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Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy

PURPOSE: The exposition of cardiac conduction system during breast radiation therapy has never been studied, despite the increasing use of intensity-modulated radiation therapy, which exposes larger volume to low-dose bath. We evaluated conduction node exposure during breast irradiation with volumet...

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Autores principales: Loap, Pierre, Goudjil, Farid, Servois, Vincent, Kirov, Krassen, Fourquet, Alain, Kirova, Youlia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Particle Therapy Co-operative Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563662/
https://www.ncbi.nlm.nih.gov/pubmed/37823017
http://dx.doi.org/10.14338/IJPT-22-00038.1
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author Loap, Pierre
Goudjil, Farid
Servois, Vincent
Kirov, Krassen
Fourquet, Alain
Kirova, Youlia
author_facet Loap, Pierre
Goudjil, Farid
Servois, Vincent
Kirov, Krassen
Fourquet, Alain
Kirova, Youlia
author_sort Loap, Pierre
collection PubMed
description PURPOSE: The exposition of cardiac conduction system during breast radiation therapy has never been studied, despite the increasing use of intensity-modulated radiation therapy, which exposes larger volume to low-dose bath. We evaluated conduction node exposure during breast irradiation with volumetric modulated arc therapy and estimated the potential dosimetric benefit with intensity-modulated proton therapy. MATERIALS AND METHODS: Atrioventricular (AVN) and sinoatrial (SAN) nodes were retrospectively delineated according to published guidelines on the simulation computed tomography scans of 12 breast cancer patients having undergone conserving surgery and adjuvant locoregional volumetric modulated arc therapy. Intensity-modulated proton therapy treatment was replanned on the simulation computed tomography scans for all breast cancer patients. Mean and maximum doses delivered to the SAN and the AVN were retrieved and compared. Correlation coefficients were calculated between doses to the SAN or the AVN and the whole heart. RESULTS: Average mean doses delivered to the SAN and AVN were 2.8 and 2.3 Gy, respectively, for left-sided irradiation and 9.6 and 3.6 Gy, respectively, for right-sided irradiation. Average maximum doses to the SAN and AVN were 3.5 Gy and 2.8 Gy, respectively, for left-sided irradiation and 13.1 and 4.6 Gy, respectively, for right-sided irradiation. Intensity-modulated proton therapy significantly reduced mean and maximum doses to the SAN and AVN. Correlations between doses to the SAN or AVN and whole heart were usually significant. CONCLUSION: SAN and AVN can be substantially exposed during breast volumetric modulated arc therapy, especially for right-sided irradiation. Cardiotoxicity studies evaluating conduction node exposure might define dose constraints and criteria for additional cardiac-sparing techniques, such as respiratory techniques or proton therapy, which could benefit patients with underlying rhythmic or conduction disorders.
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spelling pubmed-105636622023-10-11 Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy Loap, Pierre Goudjil, Farid Servois, Vincent Kirov, Krassen Fourquet, Alain Kirova, Youlia Int J Part Ther Technical Note PURPOSE: The exposition of cardiac conduction system during breast radiation therapy has never been studied, despite the increasing use of intensity-modulated radiation therapy, which exposes larger volume to low-dose bath. We evaluated conduction node exposure during breast irradiation with volumetric modulated arc therapy and estimated the potential dosimetric benefit with intensity-modulated proton therapy. MATERIALS AND METHODS: Atrioventricular (AVN) and sinoatrial (SAN) nodes were retrospectively delineated according to published guidelines on the simulation computed tomography scans of 12 breast cancer patients having undergone conserving surgery and adjuvant locoregional volumetric modulated arc therapy. Intensity-modulated proton therapy treatment was replanned on the simulation computed tomography scans for all breast cancer patients. Mean and maximum doses delivered to the SAN and the AVN were retrieved and compared. Correlation coefficients were calculated between doses to the SAN or the AVN and the whole heart. RESULTS: Average mean doses delivered to the SAN and AVN were 2.8 and 2.3 Gy, respectively, for left-sided irradiation and 9.6 and 3.6 Gy, respectively, for right-sided irradiation. Average maximum doses to the SAN and AVN were 3.5 Gy and 2.8 Gy, respectively, for left-sided irradiation and 13.1 and 4.6 Gy, respectively, for right-sided irradiation. Intensity-modulated proton therapy significantly reduced mean and maximum doses to the SAN and AVN. Correlations between doses to the SAN or AVN and whole heart were usually significant. CONCLUSION: SAN and AVN can be substantially exposed during breast volumetric modulated arc therapy, especially for right-sided irradiation. Cardiotoxicity studies evaluating conduction node exposure might define dose constraints and criteria for additional cardiac-sparing techniques, such as respiratory techniques or proton therapy, which could benefit patients with underlying rhythmic or conduction disorders. The Particle Therapy Co-operative Group 2023-03-09 /pmc/articles/PMC10563662/ /pubmed/37823017 http://dx.doi.org/10.14338/IJPT-22-00038.1 Text en ©Copyright 2023 The Author(s) https://creativecommons.org/licenses/by/3.0/This is an Open Access article distributed in accordance with Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/ (https://creativecommons.org/licenses/by/3.0/) ).
spellingShingle Technical Note
Loap, Pierre
Goudjil, Farid
Servois, Vincent
Kirov, Krassen
Fourquet, Alain
Kirova, Youlia
Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy
title Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy
title_full Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy
title_fullStr Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy
title_full_unstemmed Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy
title_short Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy
title_sort radiation exposure of cardiac conduction nodes during breast proton therapy
topic Technical Note
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563662/
https://www.ncbi.nlm.nih.gov/pubmed/37823017
http://dx.doi.org/10.14338/IJPT-22-00038.1
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