Dosimetric impact of sparing base of heart on organ at risk doses during lung radiotherapy

Tom Marchant; Joseph Wood; Kathryn Banfill; Alan McWilliam; Gareth Price; Corinne Faivre-Finn

doi:10.1016/j.radonc.2024.110654

Dosimetric impact of sparing base of heart on organ at risk doses during lung radiotherapy

Tom Marchant, Joseph Wood, Kathryn Banfill, Alan McWilliam, Gareth Price, Corinne Faivre-Finn

Division of Cancer Sciences (L5)

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Minimising heart exposure during lung radiotherapy (RT) is important due to association between increased cardiac dose and adverse outcomes such as cardiac toxicity and reduced overall survival. This study evaluated the impact of incorporating a cardiac avoidance area (CAA) located at the base of the heart on the dose received by cardiac subregions and thoracic organs at risk.

METHODS: A comparative analysis was conducted on patients treated with lung RT at a single centre before and after the CAA was introduced as an anatomical region at risk (ARR) in April 2023. Two patient cohorts were analysed: those treated prior to CAA implementation (April 2021-March 2023, 923 patients) and those treated post implementation (April 2023-March 2024, 477 patients). For the second group, plans were optimised to keep CAA maximum dose to 1 cc below 19.5 Gy in 20 fractions (or equivalent biologically effective dose). Key dose metrics for the CAA, heart, lungs, oesophagus, and spinal canal were compared between the cohorts.

RESULTS: The introduction of the CAA as an ARR resulted in significant reductions in CAA and overall heart dose, with median CAA maximum dose (EQD2) decreasing from 32.0 Gy3 to 16.9 Gy3 (p < 0.001). No significant increases in dose were observed for other thoracic organs at risk.

CONCLUSIONS: Implementing a cardiac avoidance area in lung RT planning significantly reduces doses to critical heart regions without compromising the safety of other organs. This approach holds promise for reducing cardiac-related adverse events and improving overall survival in patients with lung cancer undergoing RT.

Original language	English
Article number	110654
Journal	Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Volume	202
Early online date	27 Nov 2024
DOIs	https://doi.org/10.1016/j.radonc.2024.110654
Publication status	Published - 1 Jan 2025

Keywords

Humans
Organs at Risk/radiation effects
Lung Neoplasms/radiotherapy
Heart/radiation effects
Radiotherapy Dosage
Male
Female
Aged
Organ Sparing Treatments/methods
Radiotherapy Planning, Computer-Assisted/methods
Middle Aged
Radiotherapy, Intensity-Modulated/methods
Radiation Injuries/prevention & control

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.radonc.2024.110654Licence: CC BY

NIHR Manchester Biomedical Research Centre
Bruce, I. (PI), Lord, G. (CoI), Lennon, R. (CoI), Black, G. (CoI), Wedge, D. (CoI), Morris, A. (CoI), Hussell, T. (CoI), Sharrocks, A. (CoI), Stivaros, S. (CoI), Buch, M. (CoI), Gough, J. (CoI), Kostarelos, K. (CoI), Thistlethwaite, F. (CoI), Kadler, K. (CoI), Barton, A. (CoI), Hyrich, K. (CoI), Mcbeth, J. (CoI), O'Neill, T. (CoI), Vestbo, J. (CoI), Simpson, A. (CoI), Singh, S. (CoI), Smith, J. (CoI), Felton, T. (CoI), Murray, C. (CoI), Griffiths, C. (CoI), Cullum, N. (CoI), Rhodes, L. (CoI), Warren, R. (CoI), Paus, R. (CoI), Dumville, J. (CoI), Viros Usandizaga, A. (CoI), Keavney, B. (CoI), Tomaszewski, M. (CoI), Allan, S. (CoI), Body, R. (CoI), Cartwright, E. (CoI), Heagerty, A. (CoI), Kalra, P. (CoI), Miller, C. (CoI), Rutter, M. (CoI), Smith, C. (CoI), Trafford, A. (CoI), Evans, D. (CoI), Crosbie, E. (CoI), Crosbie, P. (CoI), Harvie, M. (CoI), Howell, S. (CoI), Renehan, A. (CoI), Dive, C. (CoI), Blackhall, F. (CoI), Landers, D. (CoI), Krebs, M. (CoI), Cook, N. (CoI), Clarke, R. (CoI), Taylor, S. (CoI), Jorgensen, C. (CoI), Lorigan, P. (CoI), Jayson, G. (CoI), Valle, J. (CoI), Mccabe, M. (CoI), Armstrong, A. (CoI), Freitas, A. (CoI), Illidge, T. (CoI), Choudhury, A. (CoI), Hoskin, P. (CoI), West, C. (CoI), Van Herk, M. (CoI), Faivre-Finn, C. (CoI), Bristow, R. (CoI), Kirkby, K. (CoI), Birtle, A. (CoI), Mackay, R. (CoI), Radford, J. (CoI), Linton, K. (CoI), Higham, C. (CoI), Munro, K. (CoI), Plack, C. (CoI), Arden Armitage, C. (CoI), Bruce, I. (CoI), Moore, D. (CoI), Saunders, G. (CoI), Stone, M. (CoI), Haddock, G. (CoI), Lewis, S. (CoI), Elliott, R. (CoI), Green, J. (CoI), Lovell, K. (CoI), Morrison, A. (CoI), Shaw, J. (CoI), Bucci, S. (CoI), Ainsworth, J. (CoI), Webb, R. (CoI), Newman, W. (CoI), Banka, S. (CoI), Clayton-Smith, J. (CoI), Payne, K. (CoI), Moldovan, R. (CoI), Wynn, R. (CoI) & Jones, S. (CoI)
1/12/22 → 30/11/27
Project: Research

Cite this

@article{51d2aa2b7f4e481dbde2a376513c84bb,

title = "Dosimetric impact of sparing base of heart on organ at risk doses during lung radiotherapy",

abstract = "BACKGROUND: Minimising heart exposure during lung radiotherapy (RT) is important due to association between increased cardiac dose and adverse outcomes such as cardiac toxicity and reduced overall survival. This study evaluated the impact of incorporating a cardiac avoidance area (CAA) located at the base of the heart on the dose received by cardiac subregions and thoracic organs at risk.METHODS: A comparative analysis was conducted on patients treated with lung RT at a single centre before and after the CAA was introduced as an anatomical region at risk (ARR) in April 2023. Two patient cohorts were analysed: those treated prior to CAA implementation (April 2021-March 2023, 923 patients) and those treated post implementation (April 2023-March 2024, 477 patients). For the second group, plans were optimised to keep CAA maximum dose to 1 cc below 19.5 Gy in 20 fractions (or equivalent biologically effective dose). Key dose metrics for the CAA, heart, lungs, oesophagus, and spinal canal were compared between the cohorts.RESULTS: The introduction of the CAA as an ARR resulted in significant reductions in CAA and overall heart dose, with median CAA maximum dose (EQD2) decreasing from 32.0 Gy3 to 16.9 Gy3 (p < 0.001). No significant increases in dose were observed for other thoracic organs at risk.CONCLUSIONS: Implementing a cardiac avoidance area in lung RT planning significantly reduces doses to critical heart regions without compromising the safety of other organs. This approach holds promise for reducing cardiac-related adverse events and improving overall survival in patients with lung cancer undergoing RT.",

keywords = "Humans, Organs at Risk/radiation effects, Lung Neoplasms/radiotherapy, Heart/radiation effects, Radiotherapy Dosage, Male, Female, Aged, Organ Sparing Treatments/methods, Radiotherapy Planning, Computer-Assisted/methods, Middle Aged, Radiotherapy, Intensity-Modulated/methods, Radiation Injuries/prevention & control",

author = "Tom Marchant and Joseph Wood and Kathryn Banfill and Alan McWilliam and Gareth Price and Corinne Faivre-Finn",

year = "2025",

month = jan,

day = "1",

doi = "10.1016/j.radonc.2024.110654",

language = "English",

volume = "202",

journal = "Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology",

issn = "0167-8140",

publisher = "Elsevier BV",

}

TY - JOUR

T1 - Dosimetric impact of sparing base of heart on organ at risk doses during lung radiotherapy

AU - Marchant, Tom

AU - Wood, Joseph

AU - Banfill, Kathryn

AU - McWilliam, Alan

AU - Price, Gareth

AU - Faivre-Finn, Corinne

PY - 2025/1/1

Y1 - 2025/1/1

N2 - BACKGROUND: Minimising heart exposure during lung radiotherapy (RT) is important due to association between increased cardiac dose and adverse outcomes such as cardiac toxicity and reduced overall survival. This study evaluated the impact of incorporating a cardiac avoidance area (CAA) located at the base of the heart on the dose received by cardiac subregions and thoracic organs at risk.METHODS: A comparative analysis was conducted on patients treated with lung RT at a single centre before and after the CAA was introduced as an anatomical region at risk (ARR) in April 2023. Two patient cohorts were analysed: those treated prior to CAA implementation (April 2021-March 2023, 923 patients) and those treated post implementation (April 2023-March 2024, 477 patients). For the second group, plans were optimised to keep CAA maximum dose to 1 cc below 19.5 Gy in 20 fractions (or equivalent biologically effective dose). Key dose metrics for the CAA, heart, lungs, oesophagus, and spinal canal were compared between the cohorts.RESULTS: The introduction of the CAA as an ARR resulted in significant reductions in CAA and overall heart dose, with median CAA maximum dose (EQD2) decreasing from 32.0 Gy3 to 16.9 Gy3 (p < 0.001). No significant increases in dose were observed for other thoracic organs at risk.CONCLUSIONS: Implementing a cardiac avoidance area in lung RT planning significantly reduces doses to critical heart regions without compromising the safety of other organs. This approach holds promise for reducing cardiac-related adverse events and improving overall survival in patients with lung cancer undergoing RT.

AB - BACKGROUND: Minimising heart exposure during lung radiotherapy (RT) is important due to association between increased cardiac dose and adverse outcomes such as cardiac toxicity and reduced overall survival. This study evaluated the impact of incorporating a cardiac avoidance area (CAA) located at the base of the heart on the dose received by cardiac subregions and thoracic organs at risk.METHODS: A comparative analysis was conducted on patients treated with lung RT at a single centre before and after the CAA was introduced as an anatomical region at risk (ARR) in April 2023. Two patient cohorts were analysed: those treated prior to CAA implementation (April 2021-March 2023, 923 patients) and those treated post implementation (April 2023-March 2024, 477 patients). For the second group, plans were optimised to keep CAA maximum dose to 1 cc below 19.5 Gy in 20 fractions (or equivalent biologically effective dose). Key dose metrics for the CAA, heart, lungs, oesophagus, and spinal canal were compared between the cohorts.RESULTS: The introduction of the CAA as an ARR resulted in significant reductions in CAA and overall heart dose, with median CAA maximum dose (EQD2) decreasing from 32.0 Gy3 to 16.9 Gy3 (p < 0.001). No significant increases in dose were observed for other thoracic organs at risk.CONCLUSIONS: Implementing a cardiac avoidance area in lung RT planning significantly reduces doses to critical heart regions without compromising the safety of other organs. This approach holds promise for reducing cardiac-related adverse events and improving overall survival in patients with lung cancer undergoing RT.

KW - Humans

KW - Organs at Risk/radiation effects

KW - Lung Neoplasms/radiotherapy

KW - Heart/radiation effects

KW - Radiotherapy Dosage

KW - Male

KW - Female

KW - Aged

KW - Organ Sparing Treatments/methods

KW - Radiotherapy Planning, Computer-Assisted/methods

KW - Middle Aged

KW - Radiotherapy, Intensity-Modulated/methods

KW - Radiation Injuries/prevention & control

U2 - 10.1016/j.radonc.2024.110654

DO - 10.1016/j.radonc.2024.110654

M3 - Article

C2 - 39608678

SN - 0167-8140

VL - 202

JO - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

JF - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

M1 - 110654

ER -

Dosimetric impact of sparing base of heart on organ at risk doses during lung radiotherapy

Abstract

Keywords

UN SDGs

Access to Document

Fingerprint

Projects

NIHR Manchester Biomedical Research Centre

Cite this