Factors Affecting Mean Heart Dose in Patients Receiving Breast Radiotherapy from 2011 to 2018 in a Single Institution

Razvi, Yasmeen; McKenzie, Erin; Wronski, Matt; Zhang, Liying; Vesprini, Danny; Bosnic, Sandi; Paszat, Lawrence; Rakovitch, Eileen; Drost, Leah; Yee, Caitlin; Russell, Steve; McCann, Claire; Chow, Edward

doi:10.1016/j.jmir.2020.03.003

Cited by 2 publications

References 19 publications

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Variation of heart and lung radiation doses according to setup uncertainty in left breast cancer

2021

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Purpose Breast radiotherapy set-up is often uncertain. Actual dose distribution to normal tissues could be different from planned dose distribution. The objective of this study was to investigate such difference in dose distribution according to the extent of set-up error in breast radiotherapy. Materials and methods A total of 50 Gy with fraction size of 2 Gy was given to 30 left breasts with different set-ups applying a deep inspiration breath holding (DIBH) or a free breathing (FB) technique. Under the assumption that errors might come from translational axes of deep or caudal directions, the isocenter was shifted from the original tangential alignment every 2.5 mm to simulate uncertainty of deep and caudal tangential set-up in DIBH and FB. Changes were evaluated for dosimetric parameters for the heart, the left ventricle (LV), the left anterior descending coronary artery (LAD), and the ipsilateral lung. Results On the original plan, mean doses of heart and ipsilateral lung were 2.0 ± 1.1 Gy and 3.7 ± 1.4 Gy in DIBH and 8.4 ± 1.3 Gy and 7.8 ± 1.5 Gy in FB, respectively. The change of dose distribution for the heart in DIBH was milder than that in FB. The deeper the tangential set-up, the worse the heart, LV, LAD, and ipsilateral lung doses, showing as much as 49.4%, 56.4%, 90.3%, and 26.1% shifts, respectively, in 5 mm DIBH setup. The caudal set-up did not show significant dose difference. In multiple comparison of DIBH, differences of mean dose occurred in all 7.5 mm deep set-ups for the heart (p = 0.025), the LV (p = 0.049), and LAD (p = 0.025) in DIBH. Conclusions To correct set-up error over indicated limitation for deep tangential set-up in DIBH at 5 mm action level, mean heart and ipsilateral lung doses are expected to increase approximately 50% and 25%, respectively.

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Variation of heart and lung radiation doses according to setup uncertainty in left breast cancer

2021

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Deep Inspiration Breath Hold versus Free Breathing in Postoperative Radiotherapy Strategy for Patients with Left-sided Breast Cancer Treated with Volumetric Modulated Arc Therapy: A Meta-analysis and Systematic Review

Chiang,

Huang,

Hung

et al. 2024

Preprint

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Background This meta-analysis aimed to determine the effect of deep inspiration breath hold (DIBH) compared with free breathing (FB) on dose to the organs at risk (OARs), such as the heart, left anterior descending (LAD) coronary artery, lungs, and contralateral breast, in patients with left-sided breast cancer treated with volumetric modulated arc therapy (VMAT). Methods Pubmed, EMBASE, and Cochrane Library electronic databases were searched for studies until March 21, 2024. Cochrane RevMan version 5.4 statistical software was used to analyze 11 eligible studies. Standard mean difference (SMD), with 95% confidence interval for OAR dose reductions, was calculated. Results DIBH considerably resulted in lower mean doses (Dmean) to the heart (SMD =. −1.40 Gy), LAD (SMD = − 1.65 Gy), ipsilateral lung (SMD = − 0.57 Gy), contralateral lung (SMD = − 0.46 Gy), and contralateral breast (SMD = − 0.20 Gy). If VMAT was delivered with an arc of > 180%, the heart Dmean reduction was even more pronounced. Subgroup analysis revealed that DIBH efficiently reduced heart Dmean, especially in patients with tumor bed boost without nodal irradiation. Conclusions DIBH was effective in reducing dose to OARs in patients treated with VMAT in all subgroups, i.e., breast only, with/without tumor bed boost, and with/without nodal irradiation. Furthermore, the use of DIBH is strongly recommended for patients undergoing VMAT with a tumor bed boost or without nodal irradiation, as it is more effective in reducing heart Dmean than FB.

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Factors Affecting Mean Heart Dose in Patients Receiving Breast Radiotherapy from 2011 to 2018 in a Single Institution

Cited by 2 publications

References 19 publications

Variation of heart and lung radiation doses according to setup uncertainty in left breast cancer

Variation of heart and lung radiation doses according to setup uncertainty in left breast cancer

Deep Inspiration Breath Hold versus Free Breathing in Postoperative Radiotherapy Strategy for Patients with Left-sided Breast Cancer Treated with Volumetric Modulated Arc Therapy: A Meta-analysis and Systematic Review

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