Reshma Jagsi1, Kent A Griffith2, Jean M Moran3, Edward Ficaro4, Robin Marsh3, Robert T Dess3, Eugene Chung3, Adam L Liss3, James A Hayman3, Charles S Mayo3, Kevin Flaherty5, James Corbett6, Lori Pierce3. 1. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: rjagsi@med.umich.edu. 2. Center for Cancer Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan. 3. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. 4. Department of Radiology, University of Michigan, Ann Arbor, Michigan. 5. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan. 6. Department of Radiology, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Abstract
PURPOSE: Although inverse-planned intensity modulated radiotherapy (IMRT) and deep inspiration breath hold (DIBH) may allow for more conformal dose distributions, it is unknown whether using these technologies reduces cardiac or pulmonary toxicity of breast radiotherapy. METHODS AND MATERIALS: A randomized controlled trial compared IMRT-DIBH versus standard, free-breathing, forward-planned, three-dimensional conformal radiotherapy in patients with left-sided, node-positive breast cancer in whom the internal mammary nodal region was targeted. Endpoints included dosimetric parameters and changes in pulmonary and cardiac perfusion and function, measured by single photon emissioncomputed tomography (SPECT) scans and pulmonary function testing performed at baseline and 1 year post treatment. RESULTS: Of 62 patients randomized, 54 who completed all follow-up procedures were analyzed. Mean doses to the ipsilateral lung, left ventricle, whole heart, and left anterior descending coronary artery were lower with IMRT-DIBH; the percent of left ventricle receiving ≥5 Gy averaged 15.8% with standard radiotherapy and 5.6% with IMRT-DIBH (P < .001). SPECT revealed no differences in perfusion defects in the left anterior descending coronary artery territory, the study's primary endpoint, but did reveal statistically significant differences (P = .02) in left ventricular ejection fraction (LVEF), a secondary endpoint. No differences were found for lung perfusion or function. CONCLUSION: The small but statistically significant benefit in preservation of cardiac LVEF observed here should motivate future studies that include LVEF as a potentially meaningful endpoint. Future studies should disaggregate the impact of IMRT from that of DIBH. Clinical practice should recognize the importance of minimizing cardiac dose, even when already low in comparison to historical levels.
RCT Entities:
PURPOSE: Although inverse-planned intensity modulated radiotherapy (IMRT) and deep inspiration breath hold (DIBH) may allow for more conformal dose distributions, it is unknown whether using these technologies reduces cardiac or pulmonary toxicity of breast radiotherapy. METHODS AND MATERIALS: A randomized controlled trial compared IMRT-DIBH versus standard, free-breathing, forward-planned, three-dimensional conformal radiotherapy in patients with left-sided, node-positive breast cancer in whom the internal mammary nodal region was targeted. Endpoints included dosimetric parameters and changes in pulmonary and cardiac perfusion and function, measured by single photon emission computed tomography (SPECT) scans and pulmonary function testing performed at baseline and 1 year post treatment. RESULTS: Of 62 patients randomized, 54 who completed all follow-up procedures were analyzed. Mean doses to the ipsilateral lung, left ventricle, whole heart, and left anterior descending coronary artery were lower with IMRT-DIBH; the percent of left ventricle receiving ≥5 Gy averaged 15.8% with standard radiotherapy and 5.6% with IMRT-DIBH (P < .001). SPECT revealed no differences in perfusion defects in the left anterior descending coronary artery territory, the study's primary endpoint, but did reveal statistically significant differences (P = .02) in left ventricular ejection fraction (LVEF), a secondary endpoint. No differences were found for lung perfusion or function. CONCLUSION: The small but statistically significant benefit in preservation of cardiac LVEF observed here should motivate future studies that include LVEF as a potentially meaningful endpoint. Future studies should disaggregate the impact of IMRT from that of DIBH. Clinical practice should recognize the importance of minimizing cardiac dose, even when already low in comparison to historical levels.
Authors: Minji Koh; Jinhong Jung; Su Ssan Kim; Seung Do Ahn; Eun Kyung Choi; Il Yong Chung; Jong Won Lee; Sung-Bae Kim; Jae Ho Jeong Journal: Breast Cancer Res Treat Date: 2021-04-23 Impact factor: 4.872
Authors: Kekoa Taparra; Scott C Lester; W Scott Harmsen; Molly Petersen; Ryan K Funk; Miran J Blanchard; Phillip Young; Joerg Herrmann; Ashley Hunzeker; Heather Schultz; Cynthia McCollough; Alexandria Tasson; Shuai Leng; James A Martenson; Thomas J Whitaker; Eric Williamson; Nadia N Laack Journal: Int J Part Ther Date: 2020-09-04
Authors: Jose G Bazan; Dominic DiCostanzo; Karen Hock; Sachin Jhawar; Karla Kuhn; Kylee Lindsey; Kayla Tedrick; Erin Healy; Sasha Beyer; Julia R White Journal: Front Oncol Date: 2021-03-11 Impact factor: 6.244
Authors: Dean A Shumway; Amy Motomura; Kent A Griffith; James A Hayman; Lori J Pierce; Reshma Jagsi Journal: Int J Radiat Oncol Biol Phys Date: 2020-05-23 Impact factor: 7.038
Authors: Lia M Halasz; Shilpen A Patel; Jean A McDougall; Catherine Fedorenko; Qin Sun; Bernardo H L Goulart; Joshua A Roth Journal: PLoS One Date: 2019-09-30 Impact factor: 3.240