Variability of Medial and Lateral Borders Delineation in Guidelines for Post-Mastectomy Irradiation and its effect on Radiation Dose Received by Left Lung and Heart

Document Type : Original Article

Authors

1 Department of Clinical Oncology, Faculty of Medicine, Beni-Suef University.

2 Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University.

10.21608/ejmr.2025.353362.1778

Abstract

Background: Clinical Target Volume (CTV) delineation is an essential step in post-mastectomy irradiation. Due to the anatomical positioning of the affected breast, it is anticipated that the delineation of the lateral margin will impact on the standard tangential fields, consequently affecting the volumes of the ipsilateral lung and heart (on the left side) that are exposed to high doses of radiation. Aim of work: Assessment of impact of different guidelines for chest wall CTV delineation on the doses received by the contralateral breast and left lung, and a comparison with wire-based delineation (WBD) results. Methodology: Following surgery, Chest wall(CW) 3-Dimensional(3D) Conformal radiation was planned for 13 left breast cancer women with T3/4 &/or Nodal +ve. One radiation oncologist's CW delineation was followed by several ESTRO recommendations, along with a 3D WBD of CW beneath the diseased breast based on anatomy.We compared between the 2 plans regarding coverage, homogeneity, radiation dose received by heart, lt lung and contralateral breast. Results: The 2 plans was equal regarding coverage and homogeneity. For heart dose(D50%) in plans based on wire delineation was (89.0 + 9.8 cGy) Vs (121.4 +/-24.5 cGy , p= 0.001) in ESTRO guidelines. The chest wall volume in the plan based on wire was smaller than the ESTRO plan. Regarding lt lung there was a significant difference in V20(15.2 +/- 2.1%) for ESRTO delineation Vs(12.4 +/- 1.8%) for wire based delineation .Conclusion: Using a wire in post modified radical mastectomy irradiation had an effect on radiation dose received by heart, lung and contralateral breast .

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Egyptian Journal of Medical Research
Volume 6, Issue 2
April 2025
Pages 131-141

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