Clinical Results of Image-Guided Deep Inspiration Breath Hold Breast Irradiation

Borst, Gerben R.; Sonke, Jan‐Jakob; Hollander, Suzanne den; Betgen, A.; Remeijer, P.; Giersbergen, A.; Russell, Nicola S.; Elkhuizen, Paula H.M.; Bartelink, Harry; Vliet-Vroegindeweij, Corine van

doi:10.1016/j.ijrobp.2009.10.006

Cited by 131 publications

(103 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Treatment setup errors were consistent with other studies of DIBH which have used EPI for verification [18,29], but smaller than many free-breathing studies [30], suggesting that DIBH is at least as reproducible as standard free-breathing breast radiotherapy. In this study, errors were greatest in the u-direction, which is subject to the most change with variations in depth of DIBH or breathing pattern (e.g.…”

Section: Discussionsupporting

confidence: 84%

“…Cardiac doses reported in this study were lower than in other published data [29,[33][34][35][36], although comparison is not straightforward due to differences in target volumes and LAD margins. Ipsilateral lung doses were consistent with other published works [29,34], although whole lung doses are not widely reported.…”

Section: Discussioncontrasting

confidence: 75%

“…In view of this, it is likely that CBCT-derived setup errors in this study are an overestimate of the true setup errors associated with these techniques. Clip-based match errors were better than DIBH setup data reported by another centre [29]; in relation to free-breathing data, r were similar but R greater than previously reported [32]. The difference in MD in the AP direction suggests imprecision of the ABC equipment and/or procedure.…”

Section: Discussionsupporting

confidence: 43%

See 2 more Smart Citations

The UK HeartSpare Study: Randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy

Bartlett

Colgan

Carr

et al. 2013

Radiotherapy and Oncology

174

169

View full text Add to dashboard Cite

a b s t r a c tPurpose: To determine whether voluntary deep-inspiratory breath-hold (v_DIBH) and deep-inspiratory breath-hold with the active breathing coordinator™ (ABC_DIBH) in patients undergoing left breast radiotherapy are comparable in terms of normal-tissue sparing, positional reproducibility and feasibility of delivery. Methods: Following surgery for early breast cancer, patients underwent planning-CT scans in v_DIBH and ABC_DIBH. Patients were randomised to receive one technique for fractions 1-7 and the second technique for fractions 8-15 (40 Gy/15 fractions total). Daily electronic portal imaging (EPI) was performed and matched to digitally-reconstructed radiographs. Cone-beam CT (CBCT) images were acquired for 6/15 fractions and matched to planning-CT data. Population systematic (R) and random errors (r) were estimated. Heart, left-anterior-descending coronary artery, and lung doses were calculated. Patient comfort, radiographer satisfaction and scanning/treatment times were recorded. Within-patient comparisons between the two techniques used the paired t-test or Wilcoxon signed-rank test. Results: Twenty-three patients were recruited. All completed treatment with both techniques. EPIderived R were 61.8 mm (v_DIBH) and 62.0 mm (ABC_DIBH) and r 62.5 mm (v_DIBH) and 62.2 mm (ABC_DIBH) (all p non-significant). CBCT-derived R were 63.9 mm (v_DIBH) and 64.9 mm (ABC_DIBH) and r 6 4.1 mm (v_DIBH) and 6 3.8 mm (ABC_DIBH). There was no significant difference between techniques in terms of normal-tissue doses (all p non-significant). Patients and radiographers preferred v_DIBH (p = 0.007, p = 0.03, respectively). Scanning/treatment setup times were shorter for v_DIBH (p = 0.02, p = 0.04, respectively). Conclusions: v_DIBH and ABC_DIBH are comparable in terms of positional reproducibility and normal tissue sparing. v_DIBH is preferred by patients and radiographers, takes less time to deliver, and is cheaper than ABC_DIBH.

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Discussioncontrasting

confidence: 75%

Section: Discussionsupporting

confidence: 43%

See 1 more Smart Citation

The UK HeartSpare Study: Randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy

Bartlett

Colgan

Carr

et al. 2013

Radiotherapy and Oncology

174

169

View full text Add to dashboard Cite

show abstract

“…Excluding the heart from the field might compromise the dose to the target, but by means of the deep inspiration breath hold (DIBH) technique it is possible to reduce the cardiopulmonary doses while maintaining the prescribed dose to the breast 6, 7. The method is well established and several groups have previously reported beneficial results using DIBH 6, 8, 9, 10, 11, 12, 13, 14. Since DIBH is capable of decreasing dose to the heart; it is also assumed that the long‐term risk of developing cardiac damage is reduced.…”

Section: Introductionmentioning

confidence: 99%

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Jensen

Абрамова

Frengen

et al. 2017

J Applied Clin Med Phys

View full text Add to dashboard Cite

Deep inspiration breath hold (DIBH) in left‐sided breast cancer radiotherapy is a technique to reduce cardiac and pulmonary doses while maintaining target coverage. This study aims at evaluating an in‐house developed DIBH system. Free‐breathing (FB) and DIBH plans were generated for 22 left‐sided localized breast cancer patients who had radiation therapy (RT) after breast‐conserving surgery. All patients were treated utilizing an in‐house laser distance measuring system. 50 Gy was prescribed, and parameters of interest were target coverage, left anterior descending coronary artery, (LAD) and heart doses. Portal images were acquired and the reproducibility and stability of DIBH treatment were compared to FB. The comparing result shows there is a significant reduction in all LAD and heart dose statistics for DIBH compared to FB plans without compromising the target coverage. The maximum LAD dose was reduced from 43.7 Gy to 29.0 Gy and the volume of the heart receiving >25 Gy was reduced from 3.3% to 1.0% using the in‐house system, both statistically significant. The in‐house system gave a reproducible and stable DIBH treatment where the systematic error ∑, and random error σ, were less than 2.2 mm in all directions, but were not significantly better than at FB. The system was well tolerated and all patients completed their treatment sessions with DIBH.

show abstract

“…As mentioned previously, this highlights the importance of minimising both the dose to these structures and the volume being irradiated as much as possible. There has been considerable interest in developing modern technology for radiotherapy planning to avoid excess cardiac irradiation, by modulation of the dose around organs at risk (OAR) using intensity modulated radiotherapy (IMRT) [18,19], IMRT with simultaneously integrated boost [20], placement of heart blocks [21] and deep inspiratory breathholding (DIBH) and gated techniques [22][23][24][25]. Beam angle modulation remains a very simple, and, up until now, rather neglected way of achieving this outcome.…”

mentioning

confidence: 99%

Beam angle manipulation to reduce cardiac dose during breast radiotherapy

Vivekanandan

Mhlanga

Launders

et al. 2012

BJR

View full text Add to dashboard Cite

Objective: Standard tangential radiotherapy techniques after breast conservative surgery (BCS) often results in the irradiation of the tip of the left ventricle and the left anterior descending coronary artery (LAD), potentially increasing cardiovascular morbidity. The importance of minimising radiation dose to these structures has attracted increased interest in recent years. We tested a hypothesis that in some cases, by manipulating beam angles and accepting lower-than-prescribed doses of radiation in small parts of the breast distant from the surgical excision site, significant cardiac sparing can be achieved compared with more standard plans. Methods: A sample of 12 consecutive patients undergoing radiotherapy after left-sided BCS was studied. All patients were planned with a 6 MV tangential beam, beam angles were manipulated carefully and if necessary lower doses were given to small parts of the breast distant from the surgical excision site to minimise cardiac irradiation (''institutional'' plan). Separate ''hypothetical standard'' plans were generated for seven patients using set field margins that met published guidelines. Results: In seven patients, the institutional plans resulted in lower doses to the LAD and myocardium than the hypothetical standard plans. In the other five patients, LAD and myocardial doses were deemed minimal using the hypothetical standard plan, which in these patients corresponded to the institutional plan (the patients were actually treated using the institutional plans). Conclusion: Much attention has been devoted to ways of minimising cardiac radiation dose. This small sample demonstrates that careful manipulation of beam angles can often be a simple, but effective technique to achieve this.

show abstract

Clinical Results of Image-Guided Deep Inspiration Breath Hold Breast Irradiation

Cited by 131 publications

References 25 publications

The UK HeartSpare Study: Randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy

The UK HeartSpare Study: Randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Beam angle manipulation to reduce cardiac dose during breast radiotherapy

Contact Info

Product

Resources

About