Adoption of Expansion Margins to Reduce the Dose Received by the Coronary Arteries and the Risk of Cardiovascular Events in Lymphoma Patients |
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| Authors: | Viola De Luca Elena Gallio Sara Bartoncini Francesca Romana Giglioli Anna Sardo Chiara Cavallin Giuseppe Carlo Iorio Erika Orlandi Ramona Parise Carmela Palladino Alberto Buonavita Christian Fiandra Mario Levis Umberto Ricardi |
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| Affiliation: | 1. Department of Oncology, University of Torino, Torino, Italy;2. Medical Physics Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy;1. Medical Physics Service, Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy;2. Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy;3. Department of Medical Physics, Aarhus University Hospital, Denmark;4. Bone Marrow Transplantation Unit, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy;5. Medical Oncology Department, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy;6. Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy;1. Department of Clinical Oncology, La Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 1/F, Professorial Block, 102 Pokfulam Road, Hong Kong, China;2. Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Haiyuan 1st Road, Futien District, Shenzhen 518053, China;1. Department of Radiation Oncology and Department of Head & Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China;2. Department of Radiation Oncology, Seidman Cancer Center, University Hospitals and Case Western Reserve University, Cleveland, OH 44106, United States;1. Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, United States;2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, United States;3. Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, United States;4. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, United States;5. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, United States;6. Department of Radiation Oncology, Mayo Clinic, United States;7. Department of Radiation Oncology, Keck School of Medicine of USC, United States |
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| Abstract: | ![]()
PurposeMediastinal radiation therapy (RT) in patients with lymphoma implies involuntary coronary artery (CA) exposure, resulting in an increased risk of coronary artery disease (CAD). Accurate delineation of CAs may spare them from higher RT doses. However, heart motion affects the estimation of the dose received by CAs. An expansion margin (planning organ at risk volume [PRV]), encompassing the nearby area where CAs displace, may compensate for these uncertainties, reducing CA dose and CAD risk. Our study aimed to evaluate if a planning process optimized on CA-specific PRVs, rather than just on CAs, could provide any dosimetric or clinical benefit.Methods and MaterialsForty patients receiving RT for mediastinal lymphomas were included. We contoured left main trunk, left anterior descending, left circumflex, and right coronary arteries. An isotropic PRV was then applied to all CAs, in accordance with literature data. A comparison was then performed by optimizing treatment plans either on CAs or on PRVs, to detect any difference in CA sparing in terms of maximum (Dmax), median (Dmed), and mean (Dmean) dose. We then investigated, through risk modeling, if any dosimetric benefit obtained with the PRV-related optimization process could translate to a lower risk of ischemic complications.ResultsPlan optimization on PRVs demonstrated a significant dose reduction (range, 7%-9%) in Dmax, Dmed, and Dmean for the whole coronary tree, and even higher dose reductions when vessels were located 5- to 20-mm from PTV (range, 13%-15%), especially for left main trunk and left circumflex (range, 16%-21%). This translated to a mean risk reduction of developing CAD of 12% (P < .01), which increased to 17% when CAs were located 5- to 20-mm from PTV.ConclusionsIntegration of CA-related PRVs in the optimization process reduces the dose received by CAs and translates to a meaningful prevention of CAD risk in patients with lymphoma treated with mediastinal RT. |
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