Heart toxicity from breast cancer radiotherapy

Springer Science and Business Media LLC - Tập 195 Số 1 - Trang 1-12 - 2019
Marc D. Piroth1, René Baumann2, Wilfried Budach3, Jürgen Dunst4, Petra Feyer5, Rainer Fietkau6, Wulf Haase7, Wolfgang Harms8, Thomas Hehr9, David Krug10, A. Röser1, Felix Sedlmayer11, Rainer Souchon12, Frederik Wenz13, Rolf Sauer6
1Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstraße 40, 42283, Wuppertal, Germany
2St. Marien-Krankenhaus Siegen, Siegen, Germany
3Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany
4University Hospital Schleswig-Holstein, Kiel, Germany
5Vivantes Hospital Neukoelln, Berlin, Germany
6University Hospital Erlangen, Erlangen, Germany
7formerly St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
8St. Claraspital Basel, Basel, Switzerland
9Marienhospital Stuttgart, Stuttgart, Germany
10University Hospital Heidelberg, Heidelberg, Germany
11Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
12formerly University Hospital, Tübingen, Germany
13University Hospital Mannheim, Medical Faculty, Heidelberg University, Mannheim, Germany

Tóm tắt

Abstract Background Late cardiac toxicities caused by (particularly left-sided) breast radiotherapy (RT) are now recognized as rare but relevant sequelae, which has prompted research on risk structure identification and definition of threshold doses to heart subvolumes. The aim of the present review was to critically discuss the clinical evidence on late cardiac reactions based on dose-dependent outcome reports for mean heart doses as well as doses to cardiac substructures. Methods A literature review was performed to examine clinical evidence on radiation-induced heart toxicities. Mean heart doses and doses to cardiac substructures were focused upon based on dose-dependent outcome reports. Furthermore, an overview of radiation techniques for heart protection is given and non-radiotherapeutic aspects of cardiotoxicity in the multimodal setting of breast cancer treatment are discussed. Results Based on available findings, the DEGRO breast cancer expert panel recommends the following constraints: mean heart dose <2.5 Gy; DmeanLV (mean dose left ventricle) < 3 Gy; V5LV (volume of LV receiving ≥5 Gy) < 17%; V23LV (volume of LV receiving ≥23 Gy) < 5%; DmeanLAD (mean dose left descending artery) < 10 Gy; V30LAD (volume of LAD receiving ≥30 Gy) < 2%; V40LAD (volume of LAD receiving ≥40 Gy) < 1%. Conclusion In addition to mean heart dose, breast cancer RT treatment planning should also include constraints for cardiac subvolumes such as LV and LAD. The given constraints serve as a clinicians’ aid for ensuring adequate heart protection. The individual decision between sufficient protection of cardiac structures versus optimal target volume coverage remains in the physician’s hand. The risk of breast cancer-specific mortality and a patient’s cardiac risk factors must be individually weighed up against the risk of radiation-induced cardiotoxicity.

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Tài liệu tham khảo

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