{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:54:56Z","timestamp":1790736896332,"version":"4.1.0"},"reference-count":38,"publisher":"Korean Society for Therapeutic Radiology and Oncology","issue":"3","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"funder":[{"DOI":"10.13039\/501100002642","name":"Korea University","doi-asserted-by":"publisher","award":["K2610281"],"award-info":[{"award-number":["K2610281"]}],"id":[{"id":"10.13039\/501100002642","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002642","name":"Korea University","doi-asserted-by":"publisher","award":["K2610891"],"award-info":[{"award-number":["K2610891"]}],"id":[{"id":"10.13039\/501100002642","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["e-roj.org"],"crossmark-restriction":true},"short-container-title":["Radiat Oncol J"],"published-print":{"date-parts":[[2026,9,30]]},"abstract":"<jats:p>Purpose: This study aimed to compare left-sided breast volumetric modulated arc therapy plans using heart-only dose constraints with plans that include additional left ventricle (LV) and left anterior descending coronary artery (LAD) dose constraints (heart + LV + LAD).Materials and Methods: Thirty patients treated with whole-breast irradiation with simultaneous integrated boost were replanned using both strategies. The heart + LV + LAD strategy applied dose constraints based on German Society for Radiation Oncology recommendations and Danish Breast Cancer Group HYPO protocol (LV: Dmean [mean dose] &lt;3 Gy, V5Gy [percentage of volume receiving \u22655 Gy] &lt;17%, V23Gy &lt;5%; LAD: Dmean &lt;10 Gy, Dmax [maximum dose] &lt;17 Gy). Target and organ-at-risk (OAR) metrics were compared using Wilcoxon signed-rank tests. For exploratory analyses, LAD\u2013planning target volume (PTV) distance was defined as the minimum distance between LAD and whole-breast PTV, and Spearman\u2019s correlations between LAD-PTV distance and LAD or target metrics were evaluated.Results: Compared with heart-only plans, heart + LV + LAD plans reduced LV Dmean, V5Gy, and V23Gy, as well as LAD Dmean and Dmax (all p &lt; 0.001), meeting all prespecified dose constraints except LV Dmean and LAD Dmax (achieved in 70.0% and 63.3%, respectively). Target metrics showed small compromises (e.g., PTV V95% [percentage of volume receiving \u226595% of the prescription dose] 98.391% vs. 99.431%; p &lt; 0.001). Ipsilateral lung Dmean and V5Gy decreased, whereas contralateral breast Dmean and lung V10Gy increased (all p &lt; 0.05). In heart + LV + LAD plans, greater LAD-PTV distance correlated with lower LAD Dmax and Dmean and higher PTV D98%.Conclusion: Applying LV and LAD dose constraints improved cardiac substructure sparing with modest trade-offs in target and contralateral OAR metrics. LAD-PTV distance may influence the feasibility of LAD sparing, but this exploratory association warrants further study.<\/jats:p>","DOI":"10.3857\/roj.2026.00437","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T07:54:40Z","timestamp":1788162880000},"page":"210-221","update-policy":"https:\/\/doi.org\/10.3857\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility and trade-offs of incorporating cardiac substructure dose constraints in left-sided breast volumetric modulated arc therapy planning"],"prefix":"10.3857","volume":"44","author":[{"given":"Song Heui","family":"Cho","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Jeong","family":"Heo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea"},{"name":"Department of Medical Physics, Graduate School of Korea University, Sejong, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chul Yong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Yun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae Sik","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakyoung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Hwa","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam Kwon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suk","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Korea University Anam 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