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Multileaf collimation cardiac shielding in breast radiotherapy: Cardiac doses are reduced, but at what cost?

Bartlett, FR, Yarnold, JR, Locke, I, Kirby, AM, Donovan, EM and Evans, PM (2013) Multileaf collimation cardiac shielding in breast radiotherapy: Cardiac doses are reduced, but at what cost? Clinical Oncology, 25 (12). pp. 690-696.

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Abstract

Aims: To measure cardiac tissue doses in left-sided breast cancer patients receiving supine tangential field radiotherapy with multileaf collimation (MLC) cardiac shielding of the heart and to assess the effect on target volume coverage. Materials and methods: Sixty-seven consecutive patients who underwent adjuvant radiotherapy to the left breast (n=48) or chest wall (n=19) in 2009/2010 were analysed. The heart, left anterior descending coronary artery (LAD), whole breast and partial breast clinical target volumes (WBCTV and PBCTV) were outlined retrospectively (the latter only in patients who had undergone breast-conserving surgery [BCS]). The mean heart and LAD NTD and maximum LAD doses (LAD) were calculated for all patients (NTD is a biologically weighted mean dose normalised to 2Gy fractions using a standard linear quadratic model). Coverage of WBCTV and PBCTV by the 95% isodose was assessed (BCS patients only). Results: The mean heart NTD (standard deviation) was 0.8 (0.3) Gy, the mean LAD NTD 6.7 (4.3) Gy and the mean LAD 40.3 (10.1) Gy. Coverage of the WBCTV by 95% isodose was <90% in one in three patients and PBCTV coverage <95% (range 78-94%) in one in 10 BCS patients. Conclusion: The use of MLC cardiac shielding reduces doses to cardiac tissues at the expense of target tissue coverage. Formal target volume delineation in combination with an assessment of the likelihood of local relapse is recommended in order to aid decisions regarding field and MLC placement. © 2013 The Royal College of Radiologists.

Item Type: Article
Divisions : Faculty of Engineering and Physical Sciences > Electronic Engineering > Centre for Vision Speech and Signal Processing
Authors :
AuthorsEmailORCID
Bartlett, FRUNSPECIFIEDUNSPECIFIED
Yarnold, JRUNSPECIFIEDUNSPECIFIED
Locke, IUNSPECIFIEDUNSPECIFIED
Kirby, AMUNSPECIFIEDUNSPECIFIED
Donovan, EMUNSPECIFIEDUNSPECIFIED
Evans, PMUNSPECIFIEDUNSPECIFIED
Date : December 2013
Identification Number : 10.1016/j.clon.2013.09.002
Additional Information : Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Depositing User : Symplectic Elements
Date Deposited : 17 Dec 2014 11:17
Last Modified : 17 Dec 2014 14:33
URI: http://epubs.surrey.ac.uk/id/eprint/806908

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