Eber Jordan, Schmitt Martin, Dehaynin Nicolas, Le Fèvre Clara, Antoni Delphine, Noël Georges
Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France.
Centre Paul Strauss, Strasbourg University, CNRS, IPHC UMR 7178, UNICANCER, 67000 Strasbourg, France.
Cancers (Basel). 2023 Jun 29;15(13):3406. doi: 10.3390/cancers15133406.
Left-sided breast cancer radiotherapy can lead to late cardiovascular complications, including ischemic events. To mitigate these risks, cardiac-sparing techniques such as deep-inspiration breath-hold (DIBH) and intensity-modulated radiotherapy (IMRT) have been developed. However, recent studies have shown that mean heart dose is not a sufficient dosimetric parameter for assessing cardiac exposure. In this study, we aimed to compare the radiation exposure to cardiac substructures for ten patients who underwent hypofractionated radiotherapy using DIBH three-dimensional conformal radiation therapy (3DCRT), free-breathing (FB)-3DCRT, and FB helical tomotherapy (HT). Dosimetric parameters of cardiac substructures were analyzed, and the results were statistically compared using the Wilcoxon signed-rank test. This study found a significant reduction in the dose to the heart, left anterior descending coronary artery, and ventricles with DIBH-3DCRT and FB-HT compared to FB-3DCRT. While DIBH-3DCRT was very effective in sparing the heart, in some cases, it provided little or no cardiac sparing. FB-HT can be an interesting treatment modality to reduce the dose to major coronary vessels and ventricles and may be of interest for patients with cardiovascular risks who do not benefit from or cannot perform DIBH. These findings highlight the importance of cardiac-sparing techniques for precise delivery of radiation therapy.
左侧乳腺癌放疗可导致包括缺血性事件在内的晚期心血管并发症。为降低这些风险，已开发出诸如深吸气屏气（DIBH）和调强放疗（IMRT）等心脏保护技术。然而，最近的研究表明，平均心脏剂量并非评估心脏受照情况的充分剂量学参数。在本研究中，我们旨在比较10例接受大分割放疗的患者，分别采用DIBH三维适形放疗（3DCRT）、自由呼吸（FB）-3DCRT和FB螺旋断层放疗（HT）时心脏亚结构的辐射暴露情况。分析了心脏亚结构的剂量学参数，并使用Wilcoxon符号秩检验对结果进行统计学比较。本研究发现，与FB-3DCRT相比，DIBH-3DCRT和FB-HT可显著降低心脏、左前降支冠状动脉和心室的剂量。虽然DIBH-3DCRT在保护心脏方面非常有效，但在某些情况下，它提供的心脏保护很少或没有。FB-HT可能是一种有趣的治疗方式，可降低主要冠状动脉和心室的剂量，对于那些无法从DIBH中获益或无法进行DIBH的有心血管风险的患者可能具有吸引力。这些发现凸显了心脏保护技术对于精确放疗的重要性。
