CT-planned internal mammary node radiotherapy in the DBCG-IMN study: Benefit versus potentially harmful effects
| Autor: | Marie Overgaard, M.S. Thomsen, Ingelise Jensen, Peter Skogholt, Martin Berg, Lise Bech Jellesmark Thorsen, Birgitte Vrou Offersen, Mirjana Josipovic, Jens Overgaard |
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| Rok vydání: | 2014 |
| Předmět: |
Organs at Risk
medicine.medical_specialty Neoplasm Residual Heart disease Radiography medicine.medical_treatment Population Myocardial Ischemia Breast Neoplasms law.invention Cohort Studies Breast cancer Randomized controlled trial law medicine Humans Radiology Nuclear Medicine and imaging education Lung education.field_of_study Lymphatic Irradiation business.industry Radiotherapy Planning Computer-Assisted Heart Radiotherapy Dosage Hematology General Medicine Middle Aged medicine.disease Surgery Radiation therapy Oncology Number needed to treat Female Lymph Nodes Radiology business Algorithms Numbers Needed To Treat Radiotherapy Image-Guided Cohort study |
| Zdroj: | Thorsen, L B J, Thomsen, M S, Berg, M, Jensen, I, Josipovic, M, Overgaard, M, Overgaard, J, Skogholt, P, Offersen, B V & Danish Breast Cancer Cooperative Group Radiotherapy Committee 2014, ' CT-planned internal mammary node radiotherapy in the DBCG-IMN study: benefit versus potentially harmful effects ', Acta Oncologica, vol. 53, no. 8, pp. 1027-34 . https://doi.org/10.3109/0284186X.2014.925579 Thorsen, L B J, Thomsen, M S, Berg, M, Jensen, I, Josipovic, M, Overgaard, M, Overgaard, J, Skogholt, P, Offersen, B V & Danish Breast Cancer Cooperative Group Radiotherapy committee 2014, ' CT-planned internal mammary node radiotherapy in the DBCG-IMN study : Benefit versus potentially harmful effects ', Acta Oncologica, vol. 53, no. 8, pp. 1027-1034 . https://doi.org/10.3109/0284186X.2014.925579 |
| ISSN: | 1651-226X 0284-186X |
| Popis: | BACKGROUND: The DBCG-IMN is a nationwide population-based cohort study on the effect of internal mammary node radiotherapy (IMN-RT) in patients with node positive early breast cancer. Due to the risk of RT-induced heart disease, only patients with right-sided breast cancer received IMN-RT, whereas patients with left-sided breast cancer did not. At seven-year median follow-up, a 3% gain in overall survival with IMN-RT has been reported. This study estimates IMN doses and doses to organs at risk (OAR) in patients from the DBCG-IMN. Numbers needed to harm (NNH) if patients with left-sided breast cancer had received IMN-RT are compared to the number needed to treat (NNT).MATERIAL AND METHODS: Ten percent of CT-guided treatment plans from the DBCG-IMN patients were selected randomly. IMNs and OAR were contoured in 68 planning CT scans. Dose distributions were re-calculated. IMNs and OAR dose estimates were compared in right-sided versus left-sided breast cancer patients. In six left-sided patients, IMN-RT was simulated, and OAR doses were compared to those in the original plan. The NNH resulting from the change in mean heart dose (MHD) was calculated using a published model for risk of RT-related ischemic heart death.RESULTS: In original plans, the absolute difference between right- and left-sided V90% to the IMNs was 38.0% [95% confidence interval (5.5%; 70.5%), p < 0.05]. Heart doses were higher in left-sided plans. With IMN-RT simulation without regard to OAR constraints, MHD increased 4.8 Gy (0.9 Gy; 8.7 Gy), p < 0.05. Resulting NNHs from ischemic heart death were consistently larger than the NNT with IMN-RT.CONCLUSION: Refraining from IMN-RT on the left side may have spared some ischemic heart deaths. Assuming left-sided patients benefit as much from IMN-RT as right-sided patients, the benefits from IMN-RT outweigh the costs in terms of ischemic heart death. |
| Databáze: | OpenAIRE |
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