Risk of Heart Disease in Left-Sided Breast Cancer Radiotherapy: With Considering Baseline Risk of Heart Diseases

Document Type : Original Paper

Authors

1 Department of Radiology, Faculty of Paramedical school, Kurdistan university of medical sciences

2 Radiation therapy division, Ayatollah Khansari Hospital, Arak University of Medical Sciences, Arak, Iran

Abstract

Introduction: After lumpectomy, radiation therapy is used to control the tumor and increase patient survival. Following radiation therapy, the organs at risk are vulnerable to toxicity and secondary cancer.
Material and Methods: Thirty-two patients with early-stage of left breast cancer were selected for this study. Intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT) were planned to deliver the prescribed dose to the target volume. Considering baseline risk of heart disease, the excess absolute risk (EAR) of heart disease was calculated using the Reynolds risk score for ages 50-70.
Results: There was a significant difference in 10-year EAR of heart disease when comparing 3DCRT plans to IMRT (p <0.05). The 10-year EAR for IMRT in the low, median, and high-risk groups was superior to 3DCRT.  Among factors involved in baseline risk, by increasing the age, the impact of smoking on increasing EAR was clearer compared to a family history of heart disease. 
Conclusion: IMRT had a more uniform dose distribution and a better conformity-homogeneity index than 3DCRT. However, the mean heart dose and subsequently the risk of heart disease significantly were lower in 3DCRT. Considering baseline risk leads to accurate estimates of the heart disease risk after breast cancer radiotherapy.

Keywords

Main Subjects

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA: A Cancer Journal for Clinicians. 2020;70(1):7-30.
  2. Corradini S, Niyazi M, Niemoeller OM, Li M, Roeder F, Eckel R, et al. Adjuvant radiotherapy after breast conserving surgery–a comparative effectiveness research study. Radiotherapy and Oncology. 2015;114(1):28-34.
  3. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. New England Journal of Medicine. 2002;347(16):1227-32.
  4. Jin G-H, Chen L-X, Deng X-W, Liu X-W, Huang Y, Huang X-B. A comparative dosimetric study for treating left-sided breast cancer for small breast size using five different radiotherapy techniques: conventional tangential field, filed-in-filed, tangential-IMRT, multi-beam IMRT and VMAT. Radiation oncology. 2013;8(1):89.
  5. Yim J, Suttie C, Bromley R, Morgia M, Lamoury G. Intensity modulated radiotherapy and 3D conformal radiotherapy for whole breast irradiation: a comparative dosimetric study and introduction of a novel qualitative index for plan evaluation, the normal tissue index. Journal of medical radiation sciences. 2015;62(3):184-91.
  6. Hall EJ. Intensity-modulated radiation therapy, protons, and the risk of second cancers. International Journal of Radiation Oncology* Biology* Physics. 2006;65(1):1-7.
  7. Paganetti H. Assessment of the risk for developing a second malignancy from scattered and secondary radiation in radiation therapy. Health physics. 2012;103(5):652.
  8. Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Brønnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. New England Journal of Medicine. 2013;368(11):987-9.
  9. Abe O, Abe R, Enomoto K, Kikuchi K, Koyama H, Masuda H, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005 Dec 17;366(9503):2087-106.
  10. Jacob S, Pathak A, Franck D, Latorzeff I, Jimenez G, Fondard O, et al. Early detection and prediction of cardiotoxicity after radiation therapy for breast cancer: the BACCARAT prospective cohort study. Radiation Oncology. 2016;11(1): 54.
  11. Correa CR, Litt HI, Hwang W-T, Ferrari VA, Solin LJ, Harris EE. Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. Journal of clinical oncology. 2007;25(21):3031-7.
  12. Boda-Heggemann J, Knopf A-C, Simeonova-Chergou A, Wertz H, Stieler F, Jahnke A, et al. Deep inspiration breath hold—based radiation therapy: a clinical review. International Journal of Radiation Oncology* Biology* Physics. 2016;94(3):478-92.
  13. Abo-Madyan Y, Aziz MH, Aly MM, Schneider F, Sperk E, Clausen S, et al. Second cancer risk after 3D-CRT, IMRT and VMAT for breast cancer. Radiotherapy and Oncology. 2014;110(3):471-6.
  14. Corradini S, Ballhausen H, Weingandt H, Freislederer P, Schönecker S, Niyazi M, et al. Left-sided breast cancer and risks of secondary lung cancer and ischemic heart disease. Strahlentherapie und Onkologie. 2018;194(3):196-205.
  15. Sakthivel V, Mani GK, Mani S, Boopathy R, Selvaraj J. Estimating second malignancy risk in intensity-modulated radiotherapy and volumetric-modulated arc therapy using a mechanistic radiobiological model in radiotherapy for carcinoma of left breast. Journal of medical physics. 2017;42(4):234.
  16. Radiation Therapy Oncology Group. Ref Type: Electronic Citation. 2017. Available from: https://www.rtog.org/clinicaltrials/protocoltable/studydetails.aspx?study=1005/.
  17. Brenner DJ, Shuryak I, Jozsef G, DeWyngaert KJ, Formenti SC. Risk and risk reduction of major coronary events associated with contemporary breast radiotherapy. JAMA internal medicine. 2014;174(1):158-60.
  18. Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. Jama. 2007;297(6):611-9.
  19. Schneider U, Sumila M, Robotka J. Site-specific dose-response relationships for cancer induction from the combined Japanese A-bomb and Hodgkin cohorts for doses relevant to radiotherapy. Theoretical Biology and Medical Modelling. 2011;8(1):27.
  20. Emami B. Tolerance of normal tissue to therapeutic radiation. Reports of radiotherapy and Oncology. 2013;1(1).
  21. Kausar M, Gurjar OP, Bagdare P, Gupta KL, Bhandari V, Naik A, et al. Dosimetric analysis of intensity-modulated radiotherapy and three-dimensional conformal radiotherapy for chest wall irradiation in breast cancer patients. Journal of Radiotherapy in Practice. 2016;15(1):30-7.
  22. Kivanc H, Gultekin M, Gurkaynak M, Ozyigit G, Yildiz F. DKivanc H, Gultekin M, Gurkaynak M, Ozyigit G, Yildiz F. Dosimetric comparison of three‐dimensional conformal radiotherapy and intensity‐modulated radiotherapy for left‐sided chest wall and lymphatic irradiation. Journal of applied clinical medical physics. 2019;20(12):36-44.
  23. Haciislamoglu E, Colak F, Canyilmaz E, Dirican B, Gurdalli S, Yilmaz AH, et al. Dosimetric comparison of left-sided whole-breast irradiation with 3DCRT, forward-planned IMRT, inverse-planned IMRT, helical tomotherapy, and volumetric arc therapy. Physica medica. 2015;31(4):360-7.
  24. Morsy MA, Attalla EM, Attia WM. A Comparative Study of 3-D Conformal Radiotherapy Treatment Plans with and Without Deep Inspiration Breath-Hold Technique for Left-Sided Breast Cancer. Iranian Journal of Medical Physics. 2020; 17: 90-8.
  25. De Rose F, Cozzi L, Meattini I, Fogliata A, Franceschini D, Franzese C, et al. The Potential Role of Intensity-modulated Proton Therapy in the Regional Nodal Irradiation of Breast Cancer: A Treatment Planning Study. Clinical Oncology. 2020;32(1):26-34.
  26. Dobler B, Maier J, Knott B, Maerz M, Loeschel R, Koelbl O. Second cancer risk after simultaneous integrated boost radiation therapy of right sided breast cancer with and without flattening filter. Strahlentherapie und Onkologie. 2016;192(10):687-95.
  27. Feng Z, Hao W, Tie J, Cheng J, Sun Q. Radiotherapy-induced secondary primary cancer risks for early breast cancer: flattening filter versus flattening filter free IMRT radiotherapy. Chinese Journal of Radiological Medicine and Protection. 2018;38(3):210-4.
  28. Chao P-J, Lee H-F, Lan J-H, Guo S-S, Ting H-M, Huang Y-J, et al. Propensity-score-matched evaluation of the incidence of radiation pneumonitis and secondary cancer risk for breast cancer patients treated with IMRT/VMAT. Scientific reports. 2017;7(1):1-9.
  29. Haciislamoglu E, Cinar Y, Gurcan F, Canyilmaz E, Gungor G, Yoney A. Secondary cancer risk after whole-breast radiation therapy: field-in-field versus intensity modulated radiation therapy versus volumetric modulated arc therapy. The British journal of radiology. 2019;92(1102):20190317.
  30. Nedaie HA, Mahmoudi S, Kavousi N, Hassani M, Esfahani M. Assessment of Radiation-Induced Secondary Cancer Risks In Breast Cancer Patients Treated with 3D Conformal Radiotherapy. Iranian Journal of Medical Physics. 2020.
  31. Ghaznavi H. Comment on Long-term risks of secondary cancer for various whole and partial breast irradiation techniques. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology. 2019, 1;141:331.

 

 

 

 

 

 

Iranian Journal of Medical Physics
Volume 19, Issue 5
September and October 2022
Pages 275-281

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History

  • Receive Date: 11 April 2021
  • Revise Date: 13 October 2021
  • Accept Date: 03 November 2021

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