Lateral wedge with medial only cardiac shielding (LEMONADE) technique in left chest wall adjuvant radiotherapy

Abstract

background: This dosimetric study compared lateral wedge with medial only cardiac shielding (LeMONaDe) technique, for left chest wall (LcW) irradiation against three other commonly used techniques. Materials and methods: Dosimetric parameters of 22 consecutive LBc patients treated using the p1 (LeMONaDe technique) were compared with 3 other virtually reconstructed plans: no cardiac shielding with paired wedges; p2 (paired wedges and medial only Y-direction shielding) and p3 (paired wedges and bilateral Y-direction shielding). results: p1 showed better target volume (TV) coverage with the mean 90% isodose coverage of 85.59% ± 5.44 compared to 78.90% ± 8.59 and 74.22% ± 9.50 for p2 and p3, respectively. compared to no cardiac shielding, for a 4.65% drop in TV coverage the V26Gy of heart dropped from 6.68% to a negligible 0.85% for p1. TV receiving < 30Gy is also significantly lesser for p1 compared to p2 and p3 (5.42% vs 10.64% and 15.8%), whilst there is a small difference of 2.75% between no cardiac shielding and p1. conclusion: With the improvement in Bc survival rate, cardiac toxicity associated with adjuvant irradiation for LBc is a major concern. p1 (LeMONaDe) technique has a good compromise between cardiac sparing and target coverage and should suffice for most LcW irradiations. Furthermore, the LeMONaDe technique is a simple, reproducible and involves fast planning for cardiac sparing, which is ideal for under-resourced departments with heavy workload.