Cardiac Protective Techniques in Left Breast Radiotherapy: Rapid selection criteria for routine clinical decision making

Abstract

Abstract Objective: In left breast radiotherapy (RT) desired heart doses may be achieved without heart-sparing RT techniques in some patients. We aimed to examine the existence of predictive factors and cut-off points to determine which patients are the main candidates for heart-sparing RT techniques. Material and method: Dosimetric data for left breast cancer was examined. RT plans were made at conventional doses to the breast and peripheral lymph nodes. Statistical analyzes were performed using SPSS 22.0 (SPSS Inc.,IBM Corp.,Armonk, NY). Results: 114 cases were evaluated by ROC analysis in the breast conserving surgery (BCS) and mastectomy groups. While only left lung volume (AUC:0.74, 95%CI:0.61-0.87, p=0.002) was significant in BCS cases, in cases with mastectomy, left lung volume (AUC:0.81, 95%CI:0.69-0.94, p=0.002) and lung/heart volume ratio (AUC:0.83,95%CI:0.70-0.96, p=0.001) had a significant relationship with the relevance of heart doses. The cut-off point of 1.92 was selected for the lung/heart volume ratio for the mastectomized patients. Moreover, the cut-off point 1154 cc and 1208 cc was determined for the left lung volume for the BCS and mastectomized patients, respectively. Conclusion: Various cut-off points in left breast RT can be used to predict whether RT plans will meet QUANTEC heart dose limits. Evaluating only these few cut-off points before planning makes it possible to eliminate 70% of patients with BCS and 40% of patients with mastectomy from respiratory-controlled methods, which require time and effort. Patients with lung volume and lung/heart volume ratio smaller than the cut-off values can be considered primary candidates for heart-sparing techniques.