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Spatial orientation of coronary arteries and its implication for breast and thoracic radiotherapy—proposing “coronary strip” as a new organ at risk

Räumliche Orientierung der Koronararterien und ihre Implikation in der Strahlentherapie von Brust und Thorax – Vorschlag „Koronarstreifen“ als neues Risikoorgan

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Abstract

Objectives

Radiotherapy for breast cancer has been associated with various side effects including cardiac sequelae. Our study aimed to define the spatial arc of spread of coronary vessels in a radian angle.

Materials and methods

We analysed the records of 51 CT coronary angiographies done in our hospital from January 2016 to July 2016. Left anterior descending (LAD) and right coronary (RC) were contoured for each patient. In each axial section, the radial spread of each artery was noted. A 5 mm brush tool was used to join the start and stop angles for making the summated “coronary strips”.

Results

Start and end angle of LAD with 95% confidence interval (CI) (in clockwise direction) were 23.9 ± 4° and 79.0 ± 6.6°, respectively. Mean LAD arc length ± SD (standard deviation) noted was 55.1° ± 7.7° (95% CI). For RC the smallest start angle and the largest end angle in all patients was 297.6° and 322.6°, respectively. RC start angle, end angle and arc length for 95% confidence interval were 322.2 ± 6.1°, 292.4 ± 11.6° and 29.8 ± 13.1°, respectively.

Conclusions

Our study provides a measure of the radial spread of the coronary arteries, especially from the perspective of breast radiotherapy. We have proposed a new organ at risk (OAR) of coronary strip. This should provide an easy and cost-effective way to delineate the coronary vasculature in breast cancer patients undergoing radiotherapy.

Zusammenfassung

Ziele

Die Strahlentherapie bei Brustkrebs wurde jedoch auch mit verschiedenen Nebenwirkungen einschließlich kardialen Effekten in Verbindung gebracht. Unsere Studie zielte darauf ab, den räumlichen Ausbreitungsbogen der Herzkranzgefäße im Bogenwinkel zu bestimmen.

Material und Methoden

Wir analysierten die Datensätze von 51 CT-Koronarangiographien, die in unserem Krankenhaus von Januar 2016 bis Juli 2016 durchgeführt wurden. Links anterior abwärts (LAD) und rechts koronar (RC) wurden für jeden Patienten konturiert. In jedem axialen Abschnitt wurde die radiale Ausbreitung jeder Arterie festgestellt. Ein 5‑mm-Bürstenwerkzeug wurde verwendet, um die Start- und Stopwinkel zur Herstellung der summierten „Koronarstreifen“ zu verbinden.

Ergebnisse

Anfangs- und Endwinkel der LAD mit 95%-Konfidenzintervall (95%-KI; im Uhrzeigersinn) sind 23,9 ± 4° bzw. 79,0 ± 6,6°. Die gemessene mittlere Bogenlänge ± SD betrug 55,1 ± 7,7° für ein 95%-KI. Für RC war der kleinste Startwinkel und der größte Endwinkel bei allen Patienten 297,6° bzw. 322,6°. RC-Startwinkel, -Endwinkel und -Bogenlänge für ein 95%-KI betrugen 322,2 ± 6,1°, 292,4 ± 11,6° bzw. 29,8 ± 13,1°.

Schlussfolgerung

Unsere Studie liefert einen Maßstab für die radiale Ausbreitung der Koronararterien, insbesondere aus Sicht der Brust-Strahlentherapie. Wir haben als neues Risikoorgan (OAR) den Koronarstreifen vorgeschlagen. Dies sollte eine einfache und kostengünstige Möglichkeit zur Abgrenzung der Koronarvaskulatur bei Brustkrebspatienten, die einer Strahlentherapie unterzogen werden, bereitstellen.

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Authors and Affiliations

  1. Department of Radiation Oncology, Fortis Memorial Research Institute, 122002, Gurgaon, Haryana, India

    Anusheel Munshi, Nilaxi Khataniar, Biplab Sarkar & Bidhu Kalyan Mohanti

  2. Department of Radiology, Fortis Memorial Research Institute, Gurgaon, Haryana, India

    Moti Lal Bera

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  1. Anusheel Munshi
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  2. Nilaxi Khataniar
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  3. Biplab Sarkar
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Correspondence to Anusheel Munshi.

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Conflict of interest

A. Munshi, N. Khataniar, B. Sarkar, M.L. Bera and B.K. Mohanti declare that they have no competing interests.

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Munshi, A., Khataniar, N., Sarkar, B. et al. Spatial orientation of coronary arteries and its implication for breast and thoracic radiotherapy—proposing “coronary strip” as a new organ at risk. Strahlenther Onkol 194, 711–718 (2018). https://doi.org/10.1007/s00066-018-1299-x

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