Influence of different treatment techniques on radiation dose to the LAD coronary artery

Carsten Nieder, Sabine Schill, Peter Kneschaurek, Michael Molls, Carsten Nieder, Sabine Schill, Peter Kneschaurek, Michael Molls

Abstract

Background: The purpose of this proof-of-principle study was to test the ability of an intensity-modulated radiotherapy (IMRT) technique to reduce the radiation dose to the heart plus the left ventricle and a coronary artery. Radiation-induced heart disease might be a serious complication in long-term cancer survivors.

Methods: Planning CT scans from 6 female patients were available. They were part of a previous study of mediastinal IMRT for target volumes used in lymphoma treatment that included 8 patients and represent all cases where the left anterior descending coronary artery (LAD) could be contoured. We compared 6 MV AP/PA opposed fields to a 3D conformal 4-field technique and an optimised 7-field step-and-shoot IMRT technique and evaluated DVH's for several structures. The planning system was BrainSCAN 5.21 (BrainLAB, Heimstetten, Germany).

Results: IMRT maintained target volume coverage but resulted in better dose reduction to the heart, left ventricle and LAD than the other techniques. Selective dose reduction could be accomplished, although not to the degree initially attempted. The median LAD dose was approximately 50% lower with IMRT. In 5 out of 6 patients, IMRT was the best technique with regard to heart sparing.

Conclusion: IMRT techniques are able to reduce the radiation dose to the heart. In addition to dose reduction to whole heart, individualised dose distributions can be created, which spare, e.g., one ventricle plus one of the coronary arteries. Certain patients with well-defined vessel pathology might profit from an approach of general heart sparing with further selective dose reduction, accounting for the individual aspects of pre-existing damage.

Figures

Figure 1
Figure 1
Treatment planning computed tomography scan with contoured left anterior descending coronary artery (and part of the left circumflex artery) in green color, left ventricle in orange and heart in purple.
Figure 2
Figure 2
Treatment planning computed tomography scan with contoured organs at risk (incl. left anterior descending coronary artery in red color, on the small images in green color), clinical target volume (both intermediate and large scenario in the same patient) and isodose distributions for the intermediate scenario with ap-pa (upper left), 4-field (lower left), and 7-field IMRT technique (right) in the same patient.
Figure 3
Figure 3
Dose-volume histogram for the left anterior descending coronary artery with the 7-field IMRT technique in the intermediate target volume scenario.

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Source: PubMed

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