Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-21T23:24:53.608Z Has data issue: false hasContentIssue false
  • English
  • Français

Is 5 mm breath-hold window (BHW) sufficient to treat carcinoma left breast patients post-conservative surgery: a comparative study using forward intensity-modulated radiotherapy (FIMRT) and volumetric modulated arc therapy (VMAT)

Published online by Cambridge University Press:  29 September 2020

Karthikeyan Kalyanasundaram Open the ORCID record for Karthikeyan Kalyanasundaram [Opens in a new window]  and
Subramani Vellaiyan
Karthikeyan Kalyanasundaram
Affiliation:
Department of Radiation Oncology, Yashoda Hospitals, Secunderabad500003, India Research and Development Centre, Bharathiar University, Coimbatore641046, India
Subramani Vellaiyan*
Affiliation:
Research and Development Centre, Bharathiar University, Coimbatore641046, India Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi110029, India
*
Author for correspondence: V. Subramani, Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi29, India. Tel: +91 9818590276. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose:

The purpose of the study was to evaluate the impact of changes in breathing pattern inside the breath-hold window (BHW) during deep inspiration breath hold treatment for carcinoma left breast patients post-conservative surgery.

Methods:

Ten patients of carcinoma left breast post-conservative surgery were prospectively selected. Three sets of CT plain images were acquired, one with 5 mm deep inspiration BHW (DIBHR) and the other one with 1 mm BHW matching the lower threshold (DIBHL) and the third one with 1 mm BHW matching the upper threshold (DIBHH) as DIBHR. For all patients, forward intensity-modulated radiotherapy (FIMRT) and volumetric modulated arc therapy (VMAT) plans were generated in the 5 mm BHW CT series and the same plan being copy and pasted in other series. Target volume doses and critical structure doses were tabulated.

Results:

Planning target volume coverage was adequate and no significant differences were found in any CT series. Significant differences noted in average left lung V5%, V10% and V18% doses between DIBHR versus DIBHH (p values = 0·0461, 0·0283 and 0·0213, respectively) and DIBHL versus DIBHH (p values = 0·0434, 0·0484 and 0·0334, respectively) for FIMRT plans and V18% doses in DIBHR versus DIBHH (p = 0·0067) in VMAT. No differences in heart and apex of heart doses were found. Left anterior descending artery (LAD) mean doses were significant in DIBHL versus DIBHR, DIBHR versus DIBHH and DIBHL versus DIBHH (p = 0·0012, 0·0444 and 0·0048, respectively) series for FIMRT plans and DIBHR versus DIBHH and DIBHL versus DIBHH (p = 0·0341, 0·0001) for VMAT plans.

Finding:

The changes in the breathing pattern inside DIBH window level cause some variation in LAD doses and no other significant differences in any parameters noted, so care should be taken while treating patients with preexisting cardiac conditions.

Keywords

breath hold window (BHW)deep inspiration breath hold (DIBH)forward intensity-modulated radiotherapy (FIMRT)organ at risk (OAR)Real-time Position Management (RPM)Volumetric modulated arc therapy (VMAT)
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 1 , March 2022 , pp. 51 - 59
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bray, F, Ferlay, J, Soerjomataram, I et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer J Clin 2018; 68 (6): 394–424.Google ScholarPubMed
Yang, PS, Chen, CM, Liu, MC et al. Radiotherapy can decrease locoregional recurrence and increase survival in mastectomy patients with T1 to T2 breast cancer and one to three positive nodes with negative estrogen receptor and positive lymphovascular invasion status. Int J Rad Oncol Biol Phys 2010; 77 (2): 516–522.CrossRefGoogle ScholarPubMed
Clarke, M, Collins, R, Darby, S et al. Early Breast Cancer Trialists Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 366 (9503): 2087–2106.Google Scholar
Fisher, B, Anderson, S, Bryant, J et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. NEngl J Med 2002; 347 (16): 1233–1241.CrossRefGoogle ScholarPubMed
Noel, G, Mazeron, JJ. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomized trials. Cancer Radiother 2001; 5 (1): 92–94.Google Scholar
Darby, SC, Ewertz, M, McGale, P et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. NEngl J Med 2013; 368 (11): 987–998.CrossRefGoogle ScholarPubMed
Rudat, V, Alaradi, AA, Mohamed, A et al. Tangential beam IMRT versus tangential beam 3D-CRT of the chest wall in postmastectomy breast cancer patients: a dosimetric comparison. Rad Oncol 2011; 6 (1): 1–7.Google ScholarPubMed
Hall, EJ, Wuu, CS. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Rad Oncol Biol Phys 2003; 56 (1): 83–88.CrossRefGoogle ScholarPubMed
Sixel, KE, Aznar, MC, Ung, YC. Deep inspiration breath hold to reduce irradiated heart volume in breast cancer patients. Int J Rad Oncol Biol Phys 2001; 49 (1): 199–204.CrossRefGoogle ScholarPubMed
Zagar, TM, Kaidar-Person, O, Tang, X et al. Utility of deep inspiration breath hold for left-sided breast radiation therapy in preventing early cardiac perfusion defects: a prospective study. Int J Rad Oncol Biol Phys 2017; 97 (5): 903–909.CrossRefGoogle ScholarPubMed
Pepin, EW, Wu, H, Shirato, H. Dynamic gating window for compensation of baseline shift in respiratory-gated radiation therapy. Med Phy 2011; 38 (4): 1912–1918.CrossRefGoogle ScholarPubMed
Wong, JW, Sharpe, MB, Jaffray, DA et al. The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Rad Oncol Biol Phys 1999; 44 (4): 911–919.CrossRefGoogle ScholarPubMed
Rusu, IA, Choi, M, Thomas, TO et al. A novel method to set appropriate gating window for deep inspiration breath hold patients. Int J Rad Oncol Biol Phys 2015; 93 (3): E52.CrossRefGoogle Scholar
Hayden, AJ, Rains, M, Tiver, K. Deep inspiration breath hold technique reduces heart dose from radiotherapy for left-sided breast cancer. J Med Imag Rad Oncol 2012; 56 (4): 464–472.CrossRefGoogle ScholarPubMed
Radiation Therapy Oncology Group (RTOG). RTOG 1005: a phase III trial of accelerated whole breast irradiation with hypo-fractionation plus concurrent boost versus standard whole breast irradiation plus sequential boost for early stage breast cancer. https://www.rtog.org/clinicaltrials/protocoltable/studydetails.aspx?study=1005. Accessed on 5th December 2019.Google Scholar
Virginia Wolstenholme. Guidelines for the Treatment of Breast Cancer with Radiotherapy. London, UK: Barts Health, UCLH Cancer Collaborative, 2018.Google Scholar
Lawler, G, Leech, M. Dose sparing potential of deep inspiration breath-hold technique for left breast cancer radiotherapy organs-at-risk. Anticancer Res 2017; 37 (2): 883–890.CrossRefGoogle ScholarPubMed
Latty, D, Stuart, KE, Wang, W et al. Review of deep inspiration breath-hold techniques for the treatment of breast cancer. J Med Rad Sci 2015; 62 (1): 74–81.CrossRefGoogle ScholarPubMed
Pham, TT, Ward, R, Latty, D et al. Left-sided breast cancer loco-regional radiotherapy with deep inspiration breath-hold: does volumetric-modulated arc radiotherapy reduce heart dose further compared with tangential intensity-modulated radiotherapy? J Med Imag Rad Oncol 2016; 60 (4): 545–553.CrossRefGoogle ScholarPubMed
Vikström, J, Hjelstuen, MH, Mjaaland, I et al. Cardiac and pulmonary dose reduction for tangentially irradiated breast cancer, utilizing deep inspiration breath-hold with audio-visual guidance, without compromising target coverage. Acta Oncol 2011; 50 (1): 42–50.CrossRefGoogle ScholarPubMed
Badakhshi, H, Kaul, D, Nadobny, J et al. Image-guided volumetric modulated arc therapy for breast cancer: a feasibility study and plan comparison with three-dimensional conformal and intensity-modulated radiotherapy. Brit J Rad 2013; 86 (1032): 20130515.CrossRefGoogle ScholarPubMed
Jin, GH, Chen, LX, Deng, XW et al. A comparative dosimetric study for treating left-sided breast cancer for small breast size using five different radiotherapy techniques: conventional tangential field, filed-in-filed, tangential-IMRT, multi-beam IMRT and VMAT. Rad Oncol 2013; 8 (1): 89.CrossRefGoogle ScholarPubMed
Xu, C, Guo, L, Liao, Z et al. Heart and lung doses are independent predictors of overall survival in esophageal cancer after chemoradiotherapy. Clin Transl Rad Oncol 2019; 17: 17–23.Google ScholarPubMed
Loap, P, Fourquet, A, Kirova, Y. Should we move beyond mean heart dose?. Int J Rad Oncol Biol Phys 2020; 107 (2): 386–387.CrossRefGoogle ScholarPubMed
Wennstig, AK, Garmo, H, Isacsson, U et al. The relationship between radiation doses to coronary arteries and location of coronary stenosis requiring intervention in breast cancer survivors. Rad Oncol 2019; 14 (1): 40.CrossRefGoogle ScholarPubMed
Rygiel, K. Cardiotoxic effects of radiotherapy and strategies to reduce them in patients with breast cancer: an overview. J Cancer Res Therapeut 2017; 13 (2): 186–192.CrossRefGoogle ScholarPubMed
Taylor, CW, Nisbet, A, McGale, P et al. Cardiac exposures in breast cancer radiotherapy: 1950s–1990s. Int J Rad Oncol Biol Phys 2007; 69 (5): 1484–1495.CrossRefGoogle ScholarPubMed
Hu, J, Han, G, Lei, Y et al. Dosimetric comparison of three radiotherapy techniques in irradiation of left-sided breast cancer patients after radical mastectomy. Biomed Res Int 2020; 2020: 7131590.CrossRefGoogle ScholarPubMed
Taylor, CW, Povall, JM, McGale, P et al. Cardiac dose from tangential breast cancer radiotherapy in the year 2006. Int J Rad Oncol Biol Phys 2008; 72 (2): 501–507.CrossRefGoogle ScholarPubMed
Nilsson, G, Witt Nyström, P, Isacsson, U et al. Radiation dose distribution in coronary arteries in breast cancer radiotherapy. Acta Oncol 2016; 55 (8): 959–963.CrossRefGoogle ScholarPubMed
Piroth, MD, Baumann, R, Budach, W et al. Heart toxicity from breast cancer radiotherapy. Strahlenther Onkol 2019; 195 (1): 1–2.CrossRefGoogle ScholarPubMed