title: Chest Wall Deformity in the Radiation Oncology Clinic.
abstract: To determine the incidence of pectus excavatum (PE) and define anatomical chest wall metrics predictive of elevated mean heart dose (MHD) in patients with left-sided breast cancer receiving adjuvant radiotherapy.
  
  
  
  We reviewed 273 consecutively simulated patients from 1/2013-12/2014. Physical examination identified patients with clinically identifiable PE. Characteristics were compared between patients with and those without PE. Predictors of MHD were evaluated using linear regression.
  
  
  
  The average MHD for the entire cohort was 172 cGy. Of 273 patients, 10 (3.7%) were found to have clinically significant PE. Increase in the Haller Index was correlated with higher MHD (p<0.001). Through the use of individually optimized patient positioning and respiratory gating, MHD was not statistically different in patients with PE compared to those without (p=0.093).
  
  
  
  Although PE deformity is associated with unfavorable geometry in patients undergoing left-sided breast irradiation, carefully selected treatment technique can maintain acceptable MHD.
authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, U.S.A.
authors: John M
authors: JM
authors: Stahl
authors: Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, U.S.A.
authors: Julian C
authors: JC
authors: Hong
authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, U.S.A.
authors: Nataniel H
authors: NH
authors: Lester-Coll
authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, U.S.A.
authors: Benjamin H
authors: BH
authors: Kann
authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, U.S.A.
authors: Lynn D
authors: LD
authors: Wilson
authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, U.S.A.
authors: Susan A
authors: SA
authors: Higgins
authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, U.S.A. suzanne.evans@yale.edu.
authors: Suzanne B
authors: SB
authors: Evans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy*; D005260:Female; D005660:Funnel Chest; D006321:Heart / Q000528:radiation effects*; D006801:Humans; D008875:Middle Aged; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D035441:Thoracic Wall / Q000002:abnormalities
keywords: Breast radiotherapy; mean heart dose; pectus excavatum