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ABSTRACT: Background and purpose
Adjuvant radiotherapy of internal mammary nodes (IMN) improves survival in high-risk early breast cancer patients but inevitably leads to more dose to heart and lung. Target coverage is often compromised to meet heart/lung dose constraints. We estimate heart and lung dose when target coverage is not compromised in consecutive patients. These estimates are used to guide the choice of selection criteria for the randomised Danish Breast Cancer Group (DBCG) Proton Trial.Materials and methods
179 breast cancer patients already treated with loco-regional IMN radiotherapy from 18 European departments were included. If the clinically delivered treatment plan did not comply with defined target coverage requirements, the plan was modified retrospectively until sufficient coverage was reached. The choice of selection criteria was based on the estimated number of eligible patients for different heart and lung dose thresholds in combination with proton therapy capacity limitations and dose-response relationships for heart and lung.Results
Median mean heart dose was 3.0 Gy (range, 1.1-8.2 Gy) for left-sided and 1.4 Gy (0.4-11.5 Gy) for right-sided treatment plans. Median V17Gy/V20Gy (hypofractionated/normofractionated plans) for ipsilateral lung was 31% (9-57%). The DBCG Radiotherapy Committee chose mean heart dose ? 4 Gy and/or lung V17Gy/V20Gy ? 37% as thresholds for inclusion in the randomised trial. Using these thresholds, we estimate that 22% of patients requiring loco-regional IMN radiotherapy will be eligible for the trial.Conclusion
The patient selection criteria for the DBCG Proton Trial are mean heart dose ? 4 Gy and/or lung V17Gy/V20Gy ? 37%.
SUBMITTER: Stick LB
PROVIDER: S-EPMC7892790 | biostudies-literature | 2021 Mar
REPOSITORIES: biostudies-literature
Stick Line Bjerregaard LB Lorenzen Ebbe Laugaard EL Yates Esben Svitzer ES Anandadas Carmel C Andersen Karen K Aristei Cynthia C Byrne Orla O Hol Sandra S Jensen Ingelise I Kirby Anna M AM Kirova Youlia M YM Marrazzo Livia L Matías-Pérez Angela A Nielsen Mette Marie Bruun MMB Nissen Henrik Dahl HD Oliveros Sileida S Verhoeven Karolien K Vikström Johan J Offersen Birgitte Vrou BV
Clinical and translational radiation oncology 20210204
<h4>Background and purpose</h4>Adjuvant radiotherapy of internal mammary nodes (IMN) improves survival in high-risk early breast cancer patients but inevitably leads to more dose to heart and lung. Target coverage is often compromised to meet heart/lung dose constraints. We estimate heart and lung dose when target coverage is not compromised in consecutive patients. These estimates are used to guide the choice of selection criteria for the randomised Danish Breast Cancer Group (DBCG) Proton Tria ...[more]