Deep inspiration breathhold for left-sided breast cancer patients with unfavorable cardiac anatomy requiring internal mammary nodal irradiation

Mohamad, Osama; Shiao, Jean; Zhao, Bo; Roach, Karen; Ramirez, Ezequiel; Vo, Dat T.; Thomas, Kris G.; Gu, Xuejun; Spangler, Ann; Albuquerque, Kevin; Rahimi, Asal

doi:10.1016/j.prro.2017.04.006

Cited by 29 publications

(31 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In one cohort, DIBH was shown to provide greater relative decreases in mean heart dose for patients receiving regional nodal irradiation compared to those who were treated to the breast alone [ 22 ], presumably due to innately greater heart exposures associated with nodal irradiation in FB plans. In studies where locoregional radiation has included the IMN, DIBH has consistently reduced both mean heart dose and dose volumes, with preservation of PTV dose coverage [ 20 , 22 – 26 ]. However, there remains a paucity of information in regards to the dosimetric properties of IMN treatment itself, apart from other regional nodal groups.…”

Section: Discussionmentioning

confidence: 99%

Cardiac sparing characteristics of internal mammary chain radiotherapy using deep inspiration breath hold for left-sided breast cancer

et al. 2018

View full text Add to dashboard Cite

BackgroundWhile breast radiotherapy typically includes regional nodal basins, the treatment of the internal mammary nodes (IMN) has been controversial due to concern for long-term cardiac toxicity. For high risk patients where IMN treatment is warranted, there is limited data with regards to the degree of heart sparing conferred by modern techniques. In this study, we sought to analyze the specific heart sparing metrics conferred by deep inspiration breath hold (DIBH) in the setting of IMN irradiation.MethodsFrom 2012 to 2015, 168 consecutive patients were treated with adjuvant left-sided radiotherapy using DIBH. Retrospective review identified 49 patients who received nodal irradiation, either to a supraclavicular field (SCF) and IMN (16), or to the SCF alone (33). Cardiac mean dose and dose volumes were calculated from free breathing (FB) and DIBH treatment plans, and compared by Wilcoxon signed-rank and Mann–Whitney U tests.ResultsDIBH achieved significant reductions in mean heart dose (p < 0.001) in both the IMN treated group from 6.73 Gy to 2.79 Gy (− 56.4%) and the IMN untreated group from 4.77 Gy to 1.55 Gy (− 63.7%). There was a 7.3% difference in relative reduction that was not statistically significant (p = 0.216). Relative reductions in heart dose volume measures were all significantly lower for IMN-irradiated patients (p ≤ 0.012), with the greatest deficits at V5 that gradually diminish with increasing dose (V25).ConclusionsThe relative heart sparing benefits of the DIBH technique are retained even with IMN inclusion. However, the addition of IMN irradiation is associated with an intrinsically greater heart dose, which translates to an estimated 9.2% proportional increase in the risk of a subsequent major coronary event. In the setting of effective cardiac sparing techniques, clinicians should take these considerations into account to guide when IMN treatment is warranted.

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiac sparing characteristics of internal mammary chain radiotherapy using deep inspiration breath hold for left-sided breast cancer

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Patients with right-sided breast cancers may also benefit from DIBH, largely due to decreased ipsilateral and total lung doses associated with use of DIBH in patients receiving IMC radiation ( 60 ). Additionally, DIBH has been shown to more significantly decrease the heart dose in women receiving nodal irradiation to the IMC ( 56 ), largely due to the increased heart dose associated with IMC treatment when compared to treatment of the breast and CW alone ( 18 ).…”

Section: Advantages Of Dibh and Patient Selectionmentioning

confidence: 99%

Deep Inspiration Breath Hold: Techniques and Advantages for Cardiac Sparing During Breast Cancer Irradiation

et al. 2018

View full text Add to dashboard Cite

Historically, heart dose from left-sided breast radiotherapy has been associated with a risk of cardiac injury. Data suggests that there is not a threshold for the deleterious effects from radiation on the heart. Over the past several years, advances in radiation delivery techniques have reduced cardiac morbidity due to treatment. Deep inspiration breath hold (DIBH) is a technique that takes advantage of a more favorable position of the heart during inspiration to minimize heart doses over a course of radiation therapy. In the accompanying review article, we outline several methods used to deliver treatment with DIBH, quantify the benefits of DIBH treatment, discuss considerations for patient selection, and identify challenges associated with DIBH techniques.

show abstract

“…Data on the use of DIBH in right-sided patients are limited, although there are some data to suggest that DIBH may allow for a reduction in ipsilateral lung dose in patients who require radiation of the IMC nodes. 21 Another study specifically analyzed patients with right-sided breast cancer and noted that DIBH decreased both the ipsilateral lung dose and volume of the liver receiving 50% of the dose. 22 This raises the question of whether select patients with right-sided breast cancers, especially those undergoing IMC radiation, may benefit from the use of DIBH.…”

Section: Discussionmentioning

confidence: 99%

“… 19 In fact, DIBH can decrease mean heart dose by 25% to 67% compared with standard free breathing. 20 Recent data also suggest that DIBH can decrease ipsilateral lung dose in patients undergoing internal mammary chain (IMC) radiation 21 and in right-sided patients, 22 which raises the question of whether DIBH may be beneficial in these cases.…”

Section: Introductionmentioning

confidence: 99%

Nationwide Trends in Heart-Sparing Techniques Utilized in Radiation Therapy for Breast Cancer

Desai

Currey

Kelly

et al. 2019

Advances in Radiation Oncology

View full text Add to dashboard Cite

Purpose Radiation dose to the heart correlates with cardiac-related deaths and may partially diminish the benefit of radiation for breast cancer. This study assessed the current nationwide trends in heart-sparing techniques for breast cancer radiation. Methods and Materials In November 2017, an institutional review board–approved survey was sent to radiation oncologists in the United States. Questions assessed demographics and the type and frequency of heart-sparing techniques. Data were analyzed using descriptive statistics and χ 2 tests. Results In total, 530 responses (13%) were obtained. Most physicians had practiced >15 years (46%), with most in a private setting (59%). Eighty-three percent of physicians offered prone positioning and/or deep inspiration breath hold (DIBH). This was more common in academic practice ( P < .01). Seventy-three percent of physicians used heart-sparing techniques for more than three-fourths of left-sided patients. The most commonly used technique was DIBH, and 43% of physicians used the technique more than three-fourths of the time. Commonly used DIBH systems were Varian RPM (54%) and Vision RT/Align RT (31%). No increase in DIBH use was observed with regional nodal irradiation, and coverage of internal mammary chain nodes varied. Patient tolerance (78%) and cardiac-to-chest wall distance (72%) were the most common determinants of DIBH in left-sided patients. Twenty-three percent of physicians used DIBH for right-sided patients, with lung (64%) and heart sparing (46%) as the most common reasons for use. Lack of facilities was the most common reason not to use DIBH (61%). Conclusions Most respondents offer heart-sparing techniques for breast cancer radiation; this is more common in academic centers. DIBH is the most common technique across all practice settings. DIBH is much less commonly used in right-sided patients but is still used by >20% of practitioners, with lung and heart sparing cited as reasons for use. More data are needed to determine if and when this technique should be used in right-sided cases.

show abstract

Deep inspiration breathhold for left-sided breast cancer patients with unfavorable cardiac anatomy requiring internal mammary nodal irradiation

Cited by 29 publications

References 34 publications

Cardiac sparing characteristics of internal mammary chain radiotherapy using deep inspiration breath hold for left-sided breast cancer

Cardiac sparing characteristics of internal mammary chain radiotherapy using deep inspiration breath hold for left-sided breast cancer

Deep Inspiration Breath Hold: Techniques and Advantages for Cardiac Sparing During Breast Cancer Irradiation

Nationwide Trends in Heart-Sparing Techniques Utilized in Radiation Therapy for Breast Cancer

Contact Info

Product

Resources

About