Comparison of esophagus dose in breast cancer patients undergoing supraclavicular irradiation with and without esophagus countering.

CONTEXT: Esophagus toxicity and the risk of esophageal cancer are linked to radiation dose to the esophagus in breast cancer patients undergoing supraclavicular irradiation. AIMS: The aim of this study was to evaluate the impact of esophagus contouring on the dose received in the esophagus in breast cancer patients undergoing supraclavicular irradiation. SETTING AND DESIGN: This study included 30 treatment plans for breast cancer patients who received 50 Gy/25 fractions (2 Gy/fraction/day) using 3D-conformal radiation therapy (3D-CRT) to the whole breast or chest wall and supraclavicular. METHODS AND MATERIALS: Our study included two groups: the non-sparing group was the treatment plan in which the esophagus was not delineated and the esophagus sparing group was generated, in which the plans were modified to spare the esophagus. The maximum dose, mean dose, and percentage of esophagus volume received, 5, 10, 15, and 20 Gy, respectively (V5, V10, V15, and V20), were used to evaluate both groups. STATISTICAL ANALYSIS: One-way analysis of variance was used. A P value <0.05 was considered statistically significant. RESULTS: The esophagus sparing group plans show a reduction in the esophageal mean dose Dmean (5.72 ± 5.15) Gy when compared to the non-sparing group (7.83 ± 3.31) Gy. Likewise, the maximum dose, V5, V10, V15, and V20 were reduced in the esophagus sparing group. All dosimetric parameters were significantly higher (P < 0.05) in patients with left breast cancer for both groups. CONCLUSION: Our results suggest that it is possible to reduce the dose to the esophagus by considering the esophagus during treatment planning while maintaining plan quality. This reduction could lead to the greatest predicted decrease in acute esophagitis and esophageal cancer.

Detection of the Early Cardiotoxic Effects of Doxorubicin-Containing Chemotherapy Regimens in Patients with Breast Cancer through Novel Cardiac Magnetic Resonance Imaging: A Short-term Follow-up.

OBJECTIVES: Many patients with breast cancer (BC) require cardiotoxic anthracycline-based chemotherapy. We intended to assess the early cardiotoxic effects of doxorubicin utilizing cardiac magnetic resonance (CMR) imaging. MATERIAL AND METHODS: Forty-nine patients including 21 otherwise healthy females with BC at a mean age (±SD) of 47.62 ± 9.07 years and 28 normal controls at a mean age (±SD) of 45.18 ± 4.29 years were recruited. They underwent CMR and transthoracic echocardiography at baseline and 7 days after four biweekly cycles of doxorubicin and cyclophosphamide. Biventricular functional, volumetric, global strain, and tissue characterization findings were analyzed and compared with those of 28 controls. RESULTS: In post-chemotherapy CMR, 4 patients (19.04%), three symptomatic and one asymptomatic, exhibited evidence of doxorubicin cardiotoxicity. Significant differences in biventricular ejection fraction, left ventricular end-systolic volume index, and all 3D global strain values were noted after chemotherapy in comparison with the baseline (all P < 0.05). More than half of the study population showed a significant change in all right ventricular global strain values. One patient (4.76%) exhibited evidence of diffuse myocardial edema in post-chemotherapy CMR, and 3 patients (14.28%) showed myocardial fibrosis. The study participants were clinically followed up for 4-10 months (mean = 7 months). Overall, 8 patients (38.09%) complained of dyspnea on exertion and fatigue on follow-up. None of the CMR markers was associated with the development of symptoms. CONCLUSION: Our investigation revealed striking changes in CMR parameters in the follow-up of BC patients treated with cardiotoxic chemotherapy. These exclusive CMR features assist in the early initiation of preventive cardiac strategies.

The role of cardiac magnetic resonance imaging in the detection and monitoring of cardiotoxicity in patients with breast cancer after treatment: a comprehensive review.

The use of chemotherapy medicines for breast cancer (BC) has been associated with an increased risk of cardiotoxicity. In recent years, there have been growing interests regarding the application of cardiovascular magnetic resonance (CMR) imaging, a safe and noninvasive modality, with the potential to identify subtle morphological and functional changes in the myocardium. In this investigation, we aimed to review the performance of various CMR methods in diagnosing cardiotoxicity in BC, induced by chemotherapy or radiotherapy. For this purpose, we reviewed the literature available in PubMed, MEDLINE, Cochrane, Google Scholar, and Scopus databases. Our literature review showed that CMR is a valuable modality for identifying and predicting subclinical cardiotoxicity induced by chemotherapy. The novel T1, T2, and extracellular volume mapping techniques may provide critical information about cardiotoxicity, in addition to other CMR features such as functional and structural changes. However, further research is needed to verify the exact role of these methods in identifying cardiotoxicity and patient management. Since multiple studies have reported the improvement of left ventricular performance following the termination of chemotherapy regimens, CMR remains an essential imaging tool for the prediction of cardiotoxicity and, consequently, decreases the mortality rate of BC due to heart failure.