Utility of Deep Inspiration Breath Hold for Left-Sided Breast Radiation Therapy in Preventing Early Cardiac Perfusion Defects: A Prospective Study

Zagar, Timothy M.; Kaidar‐Person, Orit; Tang, Xiaoli; Jones, Ellen; Matney, Jason; Das, Shiva K.; Green, Rebecca L.; Sheikh, Arif; Khandani, Amir H.; McCartney, William; Oldan, Jorge; Wong, Terence Z.; Marks, Lawrence B.

doi:10.1016/j.ijrobp.2016.12.017

Cited by 67 publications

(55 citation statements)

References 27 publications

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“…IMRT is reducing the volume irradiated at high doses and may therefore result in more favorable cardiac outcomes than treating with tangents if the heart cannot be removed from the tangent by, e.g., deep inspiration breath hold techniques (DIBH). This is supported by a recent publication of Zagar et al [8] who found in a prospective study that tangential breast treatment with DIBH for left-sided breast cancer is an effective means to avoid early RT-associated cardiac perfusion defects.…”

Section: Discussionsupporting

confidence: 56%

The dose-response relationship for cardiovascular disease is not necessarily linear

2017

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The probability for a complication after radiotherapy is usually a function of dose and volume in the organ or tissue of interest. In most epidemiological studies the risk for a complication is stratified in terms of dose, but not irradiated volume. We show that the obtained risk cannot generally be applied to radiotherapy patients.The epidemiological data of Darby et al. (N Engl J Med 368:2527, 2013) who found a linear relationship between the excess relative risk of major coronary events as function of mean heart dose in patients treated with tangential breast irradiation are analyzed. We have used the relative seriality model for a partly irradiated heart (“a lot to a little”) which models radiation therapy using two tangential fields. The relative seriality model was then used to predict NTCP of cardiovascular disease for a homogenously irradiated heart (“a little to a lot”). The relative seriality model was fitted to the data of Darby et al. (N Engl J Med 368:2527, 2013) for tangential breast irradiation. For the situation “a little to a lot” it was found that the dose-response relationship is sigmoidal and contradicts the findings of Darby et al. (N Engl J Med 368:2527, 2013). It was shown in this work that epidemiological studies which predict a linear dose-response relationship for cardiovascular disease can be reproduced by bio-physical models for normal tissue complication. For irradiation situations which were not included in the epidemiological studies, e.g. a homogenous irradiation of the heart (“a little to a lot”) the dose-response curve can be different. This could have consequences whether or not IMRT should be used for treating breast cancer. We believe that the results of epidemiological studies should not be generally used to predict normal tissue complications. It is better to use such data to optimize bio-physical models which can then be applied (with caution) to general treatment situations.

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Section: Discussionsupporting

confidence: 56%

The dose-response relationship for cardiovascular disease is not necessarily linear

2017

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“…The inadequacy of the RPM‐based surrogate for the definition of the DIBH level was also assessed in Skyttä et al . and Lutz et al., reporting occasional large errors in CW position up to 16.3 mm. Our study confirmed the inherent problem of the 2D RPM system, that is, the relative estimation of the patients' breathing baseline, which does not allow taking into account interfraction baseline shifts.…”

Section: Discussionmentioning

confidence: 99%

“…By reducing lung density and increasing the distance between the heart and the chest wall, the DIBH technique allows the improvement in heart and lung sparing . Several studies report the benefit of DIBH strategy in decreasing cardio‐pulmonary exposure dose compared to free‐breathing (FB) treatments, without compromising target coverage . This can potentially contribute to a reduction in radiation‐induced cardiac diseases and pulmonary complications, which are considered one of the major factors affecting the overall survival in left‐breast patients after postoperative radiotherapy .…”

Section: Introductionmentioning

confidence: 99%

Target position reproducibility in left‐breast irradiation with deep inspiration breath‐hold using multiple optical surface control points

Fassi

Ivaldi

Fatis

et al. 2018

J Applied Clin Med Phys

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The aim of this study was to investigate the use of 3D optical localization of multiple surface control points for deep inspiration breath‐hold (DIBH) guidance in left‐breast radiotherapy treatments. Ten left‐breast cancer patients underwent whole‐breast DIBH radiotherapy controlled by the Real‐time Position Management (RPM) system. The reproducibility of the tumor bed (i.e., target) was assessed by the position of implanted clips, acquired through in‐room kV imaging. Six to eight passive fiducials were positioned on the patients' thoraco‐abdominal surface and localized intrafractionally by means of an infrared 3D optical tracking system. The point‐based registration between treatment and planning fiducials coordinates was applied to estimate the interfraction variations in patients' breathing baseline and to improve target reproducibility. The RPM‐based DIBH control resulted in a 3D error in target reproducibility of 5.8 ± 3.4 mm (median value ± interquartile range) across all patients. The reproducibility errors proved correlated with the interfraction baseline variations, which reached 7.7 mm for the single patient. The contribution of surface fiducials registration allowed a statistically significant reduction (p < 0.05) in target localization errors, measuring 3.4 ± 1.7 mm in 3D. The 3D optical monitoring of multiple surface control points may help to optimize the use of the RPM system for improving target reproducibility in left‐breast DIBH irradiation, providing insights on breathing baseline variations and increasing the robustness of external surrogates for DIBH guidance.

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“…One US approach uses a transperineal US probe to track prostate motion prior and during beam delivery . Commercial infrared and laser‐based optical surface imaging systems have been utilized by many centers to enhance patient setup, to detect intra‐fractional patient motion, and to track the respiratory pattern for gated beam delivery . The various MR‐linac projects propose to bring MR guidance to the room, and some solutions based on 60 Co have now made their way to the clinic …”

Section: Image Guidance For Radiotherapymentioning

confidence: 99%

“…22 Commercial infrared and laser-based optical surface imaging systems have been utilized by many centers to enhance patient setup, to detect intra-fractional patient motion, and to track the respiratory pattern for gated beam delivery. 23,24 The various MR-linac projects propose to bring MR guidance to the room, 25 and some solutions based on 60 Co have now made their way to the clinic. 26 To summarize, image guidance has been wholly embraced by the photon based radiation therapy community, as attested by several review papers on the topic.…”

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confidence: 99%

Current state and future applications of radiological image guidance for particle therapy

Landry

Hua

2018

Medical Physics

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In this review paper, we first give a short overview of radiological image guidance in photon radiotherapy, placing emphasis on the fact that linac based radiotherapy has outpaced particle therapy in the adoption of volumetric image guidance. While cone beam computed tomography (CBCT) has been an established technique in linac treatment rooms for almost two decades, the widespread adoption of volumetric image guidance in particle therapy, whether by means of CBCT or in‐room CT imaging, is recent. This lag may be attributable to the bespoke nature and lower number of particle therapy installations, as well as the differences in geometry between those installations and linac treatment rooms. In addition, for particle therapy the so called shift invariance of the dose distribution rarely applies. An overview of the different volumetric image guidance solutions found at modern particle therapy facilities is provided, covering gantry, nozzle, C‐arm, and couch‐mounted CBCT as well different in‐room CT configurations. A summary of the use of in‐room volumetric imaging data beyond anatomy‐based positioning is also presented as well as the necessary corrections to CBCT images for accurate water equivalent thickness calculation. Finally, the use of non‐ionizing imaging modalities is discussed.

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Utility of Deep Inspiration Breath Hold for Left-Sided Breast Radiation Therapy in Preventing Early Cardiac Perfusion Defects: A Prospective Study

Cited by 67 publications

References 27 publications

The dose-response relationship for cardiovascular disease is not necessarily linear

The dose-response relationship for cardiovascular disease is not necessarily linear

Target position reproducibility in left‐breast irradiation with deep inspiration breath‐hold using multiple optical surface control points

Current state and future applications of radiological image guidance for particle therapy

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