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Simple method to estimate mean heart dose from Hodgkin lymphoma radiation therapy according to simulation X-rays
Frederika A van Nimwegen1, David J Cutter2, Michael Schaapveld1
1Department of Psychosocial Research, Epidemiology, and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Insights
A new method uses radiation therapy simulation X-rays to estimate mean heart dose in Hodgkin lymphoma survivors, offering a faster, reproducible alternative to CT-based dosimetry for assessing cardiac complication risks.
Area of Science:
- Radiation oncology
- Cardiovascular health
- Medical imaging
Background:
- Mean heart dose is crucial for predicting late cardiovascular complications in Hodgkin lymphoma (HL) survivors.
- Retrospective dose estimation for patients treated before CT planning is often labor-intensive.
Purpose of the Study:
- To introduce and validate a novel method for estimating mean heart dose using simulation X-rays.
- To provide a simpler, more efficient approach for retrospective dosimetry in HL patients.
Main Methods:
- Cardiac contours were delineated on simulation X-rays from 42 HL survivors.
- Mean heart dose was calculated using a formula involving cardiac contour percentage within the radiation field and prescribed mediastinal dose.
- Results were compared to previously established CT-based dosimetry.
Main Results:
- The simulation X-ray method demonstrated excellent inter-rater agreement (ICC=0.93).
- Mean heart dose estimates were comparable between the simulation X-ray method (30.4 Gy) and CT-based dosimetry (30.2 Gy).
- Good agreement (ICC=0.87) was found between the two dosimetry methods.
Conclusions:
- Estimating mean heart dose from simulation X-rays is a reproducible and fast method.
- This technique accounts for individual patient anatomy.
- The simulation X-ray method provides results comparable to labor-intensive CT-based dosimetry, aiding studies on cardiac complications.
Purpose:
To describe a new method to estimate the mean heart dose for Hodgkin lymphoma patients treated several decades ago, using delineation of the heart on radiation therapy simulation X-rays. Mean heart dose is an important predictor for late cardiovascular complications after Hodgkin lymphoma (HL) treatment. For patients treated before the era of computed tomography (CT)-based radiotherapy planning, retrospective estimation of radiation dose to the heart can be labor intensive.
Methods And Materials:
Patients for whom cardiac radiation doses had previously been estimated by reconstruction of individual treatments on representative CT data sets were selected at random from a case-control study of 5-year Hodgkin lymphoma survivors (n=289). For 42 patients, cardiac contours were outlined on each patient's simulation X-ray by 4 different raters, and the mean heart dose was estimated as the percentage of the cardiac contour within the radiation field multiplied by the prescribed mediastinal dose and divided by a correction factor obtained by comparison with individual CT-based dosimetry.
Results:
According to the simulation X-ray method, the medians of the mean heart doses obtained from the cardiac contours outlined by the 4 raters were 30 Gy, 30 Gy, 31 Gy, and 31 Gy, respectively, following prescribed mediastinal doses of 25-42 Gy. The absolute-agreement intraclass correlation coefficient was 0.93 (95% confidence interval 0.85-0.97), indicating excellent agreement. Mean heart dose was 30.4 Gy with the simulation X-ray method, versus 30.2 Gy with the representative CT-based dosimetry, and the between-method absolute-agreement intraclass correlation coefficient was 0.87 (95% confidence interval 0.80-0.95), indicating good agreement between the two methods.
Conclusion:
Estimating mean heart dose from radiation therapy simulation X-rays is reproducible and fast, takes individual anatomy into account, and yields results comparable to the labor-intensive representative CT-based method. This simpler method may produce a meaningful measure of mean heart dose for use in studies of late cardiac complications.
