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. 2017 Sep 1;12(9):e0184137.
doi: 10.1371/journal.pone.0184137. eCollection 2017.

The feasibility of a heart block with an electron compensation as an alternative whole breast radiotherapy technique in patients with underlying cardiac or pulmonary disease

Hye Jin Kang  1 , Shin-Wook Kim  1 , Seok Hyun Son  1
Affiliations

The feasibility of a heart block with an electron compensation as an alternative whole breast radiotherapy technique in patients with underlying cardiac or pulmonary disease

Hye Jin Kang et al. PLoS One. .

Abstract

Purpose: We aimed to evaluate the feasibility of the heart block with electron compensation (HBE) technique, based on three-dimensional conformal radiotherapy (3D-CRT) in left-sided breast cancer patients with underlying cardiac or pulmonary disease.

Methods: Twenty patients with left-sided breast cancer who were treated with whole breast radiotherapy (WBRT) were included in this study. Intensity-modulated radiotherapy (IMRT), 3D-CRT, and HBE treatment plans were generated for each patient. Based on the 3D-CRT plan, the HBE plan included a heart block from the medial tangential field to shield the heart and added an electron beam to compensate for the loss in target volume coverage. The dosimetric parameters for the heart and lung and the target volume between the three treatment types were compared.

Results: Of the three plans, the HBE plan yielded the most significant reduction in the doses received by the heart and lung (heart Dmean: 5.1 Gy vs. 12.9 Gy vs. 4.0 Gy and lung Dmean: 11.4 Gy vs. 13.2 Gy vs. 10.5 Gy, for 3D-CRT, IMRT, and HBE, respectively). Target coverage with all three techniques was within the acceptable range (Dmean 51.0 Gy vs. 51.2 Gy vs. 50.6 Gy, for 3D-CRT, IMRT, and HBE, respectively).

Conclusions: The HBE plan effectively reduced the amount of radiation exposure to the heart and lung. It could be beneficial for patients who are vulnerable to radiation-related cardiac or pulmonary toxicities.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Beam arrangement for the IMRT technique.
Fig 2
Fig 2. Beam’s eye views of the HBE plans.
(A) The medial tangential field of the 3D-CRT plan was the base of the HBE plan. The medial border of the field was the patient’s midline; (B) The medial tangential field of the HBE plan was designed by blocking the shape of the heart; (C) The electron beam of the HBE plan was completely overlapped with the heart block on the beam’s eye view at an angle of 5° (PTV = red area; heart = blue area; midline = light green line). (Abbreviation: HBE = heart block with electron compensation radiotherapy; PTV = planning target volume; 3D-CRT = three-dimensional conformal radiotherapy).
Fig 3
Fig 3
Dose distributions of (A) the 3D-CRT, (B) IMRT and (C) HBE plans (PTV = semi-lucent red area; heart = semi-lucent orange area; pink line = 49 Gy; yellow line = 47.5 Gy; yellowish green line = 45 Gy; blue line = 40 Gy; navy line = 25 Gy; green line = 10 Gy; white line = 5 Gy). (Abbreviation: 3D-CRT = three-dimensional conformal radiotherapy; HBE = heart block with electron compensation radiotherapy; IMRT = intensity-modulated radiotherapy; PTV = planning target volume).
Fig 4
Fig 4. Comparison of dose–volume histograms for heart, ipsilateral lung and PTV between plans.
(Abbreviation: PTV = planning target volume; 3D-CRT = three-dimensional conformal radiotherapy; HBE = heart block with electron compensation radiotherapy; IMRT = intensity-modulated radiotherapy).
See this image and copyright information in PMC

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