Carolyn W Taylor1, Zhe Wang2, Elizabeth Macaulay3, Reshma Jagsi4, Frances Duane2, Sarah C Darby2. 1. Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom. Electronic address: carolyn.taylor@ctsu.ox.ac.uk. 2. Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom. 3. Banbury, United Kingdom. 4. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Abstract
PURPOSE: Breast cancer radiation therapy cures many women, but where the heart is exposed, it can cause heart disease. We report a systematic review of heart doses from breast cancer radiation therapy that were published during 2003 to 2013. METHODS AND MATERIALS: Eligible studies were those reporting whole-heart dose (ie, dose averaged over the whole heart). Analyses considered the arithmetic mean of the whole-heart doses for the CT plans for each regimen in each study. We termed this "mean heart dose." RESULTS: In left-sided breast cancer, mean heart dose averaged over all 398 regimens reported in 149 studies from 28 countries was 5.4 Gy (range, <0.1-28.6 Gy). In regimens that did not include the internal mammary chain (IMC), average mean heart dose was 4.2 Gy and varied with the target tissues irradiated. The lowest average mean heart doses were from tangential radiation therapy with either breathing control (1.3 Gy; range, 0.4-2.5 Gy) or treatment in the lateral decubitus position (1.2 Gy; range, 0.8-1.7 Gy), or from proton radiation therapy (0.5 Gy; range, 0.1-0.8 Gy). For intensity modulated radiation therapy mean heart dose was 5.6 Gy (range, <0.1-23.0 Gy). Where the IMC was irradiated, average mean heart dose was around 8 Gy and varied little according to which other targets were irradiated. Proton radiation therapy delivered the lowest average mean heart dose (2.6 Gy, range, 1.0-6.0 Gy), and tangential radiation therapy with a separate IMC field the highest (9.2 Gy, range, 1.9-21.0 Gy). In right-sided breast cancer, the average mean heart dose was 3.3 Gy based on 45 regimens in 23 studies. CONCLUSIONS: Recent estimates of typical heart doses from left breast cancer radiation therapy vary widely between studies, even for apparently similar regimens. Maneuvers to reduce heart dose in left tangential radiation therapy were successful. Proton radiation therapy delivered the lowest doses. Inclusion of the IMC doubled typical heart dose.
PURPOSE: Breast cancer radiation therapy cures many women, but where the heart is exposed, it can cause heart disease. We report a systematic review of heart doses from breast cancer radiation therapy that were published during 2003 to 2013. METHODS AND MATERIALS: Eligible studies were those reporting whole-heart dose (ie, dose averaged over the whole heart). Analyses considered the arithmetic mean of the whole-heart doses for the CT plans for each regimen in each study. We termed this "mean heart dose." RESULTS: In left-sided breast cancer, mean heart dose averaged over all 398 regimens reported in 149 studies from 28 countries was 5.4 Gy (range, <0.1-28.6 Gy). In regimens that did not include the internal mammary chain (IMC), average mean heart dose was 4.2 Gy and varied with the target tissues irradiated. The lowest average mean heart doses were from tangential radiation therapy with either breathing control (1.3 Gy; range, 0.4-2.5 Gy) or treatment in the lateral decubitus position (1.2 Gy; range, 0.8-1.7 Gy), or from proton radiation therapy (0.5 Gy; range, 0.1-0.8 Gy). For intensity modulated radiation therapy mean heart dose was 5.6 Gy (range, <0.1-23.0 Gy). Where the IMC was irradiated, average mean heart dose was around 8 Gy and varied little according to which other targets were irradiated. Proton radiation therapy delivered the lowest average mean heart dose (2.6 Gy, range, 1.0-6.0 Gy), and tangential radiation therapy with a separate IMC field the highest (9.2 Gy, range, 1.9-21.0 Gy). In right-sided breast cancer, the average mean heart dose was 3.3 Gy based on 45 regimens in 23 studies. CONCLUSIONS: Recent estimates of typical heart doses from left breast cancer radiation therapy vary widely between studies, even for apparently similar regimens. Maneuvers to reduce heart dose in left tangential radiation therapy were successful. Proton radiation therapy delivered the lowest doses. Inclusion of the IMC doubled typical heart dose.
Authors: Carolyn Taylor; Candace Correa; Frances K Duane; Marianne C Aznar; Stewart J Anderson; Jonas Bergh; David Dodwell; Marianne Ewertz; Richard Gray; Reshma Jagsi; Lori Pierce; Kathleen I Pritchard; Sandra Swain; Zhe Wang; Yaochen Wang; Tim Whelan; Richard Peto; Paul McGale Journal: J Clin Oncol Date: 2017-03-20 Impact factor: 44.544
Authors: Hirofumi Saiki; Ivy A Petersen; Christopher G Scott; Kent R Bailey; Shannon M Dunlay; Randi R Finley; Kathryn J Ruddy; Elizabeth Yan; Margaret M Redfield Journal: Circulation Date: 2017-01-29 Impact factor: 29.690
Authors: Serban Mihai Balanescu; Dinu Valentin Balanescu; Teodora Donisan; Eric H Yang; Nicolas Palaskas; Juan Lopez-Mattei; Saamir Hassan; Peter Kim; Mehmet Cilingiroglu; Konstantinos Marmagkiolis; Biswajit Kar; Cezar Iliescu Journal: Curr Cardiol Rep Date: 2019-07-08 Impact factor: 2.931