title: Estimating cardiac exposure from breast cancer radiotherapy in clinical practice.
abstract: OBJECTIVE
  To assess the value of maximum heart distance (MHD) in predicting the dose and biologically effective dose (BED) to the heart and the left anterior descending (LAD) coronary artery for left-tangential breast or chest wall irradiation.
  
  
  METHODS
  A total of 50 consecutive breast cancer patients given adjuvant left-tangential irradiation at a large U.K. radiotherapy center during 2006 were selected. For each patient, the following were derived using three-dimensional computed tomography (CT) planning: (1) mean dose and BED to the heart, (2) mean dose and BED to the LAD coronary artery, (3) MHD, (4) position of the CT slice showing the maximum area of the irradiated heart relative to the mid-plane slice, and (5) sternal and contralateral breast thickness (measures of body fat).
  
  
  RESULTS
  A strong linear correlation was found between the MHD and the mean heart dose. For every 1-cm increase in MHD, the mean heart dose increased by 2.9% on average (95% confidence interval 2.5-3.3). A strong linear-quadratic relationship was seen between the MHD and the mean heart BED. The mean LAD coronary artery dose and BED were also correlated with the MHD but the associations were weaker. These relationships were not affected by body fat. The mid-plane CT slice did not give a reliable assessment of cardiac irradiation.
  
  
  CONCLUSIONS
  The MHD is a reliable predictor of the mean heart dose and BED and gives an approximate estimate of the mean LAD coronary artery dose and BED. Doses predicted by the MHD could help assess the risk of radiation-induced cardiac toxicity where individual CT-based cardiac dosimetry is not possible.
authors.affiliation: Clinical Trial Service Unit, Oxford, United Kingdom. carolyn.taylor@ctsu.ox.ac.uk
authors.forename: C W
authors.initials: CW
authors.lastname: Taylor
authors.forename: P
authors.initials: P
authors.lastname: McGale
authors.forename: J M
authors.initials: JM
authors.lastname: Povall
authors.forename: E
authors.initials: E
authors.lastname: Thomas
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.forename: D
authors.initials: D
authors.lastname: Dodwell
authors.forename: S C
authors.initials: SC
authors.lastname: Darby
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000528:radiation effects*; D005260:Female; D006321:Heart / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000528:radiation effects*; D006801:Humans; D015412:Mastectomy, Segmental; D011829:Radiation Dosage; D018714:Radiotherapy, Adjuvant; D012062:Relative Biological Effectiveness; D014057:Tomography, X-Ray Computed