The Advantages of Active Breathing Coordinator Device During Left-Sided Breast Cancer Radiation Therapy: A Dosimetric Comparison Study

2020 ◽  
Author(s):  
Nadia Pasinetti ◽  
Lilia Bardoscia ◽  
Luigi Spiazzi ◽  
Barbara Ghedi ◽  
Sara Pedretti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
At Risk ◽  
Side Effects ◽  
Organs At Risk ◽  
Left Lung ◽  
Normal Tissue Complication Probability ◽  
Left Breast ◽  
Breath Hold ◽  
Deep Inspiration Breath Hold ◽  
Dose Volume Histograms

Abstract Background: Radiotherapy (RT) improves local control and survival in breast cancer (BC) patients. However, risk of heart and lung side effects after post-operative left breast RT for breast cancer remain despite technological and technical RT advances. In a retrospective cohort we investigated if Active Breathing Coordinator (ABC) device can reduce risk of cardiopulmonary morbidity.Methods: we performed two different dosimetric analyses by Normal Tissue Complication Probability (NTCP) and Bio-Dose-Volume Histograms (Bio-DVH) in order to determine whether left breast RT using moderating deep inspiration breath-hold (mDIBH) with the Active Breathing Coordinator (ABC) device, may significantly reduce heart, left anterior descending coronary artery (LADCA) and lung radiation exposure during left breast RT performed with 3d-CRT technique.Results: Several dosimetric parameters were used in the present study to compare the treatment plans generated by FB and mDIBH images of sixty-nine consecutive patients treated between May 2012 and April 2016 at the Istituto del Radio Radiation Oncology Dept. All data derived by Bio-DVH and the heart NTCP calculation showed that ABC led to significant sparing of organs at risk compared with FB, expecially for the heart and LADCA. We also showed that the mDIBH technique significantly reduced left lung dose: in fact, through inflation, only low density lung tissue remains within the tangential field, thus avoiding its deterioration.Conclusions: Use of mDIBH gives a real advantage on breast cancer RT by reducing the radiation to the organs at risk (OARs) and consequently, the risk of cardiac and pulmonary late side effects.

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.

scholarly journals Analysis Of Dose At 3D-Crt And Imrt Techniques In Left Breast Cancer Case With Hypofractionation Using Deep Inspiration Breath-Hold (Dibh)

2021 ◽  
Author(s):  
Samsun - ◽  
Muhammad Arif Arif ◽  
Gregorius Septayudha Septayudha
Keyword(s):  
Breast Cancer ◽  
At Risk ◽  
Organs At Risk ◽  
Left Breast ◽  
Breath Hold ◽  
Tolerance Limits ◽  
Deep Inspiration Breath Hold ◽  
Organ At Risk ◽  
The Difference ◽  
3D Crt

Abstract In terms of breast cancer radiation treatment, it has radiation using the 3D-Conformal Radiotherapy (3D-CRT) technique and the continuation of the 3D-CRT technique, namely the Intensity Modulated Radiation Therapy (IMRT) technique. This study aims to evaluate the dosage aspects of PTV and OAR between the 3D-CRT and IMRT techniques in cases of left breast cancer with hypofractionation using the Deep Inspiration Breath Hold (DIBH) method using the Conformity Index (CI) and Homogeneity Index (H.I.) and H.I. organ at risk uses tolerance limits. This type of research is comparative quantitative with ten samples with primary data conducted at Siloam T.B. Hospital. Simatupang from November 2019 to April 2020. The research was carried out in the form of radiation planning with 3D-CRT techniques and IMRT techniques, and the results of planning both techniques were evaluated between 3D-CRT techniques and IMRT techniques through PTV evaluations using CI and H.I. values. Furthermore, the organs at risk use tolerance limits on each organ. The results showed the assessment between 3D-CRT and IMRT on PTV and organs at risk received different doses. The PTV shows the CI value, which is almost the same as the difference of 0.034, and there is a slight difference in H.I. with an average value in the IMRT technique of 0.07 and 3D-CRT of 0.11, and it can be seen that the IMRT is slightly superior because the excellent H.I. value is the closest to 0. Then at the dose of organ at risk received by the sample, the 3D-CRT technique is slightly superior by obtaining a lower dose that obtains the difference in the heart by 0.53%, lung by 3.46%, spinal cord by 6.51 Gy, esophagus at 4.5 Gy, and larynx at 5.18 Gy.

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 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.

scholarly journals Evaluation of DIBH and VMAT in Hypofractionated Radiotherapy for Left-sided Breast Cancers After Breast-conserving Surgery: a Planning Study

2021 ◽  
Author(s):  
Liuwei Tang ◽  
Yojiro Ishikawa ◽  
Kengo Ito ◽  
Takaya Yamamoto ◽  
Rei Umezawa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Organs At Risk ◽  
Left Lung ◽  
Breast Conserving Surgery ◽  
Left Breast ◽  
Breath Hold ◽  
Breast Cancer Patients ◽  
Lung Dose ◽  
Dose Reductions

Abstract Background This paper aims to compare dosimetric parameters of the organs at risk (OARs) among three different radiotherapy (RT) modalities in left breast cancer patients after breast-conserving surgery (BCS). Methods Eleven patients with left breast cancer after BCS were enrolled and underwent CT simulation in the free breathing (FB) and deep inspiration breath hold (DIBH) position. Three-dimensional radiotherapy (3DCRT) and volumetric modulated arc therapy (VMAT) plans were generated for each patient in the DIBH position. A 3DCRT plan was also created in the FB position. Dose-volume histogram (DVH) was used to analyze each evaluation index of OARs. The principal outcome was heart dose, left anterior descending coronary artery (LADCA) dose and left lung dose.Results For the 3D-CRT plans, significant dose reductions were demonstrated in all evaluation parameters to heart, LADCA and left lung dose in the DIBH position compared with the FB position (p < 0.05). In DIBH position, significant dose reductions were founded in heart and LADCA in VMAT plan compared to 3DCRT plan (p < 0.05). There were no significant differences between 3DCRT and VMAT plan for the left lung dose in DIBH position.Conclusion DIBH and VMAT could reduce dosimetric parameters of the OARs in left breast cancer patients after BCS. RT plans for left breast cancer after BCS can be optimized by DIBH and VMAT techniques to minimize radiation-induced toxicity

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