Image-Guided Radiotherapy for Cardiac Sparing in Patients with Left-Sided Breast Cancer

Lemanski, C.; Thariat, Juliette; Ampil, Federico L.; Bose, S.; Vock, Jacqueline; Davis, Robert S.; Chi, Alexander; Dutta, Suresh; Woods, William G.; Desai, Anand; Godinez, Juan; Karlsson, Ulf; Mills, Melissa; Nguyen, Nam P.; Vinh-Hung, Vincent

doi:10.3389/fonc.2014.00257

Cited by 21 publications

(16 citation statements)

References 34 publications

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“…A good number of technical procedures seeking to find the best trade-off between side effects and tumor control are actively pursued [15][16][17][18][19][20]. This subject matter is even more relevant when considering treatment optimization for left-sided breast cancer [21][22][23][24][25][26][27][28]. A prone setup has been advocated to spare the left lung and the heart when irradiating such patients.…”

Section: Introductionmentioning

confidence: 99%

Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis

et al. 2021

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Purpose The advantage of prone setup compared with supine for left-breast radiotherapy is controversial. We evaluate the dosimetric gain of prone setup and aim to identify predictors of the gain. Methods Left-sided breast cancer patients who had dual computed tomography (CT) planning in prone free breathing (FB) and supine deep inspiration breath-hold (DiBH) were retrospectively identified. Radiation doses to heart, lungs, breasts, and tumor bed were evaluated using the recently developed mean absolute dose deviation (MADD). MADD measures how widely the dose delivered to a structure deviates from a reference dose specified for the structure. A penalty score was computed for every treatment plan as a weighted sum of the MADDs normalized to the breast prescribed dose. Changes in penalty scores when switching from supine to prone were assessed by paired t-tests and by the number of patients with a reduction of the penalty score (i.e., gain). Robust linear regression and fractional polynomials were used to correlate patients’ characteristics and their respective penalty scores. Results Among 116 patients identified with dual CT planning, the prone setup, compared with supine, was associated with a dosimetric gain in 72 (62.1%, 95% CI: 52.6–70.9%). The most significant predictors of a gain with the prone setup were the breast depth prone/supine ratio (>1.6), breast depth difference (>31 mm), prone breast depth (>77 mm), and breast volume (>282 mL). Conclusion Prone compared with supine DiBH was associated with a dosimetric gain in 62.1% of our left-sided breast cancer patients. High pendulousness and moderately large breast predicted for the gain.

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Section: Introductionmentioning

confidence: 99%

Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis

et al. 2021

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“…For example, when the isocenter is in the middle of the breast instead of the chest wall, 13 the result can be greater setup and interfractional variations. 11 Based on the studies of setup accuracy with different image assessment methods 14 and of cardiac sparing in left-sided breast cancer, 15,16 daily image guidance is usually required.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric effects of the kV based image‐guided radiation therapy of prone breast external beam radiation: Towards the optimized imaging frequency

Lee

Guerrero

et al. 2018

J Applied Clin Med Phys

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PurposeFor prone breast treatment, daily image‐guided radiation therapy (IGRT) allows couch shifting to correct breast position relative to the treatment field. This work investigates the dosimetric effect of reducing kV imaging frequencies and the feasibility of optimizing the frequency using patient anatomy or their first 3‐day shifts.MethodThirty‐seven prone breast patients who had been treated with skin marker alignment followed by daily kV were retrospectively analyzed. Three IGRT schemes (daily‐kV, weekly‐kV, no‐kV) were simulated, assuming that fractions with kV imaging deliver a dose distribution equivalent to that in computed tomography (CT) planning, whereas other fractions yield a dose distribution as recreated by shifting the CT plan isocenter back to its position before the couch shift was applied. Treatment dose to targets (breast and lumpectomy cavity [LPC]) and organs at risks (OAR)s (heart, ipsilateral lung) in different schemes were calculated. Patient anatomy information on CT plans and first 3‐day couch shift data were analyzed to investigate whether these factors could guide imaging scheme optimization.ResultsWhen kV imaging frequency was reduced, the percentage dose changes (δD) for breast and LPC objectives (average <1%) were smaller than those for heart and lung (average 28%–31% for Dmean). In general, the δD of no‐kV imaging was approximately that of weekly kV imaging × a factor of 1.2–1.4. Although most dose objectives were not affected, the potential higher heart dose may be of concern. No strong correlation was found between δD for different kV frequencies and patient anatomy size/distance or the first 3‐day couch shift data.ConclusionsDespite resulting in lower imaging dose, time, cost, and similar target coverage, a reduction in kV imaging frequency may introduce higher heart complication risk. Daily kVs are needed more in left‐sided breast patients. A less frequent imaging schedule, if considered, cannot be individually optimized using CT anatomic features or early shift data.

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“…To reduce lung irradiation dose, other techniques, such as non-continuous partial arc [25] and hybrid 3D-CRT/IMRT, are used. The dosimetry of patients with left breast cancer have been discussed in many literatures [26][27][28][29][30] to avoid unnecessary radiotherapy to the tissues of the heart. However, studies on the dosimetry of right breast radiotherapy were limited.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric Comparison of Intensity-Modulated Radiotherapy, Volumetric Modulated Arc Therapy and Hybrid Three-Dimensional Conformal Radiotherapy/Intensity-Modulated Radiotherapy Techniques for Right Breast Cancer

Liu

Chang²,

Lin

et al. 2020

JCM

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This study aimed to compare different types of right breast cancer radiotherapy planning techniques and to estimate the whole-body effective doses and the critical organ absorbed doses. The three planning techniques are intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT; two methods) and hybrid 3D-CRT/IMRT (three-dimensional conformal radiotherapy/intensity-modulated radiotherapy). The VMAT technique includes two methods to deliver a dose: non-continuous partial arc and continuous partial arc. A thermoluminescent dosimeter (TLD) is placed in the RANDO phantom to estimate the organ absorbed dose. Each planning technique applies 50.4 Gy prescription dose and treats critical organs, including the lung and heart. Dose-volume histogram was used to show the planning target volume (V95%), homogeneity index (HI), conformity index (CI), and other optimized indices. The estimation of whole-body effective dose was based on the International Commission on Radiation Protection (ICRP) Publication 60 and 103. The results were as follows: Continuous partial arc and non-continuous partial arc showed the best CI and HI. The heart absorbed doses in the continuous partial arc and hybrid 3D-CRT/IMRT were 0.07 ± 0.01% and 0% (V5% and V10%, respectively). The mean dose of the heart was lowest in hybrid 3D-CRT/IMRT (1.47 Gy ± 0.02). The dose in the left contralateral lung (V5%) was lowest in continuous partial arc (0%). The right ipsilateral lung average dose and V20% are lowest in continuous partial arc. Hybrid 3D-CRT/IMRT has the lowest mean dose to contralateral breast (organs at risk). The whole-body effective doses for ICRP-60 and ICRP-103 were highest in continuous partial arc (2.01 Sv ± 0.23 and 2.89 Sv ± 0.15, respectively). In conclusion, the use of VMAT with continuous arc has a lower risk of radiation pneumonia, while hybrid 3D-CRT/IMRT attain lower secondary malignancy risk and cardiovascular complications.

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Image-Guided Radiotherapy for Cardiac Sparing in Patients with Left-Sided Breast Cancer

Cited by 21 publications

References 34 publications

Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis

Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis

Dosimetric effects of the kV based image‐guided radiation therapy of prone breast external beam radiation: Towards the optimized imaging frequency

Dosimetric Comparison of Intensity-Modulated Radiotherapy, Volumetric Modulated Arc Therapy and Hybrid Three-Dimensional Conformal Radiotherapy/Intensity-Modulated Radiotherapy Techniques for Right Breast Cancer

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