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. 2021 Mar 31;57(4):320.
doi: 10.3390/medicina57040320.

A Pilot Study of Safer Radiation Dosage to the Heart and Its Subregions

Rita Steponavičienė  1 , Justinas Jonušas  2 , Romualdas Griškevičius  3 , Jonas Venius  3   4 , Saulius Cicėnas  5
Affiliations

A Pilot Study of Safer Radiation Dosage to the Heart and Its Subregions

Rita Steponavičienė et al. Medicina (Kaunas). .

Abstract

Background and Objectives: The real impact of ionizing radiation on the heart and poorer overall survival for patients with non small cell lung cancer (NSCLC) remains unclear. This study aims to determine the safe dose constraints to the heart's subregions that could prevent patients' early non-cancerous death and improve their quality of life. Methods and Materials: A retrospective cohort study was performed containing 51 consecutive patients diagnosed with stage III NSCLC and treated using 3D, Intensity-modulated radiation therapy (IMRT), and Volumetric modulated arc therapy (VMAT) radiotherapy. For a dosimetric analysis, these structures were chosen: heart, heart base (HB), and region of great blood vessels (GBV). Dose-volume histograms (DVH) were recorded for all mentioned structures. Maximum and mean doses to the heart, HB, the muscle mass of the HB, and GBV were obtained. V10-V60 (%) parameters were calculated from the DVH. After performed statistical analysis, logistic regression models were created, and critical doses calculated. Results: The critical dose for developing a fatal endpoint for HB was 30.5 Gy, while for GBV, it was 46.3 Gy. Increasing the average dose to the HB or GBV by 1 Gy from the critical dose further increases the possibility of early death by 22.0% and 15.8%, respectively. Conclusions: We suggest that the non-canonical sub-regions of the heart (HB and GBV) should be considered during the planning stage. Additional constraints of the heart subregions should be chosen accordingly, and we propose that the mean doses to these regions be 30.5 Gy and 46.3 Gy, respectively, or less. Extrapolated DVH curves for both regions may be used during the planning stage with care.

Keywords: IMRT; NSCLC; heart base; pulmonary artery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Delineation of right atrium (RA), left atrium (LA), and base of the aorta is shown (yellow). Delineated tumor mass is visible (red). (B) Formed structure of heart base (HB) is showed (yellow).
Figure 2
Figure 2
Mean dose–volume histograms (DVH) curves of patients included in the investigation for HB (A) and GBV (B). Group 1 represents patients who died during the follow-up, while group 2 represents patients who survived during this time.
Figure 3
Figure 3
Logistic regression graph plots for HB (A) and GBV (B). The critical average doses to the heart base and great blood vessels were extracted from these graphs using the above-mentioned analysis methods. The critical dose for HB was 30.5 Gy, while for GBV, it was 46.3 Gy.
Figure 4
Figure 4
Created critical DVH curves with their significance plotted for HB (A) and GBV (B). Curves are statistically significant and have a good fit for both subregions in the shown interval from V13 to V60.
See this image and copyright information in PMC

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