Cardiac Sparing with Personalized Treatment Planning for Early-stage Left Breast Cancer

Mathieu, Dominique; Bedwani, Stéphane; Mascolo-Fortin, Julia; Côté, Nicolas; Bernard, Andrée-Anne; Roberge, David; Yassa, M.; Bahig, Houda; Vu, Toni

doi:10.7759/cureus.7247

Cited by 8 publications

(9 citation statements)

References 15 publications

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“…al showed that the average mean dose to the heart was 3.2 ± 0.8 Gy with FB and 1.1 ± 0.3 with DIBH. The LAD mean dose was 27.0 ± 6.30 Gy and 8.0 ± 7.60 Gy for FB and DIBH plans respectively [ 14 ]. The reason for higher heart and LAD mean doses reported in the current study compared to the studies mentioned above is that most of the patients in the current study have locally advanced left breast cancer with supraclavicular, axillary, and internal mammary lymph nodes involved in radiation fields.…”

Section: Discussionmentioning

confidence: 99%

“…DIBH radiotherapy can be used for further heart and ipsilateral lung dose reduction by creating an increased separation between the heart and the treatment volume. Studies have shown that the mean heart and LAD dose can be reduced by more than 50% as compared to the free-breathing technique [6,[14][15][16][17][18][19]. During implementation of a new technology like surface-guided DIBH radiotherapy, thorough quality control and frequent quality assurance measures should be carried out before the new technique becomes a well-integrated part of routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran

Abdollahi

Yazdi²,

Mowlavi³

et al. 2022

Rep Pract Oncol Radiother.

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background:The aim of the study is to evaluate the overall accuracy of the surface-guided radiotherapy (sGrT) workflow through a comprehensive commissioning and quality assurance procedures and assess the potential benefits of deep-inspiration breath-hold (DIBh) radiotherapy as a cardiac and lung dose reduction approach for left-sided breast cancer irradiation. Materials and methods:Accuracy and reproducibility of the optical surface scanner used for DIBh treatment were evaluated using different phantoms. patient positioning accuracy and reproducibility of DIBh treatment were evaluated. Twenty patients were studied for treatment plan quality in target dose coverage and healthy organ sparing for the two different treatment techniques. results: reproducibility tests for the surface scanner showed good stability within 1 mm in all directions. The maximum position variation between applied shifts on the couch and the scanner measured offsets is 1 mm in all directions. The clinical study of 200 fractions showed good agreement between the surface scanner and portal imaging with the isocenter position deviation of less than 3 mm in each lateral, longitudinal, and vertical direction. The standard deviation of the DIBh level showed a value of < 2 mm during all evaluated DIBhs. Compared to the free breathing (FB) technique, DIBh showed significant reduction of 48% for heart mean dose, 43% for heart V25, and 20% for ipsilateral lung V20. conclusion: surface-guided radiotherapy can be regarded as an accurate tool for patient positioning and monitoring in breast radiotherapy. DIBh treatment are considered to be effective techniques in heart and ipsilateral lung dose reductions for left breast radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran

Abdollahi

Yazdi²,

Mowlavi³

et al. 2022

Rep Pract Oncol Radiother.

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“…Respiratory motion was monitored using the Varian respiratory gating system and the patient was instructed to take a deep breath in and hold it. The treatment beam was stopped when the breathing signal dropped outside a defined threshold for the respiratory motion of the heart [ 10 ]. The total whole-breast radiation dose was 48 ± 4 Gy and the mean cardiac dose was 2 ± 2 Gy.…”

Section: Methodsmentioning

confidence: 99%

Myocardial injury detected by T1 and T2 mapping on CMR predicts subsequent cancer therapy–related cardiac dysfunction in patients with breast cancer treated by epirubicin-based chemotherapy or left-sided RT

et al. 2021

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Objectives Cancer therapy-related cardiac dysfunction (CTRCD) is a relevant clinical problem and needs early prediction. This study aimed to analyze myocardial injury using serial laboratory and cardiac magnetic resonance imaging (CMR) parameters after epirubicin-based chemotherapy compared with left-sided radiotherapy and to study their value for early prediction of CTRCD. Methods Sixty-six consecutive women (53 ± 13 years) including n = 39 with epirubicin-based chemotherapy and n = 27 with left-sided radiotherapy were prospectively studied by 3 T CMR including left ventricular (LV) mass and volumes for ejection fraction (LVEF), as well as feature-tracking with global longitudinal strain (GLS) and T1/T2 mapping. CMR was performed at baseline, at therapy completion (follow-up 1, FU1), and after 13 ± 2 months (FU2). CTRCD was defined as LVEF decline of at least 10% to < 55% or a > 15% GLS change at FU2. Results T1 and T2 increased at FU1 after epirubicin-based chemotherapy, but not after left-sided radiotherapy. CTRCD occurred in 20% of patients after epirubicin-based chemotherapy and in 4% after left-sided radiotherapy. T1 at FU1 was the best single parameter to predict CTRCD with an area under the curve (AUC) of 0.712 (CI 0.587–0.816, p = 0.005) with excellent sensitivity (100%, 66–100%), but low specificity (44%, 31–58%). Combined use of increased T1 and LVEF ≤ 60% at FU1 improved AUC to 0.810 (0.695–0.896) resulting in good sensitivity (78%, 44–95%) and specificity (84%, 72–92%). Conclusion Only epirubicin-based chemotherapy, but not left-sided radiotherapy, resulted in increased T1/T2 myocardial relaxation times as a marker of myocardial injury. Combined use of CMR parameters may allow an early prediction of subsequent CTCRD. Key Points • Myocardial T1 and T2 relaxation times increased at FU1 after epirubicin-based chemotherapy, but not after left-sided radiotherapy. • Cancer therapy–related cardiac dysfunction (CTRCD) occurred in 20% of patients after epirubicin-based chemotherapy and in 4% after left-sided radiotherapy. • Combined use of increased T1 and reduced LVEF had an AUC of 0.810 (0.695–0.896) to predict CTRCD with good sensitivity (78%, 44–95%) and specificity (84%, 72–92%).

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“…The most important goal of DIBH in patients with left‐sided breast cancer is to reduce cardiac irradiation. Several dosimetric studies have examined DIBH for left‐sided breast cancer using Abches, 7 , 8 , 9 and all of them have reported a reduction in cardiac irradiation with DIBH and Abches. However, the accuracy of breath‐hold is also important for successful treatment in actual clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Reproducibility of deep inspiration breath‐hold technique for left‐side breast cancer with respiratory monitoring device, Abches

Saito

Kajihara

Suzuki

et al. 2022

J Applied Clin Med Phys

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Purpose This study aimed to evaluate the reproducibility of deep inspiration breath‐hold (DIBH) using a respiratory control device, Abches, in patients with left‐sided breast cancer. Material and methods Abches comprises a main body, an indicator panel, and two fulcrums, one each on the chest and abdomen. Forty left side breast cancer patients treated with DIBH using abches were enrolled in this study. For all patients, CT images were taken three times to confirm the target position inside the body and to check the breath‐hold reproducibility. Three anatomical points on the nipple, sternum, and heart were selected as measurement points on CT images. After measuring the coordinates, breath‐hold reproducibility was defined as the mean of the absolute difference in the coordinates between the three CT images. The maximum differences were also investigated. In addition, the dice similarity coefficient (DSC) was calculated to examine the displacement of the heart volume in detail. Moreover, digitally reconstructed radiographs (DRRs) and linac graphs (LGs) were used to measure the positional accuracy of the chest and heart. Results The reproducibility in all patients was within 0.75 mm for the nipple, 0.78 mm for the sternum, and 2.18 mm for the heart in each direction. Similarly, the maximum displacements for all patients were within 1.90 mm, 1.69 mm, and 4.75 mm, respectively, in each direction. For heart volume, the average DSC for all cases was 0.93 ± 0.01. The differences between the DRR and LG images were 1.70 ± 1.10 mm and 2.10 ± 1.60 mm, for the chest and heart, respectively. Conclusion Our study showed that DIBH using Abches can be performed with good target reproducibility of less than 3 mm with proper breath‐hold practice, whereas the heartbeat‐derived reproducibility of the cardiac position is poor and needs to be monitored carefully during treatment simulation

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Cardiac Sparing with Personalized Treatment Planning for Early-stage Left Breast Cancer

Abstract: To compare cardiac doses of different whole-breast optimization schemes including freebreathing (FB) tangential radiotherapy (TRT), deep-inspiration breath-hold (DIBH) TRT, and FB helical tomotherapy (HT).

Cited by 8 publications

References 15 publications

Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran

Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran

Myocardial injury detected by T1 and T2 mapping on CMR predicts subsequent cancer therapy–related cardiac dysfunction in patients with breast cancer treated by epirubicin-based chemotherapy or left-sided RT

Reproducibility of deep inspiration breath‐hold technique for left‐side breast cancer with respiratory monitoring device, Abches

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