Prospective Assessment of Deep Inspiration Breath Hold Using 3-Dimensional Surface Tracking for Irradiation of Left-Sided Breast Cancer

Tanguturi, Shyam; Lyatskaya, Yulia; Chen, Y.H.; Catalano, Paul J.; Truong, Linh; Yeh, Mary J.; Yeo, Wee Pin; Orlina, Lawrence; Wong, Julia S.; Punglia, Rinaa S.; Bellon, Jennifer R.

doi:10.1016/j.ijrobp.2015.07.554

Cited by 10 publications

(19 citation statements)

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“…This method delays the treatment start date, doubles high-dose CT exposure, and requires two plans (CT FB and CT DIBH ) to be generated, which results in more demand on resources. This is in agreement with a study by Tanguturi et al [32] that identified a relationship between greater inspiratory lung volumes and larger dose reductions to cardiopulmonary structures when treating with the DIBH technique. Tanguturi et al [32] suggested that all patients should be scanned in both DIBH and FB, as not every patient will experience a benefit from DIBH.…”

Section: Discussionsupporting

confidence: 93%

“…This is in agreement with a study by Tanguturi et al [32] that identified a relationship between greater inspiratory lung volumes and larger dose reductions to cardiopulmonary structures when treating with the DIBH technique. Tanguturi et al [32] suggested that all patients should be scanned in both DIBH and FB, as not every patient will experience a benefit from DIBH. Their multivariate analysis concluded that younger age, higher BMI and larger difference in inspiratory volume was associated with a greater reduction in D mean of the heart using DIBH.…”

Section: Discussionsupporting

confidence: 93%

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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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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

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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“…Although this technique was time consuming, needed patient cooperation and technical expertise it clearly reduced the doses to the heart and left lung. Similar findings have been reported in literature [20,42,47].…”

Section: Technical Problemssupporting

confidence: 93%

5 years of experience with DIBH (Deep inspiration breath-hold) combined with SGRT (Surface-Guided Radiation Therapy) in left-sided breast cancer

Steffal

Schratter-Sehn

Brinda-Raitmayr

et al. 2020

Senologie - Zeitschrift für Mammadiagnostik und -therapie

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Background Radiation treatment to the left breast is associated with increased cardiac morbidity as well as mortality. Deep inspiration breath-hold (DIBH) technique with Surface Guided Radiation Therapy (SGRT) could have dosimetric advantages over the free breathing technique (NB, normal breathing) in cardiac (heart and LAD) and ipsilateral lung sparing in patients with left-sided breast cancer after surgery. Therefore this technique was implemented in 2013 at the institute of radiooncology at the KFJ/SMZ-South – Hospital Vienna. Methods From Oct 2013 – December 2018 548 patients were referred to radiotherapy following conservative operation of left-sided invasive breast cancer. All patients gave their informed consent and underwent training sessions for the DIBH-technique independent of age or breathing activity or respiratory disorders. Patients who turned out to be unfit for DIBH were enrolled for NB. The relative reduction in Dmean heart and left lung dose was compared between the two cohorts. Acute radiation induced side effects were classified according to the Radiation Therapy Oncology Group/The European Organisation for Research (RTOG) 37; late toxicity rates according to the Common Terminology Criteria for Adverse Events (CTCAE Version 4.03) Results The median age of the DIBH-patients was 58 years (27–90), of the NB-patients 65 (30–80) years. Follow-up was obtained until June 2019. The median follow-up was 52 months (range 7–73 m). The average coverage of Dmean left lung was 6.91 Gy (1.44 Gy – 12.4 Gy). The average coverage of Dmean heart was 1.17 Gy (0.12 Gy – 3.19 Gy) in the DIBH-cohort. The NB – plans had a Dmean of 8.92 Gy (5.23–16.9 Gy) at the ipsilateral lung and a Dmean of 2.31 Gy (0.71–4.21 Gy) at the heart. This shows that the DIBH-technique halved the Dmean of the heart. The amount of acute side effects was comparable between the two groups: RTOG 1: 70.8 % vs. 64 %, RTOG 3 6.6 % vs. 5.6 %, no reaction 3.2 % vs. 1.4 %. There were more CTCAE 1-late events in the NB-group (51.6 % vs. 12.67 %). Conclusion Deep inspiration breath-hold (DIBH) technique with Surface Guided Radiation Therapy (SGRT) is a rather simple, reproducable method with a high acceptance of the patients who can actively participate in the whole treatment process. The mean dose at the heart and the left lung can be reduced, at the heart even by as much as 50 %.

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“…stage, smoking status, co-morbidities and radiation prescription. DIBH technique-specific factors investigated in previous studies as potential factors associated with reduction in heart and lung dose were also collected, 6,[8][9][10][11][12][13][14][15][16][17][18] and are provided in Table 2. Multiple heart, lung and LAD doses were recorded from both the FB and DIBH plans ( Table 2).…”

Section: Treatment Planningmentioning

confidence: 99%

“…To date, various potential patient and radiation therapy technique-specific factors have been investigated as potential predictors of mean heart dose reduction. 6,[8][9][10][11][12][13][14][15][16][17][18] While these studies have all compared heart doses on free breathing (FB) versus DIBH planning computed tomography (CT) scans of left-sided breast cancer patients receiving radiation therapy to their whole breast or chest wall, predictive factors identified have varied. The aim of this study was to investigate if any factors existed that could identify breast cancer patients who may benefit most from DIBH, to develop a cardiac dose risk profile approach to facilitate appropriate utilisation of departmental resources.…”

Section: Introductionmentioning

confidence: 99%

Identifying breast cancer patients who gain the most dosimetric benefit from deep inspiration breath hold radiotherapy

Browne

Beaton

Sharma

et al. 2020

J of Medical Radiation Sci

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Introduction: Deep inspiration breath hold (DIBH) has been proven to reduce cardiac dose for women receiving left breast and chest wall radiation therapy. However, it utilises extra departmental resources and patient exertion. The aim of this exploratory study was to investigate if any factors existed that could identify breast cancer patients who may benefit most from DIBH, to facilitate appropriate utilisation of departmental resources. Methods: Left-sided breast cancer patients aged 18-70 years, and right-sided breast cancer patients with internal mammary nodes included, were recruited. DIBH and free breathing (FB) plans were created for all patients. Patient demographic and clinical history were recorded. Variables including lung threshold value, lung volume, patient separation, maximum heart in field, volume of planning target volume (PTV), heart dose, ipsilateral lung dose were compared between plans. Results: Plans for 31 patients were analysed. No correlations were found between lung threshold value or patient separation and cardiac dose. Moderate to strong correlations were found with BMI, PTV volume and lung volume change however no definitive thresholds were determined. A significant difference was found in the maximum heart in field between DIBH and FB (P < 0.001) with those patients with greater than 0.7 cm heart in the field on the FB scan demonstrating greater reductions in mean heart dose. Conclusion: Maximum heart in the field of greater than 0.7 cm in FB could be a potential factor to identify patients who may benefit most from DIBH. This factor warrants investigation in a larger patient cohort to test its validity.

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Prospective Assessment of Deep Inspiration Breath Hold Using 3-Dimensional Surface Tracking for Irradiation of Left-Sided Breast Cancer

Cited by 10 publications

References 0 publications

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

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

5 years of experience with DIBH (Deep inspiration breath-hold) combined with SGRT (Surface-Guided Radiation Therapy) in left-sided breast cancer

Identifying breast cancer patients who gain the most dosimetric benefit from deep inspiration breath hold radiotherapy

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