Dose variability in different lymph node levels during locoregional breast cancer irradiation: the impact of deep-inspiration breath hold

Pazos, Montserrat; Fiorentino, Alba; Gaasch, A.; Schönecker, S.; Reitz, D.; Heinz, C.; Niyazi, Maximilian; Duma, Marciana-Nona; Alongi, Filippo; Belka, Claus; Corradini, Stefanie

doi:10.1007/s00066-018-1350-y

Cited by 22 publications

(20 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the other hand, respiratory motion can also be used to increase OAR sparing for specific tumor sites, in which DIBH increases the distance between the PTV and the OARs [58]. For example, in breast cancer the DIBH technique leads to a reduction in cardiac dose, especially to radiosensitive structures like the left anterior descending artery (LAD) where any additional dose increases the risk of coronary artery disease and risk of ischemic heart disease [59][60][61][62][63]. Laaksomaa et al reported the possibility of portal imaging reduction for whole breast DIBH with residual errors of ≤3 mm [30].…”

Section: Breath-holdmentioning

confidence: 99%

Recent advances in Surface Guided Radiation Therapy

et al. 2020

View full text Add to dashboard Cite

The growing acceptance and recognition of Surface Guided Radiation Therapy (SGRT) as a promising imaging technique has supported its recent spread in a large number of radiation oncology facilities. Although this technology is not new, many aspects of it have only recently been exploited. This review focuses on the latest SGRT developments, both in the field of general clinical applications and special techniques. SGRT has a wide range of applications, including patient positioning with real-time feedback, patient monitoring throughout the treatment fraction, and motion management (as beam-gating in free-breathing or deep-inspiration breath-hold). Special radiotherapy modalities such as accelerated partial breast irradiation, particle radiotherapy, and pediatrics are the most recent SGRT developments. The fact that SGRT is nowadays used at various body sites has resulted in the need to adapt SGRT workflows to each body site. Current SGRT applications range from traditional breast irradiation, to thoracic, abdominal, or pelvic tumor sites, and include intracranial localizations. Following the latest SGRT applications and their specifications/requirements, a stricter quality assurance program needs to be ensured. Recent publications highlight the need to adapt quality assurance to the radiotherapy equipment type, SGRT technology, anatomic treatment sites, and clinical workflows, which results in a complex and extensive set of tests. Moreover, this review gives an outlook on the leading research trends. In particular, the potential to use deformable surfaces as motion surrogates, to use SGRT to detect anatomical variations along the treatment course, and to help in the establishment of personalized patient treatment (optimized margins and motion management strategies) are increasingly important research topics. SGRT is also emerging in the field of patient safety and integrates measures to reduce common radiotherapeutic risk events (e.g. facial and treatment accessories recognition). This review covers the latest clinical practices of SGRT and provides an outlook on potential applications of this imaging technique. It is intended to provide guidance for new users during the implementation, while triggering experienced users to further explore SGRT applications.

show abstract

Section: Breath-holdmentioning

confidence: 99%

Recent advances in Surface Guided Radiation Therapy

et al. 2020

View full text Add to dashboard Cite

show abstract

“…It is noteworthy, that the dose to axillary lymph node levels I and II usually is significantly lower than the prescribed dose and can range from 5% to 80% of the prescribed dose (mean value 48.7%). Even in patients receiving regional nodal irradiation of 50 Gray (Gy) to the supra-/infraclavicular lymph node levels (corresponding to levels IV, III and interpectoral lymph nodes), level I receives a reduced dose coverage of mean 41.3 Gy [26,27]. The potential influence of whole breast irradiation, especially in cases of pN+, needs further evaluation in randomized studies.…”

Section: Discussionmentioning

confidence: 99%

Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

Corradini

Reitz

Pazos

et al. 2019

Cancers

Self Cite

View full text Add to dashboard Cite

Although the organ preservation strategy by breast-conserving surgery (BCS) followed by radiation therapy (BCT) has revolutionized the treatment approach of early stage breast cancer (BC), the choice between treatment options in this setting can still vary according to patient preferences. The aim of the present study was to compare the oncological outcome of mastectomy versus breast-conserving therapy in patients treated in a modern clinical setting outside of clinical trials. 7565 women diagnosed with early invasive BC (pT1/2pN0/1) between 1998 and 2014 were included in this study (median follow-up: 95.2 months). In order to reduce selection bias and confounding, a subgroup analysis of a matched 1:1 case-control cohort consisting of 1802 patients was performed (median follow-up 109.4 months). After adjusting for age, tumor characteristics and therapies, multivariable analysis for local recurrence-free survival identified BCT as an independent predictor for improved local control (hazard ratio [HR]:1.517; 95%confidence interval:1.092–2.108, p = 0.013) as compared to mastectomy alone in the matched cohort. Ten-year cumulative incidence (CI) of lymph node recurrences was 2.0% following BCT, compared to 5.8% in patients receiving mastectomy (p < 0.001). Similarly, 10-year distant-metastasis-free survival (89.4% vs. 85.5%, p = 0.013) was impaired in patients undergoing mastectomy alone. This translated into improved survival in patients treated with BCT (10-year overall survival (OS) estimates 85.3% vs. 79.3%, p < 0.001), which was also significant on multivariable analysis (p = 0.011). In conclusion, the present study showed that patients treated with BCS followed by radiotherapy had an improved outcome compared to radical mastectomy alone. Specifically, local control, distant control, and overall survival were significantly better using the conservative approach. Thus, as a result of the present study, physicians should encourage patients to receive BCS with radiotherapy rather than mastectomy, whenever it is medically feasible and appropriate.

show abstract

“…In order to achieve optimal irradiation results for patients with left-sided breast cancer, i. e. best local control, lowest acute and late toxicity and lowest second cancer induction, modern irradiation techniques are used, including DIBH, t-IMRT and t-VMAT. Some studies have shown the superiority of 3D-DIBH over conventional 3D-CRT in regard to improving OAR constraints [9–11, 18, 32–34]. Regarding dose conformity and homogeneity there is a clear theoretical advantage for t-IMRT/ t-VMT -plan over 3D (32–33).…”

Section: Discussionmentioning

confidence: 99%

Left breast irradiation with tangential intensity modulated radiotherapy (t-IMRT) versus tangential volumetric modulated arc therapy (t-VMAT): trade-offs between secondary cancer induction risk and optimal target coverage

et al. 2019

View full text Add to dashboard Cite

Background Adjuvant radiotherapy is the standard treatment after breast-conserving surgery. According to meta-analyses, adjuvant 3d-conventional irradiation reduces the risk of local recurrence and thereby improves long-term survival by 5–10%. However, there is an unintended exposure of organs such as the heart, lungs and contralateral breast. Irradiation of the left breast has been related to long-term effects like increased rates of coronary events as well as second cancer induction. Modern radiotherapy techniques such as tangential intensity modulated radiotherapy (t-IMRT) and tangential volumetric modulated arc therapy (t-VMAT) and particularly deep inspiration breath hold (DIBH) technique have been developed in order to improve coverage of target volume and to reduce dose to normal tissue. The aim of this study was to compare t-IMRT-plans with t-VMAT-plans in DIBH position for left-sided breast irradiation in terms of normal tissue exposure, i.e. of lungs, heart, left anterior descending coronary artery (LADCA), as well as homogeneity (HI) and conformity index (CI) and excess absolute risk (EAR) for second cancer induction for organs at risk (OAR) after irradiation. Methods Twenty patients, diagnosed with left-sided breast cancer and treated with breast-preserving surgery, were included in this planning study. For each patient DIBH-t-IMRT plan using 5 to 7 beams and t-VMAT plan using four rotations were generated to achieve 95% dose coverage to 95% of the volume. Data were evaluated on the basis of dose-volume histograms: Cardiac dose and LADCA (mean and maximum dose, D25% and D45%), dose to ipsilateral and contralateral lung (mean, D20%, D30%), dose to contralateral breast (mean dose), total monitor units, V5% of total body and normal tissue integral dose (NTID). In addition, homogeneity index and conformity index, as well as the excess absolute risk (EAR) to estimate the risk of second malignancy were calculated. Results T-IMRT showed a significant reduction in mean cardiac dose of 26% ( p = 0.002) compared to t-VMAT, as well as a significant reduction in the mean dose to LADCA of 20% ( p = 0.03). Following t-IMRT, mean dose to the left lung was increased by 5% ( p = 0.006), whereas no significant difference was found in the mean dose to the right lung and contralateral breast between the two procedures. Monitor units were 31% ( p = 0.000004) lower for t-IMRT than for t-VMAT. T-IMRT technique significantly reduced normal tissue integral dose (NTID) by 19% ( p = 0.000005) and the V5% of total body by 24% ( p = 0.0007). In contrast, t-VMAT improved CI and HI by 2% ( p = 0.001) and 0.4% ( p = 0.00001), respectively. EAR with t-IMRT was significantly lower, especially for contralateral lung and contralateral breast (2–5/10...

show abstract

Dose variability in different lymph node levels during locoregional breast cancer irradiation: the impact of deep-inspiration breath hold

Abstract: A significant movement of the axillary lymph node levels was observed during DIBH in anterior and cranial directions for node-positive breast cancer patients in comparison to FB. The movement leads to a significant dose reduction in level I and level II.

Cited by 22 publications

References 37 publications

Recent advances in Surface Guided Radiation Therapy

Recent advances in Surface Guided Radiation Therapy

Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

Left breast irradiation with tangential intensity modulated radiotherapy (t-IMRT) versus tangential volumetric modulated arc therapy (t-VMAT): trade-offs between secondary cancer induction risk and optimal target coverage

Contact Info

Product

Resources

About