Cardiac dose evaluation for 3-dimensional conformal partial breast irradiation compared with whole breast irradiation

To compare the radiation dose to normal cardiac tissue for 3Dimensional (3D) conformal external beam partial breast irradiation (PBI) and standard whole breast irradiation (WBI), and examine the effect of tumor bed location. For 14 patients with left breast tumors randomized on the National Surgical Adjuvant Breast and Bowel Project B-39 protocol, computer-generated radiotherapy treatment plans were devised for WBI and PBI. Tumor bed location was designated according to whether more than 50% of the excision cavity was medial or lateral to the nipple line. The volume of heart receiving doses of 2.5, 5, 10, and 20 Gy was calculated for all PBI and WBI plans. Dose to 5% of the heart volume (D5) and mean heart dose were also calculated. The biologically-equivalent dose (BED) was calculated to account for the different fractionation used in PBI and WBI. Of the 14 patients, 8 had lateral tumor beds, and 6 had medial tumor beds. The volumes of heart receiving 2.5, 5, 10, and 20 Gy were significantly lower for lateral PBI compared with WBI. For medial PBI, significant cardiac sparing was only seen at a dose of 20 Gy. The difference of D5 values was significant for lateral PBI compared with WBI (p=0.008), but not for medial PBI compared with WBI (p=0.84). The mean dose was also significantly lower for lateral PBI compared with WBI (p=0.008), but not for medial PBI (p=0.16). The results from BED calculations did not change this outcome. Both 3D conformal PBI and standard WBI can deliver relatively low doses to the heart. For patients with lateralized tumor beds, PBI offers significant cardiac sparing compared with WBI. Patients with medial lesions have relatively similar heart dosimetry with PBI and WBI. 3D conformal PBI is an emerging treatment modality and continued participation on clinical trials is encouraged. Patients with left-sided lesions and lateralized tumor beds warrant special consideration for PBI, given the significant cardiac dose sparing.