Cardiac risk and MCNP/SISCODES doses in RT of the left internal mammary chain with photon and electron portals

The present study evaluated the increment of cardiac risk (CR) and absorbed dose in radiotherapy of the internal mammary chain (IMC), in particular with photon portals of 4 6 MV, and cobalt therapy (Co60); and, electron portals of 8, 12 and 16 MeV applied in the left breast, considering the adoption of a combined photon (16 Gy) and electron (30 Gy) protocols.

The modified ICRP-reference female model of 60 kg, 163 cm and 43 years of age, coil RCP-AF, was modelled. The MCNP6/SICODES codes were employed, where the spatial dose distributions and dose-volume histograms were generated. Toxicity limits and a CR model were considered.

CR associated with the 6 MV, 4 MV and Co60 portals increased 41.1; 40.6 and 34.5%, respectively; while, in 8, 12 and 16 MeV portals, they were 5.0, 32.5 and 49.2%, respectively. High anomalous scatter radiation from electron portals was found in the left lung providing an average dose of 3.3-5.0 Gy.

To RCP-AF, the Co60 portal for IMC-RT presented more attractive dose distribution, whose 16 Gy for photon-component produced less CR increase, 5% lower than the other photon portals. Considering electron portals, the smallest CR increase was produced by 8 MeV portal while 12-16 MeV made the risk higher. There is a call for a less hardened energetic spectrum in order to reduce CR; however, holding suitable IMC penetration. A combined Co60/8-12 MeV may bring benefits, reducing CR. The lowest risk was found to 46 Gy electron portals exclusively.