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Cardiac dosimetry for adjuvant left-sided breast radiotherapy: patterns with 2D- versus 3D-era planning and correlates of coronary dose with maximum depth of myocardial exposure.

Abstract：

INTRODUCTION:The purpose of this study was to evaluate the cardiac dosimetry delivered before and after routine 3D CT whole-breast radiotherapy planning, including cardiac contouring and the relevance of a 15-mm maximum myocardial depth (MMD) planning tolerance threshold. METHODS:The PULp FICTion study permitted cardiac dosimetry comparisons for 140 patients (70 in the 'before-contouring era' (BC) and 70 in the 'post-contouring era' (PC) ). Comparisons were made of MMD and dosimetry for whole heart, anterior myocardium and left anterior descending (LAD)/coronary artery (overall, superior and inferior) by contouring era. RESULTS:The MMD mean was 15.6 mm (range 1-40). If the internal mammary chain (IMC) was treated, the MMD increased from 15 to 27.7 mm (P < 0.0001). Excluding IMC patients revealed no difference in MMD between conservation and mastectomy (14.9 vs 17.4, P = 0.3), boost and no boost (14.5 vs 15.5, P = 0.41) or BC and PC (15.7 vs 14.5. P = 0.33) and no differences related to treating clinician, anthracycline use or age. Only in potentially low-risk patients defined as not requiring IMC or boost treatment was there a difference in MMD by era, with 17.7 mm (1-40) in the BC era and 13.9 mm (1-31) mm in the PC era (P = 0.013). Inferior LAD mean doses increased from 49% to 84% of the prescribed breast dose when MMD was >15 mm, and the proportion of patients with a mean dose <40% of the prescribed breast dose fell from 48% to 8%. CONCLUSION:Changes in cardiac dosimetry associated with routine cardiac contouring have initially been minor and restricted to low-risk patients. A 15-mm MMD reasonably represents a transition from low mean distal LAD doses to substantial doses.

journal_name

J Med Imaging Radiat Oncol

journal_title

Journal of medical imaging and radiation oncology

authors

Graham P

doi

10.1111/1754-9485.12167

subject

Has Abstract

pub_date

2014-08-01 00:00:00

pages

517-22

issue

eissn

1754-9477

issn

1754-9485

journal_volume

pub_type

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Cardiac dosimetry for adjuvant left-sided breast radiotherapy: patterns with 2D- versus 3D-era planning and correlates of coronary dose with maximum depth of myocardial exposure.