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.

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.

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.

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.

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