Vol 70, No 2 (2020)
Review paper
Published online: 2020-04-07

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Contouring of the left anterior descending coronary artery in patients with breast cancer – the radiation oncologist’s view

Marta Biedka1, Elżbieta Żmuda1
DOI: 10.5603/NJO.2020.0014
Nowotwory. Journal of Oncology 2020;70(2):60-64.


Breast cancer is the cancer with the largest prevalence, both in Poland and worldwide. The standard treatment in patients with this disease is breast-conserving therapy (BCT), followed by whole breast radiotherapy (WBRT) with a boost dose applied to the area of the bed created after tumour resection. In women who have undergone breast amputation – in the presence of poor prognostic factors – the chest wall is irradiated with or without the irradiation of the axillary fossa and clavicular area. Radiotherapy is used as an adjuvant treatment in connection with the high rate of relapses in the area of the treated breast – as much as 20% after 10 years. Some patients, before the commencement of the irradiation, are treated systemically with the use of regimens comprising drugs with a high degree of cardiotoxicity. This effect may even be increased during the course of radiotherapy – mainly in patients after amputation of the left breast. The side-effects induced by radiotherapy depend on area of the heart within the field of irradiation. Studies suggest that the vulnerable parts of the heart are the coronary vessels, and primarily, the left anterior descending (LAD) artery, which is located close to the chest wall.

The objective of this study is to present practical guidelines concerning contouring the left anterior descending (LAD) artery in patients with cancer of the left breast, who have qualified for radiotherapy.

Contouring the LAD seems to be significant as a method of assessing the critical organ during radiotherapy. The results may cause a modification of the treatment strategy: a change to the planned radiotherapy, the quantity of the beams and/or their angle of incidence or a change in the beam weight.

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  1. Kuźba-Kryszak T, Biedka M, Ziółkowski S, et al. Intraoperative radiotherapy using in breast cancers of women. Onkol Radioter. ; 2015(1): 22–30.
  2. Correa CR, Das IJ, Litt HI, et al. Association between tangential beam treatment parameters and cardiac abnormalities after definitive radiation treatment for left-sided breast cancer. Int J Radiat Oncol Biol Phys. 2008; 72(2): 508–516.
  3. Gagliardi G, Lax I, Ottolenghi A, et al. Long-term cardiac mortality after radiotherapy of breast cancer--application of the relative seriality model. Br J Radiol. 1996; 69(825): 839–846.
  4. Paszat LF, Vallis KA, Benk VMA, et al. A population-based case-cohort study of the risk of myocardial infarction following radiation therapy for breast cancer. Radiother Oncol. 2007; 82(3): 294–300.
  5. Giordano SH, Kuo YF, Freeman JL, et al. Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst. 2005; 97(6): 419–424.
  6. Di Franco R, Ravo V, Nieddu V, et al. Detection of a numeric value predictive of increased dose to left anterior descending coronary artery (LAD) in radiotherapy of breast cancer. Springerplus. 2016; 5(1): 841.
  7. de Almeida CE, Fournier-Bidoz N, Massabeau C, et al. Potential benefits of using cardiac gated images to reduce the dose to the left anterior descending coronary during radiotherapy of left breast and internal mammary nodes. Cancer Radiother. 2012; 16(1): 44–51.
  8. Jagsi R, Moran J, Marsh R, et al. Evaluation of four techniques using intensity-modulated radiation therapy for comprehensive locoregional irradiation of breast cancer. Int J Radiat Oncol Biol Phys. 2010; 78(5): 1594–1603.
  9. Tanaka H, Hayashi S, Hoshi H. Cardiac counterclockwise rotation is a risk factor for high-dose irradiation to the left anterior descending coronary artery in patients with left-sided breast cancer who receiving adjuvant radiotherapy after breast-conserving surgery. Nagoya J Med Sci. 2014; 76(3-4): 265–272.
  10. Borger JH, Hooning MJ, Boersma LJ, et al. Cardiotoxic effects of tangential breast irradiation in early breast cancer patients: the role of irradiated heart volume. Int J Radiat Oncol Biol Phys. 2007; 69(4): 1131–1138.
  11. Marks LB, Yu X, Prosnitz RG, et al. The incidence and functional consequences of RT-associated cardiac perfusion defects. Int J Radiat Oncol Biol Phys. 2005; 63(1): 214–223.
  12. Gyenes G, Fornander T, Carlens P, et al. Detection of radiation-induced myocardial damage by technetium-99m sestamibi scintigraphy. Eur J Nucl Med. 1997; 24(3): 286–292.
  13. Vennarini S, Fournier-Bidoz N, Aristei C, et al. Visualisation of the left anterior descending coronary artery on CT images used for breast radiotherapy planning. Br J Radiol. 2013; 86(1025): 20120643.
  14. Jagsi R, Moran JM, Kessler ML, et al. Respiratory motion of the heart and positional reproducibility under active breathing control. Int J Radiat Oncol Biol Phys. 2007; 68(1): 253–258.
  15. Borst GR, Sonke JJ, den Hollander S, et al. Clinical results of image-guided deep inspiration breath hold breast irradiation. Int J Radiat Oncol Biol Phys. 2010; 78(5): 1345–1351.
  16. Vikström J, Hjelstuen MHB, Mjaaland I, et al. Cardiac and pulmonary dose reduction for tangentially irradiated breast cancer, utilizing deep inspiration breath-hold with audio-visual guidance, without compromising target coverage. Acta Oncol. 2011; 50(1): 42–50.
  17. Stranzl H, Zurl B. Postoperative irradiation of left-sided breast cancer patients and cardiac toxicity. Does deep inspiration breath-hold (DIBH) technique protect the heart? Strahlenther Onkol. 2008; 184(7): 354–358.
  18. Nemoto K, Oguchi M, Nakajima M, et al. Cardiac-sparing radiotherapy for the left breast cancer with deep breath-holding. Jpn J Radiol. 2009; 27(7): 259–263.
  19. Blank E, Willich N, Fietkau R, et al. Evaluation of time, attendance of medical staff, and resources during radiotherapy for breast cancer patients. The DEGRO-QUIRO trial. Strahlenther Onkol. 2012; 188(2): 113–119.
  20. Nieder C, Schill S, Kneschaurek P, et al. Influence of different treatment techniques on radiation dose to the LAD coronary artery. Radiat Oncol. 2007; 2: 20.

Nowotwory. Journal of Oncology