Desai Nina, Currey Adam, Kelly Tracy, Bergom Carmen
Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, Wisconsin.
Adv Radiat Oncol. 2019 Jan 30;4(2):246-252. doi: 10.1016/j.adro.2019.01.001. eCollection 2019 Apr-Jun.
Radiation dose to the heart correlates with cardiac-related deaths and may partially diminish the benefit of radiation for breast cancer. This study assessed the current nationwide trends in heart-sparing techniques for breast cancer radiation.
In November 2017, an institutional review board-approved survey was sent to radiation oncologists in the United States. Questions assessed demographics and the type and frequency of heart-sparing techniques. Data were analyzed using descriptive statistics and χ tests.
In total, 530 responses (13%) were obtained. Most physicians had practiced >15 years (46%), with most in a private setting (59%). Eighty-three percent of physicians offered prone positioning and/or deep inspiration breath hold (DIBH). This was more common in academic practice ( < .01). Seventy-three percent of physicians used heart-sparing techniques for more than three-fourths of left-sided patients. The most commonly used technique was DIBH, and 43% of physicians used the technique more than three-fourths of the time. Commonly used DIBH systems were Varian RPM (54%) and Vision RT/Align RT (31%). No increase in DIBH use was observed with regional nodal irradiation, and coverage of internal mammary chain nodes varied. Patient tolerance (78%) and cardiac-to-chest wall distance (72%) were the most common determinants of DIBH in left-sided patients. Twenty-three percent of physicians used DIBH for right-sided patients, with lung (64%) and heart sparing (46%) as the most common reasons for use. Lack of facilities was the most common reason not to use DIBH (61%).
Most respondents offer heart-sparing techniques for breast cancer radiation; this is more common in academic centers. DIBH is the most common technique across all practice settings. DIBH is much less commonly used in right-sided patients but is still used by >20% of practitioners, with lung and heart sparing cited as reasons for use. More data are needed to determine if and when this technique should be used in right-sided cases.
心脏所接受的辐射剂量与心脏相关死亡有关，可能会部分削弱乳腺癌放疗的益处。本研究评估了目前全国范围内乳腺癌放疗中保护心脏技术的应用趋势。
2017年11月，一项经机构审查委员会批准的调查被发送给美国的放射肿瘤学家。问题涉及人口统计学以及保护心脏技术的类型和使用频率。使用描述性统计和χ检验对数据进行分析。
共获得530份回复（回复率为13%）。大多数医生从业超过15年（46%），大多数在私人诊所工作（59%）。83%的医生提供俯卧位和/或深吸气屏气（DIBH）技术。这在学术机构中更为常见（P<0.01）。73%的医生对超过四分之三的左侧患者使用保护心脏技术。最常用的技术是DIBH，43%的医生超过四分之三的时间使用该技术。常用的DIBH系统是Varian RPM（54%）和Vision RT/Align RT（31%）。区域淋巴结照射时未观察到DIBH使用的增加，内乳链淋巴结的覆盖情况各不相同。患者耐受性（78%）和心脏至胸壁距离（72%）是左侧患者使用DIBH最常见的决定因素。23%的医生对右侧患者使用DIBH，最常见的使用原因是保护肺部（64%）和保护心脏（46%）。缺乏设备是不使用DIBH最常见的原因（61%）。
大多数受访者提供乳腺癌放疗的保护心脏技术；这在学术中心更为常见。DIBH是所有医疗机构中最常用的技术。DIBH在右侧患者中的使用要少得多，但仍有超过20%的从业者使用，保护肺部和心脏被列为使用原因。需要更多数据来确定在右侧病例中是否以及何时应使用该技术。
