Heart toxicity from breast cancer radiotherapy

• Verfasst von: Piroth, Marc Dieter [VerfasserIn]
• Verfasst von: Krug, David [VerfasserIn]
• Verfasst von: Wenz, Frederik [VerfasserIn]
• Titel: Heart toxicity from breast cancer radiotherapy
• Titelzusatz: current findings, assessment, and prevention
• Verf.angabe: Marc D. Piroth, René Baumann, Wilfried Budach, Jürgen Dunst, Petra Feyer, Rainer Fietkau, Wulf Haase, Wolfgang Harms, Thomas Hehr, David Krug, Arnd Röser, Felix Sedlmayer, Rainer Souchon, Frederik Wenz, Rolf Sauer
• Jahr: 2019
• Umfang: 12 S.
• Fussnoten: Published online: 11 October 2018 ; Gesehen am 23.07.2019
• Titel Quelle: Enthalten in: Strahlentherapie und Onkologie
• Ort Quelle: Berlin : Springer Medizin, 1997
• Jahr Quelle: 2019
• Band/Heft Quelle: 195(2019), 1, Seite 1-12
• ISSN Quelle: 1439-099X
• DOI: doi:10.1007/s00066-018-1378-z
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Bestrahlung bei Brustkrebs
• Sach-SW: Breast cancer
• Sach-SW: Breast cancer radiotherapy
• Sach-SW: Brustkrebs
• Sach-SW: Heart toxicity
• Sach-SW: Herztoxizität
• Sach-SW: LAD
• Sach-SW: Mean heart dose
• Sach-SW: Mittlere Herzdosis
• K10plus-PPN: 166964586X

Abstract

BackgroundLate cardiac toxicities caused by (particularly left-sided) breast radiotherapy (RT) are now recognized as rare but relevant sequelae, which has prompted research on risk structure identification and definition of threshold doses to heart subvolumes. The aim of the present review was to critically discuss the clinical evidence on late cardiac reactions based on dose-dependent outcome reports for mean heart doses as well as doses to cardiac substructures.MethodsA literature review was performed to examine clinical evidence on radiation-induced heart toxicities. Mean heart doses and doses to cardiac substructures were focused upon based on dose-dependent outcome reports. Furthermore, an overview of radiation techniques for heart protection is given and non-radiotherapeutic aspects of cardiotoxicity in the multimodal setting of breast cancer treatment are discussed.ResultsBased on available findings, the DEGRO breast cancer expert panel recommends the following constraints: mean heart dose <2.5 Gy; DmeanLV (mean dose left ventricle) < 3 Gy; V5LV (volume of LV receiving ≥5 Gy) < 17%; V23LV (volume of LV receiving ≥23 Gy) < 5%; DmeanLAD (mean dose left descending artery) < 10 Gy; V30LAD (volume of LAD receiving ≥30 Gy) < 2%; V40LAD (volume of LAD receiving ≥40 Gy) < 1%.ConclusionIn addition to mean heart dose, breast cancer RT treatment planning should also include constraints for cardiac subvolumes such as LV and LAD. The given constraints serve as a clinicians’ aid for ensuring adequate heart protection. The individual decision between sufficient protection of cardiac structures versus optimal target volume coverage remains in the physician’s hand. The risk of breast cancer-specific mortality and a patient’s cardiac risk factors must be individually weighed up against the risk of radiation-induced cardiotoxicity.