Beaton, L;
Bergman, A;
Nichol, A;
Aparicio, M;
Wong, G;
Gondara, L;
Speers, C;
... Tyldesley, S; + view all
(2019)
Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines.
Clinical and Translational Radiation Oncology
, 19
pp. 39-45.
10.1016/j.ctro.2019.08.001.
Preview |
Text
Cardiac Paper Beaton et al.pdf - Published Version Download (481kB) | Preview |
Abstract
Background: Breast/chest wall irradiation (RT) increases risk of cardiovascular death. International Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) guidelines state for partial heart irradiation a “V25Gy <10% will be associated with a <1% probability of cardiac mortality” in long-term follow-up after RT. We assessed whether women treated with breast/chest wall RT 10-years ago who died of cardiovascular disease (CVD) violated QUANTEC guidelines. / Materials/methods: A population-based database identified all cardiovascular deaths in women with early-stage breast cancer <80 years, treated with adjuvant breast/chest wall RT from 2002 to 2006. Ten-year rate of cardiovascular death was calculated using a Kaplan-Meier method. Patients were matched on a 2:1 basis with controls that did not die of CVD. For left-sided cases, the heart and left anterior descending (LAD) artery were retrospectively delineated. Dose-volume histograms were calculated, and heart V25Gy compared to QUANTEC guidelines. / Results: 5249 eligible patients received breast/chest wall RT from 2002 to 2006: 76 (1.4% at 10-years) died of CVD by June 2015. Forty-two patients received left-sided RT (1.7% CVD death at 10-years), 34 right-sided RT (1.3% at 10-years). Heart V25Gy did not exceed 10% in any left-sided cases. No cardiac dosimetry parameter distinguished left-sided cases from controls. / Conclusions: QUANTEC guidelines were not violated in any patient that died of CVD after left-sided RT. The risk of radiation induced cardiac death at 10-years appears to be very low if MHD is <3.3 Gy and maximum LAD dose (EQD23 Gy) is <45.4 Gy. Further studies are needed to evaluate heart and LAD constraints in the CT-planning era.
| Type: | Article |
|---|---|
| Title: | Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.ctro.2019.08.001 |
| Publisher version: | https://doi.org/10.1016/j.ctro.2019.08.001 |
| Language: | English |
| Additional information: | Copyright © 2019 The Authors. Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10081192 |
Archive Staff Only
 |
View Item |
