Exposure of the Heart in Breast Cancer Radiation Therapy: A Systematic Review of Heart Doses Published During 2003 to 2013
Purpose Breast cancer radiation therapy cures many women, but where the heart is exposed, it can cause heart disease. We report a systematic review of heart doses from breast cancer radiation therapy that were published during 2003 to 2013. Methods and Materials Eligible studies were those reporting...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2015-11, Vol.93 (4), p.845-853 |
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| container_title | International journal of radiation oncology, biology, physics |
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| creator | Taylor, Carolyn W., DPhil, FRCR Wang, Zhe, PhD Macaulay, Elizabeth, MSc Jagsi, Reshma, MD, DPhil Duane, Frances, FFRRCSI Darby, Sarah C., PhD |
| description | Purpose Breast cancer radiation therapy cures many women, but where the heart is exposed, it can cause heart disease. We report a systematic review of heart doses from breast cancer radiation therapy that were published during 2003 to 2013. Methods and Materials Eligible studies were those reporting whole-heart dose (ie, dose averaged over the whole heart). Analyses considered the arithmetic mean of the whole-heart doses for the CT plans for each regimen in each study. We termed this “mean heart dose.” Results In left-sided breast cancer, mean heart dose averaged over all 398 regimens reported in 149 studies from 28 countries was 5.4 Gy (range, |
| doi_str_mv | 10.1016/j.ijrobp.2015.07.2292 |
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We report a systematic review of heart doses from breast cancer radiation therapy that were published during 2003 to 2013. Methods and Materials Eligible studies were those reporting whole-heart dose (ie, dose averaged over the whole heart). Analyses considered the arithmetic mean of the whole-heart doses for the CT plans for each regimen in each study. We termed this “mean heart dose.” Results In left-sided breast cancer, mean heart dose averaged over all 398 regimens reported in 149 studies from 28 countries was 5.4 Gy (range, <0.1-28.6 Gy). In regimens that did not include the internal mammary chain (IMC), average mean heart dose was 4.2 Gy and varied with the target tissues irradiated. The lowest average mean heart doses were from tangential radiation therapy with either breathing control (1.3 Gy; range, 0.4-2.5 Gy) or treatment in the lateral decubitus position (1.2 Gy; range, 0.8-1.7 Gy), or from proton radiation therapy (0.5 Gy; range, 0.1-0.8 Gy). For intensity modulated radiation therapy mean heart dose was 5.6 Gy (range, <0.1-23.0 Gy). Where the IMC was irradiated, average mean heart dose was around 8 Gy and varied little according to which other targets were irradiated. Proton radiation therapy delivered the lowest average mean heart dose (2.6 Gy, range, 1.0-6.0 Gy), and tangential radiation therapy with a separate IMC field the highest (9.2 Gy, range, 1.9-21.0 Gy). In right-sided breast cancer, the average mean heart dose was 3.3 Gy based on 45 regimens in 23 studies. Conclusions Recent estimates of typical heart doses from left breast cancer radiation therapy vary widely between studies, even for apparently similar regimens. Maneuvers to reduce heart dose in left tangential radiation therapy were successful. Proton radiation therapy delivered the lowest doses. Inclusion of the IMC doubled typical heart dose.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2015.07.2292</identifier><identifier>PMID: 26530753</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Cardiotoxicity - etiology ; Cardiotoxicity - prevention & control ; CARDIOVASCULAR DISEASES ; Female ; GY RANGE 01-10 ; GY RANGE 10-100 ; HEART ; Heart - radiation effects ; Hematology, Oncology and Palliative Medicine ; Humans ; IRRADIATION ; Lymphatic Irradiation - statistics & numerical data ; MAMMARY GLANDS ; NEOPLASMS ; Organs at Risk - radiation effects ; Proton Therapy - statistics & numerical data ; PROTONS ; Radiation Dosage ; RADIATION DOSES ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; Radiotherapy, Intensity-Modulated - statistics & numerical data ; REVIEWS ; Unilateral Breast Neoplasms - radiotherapy</subject><ispartof>International journal of radiation oncology, biology, physics, 2015-11, Vol.93 (4), p.845-853</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c566t-2751bb42c750c02fb38f8f2f0618f99a90d6452af39bff0576b92ab8d8e7544a3</citedby><cites>FETCH-LOGICAL-c566t-2751bb42c750c02fb38f8f2f0618f99a90d6452af39bff0576b92ab8d8e7544a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S036030161503103X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26530753$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22645009$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Taylor, Carolyn W., DPhil, FRCR</creatorcontrib><creatorcontrib>Wang, Zhe, PhD</creatorcontrib><creatorcontrib>Macaulay, Elizabeth, MSc</creatorcontrib><creatorcontrib>Jagsi, Reshma, MD, DPhil</creatorcontrib><creatorcontrib>Duane, Frances, FFRRCSI</creatorcontrib><creatorcontrib>Darby, Sarah C., PhD</creatorcontrib><title>Exposure of the Heart in Breast Cancer Radiation Therapy: A Systematic Review of Heart Doses Published During 2003 to 2013</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose Breast cancer radiation therapy cures many women, but where the heart is exposed, it can cause heart disease. We report a systematic review of heart doses from breast cancer radiation therapy that were published during 2003 to 2013. Methods and Materials Eligible studies were those reporting whole-heart dose (ie, dose averaged over the whole heart). Analyses considered the arithmetic mean of the whole-heart doses for the CT plans for each regimen in each study. We termed this “mean heart dose.” Results In left-sided breast cancer, mean heart dose averaged over all 398 regimens reported in 149 studies from 28 countries was 5.4 Gy (range, <0.1-28.6 Gy). In regimens that did not include the internal mammary chain (IMC), average mean heart dose was 4.2 Gy and varied with the target tissues irradiated. The lowest average mean heart doses were from tangential radiation therapy with either breathing control (1.3 Gy; range, 0.4-2.5 Gy) or treatment in the lateral decubitus position (1.2 Gy; range, 0.8-1.7 Gy), or from proton radiation therapy (0.5 Gy; range, 0.1-0.8 Gy). For intensity modulated radiation therapy mean heart dose was 5.6 Gy (range, <0.1-23.0 Gy). Where the IMC was irradiated, average mean heart dose was around 8 Gy and varied little according to which other targets were irradiated. Proton radiation therapy delivered the lowest average mean heart dose (2.6 Gy, range, 1.0-6.0 Gy), and tangential radiation therapy with a separate IMC field the highest (9.2 Gy, range, 1.9-21.0 Gy). In right-sided breast cancer, the average mean heart dose was 3.3 Gy based on 45 regimens in 23 studies. Conclusions Recent estimates of typical heart doses from left breast cancer radiation therapy vary widely between studies, even for apparently similar regimens. Maneuvers to reduce heart dose in left tangential radiation therapy were successful. Proton radiation therapy delivered the lowest doses. Inclusion of the IMC doubled typical heart dose.</description><subject>Cardiotoxicity - etiology</subject><subject>Cardiotoxicity - prevention & control</subject><subject>CARDIOVASCULAR DISEASES</subject><subject>Female</subject><subject>GY RANGE 01-10</subject><subject>GY RANGE 10-100</subject><subject>HEART</subject><subject>Heart - radiation effects</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>IRRADIATION</subject><subject>Lymphatic Irradiation - statistics & numerical data</subject><subject>MAMMARY GLANDS</subject><subject>NEOPLASMS</subject><subject>Organs at Risk - radiation effects</subject><subject>Proton Therapy - statistics & numerical data</subject><subject>PROTONS</subject><subject>Radiation Dosage</subject><subject>RADIATION DOSES</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy, Intensity-Modulated - statistics & numerical data</subject><subject>REVIEWS</subject><subject>Unilateral Breast Neoplasms - radiotherapy</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU9v1DAQxSMEokvhI4AscU4Y23H-cAC120KRKoHaIvVmOc6YddiNI9sBlk-PowAHLpxGGr33ZuY3WfacQkGBVq-Gwg7edVPBgIoC6oKxlj3INrSp25wLcf8w2wCvIOdJfZI9CWEAAErr8nF2wirBoRZ8k_28_DG5MHskzpC4Q3KFykdiR3LuUYVItmrU6MmN6q2K1o3kbodeTcfX5IzcHkPEQ2prcoPfLH5fQtaACxcwkE9zt7dhhz25mL0dvxAGwEl0qVL-NHtk1D7gs9_1NPv87vJue5Vff3z_YXt2nWtRVTFntaBdVzJdC9DATMcb0xhmoKKNaVvVQl-VginD284YEHXVtUx1Td9gLcpS8dPs5ZrrQrQyaBtR77QbR9RRMpbMAG1SiVWlvQvBo5GTtwflj5KCXIjLQa7E5UJcQi0X4sn3YvVNc3fA_q_rD-IkeLsKMN2YIPllBUxQe-uXDXpn_zvizT8Jem9Hq9X-Kx4xDG72YwIoqQxMgrxd3r58nQrgFPg9_wWLMacT</recordid><startdate>20151115</startdate><enddate>20151115</enddate><creator>Taylor, Carolyn W., DPhil, FRCR</creator><creator>Wang, Zhe, PhD</creator><creator>Macaulay, Elizabeth, MSc</creator><creator>Jagsi, Reshma, MD, DPhil</creator><creator>Duane, Frances, FFRRCSI</creator><creator>Darby, Sarah C., PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>OTOTI</scope></search><sort><creationdate>20151115</creationdate><title>Exposure of the Heart in Breast Cancer Radiation Therapy: A Systematic Review of Heart Doses Published During 2003 to 2013</title><author>Taylor, Carolyn W., DPhil, FRCR ; Wang, Zhe, PhD ; Macaulay, Elizabeth, MSc ; Jagsi, Reshma, MD, DPhil ; Duane, Frances, FFRRCSI ; Darby, Sarah C., PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c566t-2751bb42c750c02fb38f8f2f0618f99a90d6452af39bff0576b92ab8d8e7544a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Cardiotoxicity - etiology</topic><topic>Cardiotoxicity - prevention & control</topic><topic>CARDIOVASCULAR DISEASES</topic><topic>Female</topic><topic>GY RANGE 01-10</topic><topic>GY RANGE 10-100</topic><topic>HEART</topic><topic>Heart - radiation effects</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>IRRADIATION</topic><topic>Lymphatic Irradiation - statistics & numerical data</topic><topic>MAMMARY GLANDS</topic><topic>NEOPLASMS</topic><topic>Organs at Risk - radiation effects</topic><topic>Proton Therapy - statistics & numerical data</topic><topic>PROTONS</topic><topic>Radiation Dosage</topic><topic>RADIATION DOSES</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy, Intensity-Modulated - statistics & numerical data</topic><topic>REVIEWS</topic><topic>Unilateral Breast Neoplasms - radiotherapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Taylor, Carolyn W., DPhil, FRCR</creatorcontrib><creatorcontrib>Wang, Zhe, PhD</creatorcontrib><creatorcontrib>Macaulay, Elizabeth, MSc</creatorcontrib><creatorcontrib>Jagsi, Reshma, MD, DPhil</creatorcontrib><creatorcontrib>Duane, Frances, FFRRCSI</creatorcontrib><creatorcontrib>Darby, Sarah C., PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Taylor, Carolyn W., DPhil, FRCR</au><au>Wang, Zhe, PhD</au><au>Macaulay, Elizabeth, MSc</au><au>Jagsi, Reshma, MD, DPhil</au><au>Duane, Frances, FFRRCSI</au><au>Darby, Sarah C., PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Exposure of the Heart in Breast Cancer Radiation Therapy: A Systematic Review of Heart Doses Published During 2003 to 2013</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2015-11-15</date><risdate>2015</risdate><volume>93</volume><issue>4</issue><spage>845</spage><epage>853</epage><pages>845-853</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Purpose Breast cancer radiation therapy cures many women, but where the heart is exposed, it can cause heart disease. We report a systematic review of heart doses from breast cancer radiation therapy that were published during 2003 to 2013. Methods and Materials Eligible studies were those reporting whole-heart dose (ie, dose averaged over the whole heart). Analyses considered the arithmetic mean of the whole-heart doses for the CT plans for each regimen in each study. We termed this “mean heart dose.” Results In left-sided breast cancer, mean heart dose averaged over all 398 regimens reported in 149 studies from 28 countries was 5.4 Gy (range, <0.1-28.6 Gy). In regimens that did not include the internal mammary chain (IMC), average mean heart dose was 4.2 Gy and varied with the target tissues irradiated. The lowest average mean heart doses were from tangential radiation therapy with either breathing control (1.3 Gy; range, 0.4-2.5 Gy) or treatment in the lateral decubitus position (1.2 Gy; range, 0.8-1.7 Gy), or from proton radiation therapy (0.5 Gy; range, 0.1-0.8 Gy). For intensity modulated radiation therapy mean heart dose was 5.6 Gy (range, <0.1-23.0 Gy). Where the IMC was irradiated, average mean heart dose was around 8 Gy and varied little according to which other targets were irradiated. Proton radiation therapy delivered the lowest average mean heart dose (2.6 Gy, range, 1.0-6.0 Gy), and tangential radiation therapy with a separate IMC field the highest (9.2 Gy, range, 1.9-21.0 Gy). In right-sided breast cancer, the average mean heart dose was 3.3 Gy based on 45 regimens in 23 studies. Conclusions Recent estimates of typical heart doses from left breast cancer radiation therapy vary widely between studies, even for apparently similar regimens. Maneuvers to reduce heart dose in left tangential radiation therapy were successful. Proton radiation therapy delivered the lowest doses. Inclusion of the IMC doubled typical heart dose.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26530753</pmid><doi>10.1016/j.ijrobp.2015.07.2292</doi><tpages>9</tpages></addata></record> |
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| subjects | Cardiotoxicity - etiology Cardiotoxicity - prevention & control CARDIOVASCULAR DISEASES Female GY RANGE 01-10 GY RANGE 10-100 HEART Heart - radiation effects Hematology, Oncology and Palliative Medicine Humans IRRADIATION Lymphatic Irradiation - statistics & numerical data MAMMARY GLANDS NEOPLASMS Organs at Risk - radiation effects Proton Therapy - statistics & numerical data PROTONS Radiation Dosage RADIATION DOSES Radiology RADIOLOGY AND NUCLEAR MEDICINE RADIOTHERAPY Radiotherapy, Intensity-Modulated - statistics & numerical data REVIEWS Unilateral Breast Neoplasms - radiotherapy |
| title | Exposure of the Heart in Breast Cancer Radiation Therapy: A Systematic Review of Heart Doses Published During 2003 to 2013 |
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