Radiography (London, England : 1995) · 2025
Cardiovascular magnetic resonance assessment of radiation-induced cardiotoxicity in post-mastectomy left-sided breast cancer patients treated with the 3-dimensional conformal radiotherapy.
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Nuruddeen M G, Karim N K A, Al Appalanaido G K, Mohd Zin M H, Sayuti K A, Mad Naser M N, Abdulkadir M K
Аннотация
INTRODUCTION: Radiation-induced cardiotoxicity remains a critical concern in left-sided breast cancer (BC) radiotherapy (RT), particularly for post-mastectomy patients. This study evaluates the effectiveness and cardiac-sparing efficacy of the innovative Lateral Wedge with Medial-Only Cardiac Shielding (LEMONADE) 3D-CRT technique using cardiovascular magnetic resonance (CMR) imaging.
METHODS: Ten female patients with left-sided BC who underwent post-mastectomy RT with the LEMONADE 3D-CRT technique between 2016 and 2020 were prospectively evaluated. All patients received 42.56 Gy in 16 fractions and underwent CMR imaging 5 years post-RT. Cardiac substructures were retrospectively contoured, and dosimetric data were extracted. Biventricular function, volumes, and tissue characterization were assessed using CMR. Locoregional recurrence was evaluated from clinical follow-up.
RESULTS: Mean heart dose (MHD) was 3.12 ± 1.5Gy, with the left anterior descending coronary artery (LAD) receiving the highest mean dose (15.8 ± 6.6Gy). CMR revealed preserved biventricular function with a mean left ventricular ejection fraction (LVEF) of 58.3 ± 8.2 % and right ventricular ejection fraction (RVEF) of 57 ± 5 %. No myocardial fibrosis was detected in 90 % of patients. All patients remained free of locoregional recurrence.
CONCLUSION: The LEMONADE 3D-CRT technique preserves cardiac structure and function at a five-year follow-up in left-sided post-mastectomy patients without compromising oncological efficacy. Radiation dose was heterogeneous, with the LAD receiving the highest exposure. The observed positive correlations between heart doses and RVEF are considered exploratory and require cautious interpretation. LEMONADE represents a pragmatic cardiac-sparing approach, particularly valuable in resource-limited settings.
IMPLICATIONS FOR PRACTICE: The LEMONADE 3D-CRT techniques offer a clinically effective and pragmatically accessible solution for optimizing cardiac safety of left-sided post-mastectomy radiotherapy. It provides a vital, cost-effective alternative for centres lacking advanced technology, enabling improved therapeutic outcomes and enhanced cardio-protection in both high-risk patients and resource-limited settings.
METHODS: Ten female patients with left-sided BC who underwent post-mastectomy RT with the LEMONADE 3D-CRT technique between 2016 and 2020 were prospectively evaluated. All patients received 42.56 Gy in 16 fractions and underwent CMR imaging 5 years post-RT. Cardiac substructures were retrospectively contoured, and dosimetric data were extracted. Biventricular function, volumes, and tissue characterization were assessed using CMR. Locoregional recurrence was evaluated from clinical follow-up.
RESULTS: Mean heart dose (MHD) was 3.12 ± 1.5Gy, with the left anterior descending coronary artery (LAD) receiving the highest mean dose (15.8 ± 6.6Gy). CMR revealed preserved biventricular function with a mean left ventricular ejection fraction (LVEF) of 58.3 ± 8.2 % and right ventricular ejection fraction (RVEF) of 57 ± 5 %. No myocardial fibrosis was detected in 90 % of patients. All patients remained free of locoregional recurrence.
CONCLUSION: The LEMONADE 3D-CRT technique preserves cardiac structure and function at a five-year follow-up in left-sided post-mastectomy patients without compromising oncological efficacy. Radiation dose was heterogeneous, with the LAD receiving the highest exposure. The observed positive correlations between heart doses and RVEF are considered exploratory and require cautious interpretation. LEMONADE represents a pragmatic cardiac-sparing approach, particularly valuable in resource-limited settings.
IMPLICATIONS FOR PRACTICE: The LEMONADE 3D-CRT techniques offer a clinically effective and pragmatically accessible solution for optimizing cardiac safety of left-sided post-mastectomy radiotherapy. It provides a vital, cost-effective alternative for centres lacking advanced technology, enabling improved therapeutic outcomes and enhanced cardio-protection in both high-risk patients and resource-limited settings.