Chest Wall Deformity in the Radiation Oncology Clinic.

BACKGROUND/AIM: To determine the incidence of pectus excavatum (PE) and define anatomical chest wall metrics predictive of elevated mean heart dose (MHD) in patients with left-sided breast cancer receiving adjuvant radiotherapy.

PATIENTS AND

METHODS

We reviewed 273 consecutively simulated patients from 1/2013-12/2014. Physical examination identified patients with clinically identifiable PE. Characteristics were compared between patients with and those without PE. Predictors of MHD were evaluated using linear regression.

RESULTS

The average MHD for the entire cohort was 172 cGy. Of 273 patients, 10 (3.7%) were found to have clinically significant PE. Increase in the Haller Index was correlated with higher MHD (p<0.001). Through the use of individually optimized patient positioning and respiratory gating, MHD was not statistically different in patients with PE compared to those without (p=0.093).

CONCLUSION

Although PE deformity is associated with unfavorable geometry in patients undergoing left-sided breast irradiation, carefully selected treatment technique can maintain acceptable MHD.