Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation

Mulliez, Thomas; Veldeman, Liv; Speleers, Bruno; Mahjoubi, K.; Remouchamps, Vincent; Greveling, Annick Van; Gilsoul, M.; Berwouts, Dieter; Lievens, Yolande; Broecke, Rudy Van den; Neve, Wilfried De

doi:10.1016/j.radonc.2014.11.038

Cited by 73 publications

(73 citation statements)

References 34 publications

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“…Superior cardiac sparing was shown with supine breath hold than with freebreathing prone WBI in large-breasted patients in the UK HeartSpare study (7). Preliminary data on prone breath hold are promising, showing an at least as effective displacement of the heart out of the radiation field as in the supine position (8).…”

Section: Introductionmentioning

confidence: 96%

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

Paelinck

Gulybán²,

Lakosi³

et al. 2017

Radiotherapy and Oncology

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SummaryThis is the first randomized trial reporting on the 2-year cosmetic outcome of prone and supine whole-breast irradiation in 94 patients with a cup size of at least C. Better cosmetic outcome was observed in prone-treated patients after 2 years with less skin color changes (PZ.05), less edema (PZ.06), and less worsening of cosmesis assessed by the Breast Cancer Conservation Treatment.cosmetic results software on digital photographs with both arms elevated.Purpose: To report the 2-year cosmetic outcome of a randomized trial comparing prone and supine whole-breast irradiation in large-breasted patients. Methods and Materials: One hundred patients with a (European) cup size C were included. Before and 2 years after radiation therapy, clinical endpoints were scored and digital photographs were taken with the arms alongside the body and with the arms elevated 180 . Three observers rated the photographs using the 4-point Harvard cosmesis scale. Cosmesis was also evaluated with the commercially available Breast Cancer Conservation Treatment.cosmetic results (BCCT.core) software. Results: Two-year follow-up data and photographs were available for 94 patients (47 supine treated and 47 prone treated). Patient and treatment characteristics were not significantly different between the 2 cohorts. Aworsening of color change occurred more frequently in the supine than in the prone cohort (19/46 vs 10/46 patients, respectively, PZ.04). Five patients in the prone group (11%) and 12 patients in the supine group (26%) presented with a worse scoring of edema at 2-year follow-up (PZ.06). For retraction and fibrosis, no significant differences were found between the 2 cohorts, although scores were generally worse in the supine cohort. The cosmetic scoring by 3 observers did not reveal differences between the prone and supine groups. On the photographs with the hands up, 7 patients in the supine group versus none in the prone group had a worsening of cosmesis of 2 categories using the BCCT.org software (PZ.02). Conclusion: With a limited follow-up of 2 years, better cosmetic outcome was observed in prone-treated than in supine-treated patients. Ó

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Section: Introductionmentioning

confidence: 96%

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

Paelinck

Gulybán²,

Lakosi³

et al. 2017

Radiotherapy and Oncology

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“…Roughly, they can be divided in three categories: displacing the heart out of the treatment field; irradiating a smaller planning target volume (PTV) and using modern, highly conformal radiotherapy techniques [4].The displacement of the heart out of the treatment field can be achieved either by a modified patient setup -i.e. prone position [5,6] or by specific breathing techniques -i.e. deep inspiration breath hold (DIBH) / gating / tracking [7][8][9][10][11].…”

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

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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.

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“…There are a variety of techniques available to reduce irradiation of the heart and left anterior descending artery (LAD) from the tangential left breast fields, including voluntary deep inspiration breath‐hold (DIBH) (7) active breathing control (ABC) (8) and prone positioning (9) . Additionally, with audio and/or visual coaching, patients can be trained to take a deeper breath‐hold (10) .…”

Section: Introductionmentioning

confidence: 99%

“…Using this technique, the respiratory tumor motion is reduced and the separation of the target volume from critical structures is increased. A number of previous studies reported the significant reduction of cardiac doses with DIBH 9 , 11 , 12 . For example, the comparison study with 17 breast cancer patients by Korreman et al (13) showed that the median heart volume receiving more than 50% of the prescription dose was reduced from 19.2% with free breathing (FB) to 1.9% with DIBH when the mean chest wall position with DIBH was 12.6 mm higher from that of FB.…”

Section: Introductionmentioning

confidence: 99%

How dose sparing of cardiac structures correlates with in‐field heart volume and sternal displacement

Kim

Reardon

Trifiletti

et al. 2016

J Applied Clin Med Phys

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Cardiac irradiation increases the risk of coronary artery disease in patients with left‐sided breast cancer. Techniques exist to reduce cardiac irradiation, but the optimum technique depends on individual patient anatomy and physiology. We investigated the correlation of delta heart volume in field (dHVIF) and sternal excursion with dose sparing in heart and left anterior descending artery (LAD) to develop quantitative predictive models for expected dose to heart and LAD. A treatment planning study was performed on 97 left‐breast cancer patients who underwent whole breast radiotherapy (prescription dose = 50 Gy) under deep inspiratory breath hold (DIBH). Two CT datasets, free breathing (FB) and DIBH, were utilized for treatment planning and for determination of the internal anatomy‐based DIBH amplitude. The mean heart and LAD dose were compared between FB and DIBH plans and dose to the heart and LAD as a function of dHVIF and sternal excursion were determined. The [Average (STD); Range] mean heart doses from free breathing and DIBH are [120.5(65.2); 28.9 ~ 393.8] cGy and [67.5(25.1); 19.7 ~ 145.6] cGy, respectively. The mean LAD doses from free breathing and DIBH are [571.0(582.2); 42.2 ~ 2332.2] cGy and [185.9(127.0); 41.2 ~ 898.4] cGy, respectively. The mean dose reductions with DIBH are [53.1(50.6); ‐15.4 ~ 295.1] cGy for the heart and [385.1(513.4); ‐0.6 ~ 2105.8] cGy for LAD. Percent mean dose reductions to the heart and LAD with DIBH are 44% (p < 0.0001) and 67% (p < 0.0001), respectively, compared to FB. The dHVIF mean dose reduction correlation is 8.1 cGy/cc for the heart and 81.6 cGy/cc for LAD (with linear trend and y intercept: 26.0 cGy for the heart, 109.1 cGy for LAD). DIBH amplitude using sternal position was [1.3(4.8); .38 ~2.5] cm. The DIBH amplitude mean dose reduction correlation is 14 cGy/cm for the heart and 212 cGy/cm for LAD (with linear trend with y intercept: 35.6 cGy for the heart, 102.4 cGy for LAD). The strong correlation of dose sparing to the heart and LAD with dHVIF and sternal excursion suggests that mean dose sparing to heart and LAD can be predicted with either dHVIF or sternal excursion equally well. The metrics proposed could be utilized to allow providers to determine the relative dosimetric benefits of different heart‐sparing techniques as early as time of consultation.PACS number(s): 87.53.Tf

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Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation

Cited by 73 publications

References 34 publications

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

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)

How dose sparing of cardiac structures correlates with in‐field heart volume and sternal displacement

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