Alba Fiorentino, Full Professor of Radiation Oncology and Head of the Radiation Oncology Residency Program LUM University of Medicine, shared on LinkedIn:
“We read with interest the American Society for Radiation Oncology (ASTRO) consensus paper on the dose constraints for radiation therapy (RT).
Reducing cardiac exposure in left-sided breast cancer patients is vital due to long-term risks. Darby et alshowed that older RT methods, such as 3-dimensional conformal RT (3D-CRT), increase the risk of ischemic disease by 7.4% per Gy, with no safe threshold.
The recent ASTRO consensus reported a mean heart dose (Dmean) for RT hypofractionated breast/chest wall of <1.6 Gy and 0.8 Gy for the left and right sides, respectively.
The latter consensus and proposed dosimetric indications prompt some considerations.
Title: Heart Dose in Breast Cancer Hypofractionated Radiation Therapy: An Ongoing Concern
Authors: Roberta Carbonara, Fiorella Cristina Di Guglielmo, Maria Paola Ciliberti, Valerio Davì, Silvia Manieri, Domenico Losurdo, Tiziana Talienti, Ilaria Bonaparte, Morena Caliandro, Alessia Surgo, Alba Fiorentino
In conclusion, techniques such as VMAT and deep inspiration breath-hold improve RT for BC.
With personalized medicine and longer survival, sparing normal tissue is key.
The new ASTRO heart constraints should guide RT in young or selected BC patients, while a Dmean of 3.2 Gy, proposed by European Society for Radiotherapy and Oncology (ESTRO), can be safely used in others.”
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