在一个大型全州质量联盟中，与局部左侧乳腺癌大分割放疗后心脏辐射剂量降低相关的因素

Factors Associated With Cardiac Radiation Dose Reduction After Hypofractionated Radiation Therapy for Localized, Left-Sided Breast Cancer in a Large Statewide Quality Consortium.

作者信息

Herr Daniel J, Moncion Alexander, Griffith Kent A, Marsh Robin, Grubb Margaret, Bhatt Amit, Dominello Michael, Walker Eleanor M, Narayana Vrinda, Abu-Isa Eyad, Vicini Frank A, Hayman James A, Pierce Lori J

机构信息

Department of Radiation Oncology and.

School of Public Health, University of Michigan, Ann Arbor, Michigan.

出版信息

Int J Radiat Oncol Biol Phys. 2024 Mar 1;118(3):632-638. doi: 10.1016/j.ijrobp.2023.09.013. Epub 2023 Oct 3.

DOI:10.1016/j.ijrobp.2023.09.013

PMID:37797748

Abstract

PURPOSE

Limiting cardiac radiation dose is important for minimizing long-term cardiac toxicity in patients with left-sided early-stage breast cancer.

METHODS AND MATERIALS

Prospectively collected dosimetric data were analyzed for patients undergoing moderately hypofractionated radiation therapy to the left breast within the Michigan Radiation Oncology Quality Consortium from 2016 to 2022. The mean heart dose (MHD) goal was progressively tightened from ≤2 Gy in 2016 to MHD ≤ 1.2 Gy in 2018. In 2021, a planning target volume (PTV) coverage goal was added, and the goal MHD was reduced to ≤1 Gy. Multivariate logistic regression models were developed to assess for covariates associated with meeting the MHD goals in 2016 to 2020 and the combined MHD/PTV coverage goal in 2021 to 2022.

RESULTS

In total, 4165 patients were analyzed with a median age of 64 years. Overall average cardiac metric compliance was 91.7%. Utilization of motion management increased from 41.8% in 2016 to 2020 to 46.5% in 2021 to 2022. Similarly, use of prone positioning increased from 12.2% to 22.2% in these periods. On multivariate analysis in the 2016 to 2020 cohort, treatment with motion management (odds ratio [OR], 5.20; 95% CI, 3.59-7.54; P < .0001) or prone positioning (OR, 3.21; 95% CI, 1.85-5.57; P < .0001) was associated with meeting the MHD goal, while receipt of boost (OR, 0.25; 95% CI, 0.17-0.39; P < .0001) and omission of hormone therapy (OR, 0.65; 95% CI, 0.49-0.88; P = .0047) were associated with not meeting the MHD goal. From 2021 to 2022, treatment with motion management (OR, 1.89; 95% CI, 1.12-3.21; P = .018) or prone positioning (OR, 3.71; 95% CI, 1.73-7.95; P = .0008) was associated with meeting the combined MHD/PTV goal, while larger breast volume (≥1440 cc; OR, 0.34; 95% CI, 0.13-0.91; P = .031) was associated with not meeting the combined goal.

CONCLUSIONS

In our statewide consortium, high rates of compliance with aggressive targets for limiting cardiac dose were achievable without sacrificing target coverage.

摘要

目的

限制心脏辐射剂量对于将左侧早期乳腺癌患者的长期心脏毒性降至最低至关重要。

方法和材料

对2016年至2022年在密歇根放射肿瘤学质量联盟接受左侧乳腺中度低分割放射治疗的患者的前瞻性收集的剂量学数据进行分析。平均心脏剂量（MHD）目标从2016年的≤2 Gy逐步收紧至2018年的MHD≤1.2 Gy。2021年，增加了计划靶体积（PTV）覆盖目标，目标MHD降至≤1 Gy。建立多变量逻辑回归模型，以评估与2016年至2020年达到MHD目标以及2021年至2022年达到MHD/PTV联合覆盖目标相关的协变量。

结果

共分析了4165例患者，中位年龄为64岁。总体平均心脏指标达标率为91.7%。运动管理的使用率从2016年至2020年的41.8%增加到2021年至2022年的46.5%。同样，在这些时期，俯卧位的使用从12.2%增加到22.2%。在2016年至2020年队列的多变量分析中，采用运动管理（优势比[OR]，5.20；95%置信区间，3.59 - 7.54；P <.0001）或俯卧位（OR，3.21；95%置信区间，1.85 - 5.57；P <.0001）与达到MHD目标相关，而接受增量照射（OR，0.25；95%置信区间，0.17 - 0.39；P <.0001）和未进行激素治疗（OR，0.65；95%置信区间，0.49 - 0.88；P =.0047）与未达到MHD目标相关。从2021年到2022年，采用运动管理（OR，1.89；95%置信区间，1.12 - 3.21；P =.018）或俯卧位（OR，3.71；95%置信区间，1.73 - 7.95；P =.0008）与达到MHD/PTV联合目标相关，而较大的乳房体积（≥1440 cc；OR，0.34；95%置信区间，0.13 - 0.91；P =.031）与未达到联合目标相关。