Vol 71, No 5 (2021)
Research paper (original)
Published online: 2021-08-20

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What new dose distribution statistics may be included in the optimization of dose distribution in radiotherapy for post-mastectomy patients

Piotr Mężeński1, Paweł Kukołowicz1
Nowotwory. Journal of Oncology 2021;71(5):267-273.


Introduction. The main aim of this study was to evaluate the doses delivered to heart substructures and calculate normal tissue complication probability (NTCP) for the intensity modulation radiotherpy (IMRT) irradiated group of left-sided post-mastectomy patients.

Material and methods. In this retrospective study for 30 randomly chosen breast cancer patients, the mean dose, V2, V4, V10, V20 and D2% in the heart substructures were evaluated.

Results. The mean heart dose was 12.3 Gy, the mean left anterior descending artery (LAD) dose was 28.5 Gy. The average value of long-term cardiac mortality was 0.17%, pericarditis 0.0%, left ventricle perfusion defects 24.5% and LAD toxicity 0.2%. In the literature, for the IMRT technique for left-sided mastectomy patients, the mean heart dose ranged from 8.7–14.0 Gy and the V20 10.5–14%. Additional studies are needed to describe the cardiac toxicity.

Conclusions. It is necessary to contour cardiac substructures for reliable assessment of the dose distribution, although the mean heart dose is simplification for modern radiotherapy techniques.

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  1. Kirova YM, Loap P, Fourquet A. Benefit of Post Mastectomy Radiation Therapy (PMRT) in Node-Positive, HER2-Positive Patients With Breast Cancer Receiving Anti-HER2 Treatments. Int J Radiat Oncol Biol Phys. 2020; 106(3): 511–513.
  2. McGale P, Taylor C, Correa C, et al. EBCTCG (Early Breast Cancer Trialists' Collaborative Group). Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014; 383(9935): 2127–2135.
  3. Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013; 368(11): 987–998.
  4. Kong FM, Klein EE, Bradley JD, et al. The impact of central lung distance, maximal heart distance, and radiation technique on the volumetric dose of the lung and heart for intact breast radiation. Int J Radiat Oncol Biol Phys. 2002; 54(3): 963–971.
  5. Schneider U, Ernst M, Hartmann M. The dose-response relationship for cardiovascular disease is not necessarily linear. Radiat Oncol. 2017; 12(1): 74.
  6. Abouegylah M, Braunstein LZ, Alm El-Din MA, et al. Evaluation of radiation-induced cardiac toxicity in breast cancer patients treated with Trastuzumab-based chemotherapy. Breast Cancer Res Treat. 2019; 174(1): 179–185.
  7. Soumarová R, Rušinová L. Cardiotoxicity of breast cancer radiotherapy - overview of current results. Rep Pract Oncol Radiother. 2020; 25(2): 182–186.
  8. Zhang Li, Mei X, Chen X, et al. Estimating cardiac substructures exposure from diverse radiotherapy techniques in treating left-sided breast cancer. Medicine (Baltimore). 2015; 94(18): e847.
  9. Ferretti S, Patriarca S, Carbone A, et al. [TNM classification of malignant tumours, VII edition 2009. Changes and practical effects on cancer epidemiology]. Epidemiol Prev. 2010; 34(3): 125–128.
  10. Feng M, Moran JM, Koelling T, et al. Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys. 2011; 79(1): 10–18.
  11. Deasy J. Comments on the use of the Lyman-Kutcher-Burman model to describe tissue response to nonuniform irradiation (multiple letters). Int J Radiat Oncol Biol Phys. 2000; 47(5): 1458–1459.
  12. Ma J, Li J, Xie J, et al. Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities. Radiat Oncol. 2013; 8: 81.
  13. Ma C, Zhang W, Lu J, et al. Dosimetric Comparison and Evaluation of Three Radiotherapy Techniques for Use after Modified Radical Mastectomy for Locally Advanced Left-sided Breast Cancer. Sci Rep. 2015; 5: 12274.
  14. Ma C, Zhang W, Lu J, et al. Dosimetric Comparison and Evaluation of Three Radiotherapy Techniques for Use after Modified Radical Mastectomy for Locally Advanced Left-sided Breast Cancer. Sci Rep. 2015; 5: 12274.
  15. Li W, Ma J, Chen J, et al. IMRT Versus 3D-CRT for Postmastectomy Irradiation of Chest Wall and Regional Nodes: A Population-Based Comparison of Normal Lung Dose. Int J Clin Exp Med. 2014; 90(1): S246–S247.
  16. Landis DM, Luo W, Song J, et al. Variability among breast radiation oncologists in delineation of the postsurgical lumpectomy cavity. Int J Radiat Oncol Biol Phys. 2007; 67(5): 1299–1308.
  17. Caudrelier JM, Meng J, Esche B, et al. IMRT sparing of normal tissues in locoregional treatment of breast cancer. Radiat Oncol. 2014; 9: 161.
  18. Gagliardi G, Constine LS, Moiseenko V, et al. Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl): S77–S85.
  19. Carmel R, Kaplan H. Mantle irradiation in Hodgkin's disease.An analysis of technique, tumor eradication, and complications. Cancer. 1976; 37(6): 2813–2825, doi: 10.1002/1097-0142(197606)37:6<2813::aid-cncr2820370637>3.0.co;2-s.
  20. Ph.D. MM, M.D. WS, Ph.D. RT, et al. Fraction Size and Dose Parameters Related to the Incidence of Pericardial Effusions. Int J Radiat Oncol Biol Phys. 1998; 40(1): 155–161.
  21. Wei X, Liu HH, Tucker SL, et al. Risk factors for pericardial effusion in inoperable esophageal cancer patients treated with definitive chemoradiation therapy. Int J Radiat Oncol Biol Phys. 2008; 70(3): 707–714.
  22. Marks LB, Yu X, Prosnitz RG, et al. The incidence and functional consequences of RT-associated cardiac perfusion defects. Int J Radiat Oncol Biol Phys. 2005; 63(1): 214–223.
  23. Das SK, Baydush AH, Zhou S, et al. Predicting radiotherapy-induced cardiac perfusion defects. Med Phys. 2005; 32(1): 19–27.
  24. Trott KR, Doerr W, Facoetti A, et al. Biological mechanisms of normal tissue damage: importance for the design of NTCP models. Radiother Oncol. 2012; 105(1): 79–85.
  25. Schultz-Hector S, Trott KR. Radiation-induced cardiovascular diseases: is the epidemiologic evidence compatible with the radiobiologic data? Int J Radiat Oncol Biol Phys. 2007; 67(1): 10–18.
  26. Correa CR, Litt HI, Hwang WT, et al. Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. J Clin Oncol. 2007; 25(21): 3031–3037.
  27. Nilsson G, Holmberg L, Garmo H, et al. Distribution of coronary artery stenosis after radiation for breast cancer. J Clin Oncol. 2012; 30(4): 380–386.
  28. Taylor CW, Nisbet A, McGale P, et al. Cardiac exposures in breast cancer radiotherapy: 1950s-1990s. Int J Radiat Oncol Biol Phys. 2007; 69(5): 1484–1495.
  29. Taylor CW, Povall JM, McGale P, et al. Cardiac dose from tangential breast cancer radiotherapy in the year 2006. Int J Radiat Oncol Biol Phys. 2008; 72(2): 501–507.
  30. Bruzzaniti V, Abate A, Pinnarò P, et al. Dosimetric and clinical advantages of deep inspiration breath-hold (DIBH) during radiotherapy of breast cancer. J Exp Clin Cancer Res. 2013; 32: 88.