Study on the safety of simultaneous integrated boost and the importance of cardiac substructural dose assessment of hypofractionated radiotherapy after early left breast cancer breast-conserving surgery
Background and purpose: Adjuvant radiotherapy for breast cancer after early breast-conserving surgery has been recommended by the guidelines. However, the feasibility of hypofractionated radiotherapy with simultaneous integrated boost is not available. In this randomized controlled study, the cardia...
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| Format: | Article |
| Language: | English |
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Editorial Office of China Oncology
2022-05-01
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| Series: | Zhongguo aizheng zazhi |
| Subjects: | |
| Online Access: | http://www.china-oncology.com/fileup/1007-3639/PDF/1654759396518-1192058626.pdf |
| _version_ | 1811209384023293952 |
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| author | ZHANG Qian, FANG Xiaoyan, LIU Juan, LIU Jin, CHENG Leilei, SUN Jing |
| author_facet | ZHANG Qian, FANG Xiaoyan, LIU Juan, LIU Jin, CHENG Leilei, SUN Jing |
| author_sort | ZHANG Qian, FANG Xiaoyan, LIU Juan, LIU Jin, CHENG Leilei, SUN Jing |
| collection | DOAJ |
| description | Background and purpose: Adjuvant radiotherapy for breast cancer after early breast-conserving surgery has been recommended by the guidelines. However, the feasibility of hypofractionated radiotherapy with simultaneous integrated boost is not available. In this randomized controlled study, the cardiac dosimetry parameters and cardiac ultrasound indexes of the two radiotherapy plans were compared to evaluate the safety of hypofractionated radiotherapy with simultaneous integrated boost plan in terms of cardiotoxicity. Methods: A total of 40 patients with breast cancer who received breast-conserving surgery were selected in Zhongshan Hospital, Fudan University from March 2017 to March 2018. They were randomly divided into two groups, including 20 patients reveiving hypofractionated radiotherapy with simultaneous integrated boost plan (whole breast 4 005 cGy/15 Fx, tumor bed 4 500 cGy/15 Fx) and 20 patients reveiving conventional fractionation with simultaneous integrated boost plan (whole breast 5 000 cGy/25 Fx, tumor bed 6 000 cGy/25 Fx). The cardiac dosimetric parameters and cardiac ultrasound indexes of the two groups were compared. The dosimetric parameters included the average doses (Dmean) of the whole heart, left ventricle, right ventricle, right ventricular free wall, ventricular septum and left anterior descending (LAD) coronary artery, and the relative volume fraction of each structure irradiated by 5-35 Gy (V5 Gy-V35 Gy). The follow-up indexes of echocardiography included aortic root diameter, left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, ventricular septal thickness, left ventricular posterior wall thickness, pulmonary artery systolic pressure, left ventricular ejection fraction, E peak, A peak, E-peak deceleration time (DT), E, A, E/A and S wave peak. In addition, the cosmetic effect on breast after radiotherapy in the two groups was also evaluated. Results: Dmean of the whole heart in the hypofractionated group and the conventional group were (471.86±170.54) and (733.07±79.11) cGy (P<0.05); V20 Gy of the whole heart was (3.63±1.74) and (8.43±0.74)% (P<0.05), and V30 Gy was (1.55±1.15) and (4.48±1.01)% (P<0.05). Dmean of LAD were (1 250.17±600.33) and (1 847.20±933.23) cGy (P>0.05); Dmean of left ventricle were (908.64±865.60) vs (946.93±116.13) cGy (P>0.05). Dmean of right ventricle were (590.37±197.99) vs (905.73±180.82) cGy (P<0.05); Dmean of right ventricular free wall were (939.40±284.23) vs (1 597.30±446.3) cGy (P<0.05); Dmean of ventricular septum were (1 637.49±248.19) vs (988.60±159.77) cGy (P<0.05). After one year of follow-up, the cardiac ultrasound indexes in the hypofractionated group and the conventional group were in the normal range, and there was no significant difference between the two groups (P>0.05). There was no significant difference in cosmetic effect between the two groups (P>0.05). Conclusion: Compared with the conventional fractionation plan, hypofractionated radiotherapy with simultaneous integrated boost significantly reduced the radiation dose of the whole heart and some cardiac substructures, and there were no abnormal cardiac ultrasound indexes during one-year follow-up. The dose fractionation method in this study is safe and feasible. Limiting the whole heart dose alone can not effectively protect LAD, so it is recommended to outline the cardiac substructure and limit the dose alone to better protect the heart. |
| first_indexed | 2024-04-12T04:38:34Z |
| format | Article |
| id | doaj.art-09680dc948c640129aeafdc27b2ee972 |
| institution | Directory Open Access Journal |
| issn | 1007-3639 |
| language | English |
| last_indexed | 2024-04-12T04:38:34Z |
| publishDate | 2022-05-01 |
| publisher | Editorial Office of China Oncology |
| record_format | Article |
| series | Zhongguo aizheng zazhi |
| spelling | doaj.art-09680dc948c640129aeafdc27b2ee9722022-12-22T03:47:44ZengEditorial Office of China OncologyZhongguo aizheng zazhi1007-36392022-05-0132542743510.19401/j.cnki.1007-3639.2022.05.008Study on the safety of simultaneous integrated boost and the importance of cardiac substructural dose assessment of hypofractionated radiotherapy after early left breast cancer breast-conserving surgeryZHANG Qian, FANG Xiaoyan, LIU Juan, LIU Jin, CHENG Leilei, SUN Jing01. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;2. Department of echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaBackground and purpose: Adjuvant radiotherapy for breast cancer after early breast-conserving surgery has been recommended by the guidelines. However, the feasibility of hypofractionated radiotherapy with simultaneous integrated boost is not available. In this randomized controlled study, the cardiac dosimetry parameters and cardiac ultrasound indexes of the two radiotherapy plans were compared to evaluate the safety of hypofractionated radiotherapy with simultaneous integrated boost plan in terms of cardiotoxicity. Methods: A total of 40 patients with breast cancer who received breast-conserving surgery were selected in Zhongshan Hospital, Fudan University from March 2017 to March 2018. They were randomly divided into two groups, including 20 patients reveiving hypofractionated radiotherapy with simultaneous integrated boost plan (whole breast 4 005 cGy/15 Fx, tumor bed 4 500 cGy/15 Fx) and 20 patients reveiving conventional fractionation with simultaneous integrated boost plan (whole breast 5 000 cGy/25 Fx, tumor bed 6 000 cGy/25 Fx). The cardiac dosimetric parameters and cardiac ultrasound indexes of the two groups were compared. The dosimetric parameters included the average doses (Dmean) of the whole heart, left ventricle, right ventricle, right ventricular free wall, ventricular septum and left anterior descending (LAD) coronary artery, and the relative volume fraction of each structure irradiated by 5-35 Gy (V5 Gy-V35 Gy). The follow-up indexes of echocardiography included aortic root diameter, left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, ventricular septal thickness, left ventricular posterior wall thickness, pulmonary artery systolic pressure, left ventricular ejection fraction, E peak, A peak, E-peak deceleration time (DT), E, A, E/A and S wave peak. In addition, the cosmetic effect on breast after radiotherapy in the two groups was also evaluated. Results: Dmean of the whole heart in the hypofractionated group and the conventional group were (471.86±170.54) and (733.07±79.11) cGy (P<0.05); V20 Gy of the whole heart was (3.63±1.74) and (8.43±0.74)% (P<0.05), and V30 Gy was (1.55±1.15) and (4.48±1.01)% (P<0.05). Dmean of LAD were (1 250.17±600.33) and (1 847.20±933.23) cGy (P>0.05); Dmean of left ventricle were (908.64±865.60) vs (946.93±116.13) cGy (P>0.05). Dmean of right ventricle were (590.37±197.99) vs (905.73±180.82) cGy (P<0.05); Dmean of right ventricular free wall were (939.40±284.23) vs (1 597.30±446.3) cGy (P<0.05); Dmean of ventricular septum were (1 637.49±248.19) vs (988.60±159.77) cGy (P<0.05). After one year of follow-up, the cardiac ultrasound indexes in the hypofractionated group and the conventional group were in the normal range, and there was no significant difference between the two groups (P>0.05). There was no significant difference in cosmetic effect between the two groups (P>0.05). Conclusion: Compared with the conventional fractionation plan, hypofractionated radiotherapy with simultaneous integrated boost significantly reduced the radiation dose of the whole heart and some cardiac substructures, and there were no abnormal cardiac ultrasound indexes during one-year follow-up. The dose fractionation method in this study is safe and feasible. Limiting the whole heart dose alone can not effectively protect LAD, so it is recommended to outline the cardiac substructure and limit the dose alone to better protect the heart.http://www.china-oncology.com/fileup/1007-3639/PDF/1654759396518-1192058626.pdf|early breast cancer|breast-conserving surgery|hypofractionated radiotherapy|simultaneous integrated boost|cardiac injury |
| spellingShingle | ZHANG Qian, FANG Xiaoyan, LIU Juan, LIU Jin, CHENG Leilei, SUN Jing Study on the safety of simultaneous integrated boost and the importance of cardiac substructural dose assessment of hypofractionated radiotherapy after early left breast cancer breast-conserving surgery Zhongguo aizheng zazhi |early breast cancer|breast-conserving surgery|hypofractionated radiotherapy|simultaneous integrated boost|cardiac injury |
| title | Study on the safety of simultaneous integrated boost and the importance of cardiac substructural dose assessment of hypofractionated radiotherapy after early left breast cancer breast-conserving surgery |
| title_full | Study on the safety of simultaneous integrated boost and the importance of cardiac substructural dose assessment of hypofractionated radiotherapy after early left breast cancer breast-conserving surgery |
| title_fullStr | Study on the safety of simultaneous integrated boost and the importance of cardiac substructural dose assessment of hypofractionated radiotherapy after early left breast cancer breast-conserving surgery |
| title_full_unstemmed | Study on the safety of simultaneous integrated boost and the importance of cardiac substructural dose assessment of hypofractionated radiotherapy after early left breast cancer breast-conserving surgery |
| title_short | Study on the safety of simultaneous integrated boost and the importance of cardiac substructural dose assessment of hypofractionated radiotherapy after early left breast cancer breast-conserving surgery |
| title_sort | study on the safety of simultaneous integrated boost and the importance of cardiac substructural dose assessment of hypofractionated radiotherapy after early left breast cancer breast conserving surgery |
| topic | |early breast cancer|breast-conserving surgery|hypofractionated radiotherapy|simultaneous integrated boost|cardiac injury |
| url | http://www.china-oncology.com/fileup/1007-3639/PDF/1654759396518-1192058626.pdf |
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