Limits...
Whole breast proton irradiation for maximal reduction of heart dose in breast cancer patients.

Mast ME, Vredeveld EJ, Credoe HM, van Egmond J, Heijenbrok MW, Hug EB, Kalk P, van Kempen-Harteveld LM, Korevaar EW, van der Laan HP, Langendijk JA, Rozema HJ, Petoukhova AL, Schippers JM, Struikmans H, Maduro JH - Breast Cancer Res. Treat. (2014)

Bottom Line: As compared to IMRT, IMPT resulted in significant dose reductions to the heart and LAD-region even without breath-hold.In the majority of the IMPT cases, a reduction to almost zero to the heart and LAD-region was obtained.With IMPT the dose to the heart and LAD-region could be significantly decreased compared to tangential IMRT with breath-hold.

View Article: PubMed Central - PubMed

Affiliation: Radiotherapy Centre West, Lijnbaan 32, 2501 CK, The Hague, The Netherlands, m.mast@mchaaglanden.nl.

ABSTRACT

Purpose: In left-sided breast cancer radiotherapy, tangential intensity modulated radiotherapy combined with breath-hold enables a dose reduction to the heart and left anterior descending (LAD) coronary artery. Aim of this study was to investigate the added value of intensity modulated proton therapy (IMPT) with regard to decreasing the radiation dose to these structures.

Methods: In this comparative planning study, four treatment plans were generated in 20 patients: an IMPT plan and a tangential IMRT plan, both with breath-hold and free-breathing. At least 97 % of the target volume had to be covered by at least 95 % of the prescribed dose in all cases. Specifically with respect to the heart, the LAD, and the target volumes, we analyzed the maximum doses, the mean doses, and the volumes receiving 5-30 Gy.

Results: As compared to IMRT, IMPT resulted in significant dose reductions to the heart and LAD-region even without breath-hold. In the majority of the IMPT cases, a reduction to almost zero to the heart and LAD-region was obtained. IMPT treatment plans yielded the lowest dose to the lungs.

Conclusions: With IMPT the dose to the heart and LAD-region could be significantly decreased compared to tangential IMRT with breath-hold. The clinical relevance should be assessed individually based on the baseline risk of cardiac complications in combination with the dose to organs at risk. However, as IMPT for breast cancer is currently not widely available, IMPT should be reserved for patients remaining at high risk for major coronary events.

Show MeSH

Related in: MedlinePlus

Left Mean dose administered to the heart. Right Mean dose administered to the LAD-region; both with intensity modulated radiotherapy (IMRT) and intensity modulated proton therapy (IMPT) in breath-hold (BH) and free-breathing (FB). The cases were rearranged using the increasing (from left to right) IMRT FB technique values
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4196139&req=5

Fig2: Left Mean dose administered to the heart. Right Mean dose administered to the LAD-region; both with intensity modulated radiotherapy (IMRT) and intensity modulated proton therapy (IMPT) in breath-hold (BH) and free-breathing (FB). The cases were rearranged using the increasing (from left to right) IMRT FB technique values

Mentions: An additional reduction of the various dose parameters could be obtained with IMPT as well as with breath-hold IMPT. The volume of the heart and LAD-region receiving 20 Gy (V20 Gy) could be reduced to almost zero in all patients (Figs. 1, 2; Table 1).Fig. 2


Whole breast proton irradiation for maximal reduction of heart dose in breast cancer patients.

Mast ME, Vredeveld EJ, Credoe HM, van Egmond J, Heijenbrok MW, Hug EB, Kalk P, van Kempen-Harteveld LM, Korevaar EW, van der Laan HP, Langendijk JA, Rozema HJ, Petoukhova AL, Schippers JM, Struikmans H, Maduro JH - Breast Cancer Res. Treat. (2014)

Left Mean dose administered to the heart. Right Mean dose administered to the LAD-region; both with intensity modulated radiotherapy (IMRT) and intensity modulated proton therapy (IMPT) in breath-hold (BH) and free-breathing (FB). The cases were rearranged using the increasing (from left to right) IMRT FB technique values
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4196139&req=5

Fig2: Left Mean dose administered to the heart. Right Mean dose administered to the LAD-region; both with intensity modulated radiotherapy (IMRT) and intensity modulated proton therapy (IMPT) in breath-hold (BH) and free-breathing (FB). The cases were rearranged using the increasing (from left to right) IMRT FB technique values
Mentions: An additional reduction of the various dose parameters could be obtained with IMPT as well as with breath-hold IMPT. The volume of the heart and LAD-region receiving 20 Gy (V20 Gy) could be reduced to almost zero in all patients (Figs. 1, 2; Table 1).Fig. 2

Bottom Line: As compared to IMRT, IMPT resulted in significant dose reductions to the heart and LAD-region even without breath-hold.In the majority of the IMPT cases, a reduction to almost zero to the heart and LAD-region was obtained.With IMPT the dose to the heart and LAD-region could be significantly decreased compared to tangential IMRT with breath-hold.

View Article: PubMed Central - PubMed

Affiliation: Radiotherapy Centre West, Lijnbaan 32, 2501 CK, The Hague, The Netherlands, m.mast@mchaaglanden.nl.

ABSTRACT

Purpose: In left-sided breast cancer radiotherapy, tangential intensity modulated radiotherapy combined with breath-hold enables a dose reduction to the heart and left anterior descending (LAD) coronary artery. Aim of this study was to investigate the added value of intensity modulated proton therapy (IMPT) with regard to decreasing the radiation dose to these structures.

Methods: In this comparative planning study, four treatment plans were generated in 20 patients: an IMPT plan and a tangential IMRT plan, both with breath-hold and free-breathing. At least 97 % of the target volume had to be covered by at least 95 % of the prescribed dose in all cases. Specifically with respect to the heart, the LAD, and the target volumes, we analyzed the maximum doses, the mean doses, and the volumes receiving 5-30 Gy.

Results: As compared to IMRT, IMPT resulted in significant dose reductions to the heart and LAD-region even without breath-hold. In the majority of the IMPT cases, a reduction to almost zero to the heart and LAD-region was obtained. IMPT treatment plans yielded the lowest dose to the lungs.

Conclusions: With IMPT the dose to the heart and LAD-region could be significantly decreased compared to tangential IMRT with breath-hold. The clinical relevance should be assessed individually based on the baseline risk of cardiac complications in combination with the dose to organs at risk. However, as IMPT for breast cancer is currently not widely available, IMPT should be reserved for patients remaining at high risk for major coronary events.

Show MeSH
Related in: MedlinePlus