{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:04:14Z","timestamp":1790035454452,"version":"4.0.1"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T00:00:00Z","timestamp":1741910400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T00:00:00Z","timestamp":1741910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Justus-Liebig-Universit\u00e4t Gie\u00dfen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Radiat Oncol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the feasibility of active heart sparing (AHS) planning in patients with locally advanced and centrally located NSCLC receiving standard definitive radiotherapy (RT), while maintaining or improving appropriate lung, esophagus, and spinal cord constraints and planning target volume (PTV) coverage intent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and materials<\/jats:title>\n                    <jats:p>A total of 27 patients with stage IIIA\/B NSCLC treated with curative intent RT were selected for this analysis. All existing radiation plans were revised and 27 further new equivalent plans were calculated using AHS for the same cohort of patients. Primary end-point was feasibility of AHS using constraints for heart substructures. The secondary end point was to calculate the difference in terms of dosimetric parameters of heart substructures and principal OARs as well as PTV-coverage parameters within the current patient group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      AHS was feasible in the entire group of patients. An optimal coverage of the target volume was obtained and all mandatory constraints for OARs have been met. The median value of the mean heart dose (MHD) was 8.18\u00a0Gy and 6.71\u00a0Gy in the standard planning group and AHS-group, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.000). Other heart parameters such as V\n                      <jats:sub>5Gy<\/jats:sub>\n                      (40.57% vs. 27.7%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.000) and V\n                      <jats:sub>30Gy<\/jats:sub>\n                      (5.39% vs. 3.86%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.000) were significantly worse in the standard planning group. The following relevant dosimetric parameters regarding heart substructures were found to be significantly worse in the standard planning group compared to the AHS-group: median dose to heart base (16.97\u00a0Gy vs. 6.37\u00a0Gy,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.000), maximum dose (18.64\u00a0Gy vs. 6.05\u00a0Gy,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.000) and V\n                      <jats:sub>15Gy<\/jats:sub>\n                      (11.11% vs. 0%\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.000) to LAD; mean dose; V\n                      <jats:sub>5Gy<\/jats:sub>\n                      (9.55% vs. 0.94%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.000) and V\n                      <jats:sub>23Gy<\/jats:sub>\n                      (0.00% vs. 0.00% maximum 45.68% vs. 6.57%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002 to the left ventricle.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our analysis showed an improvement of dosimetric parameters of the heart and heart substructures in patients affected by locally advanced and centrally located NSCLC treated with curative RT using AHS optimization. This approach could lead to a possible reduction of heart events and a prolonged survival. New clinical studies regarding RT in advanced NSCLC should include cardiologic evaluations and biomarkers as well as the contouring of cardiac substructures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13014-025-02597-9","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T05:33:52Z","timestamp":1741930432000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Development of heart-sparing VMAT radiotherapy technique incorporating heart substructures for advanced NSCLC patients"],"prefix":"10.1186","volume":"20","author":[{"given":"Linda","family":"Agolli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann-Katrin","family":"Exeli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra Michaela","family":"Ihne-Schubert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Lurtz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Habermehl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"key":"2597_CR1","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1200\/JCO.2016.71.6142","volume":"35","author":"RT Dess","year":"2017","unstructured":"Dess RT, Sun Y, Matuszak MM, Sun G, Soni PD, Bazzi L, et al. 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The study was performed in accordance with the Declaration of Helsinki Version 2013. The current study was approved from our internal review board of Justus-Liebig University of Giessen (ethic approval AZ 197\/23 \u2013 Ethik-Kommission des Fachbereiches Medizin).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"40"}}