Abstract
Cardiac toxicity after breast cancer (BC) radiation therapy is partly due to the large radiation doses to coronary arteries. The left anterior descending artery (LAD) is particularly exposed. A first step in achieving robust dose constraints to the LAD during treatment planning is homogeneous delineation based on guidelines. LAD delineation can be problematic due to heart movements. The aim of the study was to establish a safety margin for delineation of the LAD in patients with BC. We studied 45 patients with left-sided BC who had an indication for adjuvant radiation therapy between 2015 and 2018. They all underwent cardiac-gated computed tomography scan, as well as planning computed tomography scans with or without contrast agents, to assess LAD diameter and movements. Cardiac-gated computed tomography scan was performed during monitoring of the cardiac cycle. Acquisition was launched immediately after contrast injection (arterial sequence), with deep-inspiration breath hold and use of a beta-receptor blocking agent. By manually reviewing each scan, the LAD positions and diameter were defined at 20 different phases of the cardiac cycle at 5 different sites: ostium (OS), circumflex bifurcation (bfc), first diagonal bfc, second diagonal (D2) bfc, and apex (right coronary anastomosis). Movement of the LAD is maximal at the ostium and then constant overall even when far from its origin. The diameter decreases with the distance from ostium: 4.9 mm (OS), 3.9 mm (circumflex), 3.5 mm (D2), and 3.1 mm (D2). We suggest using a safety delineation margin consisting of a cylinder with a diameter of 10 mm surrounding the LAD. These findings must be validated in independent series of patients treated for BC.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
More From: International Journal of Radiation Oncology, Biology, Physics
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.