<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2020-0013_s_007_w2aab3b8c31b1b7b1aab1c16b1Aa"><h3>Background</h3><p>There are certain risks of radiotherapy (RT), especially patients with left-sided breast cancer have a higher tendency to develop cardiac complications than the right-sided cancers. This study aims to perform a dosi-metric analysis the effect of RT on coronary arteries and heart in breast-conserving surgery.</p></sec><sec id="j_raon-2020-0013_s_008_w2aab3b8c31b1b7b1aab1c16b2Aa"><h3>Patients and methods</h3><p>A total of 40 patients with early stage right and left-sided breast carcinomas (T1/T2 + N0) were randomly selected. RT was delivered to the entire breast, and tumor beds were boosted in these patients using tangential fields with computed tomography based planning. The doses for Left anterior descending coronary artery (LAD), left circumflex coronary artery (LCx), right ventricle (RV), left ventricle (LV), and heart were recorded and median values compared between groups.</p></sec><sec id="j_raon-2020-0013_s_009_w2aab3b8c31b1b7b1aab1c16b3Aa"><h3>Results</h3><p>The highest mean of radiation dose in patients with left-sided breast cancer was to LAD 2402.48 ± 838.39 cGy, while the highest mean dose in right-sided breast cancer patients was to RV 130.18 ± 24.92. The highest maximum dose of radiotherapy was applied to heart at left-sided breast cancer patients as well as at right-sides prients. The mean V5 of the LV was 18.68% (6.89–31.69), mean V25 of the LV was 5.22% (0.45–16.54), mean V5 in bilateral ventricles was 23.73% (2.56–26.89), and mean V25 in bilateral ventricles 6.78% (0.63–13.63).</p></sec><sec id="j_raon-2020-0013_s_010_w2aab3b8c31b1b7b1aab1c16b4Aa"><h3>Conclusions</h3><p>Especially in left-sided breast cancer, the most direct and best strategy to reduce and protect radiation-induced cardiac injury is to balance dose constraints between several high-dose regions of cardiac substructures and the mean heart dose.</p></sec></abstract>

BackgroundThere are certain risks of radiotherapy (RT), especially patients with left-sided breast cancer have a higher tendency to develop cardiac complications than the right-sided cancers. This study aims to perform a dosi-metric analysis the effect of RT on coronary arteries and heart in breast-conserving surgery.Patients and methodsA total of 40 patients with early stage right and left-sided breast carcinomas (T1/T2 + N0) were randomly selected. RT was delivered to the entire breast, and tumor beds were boosted in these patients using tangential fields with computed tomography based planning. The doses for Left anterior descending coronary artery (LAD), left circumflex coronary artery (LCx), right ventricle (RV), left ventricle (LV), and heart were recorded and median values compared between groups.ResultsThe highest mean of radiation dose in patients with left-sided breast cancer was to LAD 2402.48 ± 838.39 cGy, while the highest mean dose in right-sided breast cancer patients was to RV 130.18 ± 24.92. The highest maximum dose of radiotherapy was applied to heart at left-sided breast cancer patients as well as at right-sides prients. The mean V5 of the LV was 18.68% (6.89–31.69), mean V25 of the LV was 5.22% (0.45–16.54), mean V5 in bilateral ventricles was 23.73% (2.56–26.89), and mean V25 in bilateral ventricles 6.78% (0.63–13.63).ConclusionsEspecially in left-sided breast cancer, the most direct and best strategy to reduce and protect radiation-induced cardiac injury is to balance dose constraints between several high-dose regions of cardiac substructures and the mean heart dose.

Effect of radiotherapy on coronary arteries and heart in breast-conserving surgery: a dosimetric analysis

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

BackgroundThere are certain risks of radiotherapy (RT), especially patients with left-sided breast cancer have a higher tendency to develop cardiac...

		Right-sided breast cancer n (%)	Left-sided breast cancer n (%)
Breast conservation surgery		20 (100%)	20 (100%)
Age		57.33 ± 10.21(40–80)	61.35 ± 9.91(42–76)
T stage	T1	15 (75%)	12 (60%)
T stage	T2	5 (25%)	8 (40%)
N stage	N0	20 (100%)	20 (100%)
M stage	M0	20 (100%)	20 (100%)
Tumor location	inner quadrant	6 (30%)	10 (50%)
Tumor location	outer quadrant	14 (70%)	10 (50%)
Tumor size	≤ 2 cm	15 (75%)	12 (60%)
Tumor size	2–5 cm	5 (25%)	8 (40%)
Chemotherapy	Yes	7 (35%)	11 (55%)
Chemotherapy	No	13 (65%)	9 (45%)
Number of chemotherapy cycles	4	4 (20%)	6 (30%)

	6	3 (15%)	5 (25%)

Dosimetric parameters		Right-sided breast cancer	Left-sided breast cancer	P value
LAD	D_mean	97.57 ± 10.26(73.8–114)	2402.48 ± 838.39(1020–3783)	< 0.0001
	D_max	111.87 ± 16.15(78.8–145)	4752.83 ± 498.46(3700–5703.8)	< 0.0001
	D_min	83.12 ± 9.31(63.7–100.1)	222.59 ± 76.42(95–471)	< 0.0001
LCx	D_mean	84.99 ± 9.09(63.8–100.8)	170.55 ± 45.36(85.8–260.2)	< 0.0001
	D_max	96.27 ± 11.33(75.6–116.3)	203.49 ± 55.9(112–353.9)	< 0.0001
	D_min	74.59 ± 8.57(54.5–92.1)	137.63 ± 38.59(69.7–235.5)	< 0.0001
RV	D_mean	130.18 ± 24.92(110.8–224.2)	563.65 ± 221.78(140.9–875.6)	< 0.0001
	D_max	464.76 ± 517.55(221.2–2619)	4576.55±1077.66(460.1–6149.3)	< 0.0001
	D_min	75.51 ± 7.81(58.8–90.5)	103.41 ± 28.67(49.3–184.9)	< 0.0001
LV	D_mean	81.71 ± 7.9(60.9–96.5)	536.8 ± 193.24(230–1018.1)	< 0.0001
	D_max	149.13 ± 43.75(85.1–264.2)	4822.6 ± 362.4(3964.4–5835.4)	< 0.0001
	D_min	65.75 ± 7.02(47.1–80.2)	105.49 ± 26.64(52.2–184.2)	< 0.0001
Heart	D_mean	120.33 ± 19.05(97.3 – 189.2)	396.56 ± 131.73(158.5–588.7)	< 0.0001
Heart	D_max	634.48 ± 751.55(277–3759.5)	5032.44 ± 331.02(4134.3–5992.9)	< 0.0001

Effect of radiotherapy on coronary arteries and heart in breast-conserving surgery: a dosimetric analysis

Article Category: research article

Pubblicato online: 07 mar 2020

Pagine: 128 - 134

Ricevuto: 04 dic 2019

Accettato: 15 feb 2020

DOI: https://doi.org/10.2478/raon-2020-0013

© 2020 Gulsen Pinar Soydemir Gocer, Elif Eda Ozer, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Patients’ characteristics

The dosimetric parameters of left anterior descending coronary artery (LAD), left circumflex coronary artery (LCx), right ventricle (RV), left ventricle (LV) and heart depending on the side of the tumor