Evaluation of Heart Dose for Left-Sided Breast Cancer Patients Over an 11-Year Period Spanning the Transition From 2-Dimensional to 3-Dimensional Planning

    loading  Checking for direct PDF access through Ovid



We evaluated heart dose from left breast radiotherapy with 2-dimensional (2D) versus 3-dimensional (3D) plans.

Patients and Methods:

Treatment plans from patients treated with standard fractionation for left breast cancer from 2003 to 2013 were reviewed, with patients grouped into 3 cohorts: 2003 to 2004 (“2D”, with computed tomography scans for dose calculation but fields defined using simulation films; n = 29), 2005 to 2006 (“2D-post,” after several influential articles on heart dose were published; n = 31), and 2007 to 2013 (“3D”; n = 256). All patients were treated with free-breathing technique. Heart volumes were retrospectively contoured for the earlier 2 cohorts. Mean heart dose (MHD) and percentage of structure receiving at least 25 Gy (V25 Gy) and percentage of structure receiving at least 5 Gy for the whole heart, left ventricle (LV), right ventricle (RV), and both ventricles were recorded and compared among cohorts.


MHD was 345 cGy (2D), 213 cGy (2D-post) and 213 cGy (3D). LV V25 Gy was 6.3%, 1.5%, and 1.1%, respectively. Lower doses were seen over time for all indices (analysis of variance, P < .0001). Post hoc tests indicated significantly higher doses for 2D versus 2D-post or 3D cohorts (P ≤ .001) for all parameters except RV V25 Gy (P = .24).


Heart doses were higher with 2D versus 3D plans. Cardiac doses and resulting toxicity with modern 3D planning might be lower than those in previous reports.


In this study we examined the evolution in heart dose for patients treated with radiation for left-sided breast cancer from 2003 to 2013. Patients were grouped into 3 cohorts spanning the transition from 2-dimensional to 3-dimensional planning, and heart dose was calculated. Lower heart dose was seen over time, suggesting that modern treatment planning results in lower heart doses and, potentially, less toxicity.

Related Topics

    loading  Loading Related Articles