Dosimetric evaluation of left ventricle and left anterior descending artery in left breast radiotherapy



We evaluated the dosimetric results of the identification of the left ventricle (LV) and left anterior descending artery (LAD) as organs at risk (OARs) in adjuvant radiotherapy (RT) after breast-conserving surgery (BCS).

Materials and Methods

Twenty-two patients who had previously received RT in our center were evaluated retrospectively. All patients had undergone BCS operation for left breast cancer. LV and LAD were contoured as OARs on the same simulation CTs for these patients whose treatment was previously completed in which LV and LAD were not defined as OARs. Complying with the initial plans, intensity-modulated RT plans with 7–9 fields were made on the computer. Planning target volume (PTV), homogeneity index (HI), conformity index (CI), monitor unit (MU) values, and doses of OARs were compared using the Wilcoxon signed-rank test (p < 0.05).


There were no significant differences in PTV 50 (D 50% and D 98%), PTV 60 (D 2% and D 50%), HI, CI, and MU values when treatment plans and control plans were compared (p > 0.05). While it was possible to protect the heart, LAD, and LV better, LAD and LV were not contoured in the treatment plans, and they received higher doses compared to the control plans (p < 0.05). There was no significant difference in the other OARs.


In conclusion, it is essential to define the lower anatomical regions of the heart as OARs. Otherwise, the doses taken by these regions are ignored and may be maintained less than possible. In our study, it was shown that LV and LAD doses were significantly reduced even in the same center and planning by the same team.

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All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. AA and BS were involved in conceptualization and methodology. AA, EA, and BS contributed to investigation and formal analysis. AA and BT were involved in writing—original draft, review, and editing and visualization.

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Correspondence to Alaettin Arslan.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Institutional review board approval was obtained for this study. The study was conducted with the approval of the Non-Interventional Clinical Research Ethics Committee of Kayseri City Hospital. Ethics Committee convened on 12.03.2020 and received the protocol number 2020/15.

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Arslan, A., Aktas, E., Sengul, B. et al. Dosimetric evaluation of left ventricle and left anterior descending artery in left breast radiotherapy. Radiol med 126, 14–21 (2021).

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  • Left breast cancer
  • Breast-conserving surgery
  • Adjuvant radiotherapy
  • Left ventricle and left anterior descending artery