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

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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Comparison of cardiac and lung doses for breast cancer patients with free breathing and deep inspiration breath hold technique in 3 dimensional conformal radiotherapy - a dosimetric study

Polish Journal of Medical Physics and Engineering ◽

10.1515/pjmpe-2017-0018 ◽

2017 ◽

Vol 23 (4) ◽

pp. 109-114 ◽

Cited By ~ 1

Author(s):

Karthick Raj Mani ◽

Suresh Poudel ◽

K J Maria Das

Keyword(s):

Left Lung ◽

Free Breathing ◽

Breath Hold ◽

Relative Reduction ◽

Deep Inspiration ◽

Breast Irradiation ◽

Data Set ◽

Deep Inspiration Breath Hold ◽

Heart Dose ◽

Mean Heart Dose

Abstract Purpose: To investigate the cardio-pulmonary doses between Deep Inspiration Breath Hold (DIBH) and Free Breathing (FB) technique in left sided breast irradiation. Materials & Methods: DIBH CT and FB CT were acquired for 10 left sided breast patients who underwent whole breast irradiation with or without nodal irradiation. Three fields single isocenter technique were used for patients with node positive patients along with two tangential conformal fields whereas only two tangential fields were used in node negative patients. All the critical structures like lungs, heart, esophagus, thyroid, etc., were delineated in both DIBH and FB scan. Both DIBH and FB scans were fused with the Dicom origin as they were acquired with the same Dicom coordinates. Plans were created in the DIBH scan for a dose range between 50 Gy in 25 fractions. Critical structures doses were recorded from the Dose Volume Histogram for both the DIBH and FB data set for evaluation. Results: The average mean heart dose in DIBH vs FB was 13.18 Gy vs 6.97 Gy, (p = 0.0063) significantly with DIBH as compared to FB technique. The relative reduction in average mean heart dose was 47.12%. The relative V5 reduced by 14.70% (i.e. 34.42% vs 19.72%, p = 0.0080), V10 reduced by 13.83% (i.e. 27.79 % vs 13.96%, p = 0.0073). V20 reduced by 13.19% (i.e. 24.54 % vs 11.35%, p = 0.0069), V30 reduced by 12.38% (i.e. 22.27 % vs 9.89 %, p = 0.0073) significantly with DIBH as compared to FB. The average mean left lung dose reduced marginally by 1.43 Gy (13.73 Gy vs 12.30 Gy, p = 0.4599) but insignificantly with DIBH as compared to FB. Other left lung parameters (V5, V10, V20 and V30) shows marginal decreases in DIBH plans compare to FB plans. Conclusion: DIBH shows a substantial reduction of cardiac doses but slight and insignificant reduction of pulmonary doses as compared with FB technique. Using the simple DIBH technique, we can effectively reduce the cardiac morbidity and at the same time radiation induced lung pneumonitis is unlikely to increase.

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[P277] Investigation of mean heart dose reduction inter-fraction variation in left-sided breast cancer radiotherapy using active breath coordinator moderate deep inspiration breath hold

Physica Medica ◽

10.1016/j.ejmp.2018.06.554 ◽

2018 ◽

Vol 52 ◽

pp. 180

Author(s):

Chryssa Paraskevopoulou ◽

Efi Koutsouveli ◽

Nikos Giakoumakis ◽

Giorgos Kollias ◽

Pantelis Karaiskos

Keyword(s):

Breast Cancer ◽

Dose Reduction ◽

Breath Hold ◽

Deep Inspiration ◽

Cancer Radiotherapy ◽

Deep Inspiration Breath Hold ◽

Heart Dose ◽

Breast Cancer Radiotherapy ◽

Mean Heart Dose

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Deep inspiration breath hold reduces the mean heart dose in left breast cancer radiotherapy

Radiology and Oncology ◽

10.2478/raon-2021-0008 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Michał Falco ◽

Bartłomiej Masojć ◽

Agnieszka Macała ◽

Magdalena Łukowiak ◽

Piotr Woźniak ◽

...

Keyword(s):

Breast Cancer ◽

Free Breathing ◽

Left Breast ◽

Breath Hold ◽

Deep Inspiration ◽

Breast Cancer Patients ◽

Deep Inspiration Breath Hold ◽

Heart Dose ◽

The Mean ◽

Mean Heart Dose

Abstract Background Patients with left breast cancer who undergo radiotherapy have a non-negligible risk of developing radiation-induced cardiovascular disease (CVD). Cardioprotection can be achieved through better treatment planning protocols and through respiratory gating techniques, including deep inspiration breath hold (DIBH). Several dosimetric studies have shown that DIBH reduces the cardiac dose, but clinical data confirming this effect is limited. The aim of the study was to compare the mean heart dose (MHD) in patients with left breast cancer who underwent radiotherapy at our institution as we transitioned from non-gated free-breathing (FB) radiotherapy to gated radiotherapy (FB-GRT), and finally to DIBH. Patients and methods Retrospective study involving 2022 breast cancer patients who underwent radiotherapy at West Pomeranian Oncology Center in Szczecin from January 1, 2014 through December 31, 2017. We compared the MHD in these patients according to year of treatment and technique. Results Overall, the MHD for patients with left breast cancer in our cohort was 3.37 Gy. MHD values in the patients treated with DIBH were significantly lower than in patients treated with non-gated FB (2.1 vs. 3.48 Gy, p < 0.0001) and gated FB (3.28 Gy, p < 0.0001). The lowest MHD values over the four-year period were observed in 2017, when nearly 85% of left breast cancer patients were treated with DIBH. The proportion of patients exposed to high (> 4 Gy) MHD values decreased every year, from 40% in 2014 to 7.9% in 2017, while the percentage of patients receiving DIBH increased. Conclusions Compared to free-breathing techniques (both gated and non-gated), DIBH reduces the mean radiation dose to the heart in patients with left breast cancer. These findings support the use of DIBH in patients with left breast cancer treated with radiotherapy.

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Planning strategies and practical implementation of the cardiac dose reduction in the left-side breast irradiation with the deep inspiration breath-hold (DIBH) method

Current Directions in Biomedical Engineering ◽

10.1515/cdbme-2017-0071 ◽

2017 ◽

Vol 3 (2) ◽

pp. 347-350

Author(s):

Linda Wagner ◽

Thomas Koch ◽

Antje Fahrig

Keyword(s):

Dose Reduction ◽

Maximum Dose ◽

Heart Diseases ◽

Thoracic Wall ◽

Breath Hold ◽

Practical Implementation ◽

Deep Inspiration ◽

Deep Inspiration Breath Hold ◽

Increased Risk ◽

The Mean

AbstractBackground: Despite of the use of tangential beam directions during the irradiation of mammary carcinomas, a dose reduction of the heart cannot always be achieved. This is decivise for the increased risk of heart diseases and the associated mortality. Especially affected is the cardiac apex. However, by using respiratory gated treatment techniques, like the deep inspiration breath-hold (DIBH), a dose sparing of this area can be reached.Material and Methods: The Elekta ABC system was used to control the respiratory stop of early staged breast cancer patients. The treatment planning was implemented by a 3D and VMAT technique. The focus was the optimization of irradiation plans and the evaluation of the respective dose exposure to the heart, the left ventricle and the left anterior descending coronary artery (LAD artery). A planning concept of 28 x 2,25 Gy in the SIB and 28 x 1,8 Gy in the left breast was used.Results: The results showed that a dose reduction of 30-40% in mean and maximal in all structures is possible by using the VMAT technique in combination with the ABC system. In the case of 3D irradiation planning, a substantial relief can only be seen at the mean dose exposure of approximately 50%. Also, only a maximum dose reduction of 13% could be achieved.Conclusion: The mean dose reduction was mainly achieved by the increased distance between the heart and the thorax wall. The maximum dose was reduced by the volumentric optimization algortihm of the VMAT and the resulting steeper dose fall-off at the inner thoracic wall. Due to the lack of this optimization and thus the greater dose drop, the maximum dose of the 3D plans could only reduced by 13%.

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