Incidental dose to coronary arteries is higher in prone than in supine whole breast irradiation

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• 作者：Florian Würschmidt (1)
  Solveigh Stoltenberg (1)
  Matthias Kretschmer (1)
  Cordula Petersen (1)
  
• 关键词：Organ sparing treatments ; Organs at risk ; Heart ; Breast ; conserving surgery ; Patient positioning ; Organschonende Behandlung ; Risikoorgane ; Herz ; Brusterhaltende Operation ; Patientenpositionierung
• 刊名：Strahlentherapie und Onkologie
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：190
• 期：6
• 页码：563-568
• 全文大小：
• 参考文献：1. Darby S, McGale P, Correa C et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378:1707-716 CrossRef
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  6. Schubert LK, Gondi V, Sengbusch E et al (2011) Dosimetric comparison of left-sided whole breast irradiation with 3DCRT, forward-planned IMRT, inverse-planned IMRT, helical tomotherapy, and topotherapy. Radiother Oncol 100:241-46 CrossRef
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  18. Subramaniam S, Thirumalaiswamy S, Srinivas C et al (2012) Chest wall radiotherapy with volumetric modulated arcs and the potential role of flattening filter free photon beams. Strahlenther Onkol 188:484-90 CrossRef
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• 作者单位：Florian Würschmidt (1)
  Solveigh Stoltenberg (1)
  Matthias Kretschmer (1)
  Cordula Petersen (1)
  
  1. M?rkenstr. 47, 22767, Hamburg, Germany
  
• ISSN：1439-099X

文摘

Purpose Sparing of normal lung is best achieved in prone whole breast irradiation (WBI). However, exposure of the heart and coronary arteries might increase due to anterior movement of the heart in prone WBI. Patients and methods Treatment plans of 46?patients with large breasts irradiated for mammary cancer after breast-conserving surgery were retrospectively analyzed. The average treated breast volume of right-sided breasts (n--3) was 1,804?ccm and 1,500?ccm for left-sided breasts (n--3). The majority had invasive cancer (96-) of which 61- were pT1 and 39- pT2 tumors. All patients received radiation therapy to the breast only. For three-dimensional (3D) treatment planning, all patients underwent a noncontrast-enhanced CT in the supine position with a wingboard and a second CT in the prone position using a prone breastboard. Nontarget volumes of the lung, heart, and coronary arteries were contoured. A total dose of 50.4?Gy was prescribed to the breast only. Differences were calculated for each patient and compared using the Wilcoxon signed-rank test. Results Treatment of left-sided breasts resulted in similar average mean heart doses in prone versus supine WBI (4.16 vs. 4.01?Gy; p--.70). The left anterior descending artery (LAD) had significantly higher dose exposure in left versus right WBI independent of position. Prone WBI always resulted in significantly higher exposures of the right circumflex artery (RCA) and LAD as compared to supine WBI. In left WBI, the mean LADprone was 33.5?Gy vs. LADsupine of 25.6?Gy (p--.0051). The V20prone of the LAD was 73.6- vs. V20supine 50.4- (p--.0006). Conclusion The heart dose is not different between supine and prone WBI. However, in left WBI the incidental dose to the LAD with clinically relevant doses can be significantly higher in prone WBI. This is discussed controversially in the literature as it might depend on contouring and treatment techniques. We recommend contouring of LAD if patients are treated in prone WBI and evaluation of alternative treatment techniques for optimal sparing of coronary arteries.