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Modern hypofractionation schedules for tangential whole breast irradiation decrease the fraction size-corrected dose

A L Appelt¹, I R Vogelius, S M Bentzen

¹Department of Oncology, Vejle Hospital, Vejle, Denmark. ane.lindegaard.appelt@slb.regionsyddanmark.dk

Clinical Oncology (Royal College of Radiologists (Great Britain))

|August 23, 2012

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Hypofractionation radiotherapy for breast cancer generally spares the heart, reducing cardiac toxicity. This study confirms that most hypofractionation schedules deliver a lower, fraction size-corrected dose to the heart compared to standard fractionation.

Area of Science:

Radiation Oncology
Medical Physics
Cardiology

Background:

Hypofractionation in breast cancer radiotherapy is increasingly used but raises concerns about late cardiac toxicity.
The linear quadratic model is crucial for predicting radiation dose-effect relationships.

Purpose of the Study:

To evaluate the linear quadratic model's predictions for heart dose with four evidence-based hypofractionation regimens.
To compare estimated fraction size-corrected heart doses between hypofractionation and conventional fractionation schedules.

Main Methods:

Analysis of dose plans from 60 left-sided breast cancer patients.
Calculation of equivalent dose in 2 Gy fractions (EQD(2)) using the linear quadratic model for various fractionation schedules and alpha/beta values.

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Comparison of mean EQD(2) to the heart and the volume receiving 40 Gy between schedules.

Main Results:

Most hypofractionation schedules (40 Gy/15 fractions, 39 Gy/13 fractions, 42.5 Gy/16 fractions) showed favorable heart sparing for alpha/beta values >= 1.5 Gy.
All hypofractionation schedules resulted in lower mean EQD(2) to the heart compared to normofractionation.
Heart blocking further reduced the fraction size-corrected dose for hypofractionation regimens.

Conclusions:

Most examined hypofractionation schedules for whole breast irradiation are predicted to spare the heart compared to normofractionation.
The fraction size-corrected dose to the heart is generally lower with hypofractionated schedules, even at low alpha/beta values.