Deep inspiration breath-hold technique for left-sided breast cancer: An analysis of predictors for organ-at-risk sparing

Register, Steven; Takita, Cristiane; Reis, Isildinha M.; Zhao, Wei; Amestoy, William; Wright, Jean L.

doi:10.1016/j.meddos.2014.10.005

Cited by 42 publications

(35 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, the number of centers adopting this technique will likely increase with recent publication of randomized data demonstrating improved cosmesis in large-breasted women treated in the prone compared with the supine position 18 . Although there is some controversy regarding the benefit of prone technique to decrease coronary artery dose, 19 we routinely treat the majority of women at our institution prone because of the demonstrable benefit in both cardiac volume exposed to radiation 15 and LAD dose 20 . The different results reported by other investigators likely reflect the use of prone techniques that interpose a wedge under the contralateral breast, forcing an axial rotation that enhances the displacement of the heart toward the chest wall when prone 21 .…”

Section: Discussionmentioning

confidence: 99%

“…Other techniques, such as deep inspiratory breath hold,19, 20, 21 respiratory gating, 22 and proton therapy 23 have also been used to decrease the dose to the heart and lungs because even low doses of irradiation have been found to correlate with an increase in cardiovascular disease 24 . Deep inspiratory breath hold has the benefit of maintaining patients in the supine position, often more comfortable for elderly or otherwise infirm patients, but it requires highly trained staff and a cooperative patient.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Preplanning prediction of the left anterior descending artery maximum dose based on patient, dosimetric, and treatment planning parameters

Cooper

Shin

et al. 2016

Advances in Radiation Oncology

View full text Add to dashboard Cite

PurposeMaximum dose to the left anterior descending artery (LADmax) is an important physical constraint to reduce the risk of cardiovascular toxicity. We generated a simple algorithm to guide the positioning of the tangent fields to reliably maintain LADmax <10 Gy.Methods and materialsDosimetric plans from 146 consecutive women treated prone to the left breast enrolled in prospective protocols of accelerated whole breast radiation therapy, with a concomitant daily boost to the tumor bed (40.5 Gy/15 fraction to the whole breast and 48 Gy to the tumor bed), provided the training set for algorithm development. Scatter plots and correlation coefficients were used to describe the bivariate relationships between LADmax and several parameters: distance from the tumor cavity to the tangent field edge, cavity size, breast separation, field size, and distance from the tangent field. A logistic sigmoid curve was used to model the relationship of LADmax and the distance from the tangent field. Furthermore, we tested this prediction model on a validation data set of 53 consecutive similar patients.ResultsA lack of linear relationships between LADmax and distance from cavity to LAD (−0.47), cavity size (−0.18), breast separation (−0.02), or field size (−0.28) was observed. In contrast, distance from the tangent field was highly negatively correlated to LADmax (-0.84) and was used in the models to predict LADmax. From a logistic sigmoid model we selected a cut-point of 2.46 mm (95% confidence interval, 2.19-2.74 mm) greater than which LADmax is <10 Gy (95% confidence interval, 9.30-10.72 Gy) and LADmean is <3.3 Gy.ConclusionsPlacing the edge of the tangents at least 2.5 mm from the closest point of the contoured LAD is likely to assure LADmax is <10 Gy and LADmean is <3.3 Gy in patients treated with prone accelerated breast radiation therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preplanning prediction of the left anterior descending artery maximum dose based on patient, dosimetric, and treatment planning parameters

Cooper

Shin

et al. 2016

Advances in Radiation Oncology

View full text Add to dashboard Cite

show abstract

“…Regardless of selection criteria, the risk of cardiac mortality should be estimated by dosimetric parameters . Several studies have suggested that cardiac dosimetric parameters can be predicted using geometric structures of the heart without dosimetric analysis . Although the risk assessments of cardiac mortality using dosimetric parameters and geometric structures have been clearly demonstrated in the previous studies, there are limited data evaluating clinical usefulness of geometric structures related to the heart.…”

Section: Introductionmentioning

confidence: 99%

Cardiac risk index as a simple geometric indicator to select patients for the heart‐sparing radiotherapy of left‐sided breast cancer

2016

View full text Add to dashboard Cite

show abstract

“…A parameteric model for cardiac dosimetric sparing with DIBH has not been fully established in routine clinical practice 12 , 15 . For example, Nissen and Appelt (12) reported the lack of correlation between age/breath‐hold volume and the heart dose from 319 breast cancer patients.…”

Section: Introductionmentioning

confidence: 99%

“…For example, Nissen and Appelt (12) reported the lack of correlation between age/breath‐hold volume and the heart dose from 319 breast cancer patients. Register et al (15) showed dosimetric sparing with DIBH has a good correlation with heart volume in field (HVIF) and mean heart dose from 64 breast cancer patients. Although useful, its main limitation is that the dosimetric results are unknown until after radiotherapy planning when changing the technique may require repeat simulation and delay of treatment.…”

Section: Introductionmentioning

confidence: 99%

How dose sparing of cardiac structures correlates with in‐field heart volume and sternal displacement

Kim

Reardon

Trifiletti

et al. 2016

J Applied Clin Med Phys

View full text Add to dashboard Cite

Cardiac irradiation increases the risk of coronary artery disease in patients with left‐sided breast cancer. Techniques exist to reduce cardiac irradiation, but the optimum technique depends on individual patient anatomy and physiology. We investigated the correlation of delta heart volume in field (dHVIF) and sternal excursion with dose sparing in heart and left anterior descending artery (LAD) to develop quantitative predictive models for expected dose to heart and LAD. A treatment planning study was performed on 97 left‐breast cancer patients who underwent whole breast radiotherapy (prescription dose = 50 Gy) under deep inspiratory breath hold (DIBH). Two CT datasets, free breathing (FB) and DIBH, were utilized for treatment planning and for determination of the internal anatomy‐based DIBH amplitude. The mean heart and LAD dose were compared between FB and DIBH plans and dose to the heart and LAD as a function of dHVIF and sternal excursion were determined. The [Average (STD); Range] mean heart doses from free breathing and DIBH are [120.5(65.2); 28.9 ~ 393.8] cGy and [67.5(25.1); 19.7 ~ 145.6] cGy, respectively. The mean LAD doses from free breathing and DIBH are [571.0(582.2); 42.2 ~ 2332.2] cGy and [185.9(127.0); 41.2 ~ 898.4] cGy, respectively. The mean dose reductions with DIBH are [53.1(50.6); ‐15.4 ~ 295.1] cGy for the heart and [385.1(513.4); ‐0.6 ~ 2105.8] cGy for LAD. Percent mean dose reductions to the heart and LAD with DIBH are 44% (p < 0.0001) and 67% (p < 0.0001), respectively, compared to FB. The dHVIF mean dose reduction correlation is 8.1 cGy/cc for the heart and 81.6 cGy/cc for LAD (with linear trend and y intercept: 26.0 cGy for the heart, 109.1 cGy for LAD). DIBH amplitude using sternal position was [1.3(4.8); .38 ~2.5] cm. The DIBH amplitude mean dose reduction correlation is 14 cGy/cm for the heart and 212 cGy/cm for LAD (with linear trend with y intercept: 35.6 cGy for the heart, 102.4 cGy for LAD). The strong correlation of dose sparing to the heart and LAD with dHVIF and sternal excursion suggests that mean dose sparing to heart and LAD can be predicted with either dHVIF or sternal excursion equally well. The metrics proposed could be utilized to allow providers to determine the relative dosimetric benefits of different heart‐sparing techniques as early as time of consultation.PACS number(s): 87.53.Tf

show abstract

Deep inspiration breath-hold technique for left-sided breast cancer: An analysis of predictors for organ-at-risk sparing

Cited by 42 publications

References 25 publications

Preplanning prediction of the left anterior descending artery maximum dose based on patient, dosimetric, and treatment planning parameters

Preplanning prediction of the left anterior descending artery maximum dose based on patient, dosimetric, and treatment planning parameters

Cardiac risk index as a simple geometric indicator to select patients for the heart‐sparing radiotherapy of left‐sided breast cancer

How dose sparing of cardiac structures correlates with in‐field heart volume and sternal displacement

Contact Info

Product

Resources

About