TY - JOUR
T1 - Nationwide Trends in Heart-Sparing Techniques Utilized in Radiation Therapy for Breast Cancer
AU - Desai, Nina
AU - Currey, Adam
AU - Kelly, Tracy
AU - Bergom, Carmen
N1 - Publisher Copyright:
© 2019 The Authors
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Purpose: Radiation dose to the heart correlates with cardiac-related deaths and may partially diminish the benefit of radiation for breast cancer. This study assessed the current nationwide trends in heart-sparing techniques for breast cancer radiation. Methods and Materials: In November 2017, an institutional review board–approved survey was sent to radiation oncologists in the United States. Questions assessed demographics and the type and frequency of heart-sparing techniques. Data were analyzed using descriptive statistics and χ2 tests. Results: In total, 530 responses (13%) were obtained. Most physicians had practiced >15 years (46%), with most in a private setting (59%). Eighty-three percent of physicians offered prone positioning and/or deep inspiration breath hold (DIBH). This was more common in academic practice (P <.01). Seventy-three percent of physicians used heart-sparing techniques for more than three-fourths of left-sided patients. The most commonly used technique was DIBH, and 43% of physicians used the technique more than three-fourths of the time. Commonly used DIBH systems were Varian RPM (54%) and Vision RT/Align RT (31%). No increase in DIBH use was observed with regional nodal irradiation, and coverage of internal mammary chain nodes varied. Patient tolerance (78%) and cardiac-to-chest wall distance (72%) were the most common determinants of DIBH in left-sided patients. Twenty-three percent of physicians used DIBH for right-sided patients, with lung (64%) and heart sparing (46%) as the most common reasons for use. Lack of facilities was the most common reason not to use DIBH (61%). Conclusions: Most respondents offer heart-sparing techniques for breast cancer radiation; this is more common in academic centers. DIBH is the most common technique across all practice settings. DIBH is much less commonly used in right-sided patients but is still used by >20% of practitioners, with lung and heart sparing cited as reasons for use. More data are needed to determine if and when this technique should be used in right-sided cases.
AB - Purpose: Radiation dose to the heart correlates with cardiac-related deaths and may partially diminish the benefit of radiation for breast cancer. This study assessed the current nationwide trends in heart-sparing techniques for breast cancer radiation. Methods and Materials: In November 2017, an institutional review board–approved survey was sent to radiation oncologists in the United States. Questions assessed demographics and the type and frequency of heart-sparing techniques. Data were analyzed using descriptive statistics and χ2 tests. Results: In total, 530 responses (13%) were obtained. Most physicians had practiced >15 years (46%), with most in a private setting (59%). Eighty-three percent of physicians offered prone positioning and/or deep inspiration breath hold (DIBH). This was more common in academic practice (P <.01). Seventy-three percent of physicians used heart-sparing techniques for more than three-fourths of left-sided patients. The most commonly used technique was DIBH, and 43% of physicians used the technique more than three-fourths of the time. Commonly used DIBH systems were Varian RPM (54%) and Vision RT/Align RT (31%). No increase in DIBH use was observed with regional nodal irradiation, and coverage of internal mammary chain nodes varied. Patient tolerance (78%) and cardiac-to-chest wall distance (72%) were the most common determinants of DIBH in left-sided patients. Twenty-three percent of physicians used DIBH for right-sided patients, with lung (64%) and heart sparing (46%) as the most common reasons for use. Lack of facilities was the most common reason not to use DIBH (61%). Conclusions: Most respondents offer heart-sparing techniques for breast cancer radiation; this is more common in academic centers. DIBH is the most common technique across all practice settings. DIBH is much less commonly used in right-sided patients but is still used by >20% of practitioners, with lung and heart sparing cited as reasons for use. More data are needed to determine if and when this technique should be used in right-sided cases.
UR - http://www.scopus.com/inward/record.url?scp=85063093988&partnerID=8YFLogxK
U2 - 10.1016/j.adro.2019.01.001
DO - 10.1016/j.adro.2019.01.001
M3 - Article
C2 - 31011669
AN - SCOPUS:85063093988
SN - 2452-1094
VL - 4
SP - 246
EP - 252
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 2
ER -