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Topics:
Breast Cancer • Radiation Oncology
When deciding whether to include an IMN field in a PMRT case, what do you consider a "safe dose" to the heart that you are willing to accept?
Do you prioritize certain dosimetric parameters over others (e.g., considering the Darby report, mean dose to the heart vs. mean LAD dose?)
Answer from: Radiation Oncologist at Community Practice
I agree with @Benjamin D. Smith about keeping the heart dose as low as possible. Aim for a mean heart dose of ≤ 4 Gy. I prioritize the heart dose constraint, especially in younger women, women with pre-exisiting cardiac conditions and those who have had cardiotoxic chemotherapy.&...
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Answer from: Radiation Oncologist at Academic Institution
We routinely treat the IM nodes and chest wall in breath hold for left sided cases. Our average mean heart dose typically ranges from 2.5 to 3.5 Gy, which we feel is acceptable. In general, I follow the ALARA principal with heart dosing and will try to optimize my plan as much as possible, which usu...
Answer from: Radiation Oncologist at Community Practice
We try to make sure no direct photon beam tangent goes through heart by using a partially wide tangent or a combination of photon and electrons. We dont have ABC but that is certainly an option to avoid that.
By doing this our V25 is usually 1 to 2%. The current NRG protocol I think allows upto 5%.
Answer from: Radiation Oncologist at Community Practice
@Eleanor E. Harris, can you please share the references for non-tangential IMRT?