title: Radiation dose distribution in coronary arteries in breast cancer radiotherapy.
abstract: BACKGROUND
  Women irradiated for left-sided breast cancer (BC) have an increased risk of coronary artery disease compared to women with right-sided BC. We describe the distribution of radiation dose in segments of coronary arteries in women receiving adjuvant radiotherapy (RT) for left- or right-sided BC.
  
  
  METHODS
  Fifteen women with BC, seven left-sided and eight right-sided, who had received three-dimensional conformal radiotherapy (3DCRT), constituted the study base. The heart and the segments of the coronary arteries were defined as separate organs at risk (OAR), and the mean and maximum radiation doses were calculated for each OAR.
  
  
  RESULTS
  In women with left-sided BC, irrespective of if regional lymph node RT was given or not, maximum dose in mid and distal left anterior descending artery (mdLAD) was approximately 50 Gy in 6/7 patients, whereas women with right-sided BC mainly received low doses of radiation. In women with left-sided BC, 6/7 patients had substantially higher mean dose to the distal LAD than to the heart, ranging from 30 to 55 Gy and 3 to13 Gy, respectively.
  
  
  CONCLUSIONS
  We found a pronounced difference of radiation dose distribution in the coronary arteries between women with left- and right-sided BC. Women with left-sided BC had almost full treatment dose in parts of mdLAD, regardless of if regional lymph node irradiation was given or not, while women with right-sided BC mainly received low doses to the coronary arteries.
authors.affiliation: a Department of Immunology, Genetics and Pathology, Section of Experimental and Clinical Oncology , Uppsala University, University Hospital , Uppsala , Sweden ;|b Department of Oncology , Gävle Hospital , Gävle , Sweden ;|c Section of Oncology, Visby Hospital , Visby , Sweden ;
authors.forename: Greger
authors.initials: G
authors.lastname: Nilsson
authors.affiliation: a Department of Immunology, Genetics and Pathology, Section of Experimental and Clinical Oncology , Uppsala University, University Hospital , Uppsala , Sweden ;
authors.forename: Petra
authors.initials: P
authors.lastname: Witt Nyström
authors.affiliation: d Department of Immunology, Genetics and Pathology, Section of Medical Radiation Science , Uppsala University, University Hospital , Uppsala , Sweden ;
authors.forename: Ulf
authors.initials: U
authors.lastname: Isacsson
authors.affiliation: e King's College London, Faculty of Life Sciences and Medicine, Division of Cancer Studies, Guy's Campus , London , UK ;|f Regional Cancer Center, Uppsala University, University Hospital , Uppsala , Sweden ;
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.affiliation: g Department of Surgical Sciences, Section of Radiology , Uppsala University, University Hospital , Uppsala , Sweden ;
authors.forename: Olov
authors.initials: O
authors.lastname: Duvernoy
authors.affiliation: h Department of Cardiology , Falu Hospital , Falun , Sweden ;
authors.forename: Iwar
authors.initials: I
authors.lastname: Sjögren
authors.affiliation: i Department of Medical Sciences, Section of Cardiology, Uppsala University; jUppsala Clinical Research Centre, Uppsala University, University Hospital, Uppsala, Sweden; , Uppsala University, University Hospital , Uppsala , Sweden ;|j Uppsala Clinical Research Centre , Uppsala University, University Hospital , Uppsala , Sweden ;
authors.forename: Bo
authors.initials: B
authors.lastname: Lagerqvist
authors.affiliation: e King's College London, Faculty of Life Sciences and Medicine, Division of Cancer Studies, Guy's Campus , London , UK ;|k Department of Surgical Sciences, Section of Endocrine Surgery , Uppsala University, University Hospital , Uppsala , Sweden ;
authors.forename: Lars
authors.initials: L
authors.lastname: Holmberg
authors.affiliation: l Department of Oncology , Örebro University, University Hospital , Örebro , Sweden.
authors.forename: Carl
authors.initials: C
authors.lastname: Blomqvist
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology; D003331:Coronary Vessels / Q000528:radiation effects*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000528:radiation effects; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D000069584:Unilateral Breast Neoplasms / Q000532:radiotherapy*