Cardiac dose reduction using deep inspiratory breath hold (DIBH) in radiation treatment of left sided breast cancer patients with breast conservation surgery and modified radical mastectomy

Misra, Shagun; Mishra, Ashutosh; Lal, Punita; Srivastava, Resham; Verma, Mrinalani; Kumar, Sellepolyam Kaliyaperumal Senthil; Das, K.J. Maria

doi:10.1016/j.jmir.2020.12.004

Cited by 19 publications

(14 citation statements)

References 54 publications

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“…Additionally, our cardiac dosimetry was favorable, in part attributed to a majority (78%) of patients having been treated with deep-inspiratory breath hold technique, which has been previously demonstrated to reduce LAD D mean as well as other cardiac and pulmonary dosimetric parameters. 26 Our study also has several limitations. First, the ability to comprehensively capture cardiac events based on abstracting select diagnosis codes from our institutional electronic medical record may be limited in some instances, as some patients may have received medical care at other facilities.…”

Section: Discussionmentioning

confidence: 89%

Dose to the Left Anterior Descending Artery Correlates With Cardiac Events After Irradiation for Breast Cancer

Zureick

Grzywacz

Almahariq

et al. 2022

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionmentioning

confidence: 89%

Dose to the Left Anterior Descending Artery Correlates With Cardiac Events After Irradiation for Breast Cancer

Zureick

Grzywacz

Almahariq

et al. 2022

International Journal of Radiation Oncology*Biology*Physics

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“…All of the eight studies on cardiac sparing from India were dosimetric studies which reported a mean heart dose reduction ranging between 50 and 60 per cent as compared to free-breathing plans 56 57 58 59 60 61 62 63 . Chatterjee et al 60 quantified the resource utilization and the cost-effectiveness of using DIBH for all left-sided breast cancers.…”

Section: Cardiac Sparingmentioning

confidence: 99%

Adjuvant radiation therapy in breast cancer

Chakraborty

Chatterjee

2021

Indian Journal of Medical Research

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Breast cancer is the most common cancer among women in India, and adjuvant radiotherapy is an integral part of curative treatment in most patients. The recent decades have witnessed several advances in radiation therapy delivery. Several advances in radiation oncology have been identified which include technological advances, change in fractionation used, use of cardiac-sparing radiotherapy as well as efforts to personalize radiotherapy using accelerated partial breast irradiation or avoidance of radiotherapy in certain subpopulations. Indian data are available in most areas which have been summarized. However, increasing emphasis on research in these areas is needed so that effectiveness and safety in our setting can be established. Advances in breast cancer radiotherapy have resulted in improved outcomes. Data published from India suggest that these improved outcomes can be replicated in patients when appropriate treatment protocols are followed.

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“…Furthermore, recent studies showed that DIBH reduced doses to almost all cardiac substructures, particularly to LAD and left ventricle, which could potentially translate into the clinical benefit of reduced cardiac toxicity 7,8 . The reduction of cardiac doses was similar in patients with modified radical mastectomy as well as with breast conservation surgery 9 . Secondary advantages of DIBH include reducing relative volume of lung exposed to radiation and minimizing respiratory motion 2,10 …”

Section: Introductionmentioning

confidence: 99%

“…7,8 The reduction of cardiac doses was similar in patients with modified radical mastectomy as well as with breast conservation surgery. 9 Secondary advantages of DIBH include reducing relative volume of lung exposed to radiation and minimizing respiratory motion. 2,10 The earliest DIBH was implemented with spirometrybased systems including voluntary DIBH 11,12 and active breathing control.…”

Section: Introductionmentioning

confidence: 99%

Reproducibility of chestwall and heart position using surface‐guided versus RPM‐guided DIBH radiotherapy for left breast cancer

Hong

et al. 2022

J Applied Clin Med Phys

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This study compared the reproducibility of chestwall and heart position using surface‐guided versus RPM (real‐time position management)‐guided deep inspiration breath hold (DIBH) radiotherapy for left sided breast cancer. Forty DIBH patients under either surface‐guided radiotherapy (SGRT) or RPM guidance were studied. For patients treated with tangential fields, reproducibility was measured as the displacements in central lung distance (CLD) and heart shadow to field edge distance (HFD) between pretreatment MV (megavoltage) images and planning DRRs (digitally reconstructed radiographs). For patients treated with volumetric modulated arc therapy (VMAT), sternum to isocenter (ISO) distance (StID), spine to rib edge distance (SpRD), and heart shadow to central axis (CAX) distance (HCD) between pretreatment kV images and planning DRRs were measured. These displacements were compared between SGRT and RPM‐guided DIBH. In tangential patients, the mean absolute displacements of SGRT versus RPM guidance were 0.19 versus 0.23 cm in CLD, and 0.33 versus 0.62 cm in HFD. With respect to planning DRR, heart appeared closer to the field edge by 0.04 cm with surface imaging versus 0.62 cm with RPM. In VMAT patients, the displacements of surface imaging versus RPM guidance were 0.21 versus 0.15 cm in StID, 0.24 versus 0.19 cm in SpRD, and 0.72 versus 0.41 cm in HCD. Heart appeared 0.41 cm further away from CAX with surface imaging, whereas 0.10 cm closer to field CAX with RPM. None of the differences between surface imaging and RPM guidance was statistically significant. In conclusion, the displacements of chestwall were small and were comparable with SGRT‐ or RPM‐guided DIBH. The position deviations of heart were larger than those of chestwall with SGRT or RPM. Although none of the differences between SGRT and RPM guidance were statistically significant, there was a trend that the position deviations of heart were smaller and more favorable with SGRT than with RPM guidance in tangential patients.

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Cardiac dose reduction using deep inspiratory breath hold (DIBH) in radiation treatment of left sided breast cancer patients with breast conservation surgery and modified radical mastectomy

Cited by 19 publications

References 54 publications

Dose to the Left Anterior Descending Artery Correlates With Cardiac Events After Irradiation for Breast Cancer

Dose to the Left Anterior Descending Artery Correlates With Cardiac Events After Irradiation for Breast Cancer

Adjuvant radiation therapy in breast cancer

Reproducibility of chestwall and heart position using surface‐guided versus RPM‐guided DIBH radiotherapy for left breast cancer

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