Preventing Cardiotoxicity in Personalized Breast Irradiation

• Published in: Cancers Vol. 15; no. 21; p. 5153
• Main Authors: Ippolito, Edy, Greco, Carlo, Marrocco, Maristella, Rinaldi, Carla Germana, Fiore, Michele, Trodella, Luca Eolo, D’Angelillo, Rolando Maria, Ramella, Sara
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 01.11.2023
• Subjects: Adjuvant treatment; Breast cancer; Cancer; Cancer therapies; Cardiotoxicity; Cardiovascular disease; Coronary vessels; Dosimetry; Ethics; Heart; Medical imaging; Mortality; Patients; Planning; Radiation therapy; Radiotherapy; Womens health; Taiwan
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15215153

Background: This study aims to assess the benefit of a deep inspiration breath hold (DIBH) over the standard irradiation technique, and eventually to identify anatomical and/or treatment preplanning characteristics correlated with the LAD dose. Methods: Patients with left-sided breast cancer undergoing whole breast radiotherapy with DIBH were analyzed. All patients included in the analysis had plans in DIBH and free-breathing (FB). Receiving operating characteristics (ROC analysis) were used to identify the cut-off point of parameters to predict the LAD maximum dose > 10 Gy and LAD mean dose > 4 Gy, and the areas under the curve (AUCs) were computed. Post-test probability has been performed to evaluate the effect of parameters’ combination. Results: One hundred ninety-seven patients were analyzed. The LAD dose was significantly reduced in DIBH plans with the maximum and mean dose reduced by 31.7% (mean value 3.5 Gy vs. 4.8 Gy, p ≤ 0.001) and 28.1% (mean value 8.2 Gy vs. 12.8 Gy, p ≤ 0.001) in DIBH plans compared to FB plans. The strongest predictor of the LAD dose (maximum > 10 Gy and mean > 4 Gy) was the minimum distance of LAD from tangent open fields. Other parameters were lung volume and heart volume (LAD Dmax > 10 Gy) and lung volume, heart volume, and breast separation (LAD Dmean > 4 Gy). Conclusion: The dosimetric advantage of DIBH is clear in all patients and DIBH should always be preferred.