Dosimetric advantage of Deep Inspiration Breath Hold in left breast radiotherapy: comparative analysis with free breathing

Purpose: To present our clinical workflow of incorporating AlignRT for left breast deep inspiration breath-hold treatments and the dosimetric considerations with the deep inspiration breath-hold protocol. Material and Methods: Patients with stage I to III left-sided breast cancer who underwent lumpectomy or mastectomy were considered candidates for deep inspiration breath-hold technique for their external beam radiation therapy. Treatment plans were created on both free-breathing and deep inspiration breath-hold computed tomography for each patient to determine whether deep inspiration breath-hold was beneficial based on dosimetric comparison. The AlignRT system was used for patient setup and monitoring. Dosimetric measurements and their correlation with chest wall excursion and increase in left lung volume were studied for free-breathing and deep inspiration breath-hold plans. Results: Deep inspiration breath-hold plans had significantly increased chest wall excursion when compared with free breathing. This change in geometry resulted in reduced mean and maximum heart dose but did not impact lung V20 or mean dose. The correlation between chest wall excursion and absolute reduction in heart or lung dose was found to be nonsignificant, but correlation between left lung volume and heart dose showed a linear association. It was also identified that higher levels of chest wall excursion may paradoxically increase heart or lung dose. Conclusion: Reduction in heart dose can be achieved for many left-sided breast and chest wall patients using deep inspiration breath-hold. Chest wall excursion as well as left lung volume did not correlate with reduction in heart dose, and it remains to be determined what metric will provide the most optimal and reliable dosimetric advantage.

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Should deep inspiration breath-hold be used as standard in left breast radiotherapy treatment?

Physica Medica ◽

10.1016/j.ejmp.2015.07.014 ◽

2016 ◽

Vol 32 (2) ◽

pp. 416

Author(s):

Niall McAndrew ◽

Hayley Chesham ◽

Kate Walsh

Keyword(s):

Left Breast ◽

Breath Hold ◽

Deep Inspiration ◽

Breast Radiotherapy ◽

Deep Inspiration Breath Hold ◽

Radiotherapy Treatment

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Evaluation of an in-house self-held respiration monitoring device for deep inspiration breath hold techniques for radiotherapy of patients with cancer of the left breast

Journal of Radiotherapy in Practice ◽

10.1017/s1460396919000517 ◽

2019 ◽

Vol 19 (2) ◽

pp. 122-126

Author(s):

Yuen Yan Chan ◽

Ki Man Ku ◽

Yin Ping Ng ◽

Siu Ki Ben Yu ◽

Chi Wah Tony Kong ◽

...

Keyword(s):

Maximum Dose ◽

Free Breathing ◽

Left Breast ◽

Breath Hold ◽

Monitoring Device ◽

Deep Inspiration ◽

Deep Inspiration Breath Hold ◽

Respiration Monitoring ◽

Heart Dose ◽

Mean Error

AbstractBackground:An in-house self-held respiration monitoring device (SHRMD) was developed for providing deep inspiration breath hold (DIBH) radiotherapy. The use of SHRMD is evaluated in terms of reproducibility, stability and heart dose reduction.Methods and materials:Sixteen patients receiving radiotherapy of left breast cancer were planned for treatment with both a free breathing (FB) scan and a DIBH scan. Both FB and DIBH plans were generated for comparison of the heart, left anterior descending (LAD) artery and lung dose. All patients received their treatments with DIBH using SHRMD. Megavoltage cine images were acquired during treatments for evaluating the reproducibility and stability of treatment position using SHRMD.Results:Compared with FB plans, the maximum dose to the heart by DIBH technique with SHRMD was reduced by 29·9 ± 15·6%; and the maximum dose of the LAD artery was reduced by 41·6 ± 18·3%. The inter-fractional overall mean error was 0·01 cm and the intra-fractional overall mean error was 0·04 cm.Conclusion:This study demonstrated the potential benefits of using the SHRMD for DIBH to reduce the heart and LAD dose. The patients were able to perform stable and reproducible DIBHs.

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Selection of patients with left breast cancer for IMRT with deep inspiration breath-hold technique

Journal of Radiation Research ◽

10.1093/jrr/rraa003 ◽

2020 ◽

Vol 61 (3) ◽

pp. 431-439 ◽

Cited By ~ 1

Author(s):

Chih-Shen CHANG ◽

Chia-Hsin CHEN ◽

Kuo-Chi LIU ◽

Chia-Sheng HO ◽

Miao-Fen CHEN

Keyword(s):

Breast Cancer ◽

Lung Volume ◽

Free Breathing ◽

Target Volume ◽

Left Breast ◽

Breath Hold ◽

Deep Inspiration ◽

Deep Inspiration Breath Hold ◽

Total Lung Volume ◽

The Difference

Abstract The deep inspiration breath-hold (DIBH) technique has been utilized to reduce the cardiac dose in left-sided breast cancer (BC) patients undergoing radiotherapy. Further investigation of the parameters for selecting which patients will benefit most from DIBH is essential. We performed dosimetric comparisons for 21 patients with left-sided BC who had both computed tomography (CT)-based free-breathing (FB) and DIBH plans. The doses to the heart and left anterior descending artery (LAD) and any reduction due to the DIBH technique were analysed. Based on CTFB plans, dosimetric analysis revealed that the irradiation doses to the heart and LAD were significantly correlated with the target volume, the ipsilateral lung volume (ILV) and the total lung volume (TLV). When patients had an ILV ≥ 950 cm3 or a TLV ≥ 2200 cm3, the irradiation doses to the heart and LAD were significantly decreased. Furthermore, the reduction in the mean heart dose (MHD) was correlated to the difference in lung volume between FB and DIBH. The difference in ILV between DIBH and FB of 1.8 indicated that the patients obtained more benefit from the DIBH technique. The data suggest that lung volume (ILV and TLV) measured on a CT-simulation scan and the difference between FB and DIBH could be utilized to help select patients for DIBH.

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