6 cGy for the heart, 102.4 cGy for LAD). The strong correlation of dose sparing to the heart and LAD with dHVIF and sternal excursion suggests that mean dose sparing to heart and LAD can be predicted with either dHVIF or sternal excursion equally well. The metrics proposed could be utilized to allow providers to determine the relative dosimetric benefits of different heart-sparing techniques as early as time of consultation.

引用

页码：60 / 68

页数：9

共 16 条

[1]

Abe O, 2005, LANCET, V366, P2087, DOI 10.1016/s0140-6736(05)66544-0

[2] Dosimetric and clinical advantages of deep inspiration breath-hold (DIBH) during radiotherapy of breast cancer [J].

Bruzzaniti, Vicente ;

Abate, Armando ;

Pinnaro, Paola ;

D'Andrea, Marco ;

Infusino, Erminia ;

Landoni, Valeria ;

Soriani, Antonella ;

Giordano, Carolina ;

Ferraro, Anna Maria ;

Strigari, Lidia .

JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH, 2013, 32

[3] CAUSE-SPECIFIC MORTALITY IN LONG-TERM SURVIVORS OF BREAST-CANCER WHO PARTICIPATED IN TRIALS OF RADIOTHERAPY [J].

CUZICK, J ;

STEWART, H ;

RUTQVIST, L ;

HOUGHTON, J ;

EDWARDS, R ;

REDMOND, C ;

PETO, R ;

BAUM, M ;

FISHER, B ;

HOST, H ;

LYTHGOE, J ;

RIBEIRO, G ;

SCHEURLEN, H .

JOURNAL OF CLINICAL ONCOLOGY, 1994, 12 (03) :447-453

[4] 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

[5] Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials [J].

Darby S. ;

McGale P. ;

Correa C. ;

Taylor C. ;

Arriagada R. ;

Clarke M. ;

Cutter D. ;

Davies C. ;

Ewertz M. ;

Godwin J. ;

Gray R. ;

Pierce L. ;

Whelan T. ;

Wang Y. ;

Peto R. ;

Albain K. ;

Anderson S. ;

Barlow W. ;

Bergh J. ;

Bliss J. ;

Buyse M. ;

Cameron D. ;

Carrasco E. ;

Coates A. ;

Collins R. ;

Costantino J. ;

Cuzick J. ;

Davidson N. ;

Davies K. ;

Delmestri A. ;

Di Leo A. ;

Dowsett M. ;

Elphinstone P. ;

Evans V. ;

Gelber R. ;

Gettins L. ;

Geyer C. ;

Goldhirsch A. ;

Gregory C. ;

Hayes D. ;

Hill C. ;

Ingle J. ;

Jakesz R. ;

James S. ;

Kaufmann M. ;

Kerr A. ;

MacKinnon E. ;

McHugh T. ;

Norton L. ;

Ohashi Y. .

LANCET, 2011, 378 (9804) :1707-1716

[6] The management of respiratory motion in radiation oncology report of AAPM Task Group 76 [J].

Keall, Paul J. ;

Mageras, Gig S. ;

Balter, James M. ;

Emery, Richard S. ;

Forster, Kenneth M. ;

Jiang, Steve B. ;

Kapatoes, Jeffrey M. ;

Low, Daniel A. ;

Murphy, Martin J. ;

Murray, Brad R. ;

Ramsey, Chester R. ;

Van Herk, Marcel B. ;

Vedam, S. Sastry ;

Wong, John W. ;

Yorke, Ellen .

MEDICAL PHYSICS, 2006, 33 (10) :3874-3900

[7] Breathing adapted radiotherapy for breast cancer:: Comparison of free breathing gating with the breath-hold technique [J].

Korreman, SS ;

Pedersen, AN ;

Nottrup, TJ ;

Specht, L ;

Nyström, H .

RADIOTHERAPY AND ONCOLOGY, 2005, 76 (03) :311-318

[8] QUANTIFYING THE REPRODUCIBILITY OF HEART POSITION DURING TREATMENT AND CORRESPONDING DELIVERED HEART DOSE IN VOLUNTARY DEEP INHALATION BREATH HOLD FOR LEFT BREAST CANCER PATIENTS TREATED WITH EXTERNAL BEAM RADIOTHERAPY [J].

McIntosh, Alyson ;

Shoushtari, Asal N. ;

Benedict, Stanley H. ;

Read, Paul W. ;

Wijesooriya, Krishni .

INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2011, 81 (04) :E569-E576

[9] Monitoring ABC-assisted deep inspiration breath hold for left-sided breast radiotherapy with an optical tracking system [J].

Mittauer, Kathryn E. ;

Deraniyagala, Rohan ;

Li, Jonathan G. ;

Lu, Bo ;

Liu, Chihray ;

Samant, Sanjiv S. ;

Lightsey, Judith L. ;

Yan, Guanghua .

MEDICAL PHYSICS, 2015, 42 (01) :134-143

[10] Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation [J].

Mulliez, Thomas ;

Veldeman, Liv ;

Speleers, Bruno ;

Mahjoubi, Khalil ;

Remouchamps, Vincent ;

Van Greveling, Annick ;

Gilsoul, Monique ;

Berwouts, Dieter ;

Lievens, Yolande ;

Van den Broecke, Rudy ;

De Neve, Wilfried .

RADIOTHERAPY AND ONCOLOGY, 2015, 114 (01) :79-84

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