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Open Access 01-12-2019 | Computed Tomography | Research

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)

Authors: Sophie Jacob, Jérémy Camilleri, Sylvie Derreumaux, Valentin Walker, Olivier Lairez, Mathieu Lapeyre, Eric Bruguière, Atul Pathak, Marie-Odile Bernier, Dominique Laurier, Jean Ferrieres, Olivier Gallocher, Igor Latorzeff, Baptiste Pinel, Denis Franck, Christian Chevelle, Gaëlle Jimenez, David Broggio

Published in: Radiation Oncology | Issue 1/2019

Abstract

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 R² indicated that the proportion of the variance in Dmean of the substructure predictable from MHD was moderate to low (in particular R² = 0.45 for LAD). Among left-sided BC patients with MHD < 3Gy, 56% of patients could nevertheless receive LAD doses above 40Gy (V40 > 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.

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Title: 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)
Authors: Sophie Jacob
Jérémy Camilleri
Sylvie Derreumaux
Valentin Walker
Olivier Lairez
Mathieu Lapeyre
Eric Bruguière
Atul Pathak
Marie-Odile Bernier
Dominique Laurier
Jean Ferrieres
Olivier Gallocher
Igor Latorzeff
Baptiste Pinel
Denis Franck
Christian Chevelle
Gaëlle Jimenez
David Broggio
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Computed Tomography
Computed Tomography
Breast Cancer
Breast Cancer
Radiotherapy
Published in: Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-019-1234-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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)

Abstract

Background

Methods

Results

Conclusion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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