Impact of Cardiac Substructure Dosimetry on Late Cardiac Risk: A Report From the Childhood Cancer Survivor Study (CCSS)

Even among survivors with low mean heart doses (< 5 Gy), mean LAD doses ≥10 Gy increased risk of cardiac disease. Thus, for pediatric RT planning we recommend limiting mean LAD dose to < 10 Gy, even when mean heart dose constraints can be achieved. Table 1. Relative rate of grade 3 - 5 cardiac disease in childhood cancer survivors by RT dose to the heart and LAD.