Dose-response relationships for radiation-related heart disease: Impact of uncertainties in cardiac dose reconstruction.

Autor: Ntentas G; Nuffield Department of Population Health, University of Oxford, Oxford, UK; Guy's and St Thomas' NHS Foundation Trust, Department of Medical Physics, London, UK. Electronic address: georgios.ntentas@ndph.ox.ac.uk., Darby SC; Nuffield Department of Population Health, University of Oxford, Oxford, UK., Aznar MC; Nuffield Department of Population Health, University of Oxford, Oxford, UK; Manchester Cancer Research Centre, University of Manchester, UK., Hodgson DC; Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada., Howell RM; Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, USA., Maraldo MV; Department of Clinical Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen University Hospital, Denmark., Ahmed S; Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada., Ng A; Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada., Aleman BMP; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Cutter DJ; Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2020 Dec; Vol. 153, pp. 155-162. Date of Electronic Publication: 2020 Sep 03.
DOI: 10.1016/j.radonc.2020.08.022
Abstrakt: Background and Purpose: Radiation-related heart disease (RRHD) can occur many decades after thoracic radiotherapy for Hodgkin lymphoma (HL) or childhood cancer (CC). To quantify the likely risk of RRHD for patients treated today, dose-response relationships derived from patients treated in previous decades are used. Publications presenting these dose-response relationships usually include estimates of uncertainties in the risks but ignore the effect of uncertainties in the reconstructed cardiac doses.
Materials/methods: We assessed the systematic and random uncertainties in the reconstructed doses for published dose-response relationships for RRHD risk in survivors of HL or CC. Using the same reconstruction methods as were used in the original publications, we reconstructed mean heart doses and, wherever possible, mean left-ventricular doses for an independent case-series of test patients. These patients had known, CT-based, cardiac doses which were compared with the reconstructed doses to estimate the magnitude of the uncertainties and their effect on the dose-response relationships.
Results: For all five reconstruction methods the relationship between reconstructed and CT-based doses was linear. For all but the simplest reconstruction method, the dose uncertainties were moderate, the effect of the systematic uncertainty on the dose-response relationships was less than 10%, and the effects of random uncertainty were small except at the highest doses.
Conclusions: These results increase confidence in the published dose-response relationships for the risk of RRHD in HL and CC survivors. This may encourage doctors to use these dose-response relationships when estimating individualised risks for patients-an important aspect of personalising radiotherapy treatments today.
(Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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