Coronary stenosis risk analysis following Hodgkin lymphoma radiotherapy: A study based on patient specific artery segments dose calculation.
OBJECTIVE
The dose effect-effect relationship for cardiac diseases following radiotherapy suffers from uncertainties. Three dimensional coronary artery (CA) dose calculation after mediastinal Hodgkin lymphoma radiotherapy was performed, using the patient's coronary CT angiography (CCTA), and the relationship between the coronary arteries' radiation doses and the risk of stenosis was estimated.


METHODS
Radiotherapy simulation CT scans and CCTAs of patients treated for a mediastinal Hodgkin lymphoma were used to merge thoracic and detailed cardiovascular anatomies. Radiation treatment parameters were used to estimate CA radiation doses. Twenty-one patients without coronary stenosis (controls) were matched with twelve patients with stenosis (cases). CA segments were considered as sub-volumes of interest. Radiation doses to stenotic segments were compared with those received by normal segments (from cases and controls) using a logistic regression.


RESULTS
In eleven cases out of twelve, the highest of the coronary dose distribution was on a damaged segment. Logistic regression with CA segments yielded an odds ratio associated with the risk of coronary stenosis of 1.049 per additional gray with the CA segment median dose (95% confidence interval, 1.004-1.095; p-value <0.05).


CONCLUSIONS
The CA segment dose significantly increased the risk of stenosis on the segment. Such personalized CA dose calculations on larger cohorts are expected to improve the understanding of the cardiovascular radiation dose-effect relationship.
Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SDI/LEDI, France.
Alexandra
A
Moignier
Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SDI/LEDI, France.
David
D
Broggio
Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SER/UEM, France. Electronic address: sylvie.derreumaux@irsn.fr.
Sylvie
S
Derreumaux
Institut Gustave Roussy, Service de Radiothérapie Oncologique, France.
Anne
A
Beaudré
Institut Gustave Roussy, Service de Radiothérapie Oncologique, France.
Théodore
T
Girinsky
Centre Chirurgical Marie-Lannelongue, Service de Radiologie, France.
Jean-François
JF
Paul
Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SRBE/LEPID, France.
Damien
D
Drubay
Institut Gustave Roussy, Service de Radiothérapie Oncologique, France.
Dimitrios
D
Lefkopoulos
Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SDI/LEDI, France.
Didier
D
Franck
Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SER/UEM, France.
Bernard
B
Aubert
Institut Gustave Roussy, Service de Radiothérapie Oncologique, France.
Eric
E
Deutsch
Institut Gustave Roussy, Service de Radiothérapie Oncologique, France.
Jean
J
Bourhis
D000293:Adolescent; D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000209:etiology*; D003331:Coronary Vessels / Q000528:radiation effects*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods
Coronary stenosis; Dose reconstruction; Radiotherapy; Risk analysis