Hypofractionated radiotherapy of the breast may be safer for the heart
Bibliographic record
Abstract
Yolande Lievens1Lievens Y. Hypofractionated breast radiotherapy: financial and economic consequences.The Breast. 2010; 19: 192-197Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar demonstrated how cheaper for public finance could the adoption of hypofractionated schedules of radiotherapy (RT)2Bentzen S.M. Agrawal R.K. Aird E.G. Barrett J.M. Barrett-Lee P.J. Bliss J.M. et al.START Trialist’ Group. The UK standardisation of breast radiotherapy /START) trial A of radiotherapy hypofractionated for treatment of early breast cancer: a randomized trial.Lancet Oncol. 2008; 9: 331-341Abstract Full Text Full Text PDF PubMed Scopus (870) Google Scholar, 3Bentzen S.M. Agrawal R.K. Aird E.G. Barrett J.M. Barrett-Lee P.J. Bentzen S.M. et al.START Trialist’ Group. The UK standardisation of breast radiotherapy (START) trial B of radiotherapy hypofractionated for treatment of early breast cancer: a randomized trial.Lancet. 2008; 371: 1098-1107Abstract Full Text Full Text PDF PubMed Scopus (928) Google Scholar be in early breast cancer than conventional ones. She noticed that outside UK and Canada “many radiation oncologists remain hesitant, bearing in mind the devastating experience from the past, with cardiac toxicities after inappropriate irradiation schedules and techniques becoming apparent not sooner than 10 years after treatment.” In her conclusion, she correctly wrote that “some economic questions remain unanswered, the most important one is whether we expect the potential long-term (cardiac) side effects to be of such a magnitude to still justify the adherence to conventional fractionation.” Awaiting “answers in the coming years,” we think that some provision are now possible, thanks to some available probabilistic model.4Gagliardi G. Lax I. Ottolenghi A. Rutqvist L.E. Long term cardiac mortality after radiotherapy of breast cancer – application of the relative seriality model.Br J Radiol. 1996; : 69,839-69,846Google Scholar Very recently,5Gagliardi G. Constine L.S. Moiseenko V. Correa C. Pierce L.J. Allen A.M. et al.Radiation dose-volume effects in the heart.Int J Radiat Oncol Biol Phys. 2010 Mar 1; 76: S77-S85Abstract Full Text Full Text PDF PubMed Scopus (497) Google Scholar a risk of cardiac death <1% after breast RT was considered acceptable. In our small experience comparing the wedged technique versus the field-in-field-technique,6Pili G. Grimaldi L. Fidanza C. Florio E.T. Petruzzelli M.F. D’Errico M.P. et al.Geometric and dosimetric approach to determine probability of late cardiac mortality in left tangential breast irradiation: comparison between wedged beams and field-in-field technique.Int J Radiat Oncol Biol Phys. 2011 Feb 9; https://doi.org/10.1016/j.ijrobp.2010.12.021Abstract Full Text Full Text PDF Scopus (25) Google Scholar we observed a reduction of cardiac death risk from 0.9% to 0.5%. After reading Lievens’ article, we compared the risk of cardiac death at 15 years in 12 consecutive patients and applying the Relative Seriality Model,4Gagliardi G. Lax I. Ottolenghi A. Rutqvist L.E. Long term cardiac mortality after radiotherapy of breast cancer – application of the relative seriality model.Br J Radiol. 1996; : 69,839-69,846Google Scholar observed that the risk is 1.4% for the conventional schedule (50 Gy in 25 fractions) and 0.7% for the UK Standardisation of breast Radiotherapy Trial (START) schedule (40 Gy in 15 fractions) (p < 0.05). This is consistent with lower physical dose absorbed by the heart. In any case, as suggested by Fig. 1, careful evaluation of the heart-absorbed dose, and mostly of V25Gy, is mandatory in each patient and for every RT schedule; otherwise, a “devastating experience” is always around the corner.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".