Predictors of cardiac and lung dose sparing in DIBH for left breast treatment

Cao, Ning; Kalet, Alan M.; Young, L. D. G.; Fang, Lekun; Kim, Janice N.; Mayr, Nina A.; Meyer, Juergen

doi:10.1016/j.ejmp.2019.09.240

Cited by 27 publications

(35 citation statements)

References 28 publications

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“…The correlation coefficients of MHD, V 5 , and V 30 were 0.857 ( p < 0.01), 0.814 ( p < 0.01), and 0.869 ( p < 0.01), respectively. Recently, Cao et al indicated in their study that there was a positive linear correlation between cardiac contact distance (CCD ps ) and MHD (r = 0.63, p < 0.01) [ 19 ]. They also suggested that there was a negative correlation between the heart-to-chest distance (HCD) and MHD (r = -0.65, p < 0.01).…”

Section: Discussionmentioning

confidence: 99%

Predictors of heart and lung dose in left-sided breast cancer treated with VMAT relative to 3D-CRT: A retrospective study

et al. 2021

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Background Before generating radiotherapy plans for breast cancer patients, the choice of plan techniques (three-dimensional conformal radiation therapy (3D-CRT) and volumetric modulated arc therapy (VMAT)) should be made. This study investigated the performance of two geometric indices in aiding the choice of 3D-CRT and VMAT plans in women undergoing left-sided whole breast radiotherapy. Materials and methods 119 patients, previously treated with left-sided breast radiotherapy (61 3D-CRT treatments and 58 VMAT treatments) from a single institution, were retrospectively studied. Two geometric indices, which were cardiac junction (CJ) index and pulmonary junction (PJ) index, were defined and the relationship between these indices and dose of organs at risk (OARs) were evaluated. Two-tailed Student’s t-test was performed to compare patient characteristics between 3D-CRT and VMAT. Linear regressions were calculated to investigate the association between geometric indices and absorbed dose of heart and left lung, including mean dose of heart (MHD), V5, V30 of heart, and mean dose of left lung (MLLD), V5, V10, V20, V30, V40 of left lung. Results The CJ index was strongly correlated with the MHD in 3D-CRT group and VMAT group. The linear regression formulas were MHD = 4826.59 ×CJ Index+310.48 (R = 0.857, F = 163.77, P = 0.000) in 3D-CRT plans and MHD = 1789.29×CJ Index+437.50 (R = 0.45, F = 14.23, P = 0.000) in VMAT plans. The intersection of the two formulas was CJ index = 4.2% and MHD = 512.33 cGy. The PJ index demonstrated a strongly positive correlation with MLLD in 3D-CRT group and VMAT group as well. The linear regression formulas were MLLD = 2879.54×PJ Index+999.79 (R = 0.697, F = 55.86, P = 0.000) in 3D-CRT plans and MLLD = 1411.79×PJ Index+1091.88 (R = 0.676, F = 47.11, P = 0.000) in VMAT plans, the intersection of the two formulas was PJ index = 6.3% and MLLD = 1180.46 cGy. Conclusions CJ index and PJ index could be used as a practical tool to select 3D-CRT or VMAT before generating plans. We recommend that VMAT plan is preferable when CJ index is greater than 4.2% and/or PJ index is greater than 14.6%, while 3D-CRT plan is the first choice in the opposite.

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Section: Discussionmentioning

confidence: 99%

Predictors of heart and lung dose in left-sided breast cancer treated with VMAT relative to 3D-CRT: A retrospective study

et al. 2021

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“…Similarly Rochet et al in a small subset of patients found that free breathing cardiac contact distance was a good predictor for cardiac dose [20.] More recently, Cao N et al provided a very useful prediction model for mean heart dose reduction from a set of 67 consecutive breast cancer patients. Particularly, in this model FB heart-to chest distance and cardiac-contact distance measured in both the axial and sagittal planes were used as anatomic predictors of cardiac sparing [13]. In our study, the minimum distance of LAD from tangent elds was the best anatomical variable measured in FB CT scan able to discriminate patients at higher risk to receive a maximum LAD dose > 10 Gy and a mean LAD dose of 4 Gy with a PPV of 73% and 79% respectively.…”

Section: Discussionmentioning

confidence: 70%

“…Particularly, the latter increases the physical separation between the chest wall and the heart during inspiration and has recently been recommended as the best heart sparing technique available [12]. Literature data reports a reduction of mean heart dose ranging from 38-59% and a reduction of mean dose to left descending artery (LAD) ranging from 31-71% with DIBH [13].…”

Section: Introductionmentioning

confidence: 99%

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Breath Hold Breast Radiotherapy In The Era of Precision Medicine: Appropriate Selection for Left Descending Artery Sparing

Ippolito¹,

Greco²,

Marrocco³

et al. 2020

Preprint

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Background and purpose To identify anatomical and/or preplanning characteristics correlated with left descending artery (LAD) dose and therefore provide guidance in the selection of patients with left-breast cancer that could benefit the most from the use of deep inspiration breath hold radiotherapy (DIBH-RT). Materials and methods We retrospectively identified patients with left-sided breast cancer who underwent whole breast radiotherapy in DIBH and extracted data from treatment plans in free-breathing (FB) and DIBH. The following anatomical parameters were obtained from the planning CTs in FB: lung volume, heart volume, breast separation, minimum distance from LAD to tangent open field. Receiving operating characteristics was also performed to define the cut-off point of parameters to use in LAD dosimetry prediction. Areas under the curve (AUCs) were calculated for all variables. Post-test probability has been calculated to evaluate advantage for parameters combination. Results One hundred ninety-seven patients were identified. The strongest predictor at FB CT scan of LAD maximum dose > 10 Gy and a LAD mean dose > 4 Gy was the minimum distance of LAD from tangent open fields. Adding consecutively other preplanning anatomic parameters, the positive predictive value (PPV) to identify patients at risk of higher dose to LAD was > 90%. Conclusions The dosimetric benefit of DIBH is valid for all patients and DIBH should be preferred for all left sided patients; however we can identify a subgroup of patients who benefit the least from DIBH. This is the group with favorable anatomy: limited breast separation, well expanded lungs, LAD distant from open tangent fields.

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“…According to the results, CI index was associated strongly with all of the dose metrics of heart in 3D-CRT plans, the correlation coe cients were 0.857 (p 0.01), 0.814 (p 0.01), and 0.869 (p 0.01) of MHD, V 5 , and V 30 of heart, respectively. Recently, Cao et al indicated that the cardiac contact distance (CCD ps ) showed a positive linear correlation with the MHD (r = 0.63, p 0.01) in their study [16]. They also suggested that the lateral heart-to-chest distance (HCD) demonstrated a negative linear correlation with the MHD (r=-0.65, p 0.01).…”

Section: Discussionmentioning

confidence: 80%

Predictors of Heart and Lung Dose in Left-sided Breast Cancer Treated with VMAT Relative to 3D-CRT：A Retrospective Study

Kang

Chen

Shi

et al. 2021

Preprint

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Background Before radiotherapy for breast cancer patients, the choice of three-dimensional conformal radiation therapy (3D-CRT) and volumetric modulated arc therapy (VMAT) should be made. This study investigates the performance of two structural metrics in aiding the choice of 3D-CRT and VMAT plans in women undergoing left-sided whole breast radiotherapy. Materials and methods 119 patients previously treated with left-sided breast radiotherapy (61 3D-CRT treatments and 58 VMAT treatments) from a single institution were retrospectively studied. Two structural metrics, which are cardiac intersetion (CI) index and pulmonary intersection (PI) index, were defined and the relationship between these metrics and dose of organs at risk (OARs) were evaluated. Two-tailed Student’s t-test was performed to compare patient characteristics between 3D-CRT and VMAT. Linear regressions were calculated to investigate the association between structural metrics and absorbed dose of heart and left lung, including MHD, V5, V30 of heart, and MLLD, V5, V10, V20, V30, V40 of left lung. Results The CI index was strongly correlated with the mean dose of heart (MHD) in 3D-CRT group and VMAT group, the linear regression formulas were MHD = 4826.59 ×CI Index + 310.48 (R = 0.857, F = 163.77, P = 0.000) in 3D-CRT plans and MHD = 1789.29×CI Index + 437.50 (R = 0.45, F = 14.23, P = 0.000) in VMAT plans, the intercept of these formulas was CI index = 4.2% and MHD = 512.33 cGy. The PI index demonstrated a strongly positive correlation with mean dose of left lung (MLLD) in 3D-CRT group and VMAT group as well, the linear regression formulas were MLLD = 2879.54×PI Index + 999.79 (R = 0.697, F = 55.86, P = 0.000) in 3D-CRT plans and MLLD = 1411.79×PI Index + 1091.88 (R = 0.676, F = 47.11, P = 0.000) in VMAT plans, the intercept of these formulas was PI index = 6.3% and MLLD = 1180.46 cGy. Conclusions CI index and PI index could serve as a practical tool of choosing either 3D-CRT or VMAT before the plan was generated. We recommend that VMAT plan is preferable when CI index is greater than 4.2% and PI index is greater than 14.6%, while 3D-CRT plan is the first choice in the opposite.

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Predictors of cardiac and lung dose sparing in DIBH for left breast treatment

Cited by 27 publications

References 28 publications

Predictors of heart and lung dose in left-sided breast cancer treated with VMAT relative to 3D-CRT: A retrospective study

Predictors of heart and lung dose in left-sided breast cancer treated with VMAT relative to 3D-CRT: A retrospective study

Breath Hold Breast Radiotherapy In The Era of Precision Medicine: Appropriate Selection for Left Descending Artery Sparing

Predictors of Heart and Lung Dose in Left-sided Breast Cancer Treated with VMAT Relative to 3D-CRT：A Retrospective Study

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