Degree of reduction in normal liver complication probability from free-breathing to breath-hold liver SBRT: A dose-escalation strategy using radiation dose-volume effect

Abstract Introduction: This study aimed to analyze the degree of reduction in normal liver complication probability (NTCP) from free-breathing (FB) to breath-hold (BH) liver SBRT. The effect of the radiation dose-volume on the mean liver dose (MLD) was also analyzed due to dose prescription, normal liver volume (NLV), and PTV. Materials and Methods: Thirty-three stereotactic body radiation therapy (SBRT) cases of hepatocellular carcinoma were selected, retrospectively. For FB, the treatments were planned on average intensity projection scan (CTavg), and patient-specific internal target volume (ITV) margins were applied. To simulate the BH treatment, computed tomography (CT) scan correspond to the 40% - 50% of the respiratory cycle (CT40%-50%) was chosen, and an appropriate intrafraction margin of 2 mm, 1.5 mm, and 1.5 mm were given in craniocaudal (CC), superior-inferior (SI), and lateral direction to generate the final iGTV. As per RTOG 1112, all organs at risk (OAR’s) were considered during the optimization of treatment plans. NTCP was calculated using LKB fractionated model. Multivariate regression analysis was performed to see the effect of EQD2Gy, NLV, and PTV on MLD2Gy. Results: A significant dosimetric difference was observed in the normal liver (liver-ITV/iGTV). A reduction of 1.7% in NTCP was observed from FB to BH technique. The leverage of dose escalation is more in BH because MLD2Gy corresponds to 5%, 10%, 20%, and 50% NTCP was 0.099 Gy, 0.41 Gy, 1.21 Gy, and 3.432 Gy more in BH as compared to FB technique. In MVRA, the major factor which was attributed to a change in MLD2Gy is EQD2Gy. Conclusion: From FB to BH technique, a significant reduction in NTCP was observed. The dose prescription is a major factor attributed to the change in MLD2Gy. Advances in knowledge: If feasible, prefer BH treatment either for tumor dose escalation or for the reduction in NTCP.

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Deep-inspiration breath hold radiotherapy in patients with left-sided breast cancer after partial mastectomy

10.33699/pis.2021.100.4.180-185 ◽

2021 ◽

Vol 100 (4) ◽

Keyword(s):

Breast Cancer ◽

Radiation Dose ◽

Organs At Risk ◽

Left Lung ◽

Free Breathing ◽

Partial Mastectomy ◽

Breath Hold ◽

Deep Inspiration ◽

Deep Inspiration Breath Hold ◽

Dose Volume Histograms

Introduction: The purpose of this study was to compare the radiation dose to organs at risk for deep-inspiration breath hold (DIBH) and free-breathing (FB) radiotherapy in patients with lef-sided breast cancer undergoing adjuvant radiotherapy after partial mastectomy. Methods: One hundred patients with left-sided breast cancer underwent DIBH and FB planning computed tomography scans, and the 2 techniques were compared. Dose-volume histograms were analyzed for heart, left anterior descending coronary artery (LAD), and left lung. Results: Radiation dose to heart, LAD, and left lung was significantly lower for DIBH than for free breathing plans. The median mean heart dose for DIBH technique in comparison with FB was 1.21 Gy, and 3.22 Gy respectively; for LAD, 4.67 versus 24.71 Gy; and for left lung 8.32 Gy versus 9.99 Gy. Conclusion: DIBH is an effective technique to reduce cardiac and lung radiation exposure.

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SU-F-T-254: Dose Volume Histogram (DVH) Analysis of Breath Hold Vs Free Breathing Techniques for Esophageal Tumors

Medical Physics ◽

10.1118/1.4956473 ◽

2016 ◽

Vol 43 (6Part16) ◽

pp. 3520-3521

Author(s):

R Badkul ◽

K Doke ◽

D Pokhrel ◽

N Aguilera ◽

C Lominska

Keyword(s):

Free Breathing ◽

Breath Hold ◽

Dose Volume Histogram ◽

Breathing Techniques ◽

Dose Volume ◽

Esophageal Tumors

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Evaluating Radiation Dose to the Heart With Left Whole Breast Radiation Therapy in Prone, Supine Breath-Hold, and Supine Free-Breathing Positions

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2013.06.593 ◽

2013 ◽

Vol 87 (2) ◽

pp. S229

Author(s):

B.A. Perez ◽

P.R. Patel ◽

S. Yoo ◽

L. O'Neill ◽

K.P. Livengood ◽

...

Keyword(s):

Radiation Therapy ◽

Radiation Dose ◽

Free Breathing ◽

Breath Hold

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CT-based analysis of free-breathing vs. maximum inspiratory breath hold techniques for 3-D conformal radiation therapy and intensity modulated radiation therapy in lung cancer: a potential basis for dose-escalation

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(03)01360-9 ◽

2003 ◽

Vol 57 (2) ◽

pp. S417 ◽

Cited By ~ 1

Author(s):

R.R Manon ◽

R Patel ◽

T Zhang ◽

D Henderson ◽

W Tome ◽

...

Keyword(s):

Lung Cancer ◽

Radiation Therapy ◽

Dose Escalation ◽

Intensity Modulated Radiation Therapy ◽

Free Breathing ◽

Breath Hold ◽

Conformal Radiation Therapy ◽

Intensity Modulated ◽

Potential Basis

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Deep inspirational breath hold to reduce cardiac dose in left-sided breast radiotherapy

Journal of Radiotherapy in Practice ◽

10.1017/s1460396917000152 ◽

2017 ◽

Vol 16 (3) ◽

pp. 251-257 ◽

Cited By ~ 1

Author(s):

Camarie Welgemoed ◽

Jonathan Rogers ◽

Patti McNaught ◽

Susan Cleator ◽

Pippa Riddle ◽

...

Keyword(s):

Radiation Dose ◽

Free Breathing ◽

Good Method ◽

Breath Hold ◽

Treatment Area ◽

Breast Radiotherapy ◽

Deep Inspiration Breath Hold ◽

Heart Dose ◽

Set Up ◽

Mean Heart Dose

AbstractBackgroundDuring left-sided breast radiotherapy, the heart is often exposed to radiation dose. Shielding can be utilised to reduce heart exposure, but compromises the dose delivered to the breast tissue and, in a proportion of patients, to the tumour bed. Deep inspiration breath hold (DIBH) can be used as a technique to move the heart away from the treatment area and thus reduce heart dose. This study examines the efficacy of the Elekta Active Breathing Coordinator (ABC), a DIBH method, in reducing heart dose.Materials and methodsIn total, 12 patients receiving radiotherapy to the left breast were planned for treatment with both a free-breathing (FB) and an ABC scan. The dose volume histogram data for the plans was analysed with respect to heart V13, V5 Gy, mean heart dose and ipsilateral lung V18 Gy. Tumour bed D98%, threshold lung volume in breath hold (BH) and the maximum BH time for each patient was also measured. Patients then received their radiotherapy treatment using the ABC plan and the systematic error in the craniocaudal, lateral and vertical axes was assessed using orthogonal imaging.ResultsThe median heart V13 Gy for FB and DIBH patients was 3% (range, 0·85–11·28) and 0% (range, 0–1·56), respectively, with a mean heart dose of 2·62 Gy (range, 1·21–4·93) in FB and 1·51 Gy (range, 1·17–2·22) in ABC. The median lung V18 Gy was 8·7% (3·08–14·87) in FB plans and 9% (4·88–12·82) in ABC plans. The mean systematic set-up errors in all three planes were within the departmental set-up tolerance of 5 mm for both techniques. Median FB tumour bed D98% was 97·4% (92·8–99·5) and 97·5% (97·3–98·5) for ABC.ConclusionABC represents a good method of reducing radiation dose to the heart while not compromising on dose to the tumour bed, and it has a clear advantage over FB radiotherapy in reducing the risk of cardiac toxicity. It is tolerated well by patients and does not produce any difficulties in patient positioning.

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OC-0097: Radiation dose-volume effects for liver SBRT

Radiotherapy and Oncology ◽

10.1016/s0167-8140(16)31346-9 ◽

2016 ◽

Vol 119 ◽

pp. S45

Author(s):

M. Miften ◽

Y. Vinogradskiy ◽

V. Moiseenko ◽

J. Grimm ◽

E. Yorke ◽

...

Keyword(s):

Radiation Dose ◽

Dose Volume ◽

Liver Sbrt ◽

Volume Effects

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Dosimetric evaluation of deep inspiration breath hold for left-sided breast cancer: analysis of patient-specific parameters related to heart dose reduction

Journal of Radiation Research ◽

10.1093/jrr/rraa006 ◽

2020 ◽

Vol 61 (3) ◽

pp. 447-456 ◽

Cited By ~ 1

Author(s):

Ryohei Yamauchi ◽

Norifumi Mizuno ◽

Tomoko Itazawa ◽

Hidetoshi Saitoh ◽

Jiro Kawamori

Keyword(s):

Dose Reduction ◽

Patient Specific ◽

Breath Hold ◽

Relative Reduction ◽

Deep Inspiration ◽

Deep Inspiration Breath Hold ◽

Heart Dose ◽

Dose Volume ◽

The Mean ◽

Mean Heart Dose

Abstract Deep inspiration breath hold (DIBH) is a common method used worldwide for reducing the radiation dose to the heart. However, few studies have reported on the relationship between dose reduction and patient-specific parameters. The aim of this study was to compare the reductions of heart dose and volume using DIBH with the dose/volume of free breathing (FB) for patients with left-sided breast cancer and to analyse patient-specific dose reduction parameters. A total of 85 Asian patients who underwent whole-breast radiotherapy after breast-conserving surgery were recruited. Treatment plans for FB and DIBH were retrospectively generated by using an automated breast planning tool with a two-field tangential intensity-modulated radiation therapy technique. The prescribed dose was 50 Gy in 25 fractions. The dosimetric parameters (e.g., mean dose and maximum dose) in heart and lung were extracted from the dose–volume histogram. The relationships between dose–volume data and patient-specific parameters, such as age, body mass index (BMI), and inspiratory volume, were analyzed. The mean heart doses for the FB and DIBH plans were 1.56 Gy and 0.75 Gy, respectively, a relative reduction of 47%. There were significant differences in all heart dosimetric parameters (p < 0.001). For patients with a high heart dose in the FB plan, a relative reduction of the mean heart dose correlated with inspiratory volume (r = 0.646). There was correlation between the relative reduction of mean heart dose and BMI (r = −0.248). We recommend considering the possible feasibility of DIBH in low BMI patients because the degree of benefit from DIBH varied with BMI.

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