Impact of physiological breathing motion for breast cancer radiotherapy with proton beam scanning – An in silico study

Flejmer, Anna M.; Chehrazi, Behnaz; Josefsson, Dan; Toma-Daşu, Iuliana; Daşu, Alexandru

doi:10.1016/j.ejmp.2017.06.001

Cited by 13 publications

(5 citation statements)

References 31 publications

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“…The results from this study show mostly similar dosimetric values for CTV coverage and OAR dose for ABC and FB plans, with slightly higher volumes of lung receiving 5 and 20 GyE with ABC plans and similar cardiac doses with both techniques outside of maximum heart dose. Our results are concordant with other studies which have investigated differences between breath-hold and FB techniques in proton irradiation for patients with left-sided breast cancer (36)(37)(38)(39). The dosimetric plans provided in this analysis were all created using Monte Carlo optimization, which is not the nationwide or global standard.…”

Section: Discussionsupporting

confidence: 88%

Dosimetric comparison of breath-hold and free-breathing techniques in left-sided breast cancer patients treated with proton pencil beam scanning

Gogineni¹,

Fellows²,

Hrinivich³

et al. 2023

Ther Radiol Oncol

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Background: To evaluate dosimetric differences in lung and heart doses in left-sided breast cancer patients treated with intensity-modulated proton therapy (IMPT) using active breathing control (ABC) and freebreathing (FB).Methods: Eight left-sided breast cancer patients undergoing IMPT were planned on both FB and ABC computerized tomography (CT) simulation scans and were robustly optimized with range uncertainty of 3.5% and setup uncertainty of 5 mm using a fast graphics-processing units (GPU) Monte Carlo optimization.The prescription for all patients was 50 Gy radiobiological equivalent (GyE) in 25 fractions. Dosimetric parameters for target coverage and dose to heart, left anterior descending (LAD) artery, ipsilateral and contralateral lungs, in addition to lung density and time on table for beam, were determined and compared using paired t-tests.Results: Volume of ipsilateral (34.9% vs. 29.1%, P<0.01) and contralateral (3.2% vs. 2.4%, P=0.04) lungs receiving 5 GyE and volume of ipsilateral lung receiving 20 GyE (13.9% vs. 10.4%, P<0.01) were all significantly higher with ABC than with FB. Maximum heart dose was lower with ABC than FB (24.8 vs.35.8 GyE, P=0.03), but there were no statistically significant differences in any other heart or LAD artery volumetric endpoint between ABC and FB. Lung density was significantly lower with ABC than FB [−805 vs.−661 Hounsfield unit (HU), P<0.01]. Time on table for beam was significantly longer with ABC than with FB (13.8 vs. 7.6 min, P<0.01).Conclusions: ABC plans provided slightly higher lung dose and mostly similar cardiac dose in comparison with FB plans. Given the large increase in the time required for ABC treatment without obvious dosimetric or clinical benefit, FB techniques may be preferred when treating breast cancer with IMPT in order to maximize clinic workflow and minimize patient inconvenience, particularly in patients without cardiac risk factors.

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Section: Discussionsupporting

confidence: 88%

Dosimetric comparison of breath-hold and free-breathing techniques in left-sided breast cancer patients treated with proton pencil beam scanning

Gogineni¹,

Fellows²,

Hrinivich³

et al. 2023

Ther Radiol Oncol

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“…No LN irradiation ( and treatment in DIBH could potentially have reduced the dose to the heart and lungs [46], and an expansion of the chest might have allowed for wider tangential angles. Proton therapy plans for breast cancer have been shown to be robust against respiratory motion when using an en face field arrangement [47,48], and treatment planning studies have indicated no benefit from DIBH in proton therapy [5,6] despite the caudal displacement of the heart in DIBH, moving it away from the IMN. This study presents a variety of modeled radiation-induced risks, all of which come with substantial uncertainties that should be acknowledged.…”

Section: Discussionmentioning

confidence: 99%

Radiation-Induced Toxicity Risks in Photon Versus Proton Therapy for Synchronous Bilateral Breast Cancer

Stick

Bentzen

Kamby

et al. 2022

International Journal of Particle Therapy

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Purpose This study compares photon and proton therapy plans for patients with synchronous bilateral early breast cancer and estimates risks of early and late radiation-induced toxicities. Materials and Methods Twenty-four patients with synchronous bilateral early breast cancer receiving adjuvant radiation therapy using photons, 3-dimensional conformal radiation therapy or volumetric modulated arc therapy, were included and competing pencil beam scanning proton therapy plans were created. Risks of dermatitis, pneumonitis, acute esophageal toxicity, lung and breast fibrosis, hypothyroidism, secondary lung and esophageal cancer and coronary artery events were estimated using published dose-response relationships and normal tissue complication probability (NTCP) models. Results The primary clinical target volume V95% and/or nodal clinical target volume V90% were less than 95% in 17 photon therapy plans and none of the proton plans. Median NTCP of radiation dermatitis ≥ grade 2 was 18.3% (range, 5.4-41.7) with photon therapy and 58.4% (range, 31.4-69.7) with proton therapy. Median excess absolute risk (EAR) of secondary lung cancer at age 80 for current and former smokers was 4.8% (range, 0.0-17.0) using photons and 2.7% (range, 0.0-13.6) using protons. Median EAR of coronary event at age 80, assuming all patients have preexisting cardiac risk factors, was 1.0% (range, 0.0-5.6) with photons and 0.2% (range, 0.0-1.3) with protons. Conclusion Proton therapy plans improved target coverage and reduced risk of coronary artery event and secondary lung cancer while increasing the risk of radiation dermatitis.

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“…It is known that breathing motion has little effect on dosimetric parameters when making proton plans (without robustness evaluation) for breast cancer patients with and without lymph node involvement [5,8,[13][14][15][16][17]. Also, the robustness is minimally influenced by the breathing motion when assessing left-sided breast cancer patient without lymph node involvement [13,19]. This study shows that, even with the addition of the level 1 to 4 axillary lymph nodes, internal mammary lymph nodes and interpectoral lymph nodes to the target volume, the effect of the breathing motion on plan robustness is very limited.…”

Section: Discussionmentioning

confidence: 99%

Effect of breathing motion on robustness of proton therapy plans for left-sided breast cancer patients with indication for locoregional irradiation

Klaassen

Petoukhova²,

Habraken

et al. 2020

Acta Oncologica

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Impact of physiological breathing motion for breast cancer radiotherapy with proton beam scanning – An in silico study

Cited by 13 publications

References 31 publications

Dosimetric comparison of breath-hold and free-breathing techniques in left-sided breast cancer patients treated with proton pencil beam scanning

Dosimetric comparison of breath-hold and free-breathing techniques in left-sided breast cancer patients treated with proton pencil beam scanning

Radiation-Induced Toxicity Risks in Photon Versus Proton Therapy for Synchronous Bilateral Breast Cancer

Effect of breathing motion on robustness of proton therapy plans for left-sided breast cancer patients with indication for locoregional irradiation

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