Évolution des techniques d'irradiation externe et pertinence de leur application dans les carcinomes mammaires localement avancés ou avec envahissement ganglionnaire

Abstract : Radiation therapy is a standard of care for localized breast cancers. It decreases the local recurrence rate by 19% at 5 years, with an overall survival gain of 5.4% at 15 years, but with late cardiac complications. The PROBAC study (Protects the coROnaries in the BACcarat cohort), from the BACCARAT (BreAst Cancer and CArdiotoxicity Induced by RAdioTherapy) cohort, with the Institute for Radioprotection and Nuclear Safety (BACCARAT promoter), compared the doses received by the left descending artery (LAD) in adjuvant locoregional irradiations, between conformal radiotherapy with intensity modulation (IMRT) and 3D. The coronaries were detected by coroscanner. IMRT decreased LAD volumes receiving 40 Gy (0.1% versus 11.3%, p = 0.042) and 20 Gy (27.8% versus 34.7%, p = 0.003), with no difference in volume receiving 10 Gy. Mean heart dose was higher with IMRT (5.7 Gy vs 3.7 Gy, p = 0.0003). The relevance of this dose reduction to LAD is still unknown, the link between coronary sparing and reduction of late cardiac complications has still to be demonstrated. Target volume coverage was slightly better with IMRT. This study does not take into account the uncertainties associated with breathing and cardiac movements, which fall within the framework of image-guided radiotherapy (IGRT). Methods of taking breathint into account exist, but are not daily practice. The risk benefit ratio of different irradiation modalities and IGRT is discussed. The final PROBAC analysis will compare proton therapy, IMRT, and 3D and evaluate the impact of taking into account breathing.
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Emmanuel Kammerer. Évolution des techniques d'irradiation externe et pertinence de leur application dans les carcinomes mammaires localement avancés ou avec envahissement ganglionnaire. Médecine humaine et pathologie. 2018. ⟨dumas-02103110⟩

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