Deep-inspirational breath-hold (DIBH) technique in left-sided breast cancer: various aspects of clinical utility

Gaál, Szilvia; Kahán, Zsuzsanna; Paczona, Viktor; Kószó, Renáta; Drencsényi, Rita; Szabó, Judit; Rónai, Ramóna; Antal, Tímea; Deák, Bence; Varga, Zoltán

doi:10.1186/s13014-021-01816-3

Cited by 35 publications

(38 citation statements)

References 41 publications

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“…It has also been reported by Gaal et al that about one-third of 130 patients in their study did not benefit from that otherwise laborious procedure. Twenty-six patients were not suitable for the technique and heart or LAD dose constraints were not met in the DIBH plans for 16 patients [ 42 ]. For evaluating the efficacy of DIBH for plan parameters improvement, 3DCRT_DIBH was significantly effective in dose reduction of normal tissues compared to the 3DCRT_FB technique.…”

Section: Discussionmentioning

confidence: 99%

Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran

Abdollahi

Yazdi²,

Mowlavi³

et al. 2022

Rep Pract Oncol Radiother.

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background:The aim of the study is to evaluate the overall accuracy of the surface-guided radiotherapy (sGrT) workflow through a comprehensive commissioning and quality assurance procedures and assess the potential benefits of deep-inspiration breath-hold (DIBh) radiotherapy as a cardiac and lung dose reduction approach for left-sided breast cancer irradiation. Materials and methods:Accuracy and reproducibility of the optical surface scanner used for DIBh treatment were evaluated using different phantoms. patient positioning accuracy and reproducibility of DIBh treatment were evaluated. Twenty patients were studied for treatment plan quality in target dose coverage and healthy organ sparing for the two different treatment techniques. results: reproducibility tests for the surface scanner showed good stability within 1 mm in all directions. The maximum position variation between applied shifts on the couch and the scanner measured offsets is 1 mm in all directions. The clinical study of 200 fractions showed good agreement between the surface scanner and portal imaging with the isocenter position deviation of less than 3 mm in each lateral, longitudinal, and vertical direction. The standard deviation of the DIBh level showed a value of < 2 mm during all evaluated DIBhs. Compared to the free breathing (FB) technique, DIBh showed significant reduction of 48% for heart mean dose, 43% for heart V25, and 20% for ipsilateral lung V20. conclusion: surface-guided radiotherapy can be regarded as an accurate tool for patient positioning and monitoring in breast radiotherapy. DIBh treatment are considered to be effective techniques in heart and ipsilateral lung dose reductions for left breast radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran

Abdollahi

Yazdi²,

Mowlavi³

et al. 2022

Rep Pract Oncol Radiother.

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“…Nevertheless, the trade-off between the DIBH and free breath needs to be evaluated in a clinical setting for each patient. 30 The exclusion of axillary node was the limitation of this study. Irradiation of axillary node does not improve the overall and cancer-specific survival.…”

Section: Discussionmentioning

confidence: 93%

Accelerated hypofractionated radiotherapy for chest wall and nodal irradiation using hybrid techniques

Balaji

Ramasubramanian

2021

J Radiother Pract

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Aim: This study compares three different hybrid plans, for left-sided chest wall (CW) and nodal stations irradiation using a hypofractionated dose regimen. Materials and methods: Planning target volumes (PTVs) of 25 breast cancer patients that included CW, supraclavicular (SCL) and internal mammary node (IMN) were planned with 3 different hybrid techniques: 3DCRT+IMRT, 3DCRT+VMAT and IMRT+VMAT. All hybrid plans were generated with a hypofractionated dose prescription of 40·5 Gy in 15 fractions. Seventy per cent of the dose was planned with the base-dose component and remaining 30% of the dose was planned with the hybrid component. All plans were evaluated based on the PTVs and organs at risk (OARs) dosimetric parameters. Results: The results for PTVs parameters have shown that the 3DCRT+IMRT and 3DCRT+VMAT plans were superior in uniformity index to the IMRT+VMAT plan. The OARs dose parameters were comparable between hybrid plans. The IMRT+VMAT plan provided a larger low dose volume spread to the heart and ipsilateral lung (p < 0·001). The 3DCRT+VMAT plan required less monitor units and treatment time (p = 0·005) than other plans. Conclusion: The 3DCRT+VMAT hybrid plan showed superior results with efficient treatment delivery and provide clinical benefit by reducing both low and high dose levels.

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“…Although DIBH reduces cardiac dose compared to free breathing in patients receiving left-breast RT with and without RNI [28], not all patients are good candidates for DIBH. The benefit provided by DIBH may be confined to specific populations, such as those with greater lung volume, higher body mass index, postmastectomy, lower quadrant breast tumors, or tumors extending across more than one quadrant [29][30][31][32]. In addition, some patients still have a worse heart and lung dose under DIBH compared with free breathing [30,33].…”

Section: Discussionmentioning

confidence: 99%

“…The effect of DIBH varies individually. Furthermore, around 20-40% of patients are not suitable for or do not benefit from DIBH [30,32,34]. Thus, investigations of optimal techniques should consider situations where DIBH cannot be implement or is not feasible.…”

Section: Discussionmentioning

confidence: 99%

Modern Rotational Radiation Techniques with Volumetric Modulated Arc Therapy or Helical Tomotherapy for Optimal Sparing of the Lung and Heart in Left-Breast Cancer Radiotherapy Plus Regional Nodal Irradiation: A Comparative Dosimetric Analysis

Hou

Hsieh

et al. 2021

Cancers

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Background: For advanced breast cancer with lymph node involvement, adjuvant radiotherapy (RT) with regional nodal irradiation (RNI) has been indicated to reduce cancer recurrence and mortality. However, an extensive RT volume is associated with normal organ exposure, which increases the toxicity and affects patient outcomes. Modern arc RT techniques can improve normal organ sparing compared with conventional techniques. The aim of this study was to explore the optimal technique for left-breast RT with RNI. Methods: We retrospectively reviewed patients receiving RT with RNI for left-breast cancer. We used modern arc RT techniques with either volumetric-modulated arc therapy (VMAT) or helical tomotherapy (HT) with a novel block technique, and compared differences in dosimetry parameters between the two groups. Subgroup analysis of RNI with or without internal mammary node (IMN) volume was also performed. Results: A total of 108 eligible patients were enrolled between 2017 and 2020, of whom 70 received VMAT and 38 received HT. The median RT dose was 55 Gy. No significant differences were found regarding the surgery, RT dose, number of fractions, target volume, and RNI volume between the VMAT and HT groups. VMAT reduced the heart mean dose more than HT (3.82 vs. 5.13 Gy, p < 0.001), as well as the cardiac parameters of V5-V20, whole-lung mean dose, lung parameters of V5-V20, and contralateral-breast and esophagus mean dose. In the subgroup analysis of RNI with IMNs, the advantage of VMAT persisted in protecting the heart, lung, contralateral breast, and esophagus. HT was beneficial for lowering the thyroid mean dose. For RNI without IMN, VMAT improved the low-dose exposure of the heart and lung, but HT was similar to VMAT in terms of heart, whole-lung, and contralateral-breast mean dose. Conclusions: For patients with left-breast cancer receiving adjuvant RT with RNI, VMAT reduced the exposure dose to the heart, lung, contralateral breast, and esophagus compared with HT. VMAT was superior to HT in terms of normal organ sparing in the patients who underwent RNI with IMN irradiation. Considering the reduction in normal organ exposure and potential toxicity, VMAT is the optimal technique for patients receiving RNI when deep inspiration breath-hold is not available.

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Deep-inspirational breath-hold (DIBH) technique in left-sided breast cancer: various aspects of clinical utility

Cited by 35 publications

References 41 publications

Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran

Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran

Accelerated hypofractionated radiotherapy for chest wall and nodal irradiation using hybrid techniques

Modern Rotational Radiation Techniques with Volumetric Modulated Arc Therapy or Helical Tomotherapy for Optimal Sparing of the Lung and Heart in Left-Breast Cancer Radiotherapy Plus Regional Nodal Irradiation: A Comparative Dosimetric Analysis

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