Prediction of excess risk of long-term cardiac mortality after radiotherapy of stage I breast cancer

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Background and purpose: Excess cardiac mortality has been reported in long-term follow up of breast cancer patients. Due to these findings it has been emphasized that radiotherapy techniques should be designed to minimize cardiac dose. The present study aims to provide risk figures of long-term excess cardiac mortality following radiotherapy for stage I breast cancer patients, using the relative seriality model. The impact of different modifications of the conventional irradiation technique on the calculated risk value is also analyzed. Material and methods: One hundred consecutive left-sided stage I breast cancer patients were selected. All patients were treated with post-operative radiotherapy, using tangential 6 MV photon beams. The dose planning of each patient was done by means of a three-dimensional dose planning system. The prescribed mean tumor dose was 50 Gy, 2 Gy/fraction, 5 days a week. For each dose plan the differential heart and myocardium dose-volume histogram (DVH) were calculated. The excess risk of late cardiac mortality was predicted for each patient with the relative seriality model, using a parameter set previously determined. Different methods to decrease the risk of excess cardiac mortality (conventional collimation vs. multileaf collimation (MLC), partial blocking of the target in order to spare the heart and finally a general fluence modulation method) were analyzed. Results and conclusions: The mean value of the calculated excess risk was 1.8%, having the heart as organ at risk, and 2.1% having the myocardium as organ at risk. However, a subgroup of patients where the risk increased up to about 9% (heart) and 12% (myocardium) was found. The risk could be substantially decreased either using an extended blocking of the target or applying the general fluence modulation method.