Benefit of Deep Inspiratory Breath Hold for Right Breast Cancer When Regional Lymph Nodes Are Irradiated

Peters, Gabrielle W.; Gao, S.; Knowlton, Christin A.; Zhang, Andrew; Evans, Suzanne B.; Higgins, Susan A.; Wilson, Lynn D.; Saltmarsh, Nicholas; Picone, Martha; Moran, Meena S.

doi:10.1016/j.prro.2021.08.010

Cited by 12 publications

(10 citation statements)

References 24 publications

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“…Colossal amounts of studies have shown that amid left breast cancer radiotherapy, DIBH technology can separate the heart from mammary gland position, so as to signi cantly shrink the high dose volume and mean dose of the heart, and reduce heart disease risks associated [18][19][20] . Meanwhile, coupled with DIBH technology, it can also increase the lung volume, reduce the lung tissue density, which lowers the irradiation dose in the lung 13 , and slump the irradiation dose of the contralateral breast, stomach and liver to varying degrees 21,22 . Although DIBH technique is widely used in left-sided breast cancer, there are few reports on the clinical application of DIBH technique in right-sided breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Although the breath-hold height of EXP group was signi cantly higher than that of the other two groups, the lung volume increase rate was larger in all three groups without signi cant difference. Oonsiri et al 47 The results of previous radiotherapy planning studies suggested that patients receiving right breast radiotherapy with RNI had signi cant bene t in heart and lung dosimetry, while patients receiving right breast radiotherapy without RNI had less bene t [22][23][24][25][26] . To this end, DIBH radiotherapy was only applied to right breast cancer with RNI for this retrospective study.…”

Section: Discussionmentioning

confidence: 99%

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SGRT-based DIBH radiotherapy practice for right breast cancer combined with RNI: A retrospective study on dosimetry and treatment accuracy

Lai

et al. 2022

Preprint

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Background: This paper studied retrospectively the dosimetry and therapeutic accuracy of deep inspiration breath hold (DIBH) radiotherapy in regional nodal radiation (RNI)-containing right-sided breast cancer patients who had completed treatment based on surface guided radiotherapy (SGRT) technology, hoping to clarify the clinical application value and related issues . Methods: Free breath (FB) and DIBH plans were prepared for31 RNI-containing right breast cancer patients who had completed DIBH radiotherapy based on SGRT technology. Four organs at risk (OARs) including heart, right coronary artery (RCA), right lung and liver were made dosimetriccomparison on the premise that the planning target volume was met dose-volume prescription requirements. Meanwhile, 31 patients were divided into edge of xiphoid process (EXP), sternum middle (SM)and left breast wall (LBW) groups according to different positions of respiratory gating primary points. The CBCT setup error data of the three groups were contrasted for the treatment accuracy study, and the effects of different gating window heights on the lung volume increment of the right side were compared among the three groups. Results: All planning target volume met the dose-volume coverage criteria. Compared with FB, DIBH slumpedthe maximum dose of heart and RCA by 44.3% and 46.7% respectively. The mean dose was went down by 12.5% for right lung. The mean liver dosedecreased the most, with an average reduction rate of 69.4%. The setup error of EXP group in the anterior-posterior (AP) direction was 3.6±4.5mm, significantly higher than the other two groups (2.2±2.6mm, 2.4±3.1mm). The rightlung volume increment in EXP, SM and LBW groups was 72.3%, 69.9 % and 67.2%, respectively(P=0.08), and the corresponding breath-holding heights were 13.5±3.7mm, 10.3±2.4mm, and 9.6±2.8mm, respectively(p<0.05). Conclusions: SGRT-based DIBH can better protect the heart, RCA, ipsilateral lung and liver of right breast cancer patients combined with RNI. Different respiratory gating primary points have different therapeutic accuracy and breath-hold height. On the premise of reasonable respiratory gating primary points, interfractions can be widely applied as it has high repeatability and breath-holding stability to ensure therapeutic accuracy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

SGRT-based DIBH radiotherapy practice for right breast cancer combined with RNI: A retrospective study on dosimetry and treatment accuracy

Lai

et al. 2022

Preprint

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“…Although radiation‐induced liver toxicity has been widely recognized, related research in breast cancer radiotherapy is still insufficient. Only a few radiotherapy planning studies have shown that DIBH technique can achieve a good liver protection effect in right‐sided breast cancer 22,23,25 . In the DIBH state, the increase in lung volume makes the liver move away from the target volume, which is the direct reason for the reduction in liver dose.…”

Section: Disscussionmentioning

confidence: 99%

“…20,21 Although DIBH technique is widely used for left-sided breast cancer, there are few reports on the clinical application of DIBH technique in right-sided breast cancer. According to several radiotherapy planning studies, 13,[22][23][24][25] DIBH reduces lung dose compared with FB in patients with right-sided breast cancer and achieves liver protection during radiotherapy. A radiotherapy planning study conducted by Pandeli et al 22 showed that eight right-sided breast cancer patients with RNI were treated with DIBH radiotherapy.…”

Section: Disscussionmentioning

confidence: 99%

SGRT‐based DIBH radiotherapy practice for right‐sided breast cancer combined with RNI: A retrospective study on dosimetry and setup accuracy

Lai

Luo

et al. 2023

J Applied Clin Med Phys

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Background: We retrospectively studied the dosimetry and setup accuracy of deep inspiration breath-hold (DIBH) radiotherapy in right-sided breast cancer patients with regional nodal irradiation (RNI) who had completed treatment based on surface-guided radiotherapy (SGRT) technology by Sentinel/Catalyst system, aiming to clarify the clinical application value and related issues. Methods: Dosimetric indicators of four organs at risk (OARs), namely the heart, right coronary artery (RCA), right lung, and liver, were compared on the premise that the planning target volume met dose-volume prescription requirements. Meanwhile,the patients were divided into the edge of the xiphoid process (EXP), sternum middle (SM), and left breast wall (LBW) groups according to different positions of respiratory gating primary points. The CBCT setup error data of the three groups were contrasted for the treatment accuracy study, and the effects of different gating window heights on the right lung volume increases were compared among the three groups. Results: Compared with free breath (FB), DIBH reduced the maximum dose of heart and RCA by 739.3 ± 571.2 cGy and 509.8 ± 403.8 cGy, respectively (p < 0.05). The liver changed the most in terms of the mean dose (916.9 ± 318.9 cGy to 281.2 ± 150.3 cGy, p < 0.05). The setup error of the EXP group in the anterior-posterior (AP) direction was 3.6 ± 4.5 mm, which is the highest among the three groups. The right lung volume increases in the EXP, SM, and LBW groups were 72.3%, 69.9%, and 67.2%, respectively (p = 0.08), and the corresponding breath-holding heights were 13.5 ± 3.7 mm, 10.3 ± 2.4 mm, and 9.6 ± 2.8 mm, respectively (p < 0.05). Conclusions: SGRT-based DIBH radiotherapy can better protect the four OARs of right-sided breast cancer patients with RNI. Different respiratory gating primary points have different setup accuracy and breath-hold height.

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“…Radiation therapy (RT) in deep inspiration breath-hold (DIBH) is recommended for almost all left-sided breast cancer patients due to improved lung- and heart-sparing compared to free breathing (FB) [ 1 , 2 ]. In a recent study, also patients with right-sided locoregional breast cancer benefitted from the use of DIBH due to decreased doses to the lung and liver [ 3 ]. In DIBH, it is essential that the breath-hold level (BHL) is repeated accurately to achieve optimal reduction in the heart dose [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

AlignRT®, Catalyst™ and RPM™ in locoregional radiotherapy of breast cancer with DIBH. Is IGRT still needed?

Laaksomaa

Ahlroth

Pynnönen

et al. 2022

Rep Pract Oncol Radiother.

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background:In locoregional radiotherapy of breast cancer with deep inspiration breath hold (DIBh), setup accuracy may depend on hospital protocol. At present, comparison between different positioning devices is challenging due to differing hospital protocols. The aim of this study was to evaluate the setup accuracy obtained with surface-guided radiation therapy (sGrT; AlignrT®, Catalyst™) or with lasers and real-time position management (rpM™) in DIBh. Materials and methods:A total of 1692 image pairs were analyzed in three groups: positioning using AlignrT® surface guidance system (Group A, n = 45), Catalyst™ (Group C, n = 50) and conventional lasers and tattoos (Group L, n = 46). We evaluated residual errors for the bony chest wall, th1 and humeral head in kV images with laser-or sGrT-based setup with and without daily image-guided radiation therapy (IGrT). results: Less isocenter variance was found in Group A than in Group L or C (p ≤ 0.05) and in Group C than in L (p = 0.02-0.6). With sGrT only, the smallest random rotation error was found in Group A (p = 0.01). With daily IGrT, only a small difference was found for residual errors between the groups. conclusion: setup with sGrT improves the isocenter reproducibility compared to lasers and rpM™. Only small differences were found in setup accuracy between the sGrT devices. Due to improved isocenter accuracy, daily orthogonal IGrT is suggested in all the groups.

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Benefit of Deep Inspiratory Breath Hold for Right Breast Cancer When Regional Lymph Nodes Are Irradiated

Cited by 12 publications

References 24 publications

SGRT-based DIBH radiotherapy practice for right breast cancer combined with RNI: A retrospective study on dosimetry and treatment accuracy

SGRT-based DIBH radiotherapy practice for right breast cancer combined with RNI: A retrospective study on dosimetry and treatment accuracy

SGRT‐based DIBH radiotherapy practice for right‐sided breast cancer combined with RNI: A retrospective study on dosimetry and setup accuracy

AlignRT®, Catalyst™ and RPM™ in locoregional radiotherapy of breast cancer with DIBH. Is IGRT still needed?

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