Validation and Modification of a Prediction Model for Acute Cardiac Events in Patients With Breast Cancer Treated With Radiotherapy Based on Three-Dimensional Dose Distributions to Cardiac Substructures

PurposeA relationship between mean heart dose (MHD) and acute coronary event (ACE) rate was reported in a study of patients with breast cancer (BC). The main objective of our cohort study was to validate this relationship and investigate if other dose-distribution parameters are better predictors for ACEs than MHD.Patients and MethodsThe cohort consisted of 910 consecutive female patients with BC treated with radiotherapy (RT) after breast-conserving surgery. The primary end point was cumulative incidence of ACEs within 9 years of follow-up. Both MHD and various dose-distribution parameters of the cardiac substructures were collected from three-dimensional computed tomography planning data.ResultsThe median MHD was 2.37 Gy (range, 0.51 to 15.25 Gy). The median follow-up time was 7.6 years (range, 0.1 to 10.1 years), during which 30 patients experienced an ACE. The cumulative incidence of ACE increased by 16.5% per Gy (95% CI, 0.6 to 35.0; P = .042). Analysis showed that the volume of the left ventricle receiving 5 Gy (LV-V5) was the most important prognostic dose-volume parameter. The most optimal multivariable normal tissue complication probability model for ACEs consisted of LV-V5, age, and weighted ACE risk score per patient (c-statistic, 0.83; 95% CI, 0.75 to 0.91).ConclusionA significant dose-effect relationship was found for ACEs within 9 years after RT. Using MHD, the relative increase per Gy was similar to that reported in the previous study. In addition, LV-V5 seemed to be a better predictor for ACEs than MHD. This study confirms the importance of reducing exposure of the heart to radiation to avoid excess risk of ACEs after radiotherapy for BC. (C) 2017 by American Society of Clinical Oncology.</p

Th-234 in surface waters: Distribution of particle export flux across the Antarctic Circumpolar Current and in the Weddell Sea during the GEOTRACES expedition ZERO and DRAKE

ESA; Humboldt foundation; AB the Helmholtz Initiative and Networking FundAs part of the GEOTRACES Polarstern expedition ANTXXIV/3 (ZERO and DRAKE) we have measured the vertical distribution of Th-234 on sections through the Antarctic Circumpolar Current along the zero meridian and in Drake Passage and on an EW section through the Weddell Sea. Steady state export fluxes of Th-234 from the upper 100 m, derived from the depletion of Th-234 with respect to its parent U-238, ranged from 621 +/- 105 to 1773 +/- 90 dpm m(-2) d(-1). This Th-234 flux was converted into an export flux of organic carbon ranging from 3.1 to 13.2 mmol C m(-2) d(-1) (2.1-9.0 mmol C m(-2) d(-1)) using POC/Th-234 ratio of bulk (respectively > 50 mu m) suspended particles at the export depth (100 m). Non-steady state fluxes assuming zero flux under ice cover were up to 23% higher. In addition, particulate and dissolved Th-234 were measured underway in high resolution in the surface water with a semi-automated procedure. Particulate Th-234 in surface waters is inversely correlated with light transmission and pCO(2) and positively with fluorescence and optical backscatter and is interpreted as a proxy for algal biomass. High resolution underway mapping of particulate and dissolved Th-234 in surface water shows clearly where trace elements are absorbed by plankton and where they are exported to depth. Quantitative determination of the export flux requires the full Th-234 profile since surface depletion and export flux become decoupled through changes in wind mixed layer depth and in contribution to export from subsurface layers. In a zone of very low algal abundance (54-58 degrees S at the zero meridian), confirmed by satellite Chl-a data, the lowest carbon export of the ACC was observed, allowing Fe and Mn to maintain their highest surface concentrations. An ice-edge bloom that had developed in December/January in the zone 60-65 degrees S as studied during the previous leg had caused a high export flux at 64.5 degrees S when we visited the area 2 months later (February/March). The ice-edge bloom had then shifted south to 65-69 degrees S evident from uptake of CO2 and dissolved Fe, Mn and Th-234, without causing export yet. In this way, the parallel analysis of Th-234 can help to explain the scavenging behavior of other trace elements. (C) 2011 Elsevier Ltd. All rights reserved

²³⁴Th in surface waters: Distribution of particle export flux across the Antarctic Circumpolar Current and in the Weddell Sea during the GEOTRACES expedition ZERO and DRAKE

As part of the GEOTRACES Polarstern expedition ANTXXIV/3 (ZERO and DRAKE) we have measured the vertical distribution of Th-234 on sections through the Antarctic Circumpolar Current along the zero meridian and in Drake Passage and on an EW section through the Weddell Sea. Steady state export fluxes of Th-234 from the upper 100 m, derived from the depletion of Th-234 with respect to its parent U-238, ranged from 621 +/- 105 to 1773 +/- 90 dpm m(-2) d(-1). This Th-234 flux was converted into an export flux of organic carbon ranging from 3.1 to 13.2 mmol C m(-2) d(-1) (2.1-9.0 mmol C m(-2) d(-1)) using POC/Th-234 ratio of bulk (respectively > 50 mu m) suspended particles at the export depth (100 m). Non-steady state fluxes assuming zero flux under ice cover were up to 23% higher. In addition, particulate and dissolved Th-234 were measured underway in high resolution in the surface water with a semi-automated procedure. Particulate Th-234 in surface waters is inversely correlated with light transmission and pCO(2) and positively with fluorescence and optical backscatter and is interpreted as a proxy for algal biomass. High resolution underway mapping of particulate and dissolved Th-234 in surface water shows clearly where trace elements are absorbed by plankton and where they are exported to depth. Quantitative determination of the export flux requires the full Th-234 profile since surface depletion and export flux become decoupled through changes in wind mixed layer depth and in contribution to export from subsurface layers.<br>In a zone of very low algal abundance (54-58 degrees S at the zero meridian), confirmed by satellite Chl-a data, the lowest carbon export of the ACC was observed, allowing Fe and Mn to maintain their highest surface concentrations.<br>An ice-edge bloom that had developed in December/January in the zone 60-65 degrees S as studied during the previous leg had caused a high export flux at 64.5 degrees S when we visited the area 2 months later (February/March). The ice-edge bloom had then shifted south to 65-69 degrees S evident from uptake of CO2 and dissolved Fe, Mn and Th-234, without causing export yet. In this way, the parallel analysis of Th-234 can help to explain the scavenging behavior of other trace elements