Radiation Exposure of Cardiac Conduction Nodes During Breast Proton Therapy.

IF 2.1 Q3 ONCOLOGY International Journal of Particle Therapy Pub Date : 2023-03-09 eCollection Date: 2023-01-01 DOI:10.14338/IJPT-22-00038.1
Pierre Loap, Farid Goudjil, Vincent Servois, Krassen Kirov, Alain Fourquet, Youlia Kirova
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Abstract

Purpose: The exposition of cardiac conduction system during breast radiation therapy has never been studied, despite the increasing use of intensity-modulated radiation therapy, which exposes larger volume to low-dose bath. We evaluated conduction node exposure during breast irradiation with volumetric modulated arc therapy and estimated the potential dosimetric benefit with intensity-modulated proton therapy.

Materials and methods: Atrioventricular (AVN) and sinoatrial (SAN) nodes were retrospectively delineated according to published guidelines on the simulation computed tomography scans of 12 breast cancer patients having undergone conserving surgery and adjuvant locoregional volumetric modulated arc therapy. Intensity-modulated proton therapy treatment was replanned on the simulation computed tomography scans for all breast cancer patients. Mean and maximum doses delivered to the SAN and the AVN were retrieved and compared. Correlation coefficients were calculated between doses to the SAN or the AVN and the whole heart.

Results: Average mean doses delivered to the SAN and AVN were 2.8 and 2.3 Gy, respectively, for left-sided irradiation and 9.6 and 3.6 Gy, respectively, for right-sided irradiation. Average maximum doses to the SAN and AVN were 3.5 Gy and 2.8 Gy, respectively, for left-sided irradiation and 13.1 and 4.6 Gy, respectively, for right-sided irradiation. Intensity-modulated proton therapy significantly reduced mean and maximum doses to the SAN and AVN. Correlations between doses to the SAN or AVN and whole heart were usually significant.

Conclusion: SAN and AVN can be substantially exposed during breast volumetric modulated arc therapy, especially for right-sided irradiation. Cardiotoxicity studies evaluating conduction node exposure might define dose constraints and criteria for additional cardiac-sparing techniques, such as respiratory techniques or proton therapy, which could benefit patients with underlying rhythmic or conduction disorders.

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乳腺质子治疗期间心脏传导节点的辐射暴露。
目的:尽管越来越多地使用调强放射治疗,将更大的体积暴露在低剂量浴中,但从未研究过乳腺放射治疗过程中心脏传导系统的暴露。我们评估了体积调制电弧治疗乳腺照射期间的传导节点暴露,并估计了强度调制质子治疗的潜在剂量效益。材料和方法:根据已发表的12例癌症患者的计算机模拟断层扫描指南,回顾性地描述了接受保留手术和辅助局部体积调制电弧治疗的房室结(AVN)和窦房结(SAN)。对所有癌症患者进行模拟计算机断层扫描,重新计划强度调制质子治疗。检索并比较输送至SAN和AVN的平均剂量和最大剂量。计算SAN或AVN的剂量与整个心脏之间的相关系数。结果:SAN和AVN的平均剂量分别为2.8和2.3 Gy(左侧照射)和9.6和3.6 Gy(右侧照射)。SAN和AVN的平均最大剂量,左侧照射分别为3.5 Gy和2.8 Gy,右侧照射分别为13.1和4.6 Gy。强度调制质子治疗显著降低了SAN和AVN的平均和最大剂量。SAN或AVN的剂量与整个心脏之间的相关性通常是显著的。结论:SAN和AVN可在乳腺体积调制电弧治疗中大量暴露,尤其是在右侧照射时。评估传导节点暴露的心脏毒性研究可能会定义额外心脏保护技术的剂量限制和标准,如呼吸技术或质子治疗,这可能有利于潜在节律或传导障碍的患者。
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来源期刊
International Journal of Particle Therapy
International Journal of Particle Therapy Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
3.70
自引率
5.90%
发文量
23
审稿时长
20 weeks
期刊最新文献
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