Middle East Journal of Cancer

Feasibility of Dose Reduction to the Left Anterior Descending Coronary Artery without Compromising Target Volume Coverage Using Tomotherapy Techniques

Document Type : Original Article(s)

Authors

Lakshmi Venkataramana Puriparthi 1
Akkineni Naga Prasanthi 2
Anil Kumar Talluri 1
Venkatappa Rao Tumu 3
Nagarjuna Reddy Bomidika 2
Madhusudhana Sresty 1
Krishnam Raju Alluri 2

1 Department of Radiation Physics, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India

2 Department of Radiation Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India

3 Department of Physics, National Institute of Technology, Warangal, Telangana, India

https://doi.org/10.30476/mejc.2023.96091.1803
Abstract
Background: Radiotherapy is associated with a high risk of heart disease in patients with left-sided breast cancer. Previously, the entire heart was considered an organ at risk (OAR) during planning. Studies have shown that the effect of radiation therapy depends on the dose to specific heart substructures. However, the tolerance dose of the left anterior descending coronary artery (LAD), an important cardiac substructure, is yet to be determined. This study aims to verify the feasibility of reducing the LAD dose with appropriate dose-volume constraints for patients undergoing left whole-breast radiotherapy, without compromising the target dose coverage, using tomotherapy techniques.
Method: This retrospective study generated tomohelical and tomodirect plans initially without considering the LAD as OAR in the treatment planning. To reduce the LAD dose, plans were regenerated by including the LAD as an OAR with appropriate dose constraints. The dose-volume histogram parameters of these plans were compared with those of the initial plans of the respective types.
Results: Tomohelical plans showed a 4.4% reduction in maximum dose and a 3.8% reduction in V15 for LAD, while tomodirect plans registered a 3% reduction in V15, with the conformity index remaining constant. Based on the LAD dosimetric results, considering the LAD as an OAR is associated with lower LAD doses without compromising the target volume coverage.
Conclusion: It is feasible to reduce the LAD dose without compromising target volume coverage or affecting other OAR doses in patients with left breast cancer, using tomotherapy techniques.

Highlights

Venkatappa Rao Tumu (Google Scholar)

Keywords

Heart diseases
Tomotherapy
Helical
Left-sided breast cancer
Coronary artery
LAD dose reduction
Subjects

How to cite this article:

Puriparthi LV, Prasanthi AN, Talluri AK, Tumu VR, Bomidika NR, Sresty NM, et al. Feasibility of dose reduction to the left anterior descending coronary artery without compromising target volume coverage using tomotherapy techniques. Middle East J Cancer. 2024;15(1):52-61. doi: 10.30476/mejc.2023.96091.1803.

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