Hostname: page-component-848d4c4894-5nwft Total loading time: 0 Render date: 2024-05-09T23:49:35.564Z Has data issue: false hasContentIssue false
  • English
  • Français

The impact of the radiotherapy technique in sparing the heart substructures in central tumor irradiation in lung cancer

Published online by Cambridge University Press:  06 January 2022

Gulhan Guler Avci Open the ORCID record for Gulhan Guler Avci [Opens in a new window] ,
Gonca Altınısık Inan Open the ORCID record for Gonca Altınısık Inan [Opens in a new window]  and
Halis Bozkurt
Gulhan Guler Avci*
Affiliation:
Gaziosmanpaşa University, Faculty of Medicine, Department of Radiation Oncology, Tokat, Turkey
Gonca Altınısık Inan
Affiliation:
Ankara Yıldırım Beyazıt University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
Halis Bozkurt
Affiliation:
Gaziosmanpaşa University, Faculty of Medicine, Department of Radiation Oncology, Tokat, Turkey
*
Author for correspondence: Dr. Gulhan Guler Avci, Gaziosmanpaşa University, Faculty of Medicine, Department of Radiation Oncology, Tokat, 60100, Turkey. Tel: 90 356 212 00 46. Fax: 90 356 212 00 46. E-mail: drgulhanguler@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

In thoracic radiotherapy (RT), heart sparing is very essential, as the high cardiac dose is associated with poor survival in patients with locally advanced non-small-cell lung cancer (NSCLC). The study aims to determine the doses exposed to heart substructures and coronary arteries by different RT techniques in central tumor irradiation in lung cancer.

Methods:

Twenty patients with NSCLC, irradiated between January 2018 and December 2020 in our department, were included in this study. Patients whose primary tumor was centrally located in the left lung were selected. The heart substructures [left atrium, right atrium (RA), left ventricle, and right ventricle] and coronary arteries (left main, left anterior descending, circumflex, and right coronary arteries) were delineated by the same physician. The doses of 60 Gy external RT were prescribed in 30 fractions using three-dimensional conformal radiotherapy (3D-CRT), static intensity-modulated radiotherapy (s-IMRT), and dynamic intensity-modulated radiotherapy (d-IMRT) techniques in all patients. The obtaining plans using three different techniques were compared.

Results:

The d-IMRT plans were statistically the best optimal plan for planning target volume (PTV) [Dmean (p = 0 04), Dmax (p < 0 0001), V95 (p < 0 0001), V107 (p < 0 0001), CI (p < 0 0001) and HI (p < 0 0001)]. The s-IMRT plans were significantly superior to 3D-CRT plans for PTV. RA Dmax and V45 were not different between the three techniques [Dmax (p = 0 148) and V45 (p = 0 12)]. The d-IMRT technique was significantly better in other heart substructures and coronary arteries.

Conclusions:

Compared to 3D-CRT and s-IMRT techniques, the d-IMRT technique provided the best protection in all heart substructures except for a few parameters (RA Dmax and V45 doses).

Keywords

coronary arteriesheart substructureslung cancerradiotherapy technique
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e28
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bradley, JD, Paulus, R, Komaki, R et al. Standard-dose versus high- dose conformal radiotherapy with concurrent and consolidation car- boplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol 2015; 16: 187–199.CrossRefGoogle ScholarPubMed
Dess, RT, Sun, Y, Matuszak, MM et al. Cardiac events after radiation therapy: combined analysis of prospective multicenter trials for locally advanced non-small-cell lung cancer. J Clin Oncol 2017; 35: 1395–1402.CrossRefGoogle ScholarPubMed
Stam, B, van der Bijl, E, van Diessen, J et al. Heart dose associated with overall survival in locally advanced NSCLC patients treated with hypo- fractionated chemoradiotherapy. Radiother Oncol 2017; 125 (1): 62–65.CrossRefGoogle Scholar
Guberina, M, Eberhardt, W, Stuschke, M et al. Heart dose exposure as prognostic marker after radiotherapy for resectable stage IIIA/B non-small-cell lung cancer: secondary analysis of a randomized trial. Ann Oncol 2017; 28: 1084–1089.CrossRefGoogle ScholarPubMed
Stam, B, Peulen, H, Guckenberger, M et al. Dose to heart substructures is associated with non-cancer death after SBRT in stage I-II NSCLC patients. Radiother Oncol 2017; 123 (3): 370–375.CrossRefGoogle ScholarPubMed
Schytte, T, Hansen, O, Stolberg-Rohr, T, Brink, C. Cardiac toxicity and radiation dose to the heart in definitive treated non-small cell lung cancer. Acta Oncol 2010; 49: 1058–1060.CrossRefGoogle Scholar
Chun, SG, Hu, C, Choy, H et al. Impact of intensity-modulated radiation therapy technique for locally advanced non-small-cell lung cancer: a secondary analysis of the NRG Oncology RTOG 0617 randomized clinical trial. J Clin Oncol 2017; 35: 56–62.CrossRefGoogle ScholarPubMed
Ma, JT, Sun, L, Sun, X et al. Is pulmonary artery a dose-limiting organ at risk in non-small cell lung cancer patients treated with definitive radiotherapy? Radiat Oncol 2017; 12: 34.CrossRefGoogle ScholarPubMed
Wang, K, Eblan, MJ, Deal, AM et al. Cardiac toxicity after radiotherapy for stage III non-small-cell lung cancer: pooled analysis of dose- escalation trials delivering 70 to 90 Gy. J Clin Oncol 2017; 35: 1387–1394.CrossRefGoogle ScholarPubMed
Milo, MLH, Offersen, BV, Bechmann, T et al. Delineation of whole heart and substructures in thoracic radiation therapy: national guidelines and contouring atlas by the Danish multidisciplinary cancer groups. Radiother Oncol 2020; 150: 121–127.CrossRefGoogle ScholarPubMed
International Commission on Radiation Units and Measurements. ICRU report 83 prescribing, recording, and reporting photonbeam intensity-modulated radiation therapy (IMRT). J ICRU 2010; 10 (1): 27–38.Google Scholar
Jang, BS, Cha, MJ, Kim, HJ et al. Heart substructural dosimetric parameters and risk of cardiac events after definitive chemoradiotherapy for stage III non-small cell lung cancer. Radiother Oncol 2020; 152: 126–132.CrossRefGoogle ScholarPubMed
Wang, K, Pearlstein, KA, Patchett, ND et al. Heart dosimetric analysis of three types of cardiac toxicity in patients treated on dose-escalation trials for Stage III non-small-cell lung cancer. Radiother Oncol 2017; 125 (2): 293–300.CrossRefGoogle ScholarPubMed
Borkenhagen, JF, Bergom, C, Rapp, CT, Klawikowski, SJ, Rein, LE, Gore, EM. Dosimetric predictors of cardiotoxicity in thoracic radiotherapy for lung cancer. Clin Lung Cancer 2019; 20 (6): 435–441.CrossRefGoogle ScholarPubMed
Atkins, KM, Chaunzwa, TL, Lamba, N et al. Association of left anterior descending coronary artery radiation dose with major adverse cardiac events and mortality in patients with non-small cell lung cancer. JAMA Oncol 2021; 7 (2): 206–219.CrossRefGoogle ScholarPubMed
Yegya-Raman, N, Wang, K, Kim, S et al. Dosimetric predictors of symptomatic cardiac events after conventional-dose chemoradiation therapy for inoperable NSCLC. J Thorac Oncol 2018; 13 (10): 1508–1518.CrossRefGoogle ScholarPubMed
Chan, ST, Ruan, D, Shaverdian, N, Raghavan, G, Cao, M, Lee, P. Effect of radiation doses to the heart on survival for stereotactic ablative radiotherapy for early-stage non-small-cell lung cancer: an artificial neural network approach. Clin Lung Cancer 2020; 21 (2): 136–144.CrossRefGoogle Scholar
Ferris, MJ, Martin, KS, Switchenko, JM et al. Sparing cardiac substructures with optimized volumetric modulated arc therapy and intensity modulated proton therapy in thoracic radiation for locally advanced non-small cell lung cancer. Pract Radiat Oncol 2019; 9 (5): e473–e481.CrossRefGoogle ScholarPubMed