ArticleRadiation oncology journal2026
Feasibility and trade-offs of incorporating cardiac substructure dose constraints in left-sided breast volumetric modulated arc therapy planning.
Article in Radiation oncology journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aimed to compare left-sided breast volumetric modulated arc therapy plans using heart-only dose constraints with plans that include additional left ventricle (LV) and left anterior descending coronary artery (LAD) dose constraints (heart + LV + LAD). MATERIALS AND
methodsThirty patients treated with whole-breast irradiation with simultaneous integrated boost were replanned using both strategies. The heart + LV + LAD strategy applied dose constraints based on German Society for Radiation Oncology recommendations and Danish Breast Cancer Group HYPO protocol (LV: Dmean [mean dose] <3 Gy, V5Gy [percentage of volume receiving ≥5 Gy] <17%, V23Gy <5%; LAD: Dmean <10 Gy, Dmax [maximum dose] <17 Gy). Target and organ-at-risk (OAR) metrics were compared using Wilcoxon signed-rank tests. For exploratory analyses, LAD-planning target volume (PTV) distance was defined as the minimum distance between LAD and whole-breast PTV, and Spearman's correlations between LAD-PTV distance and LAD or target metrics were evaluated.
resultsCompared with heart-only plans, heart + LV + LAD plans reduced LV Dmean, V5Gy, and V23Gy, as well as LAD Dmean and Dmax (all p < 0.001), meeting all prespecified dose constraints except LV Dmean and LAD Dmax (achieved in 70.0% and 63.3%, respectively). Target metrics showed small compromises (e.g., PTV V95% [percentage of volume receiving ≥95% of the prescription dose] 98.391% vs. 99.431%; p < 0.001). Ipsilateral lung Dmean and V5Gy decreased, whereas contralateral breast Dmean and lung V10Gy increased (all p < 0.05). In heart + LV + LAD plans, greater LAD-PTV distance correlated with lower LAD Dmax and Dmean and higher PTV D98%.
conclusionApplying LV and LAD dose constraints improved cardiac substructure sparing with modest trade-offs in target and contralateral OAR metrics. LAD-PTV distance may influence the feasibility of LAD sparing, but this exploratory association warrants further study.
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