Tomotherapy and Multifield Intensity-Modulated Radiotherapy Planning Reduce Cardiac Doses in Left-Sided Breast Cancer Patients With Unfavorable Cardiac Anatomy

Journal Article · Wed Sep 01 04:00:00 EDT 2010 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.07.1705· OSTI ID:21436148

Dickler, Adam ^[1]; Kirk, Michael C ^[2]; Yixiang, Liao; Shah, Anand P; Strauss, Jonathan B; Chen, Sea; Turian, Julius; Griem, Katherine L ^[3]

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1. Department of Radiation Oncology, Little Company of Mary Hospital, Evergreen Park, IL (United States)
2. Massachusetts General/North Shore Cancer Center, Danvers, MA (United States)
3. Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (United States)

Purpose: For patients with left-sided breast cancers, radiation treatment to the intact breast results in high doses to significant volumes of the heart, increasing the risk of cardiac morbidity, particularly in women with unfavorable cardiac anatomy. We compare helical tomotherapy (TOMO) and inverse planned intensity modulated radiation therapy (IMRT) with three-dimensional conformal radiotherapy using opposed tangents (3D-CRT) for reductions in cardiac volumes receiving high doses. Methods and Materials: Fifteen patients with left-sided breast cancers and unfavorable cardiac anatomy, determined by a maximum heart depth (MHD) of {>=}1.0 cm within the tangent fields, were planned for TOMO and IMRT with five to seven beam angles, in addition to 3D-CRT. The volumes of heart and left ventricle receiving {>=}35 Gy (V35) were compared for the plans, as were the mean doses to the contralateral breast and the volume receiving {>=}20 Gy (V20) for the ipsilateral lung. Results: The mean MHD was 1.7 cm, and a significant correlation was observed between MHD and both heart and left ventricle V35. The V35s for IMRT (0.7%) and TOMO (0.5%) were significantly lower than for 3D-CRT (3.6%). The V20 for IMRT (22%) was significantly higher than for 3D-CRT (15%) or TOMO (18%), but the contralateral breast mean dose for TOMO (2.48 Gy) was significantly higher than for 3D-CRT (0.93 Gy) or IMRT (1.38 Gy). Conclusions: Both TOMO and IMRT can significantly reduce cardiac doses, with modest increases in dose to other tissues in left-sided breast cancer patients with unfavorable cardiac anatomy.

• OSTI ID: 21436148
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 78; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

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62 RADIOLOGY AND NUCLEAR MEDICINE
BODY
CARDIOVASCULAR SYSTEM
COMPUTERIZED TOMOGRAPHY
CT-GUIDED RADIOTHERAPY
DIAGNOSTIC TECHNIQUES
DISEASES
DOSES
GLANDS
HEART
MAMMARY GLANDS
MEDICINE
NEOPLASMS
NUCLEAR MEDICINE
ORGANS
PLANNING
RADIATION DOSES
RADIOLOGY
RADIOTHERAPY
THERAPY
TOMOGRAPHY