Cardiac and pulmonary complication probabilities for breast cancer patients after routine end-inspiration gated radiotherapy

TY - JOUR

T1 - Cardiac and pulmonary complication probabilities for breast cancer patients after routine end-inspiration gated radiotherapy

AU - Korreman, Stine S

AU - Pedersen, Anders N

AU - Josipovic, Mirjana

AU - Aarup, Lasse Rye

AU - Juhler-Nøttrup, Trine

AU - Specht, Lena

AU - Nyström, Håkan

AU - Josipovic, Mirjana

AU - Josipovic, Mirjana

AU - Josipovic, Mirjana

AU - Josipovic, Mirjana

AU - Josipovic, Mirjana

AU - Josipovic, Mirjana

AU - Josipovic, Mirjana

AU - Josipovic, Mirjana

AU - Aarup, Lasse Rye

AU - Josipović, Mirjana

N1 - Keywords: Adult; Aged; Breast Neoplasms; Female; Heart; Heart Diseases; Humans; Lung; Lung Diseases; Middle Aged; Radiation Injuries; Radiotherapy, Adjuvant; Radiotherapy, Conformal; Respiration

PY - 2006/8/1

Y1 - 2006/8/1

N2 - PURPOSE: Substantial reductions of radiation doses to heart and lung can be achieved using breathing adaptation of adjuvant radiotherapy following conservative surgery for breast cancer. The purpose of this study was to estimate the radiobiological implications after routine use of an end-inspiration gated treatment, and to compare the results with predictions based on pre-clinical CT-studies. PATIENTS AND METHODS: Nineteen consecutive patients with axillary lymph node-positive left-sided breast cancer were referred for adjuvant radiotherapy after breast conserving surgery. Treatment was performed with gating in the end-inspiration phase of audio-coached enhanced free breathing. The target intended to encompass the remaining breast, ipsilateral internal mammary and periclavicular nodes, and the prescription dose was 48Gy in 24 fractions. A three-field mono-isocentric conformal technique using deep tangentials and a supraclavicular field was employed. NTCPs were calculated using the relative seriality model for the heart, and the model proposed by Burman et al. for the lung. The observed values were compared to those predicted from two previous CT-studies for a deep inspiration breath-hold technique and an uncoached end-inspiration gating technique. RESULTS: The ipsilateral lung V(50) (relative volume receiving more than 50% of the prescription dose) had a median value of 23.7% (range 10.8-35.1%) over the patient population. The corresponding median lung pneumonitis probability was 1.1% (range 0-14%). The median heart V(50) was 0.8% (range 0-19.1%) with a corresponding median cardiac mortality NTCP of 0.1% (range 0-5.7%). These results compare well with the predictions of our previous CT-studies. There is a significant reduction in dose to the left anterior descending coronary artery for the enhanced end-inspiration gating technique compared to the uncoached end-inspiration technique employed in the CT-studies. CONCLUSIONS: In a routine clinical practice involving adjuvant breast radiotherapy gated in an enhanced end-inspiration phase, remarkably low doses to organs at risk are observed. The corresponding cardiac and pulmonary complication risks are of the order of 1% and smaller.

AB - PURPOSE: Substantial reductions of radiation doses to heart and lung can be achieved using breathing adaptation of adjuvant radiotherapy following conservative surgery for breast cancer. The purpose of this study was to estimate the radiobiological implications after routine use of an end-inspiration gated treatment, and to compare the results with predictions based on pre-clinical CT-studies. PATIENTS AND METHODS: Nineteen consecutive patients with axillary lymph node-positive left-sided breast cancer were referred for adjuvant radiotherapy after breast conserving surgery. Treatment was performed with gating in the end-inspiration phase of audio-coached enhanced free breathing. The target intended to encompass the remaining breast, ipsilateral internal mammary and periclavicular nodes, and the prescription dose was 48Gy in 24 fractions. A three-field mono-isocentric conformal technique using deep tangentials and a supraclavicular field was employed. NTCPs were calculated using the relative seriality model for the heart, and the model proposed by Burman et al. for the lung. The observed values were compared to those predicted from two previous CT-studies for a deep inspiration breath-hold technique and an uncoached end-inspiration gating technique. RESULTS: The ipsilateral lung V(50) (relative volume receiving more than 50% of the prescription dose) had a median value of 23.7% (range 10.8-35.1%) over the patient population. The corresponding median lung pneumonitis probability was 1.1% (range 0-14%). The median heart V(50) was 0.8% (range 0-19.1%) with a corresponding median cardiac mortality NTCP of 0.1% (range 0-5.7%). These results compare well with the predictions of our previous CT-studies. There is a significant reduction in dose to the left anterior descending coronary artery for the enhanced end-inspiration gating technique compared to the uncoached end-inspiration technique employed in the CT-studies. CONCLUSIONS: In a routine clinical practice involving adjuvant breast radiotherapy gated in an enhanced end-inspiration phase, remarkably low doses to organs at risk are observed. The corresponding cardiac and pulmonary complication risks are of the order of 1% and smaller.

U2 - 10.1016/j.radonc.2006.07.020

DO - 10.1016/j.radonc.2006.07.020

M3 - Journal article

C2 - 16905210

SN - 0167-8140

VL - 80

SP - 257

EP - 262

JO - Radiotherapy & Oncology

JF - Radiotherapy & Oncology

IS - 2

ER -