Cargando…

Optimal radiotherapy modality sparing for cardiac valves in left-sided breast cancer

BACKGROUND: The cardiotoxicity caused by radiotherapy is a critical problem in the treatment of patients with breast cancer. The appropriate radiotherapy modality sparing for cardiac valves in left-sided breast cancer has not been well defined. The aim of this study was thus to compare the dosimetri...

Descripción completa

Detalles Bibliográficos
Autores principales: Zhang, Ningning, Liu, Xianfeng, Tao, Dan, Wang, Ying, Wu, Yongzhong, Zeng, Xiaohua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9929844/
https://www.ncbi.nlm.nih.gov/pubmed/36819565
http://dx.doi.org/10.21037/atm-22-6633
_version_ 1784888947425411072
author Zhang, Ningning
Liu, Xianfeng
Tao, Dan
Wang, Ying
Wu, Yongzhong
Zeng, Xiaohua
author_facet Zhang, Ningning
Liu, Xianfeng
Tao, Dan
Wang, Ying
Wu, Yongzhong
Zeng, Xiaohua
author_sort Zhang, Ningning
collection PubMed
description BACKGROUND: The cardiotoxicity caused by radiotherapy is a critical problem in the treatment of patients with breast cancer. The appropriate radiotherapy modality sparing for cardiac valves in left-sided breast cancer has not been well defined. The aim of this study was thus to compare the dosimetric differences in heart and cardiac valves of 3-dimensional conformal radiotherapy (3D-CRT), fixed-field intensity-modulated radiation therapy (IMRT), and volumetric-modulated arc therapy (VMAT) to find the optimal radiotherapy modality sparing for cardiac valves in patients with left breast cancer. METHODS: From January 5, 2021, to March 15, 2021, 21 patients with left-sided breast cancer postmastectomy were included in this study, and 3 different plans for adjuvant radiation were created using 3D-CRT, IMRT, and VMAT for each patient. All patients received 50 Gy in 25 fractions. The mean dose (D(mean)) of the heart; percentage volume of the heart receiving ≥5 Gy (V(5)), ≥30 Gy (V(30)), and ≥40 Gy (V(40)); and the D(mean) and the near-maximum dose (D(0.03cc)) of cardiac valves were extracted from dose-volume histograms (DVHs) and compared. The correlations in dosimetric factors between cardiac valves and the whole heart were analyzed. RESULTS: IMRT significantly decreased the values of V(5), V(30), V(40), and D(mean) in the whole heart compared to 3D-CRT and VMAT (P<0.001). Among the 3 different plans, IMRT had the lowest radiation dose to the D(mean) and the D(0.03cc) of the aortic valve (1.27 Gy/1.75 Gy), pulmonary valve (3.44 Gy/6.89 Gy), tricuspid valve (1.02 Gy/1.14 Gy), and mitral valve (0.93 Gy/1.00 Gy). Pearson correlation analysis found that local parameters (D(mean) and D(0.03cc)) within valves were strongly correlated to the global parameters (V(5), V(30), V(40), and D(mean)) of the heart. CONCLUSIONS: This study revealed that IMRT showed the lowest cardiac valves dose compared with 3D-CRT and VMAT in left-sided breast cancer radiotherapy. IMRT might be the optimal modality sparing for cardiac valves in this group of patients. Further studies need to be carried out in order to validate the protective role of IMRT on the cardiac valves.
format Online
Article
Text
id pubmed-9929844
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher AME Publishing Company
record_format MEDLINE/PubMed
spelling pubmed-99298442023-02-16 Optimal radiotherapy modality sparing for cardiac valves in left-sided breast cancer Zhang, Ningning Liu, Xianfeng Tao, Dan Wang, Ying Wu, Yongzhong Zeng, Xiaohua Ann Transl Med Original Article BACKGROUND: The cardiotoxicity caused by radiotherapy is a critical problem in the treatment of patients with breast cancer. The appropriate radiotherapy modality sparing for cardiac valves in left-sided breast cancer has not been well defined. The aim of this study was thus to compare the dosimetric differences in heart and cardiac valves of 3-dimensional conformal radiotherapy (3D-CRT), fixed-field intensity-modulated radiation therapy (IMRT), and volumetric-modulated arc therapy (VMAT) to find the optimal radiotherapy modality sparing for cardiac valves in patients with left breast cancer. METHODS: From January 5, 2021, to March 15, 2021, 21 patients with left-sided breast cancer postmastectomy were included in this study, and 3 different plans for adjuvant radiation were created using 3D-CRT, IMRT, and VMAT for each patient. All patients received 50 Gy in 25 fractions. The mean dose (D(mean)) of the heart; percentage volume of the heart receiving ≥5 Gy (V(5)), ≥30 Gy (V(30)), and ≥40 Gy (V(40)); and the D(mean) and the near-maximum dose (D(0.03cc)) of cardiac valves were extracted from dose-volume histograms (DVHs) and compared. The correlations in dosimetric factors between cardiac valves and the whole heart were analyzed. RESULTS: IMRT significantly decreased the values of V(5), V(30), V(40), and D(mean) in the whole heart compared to 3D-CRT and VMAT (P<0.001). Among the 3 different plans, IMRT had the lowest radiation dose to the D(mean) and the D(0.03cc) of the aortic valve (1.27 Gy/1.75 Gy), pulmonary valve (3.44 Gy/6.89 Gy), tricuspid valve (1.02 Gy/1.14 Gy), and mitral valve (0.93 Gy/1.00 Gy). Pearson correlation analysis found that local parameters (D(mean) and D(0.03cc)) within valves were strongly correlated to the global parameters (V(5), V(30), V(40), and D(mean)) of the heart. CONCLUSIONS: This study revealed that IMRT showed the lowest cardiac valves dose compared with 3D-CRT and VMAT in left-sided breast cancer radiotherapy. IMRT might be the optimal modality sparing for cardiac valves in this group of patients. Further studies need to be carried out in order to validate the protective role of IMRT on the cardiac valves. AME Publishing Company 2023-01-12 2023-01-31 /pmc/articles/PMC9929844/ /pubmed/36819565 http://dx.doi.org/10.21037/atm-22-6633 Text en 2023 Annals of Translational Medicine. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Zhang, Ningning
Liu, Xianfeng
Tao, Dan
Wang, Ying
Wu, Yongzhong
Zeng, Xiaohua
Optimal radiotherapy modality sparing for cardiac valves in left-sided breast cancer
title Optimal radiotherapy modality sparing for cardiac valves in left-sided breast cancer
title_full Optimal radiotherapy modality sparing for cardiac valves in left-sided breast cancer
title_fullStr Optimal radiotherapy modality sparing for cardiac valves in left-sided breast cancer
title_full_unstemmed Optimal radiotherapy modality sparing for cardiac valves in left-sided breast cancer
title_short Optimal radiotherapy modality sparing for cardiac valves in left-sided breast cancer
title_sort optimal radiotherapy modality sparing for cardiac valves in left-sided breast cancer
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9929844/
https://www.ncbi.nlm.nih.gov/pubmed/36819565
http://dx.doi.org/10.21037/atm-22-6633
work_keys_str_mv AT zhangningning optimalradiotherapymodalitysparingforcardiacvalvesinleftsidedbreastcancer
AT liuxianfeng optimalradiotherapymodalitysparingforcardiacvalvesinleftsidedbreastcancer
AT taodan optimalradiotherapymodalitysparingforcardiacvalvesinleftsidedbreastcancer
AT wangying optimalradiotherapymodalitysparingforcardiacvalvesinleftsidedbreastcancer
AT wuyongzhong optimalradiotherapymodalitysparingforcardiacvalvesinleftsidedbreastcancer
AT zengxiaohua optimalradiotherapymodalitysparingforcardiacvalvesinleftsidedbreastcancer