Cardiac-sparing radiotherapy for the left breast cancer with deep breath-holding

Nemoto, Koji; Oguchi, Masahiko; Nakajima, Masaru; Kozuka, Toshiaki; Nose, Takayuki; Yamashita, Takashi

doi:10.1007/s11604-009-0336-1

Cited by 32 publications

(30 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The greatest distance of the heart and the inner thoracic wall was measured during deep inspiration breath hold (1.7 cm). Craniocaudally the heart moved around 2 cm during deep inspiration compared to end inspiration (1.5 cm) [20].…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

A prospective study on the need of gated (GAT) radiotherapy in left sided breast cancer patients treated at the Technical University Munich (TUM) The GATTUM Trial: Study Protocol (Preprint)

Duma¹,

Oechsner²,

Ertl³

et al. 2018

Preprint

View full text Add to dashboard Cite

Abstract:Background: Deep inspiration breathhold (DIBH) it is the most widely used technique for heart sparing.Nonetheless, treatment preparation, patient coaching and treatment planning/ delivery can be more time consuming than conventional techniques. The aim of our study is to find predictive measurements that will allow an estimation of the heart dose reduction by DIBH and thus allow a precise selection of these patients. Methods:The GATTUM trial is a single institution, prospective pilot study. 150 breast cancer patients who will undergo radiotherapy at the university hospital 'Klinikum rechts der Isar' will be included in the study. All patients will undergo breathing triggered radiation planning with a CT during free breathing (FB) and a CT during deep inspiration breath hold (DIBH). Patients without cardiac risk factors with heart Dmean ≥ 3 Gy and for patients with cardiac risk factors with heart Dmean ≥ 2Gy are recommended to undergo radiation therapy in DIBH. The primary endpoint of the study is to identify measurements that will predict the heart dose reduction in DIBH. Secondary endpoints include quality of life and cosmesis. Discussion:The measurements that we aim to find by this study are to be performed on a planning CT or a diagnostic CT performed beforehand; easy to perform by each staff member; correlated with clinical data (such as breast size; heart and lung morphometry; heart and lung comorbidities) and correlated with the a 3D CRT tangential field "standard" dose distribution. This study could help to improve the knowledge about the necessity of respiratory-gated radiotherapy. We expect that evidence-based indications regarding optimization-criteria for radiation planning of breast cancer patients can be determined for the first time.

show abstract

Section: Discussionmentioning

confidence: 95%

“…They were mostly performed on 4D computed tomographies (4D-CTs) and can not be extrapolated to DIBH [19,20].…”

Section: Introductionmentioning

confidence: 99%

A prospective study on the need of gated (GAT) radiotherapy in left sided breast cancer patients treated at the Technical University Munich (TUM) The GATTUM Trial: Study Protocol (Preprint)

Duma¹,

Oechsner²,

Ertl³

et al. 2018

Preprint

View full text Add to dashboard Cite

show abstract

“…As mentioned previously, this highlights the importance of minimising both the dose to these structures and the volume being irradiated as much as possible. There has been considerable interest in developing modern technology for radiotherapy planning to avoid excess cardiac irradiation, by modulation of the dose around organs at risk (OAR) using intensity modulated radiotherapy (IMRT) [18,19], IMRT with simultaneously integrated boost [20], placement of heart blocks [21] and deep inspiratory breathholding (DIBH) and gated techniques [22][23][24][25]. Beam angle modulation remains a very simple, and, up until now, rather neglected way of achieving this outcome.…”

mentioning

confidence: 99%

Beam angle manipulation to reduce cardiac dose during breast radiotherapy

Vivekanandan

Mhlanga

Launders

et al. 2012

BJR

View full text Add to dashboard Cite

Objective: Standard tangential radiotherapy techniques after breast conservative surgery (BCS) often results in the irradiation of the tip of the left ventricle and the left anterior descending coronary artery (LAD), potentially increasing cardiovascular morbidity. The importance of minimising radiation dose to these structures has attracted increased interest in recent years. We tested a hypothesis that in some cases, by manipulating beam angles and accepting lower-than-prescribed doses of radiation in small parts of the breast distant from the surgical excision site, significant cardiac sparing can be achieved compared with more standard plans. Methods: A sample of 12 consecutive patients undergoing radiotherapy after left-sided BCS was studied. All patients were planned with a 6 MV tangential beam, beam angles were manipulated carefully and if necessary lower doses were given to small parts of the breast distant from the surgical excision site to minimise cardiac irradiation (''institutional'' plan). Separate ''hypothetical standard'' plans were generated for seven patients using set field margins that met published guidelines. Results: In seven patients, the institutional plans resulted in lower doses to the LAD and myocardium than the hypothetical standard plans. In the other five patients, LAD and myocardial doses were deemed minimal using the hypothetical standard plan, which in these patients corresponded to the institutional plan (the patients were actually treated using the institutional plans). Conclusion: Much attention has been devoted to ways of minimising cardiac radiation dose. This small sample demonstrates that careful manipulation of beam angles can often be a simple, but effective technique to achieve this.

show abstract

“…Yet, research has shown an increased risk of cardiovascular-related morbidity and mortality in women who have received radiation therapy for breast cancer on the left side (Darby et al, 2013). A new radiation therapy technology, breathing adapted radiation therapy (BART), which uses the movement of the chest when the woman breathes to its advantage , was introduced to reduce the risk of cardiac events (Nemoto et al, 2009). In Sweden, BART was first introduced in a regional hospital in the south of Sweden in 2007, and it is now available in almost the whole country (RCC, 2018).…”

Section: Treatment and Women's Experiences Of The Treatment Trajectorymentioning

confidence: 99%

“…When the woman takes deep breaths the chest rises further away from the heart. The radiation is given only when the woman is in the right respiratory phase, in other words, when the chest is as far from the heart as possible Nemoto et al, 2009). There is a need to know how an active participation in radiation therapy, through breathing, is experienced by the women, especially since it is evident that women diagnosed with breast cancer experience increased levels of anxiety in connection with their radiation therapy treatment Schnur et al, 2009).…”

Section: Treatment and Women's Experiences Of The Treatment Trajectorymentioning

confidence: 99%

On a journey for survival : everyday life during radiation therapy from the perspectives of women with breast cancer and their families

Holst-Hansson¹

View full text Add to dashboard Cite

To everyone who has believed in me Vi människor är sociala varelser. Vi kommer till denna värld som ett resultat av andras handlingar. För vår överlevnad är vi ömsesidigt beroende av varandra. Vare sig vi vill eller inte finns det inte en enda stund i livet då vi inte drar nytta av sådant som andra har gjort eller gör. Det är därför knappast förvånande att det mesta av vår lycka uppstår i relationer med andra. Inte heller är det anmärkningsvärt om vår största glädje uppstår när vi motiveras av omsorg om andra. Men det är mera än så. Allt tyder på att altruistiska handlingar inte bara skapar lycka, utan att de också minskar vår upplevelse av lidande. Vårt beteende mot andra blir automatiskt positivt när vi handlar av omsorg mot dem. Det är för att vi inte har plats för några misstankar när hjärtat är fyllt av kärlek. Det är som en inre dörr öppnas och låter oss komma ut. ABSTRACTThis thesis focuses on women diagnosed with breast cancer and their family members. Since a breast cancer diagnosis and its subsequent treatment are a strenuous experience not only for the woman afflicted but also for her family members, this thesis aimed to explore the experiences of everyday life during radiation therapy from the perspectives of the woman with breast cancer and her family, as well as exploring families' experiences of participating in short family health conversations (SFamHC). All included studies were interview studies (Papers I, II, III & IV), where 30 women (20 in Paper I and 10 in Paper II) with breast cancer, 19 family members including the women with breast cancer (Paper III) and 9 families (Paper IV) were interviewed. The data from the interviews was analysed using qualitative content analysis (Papers I & II), a hermeneutical phenomenological method (Paper III) and thematic analysis (Paper IV).The women's experiences of breathing adapted radiation therapy (BART) (Paper I) were identified in an overall theme, The breath of life, as the women experienced the breathing as a way to influence their treatment and thus their survival. The overall theme could be divided into one main category: Participating in one's treatment, for good or ill, with four subcategories: Knowing one has done something good, Getting an extra bonushealthwise, The experience of being in control and Being in a hightechnology environment.Women born in Iraq and the former Yugoslavia, diagnosed with breast cancer and living in Sweden, experienced their everyday life during radiation therapy as a narrow and challenging treatment road to survival (Paper II). Their experiences were structured into three categories: Strategies for survival, Keeping up appearances and Staying in control. More focus should be on acknowledging the woman behind the diagnosis, regardless of her origin, in order to 10 develop individualised support programmes to help women cope with everyday life during radiation therapy.The families' lived experience when a family member is diagnosed with breast cancer (Paper III) was described as a challenging endeavour to regain an or...

show abstract

Cardiac-sparing radiotherapy for the left breast cancer with deep breath-holding

Abstract: We concluded that radiotherapy on the DIBH facilitates a reduction of the irradiated heart volume compared to FB and IG.

Cited by 32 publications

References 21 publications

A prospective study on the need of gated (GAT) radiotherapy in left sided breast cancer patients treated at the Technical University Munich (TUM) The GATTUM Trial: Study Protocol (Preprint)

A prospective study on the need of gated (GAT) radiotherapy in left sided breast cancer patients treated at the Technical University Munich (TUM) The GATTUM Trial: Study Protocol (Preprint)

Beam angle manipulation to reduce cardiac dose during breast radiotherapy

On a journey for survival : everyday life during radiation therapy from the perspectives of women with breast cancer and their families

Contact Info

Product

Resources

About