Deep inspiration breath-hold for patients with left-sided breast cancer – A one fits all approach? A prospective analysis of patient selection using dosimetrical and practical aspects

2021 ◽  
pp. 20210295
Author(s):  
Christina Schröder ◽  
Sebastian Kirschke ◽  
Eyck Blank ◽  
Sophia Rohrberg ◽  
Robert Förster ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Left Lung ◽  
Free Breathing ◽  
Lymphatic Drainage ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Patient Preparation ◽  
Treatment Plans ◽  
Planning Ct

Objective: To prospectively analyze the feasibility of an algorithm for patient preparation, treatment planning and selection for deep inspiration breath-hold (DIBH) treatment of left-sided breast cancer. Methods: From 02/2017 to 07/2019, 135 patients with left-sided breast cancer were selected and prepared for radiotherapy in DIBH. 99 received radiotherapy for the breast alone and 36 for the breast including the lymphatic drainage (RNI). Treatment plans DIBH and free breathing (FB) were calculated. Dosimetrical analyses were performed and criteria were defined to assess whether a patient would dosimetrically profit from DIBH. Results: Of the 135 patients, 97 received a DIBH planning CT and 72 were selected for treatment in DIBH according to predefined criteria. When using DIBH there was a mean reduction of the DmeanHeart of 2.8 Gy and DmeanLAD of 4.2 Gy. seven patients did not benefit from DIBH regarding DmeanHeart, 23 regarding DmeanLAD. For the left lung the V20Gy was reduced by 4.9%, the V30Gy by 2.7% with 15 and 29 patients not benefitting from DIBH, respectively. In the 25 patients treated in FB, the benefit of DIBH would have been lower than for patients treated with DIBH (ΔDmeanHeart0.7 Gy vs 3.4 Gy). Conclusion: Dosimetrically, DIBH is no “one fits all” approach. However, there is a statistically significant benefit when looking at a larger patient population. DIBH should be used for treatment of left-sided breast cancer in patients fit for DIBH. Advances in knowledge: This analysis offers a well-designed dosimetrical analysis in patients treated with DIBH radiotherapy in an “every day” cohort.

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

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.

Advantage of Deep Inspiration Breath Hold in Left-sided Breast Cancer Patients Treated with 3D Conformal Radiotherapy

2016 ◽  
Vol 103 (1) ◽  
pp. 72-75 ◽  
Author(s):  
Luciana Lastrucci ◽  
Simona Borghesi ◽  
Silvia Bertocci ◽  
Chiara Gasperi ◽  
Andrea Rampini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Left Lung ◽  
Conformal Radiotherapy ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Breast Cancer Patients ◽  
Deep Inspiration Breath Hold ◽  
Treatment Plans ◽  
3D Crt

Purpose To compare 3D-conformal radiotherapy (3D-CRT) treatment plans based on free-breathing (FB) and deep inspiration breath hold (DIBH) and investigated whether DIBH technique enables a decrease of cardiac left anterior descending coronary artery (LADCA) and lungs dose with respect to the FB. Methods Twenty-three left-sided breast cancer patients referred for breast radiotherapy were included. The planning target volume (PTV) encompassed the breast and organs at risk including heart, LADCA, lungs, and contralateral breast, which were contoured in FB and DIBH CT scans. Dose to PTV was 50 Gy in 25 fractions. Two treatment plans were generated for each patient: FB-3D-CRT and DIBH-3D-CRT. Dosimetry parameters were obtained from dose volume histograms. Data were compared using the paired-sample Wilcoxon signed rank test. Results For heart, LADCA, and left lung, a significant dose reduction was found using DIBH technique. By using DIBH, an average reduction of 25% was observed in LADCA for the volume receiving 20 Gy and of 48% considering the mean heart dose. Conclusions The DIBH technique results in a significant decrease of dose to the heart, LADCA, and left lung compared to FB.

scholarly journals 5 years of experience with DIBH (Deep inspiration breath-hold) combined with SGRT (Surface-Guided Radiation Therapy) in left-sided breast cancer

2020 ◽  
Vol 17 (01) ◽  
pp. 14-23
Author(s):  
Claudia Steffal ◽  
Annemarie U. Schratter-Sehn ◽  
Karin Brinda-Raitmayr ◽  
Thomas Kann ◽  
Daniela Mailat ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Side Effects ◽  
Left Lung ◽  
Breath Hold ◽  
Relative Reduction ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Ipsilateral Lung

Abstract Background Radiation treatment to the left breast is associated with increased cardiac morbidity as well as mortality. Deep inspiration breath-hold (DIBH) technique with Surface Guided Radiation Therapy (SGRT) could have dosimetric advantages over the free breathing technique (NB, normal breathing) in cardiac (heart and LAD) and ipsilateral lung sparing in patients with left-sided breast cancer after surgery. Therefore this technique was implemented in 2013 at the institute of radiooncology at the KFJ/SMZ-South – Hospital Vienna. Methods From Oct 2013 – December 2018 548 patients were referred to radiotherapy following conservative operation of left-sided invasive breast cancer. All patients gave their informed consent and underwent training sessions for the DIBH-technique independent of age or breathing activity or respiratory disorders. Patients who turned out to be unfit for DIBH were enrolled for NB. The relative reduction in Dmean heart and left lung dose was compared between the two cohorts. Acute radiation induced side effects were classified according to the Radiation Therapy Oncology Group/The European Organisation for Research (RTOG) 37; late toxicity rates according to the Common Terminology Criteria for Adverse Events (CTCAE Version 4.03) Results The median age of the DIBH-patients was 58 years (27–90), of the NB-patients 65 (30–80) years. Follow-up was obtained until June 2019. The median follow-up was 52 months (range 7–73 m). The average coverage of Dmean left lung was 6.91 Gy (1.44 Gy – 12.4 Gy). The average coverage of Dmean heart was 1.17 Gy (0.12 Gy – 3.19 Gy) in the DIBH-cohort. The NB – plans had a Dmean of 8.92 Gy (5.23–16.9 Gy) at the ipsilateral lung and a Dmean of 2.31 Gy (0.71–4.21 Gy) at the heart. This shows that the DIBH-technique halved the Dmean of the heart. The amount of acute side effects was comparable between the two groups: RTOG 1: 70.8 % vs. 64 %, RTOG 3 6.6 % vs. 5.6 %, no reaction 3.2 % vs. 1.4 %. There were more CTCAE 1-late events in the NB-group (51.6 % vs. 12.67 %). Conclusion Deep inspiration breath-hold (DIBH) technique with Surface Guided Radiation Therapy (SGRT) is a rather simple, reproducable method with a high acceptance of the patients who can actively participate in the whole treatment process. The mean dose at the heart and the left lung can be reduced, at the heart even by as much as 50 %.

scholarly journals Dosimetric Considerations in Respiratory-Gated Deep Inspiration Breath-Hold for Left Breast Irradiation

2016 ◽  
Vol 16 (1) ◽  
pp. 22-32 ◽  
Author(s):  
Steve Walston ◽  
Allison M. Quick ◽  
Karla Kuhn ◽  
Yi Rong
Keyword(s):  
Chest Wall ◽  
Lung Volume ◽  
Left Lung ◽  
Free Breathing ◽  
Left Breast ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Lung Dose ◽  
Deep Inspiration Breath Hold ◽  
Heart Dose

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.

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

2020 ◽  
Vol 61 (3) ◽  
pp. 431-439 ◽  
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.

scholarly journals Comparative analysis of dose distribution to critical organs in radiation therapy of left breast cancer with respiratory synchronization

2021 ◽  
Vol 60 (2) ◽  
pp. 27-31
Author(s):  
D. A. Yussupova ◽  
A. D. Savkhatova ◽  
M. D. Zekebayev ◽  
A. K. Quatbek
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Left Lung ◽  
Free Breathing ◽  
Left Breast ◽  
Breath Hold ◽  
Radiation Load ◽  
Deep Inspiration Breath Hold ◽  
Study Results ◽  
Respiratory Synchronization

Relevance: Breast cancer is one of the most common oncological diseases. Today, it leads among female cancers. Patients with left breast cancer undergoing radiation therapy have a considerable risk of developing cardiovascular diseases caused by ionizing radiation. Various methods are introduced to reduce the radiation load to critical organs to ensure compliance with the main radiation therapy principle. One of these methods is radiation therapy with synchronized breathing, including deep inspiration breath-hold (DIBH). DIBH can significantly reduce the dose load to the heart and the left lung. The study aimed to compare the radiation load to the heart and the left lung during radiation therapy for left breast cancer with free breathing and respiratory synchronization. Results: During radiation therapy with synchronized breathing, the average radiation load to the heart is 1.7 times lower and to the left lung – 1.26 times lower compared to radiation therapy with free breathing. Conclusion: The study results confirm that respiratory synchronization in radiation therapy for left breast cancer reduces the dose to the heart and the left lung.

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