Dosimetric evaluation of deep inspiration breath hold for left-sided breast cancer: analysis of patient-specific parameters related to heart dose reduction

Yamauchi, Ryohei; Mizuno, Norifumi; Itazawa, Tomoko; Saitoh, Hidetoshi; Kawamori, Jiro

doi:10.1093/jrr/rraa006

Cited by 32 publications

(41 citation statements)

References 26 publications

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“…However, high dose volume of the heart was increased in several 10-mm shifted ABP plans. Although the 10-mm systematically shifted scenario for all fractionations is unlikely in common clinical situations, in the case of trade-off between the target coverage and the risk of cardiac dose escalation, the combination of hybrid IMRT and the deep inspiration breath-hold technique is considered the optimal setting for patients 22 – 24 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of robustness in hybrid intensity-modulated radiation therapy plans generated by commercial software for automated breast planning

Mizuno

Yamauchi

Kawamori

et al. 2022

Sci Rep

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This study aimed to evaluate the robustness against geometric uncertainties in the hybrid intensity-modulated radiation therapy (IMRT) plans generated by commercially available software for automated breast planning (ABP). The ABP plans were compared with commonly used forward-planned field-in-field (FIF) technique plans. The planning computed tomography datasets of 20 patients who received left-sided breast-conserving surgery were used for both the ABP and FIF plans. Geometric uncertainties were simulated by shifting beam isocenters by 2, 3, 5, and 10 mm in the six directions: anterior/posterior, left/right, and superior/inferior. A total of 500 plans (20 patients and 25 scenarios, including the original plan) were created for each of the ABP and FIF plans. The homogeneity index of the target volume in the ABP plans was significantly better (p < 0.001) than the value in the FIF plans in the scenarios of shifting beam isocenters by 2, 3, and 5 mm. Mean heart dose and percentage volume of lungs receiving a dose more than 20 Gy were clinically acceptable in all scenarios. The hybrid IMRT plans generated by commercially available ABP software provided better robustness against geometric uncertainties than forward-planned FIF plans.

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Section: Discussionmentioning

confidence: 99%

Evaluation of robustness in hybrid intensity-modulated radiation therapy plans generated by commercial software for automated breast planning

Mizuno

Yamauchi

Kawamori

et al. 2022

Sci Rep

Self Cite

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“…Deep inspiration breath-hold (DIBH) is another effective method in reducing dose delivery to the heart. 35 The concept was not discussed here because free-breathing is still used in clinical practice, and DIBH was only suitable for patients capable of holding their breath to 70%–80% of the maximum inspiration capacity for a minimum 20–30 s. 46 For patients incapable of DIBH, ncVMAT is an alternative technique, which better spares the heart and other OARs.…”

Section: Discussionmentioning

confidence: 99%

Non-coplanar volumetric modulated arc therapy for locoregional radiotherapy of left-sided breast cancer including internal mammary nodes

et al. 2021

Radiology and Oncology

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Background Non-coplanar volumetric modulated arc therapy (ncVMAT) is proposed to reduce toxicity in heart and lungs for locoregional radiotherapy of left-sided breast cancer, including internal mammary nodes (IMN). Patients and methods This retrospective study included 10 patients with left-sided breast cancer who underwent locoregional radiotherapy after breast-conserving surgery. For each patient, the ncVMAT plan was designed with four partial arcs comprising two coplanar arcs and two non-coplanar arcs, with a couch rotating to 90°. The prescribed dose was normalized to cover 95% of planning target volume (PTV), with 50 Gy delivered in 25 fractions. For each ncVMAT plan, dosimetric parameters were compared with the coplanar volumetric modulated arc therapy (coV-MAT) plan. Results T here were improvements in conformity index, homogeneity index and V55 of total target volume (PTVall) comparing ncVMAT to coVMAT (p < 0.001). Among the organs at risk, the average V30, V20, V10, V5, and mean dose (Dmean) of the heart decreased significantly (p < 0.001). Furthermore, ncVMAT significantly reduced the mean V20, V10, V5, and Dmean of left lung and the mean V10 and V5 and Dmean of contralateral lung (p < 0.001). An improved sparing of the left anterior descending coronary artery and right breast were also observed with ncVMAT (p < 0.001). Conclusions Compared to coVMAT, ncVMAT provides improved conformity and homogeneity of whole P TV, better dose sparing of the heart, bilateral lungs, left anterior descending coronary artery (LAD), and right breast for locoregional radiotherapy of left-sided breast cancer with IMN, potentially reducing the risk of normal tissue damage.

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“…In a Asian cohort, the mean heart dose reduction throughout DIBH compared to FB is 47%. This effect is more significant in those with low body mass index [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Variation of heart and lung radiation doses according to setup uncertainty in left breast cancer

2021

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Purpose Breast radiotherapy set-up is often uncertain. Actual dose distribution to normal tissues could be different from planned dose distribution. The objective of this study was to investigate such difference in dose distribution according to the extent of set-up error in breast radiotherapy. Materials and methods A total of 50 Gy with fraction size of 2 Gy was given to 30 left breasts with different set-ups applying a deep inspiration breath holding (DIBH) or a free breathing (FB) technique. Under the assumption that errors might come from translational axes of deep or caudal directions, the isocenter was shifted from the original tangential alignment every 2.5 mm to simulate uncertainty of deep and caudal tangential set-up in DIBH and FB. Changes were evaluated for dosimetric parameters for the heart, the left ventricle (LV), the left anterior descending coronary artery (LAD), and the ipsilateral lung. Results On the original plan, mean doses of heart and ipsilateral lung were 2.0 ± 1.1 Gy and 3.7 ± 1.4 Gy in DIBH and 8.4 ± 1.3 Gy and 7.8 ± 1.5 Gy in FB, respectively. The change of dose distribution for the heart in DIBH was milder than that in FB. The deeper the tangential set-up, the worse the heart, LV, LAD, and ipsilateral lung doses, showing as much as 49.4%, 56.4%, 90.3%, and 26.1% shifts, respectively, in 5 mm DIBH setup. The caudal set-up did not show significant dose difference. In multiple comparison of DIBH, differences of mean dose occurred in all 7.5 mm deep set-ups for the heart (p = 0.025), the LV (p = 0.049), and LAD (p = 0.025) in DIBH. Conclusions To correct set-up error over indicated limitation for deep tangential set-up in DIBH at 5 mm action level, mean heart and ipsilateral lung doses are expected to increase approximately 50% and 25%, respectively.

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Dosimetric evaluation of deep inspiration breath hold for left-sided breast cancer: analysis of patient-specific parameters related to heart dose reduction

Cited by 32 publications

References 26 publications

Evaluation of robustness in hybrid intensity-modulated radiation therapy plans generated by commercial software for automated breast planning

Evaluation of robustness in hybrid intensity-modulated radiation therapy plans generated by commercial software for automated breast planning

Non-coplanar volumetric modulated arc therapy for locoregional radiotherapy of left-sided breast cancer including internal mammary nodes

Variation of heart and lung radiation doses according to setup uncertainty in left breast cancer

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