Association between the cardiac contact distance and the maximum dose at the left anterior descending coronary artery in post mastectomized patients

• Published in: Radiation and environmental biophysics Vol. 61; no. 3; pp. 407 - 423
• Main Authors: Badillo-Alvarado, A. H., Martín-Tovar, E. A., Molina-Salinas, G. M., Sandoval-Méndez, A. C., Sarricolea-Puch, A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2022; Springer Nature B.V
• Subjects: Biological and Medical Physics; Biophysics; Breast cancer; Conformity; Coronary artery; Coronary vessels; Correlation coefficient; Correlation coefficients; Dosimetry; Ecosystems; Effects of Radiation/Radiation Protection; Environmental Physics; Heart; Homogeneity; Irradiation; Monitoring/Environmental Analysis; Original Article; Patients; Physics; Physics and Astronomy; Radiation therapy; Breast cancer; Left anterior descending coronary artery; Radiotherapy; Postmastectomy; Cardiac contact distance
• ISSN: 0301-634X; 1432-2099
• DOI: 10.1007/s00411-022-00983-5

The clinical information on the relationship between the cardiac contact distance (CCD), the maximum dose ( D max ) delivered to the left anterior descending (LAD) coronary artery and the mean heart dose has mostly focused on patients with breast-conserving surgery (BCS), being scarce in postmastectomy patients. The aim of this study is to determine the association between the CCD and the D max delivered to the LAD. The secondary objective was to evaluate the dosimetric results of comparing three-dimensional conformal radiotherapy (3D-CRT) to intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques for post mastectomized breast cancer patients with irradiation to the left chest wall. 53 cases of women who received adjuvant standard fractionated postmastectomy radiotherapy (PMRT) were used. Three types of plans were created for each patient: 3D-CRT, seven equidistant IMRT fields, and four partial VMAT arcs. Correlations were evaluated using Pearson’s correlation coefficient. Plans made with IMRT and VMAT showed improved homogeneity and conformity. Associations between CCD and D max to LAD were positive for all three plan types. Compared to 3D-CRT, the modulated intensity plans obtained better dose homogeneity and conformity to the target volume. The LAD and heart doses were significantly lower for IMRT and VMAT plans. The CCD can be used as a predictor of the maximum and mean doses of the LAD. Modulated intensity techniques allow for better dose distribution and dose reduction to the heart and LAD.