%0 Journal Article
%T 3-D reconstruction of anterior mantle-field techniques in Hodgkin's disease survivors: doses to cardiac structures
%A Dirk Vordermark
%A Ines Seufert
%A Franz Schwab
%A Oliver K£¿lbl
%A Margret Kung
%A Christiane Angermann
%A Michael Flentje
%J Radiation Oncology
%D 2006
%I BioMed Central
%R 10.1186/1748-717x-1-10
%X Predominant technique was an anterior mantle field (cobalt-60). 26 patients (47%) were treated with anterior mantle field alone (MF), 18 (33%) with anterior mantle field and monoaxial, bisegmental rotation boost (MF+ROT), 7 (13%) with anterior mantle field and dorsal boost (MF+DORS) and 4 (7%) with other techniques. Mean ¡À SD total mediastinal doses for MF+ROT (41.7 ¡À 3.5 Gy) and for MF+DORS (42.7 ¡À 7.4) were significantly higher than for MF (36.7 ¡À 5.2 Gy). DVH analysis documented relative overdosage to right heart structures with MF (median maximal dose to RV 129%, to RCA 127%) which was siginificantly reduced to 117% and 112%, respectively, in MF+ROT. Absolute doses in right heart structures, however, did not differ between techniques. Absolute LA doses were significantly higher in MF+ROT patients than in MF patients where large parts of LA were blocked. Median maximal doses for all techniques ranged between 48 and 52 Gy (RV), 44 and 46 Gy (LV), 47 and 49 Gy (RA), 38 and 45 Gy (LA), 46 and 50 Gy (RCA), 39 and 44 Gy (LAD) and 34 and 42 Gy (LCX).In patients irradiated with anterior mantle-field techniques, high doses to anterior heart portions were partly compensated by boost treatment from non-anterior angles. As the threshold doses for coronary artery disease, cardiomyopathy, pericarditis and valvular changes are assumed to be 30 to 40 Gy, cardiac toxicity must be anticipated in these patients. Thus, dose distributions in individual subjects should be correlated to the corresponding cardiovascular findings in these long-term survivors, e. g. by cardiovascular magnetic resonance imaging.The risk of cardiac toxicity associated with mediastinal radiotherapy is well known. Multiple studies have addressed the prevalence of valvular disease, myocardial changes, coronary artery disease and the resulting risk of myocardial infarction or death from cardiac disease after thoracic radiotherapy, in particular after mantle-field irradiation in Hodgkin's disease [1-4]. Whereas
%U http://www.ro-journal.com/content/1/1/10