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

Dell’Oro, Mikaela; Giles, Eileen; Sharkey, A.; Borg, Martin; Connell, Caroline; Bezak, Eva

doi:10.3390/cancers11020259

Cited by 33 publications

(36 citation statements)

References 32 publications

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“…It has been reported that variations in chest shape can impact the cardiopulmonary dose received. 37,38 In the present study, there was a positive correlation between the MHD and DHL. The patients with DHL ≥ 2.47 cm were associated with higher MHD compared to those lower DHL.…”

Section: Discussionsupporting

confidence: 61%

<p>A Retrospective Analysis of Dose Distribution and Toxicity in Patients with Left Breast Cancer Treated with Adjuvant Intensity-Modulated Radiotherapy: Comparison with Three-Dimensional Conformal Radiotherapy</p>

Chen

Hsieh

Chang

et al. 2020

CMAR

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Background: A better understanding of the organs-at-risk (OAR) dose metrics and the related toxicity induced by radiotherapy (RT) for left breast cancer (BC) will improve the quality of life. This study addressed the issue for left-BC patients treated with intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT). Patients and Methods: Between 2012 and 2018, 308 left-BC patients underwent adjuvant RT at our hospital. Before June 2015, 134 patients were treated with 3D-CRT. Thereafter, 174 patients underwent IMRT. The patient's characteristics in the IMRT group did not significantly different compared to those in the 3D-CRT group. Results: Among the total study population, the incidence of ≥grade 2 radiation dermatitis (RID) was 17.3%. Higher volumes receiving 105% (≥5.7%) and 107% (≥1%) of prescribed dose and 3D-CRT technique were associated with a higher risk of RID. Regarding lung toxicity, the mean lung dose (≥10.2Gy) and V20 (≥20%) of ipsilateral lung were significantly associated with the incidence of RT-induced pulmonary changes. By dosimetry analysis, IMRT achieved better dose conformity and delivered lower mean doses to heart and ipsilateral lung compared to 3D-CRT. Furthermore, propensity sore and multivariate analysis showed that IMRT technique helped to reduce RT-induced dermatitis and lung toxicity. Conclusion: Our data suggest that the volume of OAR exposed to higher doses is a predictor of RT-induced toxicity. Adjuvant RT with IMRT technique offered better dose conformity and spared high-dose levels to OARs to reduce radiation-related morbidity for BC patients.

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Section: Discussionsupporting

confidence: 61%

<p>A Retrospective Analysis of Dose Distribution and Toxicity in Patients with Left Breast Cancer Treated with Adjuvant Intensity-Modulated Radiotherapy: Comparison with Three-Dimensional Conformal Radiotherapy</p>

Chen

Hsieh

Chang

et al. 2020

CMAR

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“…However, we detected no variation between EBRT and IORT with numerically similar risk differences ( Figure 6), which leads to the conclusion that the effect may be independent of the applied technique. Given the extensive efforts in modern radiation oncology of keeping the heart doses as low as possible using different techniques, like cardiac shielding and deep-inspiration breath hold (DIBH), we anticipate the difference to be lower than estimated here [57]. Unfortunately, an analysis of NBCD or cardiac death divided by laterality of breast cancer was not possible.…”

Section: Discussionmentioning

confidence: 83%

No Difference in Overall Survival and Non-Breast Cancer Deaths after Partial Breast Radiotherapy Compared to Whole Breast Radiotherapy—A Meta-Analysis of Randomized Trials

Haussmann

Budach

Corradini

et al. 2020

Cancers

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Purpose/objective: Adjuvant radiotherapy after breast conserving surgery is the standard approach in early stage breast cancer. However, the extent of breast tissue that has to be targeted with radiation has not been determined yet. Traditionally, the whole breast was covered by two opposing tangential beams. Several randomized trials have tested partial breast irradiation (PBI) compared to whole breast irradiation (WBI) using different radiation techniques. There is evidence from randomized trials that PBI might result in lower mortality rates compared to WBI. We aimed to reassess this question using current data from randomized trials. Material/methods: We performed a systematic literature review searching for randomized trials comparing WBI and PBI in early stage breast cancer with publication dates after 2009. The meta-analysis was performed using the published event rates and the effect sizes for overall survival (OS), breast cancer-specific survival (BCSS), and non-breast cancer death (NBCD) as investigated endpoints. Analysis of subgroups using different radiation techniques was intended. We used hazard ratios (HR) and risk differences (RD) to estimate pooled effect sizes. Statistical analysis was performed using the inverse variance heterogeneity model. Results: We identified eleven studies randomizing between PBI and WBI. We did not find significant differences in OS (n = 14,070; HR = 1.02; CI-95%: 0.89–1.16; p = 0.810, and n = 15,203; RD = −0.001; CI-95%: −0.008–0.006; p = 0.785) and BCSS (n = 15,203; RD = 0.001; CI-95%: −0.002–0.005; p = 0.463). PBI also did not result in a significant decrease of NBCD (n = 15,203; RD = −0.003; CI-95%: −0.010–0.003; p = 0.349). A subgroup analysis by radiation technique also did not point to any detectable differences. Conclusion: In contrast to a previous assessment of mortality, we could not find a detrimental effect of WBI on OS or NBCD. A longer follow-up might be necessary to fully assess the long-term mortality effects of PBI compared to WBI.

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“…As such, there is a need to prospectively identify patients who will dosimetrically benefit from DIBH. Anatomic factors such as tumour bed location, lung volume, and the distance of the heart from the chest wall can optimise the selection of patients for DIBH during left-breast radiotherapy, without the need for a CT scan during DIBH [36, 37]. Future studies are required to identify and validate appropriate selection criteria for the use of DIBH during right-sided breast radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Dose reduction to organs at risk with deep-inspiration breath-hold during right breast radiotherapy: a treatment planning study

Pandeli¹,

Smyth²,

David³

et al. 2019

Radiat Oncol

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Background: The addition of regional nodal radiation (RNI) to whole breast irradiation for high risk breast cancer improves metastases free survival and new data suggests it contributes additional benefit to overall survival. Deep inspiration breath hold (DIBH) has been shown to reduce cardiac and pulmonary dose in the context of left-sided disease treated with or without RNI, yet few studies have investigated its utility for right-breast cancer. This study investigates the potential advantages of DIBH in local and locoregional radiotherapy for right-sided breast cancer. Methods: Free-breathing (FB) and DIBH computed tomography datasets were obtained from twenty patients who previously underwent radiotherapy for left-sided breast cancer. Ten patients were retrospectively planned for whole right breast only irradiation and ten patients were planned for irradiation to the whole breast plus ipsilateral supraclavicular (SC) nodes, with and without irradiation of the ipsilateral internal mammary nodes (IMN). Dose-volume metrics for the clinical target volume, lungs, heart, left anterior descending artery, right coronary artery (RCA) and liver were recorded. Differences between FB and DIBH plans were analysed using Wilcoxon signed-rank tests, with P < 0.05 considered statistically significant. Results: DIBH increased the average total lung volume compared to FB in both breast only and breast plus RNI cohorts (P = 0.001). For the breast only group, there was no significant improvement in any ipsilateral lung dosevolume metric between FB and DIBH. However, for the breast plus RNI group, there was an improvement in ipsilateral lung mean dose (18.9 ± 3.2 Gy to 15.9 ± 2.3 Gy, P = 0.002) and V20Gy (45.3 ± 13.3% to 32.9 ± 9.4%, P = 0.002). In addition, DIBH significantly reduced the maximum dose to the RCA for RNI (11.6 ± 7.2 Gy to 5.6 ± 2.9 Gy, P = 0.03). Significant reductions in the liver V20Gy and maximum dose were observed in all cohorts during DIBH compared to FB. Conclusions: DIBH is a promising approach for right-breast radiotherapy with considerable sparing of normal tissue, particularly when the ipsilateral IMNs are also irradiated.

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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

Cited by 33 publications

References 32 publications

<p>A Retrospective Analysis of Dose Distribution and Toxicity in Patients with Left Breast Cancer Treated with Adjuvant Intensity-Modulated Radiotherapy: Comparison with Three-Dimensional Conformal Radiotherapy</p>

<p>A Retrospective Analysis of Dose Distribution and Toxicity in Patients with Left Breast Cancer Treated with Adjuvant Intensity-Modulated Radiotherapy: Comparison with Three-Dimensional Conformal Radiotherapy</p>

No Difference in Overall Survival and Non-Breast Cancer Deaths after Partial Breast Radiotherapy Compared to Whole Breast Radiotherapy—A Meta-Analysis of Randomized Trials

Dose reduction to organs at risk with deep-inspiration breath-hold during right breast radiotherapy: a treatment planning study

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