Nationwide Trends in Heart-Sparing Techniques Utilized in Radiation Therapy for Breast Cancer
Nationwide Trends in Heart-Sparing Techniques Utilized in Radiation Therapy for Breast Cancer
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DOI：
10.1016/j.adro.2019.01.001
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发表时间：
2019-04-01
影响因子：
2.3
通讯作者：
Bergom, Carmen
中科院分区：
文献类型：
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作者：
Desai, Nina;Currey, Adam;Bergom, Carmen
目的：对心脏的辐射剂量与心脏相关死亡相关，并可能在一定程度上削弱辐射对乳腺癌的益处。这项研究评估了目前全国范围内乳腺癌放射治疗中保留心脏技术的趋势。方法和材料：2017年11月，向美国的放射肿瘤学家发送了一份机构审查委员会批准的调查。问题评估了人口统计数据以及保心技术的类型和频率。数据分析采用描述性统计和chi(2)检验。结果：共获得530份回复（13%）。大多数医生从事bb15年（46%），其中大多数是在私人机构（59%）。83%的医生提供俯卧位和/或深吸气屏气（DIBH）。这在学术实践中更为常见（P < 0.01）。73%的医生对超过四分之三的左脑患者使用保心技术。最常用的技术是DIBH， 43%的医生使用该技术超过四分之三的时间。常用的DIBH系统是Varian RPM（54%）和Vision RT/Align RT（31%）。局部淋巴结照射未观察到DIBH的使用增加，乳腺内链淋巴结的覆盖范围有所不同。患者耐受性（78%）和心-胸壁距离（72%）是左侧患者DIBH最常见的决定因素。23%的医生对右侧患者使用DIBH，其中肺（64%）和心脏（46%）是最常见的使用原因。缺乏设施是不使用DIBH的最常见原因（61%）。结论：大多数受访者提供乳腺癌放疗保心技术；这在学术中心更为常见。DIBH是所有练习环境中最常见的技术。DIBH在右侧患者中较少使用，但仍有20%的从业者使用，肺和心脏保护被认为是使用的原因。需要更多的数据来确定是否以及何时应该在右侧病例中使用该技术。(C) 2019作者。由爱思唯尔公司代表美国放射肿瘤学会出版。
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 chi(2) 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. (C) 2019 The Authors. Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.