Department of Oncology, University of Calgary, Canada; Department of Physics & Astronomy, University of Calgary, Canada.
Department of Oncology, University of Calgary, Canada.
Radiother Oncol. 2020 Jul;148:167-173. doi: 10.1016/j.radonc.2020.04.022. Epub 2020 Apr 22.
To demonstrate achievable dose for the left anterior descending artery (LAD) for left-sided breast cancer patients.
A retrospective analysis was conducted on all left-sided breast cancer patients receiving whole breast or post-mastectomy chest wall irradiation between 2013 and 2018. All patients in this study were treated with tangent-based techniques with the LAD prospectively contoured as routine clinical care. This large patient cohort was used to benchmark achievable mean doses to the LAD in the context of heart dose. The primary cohort of study were patients undergoing treatment with deep-inspiration breath-hold (DIBH), stratified by internal mammary nodes (IMN) inclusion. In all cases, the median (25th-75th percentile) is reported.
A total of 1221 left-sided breast cancer patients were included in this study with 1045 in the DIBH cohort. The median heart mean dose for this cohort is 1.0 Gy (0.8-1.1). For patients treated in DIBH with IMNs included (n = 422), the median of the mean LAD dose is 3.6 Gy (2.9-4.4) and, for patients treated in DIBH with IMNs excluded (n = 623), the median of the mean LAD dose is 3.2 Gy (2.5-3.8).
Appropriate respiratory management can be utilized to achieve low dose to the LAD for the majority of patients without compromising target coverage.
为左侧乳腺癌患者的左前降支（LAD）展示可实现的剂量。
对 2013 年至 2018 年间接受全乳或乳房切除术后胸壁放疗的所有左侧乳腺癌患者进行回顾性分析。本研究中的所有患者均采用切线技术治疗，并将 LAD 作为常规临床护理进行前瞻性描绘。利用这一大患者队列，在心脏剂量的背景下对 LAD 的可实现平均剂量进行基准测试。研究的主要队列是接受深吸气屏气（DIBH）治疗的患者，按内乳淋巴结（IMN）纳入情况分层。在所有情况下，均报告中位数（25 分位-75 分位）。
本研究共纳入 1221 例左侧乳腺癌患者，其中 1045 例为 DIBH 队列患者。该队列的中位心脏平均剂量为 1.0 Gy（0.8-1.1）。对于接受 IMN 纳入（n=422）的 DIBH 治疗的患者，LAD 平均剂量的中位数为 3.6 Gy（2.9-4.4），对于接受 IMN 排除（n=623）的 DIBH 治疗的患者，LAD 平均剂量的中位数为 3.2 Gy（2.5-3.8）。
适当的呼吸管理可用于为大多数患者实现 LAD 的低剂量，而不会影响靶区覆盖。
