Do you use an LAD constraint in the setting of BID thoracic radiation for SCLC?

The literature is convincing that an increasing dose to the heart (using whole-heart dosimetric parameters) is associated with an increased risk of adverse cardiac events and decreased survival. Recent and current investigations have attempted to correlate dose to specific cardiac substructures with various cardiac adverse events (e.g., atrial fibrillation, valvular complications, coronary artery disease). This is challenging in a lung cancer population because there are numerous cardiac substructures, many cardiac complications that can develop, and relatively few events compared with the competing risk of death from NSCLC or SCLC. Many studies have been completed to date, with results that are not always concordant. However, dose to the l...