Mean radiation dose to the heart in patients with left breast cancer with and without breath-hold technique.

85 Background: Mean heart dose (MHD) from breast irradiation has been correlated with late risk of ischemic heart disease. We previously reported using 3-D conformal radiation with field-in-field forward planning and heart blocking; MHD is substantially lower than described for patients treated before 2001. To further reduce MHD, we treated eligible patients with left breast cancer with breath hold technique. We compared the MHD with and without breath hold technique. Methods: We reviewed 45 radiation treatment plans of patients treated to the left breast from 5/2013-5/2014. All patients were evaluated for breath hold technique. Criteria were ability to hold the breath for 20 seconds and a stable chest position. 18 patients were treated with breath hold (BH), 27 patients with non-breath hold (NBH). All treatment plans were CT-based, 3-D conformal with field-in- field forward planning and heart blocking. Two treatment regimens were used: hypofractionation (HF) (16 x 2.66 Gy, no boost) or standard fractionation (SF) (46.8-50.4 Gy, +/- 10 Gy boost). Fisher's exact test and t-test were used to assess the data between MHD with breath hold (BH) and without (NBH). Results: Average MHD was 1.03 Gy (0.59-1.7) in BH patients, in comparison to 1.57 Gy (0.89-2.50) in NBH patients p<0.0001). MHD was associated with total breast dose (p=0.01) and BH patients were younger, average age 55.78 years (21.41-48.37) vs NBH, average 62.78 years (38-82). There was no association between breath hold and BMI. BH BMI average 34.12 (21.41-48.37), NBH average BMI 32.6 (20.58-44.71) p=0.46. Conclusions: Patients treated with radiation to the left breast with breath hold technique had significantly lower MHD than those treated with non-breath hold. (p=0.0001) Breath hold eligible patients tended to be younger; there was no relation between breath hold eligibility and BMI.

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Mean radiation dose to the heart in patients with breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.26_suppl.56 ◽

2013 ◽

Vol 31 (26_suppl) ◽

pp. 56-56 ◽

Cited By ~ 2

Author(s):

Geraldine Meerbott Jacobson ◽

Sijin Wen ◽

Jianjun Zhang ◽

Hannah Hazard ◽

Jame Abraham

Keyword(s):

Breast Cancer ◽

Treatment Planning ◽

Left Breast ◽

Current Treatment ◽

Heart Dose ◽

Treatment Regimens ◽

Significant Difference ◽

Treatment Plans ◽

Heart Injury ◽

Mean Heart Dose

56 Background: Breast irradiation may expose a portion of the heart to radiation. Heart irradiation is associated with late risk of ischemic heart disease, proportional to dose. A recent publication of patients treated with 2-D planning prior to 2001 noted average mean heart dose (MHD) of 6.6 Gy for left breast tumors, 2.9 Gy for right breast. Current treatment planning can minimize the MHD, reducing the risk of late heart injury. Methods: We reviewed treatment plans of 78 patients (86 breasts) treated 1/2012-3/2013 to obtain MHD. Treatment plans were CT-based, field-in-field forward planning with heart blocking. Two treatment regimens were used; hypofractionation (HF) (16 x 2.66 Gy, no boost) or standard (SF) (46.8-50.4 Gy +/- 10 Gy boost). Statistics were obtained for MHD based on right (N = 44) or left breast (N = 42); HF (N = 31) vs SF (N = 55), and total dose. Results: Average (av) MHD for left breast was 1.45 Gy (range 0.19-3.12), for right breast 0.70 Gy (0.12-1.54). For HF patients av MHD left was 1.16 Gy (0.19-1.90), MHD right was 0.48 Gy (0.12-0.91). For SF av MHD left was 1.60 Gy (0.80-3.12), MHD right was 0.84 Gy (0.39-1.54). There was a significant difference in MHD between left and right breasts (p = 0.002) and significant correlation between breast dose and MHD (p = 0.026). Conclusions: MHD from breast RT with current treatment planning is much lower than published reports from 2-D planning. MHD correlates with total breast dose and is greater for the left than right side. Techniques to reduce MHD should be utilized, especially for left-sided breast cancer.

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Dosimetric Correlation Between The Depth of Chest Wall Expansion and Heart Dose in Left Breast Cancer Irradiation Using Deep Inspiratory Breath Hold Technique

Tumori Journal ◽

10.1177/0300891620914166 ◽

2020 ◽

Vol 106 (1_suppl) ◽

pp. 34-34

Author(s):

Ehab Saad ◽

Khaled.M. Elshahat ◽

Sarah Hazem ◽

Nadia Ebrahim ◽

Nada Osama ◽

...

Keyword(s):

Breast Cancer ◽

Chest Wall ◽

Adjuvant Radiotherapy ◽

Left Lung ◽

Left Breast ◽

Breath Hold ◽

Heart Dose ◽

The Mean ◽

Mean Heart Dose ◽

Cancer Irradiation

Introduction and Objective: In adjuvant radiotherapy for left breast cancer, a significant heart volume may be included in the radiation field leading to long-term cardiac toxicities. Deep inspiratory breath hold technique (DIBH) leads to chest wall separation away from the heart and thus can reduce the heart dose compared to free breathing technique. The aim of this study is to correlate dosimetrically the degree of chest wall expansion measured on planning 4D-CT scan to the heart dose in left breast cancer irradiation using DIBH technique. Materials and Methods: Thirty four patients with left breast cancer planned for adjuvant radiotherapy were included. All patients were scanned by Varian RPM (Real Time Position Managment) respiratory gating system using infrared reflecting markers and a video camera to detect the respiratory motion. IMRT or VMAT plans were done for all patients with a prescribed dose 50Gy/25fr/5w with or without operative bed boost dose 10Gy/5fr/1w. The degree of chest wall expansion was identified by measuring the amplitude of DIBH breathing curve from baseline in planning 4D-CT scan in centimeters. The depth of expansion was correlated dosimetrically with the heart V20, V30, and mean heartdose. Results: The mean distance of chest wall expansion was 2.9cm. The mean left lung dose was 8.6Gy. The mean left lung V20 was 13.8%. The mean heart dose was 1.8Gy. The mean heart V30 was 0.6%. A statistically significant reduction of the mean heart dose and V30 was observed with chest wall expansion of 1.4cm or higher (p<0.05). Conclusion: In DIBH technique, the depth of chest wall expansion in 4DCT planning is dosimetrically correlated with the cardiac dose reduction during adjuvant irradiation of left breast cancer. Further clinical studies are needed to translate this dosimetric advantage into clinical benefit.

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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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