[an error occurred while processing this directive] | [an error occurred while processing this directive]
Use of maximum heart distance to evaluate heart dosimetry for tangential field radiotherapy in left-sided breast cancer after modified radical mastectomy
Wang Shengye, Du Xianghui, Bai Xue, Su Feng, Wang Yuezhen, Chen Jianxiang, Shi Guodong, Zheng Yuanda,Wang Jin, Chen Ming
Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022,China
Abstract Objective To assess the value of maximum heart distance (MHD) in predicting the dose of tangential field heart irradiation in left-sided breast cancer. Methods A total of 40 left-sided breast cancer patients who were given adjuvant tangential field irradiation on the left chest wall after modified radical mastectomy in our hospital from January 2010 to December 2011 were selected in this study. For each patient, the following parameters were derived using three-dimensional treatment planning system:MHD, mean dose (Dmean) to organs at risk including the whole heart, left anterior descending (LAD) coronary artery, left ventricle (LV), and anterior myocardial territory (AMT), thickness of the contralateral breast tissue, and thickness from the sternum to the body surface (measuring body fat). The relationship between MHD and each Dmean was analyzed by curve fitting equation. The reliability of R2>0.8 represented a good correlation. Results The MHD of 40 patients was between 1.14 and 5.34 cm (2.66±0.16 cm). The R2 values of first-, second-, and third-order curve fitting equations were 0.869, 0.875, and 0.883, respectively, between MHD and whole heart Dmean(all P=0.000);0.777, 0.799, and 0.8133, respectively, between MDH and AMT Dmean(all P=0.000);0.598, 0.601, and 0.6333, respectively, between MHD and LV Dmean(all P=0.000);and 0.418, 0.470, and 0.4723, respectively, between MHD and Dmean of the LAD coronary artery (all P=0.000). The Dmean of all the heart compartments was not affected by the body fat thickness. Conclusions MHD is a reliable predictor of the mean dose to organs at risk (whole heart and AMT) in tangential field radiotherapy for left-sided breast cancer.
Corresponding Authors:
Du Xianghui,Email:duxianghui88@yahoo.com
Cite this article:
Wang Shengye,Du Xianghui,Bai Xue et al. Use of maximum heart distance to evaluate heart dosimetry for tangential field radiotherapy in left-sided breast cancer after modified radical mastectomy[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 180-183.
Wang Shengye,Du Xianghui,Bai Xue et al. Use of maximum heart distance to evaluate heart dosimetry for tangential field radiotherapy in left-sided breast cancer after modified radical mastectomy[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 180-183.
[1]Clarke M, Collins R, Darby S,et al. Early breast cancer trialists′ collaborative group. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival:an overview of the randomised trials[J]. Lancet,2005,366(9503):2087-2106. [2]Darby SC, McGale P, Taylor CW, et al. Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer:Prospective cohort study of about 300 000 women in US SEER cancer registries[J]. Lancet Oncol,2005,6(8):557-565. DOI:10.1016/S1470-2045(05)70251-5. [3]Darby S, McGale P, Peto R, et al. Mortality from cardiovascular disease more than 10 years after radiotherapy for breast cancer:Nationwide cohort study of 90000 Swedish women[J]. BMJ,2003,326(7383):256-257. [4]Carr ZA, Land CE, Kleinerman RA, et al. Coronary heart disease after radiotherapy for peptic ulcer disease[J]. Int J Radiat Oncol Biol Phys,2005,61(3):842-850.DOI:10.1016/j.ijrobp.2004.07.708. [5]Correa CR, Litt HI, Hwang WT, et al. Coronary artery findings after left-sided compared with right-sided radiation treatment for early stage breast cancer[J]. J Clin Oncol,2007,25(21):3031-3037. [6]Hurkmans CW, Cho BCJ, Damen E, et al. Reduction of cardiac and lung complication probabilities after breast irradiation using conformal radiotherapy with or without intensity modulation[J].Radiother Oncol,2002,62(2):163-171. [7]Taylor CW, McGale P, Povall JM, et al. Estimating cardiac exposure from breast cancer radiotherapy in clinical practice[J].Int J Radiat Oncol Biol Phys,2009,73(4):1061-1068. [8]Schultz-Hector S, Trott KR.Radiation-induced cardiovascular diseases:is the epidemiologic evidence compatible with theradiobiologic data?[J]. Int J Radiat Oncol Biol Phys,2007,67(1):10-18. [9]Kallman P, Agren A, Brahme A. Tumour and normal tissue responses to fractionated non-uniform dose delivery[J]. Int J Radiat Biol,1992,62(2):249-262. [10]Borger JH, Hooning MJ, Boersma LJ, et al. Cardiotoxic effects of tangential breast irradiation in early breast cancer patients:the role of irradiated heart volume[J]. Int J Radiat Oncol Biol Phys,2007,69(4):1131-1138. [11]Stewart FA, Hoving S, Russell NS. Vascular damage as an underlying mechanism of cardiac and cerebral toxicity in irradiated cancer patients[J]. Radiat Res,2010,174(6):865-869.DOI:10.1667/RR1862.1. [12]Tan W, Liu D, Xue C, et al. Anterior myocardial territory may replace the heart as organ at risk in intensity-modulatedradiotherapy for left-sided breast cancer[J].Int J Radiat Oncol Biol Phys,2012,82(5):1689-1697.DOI:10.1016/j.ijrobp.2011.03.009. [13]Louwe RJW, Wendling M, van Herk MB, et al. Three-dimensional heart dose reconstruction to estimate normal tissue complication probability after breast irradiation using portal dosimetry[J]. Med Phys,2007,34(4):1354-1363. [14]Zagars GK, Ballo MT, Lee AK, et al. Mortality after cure of testicular seminoma[J]. J Clin Oncol,2004,22(4):640-647. [15]Van den Belt AW, Nuver J, de Wit R, et al. Long-term risk of cardiovascular disease in 5-year survivors of testicular cancer[J].J Clin Oncol,2006,24(3):467-475. [16]McGale P, Darby SC. Low dose radiation and circulatory diseases:a systematic review of the published epidemiological evidence[J]. Radiat Res,2005,163(3):247-257. [17]Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer[J]. N Engl J Med,2004,351(10):971-977. [18]Julien JP, Bijker N, Fentiman IS, et al. Radiotherapy in breast conserving treatment for ductal carcinoma in situ:first results of the EORTC randomised phase Ⅲ trial 10853[J]. Lancet,2000,355(9203):528-533. [19]Hjelstuen MH, Mjaaland I, Vikstr m J, et al. Radiation during deep inspiration allows loco-regional treatment of left breast and axillary-,supraclavicular-and internal mammary lymph nodes without compromising target coverage or dose restrictions to organs at risk[J]. Acta Oncol,2012,51(3):333-344.DOI:10.3109/0284186X.2011.618510.
2015, Vol. 24 
