Whole breast proton irradiation for maximal reduction of heart dose in breast cancer patients

Mirjam E. Mast; Eline J. Vredeveld; Herman M. Credoe; Jaap van Egmond; Mark W. Heijenbrok; Eugen B. Hug; Patrick Kalk; Loes M. L. van Kempen-Harteveld; Erik W. Korevaar; Hans Paul van der Laan; Johannes A. Langendijk; Hans J. E. Rozema; Anna L. Petoukhova; Jacobus M. Schippers; Henk Struikmans; John H. Maduro

doi:10.1007/s10549-014-3149-6

Whole breast proton irradiation for maximal reduction of heart dose in breast cancer patients

Mirjam E. Mast^*, Eline J. Vredeveld, Herman M. Credoe, Jaap van Egmond, Mark W. Heijenbrok, Eugen B. Hug, Patrick Kalk, Loes M. L. van Kempen-Harteveld, Erik W. Korevaar, Hans Paul van der Laan, Johannes A. Langendijk, Hans J. E. Rozema, Anna L. Petoukhova, Jacobus M. Schippers, Henk Struikmans, John H. Maduro

^*Corresponding author for this work

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Abstract

PURPOSE: In left-sided breast cancer radiotherapy, tangential intensity modulated radiotherapy combined with breath-hold enables a dose reduction to the heart and left anterior descending (LAD) coronary artery. Aim of this study was to investigate the added value of intensity modulated proton therapy (IMPT) with regard to decreasing the radiation dose to these structures.

METHODS: In this comparative planning study, four treatment plans were generated in 20 patients: an IMPT plan and a tangential IMRT plan, both with breath-hold and free-breathing. At least 97 % of the target volume had to be covered by at least 95 % of the prescribed dose in all cases. Specifically with respect to the heart, the LAD, and the target volumes, we analyzed the maximum doses, the mean doses, and the volumes receiving 5-30 Gy.

RESULTS: As compared to IMRT, IMPT resulted in significant dose reductions to the heart and LAD-region even without breath-hold. In the majority of the IMPT cases, a reduction to almost zero to the heart and LAD-region was obtained. IMPT treatment plans yielded the lowest dose to the lungs.

CONCLUSIONS: With IMPT the dose to the heart and LAD-region could be significantly decreased compared to tangential IMRT with breath-hold. The clinical relevance should be assessed individually based on the baseline risk of cardiac complications in combination with the dose to organs at risk. However, as IMPT for breast cancer is currently not widely available, IMPT should be reserved for patients remaining at high risk for major coronary events.

Original language	English
Pages (from-to)	33-39
Number of pages	7
Journal	Breast Cancer Research and Treatment
Volume	148
Issue number	1
DOIs	https://doi.org/10.1007/s10549-014-3149-6
Publication status	Published - Nov-2014

Keywords

Breath-hold
Breast cancer
IMPT
IMRT
Heart sparing
INTENSITY-MODULATED RADIOTHERAPY
RADIATION-THERAPY
LOCAL RECURRENCE
BEAM THERAPY
RISK
DISEASE
WOMEN
HOLD
UNCERTAINTIES
OPTIMIZATION

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Mast, M. E., Vredeveld, E. J., Credoe, H. M., van Egmond, J., Heijenbrok, M. W., Hug, E. B., Kalk, P., van Kempen-Harteveld, L. M. L., Korevaar, E. W., van der Laan, H. P., Langendijk, J. A., Rozema, H. J. E., Petoukhova, A. L., Schippers, J. M., Struikmans, H., & Maduro, J. H. (2014). Whole breast proton irradiation for maximal reduction of heart dose in breast cancer patients. Breast Cancer Research and Treatment, 148(1), 33-39. https://doi.org/10.1007/s10549-014-3149-6

@article{30fb07127a5a4bdb9bd236dfaa18d335,

title = "Whole breast proton irradiation for maximal reduction of heart dose in breast cancer patients",

abstract = "PURPOSE: In left-sided breast cancer radiotherapy, tangential intensity modulated radiotherapy combined with breath-hold enables a dose reduction to the heart and left anterior descending (LAD) coronary artery. Aim of this study was to investigate the added value of intensity modulated proton therapy (IMPT) with regard to decreasing the radiation dose to these structures.METHODS: In this comparative planning study, four treatment plans were generated in 20 patients: an IMPT plan and a tangential IMRT plan, both with breath-hold and free-breathing. At least 97 % of the target volume had to be covered by at least 95 % of the prescribed dose in all cases. Specifically with respect to the heart, the LAD, and the target volumes, we analyzed the maximum doses, the mean doses, and the volumes receiving 5-30 Gy.RESULTS: As compared to IMRT, IMPT resulted in significant dose reductions to the heart and LAD-region even without breath-hold. In the majority of the IMPT cases, a reduction to almost zero to the heart and LAD-region was obtained. IMPT treatment plans yielded the lowest dose to the lungs.CONCLUSIONS: With IMPT the dose to the heart and LAD-region could be significantly decreased compared to tangential IMRT with breath-hold. The clinical relevance should be assessed individually based on the baseline risk of cardiac complications in combination with the dose to organs at risk. However, as IMPT for breast cancer is currently not widely available, IMPT should be reserved for patients remaining at high risk for major coronary events.",

keywords = "Breath-hold, Breast cancer, IMPT, IMRT, Heart sparing, INTENSITY-MODULATED RADIOTHERAPY, RADIATION-THERAPY, LOCAL RECURRENCE, BEAM THERAPY, RISK, DISEASE, WOMEN, HOLD, UNCERTAINTIES, OPTIMIZATION",

author = "Mast, {Mirjam E.} and Vredeveld, {Eline J.} and Credoe, {Herman M.} and {van Egmond}, Jaap and Heijenbrok, {Mark W.} and Hug, {Eugen B.} and Patrick Kalk and {van Kempen-Harteveld}, {Loes M. L.} and Korevaar, {Erik W.} and {van der Laan}, {Hans Paul} and Langendijk, {Johannes A.} and Rozema, {Hans J. E.} and Petoukhova, {Anna L.} and Schippers, {Jacobus M.} and Henk Struikmans and Maduro, {John H.}",

year = "2014",

month = nov,

doi = "10.1007/s10549-014-3149-6",

language = "English",

volume = "148",

pages = "33--39",

journal = "Breast Cancer Research and Treatment",

issn = "0167-6806",

publisher = "Springer",

number = "1",

}

Mast, ME, Vredeveld, EJ, Credoe, HM, van Egmond, J, Heijenbrok, MW, Hug, EB, Kalk, P, van Kempen-Harteveld, LML, Korevaar, EW , van der Laan, HP , Langendijk, JA, Rozema, HJE, Petoukhova, AL, Schippers, JM, Struikmans, H & Maduro, JH 2014, 'Whole breast proton irradiation for maximal reduction of heart dose in breast cancer patients', Breast Cancer Research and Treatment, vol. 148, no. 1, pp. 33-39. https://doi.org/10.1007/s10549-014-3149-6

TY - JOUR

T1 - Whole breast proton irradiation for maximal reduction of heart dose in breast cancer patients

AU - Mast, Mirjam E.

AU - Vredeveld, Eline J.

AU - Credoe, Herman M.

AU - van Egmond, Jaap

AU - Heijenbrok, Mark W.

AU - Hug, Eugen B.

AU - Kalk, Patrick

AU - van Kempen-Harteveld, Loes M. L.

AU - Korevaar, Erik W.

AU - van der Laan, Hans Paul

AU - Langendijk, Johannes A.

AU - Rozema, Hans J. E.

AU - Petoukhova, Anna L.

AU - Schippers, Jacobus M.

AU - Struikmans, Henk

AU - Maduro, John H.

PY - 2014/11

Y1 - 2014/11

N2 - PURPOSE: In left-sided breast cancer radiotherapy, tangential intensity modulated radiotherapy combined with breath-hold enables a dose reduction to the heart and left anterior descending (LAD) coronary artery. Aim of this study was to investigate the added value of intensity modulated proton therapy (IMPT) with regard to decreasing the radiation dose to these structures.METHODS: In this comparative planning study, four treatment plans were generated in 20 patients: an IMPT plan and a tangential IMRT plan, both with breath-hold and free-breathing. At least 97 % of the target volume had to be covered by at least 95 % of the prescribed dose in all cases. Specifically with respect to the heart, the LAD, and the target volumes, we analyzed the maximum doses, the mean doses, and the volumes receiving 5-30 Gy.RESULTS: As compared to IMRT, IMPT resulted in significant dose reductions to the heart and LAD-region even without breath-hold. In the majority of the IMPT cases, a reduction to almost zero to the heart and LAD-region was obtained. IMPT treatment plans yielded the lowest dose to the lungs.CONCLUSIONS: With IMPT the dose to the heart and LAD-region could be significantly decreased compared to tangential IMRT with breath-hold. The clinical relevance should be assessed individually based on the baseline risk of cardiac complications in combination with the dose to organs at risk. However, as IMPT for breast cancer is currently not widely available, IMPT should be reserved for patients remaining at high risk for major coronary events.

AB - PURPOSE: In left-sided breast cancer radiotherapy, tangential intensity modulated radiotherapy combined with breath-hold enables a dose reduction to the heart and left anterior descending (LAD) coronary artery. Aim of this study was to investigate the added value of intensity modulated proton therapy (IMPT) with regard to decreasing the radiation dose to these structures.METHODS: In this comparative planning study, four treatment plans were generated in 20 patients: an IMPT plan and a tangential IMRT plan, both with breath-hold and free-breathing. At least 97 % of the target volume had to be covered by at least 95 % of the prescribed dose in all cases. Specifically with respect to the heart, the LAD, and the target volumes, we analyzed the maximum doses, the mean doses, and the volumes receiving 5-30 Gy.RESULTS: As compared to IMRT, IMPT resulted in significant dose reductions to the heart and LAD-region even without breath-hold. In the majority of the IMPT cases, a reduction to almost zero to the heart and LAD-region was obtained. IMPT treatment plans yielded the lowest dose to the lungs.CONCLUSIONS: With IMPT the dose to the heart and LAD-region could be significantly decreased compared to tangential IMRT with breath-hold. The clinical relevance should be assessed individually based on the baseline risk of cardiac complications in combination with the dose to organs at risk. However, as IMPT for breast cancer is currently not widely available, IMPT should be reserved for patients remaining at high risk for major coronary events.

KW - Breath-hold

KW - Breast cancer

KW - IMPT

KW - IMRT

KW - Heart sparing

KW - INTENSITY-MODULATED RADIOTHERAPY

KW - RADIATION-THERAPY

KW - LOCAL RECURRENCE

KW - BEAM THERAPY

KW - RISK

KW - DISEASE

KW - WOMEN

KW - HOLD

KW - UNCERTAINTIES

KW - OPTIMIZATION

U2 - 10.1007/s10549-014-3149-6

DO - 10.1007/s10549-014-3149-6

M3 - Article

C2 - 25266130

SN - 0167-6806

VL - 148

SP - 33

EP - 39

JO - Breast Cancer Research and Treatment

JF - Breast Cancer Research and Treatment

IS - 1

ER -

Whole breast proton irradiation for maximal reduction of heart dose in breast cancer patients

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