Cardiac dose-sparing effects of deep-inspiration breath-hold in left breast irradiation

Sakka, Mazen; Kunzelmann, Leonie; Metzger, M.; Grabenbauer, Gerhard G.

doi:10.1007/s00066-017-1167-0

Cited by 37 publications

(34 citation statements)

References 39 publications

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“…Deep inspiration breath hold (DIBH) reduces heart and left anterior descending artery (LAD) dose during left-sided breast radiation therapy (RT); however there is limited information about which patients derive the most benefit from DIBH. Our study results are similar to published retrospective and planning studies demonstrating that DIBH lowered Dmean Heart and LAD doses [2,4,8,10,14,15,41]. Based on available findings, the DEGRO breast cancer expert panel recommends a Dmean heart dose < 2.5 Gy [55].…”

Section: Discussionsupporting

confidence: 88%

“…Modern radiation treatment techniques may reduce the dose to the heart. For this purpose the deep inspiration breath-hold technique has made considerable efforts to reach this goal in minimizing the dose to the heart [3][4][5][6][7][8][9][10][11]14]. The technique is based upon the observation that during inspiration, the flattening of the diaphragm and the expansion of the lungs pull the heart away from the chest wall.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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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“…Multiangle or rotational IMRT delivery can be used to create concave dose distributions and to reduce the high dose volume of the lung and heart abutting the chest wall at the cost of a low-dose bath to the ipsi- and contralateral lung and the whole heart [52]. DIBH-based radiation therapy can help to distance the heart from the chest wall and reduce the dose to the heart and substructures such as the LAD [53–56]; Figs. 1, 2 and 3.…”

Section: Technical Options Reducing Heart Dosementioning

confidence: 99%

Heart toxicity from breast cancer radiotherapy

et al. 2018

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BackgroundLate cardiac toxicities caused by (particularly left-sided) breast radiotherapy (RT) are now recognized as rare but relevant sequelae, which has prompted research on risk structure identification and definition of threshold doses to heart subvolumes. The aim of the present review was to critically discuss the clinical evidence on late cardiac reactions based on dose-dependent outcome reports for mean heart doses as well as doses to cardiac substructures.MethodsA literature review was performed to examine clinical evidence on radiation-induced heart toxicities. Mean heart doses and doses to cardiac substructures were focused upon based on dose-dependent outcome reports. Furthermore, an overview of radiation techniques for heart protection is given and non-radiotherapeutic aspects of cardiotoxicity in the multimodal setting of breast cancer treatment are discussed.ResultsBased on available findings, the DEGRO breast cancer expert panel recommends the following constraints: mean heart dose <2.5 Gy; DmeanLV (mean dose left ventricle) < 3 Gy; V5LV (volume of LV receiving ≥5 Gy) < 17%; V23LV (volume of LV receiving ≥23 Gy) < 5%; DmeanLAD (mean dose left descending artery) < 10 Gy; V30LAD (volume of LAD receiving ≥30 Gy) < 2%; V40LAD (volume of LAD receiving ≥40 Gy) < 1%.ConclusionIn addition to mean heart dose, breast cancer RT treatment planning should also include constraints for cardiac subvolumes such as LV and LAD. The given constraints serve as a clinicians’ aid for ensuring adequate heart protection. The individual decision between sufficient protection of cardiac structures versus optimal target volume coverage remains in the physician’s hand. The risk of breast cancer-specific mortality and a patient’s cardiac risk factors must be individually weighed up against the risk of radiation-induced cardiotoxicity.

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“…There is growing evidence from retrospective and planning studies demonstrating a significant reduction in dose to the heart (MHD and left anterior descending coronary artery) in patients with left-sided breast cancers undergoing deep-inspiration breath hold radiotherapy [12][13][14] . DIBH irradiation significantly reduces MHD using both IMRT and VMAT techniques compared with free-breathing radiation 15 . Corradini et al published the results of a comparison between 3D-CRT and VMAT with free-breathing or DIBH.…”

Section: Discussionmentioning

confidence: 99%

Audio-visual navigation reduces treatment time in deep-inspiration breath hold radiotherapy

Doležel¹,

Odrážka²,

Vaňásek³

et al. 2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims. The purpose of this study was to compare the treatment times for deep-inspiration breath hold with and without audiovisual (A-V) navigation. Methods. We measured the real treatment time in 60 patients with breast cancer undergoing postoperative radiotherapy. Thirty consecutive patients were treated without deep-inspiration breath hold (DIBH) and another 30 patients using deep-inspiration breath hold (10 patients with DIBH only, 10 patients with DIBH using visual feedback and 10 patients with DIBH using visual feedback following breath training). The treatment time was relativized to number of fields and 100 monitor units (MU). The independent t-test was used to analyse differences between cohorts. Results. The mean treatment time for patients without DIBH was 46.5 seconds per field and 90.9 seconds per 100 MU, for DIBH only 92.3 and 170.2 seconds, for DIBH with audiovisual navigation 68.1 and 133.8 seconds, and for DIBH with A-V feedback including breath training 66.1 and 132.5 seconds. The treatment times for patients treated using DIBH with visual navigation were significantly shorter in comparison with patients without visual feedback. We were not able to prove any significant benefit for breath training in terms of reducing the treatment time. Conclusion. Audiovisual navigation enables to significantly reduce the treatment time in comparison with DIBH without A-V feedback.

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Cardiac dose-sparing effects of deep-inspiration breath-hold in left breast irradiation

Cited by 37 publications

References 39 publications

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

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

Heart toxicity from breast cancer radiotherapy

Audio-visual navigation reduces treatment time in deep-inspiration breath hold radiotherapy

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