Cristoforo Simonetto1, Markus Eidemüller2, Aurélie Gaasch3, Montserrat Pazos4, Stephan Schönecker5, Daniel Reitz6, Stefan Kääb7, Michael Braun8, Nadia Harbeck9, Maximilian Niyazi10, Claus Belka11, Stefanie Corradini12. 1. Department of Radiation Sciences, Institute of Radiation Protection, Helmholtz Center Munich German Research Center for Environmental Health, 85764 Neuherberg, Germany. Electronic address: Cristoforo.Simonetto@helmholtz-muenchen.de. 2. Department of Radiation Sciences, Institute of Radiation Protection, Helmholtz Center Munich German Research Center for Environmental Health, 85764 Neuherberg, Germany. Electronic address: Markus.Eidemueller@helmholtz-muenchen.de. 3. Department of Radiation Oncology, University Hospital, LMU Munich, Germany. Electronic address: Aurelie.Gaasch@med.uni-muenchen.de. 4. Department of Radiation Oncology, University Hospital, LMU Munich, Germany. Electronic address: Montserrat.Pazos@med.uni-muenchen.de. 5. Department of Radiation Oncology, University Hospital, LMU Munich, Germany. Electronic address: Stephan.Schoenecker@med.uni-muenchen.de. 6. Department of Radiation Oncology, University Hospital, LMU Munich, Germany. Electronic address: Daniel.Reitz@med.uni-muenchen.de. 7. Department of Medicine I, University Hospital, LMU Munich, Germany; German Cardiovascular Research Centre (DZHK), Munich Heart Alliance, Germany. Electronic address: Stefan.Kaab@med.uni-muenchen.de. 8. Red Cross Breast Centre, Munich, Germany. Electronic address: Michael.Braun@swmbrk.de. 9. Department of Obstetrics and Gynecology, Breast Centre, University Hospital, LMU Munich, Munich, Germany. Electronic address: Nadia.Harbeck@med.uni-muenchen.de. 10. Department of Radiation Oncology, University Hospital, LMU Munich, Germany. Electronic address: Maximilian.Niyazi@med.uni-muenchen.de. 11. Department of Radiation Oncology, University Hospital, LMU Munich, Germany. Electronic address: Claus.Belka@med.uni-muenchen.de. 12. Department of Radiation Oncology, University Hospital, LMU Munich, Germany. Electronic address: Stefanie.Corradini@med.uni-muenchen.de.
Abstract
PURPOSE: Aim of the current comparative modelling study was to estimate the individual radiation-induced risk for death of ischaemic heart disease (IHD) under free breathing (FB) and deep inspiration breath-hold (DIBH) in a real-world population. MATERIALS AND METHODS: Eighty-nine patients with left-sided early breast cancer were enrolled in the prospective SAVE-HEART study. For each patient three-dimensional conformal treatment plans were created in FB and DIBH and corresponding radiation-induced risks of IHD mortality were estimated based on expected survival, individual IHD risk factors and the relative radiation-induced risk. RESULTS: With the use of DIBH, mean heart doses were reduced by 35% (interquartile range: 23-46%) as compared to FB. Mean expected years of life lost (YLL) due to radiation-induced IHD mortality were 0.11 years in FB, and 0.07 years in DIBH. YLL were remarkably independent of age at treatment in patients with a favourable tumour prognosis. DIBH led to more pronounced reductions in YLL in patients with high baseline risk (0.08 years for upper vs 0.02 years for lower quartile), with favourable tumour prognosis (0.05 years for patients without vs 0.02 years for those with lymph-node involvement), and in patients with high mean heart doses in FB (0.09 years for doses >3 Gy vs 0.02 years for doses <1.5 Gy). CONCLUSION: Ideally, the DIBH technique should be offered to all patients with left-sided breast cancer. However, highest benefits are expected for patients with a favourable tumour prognosis, high mean heart dose or high baseline IHD risk, independent of their age.
PURPOSE: Aim of the current comparative modelling study was to estimate the individual radiation-induced risk for death of ischaemic heart disease (IHD) under free breathing (FB) and deep inspiration breath-hold (DIBH) in a real-world population. MATERIALS AND METHODS: Eighty-nine patients with left-sided early breast cancer were enrolled in the prospective SAVE-HEART study. For each patient three-dimensional conformal treatment plans were created in FB and DIBH and corresponding radiation-induced risks of IHD mortality were estimated based on expected survival, individual IHD risk factors and the relative radiation-induced risk. RESULTS: With the use of DIBH, mean heart doses were reduced by 35% (interquartile range: 23-46%) as compared to FB. Mean expected years of life lost (YLL) due to radiation-induced IHD mortality were 0.11 years in FB, and 0.07 years in DIBH. YLL were remarkably independent of age at treatment in patients with a favourable tumour prognosis. DIBH led to more pronounced reductions in YLL in patients with high baseline risk (0.08 years for upper vs 0.02 years for lower quartile), with favourable tumour prognosis (0.05 years for patients without vs 0.02 years for those with lymph-node involvement), and in patients with high mean heart doses in FB (0.09 years for doses >3 Gy vs 0.02 years for doses <1.5 Gy). CONCLUSION: Ideally, the DIBH technique should be offered to all patients with left-sided breast cancer. However, highest benefits are expected for patients with a favourable tumour prognosis, high mean heart dose or high baseline IHD risk, independent of their age.
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