Vol 26, No 3 (2021)
Research paper
Published online: 2021-04-13

open access

Page views 488
Article views/downloads 397
Get Citation

Connect on Social Media

Connect on Social Media

Correlation between gastric volume and organs at risk dose in adjuvant radiotherapy for left breast cancer

Zahra Siavashpour1, Mona Malekzadeh Moghani1, Neda Goharpey2, Hamid Reza Mirzai1, Leila Kia Mohammadi2, Farid Zayeri3
Rep Pract Oncol Radiother 2021;26(3):367-379.


BACKGROUND: The role of the gastric volume on the dose-effect relationship for these organs has not been investigated. The aim of the study was to evaluate the correlation between gastric volume and dose-volume histogram (DVH) parameters of the heart, left lung and stomach during left breast cancer radiotherapy (RT).

MATERIALS AND METHODS: Ninety-nine left breast cancer patients who got adjuvant radiotherapy were included. Study was classified into two groups based on treatment field arrangements: 1) breast tangential fields only (T) and 2) breast tangential and supraclavicular fields (TS). Organs DVHs were extracted. Descriptive statistics, Pearson correlation, linear regression analyses, and receiver operating characteristic (ROC) analyses were performed.

RESULTS: There is a direct but not significant correlation between the gastric volume and doses to the stomach and left lung. For a 100-cc increase in the gastric volume, the stomach maximum dose and the V50 increased by 3 Gy and 4%, respectively. For the left lung, V4 and V5 increased by 1% for TS cases. Considering ROC analysis results, one can make a decision for about 74% of patients due to their left lung DVH parameters, using gastric volume as a known input data. The correlation between gastric volume and heart dose was not significant.

CONCLUSIONS: The gastric volume of about 170 cc or less can result in lower dose to the stomach and ipsilateral lung during left breast cancer radiotherapy, especially for TS cases. To reach this gastric volume threshold, patients should be fast for 2 hours before the procedure of CT simulation and treatment.

Article available in PDF format

View PDF Download PDF file


  1. Farhood B, Geraily G, Alizadeh A. Incidence and Mortality of Various Cancers in Iran and Compare to Other Countries: A Review Article. Iran J Public Health. 2018; 47(3): 309–316.
  2. Joiner M, Van der Kogel A. Basic Clinical Radiobiology. 5th ed. Taylor & Francis Group, New York 2019.
  3. Zhang Q, Liu J, Ao N, et al. Secondary cancer risk after radiation therapy for breast cancer with different radiotherapy techniques. Sci Rep. 2020; 10(1): 1220.
  4. Rastogi K, Sharma S, Gupta S, et al. Dosimetric comparison of IMRT versus 3DCRT for post-mastectomy chest wall irradiation. Radiat Oncol J. 2018; 36(1): 71–78.
  5. Nafissi N, Khayamzadeh M, Zeinali Z, et al. Epidemiology and Histopathology of Breast Cancer in Iran versus Other Middle Eastern Countries. Mid East J Cancer. 2018; 9(3): 243–251.
  6. Smith BD, Bellon JR, Blitzblau R, et al. Radiation therapy for the whole breast: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol. 2018; 8(3): 145–152.
  7. Abo-Madyan Y, Aziz MH, Aly MM, et al. Second cancer risk after 3D-CRT, IMRT and VMAT for breast cancer. Radiother Oncol. 2014; 110(3): 471–476.
  8. Cho WK, Choi DHo, Park W, et al. Gastric Complications after Adjuvant Radiotherapy for Breast Cancer. J Breast Cancer. 2019; 22(3): 464–471.
  9. Beaton L, Bergman A, Nichol A, et al. Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines. Clin Transl Radiat Oncol. 2019; 19: 39–45.
  10. Lee D, Dinniwell R, Lee G. A Retrospective Analysis of Lung Volume and Cardiac Dose in Left-Sided Whole Breast Radiotherapy. J Med Imaging Radiat Sci. 2016; 47(3S): S10–S14.
  11. Omarini C, Thanopoulou E, Johnston SRD. Pneumonitis and pulmonary fibrosis associated with breast cancer treatments. Breast Cancer Res Treat. 2014; 146(2): 245–258.
  12. Aznar MC, Duane FK, Darby SC, et al. Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010-2015. Radiother Oncol. 2018; 126(1): 148–154.
  13. Piroth MD, Baumann R, Budach W, et al. Heart toxicity from breast cancer radiotherapy : Current findings, assessment, and prevention. Strahlenther Onkol. 2019; 195(1): 1–12.
  14. Duane FK, McGale P, Brønnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013; 368(11): 987–998.
  15. van den Bogaard VAB, Ta BDP, van der Schaaf A, et al. Validation and Modification of a Prediction Model for Acute Cardiac Events in Patients With Breast Cancer Treated With Radiotherapy Based on Three-Dimensional Dose Distributions to Cardiac Substructures. J Clin Oncol. 2017; 35(11): 1171–1178.
  16. Breast cancer. National Comprehensive Cancer Network (NCCN Guidelines®); 2020. . https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf (April 2020).
  17. Halperin EC, Wazer DE, Perez CA, Brady LW. Perez & Brady's Principles and Practice of Radiation Oncology. 7th ed. Wolters Kluwer, New York 2019.
  18. Breast Cancer Atlas for Radiation Therapy Planning: Consensus Definitions. RTOG Foundations INC. https://www.srobf.cz/downloads/cilove-objemy/breastcanceratlas.pdf (Jan 2018).
  19. RTOG 1106: Atlases for Organs at Risk (OARs) in Thoracic Radiation Therapy. RTOG FoundationINC. https://www.rtog.org/LinkClick.aspx?fileticket=VyMTDbz25wY%3d&tabid=361 (March 2020).
  20. Upper Abdominal Normal Organ Contouring Guidelines RTOG FOUNDATION INC; 2013. https://www.rtog.org/LinkClick.aspx?fileticket=dgwtfz553_g%3d&tabid=387 (March 2020).
  21. Cefaro GA, Genovesi D, Perez CA. Delineating Organs at Risk in Radiation Therapy. Springer, London 2013: 33–34.
  22. A Phase III Trial Of Accelerated Whole Breast Irradiation With Hypofractionation Plus Concurrent Boost Versus Standard Whole Breast Irradiation Plus Sequential Boost For Early-Stage Breast Cancer NRG Oncology 2014. https://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?action=openFile&FileID=9366 (March 2020).
  23. A Randomized Phase III Clinical Trial Evaluating Post-Mastectomy Chestwall and Regional Nodal XRT and Post-Lumpectomy Regional Nodal XRT in Patients with Positive Axillary Nodes Before Neoadjuvant Chemotherapy Who Convert to Pathologically Negative Axillary Nodes After Neoadjuvant Chemotherapy. NRG ONCOLOGY; 2016. https://www.nrgoncology.org/Clinical-Trials/Protocol/nsabp-b-51-rtog-1304?filter=nsabp-b-51-rtog-1304 (March 2020).
  24. 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.
  25. Marks LB, Bentzen SM, Deasy JO, et al. Radiation dose-volume effects in the lung. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl): S70–S76.
  26. Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991; 21(1): 109–122.
  27. Hajian-Tilaki K. Receiver Operating Characteristic (ROC) Curve Analysis for Medical Diagnostic Test Evaluation. Caspian J Intern Med. 2013; 4(2): 627–635.
  28. Zhang S, Yu YH, Zhang Y, et al. Radiotherapy in muscle-invasive bladder cancer: the latest research progress and clinical application. Am J Cancer Res. 2015; 5(2): 854–868.
  29. Finazzi T, Nguyen VT, Zimmermann F, et al. Impact of patient and treatment characteristics on heart and lung dose in adjuvant radiotherapy for left-sided breast cancer. Radiat Oncol. 2019; 14(1): 153.
  30. Brick IB. Effects of million volt irradiation on the gastrointestinal tract. AMA Arch Intern Med. 1955; 96(1): 26–31.
  31. Zhao H, He M, Cheng G, et al. A comparative dosimetric study of left sided breast cancer after breast-conserving surgery treated with VMAT and IMRT. Radiat Oncol. 2015; 10: 231.
  32. Dracham CB, Shankar A, Madan R. Radiation induced secondary malignancies: a review article. Radiat Oncol J. 2018; 36(2): 85–94.
  33. Taylor C, Correa C, Duane FK, et al. Early Breast Cancer Trialists’ Collaborative Group. Estimating the Risks of Breast Cancer Radiotherapy: Evidence From Modern Radiation Doses to the Lungs and Heart and From Previous Randomized Trials. J Clin Oncol. 2017; 35(15): 1641–1649.
  34. Hunt JN, Spurrell WR. The pattern of emptying of the human stomach. J Physiol. 1951; 113(2-3): 157–168.
  35. Tuglu O, Gultekin M, Ozyigit G, et al. Effect of Gastric Filling on Radiation Therapy in Patients with Gastrointesinal Cancer. Int J Radiat Oncol Biol Phys. 2018; 102(3): e492.