Is the lack of respiratory gating prejudicial for left breast TomoDirect treatments?

Meyer, P.; Niederst, C.; Scius, Maximilien; Jarnet, D.; Dehaynin, N.; Gantier, M.; Waissi, Waisse; Poulin, Nicolas; Karamanoukian, D.

doi:10.1016/j.ejmp.2016.04.001

Cited by 9 publications

(3 citation statements)

References 26 publications

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“…[ 26 ] In a previous study by Meyer et al ., it was demonstrated that tomotherapy-direct reduces mean dose by 40% compared to non-BH technique and noninferior to BH technique in breast-alone radiotherapy. [ 27 ] In the current study, the mean dose to the heart was similar between forward IMRT with BH and tomotherapy-direct, however significantly lesser compared to tomotherapy-helical. On review of the plans, it was seen that the BH was not ideal in three elderly patients, which resulted in significant mean dose reduction with tomotherapy-direct plan.…”

Section: Discussionsupporting

confidence: 52%

Dosimetric comparison of four different radiotherapy planning techniques for adjuvant radiotherapy of left-sided breast, axilla, and supraclavicular fossa

Gupte¹,

Sasidharan²,

Kunheri³

et al. 2021

J Med Phys

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Purpose/Aim: Forward planned intensity-modulated radiotherapy (forward IMRT) with breath-hold (BH) technique is considered optimal by most practitioners for treating left-sided breast cancer. Regional nodal irradiation including axilla and supraclavicular fossa (SCF) increases can increase dose-to-organs at risk (OAR) especially lung. This study was done to assess the potential of inverse planned IMRT (inverse IMRT) to achieve significant reduction in dose to OAR. Materials and Methods: Ten patients with left-sided breast cancer treated with Active Breath Co-ordinator BH technique were included in the study. Forward IMRT plans were generated in both BH and free breathing (FB) scans. Inverse IMRT plans were generated in FB scan using Tomotherapy-Direct and Tomotherapy-Helical techniques. Contouring was done as per the ESTRO consensus contouring guidelines. The dose prescribed was 40 Gy in 15 fractions. Statistical significance was tested using one-way ANOVA for parametric data and Kruskall–Wallis test for nonparametric data. Multiple comparison tests were done by using Bonferroni test. P <0.05 was considered to denote statistical significance. Results: Inverse IMRT plans achieved superior homogeneity index compared to forward IMRT with BH. Tomotherapy-Direct reduced dose to ipsilateral lung, compared to the forward IMRT with BH while achieving similar doses to other OAR. Tomotherapy-Helical plans achieved significantly better conformity index and reduced maximum dose to left anterior descending artery compared to forward IMRT plans, but low dose to other OAR was significantly worse. Conclusion: For left-sided breast, axilla, and SCF radiotherapy, inverse IMRT with Tomotherapy-Direct plan achieved better homogeneity index and reduced dose to ipsilateral lung compared to forward IMRT with BH.

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Section: Discussionsupporting

confidence: 52%

Dosimetric comparison of four different radiotherapy planning techniques for adjuvant radiotherapy of left-sided breast, axilla, and supraclavicular fossa

Gupte¹,

Sasidharan²,

Kunheri³

et al. 2021

J Med Phys

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“…It is generally indicated across the literature that all left-sided breast cancer patients benefit from the DIBH technique [2,4,5,6,7,8,9,10,11,12,13,14,15,16,17]; however, not all patients achieve the same benefit. A meta-analysis performed by Latty et al [3] reviewed 18 studies which demonstrated a relative reduction of mean dose (D mean ) to the heart ranging from 26.2% to 75%.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Dosimetric Study of Radiotherapy Patients with Left-Sided Breast Cancer; Patient Selection Criteria for Deep Inspiration Breath Hold Technique

Dell’Oro

Giles

Sharkey³

et al. 2019

Cancers

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Background: Several studies have investigated cardiac dose reduction when utilizing the deep inspiration breath hold (DIBH) technique in patients undergoing radiotherapy for left-sided breast cancer. This paper aims to recommend potential selection criteria based on a retrospective single institute study of free breathing (FB) and DIBH computed tomography (CT) simulation planning scans. Methods: Dosimetric comparisons were performed retrospectively for 20 patients correlating the dose reduction and patient anatomical factors (anatomical variation of chest shape, chest wall separation, total lung volume (TLV) and others). Results: Paired t-tests demonstrated significant cardiac dose reduction for most patients but not all. Minimal cardiac dose reduction was observed for three patients using their DIBH plan, with one patient receiving a higher dose. Linear regression analysis identified a positive correlation between the patient’s TLV (on the FB CT simulation scan) and the magnitude of dosimetric benefit received (0.4045 R2). Conclusion: The TLV measured on a FB plan could potentially be utilised to predict cardiac exposure and assist with patient selection for DIBH. This is important in resource allocation, as DIBH may be unnecessarily recommended for some patients with little dosimetric benefit.

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“…Nissen et al have demonstrated as deep inspiration breath hold (DIBH) in conjunction with tangential-field, forward-planned IMRT treatment plans can lead to a significant reduction in heart and lung dose while optimizing PTV coverage (36). Other experience showed as tangential fields tomotherapy could result in better dose coverage and OARs constraints compliance compared to other RT modalities (37,38).…”

Section: Discussionmentioning

confidence: 99%

"Sequential Volumetric Modulated Arc Therapy (VMAT) Boost in Hy- brid Plan With Tangential Beams for Whole Breast Treatment: a Do- simetric Study "

Piras¹,

Boldrini²,

D’Aviero³

et al. 2022

JMRO

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"Purpose: Whole breast radiation therapy (WBRT) with a boost to the tumor bed following con-servative primary surgery in women with breast cancer (BC) plays a central role in reducing local recurrences and mortality. Volumetric modulated arc therapy (VMAT) technique has been shown to allow better dose conformation with low dose levels to organs at risk (OARs), compared to static fields three-dimensional Conformal Radiotherapy (3D-CRT). The aim of this study was to evaluate the feasibility and dosimetric advantages of sequential boost (SB), administered with VMAT tech-nique in hybrid plans with tangential beams for whole breast treatment. Material and methods: BC patients undergoing adjuvant RT from June to October 2020 were selected. ESTRO guidelines for the Clinical Target Volume (CTV) delineation were used. Total delivered dose was 60-66 Gy; 50 Gy in 2 Gy daily fractions for whole breast and 10-16 in 2 Gy daily fractions Gy to tumor bed was 10-16 Gy in 2 Gy daily fractions. Results: The analysis included 31 patients with BC treated with adjuvant RT following con-servative surgery. Hybrid treatment plans characterized by a 3D-CRT plan using tangential medi-olateral and lateromedial fields for the irradiation of the whole breast Planning Target Volume (PTV) and a sequential VMAT plan with 2 coplanar arches for boost PTV irradiation were gener-ated. Dosimetric analysis resulted in homogeneous target volumes coverage and OARs constraints compliance. As regarding to organs at risks (OARs), contralateral breast, ipsi- and contralateral lung and heart constraints values were analysed. Conclusions: In the frame BC RT, this dosimetric study showed that hybrid plans performed with 3D-CRT and VMAT techniques are feasible in terms of dosimetric outcomes. "

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Is the lack of respiratory gating prejudicial for left breast TomoDirect treatments?

Cited by 9 publications

References 26 publications

Dosimetric comparison of four different radiotherapy planning techniques for adjuvant radiotherapy of left-sided breast, axilla, and supraclavicular fossa

Dosimetric comparison of four different radiotherapy planning techniques for adjuvant radiotherapy of left-sided breast, axilla, and supraclavicular fossa

A Retrospective Dosimetric Study of Radiotherapy Patients with Left-Sided Breast Cancer; Patient Selection Criteria for Deep Inspiration Breath Hold Technique

"Sequential Volumetric Modulated Arc Therapy (VMAT) Boost in Hy- brid Plan With Tangential Beams for Whole Breast Treatment: a Do- simetric Study "

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