Is mean heart dose a relevant surrogate parameter of left ventricle and coronary arteries exposure during breast cancer radiotherapy: a dosimetric evaluation based on individually-determined radiation dose (BACCARAT study)

Autor: Jacob, Sophie, Camilleri, Jérémy, Derreumaux, Sylvie, Walker, Valentin, Lairez, Olivier, Lapeyre, Mathieu, Bruguière, Eric, Pathak, Atul, Bernier, Marie-Odile, Laurier, Dominique, Ferrieres, Jean, Gallocher, Olivier, Latorzeff, Igor, Pinel, Baptiste, Franck, Denis, Chevelle, Christian, Jimenez, Gaëlle, Broggio, David
Přispěvatelé: PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Clinique Pasteur [Toulouse], PSE-SANTE/SER/UEM, CHU Rangueil, PSE-SANTE/SESANE, Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, PSE-SANTE/SDOS/LEDI, H2020 Euratom, EURATOM 755523Fédération Française de Cardiologie, FFC, ATHENA, Irsn, Laboratoire d épidémiologie des rayonnements ionisants (IRSN/PSE-SANTE/SESANE/LEPID), Service de recherche sur les effets biologiques et Sanitaires des rayonnements ionisants (IRSN/PSE-SANTE/SESANE), Institut de Radioprotection et de Sûreté Nucléaire (IRSN)-Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Unité d'expertise en radioprotection médicale (IRSN/PSE-SANTE/SER/UEM), Service d'études et d'expertise en radioprotection (IRSN/PSE-SANTE/SER), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'évaluation de la dose interne (IRSN/PSE-SANTE/SDOS/LEDI), Service de dosimétrie (IRSN/PSE-SANTE/SDOS)
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Radiation Oncology (London, England)
Radiation Oncology
Radiation Oncology, BioMed Central, 2019, 14 (1), pp.29. ⟨10.1186/s13014-019-1234-z⟩
Radiation Oncology, Vol 14, Iss 1, Pp 1-10 (2019)
Radiation Oncology, 2019, 14 (1), pp.29. ⟨10.1186/s13014-019-1234-z⟩
ISSN: 1748-717X
DOI: 10.1186/s13014-019-1234-z⟩
Popis: International audience; Background Intra-individual heterogeneity of cardiac exposure is an issue in breast cancer (BC) radiotherapy that was poorly considered in previous cardiotoxicity studies mainly based on mean heart dose (MHD). This dosimetric study analyzes the distribution of individually-determined radiation doses to the heart and its substructures including coronary arteries and evaluate whether MHD is a relevant surrogate parameter of dose for these substructures. Methods Data were collected from the BACCARAT prospective study that included left or right unilateral BC patients treated with 3D-Conformal Radiotherapy (RT) between 2015 and 2017 and followed-up for 2 years with repeated cardiac imaging examinations. A coronary computed tomography angiography (CCTA) was performed before RT for all patients. Registration of the planning CT and CCTA images allowed delineation of the coronary arteries on the planning CT images. Using the 3D dose matrix generated during treatment planning and the added coronary contours, dose distributions were generated for whole heart and the following substructures left ventricle (LV), left main coronary artery (LMCA), left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA). A descriptive analysis of the physical doses in Gray (Gy) was performed, Dmean was the volume-weighted mean dose. Results Dose distributions were generated for 89 left-sided BC patients (MHD = 2.9 ± 1.5 Gy, Dmean-LAD = 15.7 ± 3.1 Gy) and 15 right-sided BC patients (MHD = 0.5 ± 0.1 Gy; Dmean-RCA = 1.2 ± 0.4 Gy). For left-sided BC patients, the ratio Dmean-LAD/MHD was around 5. Pearson correlation coefficients between MHD and Dmean for delineated substructures were all statistically significant. However, for all substructures, the coefficient of determination R 2 indicated that the proportion of the variance in Dmean of the substructure predictable from MHD was moderate to low (in particular R 2 = 0.45 for LAD). Among left-sided BC patients with MHD andlt; 3Gy, 56% of patients could nevertheless receive LAD doses above 40Gy (V40 andgt; 0). Conclusion Our study illustrates that MHD is not enough to predict with confidence individual patient dose to the LV and coronary arteries, in particular the LAD. For precise radiotherapy-induced cardiotoxicity studies it would be necessary to consider the distribution of doses within these cardiac substructures rather than just the MHD. Trial registration ClinicalTrials.gov NCT02605512, Registered 6 November 2015 - Retrospectively registered. © 2019 The Author(s).
Databáze: OpenAIRE
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