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dc.contributor.authorEvans, Suzanne B.
dc.contributor.authorSioshansi, Shirin
dc.contributor.authorMoran, Meena S.
dc.contributor.authorHiatt, Jessica
dc.contributor.authorPrice, Lori Lyn
dc.contributor.authorWazer, David E.
dc.date2022-08-11T08:10:45.000
dc.date.accessioned2022-08-23T17:18:43Z
dc.date.available2022-08-23T17:18:43Z
dc.date.issued2012-12-01
dc.date.submitted2014-01-25
dc.identifier.citationAm J Clin Oncol. 2012 Dec;35(6):587-92. doi: 10.1097/COC.0b013e31822d9cf6. <a href="http://dx.doi.org/10.1097/COC.0b013e31822d9cf6">Link to article on publisher's site</a>
dc.identifier.issn0277-3732 (Linking)
dc.identifier.doi10.1097/COC.0b013e31822d9cf6
dc.identifier.pmid21926900
dc.identifier.urihttp://hdl.handle.net/20.500.14038/47916
dc.description.abstractPURPOSE: : The purpose of the study was to identify patient characteristics that predict for increased cardiac exposure through dosimetric analysis of the anatomy of a cohort of women treated with left-sided tangential breast radiation. Statistical analyses estimations for the appropriate sample sizes required for detection of significant differences in cardiac mortality at 15 years were conducted, assuming a threshold V25 for radiation-induced coronary artery disease (CAD) beyond which women are at risk for radiation-induced coronary artery disease. METHODS AND MATERIALS: : Detailed heart dosimetry was recorded. Clinical factors (age, history of CAD, diabetes, receipt of cardiotoxic agents, weight/body mass index) and anatomic factors (heart volume, breast volume, cardiac contact distance) were recorded for each patient. RESULTS: : The average heart V25 was 3.57%. The median percentage of the heart included in the tangential beam was 4.02%. There were no clinical or anatomic factors that predict suboptimal heart anatomy (ie, V25 of >/=6%) on multivariate analysis. The sample size calculations using thresholds for induction of CAD of V25 >/=1%, 6%, and 10% yielded sample sizes of 1314, 9504, and 61,342, respectively; considering node-positive breast cancer mortality and 15% loss to follow-up, these change to 2237, 16,166, and 104,334, respectively. CONCLUSIONS: : Current studies with modern radiotherapy techniques would be underpowered to detect a difference in cardiac mortality where only some women are at risk. The heart, chest wall, and breast have a complex relationship to tangential breast radiation, and their interplay prevented this anatomic metric's success.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=21926900&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1097/COC.0b013e31822d9cf6
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectBody Mass Index
dc.subjectBreast
dc.subjectBreast Neoplasms
dc.subjectCarcinoma
dc.subjectCoronary Artery Disease
dc.subjectFemale
dc.subjectHeart
dc.subjectHumans
dc.subjectMiddle Aged
dc.subjectMultivariate Analysis
dc.subjectOrgan Size
dc.subjectRadiation Injuries
dc.subjectRadiotherapy Dosage
dc.subjectNeoplasms
dc.subjectOncology
dc.titlePrevalence of poor cardiac anatomy in carcinoma of the breast treated with whole-breast radiotherapy: reconciling modern cardiac dosimetry with cardiac mortality data
dc.typeJournal Article
dc.source.journaltitleAmerican journal of clinical oncology
dc.source.volume35
dc.source.issue6
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/radiationoncology_pubs/15
dc.identifier.contextkey5020112
html.description.abstract<p>PURPOSE: : The purpose of the study was to identify patient characteristics that predict for increased cardiac exposure through dosimetric analysis of the anatomy of a cohort of women treated with left-sided tangential breast radiation. Statistical analyses estimations for the appropriate sample sizes required for detection of significant differences in cardiac mortality at 15 years were conducted, assuming a threshold V25 for radiation-induced coronary artery disease (CAD) beyond which women are at risk for radiation-induced coronary artery disease.</p> <p>METHODS AND MATERIALS: : Detailed heart dosimetry was recorded. Clinical factors (age, history of CAD, diabetes, receipt of cardiotoxic agents, weight/body mass index) and anatomic factors (heart volume, breast volume, cardiac contact distance) were recorded for each patient.</p> <p>RESULTS: : The average heart V25 was 3.57%. The median percentage of the heart included in the tangential beam was 4.02%. There were no clinical or anatomic factors that predict suboptimal heart anatomy (ie, V25 of >/=6%) on multivariate analysis. The sample size calculations using thresholds for induction of CAD of V25 >/=1%, 6%, and 10% yielded sample sizes of 1314, 9504, and 61,342, respectively; considering node-positive breast cancer mortality and 15% loss to follow-up, these change to 2237, 16,166, and 104,334, respectively.</p> <p>CONCLUSIONS: : Current studies with modern radiotherapy techniques would be underpowered to detect a difference in cardiac mortality where only some women are at risk. The heart, chest wall, and breast have a complex relationship to tangential breast radiation, and their interplay prevented this anatomic metric's success.</p>
dc.identifier.submissionpathradiationoncology_pubs/15
dc.contributor.departmentDepartment of Radiation Oncology
dc.source.pages587-92


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