Delineation of the Cardiac Substructures Based on PET-CT and Contrast-Enhanced CT in Patients with Left Breast Cancer Treated with Postoperative Radiotherapy
Free accessResearch articleFirst published online April, 2013
Delineation of the Cardiac Substructures Based on PET-CT and Contrast-Enhanced CT in Patients with Left Breast Cancer Treated with Postoperative Radiotherapy
The aim of this study is to evaluate the volume differences between contrast-enhanced CT-based left ventricle (LV) and PET-CT-based LV and assess the impact of dose on the substructure volume differences in patients with left breast cancer treated with adjuvant radiotherapy. From October 2008 to February 2009, 14 patients with post-operatively confirmed left breast cancer were enrolled in the current study. The patients were scanned using contrast-enhanced CT for simulation, and 18F-FDG PET-CT was employed to display the structure of the left ventricle of each before radiotherapy (RT). The LV was delineated based on both contrast-enhanced CT and PET-CT. And other substructures, such as the left anterior descending coronary artery (LAD), were contoured in each patient, with the six-field simple intensity modulated radiotherapy (sIMRT) technique created for all. The mean volumes of the left ventricle based on contrast-enhanced CT (LV-CT) and PET-CT (LV-PET) were found to be 107.296 cm3 and 112.931 cm3, respectively (p = 0.06). The volume of LV receiving ≥50% prescription dose was significantly correlated with the volume of the heart receiving the same dosage (γ = 0.869). There was less correlation between the volume of LAD and that of the heart under the same condition (γ = 0.22). As a conclusion, the left ventricle can be delineated effectively based on the image of PET-CT, the contrast-enhanced CT based LV can serve as an appropriate alternative. Moreover, the volume of LV receiving high dose in RT closely correlated with the volume of the heart using sIMRT technique, which may pave the way for further exploring radiation-induced cardiac injuries in patients with left breast cancer.
RagazJ.JacksonS. M.LeN.PlenderleithI. H.SpinelliJ. J.BascoV. E.WilsonK. S.KnowlingM. A.CoppinC. M.ParadisM.ColdmanA. J.OlivottoI. A.Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med337, 956–962 (1997). DOI: 10.1056/NEJM199710023371402.
2.
OvergaardM.JensenM. B.OvergaardJ.HansenP. S.RoseC.AnderssonM.KambyC.KjaerM.GadebergC. C.RasmussenB. B.Blichert-ToftM.MouridsenH. T.Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomized trial. Lancet353, 1641–1648 (1999). DOI: 10.1016/S0140–6736(98)09201-0.
3.
OvergaardM.HansenP. S.OvergaardJ.RoseC.AnderssonM.BachF.KjaerM.GadebergC. C.MouridsenH. T.JensenM. B.ZedelerK.Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med337, 949–955 (1997). DOI: 10.1056/NEJM199710023371401.
4.
EBCTCG.Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet378, 1707–1716 (2011). DOI: 10.1016/S0140–6736(11)61629-2.
5.
JonesJ. M.RibeiroG. G.Mortality patterns over 34 years of breast cancer patients in a clinical trial of post-operative radiotherapy. Clin Radiology40, 204–208 (1989). DOI: 10.1016/S0009–9260(89)80099-6.
6.
HoughtonJ.BaumM.HaybittleJ. L.Role of radiotherapy following total mastectomy in patients with early breast cancer. Would J Surg18, 117–122 (1994).
7.
RutqvistL. E.JohanssonH.Mortality by laterality of the primary tumour among 55,000 breast cancer patients from the Swedish cancer registry. Br J Cancer61, 866–868 (1990). DOI: 10.1038/bjc.1990.193.
8.
RutqvistL. E.LaxI.FornanderT.JohanssonH.Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys22, 887–896 (1992).
GagliardiG.ConstineL. S.MoiseenkoV.CorreaC.PierceL. J.AllenA. M.MarksL. B.Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys76, S77–S85 (2010). DOI: 10.1016/j.ijrobp.2009.04.093.
15.
MarksL. B.YuX. L.ProsnitzR. G.ZhouS. M.HardenberghP. H.BlazingM.HollisD.LindP.TischA.WongT. Z.Borges-NetoS.The incidence and functional consequences of RT-associated cardiac perfusion defects. Int J Radiat Oncol Biol Phys63, 214–223 (2005). DOI: 10.1016/j.ijrobp.2005.01.029.
16.
YuX. L.ProsnitzR. R.ZhouS.HardenbergP. H.TischA.BlazingM. A.Borges-NetoS.HollisD.WongT.MarksL. B.Symptomatic cardiac events following radiation therapy for left-sided breast cancer: Possible association with radiation therapy-induced changes in regional perfusion. Clin Breast Cancer4, 193–197 (2003).
17.
GyenesG.FornanderT.CarlensP.RutqvistL. E.Morbidity of ischemic heart disease in early breast cancer 15–20 years after adjuvant radiotherapy. Int J Radiat Oncol Biol Phys28, 1235–1241 (1994). DOI: 10.1016/0360–3016(94)90500-2.
18.
GustavssonA.BendahlP. O.CwikielM.EskilssonJ.ThapperK. L.PahlmO.No serious late cardiac effects after adjuvant radiotherapy following mastectomy in premenopausal women with early breast cancer. Int J Radiat Oncol Biol Phys43, 745–754 (1999). DOI: 10.1016/S0360–3016(98)00454-4.
19.
ChenX. S.NieX. Q.ChenC. M.WuJ. Y.WuJ.LuJ. S.ShaoZ. M.ShenZ. Z.ShenQ. W.Weekly paclitaxol plus carboplatin is an effective nonanthracyclin-containing regimen as neoadjuvant chemotherapy in breast cancer. Ann Oncol21, 961–967 (2010).
MarksL. B.HebertM. E.BentelG.SpencerD. P.SherouseG. W.ProsnitzL. R.To treat or not to treat the internal mammary nodes: A possible compromise. Int J Radiat Oncol Biol Phys29, 903–909 (1994).
22.
van der LaanH. P.DolsmaW. V.van 't VeldA. A.BijlH. P.LangendijkJ. A.Comparison of normal tissue dose with three-dimensional conformal techniques for breast cancer irradiation including the internal mammary nodes. Int J Radiat Oncol Biol Phys63, 1522–1530 (2005). DOI: 10.1016/j.ijrobp.2005.04.027.
23.
PierceL. J.ButlerJ. B.MartelM. K.NormolleD. P.KoellingT.MarshR. B.LichterA. S.FraassB. A.Postmastectomy radiotherapy of the chest wall: Dosimetric comparison of common techniques. Int J Radiat Oncol Biol Phys52, 1220–1230 (2002). DOI: 10.1016/S0360–3016(01)02760-2.
24.
JarvisL. A.LooB. W.ThorndykeB.Left anterior descending coronary artery motion in deep inspiration breath-hold and free breathing using 4D-CT scanning: Potential impact on left-sided breast cancer radiotherapy (Abstract). Proceedings of the 47th Annual ASTRO Meeting, S491.
25.
PaszatL. F.MackillopW. J.GroomeP. A.BoydC.SchulzeK.HolowatyE.Mortality from myocardial infarction after adjuvant radiotherapy for breast cancer in the surveillance, epidemiology, and end-results cancer registries. J Clin Oncol16, 2625–2631 (1998).
26.
KraussD. J.KestinL. L.RaffG.YanD.WongJ.GentryR.LettsN.VargasC. E.MartinezA. A.ViciniF. A.MRI-based volumetric assessment of cardiac anatomy and dose reduction via active breathing control during irradiation for left-sided breast cancer. Int J Radiat Oncol Biol Phys61, 1243–1250 (2005). DOI: 10.1016/j.ijrobp.2004.10.012.
27.
HŁjrisI.SandN. P.AndersenJ.RehlingM.OvergaardM.Myocardial perfusion imaging in breast cancer patients treated with or without post-mastectomy radiotherapy. Radiother Oncol55, 163–172 (2000). DOI: 10.1016/S0167–8140(00)00170-5.
28.
CowenD.Gonzague-CasabiancaL.Brenot-RossiI.ViensP.MaceL.Hannoun-LeviJ. M.AlzieuC.ResbeutM.Thallium-201 perfusion scintigraphy in the evaluation of late myocardial injury in left-side breast cancer treated with adjuvant radiotherapy. Int J Radiat Oncol Biol Phys41, 809–815 (1998).
29.
SeddonB.CookA.GothardL.SalmonE.LatusK.UnderwoodS. R.YarnoldJ.Detection of defects in myocardial perfusion imaging in patients with early breast cancer treated with radiotherapy. Radiother Oncol64, 53–63 (2002). DOI: 10.1016/S0167–8140(02)00133-0.
30.
GyenesG.FornanderT.CarlensP.GlasU.RutqvistL. E.Myocardial injury in breast cancer patients treated with adjuvant radiotherapy: A prospective study. Int J Radiat Oncol Biol Phys36, 899–905 (1996).
31.
TaylorC. W.NisbetA.McGaleP.DarbyS. C.Cardiac exposures in breast cancer radiotherapy: 1950s-1990s. Int J Radiat Oncol Biol Phys69, 1484–1495 (2007). DOI: 10.1016/j.ijrobp.2007.05.034.
