PURPOSE: To quantify mean heart dose (MHD) and doses to the left anterior descending artery (LAD) and left ventricle (LV) in a retrospective series of patients who underwent perioperative accelerated partial breast irradiation with multicatheter interstitial brachytherapy (MIB-APBI). METHODS: Sixty-eight patients with low-risk left breast cancer were treated with MIB-APBI at our institution between 2012 and 2017. Interstitial tubes were inserted during the tumorectomy and sentinel node biopsy and APBI was started 6 days later. The prescribed dose was 34 Gy in 10 fractions (twice a day) to the clinical target volume (CTV). The heart, LAD, and LV were contoured and the distance between each structure and the CTV was measured. The MHD, mean and maximum LAD doses (LAD mean/max), and mean LV doses (LV mean) were calculated and corrected to biologically equivalent doses in 2‑Gy fractionation (EQD2). We also evaluated the impact of the distance between the cardiac structures and the CTV and of the volume receiving the prescribed dose (V100) and high-dose volume (V150) on heart dosimetry. RESULTS: Mean EQD2 for MHD, LAD mean/max, and mean LV were 0.9 ± 0.4 Gy (range 0.3-2.2), 1.6 ± 1.1 Gy (range, 0.4-5.6), 2.6 ± 1.9 Gy (range, 0.7-9.2), and 1.3 ± 0.6 Gy (range, 0.5-3.4), respectively. MHD, LAD mean/max, and LV mean significantly correlated with the distance between the CTV and these structures, but all doses were below the recommended limits (German Society of Radiation Oncology; DEGRO). The MHD and LV mean were significantly dependent on V100. CONCLUSION: Perioperative MIB-APBI resulted in low cardiac doses in our study. This finding provides further support for the value of this technique in well-selected patients with early-stage left breast cancer.

Clinical Study Center Berlin Institute of Health and Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt Universität zu Berlin Berlin Germany

Dept of Oncology and Radiotherapy University Hospital and Medical Faculty Sokolská 281 500 05 Hradec Kralove Czech Republic

Dept of Surgery University Hospital and Medical Faculty Hradec Kralove Czech Republic

Strahlenther Onkol. 2021 May;197(5):461-462. doi: 10.1007/s00066-021-01766-5. PubMed

See more in PubMed

Darby S, McGale P, Correa C et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death meta-analysis of individual patients data for 10.801 women and 17 randomised trials. Lancet 378:1707–1716 DOI

Darby SC, McGale P, Taylor CW et al (2005) Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer? Prospective cohort study of about 300.000 women in US SEER cancer registries. Lancet Oncol 6(8):557–565 DOI

Giordano SH, Kua YF, Freeman JI et al (2005) Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst 9(6):419–424 DOI

Jacob S, Ferrieres J (2016) Breast cancer radiotherapy: a case of double jeopardy. Arch Cardiovasc Dis 109(11):587–590 DOI

Darby SC, Ewertz M, McGale P et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368(11):987–998 DOI

Piroth MD, Baumann R, Budach W et al (2019) Heart toxicity from breast cancer radiotherapy. Strahlenther Onkol 195:1–12 DOI

Polgar C, Major T, Fodor J et al (2010) Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study. Radiother Oncol 94:274–279 DOI

Strnad V, Ott OJ, Hildebrandt G et al (2016) 5‑year result of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast—conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet 387:229–238 DOI

Pohanková D, Sirák I, Jandík P, Kašaová L, Grepl J, Motyčka P, Asqar A, Paluska P, Ninger V, Bydžovská I, Kopecký V, Petera J (2018) Accelerated partial breast irradiation with perioperative multicatheter interstitial brachytherapy – A feasibility study. Brachytherapy 2018:949–955

Cuzick J, Stewart H, Rutqvist L et al (1994) Cause-specific mortality in long-term survivors of breast cancer who participated in the trials of radiotherapy. J Clin Oncol 12:447–453 DOI

Wollschläger D, Merzenich H, Schwentner L et al (2017) Self-reported long-term cardiac morbidity in breast cancer patients: a retrospective cohort study in Germany (PASSOS heart study). Breast Cancer Res Treat 163:595–604 DOI

Taylor CW, Wang Z, Macaulay E et al (2015) Exposure of the heart in breast cancer radiation therapy. A systematic review of heart doses published during 2003 to 2013. Int J Radiat Oncol Biol Phys 93:845–853 DOI

Drost L, Yee C, Lam H et al (2018) A systematic review of heart dose in breast radiotherapy. Clin Breast Cancer 18:819–824 DOI

Witt JS, Gao RW, Sudmeier LJ et al (2019) Low cardiac and left anterior descending coronary artery dose achieved with left-sided multicatheter interstitial-accelerated partial breast irradiation. Brachytherapy 18:50–56 DOI

Strnad V, Krug DE, Sedlmayer F et al (2020) DEGRO practical guideline for partial-breast irradiation. Strahlenther Onkol. https://doi.org/10.1007/s00066-020-01613-z PubMed DOI PMC

Stewart A, O’Farrel DA, Cormack RA et al (2008) Dose volume histogram analysis of normal structures associated with accelerated partial breast irradiation delivered by high dose rate brachytherapy and comparison with whole breast external beam radiotherapy fields. Radiat Oncol 3(39):1–11

Holliday EB, Kirsner AM, Thames HD et al (2017) Lower mean heart dose with deep inspiration breath hold-whole breast irradiation compared with brachytherapy-based accelerated partial breast irradiation for women with left sided tumors. Practical radiation. Oncology 7:80–85

Lara TRM, Fleury E, Mashouf S et al (2014) Measurement of mean cardiac dose for various breast irradiation techniques and corresponding risk of major cardiovascular event. Front Oncol 4:1–9

Shah C, Ghilezan M, Arthur D et al (2012) Initial clinical experience with multilumen brachytherapy catheters for accelerated partial breast irradiation. Brachytherapy 11:369–373 DOI

Petoukhova A, Rűaael I, Nijst-Brouwers J et al (2017) In vivo dosimetry with MOSFETs and GAFCHROMIC films during electron IORT for accelerated partial breast irradiation. Phys Med 44:26–33 DOI

Shah C, Badiyan S, Berry S et al (2014) Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy. Radiother Oncol 112:9–16 DOI

Major T, Stelczer G, Pesznyák C et al (2017) Multicatheter interstitial brachytherapy versus intensity modulated external beam therapy for accelerated partial breast irradiation. A comparative treatment planning study with respect to dosimetry of organs at risk. Radiother Oncol 122:17–23 DOI

Anbumani S, Palled SD, Prabhakar G et al (2012) Accelerated partial breast irradiation using external beam radiotherapy—a feasibility study based on dosimetric analysis. Rep Pract Oncol Radiother 17:200–206 DOI

Stelczer G, Major T, Mezáros N et al (2019) External beam accelerated partial breast irradiation: dosimetric assessment of conformal and three different intensity modulated techniques. Radiol Oncol 53:123–130 DOI

Duma MN, Baumann R, Budach W et al (2019) Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO). Strahlenther Onkol 195:861–871 DOI

Alonso C, Janowski E, Libby E et al (2018) Comparison of heart dose in early-stage left-sided breast cancer treated with intraoperative radiation therapy or whole-breast irradiation with deep inspiratory breath hold. Brachytherapy 17:831–836 DOI

Moran JM, Ben-Daid MA, Marsh RB et al (2009) Accelerated partial breast irradiation: what is dosimetric effect of advanced technology approaches? Int J Radiat Oncol Biol Phys 75:294–301 DOI

Pantelis E, Papagiannis P, Karaiskos P et al (2005) The effect of finite patient dimensions and tissue inhomogeneities on dosimetry planning of 192Ir HDR breast brachytherapy: a Monte Carlo dose verification study. Int J Radiat Oncol Biol Phys 61:1596–1602 DOI

Lymperopoulou G, Papagiannis P, Angelopoulos A et al (2006) A dosimetric comparison of and for HDR brachytherapy of the breast, accounting for the effect of finite patient dimensions and tissue inhomogeneities. Med Phys 33:4583–4589 DOI

Cardiac doses with deep inspiration breath hold in breast cancer radiotherapy: direct comparison between WBI, PBI, and interstitial APBI