Comparison of thoracic and abdominal deep inspiration breath holds in whole-breast irradiation for patients with left-sided breast cancer

Hirata, Kimiko; Narabayashi, Masaru; Hanai, Yuki; Fukumoto, Kenta; Tomohiro, Kosuga; Tanaka, Kazunori; Mukumoto, Nobutaka; Ohtsu, Shuji

doi:10.1007/s12282-021-01259-4

Cited by 7 publications

(18 citation statements)

References 15 publications

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“…The patterns of lung displacement in the present study were similar to those observed in a previous study. 19 The left lung was displaced more towards the anterior and inferior directions. The left lung was displaced more inferiorly in A‐DIBH compared to T‐DIBH and was displaced anteriorly in T‐DIBH compared to A‐DIBH.…”

Section: Discussionmentioning

confidence: 97%

“…Hirata et al. 19 found no significant differences between A‐DIBH and T‐DIBH in the heart and left lung doses in 14 patients with left breast cancer who underwent WBI after breast‐conserving surgery; the median heart doses using A‐DIBH and T‐DIBH were 1.6 Gy and 1.5 Gy for the entire treatment period, respectively, in a prescription dose of 50 Gy. Meanwhile, Zhao et al.…”

Section: Discussionmentioning

confidence: 98%

“…However, the heart doses observed in our study were higher than those in previous studies. 16 , 19 This may be because, in clinical practice, the MLC is placed beyond the midline to reduce the heart and lungs doses, if necessary. However, we adopted the basic method of aligning the irradiation field to the mid‐chest line without manually shielding the heart to reduce planning variation in this dosimetric study.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12] Meanwhile, the deep-inspiration breath-hold (DIBH) technique has been used as an alternative method to effectively reduce the heart and lung doses by enlarging the lungs and inherently increasing the gap between the heart and the irradiation field. [13][14][15][16][17][18][19][20] Previous reports on DIBH have focused on the effects of free-breathing and deep inhalation; however, there are few reports on the abdominal and thorax deep-inspiration breath-hold (A-DIBH and T-DIBH) techniques. A-DIBH is a breathing technique that uses the intercostal muscles to raise and lower the ribs, and T-DIBH is a breathing technique consisting of raising and lowering the diaphragm.…”

Section: Introductionmentioning

confidence: 99%

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Dose and organ displacement comparisons with breast conservative radiotherapy using abdominal and thoracic deep‐inspiration breath‐holds: A comparative dosimetric study

Matsumoto

Kunieda

Futakami

et al. 2023

J Applied Clin Med Phys

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Deep‐inspiration breath‐hold (DIBH) reduces the radiation dose to the heart and lungs during breast radiotherapy in cancer. However, there is not enough discussion about suitable breathing methods for DIBH. Therefore, we investigated the radiation doses and organ and body surface displacement in abdominal DIBH (A‐DIBH) and thoracic DIBH (T‐DIBH). Free‐breathing, A‐DIBH, and T‐DIBH computed tomography images of 100 patients were used. After contouring the targets, heart, and lungs, radiotherapy plans were created. We investigated the heart and lung doses, the associations between the heart and left lung displacements, and the thorax and abdominal surface displacements. No significant differences were observed in the target dose indices. However, the heart and lung doses were significantly lower in A‐DIBH than in T‐DIBH for all the indices; the mean heart and lung doses were 1.69 and 3.48 Gy, and 1.91 and 3.55 Gy in A‐DIBH and T‐DIBH, respectively. The inferior displacement of the heart and the left lung was more significant in A‐DIBH. Therefore, inferior expansion of the heart and lungs may be responsible for the respective dose reductions. The abdominal surface displaced more than the thoracic surface in both A‐DIBH and T‐DIBH, and thoracic surface displacement was greater in T‐DIBH than in A‐DIBH. Moreover, A‐DIBH can be identified because abdominal surface displacement was greater in A‐DIBH than in T‐DIBH. In conclusion, A‐DIBH and T‐DIBH could be distinguished by comparing the abdominal and thoracic surfaces of A‐DIBH and T‐DIBH, thereby ensuring the implementation of A‐DIBH and reducing the heart and lung doses.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Dose and organ displacement comparisons with breast conservative radiotherapy using abdominal and thoracic deep‐inspiration breath‐holds: A comparative dosimetric study

Matsumoto

Kunieda

Futakami

et al. 2023

J Applied Clin Med Phys

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“…The risk–benefit of breast RT varies between studies and may not be favorable for all women equally (e.g., long-term smokers, techniques, fields) ( 2 , 4 ). Furthermore, some physiological breathing variation (chest vs. abdomen) could still occur ( 9 , 34 ). Indeed, in contrast to cardiac motion, which is rhythmic, respiratory motion is “involuntary” and nonrhythmic ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

Inter-fraction heart displacement during voluntary deep inspiration breath hold radiation therapy without visual feedback measured by daily CBCT

et al. 2022

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Purpose/ObjectiveDeep Inspiration Breath Hold (DIBH) is now considered as the standard of care for many breast cancer patients. However, there are still uncertainties about the dose given to the heart, and it is unknown if patients may improve voluntary DIBH depth by gaining experience during treatment. In this study, we will examine the interfractional three-dimensional (3D) heart displacement throughout voluntary DIBH (vDIBH) radiotherapy by means of daily cone-beam computed tomography (CBCT).Material and methodsTwo hundred twenty-five unique CBCTs from 15 patients treated in 15 fractions were analyzed. During CBCT, a vDIBH was conducted without any visual feedback. Patients performed their DIBH freely after receiving explanations and training. After daily CBCT matching to the chest wall (CW), surface-guided radiation therapy (SGRT) tracked DIBH depth to ensure that the CW position was the same as the daily acquired CBCT. The CBCTs were retrospectively registered to the DIBH planning-CT to calculate daily changes in heart displacement relative to the CW.ResultsThe mean displacement of the heart during DIBH treatment relative to the DIBH planning-CT was as follows: 1.1 mm to the right, interquartile range (IQR) 8.0; 0.5 mm superiorly, IQR 4.8; and 0 mm posteriorly, IQR 6.4. The Spearman correlation coefficients (rs) were -0.15 (p=0.025), 0.04 (p=0.549), and 0.03 (p=0.612) for the X, Y, and Z directions, respectively. The differences in median heart displacement were significant: Friedmann rank sum test p=0.031 and pairwise comparison using the Wilcoxon rank-sum test were p=0.008 for X and Y; p=0.33 for X and Z; and p=0.07 for Y and Z. The total median heart motion was δtot median= 7.26 mm, IQR= 6.86 mm.ConclusionDuring DIBH, clinicians must be aware of the wide range of intra- and inter-individual heart position variations. The inter-individual heterogeneity shown in our study should be investigated further in order to avoid unexpected cardiac overexposure and to develop a more accurate heart dose-volume model.

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A Potential Pitfall and Clinical Solutions in Surface-Guided Deep Inspiration Breath Hold Radiation Therapy for Left-Sided Breast Cancer

Zeng¹,

Fan²,

Li³

et al. 2023

Advances in Radiation Oncology

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Comparison of thoracic and abdominal deep inspiration breath holds in whole-breast irradiation for patients with left-sided breast cancer

Cited by 7 publications

References 15 publications

Dose and organ displacement comparisons with breast conservative radiotherapy using abdominal and thoracic deep‐inspiration breath‐holds: A comparative dosimetric study

Dose and organ displacement comparisons with breast conservative radiotherapy using abdominal and thoracic deep‐inspiration breath‐holds: A comparative dosimetric study

Inter-fraction heart displacement during voluntary deep inspiration breath hold radiation therapy without visual feedback measured by daily CBCT

A Potential Pitfall and Clinical Solutions in Surface-Guided Deep Inspiration Breath Hold Radiation Therapy for Left-Sided Breast Cancer

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