Dosimetry and Feasibility Studies of Volumetric Modulated Arc Therapy With Deep Inspiration Breath-Hold Using Optical Surface Management System for Left-Sided Breast Cancer Patients

Abstract

Background: During radiotherapy (RT) procedure of breast cancer, portions of the heart and lung will receive some radiation dose, which may result in acute and late toxicities. In the current study, we report the experience of our single institution with organs at risk (OARs)-sparing RT with deep inspiration breath hold (DIBH) using an Optical Surface Management System (OSMS) and compare the dosimetric parameters with that of free breathing (FB). Patients and Methods: Forty-eight cases diagnosed as early stage left-sided breast cancer scheduled for postoperative RT were enrolled. The OSMS was used to monitor the breathing magnitude and track the real-time respiratory status, which can control a stable lung and heart volume during RT delivery under DIBH. We did the dosimetric analysis of the heart, left anterior descending (LAD) coronary artery, lungs, and contralateral breast under FB and DIBH plans. Results: Compared with FB-volumetric-modulated arc therapy (FB-VMAT), DIBH-VMAT resulted in significantly changed volumes to the heart and lungs receiving irradiation dose. The average mean heart dose and average D2%, V 5 , and V 10 showed significant differences between the DIBH and FB techniques. For the LAD coronary artery, we found significantly reduced average mean dose, D2%, and V 10 with DIBH. Similar results were also found in the lungs and contralateral breast. The use of flattening-filter-free decreased treatment time compared with the flat beam mode in our VMAT (p < 0.05). For the 48 patients, there were no significant differences in the lateral, longitudinal, and vertical directions between OSMS and cone beam CT.

Hypofractionated Whole-Breast Irradiation Focus on Coronary Arteries and Cardiac Toxicity—A Narrative Review

“…DIHB VMAT planning showed a reduction from 5.4 to 3.6 Gy of MHD, and D2% to the heart was reduced from 19.3 to 13.4 Gy compared to VMAT-free breath (FB-VMAT) treatment plans. In the case of LADA, the average value of Dmean was also reduced from 6.9 to 3.9 Gy, and D2% was reduced from 19.5 to 9 Gy by using the DIHB technique associated with VMAT left breast irradiation ( 64 , 65 ).…”

Target motion management in breast cancer radiation therapy

“…75,79 Recently, the DIBH treatment using volumetric-modulated arc therapy (VMAT) is utilized for a patient with the left-sided breast cancer to irradiate both whole breast and regional node with superior target coverage and good cardiac sparing. 80,81 Fassi et al investigated target position reproducibility in the left-sided breast irradiation with DIBH using multiple optical control points. They compared the performance of optical surface imaging with that of the RPM-based methods and showed that the use of multiple surface fiducials leads to improved target and surface reproducibility.…”

“… 75 , 79 Recently, the DIBH treatment using volumetric-modulated arc therapy (VMAT) is utilized for a patient with the left-sided breast cancer to irradiate both whole breast and regional node with superior target coverage and good cardiac sparing. 80 , 81 …”

Deep inspiration breath-hold for mediastinal lymphoma patients: Evaluation of a 5-year service

“…Patients undergoing mediastinal radiotherapy for lymphoma have a risk of serious radiation-associated late toxicities such as cardiovascular disease and secondary cancers [2] . It was, hypothesised that this patient group could benefit from the use of a deep inspirational breath-hold (DIBH) technique, which has been previously implemented in breast cancer treatment, achieving heart sparing, as well as reduced lung toxicity [3] .…”