TY - JOUR
T1 - Exposure of the heart in lung cancer radiation therapy
T2 - A systematic review of heart doses published during 2013 to 2020
AU - Kearney, Maeve
AU - Keys, Maeve
AU - Faivre-Finn, Corinne
AU - Wang, Zhe
AU - Aznar, Marianne C
AU - Duane, Frances
N1 - Funding Information:
M Keys received funding from HSE-NDTP Aspire Post-CSCST Fellowship Award, Ireland. ZW and MA received funding from Cancer Research UK grant C8225/A21133. Professor Faivre-Finn is supported by a grant from the NIHR Manchester Biomedical Research Centre. M Kearney and FD received no funding. None.
Publisher Copyright:
© 2022 The Author(s)
PY - 2022/7/1
Y1 - 2022/7/1
N2 - BACKGROUND AND PURPOSE: Lung cancer radiotherapy increases the risk of cardiotoxicity and heart radiation dose is an independent predictor of poor survival. This study describes heart doses and strategies aiming to reduce exposure.MATERIALS AND METHODS: A systematic review of lung cancer dosimetry studies reporting heart doses published 2013-2020 was undertaken. Doses were compared according to laterality, region irradiated, treatment modality (stereotactic ablative body radiotherapy (SABR) and non-SABR), planning technique, and respiratory motion management.RESULTS: For 392 non-SABR regimens in 105 studies, the average MHD was 10.3 Gy (0.0-48.4) and was not significantly different between left and right-sided tumours. It was similar between IMRT and 3DCRT (10.9 Gy versus 10.6 Gy) and lower with particle beam therapy (proton 7.0 Gy; carbon-ion 1.9 Gy). Active respiratory motion management reduced exposure (7.4 Gy versus 9.3 Gy). For 168 SABR regimens in 35 studies, MHD was 4.0 Gy (0.0-32.4). Exposure was higher in central and lower lobe lesions (6.3 and 5.8 Gy respectively). MHD was lowest for carbon ions (0.5 Gy) compared to other techniques. Active respiratory motion management reduced exposure (2.4 Gy versus 5.0 Gy). Delineation guidelines and Dose Volume Constraints for the heart varied substantially.CONCLUSIONS: There is scope to reduce heart radiation dose in lung cancer radiotherapy. Consensus on planning objectives, contouring and DVCs for the heart may lead to reduced heart doses in the future. For IMRT, more stringent optimisation objectives may reduce heart dose. Active respiratory motion management or particle therapy may be considered in situations where cardiac dose is high.
AB - BACKGROUND AND PURPOSE: Lung cancer radiotherapy increases the risk of cardiotoxicity and heart radiation dose is an independent predictor of poor survival. This study describes heart doses and strategies aiming to reduce exposure.MATERIALS AND METHODS: A systematic review of lung cancer dosimetry studies reporting heart doses published 2013-2020 was undertaken. Doses were compared according to laterality, region irradiated, treatment modality (stereotactic ablative body radiotherapy (SABR) and non-SABR), planning technique, and respiratory motion management.RESULTS: For 392 non-SABR regimens in 105 studies, the average MHD was 10.3 Gy (0.0-48.4) and was not significantly different between left and right-sided tumours. It was similar between IMRT and 3DCRT (10.9 Gy versus 10.6 Gy) and lower with particle beam therapy (proton 7.0 Gy; carbon-ion 1.9 Gy). Active respiratory motion management reduced exposure (7.4 Gy versus 9.3 Gy). For 168 SABR regimens in 35 studies, MHD was 4.0 Gy (0.0-32.4). Exposure was higher in central and lower lobe lesions (6.3 and 5.8 Gy respectively). MHD was lowest for carbon ions (0.5 Gy) compared to other techniques. Active respiratory motion management reduced exposure (2.4 Gy versus 5.0 Gy). Delineation guidelines and Dose Volume Constraints for the heart varied substantially.CONCLUSIONS: There is scope to reduce heart radiation dose in lung cancer radiotherapy. Consensus on planning objectives, contouring and DVCs for the heart may lead to reduced heart doses in the future. For IMRT, more stringent optimisation objectives may reduce heart dose. Active respiratory motion management or particle therapy may be considered in situations where cardiac dose is high.
KW - Carbon
KW - Heart
KW - Humans
KW - Lung Neoplasms/radiotherapy
KW - Radiotherapy Dosage
KW - Radiotherapy Planning, Computer-Assisted/methods
KW - Radiotherapy, Intensity-Modulated/adverse effects
U2 - 10.1016/j.radonc.2022.05.007
DO - 10.1016/j.radonc.2022.05.007
M3 - Review article
C2 - 35577022
SN - 0167-8140
VL - 172
SP - 118
EP - 125
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
ER -
