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Dosimetric Performance of Orthogonal Dual-Layer Multi-Leaf Collimator System on Locally Advanced Lung Cancer: Cardiac
AiHui Feng1,2,3, YanHua Duan1,2,3, ZhangRu Yang1
1Department of Radiation Oncology, Shanghai Chest Hospital School of Medicine, Shanghai, China.
Advances in Radiation Oncology
|October 2, 2025
Summary
Dual-layer MLC plans significantly reduce cardiac and lung radiation doses in lung cancer patients, lowering risks of heart disease and radiation pneumonia. This advance offers new possibilities for immunotherapy.
Area of Science:
- Radiation Oncology
- Medical Physics
- Cardiovascular Health
Background:
- Advanced-stage lung cancer treatment often involves radiation therapy.
- Radiation exposure to the heart and its substructures can lead to cardiovascular complications.
- Minimizing radiation dose to organs at risk is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a dual-layer multileaf collimator (MLC) system in reducing radiation dose to cardiac substructures.
- To assess the impact of improved dose distribution on the risk of cardiovascular incidents and radiation pneumonia (RP).
- To compare the performance of dual-layer MLC (D-CS) plans against single-layer MLC (S-WH and S-CS) plans.
Main Methods:
- Eighteen advanced-stage lung cancer patients were included.
- Cardiac substructures and organs at risk were delineated for dose optimization.
- Three types of radiation plans were created: S-WH (single-layer, whole heart), S-CS (single-layer, cardiac substructures), and D-CS (dual-layer, cardiac substructures).
- Dose metrics, conformity index, and relative risks of cardiac events and RP were evaluated.
Main Results:
- D-CS plans significantly reduced radiation dose to left ventricle, pulmonary artery, and coronary arteries compared to single-layer plans.
- D-CS plans showed significantly lower V5Gy for the left ventricle and V15Gy for the left circumflex artery.
- The risk ranking for cardiac events and RP was D-CS < S-CS < S-WH plans.
- D-CS plans demonstrated the lowest effective dose to the immune system.
Conclusions:
- Dual-layer MLC technology significantly improves cardiac substructure dose sparing in lung cancer radiotherapy.
- This advanced technique reduces the risk of radiation-induced heart disease and radiation pneumonia.
- Dual-layer MLC offers enhanced opportunities for subsequent immunotherapy in locally advanced lung cancer patients.
