Breathing adapted radiotherapy of breast cancer: reduction of cardiac and pulmonary doses using voluntary inspiration breath-hold

Pedersen, Anders N.; Korreman, S.; Nyström, Håkan; Specht, Lena

doi:10.1016/j.radonc.2004.03.012

Cited by 240 publications

(157 citation statements)

References 18 publications

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“…reported on doses to organs at risk and target, and due to their use of PB algorithm, the mean doses to organs at risk in their study are lower than ours, while achieving higher minimum doses to target 6. Lung volume increases by 64% from FB to DIBH plans on average in our study, whereas other studies have reported on absolute lung volume increase in the range of 72%–84% 6, 8, 9. Our study has a lower lung volume increase, and there could be a potential for optimizing the doses even more.…”

Section: Discussioncontrasting

confidence: 61%

“…Excluding the heart from the field might compromise the dose to the target, but by means of the deep inspiration breath hold (DIBH) technique it is possible to reduce the cardiopulmonary doses while maintaining the prescribed dose to the breast 6, 7. The method is well established and several groups have previously reported beneficial results using DIBH 6, 8, 9, 10, 11, 12, 13, 14. Since DIBH is capable of decreasing dose to the heart; it is also assumed that the long‐term risk of developing cardiac damage is reduced.…”

Section: Introductionmentioning

confidence: 99%

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Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Jensen

Абрамова

Frengen

et al. 2017

J Applied Clin Med Phys

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Deep inspiration breath hold (DIBH) in left‐sided breast cancer radiotherapy is a technique to reduce cardiac and pulmonary doses while maintaining target coverage. This study aims at evaluating an in‐house developed DIBH system. Free‐breathing (FB) and DIBH plans were generated for 22 left‐sided localized breast cancer patients who had radiation therapy (RT) after breast‐conserving surgery. All patients were treated utilizing an in‐house laser distance measuring system. 50 Gy was prescribed, and parameters of interest were target coverage, left anterior descending coronary artery, (LAD) and heart doses. Portal images were acquired and the reproducibility and stability of DIBH treatment were compared to FB. The comparing result shows there is a significant reduction in all LAD and heart dose statistics for DIBH compared to FB plans without compromising the target coverage. The maximum LAD dose was reduced from 43.7 Gy to 29.0 Gy and the volume of the heart receiving >25 Gy was reduced from 3.3% to 1.0% using the in‐house system, both statistically significant. The in‐house system gave a reproducible and stable DIBH treatment where the systematic error ∑, and random error σ, were less than 2.2 mm in all directions, but were not significantly better than at FB. The system was well tolerated and all patients completed their treatment sessions with DIBH.

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Section: Discussioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Jensen

Абрамова

Frengen

et al. 2017

J Applied Clin Med Phys

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“…9 Further innovations in treatment planning are therefore under investigation, including intensity modulation 10,11,12 and various techniques for the control of respiratory motion. 13,14,15,16,17,18,19,20,21 The aim of these techniques is to reduce still further the dose received by the heart, in the hopes of minimizing the long-term morbidity and mortality associated with the treatment of breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Respiratory Motion of The Heart and Positional Reproducibility Under Active Breathing Control

Jagsi

Moran

Kessler

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To reduce cardiotoxicity from breast radiotherapy (RT), innovative techniques are under investigation. Information about cardiac motion with respiration and positional reproducibility under active breathing control (ABC) is necessary to evaluate these techniques.Methods-Patients requiring loco-regional RT for breast cancer were CT-scanned using an ABC device at various breath-hold states, before and during treatment. Ten patients were studied. For each patient, 12 datasets were analyzed. Mutual information-based regional rigid alignment was used to determine the magnitude and reproducibility of cardiac motion as a function of breathing state. For each scan session, motion was quantified by evaluating the displacement of a point along the left anterior descending artery (LAD) with respect to its position at end expiration. Long-term positional reproducibility was also assessed.Results-Displacement of the LAD was greatest in the inferior direction, moderate in the anterior direction, and lowest in the left-right direction. At shallow breathing states, the average displacement of LAD position was up to 6mm in the inferior direction. The maximum displacement in any patient was 2.8cm in the inferior direction, between expiration and deep-inspiration breath hold (DIBH). At end expiration, the long-term reproducibility (SD) of the LAD position was 3mm in the A-P, 6mm in the S-I, and 4mm in the L-R directions. At DIBH, long-term reproducibility was 3mm in the A-P, 7mm in the S-I, and 3mm in the L-R directions.Conclusions-These data demonstrate the extent of LAD displacement that occurs with shallow breathing and with DIBH. This information may guide optimization studies considering the effects of respiratory motion and reproducibility of cardiac position on cardiac dose, both with and without ABC.

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“…The Real‐Time Positioning Management system (Varian, Palo Alto, CA, USA) is less invasive and relies on a box with infrared markers that is placed on the patient's xiphoid process. The position of the box might vary from day to day, and its placement can influence the patient positioning and could increase the dose to the skin if placed within the field borders due to the build‐up effect 5. Noninvasive instruments like Sentinel and Catalyst (C‐RAD Positioning, Uppsala, Sweden) project a pattern onto the patient which is scanned with a CCD‐camera to produce a high‐resolution 3D reconstructed model of the patient 6, 7.…”

Section: Introductionmentioning

confidence: 99%

Development of a deep inspiration breath‐hold system for radiotherapy utilizing a laser distance measurer

Jensen

Skottner

Frengen

et al. 2016

J Applied Clin Med Phys

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Deep inspiration breath‐hold (DIBH) is a technique for treating left‐sided breast cancer (LSBC). In modern radiotherapy, one of the main aims is to exclude the heart from the beam aperture with an individualized beam design for LSBC. A deep inhalation will raise the chest wall while the volume of the lungs increase, this will again push the heart away from the breast to be treated. There are a few commercial DIBH systems, both invasive and noninvasive. We present an alternative noninvasive DIBH system based upon an industrial laser distance measurer. This system can be installed in a treatment room at a low cost; it is very easy to use and requires limited amount of training for the personnel and the patient. The system is capable of measuring the position of the chest wall with high frequency and precision in real time. The patient views its breathing curve through video glasses, and gets instructions during the treatment session. The system is well tolerated by test subjects due to its noninvasiveness.

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Breathing adapted radiotherapy of breast cancer: reduction of cardiac and pulmonary doses using voluntary inspiration breath-hold

Cited by 240 publications

References 18 publications

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Respiratory Motion of The Heart and Positional Reproducibility Under Active Breathing Control

Development of a deep inspiration breath‐hold system for radiotherapy utilizing a laser distance measurer

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