Uncertainties in estimating heart doses from 2D-tangential breast cancer radiotherapy

Background and purpose: We evaluated the accuracy of three methods of estimating radiation dose to the heart from two-dimensional tangential radiotherapy for breast cancer, as used in Denmark during 1982-2002. Material and methods: Three tangential radiotherapy regimens were reconstructed using CT-based planning scans for 40 patients with left-sided and 10 with right-sided breast cancer. Setup errors and organ motion were simulated using estimated uncertainties. For left-sided patients, mean heart dose was related to maximum heart distance in the medial field. Results: For left-sided breast cancer, mean heart dose estimated from individual CT-scans varied from <1 Gy to >8 Gy, and maximum dose from 5 to 50 Gy for all three regimens, so that estimates based only on regimen had substantial uncertainty. When maximum heart distance was taken into account, the uncertainty was reduced and was comparable to the uncertainty of estimates based on individual CT-scans. For right-sided breast cancer patients, mean heart dose based on individual CT-scans was always <1 Gy and maximum dose always <5 Gy for all three regimens. Conclusions: The use of stored individual simulator films provides a method for estimating heart doses in left-tangential radiotherapy for breast cancer that is almost as accurate as estimates based on individual CT-scans. (C) 2016 Published by Elsevier Ireland Ltd.