Breast Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_8_3401 - Nationwide Trends in Heart-Sparing Techniques Utilized in Radiation Therapy for Breast Cancer

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Nationwide Trends in Heart-Sparing Techniques Utilized in Radiation Therapy for Breast Cancer
N. Desai1, A. D. Currey2, T. R. Kelly2, and C. Bergom2; 1Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, WI, 2Medical College of Wisconsin, Milwaukee, WI

Purpose/Objective(s): Radiation dose to the heart correlates with cardiac-related deaths and may partially diminish the benefit associated with radiation for breast cancer. This study assesses current nationwide trends in heart-sparing techniques for breast cancer radiation.

Materials/Methods: In November 2017, an IRB-approved electronic survey was sent to practicing radiation oncologists in the United States. Questions assessed demographics, as well as the type and frequency of heart-sparing techniques used. Data was analyzed using descriptive statistics and Chi-squared tests.

Results: 522 (13%) responses were obtained. Most physicians had been practicing >15 years (46%), with the majority of respondents in a private practice setting (59%). Mean heart dose (83%) and volumetric constraints (66%) were the most commonly used cardiac constraints. Overall, 83% of physicians offered prone positioning and/or deep inspiration breath hold (DIBH). This was more common in physicians practicing in academic (93%) versus private practice (78%) settings (p<0.01). 72% of physicians used heart-sparing techniques for over 3/4 of their left-sided patients. In these patients, the most commonly used techniques were DIBH and heart blocking, with 44% and 12% of physicians using the technique over 3/4 of the time, respectively. This did not differ between private practice and academic settings. Proton therapy was used the least, with 87% reporting that they never use it. The most commonly used DIBH modalities were Varian RPM (54%) and Vision RT/Align RT (32%). 3D conformal was the most commonly used planning modality in patients undergoing DIBH (90%). DIBH was used at about the same frequency in left-sided patients whether they received whole breast/chest wall radiation alone or with regional nodal radiation (RNI). Patient tolerance (79%) and cardiac-to-chest wall distance (72%) were the most common factors determining whether DIBH was used in left-sided patients. 23% of responding physicians utilized DIBH for right-sided patients, and it was used more commonly in patients receiving RNI. Right-sided DIBH was also more common in an academic setting (p<0.01), with lung sparing (64%) and heart sparing (46%) cited as the most common reasons for use. A lack of facilities was cited as the most common reason not to use DIBH (60%).

Conclusion: Most respondents to this survey offer heart-sparing techniques for breast cancer radiation; this is more common in academic centers. DIBH is the most commonly used technique in both academic and private practice settings. Lack of facilities is the main reason cited for not using DIBH. DIBH is much less commonly used in right-sided patients, with lung and heart sparing cited as reasons for its use. However, over 20% reported using DIBH in right-sided patients, suggesting more data is needed to determine if and when this technique should be utilized in patients with right-sided breast cancer.

Author Disclosure: N. Desai: None. A.D. Currey: Honoraria; Wisconsin Oncology Network. T.R. Kelly: None. C. Bergom: None.

Nina Desai, MD

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