Purpose: Breast cancer survivors have a high risk of cardiac death as a consequence of heart irradiation during left breast tangential radiotherapy (RT). This study compares the cardiac dose delivered by standard 3D conformal tangential RT (CRT) to that delivered by prospective-gating RT (PGRT) or 5-field intensity-modulated RT (IMRT). Methods: Patients with early left breast cancer, referred for adjuvant RT to our institution, were enrolled in this study. For each patient, 2 simulation computed tomography scans were acquired: the first during free breathing, and the second on prospective gating during deep inspiration breath-hold. The scans were monitored by the Varian RPM™ respiratory gating system. For each patient, 3 treatment plans were performed: a 3D-CRT and an IMRT plan, each based on the free-breathing scan, and a PGRT plan, based on the deep inspiration breath-hold scan. Dose-volume histograms were compared by means of the Friedman test. Results: The median mean heart dose was 3 Gy (range 0.9-7.3 Gy) in the CRT plans, 1.9 Gy (range 0.5-3.6 Gy) in the PGRT plans, and 4.5 Gy (range 1.1-10.5 Gy) in the IMRT plans (p = 0.001). The mean heart V25 was 1.2% (range 0%-9.7%), 0% (range 0%-2.0%), and 0.2% (range 0%-7.3%) for CRT, PGRT, and IMRT plans, respectively (p<0.001). Conclusions: Prospective-gating RT to the left breast offered the best protection of heart and lung, as well as a lower irradiation of the contralateral breast, compared to CRT or IMRT.

D'agostino, G. R., Diletto, B., Mantini, G., Nardone, L., Carlo Mattiucci, G., Catucci, F., Canna, R., Martino, A., Azario, L., Valentini, V., Reducing heart dose during left breast cancer radiotherapy: Comparison among 3 radiation techniques, <<TUMORI>>, 2016; 102 (2): 184-189. [doi:10.5301/tj.5000414] [http://hdl.handle.net/10807/92461]

Reducing heart dose during left breast cancer radiotherapy: Comparison among 3 radiation techniques

D'Agostino, Giuseppe Roberto
Primo
;
Diletto, Barbara
;
Mantini, Giovanna;Nardone, Luigia;Catucci, Francesco;Canna, Roberta;Martino, Antonella;Azario, Luigi
Penultimo
;
Valentini, Vincenzo
Ultimo
2016

Abstract

Purpose: Breast cancer survivors have a high risk of cardiac death as a consequence of heart irradiation during left breast tangential radiotherapy (RT). This study compares the cardiac dose delivered by standard 3D conformal tangential RT (CRT) to that delivered by prospective-gating RT (PGRT) or 5-field intensity-modulated RT (IMRT). Methods: Patients with early left breast cancer, referred for adjuvant RT to our institution, were enrolled in this study. For each patient, 2 simulation computed tomography scans were acquired: the first during free breathing, and the second on prospective gating during deep inspiration breath-hold. The scans were monitored by the Varian RPM™ respiratory gating system. For each patient, 3 treatment plans were performed: a 3D-CRT and an IMRT plan, each based on the free-breathing scan, and a PGRT plan, based on the deep inspiration breath-hold scan. Dose-volume histograms were compared by means of the Friedman test. Results: The median mean heart dose was 3 Gy (range 0.9-7.3 Gy) in the CRT plans, 1.9 Gy (range 0.5-3.6 Gy) in the PGRT plans, and 4.5 Gy (range 1.1-10.5 Gy) in the IMRT plans (p = 0.001). The mean heart V25 was 1.2% (range 0%-9.7%), 0% (range 0%-2.0%), and 0.2% (range 0%-7.3%) for CRT, PGRT, and IMRT plans, respectively (p<0.001). Conclusions: Prospective-gating RT to the left breast offered the best protection of heart and lung, as well as a lower irradiation of the contralateral breast, compared to CRT or IMRT.
Inglese
D'agostino, G. R., Diletto, B., Mantini, G., Nardone, L., Carlo Mattiucci, G., Catucci, F., Canna, R., Martino, A., Azario, L., Valentini, V., Reducing heart dose during left breast cancer radiotherapy: Comparison among 3 radiation techniques, <<TUMORI>>, 2016; 102 (2): 184-189. [doi:10.5301/tj.5000414] [http://hdl.handle.net/10807/92461]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/92461
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