Frances K Duane1,2,3, Naomi B Boekel4, Judy N Jacobse4, Zhe Wang5, Berthe M P Aleman6, Sarah C Darby5, Michael Schaapveld4, Flora E van Leeuwen4, Margreet H A Baaijens7, Samantha Warren8, Carolyn W Taylor5. 1. St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland. 2. School of Medicine, Trinity College Dublin, Ireland. 3. Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland. 4. Netherlands Cancer Institute, Epidemiology, Amsterdam, The Netherlands. 5. Nuffield Department of Population Health, University of Oxford, UK. 6. Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands. 7. Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands. 8. Northern Centre for Cancer Care, Freeman Hospital, Newcastle Upon Tyne, UK.
Abstract
Purpose: To describe cardiac exposure from breast cancer radiotherapy regimens used during 1970-2009 for the development of dose-response relationships and to consider the associated radiation-risks using existing dose-response relationships. Material and methods: Radiotherapy charts for 771 women in the Netherlands selected for case control studies of heart disease after breast cancer radiotherapy were used to reconstruct 44 regimens on a typical CT-dataset. Doses were estimated for the whole heart (WH), left ventricle (LV) and cardiac valves. Results: For breast/chest wall radiotherapy average WH doses decreased during 1970-2009. For internal mammary chain (IMC) radiotherapy WH doses were highest during the 1980s and 1990s when direct anterior fields were used and reduced in the 2000s when oblique fields were introduced. Average doses varied substantially for IMC regimens (WH 2-33 Gy, LV < 1-23 Gy). For cardiac valves, at least one valve received >30 Gy from most regimens. Conclusions: Radiation-risks of IHD from breast/chest wall regimens likely reduced during 1970-2009. Direct anterior IMC regimens likely increased the risks of IHD and VHD over this time period but the use of oblique IMC fields from 2003 may have lowered these risks. These data provide a unique opportunity to develop dose-response relationships.
Purpose: To describe cardiac exposure from breast cancer radiotherapy regimens used during 1970-2009 for the development of dose-response relationships and to consider the associated radiation-risks using existing dose-response relationships. Material and methods: Radiotherapy charts for 771 women in the Netherlands selected for case control studies of heart disease after breast cancer radiotherapy were used to reconstruct 44 regimens on a typical CT-dataset. Doses were estimated for the whole heart (WH), left ventricle (LV) and cardiac valves. Results: For breast/chest wall radiotherapy average WH doses decreased during 1970-2009. For internal mammary chain (IMC) radiotherapy WH doses were highest during the 1980s and 1990s when direct anterior fields were used and reduced in the 2000s when oblique fields were introduced. Average doses varied substantially for IMC regimens (WH 2-33 Gy, LV < 1-23 Gy). For cardiac valves, at least one valve received >30 Gy from most regimens. Conclusions: Radiation-risks of IHD from breast/chest wall regimens likely reduced during 1970-2009. Direct anterior IMC regimens likely increased the risks of IHD and VHD over this time period but the use of oblique IMC fields from 2003 may have lowered these risks. These data provide a unique opportunity to develop dose-response relationships.
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Authors: Judy N Jacobse; Frances K Duane; Naomi B Boekel; Michael Schaapveld; Michael Hauptmann; Maartje J Hooning; Caroline M Seynaeve; Margreet H A Baaijens; Jourik A Gietema; Sarah C Darby; Flora E van Leeuwen; Berthe M P Aleman; Carolyn W Taylor Journal: Int J Radiat Oncol Biol Phys Date: 2018-10-29 Impact factor: 7.038