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Impact of patient-specific factors, irradiated left ventricular volume, and treatment set-up errors on the development of myocardial perfusion defects after radiation therapy for left-sided breast cancer.

Publication ,  Journal Article
Evans, ES; Prosnitz, RG; Yu, X; Zhou, S-M; Hollis, DR; Wong, TZ; Light, KL; Hardenbergh, PH; Blazing, MA; Marks, LB
Published in: Int J Radiat Oncol Biol Phys
November 15, 2006

PURPOSE: The aim of this study was to assess the impact of patient-specific factors, left ventricle (LV) volume, and treatment set-up errors on the rate of perfusion defects 6 to 60 months post-radiation therapy (RT) in patients receiving tangential RT for left-sided breast cancer. METHODS AND MATERIALS: Between 1998 and 2005, a total of 153 patients were enrolled onto an institutional review board-approved prospective study and had pre- and serial post-RT (6-60 months) cardiac perfusion scans to assess for perfusion defects. Of the patients, 108 had normal pre-RT perfusion scans and available follow-up data. The impact of patient-specific factors on the rate of perfusion defects was assessed at various time points using univariate and multivariate analysis. The impact of set-up errors on the rate of perfusion defects was also analyzed using a one-tailed Fisher's Exact test. RESULTS: Consistent with our prior results, the volume of LV in the RT field was the most significant predictor of perfusion defects on both univariate (p = 0.0005 to 0.0058) and multivariate analysis (p = 0.0026 to 0.0029). Body mass index (BMI) was the only significant patient-specific factor on both univariate (p = 0.0005 to 0.022) and multivariate analysis (p = 0.0091 to 0.05). In patients with very small volumes of LV in the planned RT fields, the rate of perfusion defects was significantly higher when the fields set-up "too deep" (83% vs. 30%, p = 0.059). The frequency of deep set-up errors was significantly higher among patients with BMI > or =25 kg/m2 compared with patients of normal weight (47% vs. 28%, p = 0.068). CONCLUSIONS: BMI > or =25 kg/m2 may be a significant risk factor for cardiac toxicity after RT for left-sided breast cancer, possibly because of more frequent deep set-up errors resulting in the inclusion of additional heart in the RT fields. Further study is necessary to better understand the impact of patient-specific factors and set-up errors on the development of RT-induced perfusion defects.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

November 15, 2006

Volume

66

Issue

4

Start / End Page

1125 / 1134

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Sex Distribution
  • Risk Factors
  • Risk Assessment
  • Radiotherapy, Conformal
  • Radiation Injuries
  • Prevalence
  • Oncology & Carcinogenesis
  • North Carolina
 

Citation

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Evans, E. S., Prosnitz, R. G., Yu, X., Zhou, S.-M., Hollis, D. R., Wong, T. Z., … Marks, L. B. (2006). Impact of patient-specific factors, irradiated left ventricular volume, and treatment set-up errors on the development of myocardial perfusion defects after radiation therapy for left-sided breast cancer. Int J Radiat Oncol Biol Phys, 66(4), 1125–1134. https://doi.org/10.1016/j.ijrobp.2006.06.025
Evans, Elizabeth S., Robert G. Prosnitz, Xiaoli Yu, Su-Min Zhou, Donna R. Hollis, Terence Z. Wong, Kim L. Light, Patricia H. Hardenbergh, Michael A. Blazing, and Lawrence B. Marks. “Impact of patient-specific factors, irradiated left ventricular volume, and treatment set-up errors on the development of myocardial perfusion defects after radiation therapy for left-sided breast cancer.Int J Radiat Oncol Biol Phys 66, no. 4 (November 15, 2006): 1125–34. https://doi.org/10.1016/j.ijrobp.2006.06.025.
Evans, Elizabeth S., et al. “Impact of patient-specific factors, irradiated left ventricular volume, and treatment set-up errors on the development of myocardial perfusion defects after radiation therapy for left-sided breast cancer.Int J Radiat Oncol Biol Phys, vol. 66, no. 4, Nov. 2006, pp. 1125–34. Pubmed, doi:10.1016/j.ijrobp.2006.06.025.
Evans ES, Prosnitz RG, Yu X, Zhou S-M, Hollis DR, Wong TZ, Light KL, Hardenbergh PH, Blazing MA, Marks LB. Impact of patient-specific factors, irradiated left ventricular volume, and treatment set-up errors on the development of myocardial perfusion defects after radiation therapy for left-sided breast cancer. Int J Radiat Oncol Biol Phys. 2006 Nov 15;66(4):1125–1134.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

November 15, 2006

Volume

66

Issue

4

Start / End Page

1125 / 1134

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Sex Distribution
  • Risk Factors
  • Risk Assessment
  • Radiotherapy, Conformal
  • Radiation Injuries
  • Prevalence
  • Oncology & Carcinogenesis
  • North Carolina