Dosimetric impact of sparing base of heart on organ at risk doses during lung radiotherapy

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2024-11-27 DOI:10.1016/j.radonc.2024.110654

Tom Marchant , Joseph Wood , Kathryn Banfill , Alan McWilliam , Gareth Price , Corinne Faivre-Finn

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引用次数: 0

Abstract

Background

Minimising heart exposure during lung radiotherapy (RT) is important due to association between increased cardiac dose and adverse outcomes such as cardiac toxicity and reduced overall survival. This study evaluated the impact of incorporating a cardiac avoidance area (CAA) located at the base of the heart on the dose received by cardiac subregions and thoracic organs at risk.

Methods

A comparative analysis was conducted on patients treated with lung RT at a single centre before and after the CAA was introduced as an anatomical region at risk (ARR) in April 2023. Two patient cohorts were analysed: those treated prior to CAA implementation (April 2021-March 2023, 923 patients) and those treated post implementation (April 2023-March 2024, 477 patients). For the second group, plans were optimised to keep CAA maximum dose to 1 cc below 19.5 Gy in 20 fractions (or equivalent biologically effective dose). Key dose metrics for the CAA, heart, lungs, oesophagus, and spinal canal were compared between the cohorts.

Results

The introduction of the CAA as an ARR resulted in significant reductions in CAA and overall heart dose, with median CAA maximum dose (EQD2) decreasing from 32.0 Gy₃ to 16.9 Gy₃ (p < 0.001). No significant increases in dose were observed for other thoracic organs at risk.

Conclusions

Implementing a cardiac avoidance area in lung RT planning significantly reduces doses to critical heart regions without compromising the safety of other organs. This approach holds promise for reducing cardiac-related adverse events and improving overall survival in patients with lung cancer undergoing RT.

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肺放射治疗中危险剂量下心脏保留基底对器官的剂量学影响

背景：由于心脏剂量增加与心脏毒性和总生存率降低等不良后果之间存在关联，因此在肺放射治疗（RT）期间尽量减少心脏暴露是很重要的。本研究评估了在心脏底部植入心脏避免区（CAA）对高危心脏亚区和胸部器官接受剂量的影响。方法对2023年4月CAA作为危险解剖区（ARR）引入前后在单一中心接受肺RT治疗的患者进行对比分析。分析了两个患者队列：实施CAA之前治疗的患者（2021年4月至2023年3月，923例）和实施CAA后治疗的患者（2023年4月至2024年3月，477例）。对于第二组，优化计划以保持CAA最大剂量为1cc，低于19.5 Gy，分为20份（或等效生物有效剂量）。比较各组间CAA、心脏、肺、食道和椎管的关键剂量指标。结果作为ARR引入CAA导致CAA和心脏总剂量显著降低，中位CAA最大剂量（EQD2）从32.0 Gy3降至16.9 Gy3 (p <；0.001)。其他有危险的胸部器官未观察到明显的剂量增加。结论在肺RT计划中引入心脏回避区可显著减少对心脏关键区域的剂量，且不影响其他器官的安全性。这种方法有望减少心脏相关不良事件，提高肺癌患者接受放疗的总生存率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.