Dosimetric and clinical advantages of deep inspiration breath-hold (DIBH) during radiotherapy of breast cancer

Bruzzaniti, Vicente; Abate, A; Pinnarò, Paola; D’Andrea, M.; Infusino, E.; Landoni, V.; Soriani, A.; Giordano, Carolina; Ferraro, Anna Maria; Strigari, Lidia

doi:10.1186/1756-9966-32-88

Cited by 110 publications

(113 citation statements)

References 28 publications

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“…• Technika wstrzymywania oddechu w fazie głębokiego wdechu, inaczej bramkowania oddechowego, umoż-liwiająca osłonięcie serca przed polami stycznymi i zmniejszenie napromienienia narażonych narządów bez niekorzystnego wpływu na kliniczną objętość docelową [294].…”

Section: Radioterapiaunclassified

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

Zamorano¹,

Lancellotti²,

Muñoz³

et al. 2016

Kardiol Pol

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Section: Radioterapiaunclassified

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

Zamorano¹,

Lancellotti²,

Muñoz³

et al. 2016

Kardiol Pol

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“…The DIBH method physically increases the separation between the heart/LAD and the target volume to reduce the irradiated heart volume without degrading planning target volume (PTV) coverage 10 , 11 , 12 , 13 , 14 . In the voluntary DIBH technique, patients are instructed verbally and/or visually to maintain their respiratory position during treatment delivery (10) .…”

Section: Introductionmentioning

confidence: 99%

“…Using this technique, the respiratory tumor motion is reduced and the separation of the target volume from critical structures is increased. A number of previous studies reported the significant reduction of cardiac doses with DIBH 9 , 11 , 12 . For example, the comparison study with 17 breast cancer patients by Korreman et al (13) showed that the median heart volume receiving more than 50% of the prescription dose was reduced from 19.2% with free breathing (FB) to 1.9% with DIBH when the mean chest wall position with DIBH was 12.6 mm higher from that of FB.…”

Section: Introductionmentioning

confidence: 99%

“…McIntosh et al (14) reported that DIBH reduced the mean heart dose by 48% with a 20.7 mm mean external breath‐hold sternal displacement using the Varian real‐time position management system (RPM: Palo Alto, CA). In addition, Bruzzaniti et al (11) reported that the mean dose was reduced from 168 cGy to 124 cGy for the heart and from 901 cGy to 274 cGy for LAD with DIBH, while the minimum distance between the heart and the target volume was increased from 14.3 mm with FB to 26.2 mm with DIBH (11.9 mm separation).…”

Section: Introductionmentioning

confidence: 99%

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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

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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

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“…IMRT has widened the horizons of radiation therapy due to its ability to conform radiation dose distributions to complex tumor target volumes while sparing nearby critical structures as much as physically possible. The use of IMRT to treat prostate cancer improves the overall survival and disease-free survival rates (3). Furthermore, compared with traditional three-dimensional conformal radiotherapy, IMRT improves normal tissue sparing in prostate cancer therapy, without compromising the dose delivered to the target (4).…”

Section: Introductionmentioning

confidence: 99%

Use of a correlation analysis model in the optimization of intensity-modulated radiotherapy of prostate cancer

Deng

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to develop a statistical model-based method for the optimization of intensity-modulated radiotherapy (IMRT). A prostate cancer IMRT plan was redesigned while retaining the same beam orientation and prescribed dose as the regular plan. A series of dosimetric parameters were generated, and a 4-step protocol was performed to analyze the data: i) The tumor control probability of the target was ensured by setting a number of strict constraint parameters so that much of the target was covered by the 95% isodose line; ii) the parameters for optimization [weight ratio, equivalent characteristic parameter a and maximum equivalent uniform dose of the organ at risk (OAR)] were adjusted; iii) the overall optimization space (OOS) was determined via analysis of the dose-parameter tables based on the correlation factor (CF) and optimization efficiency factor analysis; iv) the OOS in the Pinnacle V 7.6 treatment planning system with IMRT function was transposed. A selected optimization phenomenon existed when different optimization methods were used to optimize dose distribution to the targets and OARs, which demonstrates a wide variation in the CFs between the percentage of planning target volume receiving 95% of the prescribed dose and the maximum dose of the bladder, rectum and femur. The OOS used to optimize the randomly selected plan exhibited relatively high efficiency, with benefits for the optimization of IMRT plans. For patients with prostate cancer who require complex IMRT plan optimization, the obtained OOS from the two core analysis techniques is likely to have relatively high efficiency in achieving an optimized plan. These results suggest that the correlation analysis model is a novel method for the optimization of IMRT for prostate cancer. IntroductionProstate cancer is one of the leading causes of cancer-related mortality in men worldwide. It has been estimated that ~218,000 men were diagnosed with prostate cancer in the United States in 2010, while >32,000 succumbed to the disease (1). Intensity-modulated radiotherapy (IMRT) and image-guided source placement (2) are often used in the treatment of prostate cancer. IMRT has widened the horizons of radiation therapy due to its ability to conform radiation dose distributions to complex tumor target volumes while sparing nearby critical structures as much as physically possible. The use of IMRT to treat prostate cancer improves the overall survival and disease-free survival rates (3). Furthermore, compared with traditional three-dimensional conformal radiotherapy, IMRT improves normal tissue sparing in prostate cancer therapy, without compromising the dose delivered to the target (4). To be effective, however, the implementation of IMRT requires accurate targeting of the prostate and the selection of appropriate treatment parameters.Wu Q et al (4) used equivalent uniform dose (EUD)-based optimization to obtain intensity-modulated radiotherapy plans for prostate and head-and-neck cancer patients and compared them with the co...

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Dosimetric and clinical advantages of deep inspiration breath-hold (DIBH) during radiotherapy of breast cancer

Cited by 110 publications

References 28 publications

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

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

Use of a correlation analysis model in the optimization of intensity-modulated radiotherapy of prostate cancer

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