Left‐sided breast cancer loco‐regional radiotherapy with deep inspiration breath‐hold: Does volumetric‐modulated arc radiotherapy reduce heart dose further compared with tangential intensity‐modulated radiotherapy?

Pham, Toan M.; Ward, Rachel; Latty, Drew; Owen, Catherine J.; Gebski, Val; Chojnowski, Jacek M.; Kelly, Christopher; Ahern, Verity; Tiver, K. W.; Stuart, Kirsty; Wang, Wei

doi:10.1111/1754-9485.12459

Cited by 52 publications

(51 citation statements)

References 29 publications

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“…Anyway, breathing control has been used to minimize heart dose but it may also reduce uncertainties due to breathing movements. Several studies with arc therapy have been published 22, 47, 48, 49. The team of the Oncology Institute of Southern Switzerland reported the first preclinical experience for breast treatment with VMAT and breathing control 50…”

Section: Discussionmentioning

confidence: 99%

Safety and benefit of using a virtual bolus during treatment planning for breast cancer treated with arc therapy

Tyran

Tallet

Resbeut

et al. 2018

J Applied Clin Med Phys

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PurposeThis study evaluates the benefit of a virtual bolus method for volumetric modulated arc therapy (VMAT) plan optimization to compensate breast modifications that may occur during breast treatment.MethodsTen files were replanned with VMAT giving 50 Gy to the breast and 47 Gy to the nodes within 25 fractions. The planning process used a virtual bolus for the first optimization, then the monitors units were reoptimized without bolus, after fixing the segments shapes. Structures and treatment planning were exported on a second scanner (CT) performed during treatment as a consequence to modifications in patient's anatomy. The comparative end‐point was clinical target volume's coverage. The first analysis compared the VMAT plans made using the virtual bolus method (VB‐VMAT) to the plans without using it (NoVB‐VMAT) on the first simulation CT. Then, the same analysis was performed on the second CT. Finally, the level of degradation of target volume coverage between the two CT using VB‐VMAT was compared to results using a standard technique of forward‐planned multisegment technique (Tan‐IMRT).ResultsUsing a virtual bolus for VMAT does not degrade dosimetric results on the first CT. No significant result in favor of the NoVB‐VMAT plans was noted. The VB‐VMAT method led to significant better dose distribution on a second CT with modified anatomies compared to NoVB‐VMAT. The clinical target volume's coverage by 95% (V95%) of the prescribed dose was 98.9% [96.1–99.6] on the second CT for VB‐VMAT compared to 92.6% [85.2–97.7] for NoVB‐VMAT (P = 0.0002). The degradation of the target volume coverage for VB‐VMAT is not worse than for Tan‐IMRT: the median differential of V95% between the two CT was 0.9% for VMAT and 0.7% for Tan‐IMRT (P = 1).ConclusionThis study confirms the safety and benefit of using a virtual bolus during the VMAT planning process to compensate potential breast shape modifications.

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Section: Discussionmentioning

confidence: 99%

Safety and benefit of using a virtual bolus during treatment planning for breast cancer treated with arc therapy

Tyran

Tallet

Resbeut

et al. 2018

J Applied Clin Med Phys

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“…In the literature, there are limited data of LAD doses during breast irradiation, with only two published reports considering multi-catheter high-dose-rate BT (HDR-BT) as a form of APBI [13, 14, 15, 16, 17, 18, 19, 20, 21] (Table 5). Chan et al .…”

Section: Discussionmentioning

confidence: 99%

“…In WBRT for left-sided breast cancer, the LAD dose distribution varied among studies and depended on the technique used, being the highest with free-breathing (FB) CRT [13, 16, 18, 21]. Techniques to reduce cardiac irradiation dose include two-tangential or multi-beam intensity-modulated RT (IMRT), prone positioning, and breath holding techniques.…”

Section: Discussionmentioning

confidence: 99%

“…In terms of LAD dose, D mean of the LAD for prone position is substantially lower compared to supine position, but at the expense of a higher MHD. Volumetric-modulated arc radiotherapy (VMAT) resulted in a significant further reduction in both D mean and D max of the LAD compared with tangential IMRT, based on deep inspiration breath-hold (DIBH) [18]. Plans based on DIBH resulted in a dose reduction compared with FB for all heart and LAD parameters.…”

Section: Discussionmentioning

confidence: 99%

“…In this series, the maximal dose for LAD with 5 mm margin was on average 1.99 Gy, and ranged from 1% to 75% of the tumor dose. Given the geometric uncertainties, it was postulated to consider all cardiac dose parameters including V 4Gy and V 25Gy , along with MHD, when assessing the risk of future cardiac morbidity [18]. For interstitial BT with the use of both metal and plastic catheters, the planning system applied was demonstrated to influence the dose to various volumes of interest [29, 30].…”

Section: Discussionmentioning

confidence: 99%

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Radiation dose to the left anterior descending coronary artery during interstitial pulsed-dose-rate brachytherapy used as a boost in breast cancer patients undergoing organ-sparing treatment

Sinacki

Serkies

Dziadziuszko

et al. 2017

jcb

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PurposeTo assess dose received by the left anterior descending (LAD) coronary artery during interstitial pulsed-dose-rate brachytherapy (PDR-BT) boost for left-sided breast cancer patients undergoing organ-sparing treatment.Material and methodsThirty consecutive pT1-3N0-1M0 breast cancer patients boosted between 2014 and 2015 with 10 Gy/10 pulses/hour PDR-BT following a computed tomography (CT) simulation with the multi-catheter implant were included. The most common localization of primary tumor were upper quadrants. Patients were implanted with rigid tubes following breast conserving surgery and whole breast external beam irradiation (40 Gy/15 or 50 Gy/25 fractions). Computed tomography scans were retrospectively reviewed and LADs were contoured without and with margin of 5 mm (LAD5mm). Standard treatment plan encompassed tumor bed determined by the surgical clips with margin of 2 cm. Dosimetric parameters were extracted from the dose-volume histograms.ResultsThe mean D90 and V100 were 10.3 Gy (range: 6.6-13.3), and 42.0 cc (range: 15.3-109.3), respectively. The median dose non-uniformity ratio (DNR) was 0.50 (range: 0.27-0.82). The mean doses to LAD and LAD5mm were 1.0 Gy and 0.96 Gy, and maximal doses were 1.57 Gy and 1.99 Gy, respectively. Dose to the 0.1 cc of the LAD and LAD5mm were 1.42 Gy and 1.85 Gy (range: 0.01-4.98 Gy and 0.1-6.89 Gy), respectively.ConclusionsInterstitial multi-catheter PDR-BT used as a boost for left-sided breast cancer is generally associated with low dose to the LAD. However, higher dose in individual cases may require alternative approaches.

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Reduction of cardiac and coronary artery doses in irradiation of left-sided breast cancer during inspiration breath hold

et al. 2016

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Left‐sided breast cancer loco‐regional radiotherapy with deep inspiration breath‐hold: Does volumetric‐modulated arc radiotherapy reduce heart dose further compared with tangential intensity‐modulated radiotherapy?

Abstract: On average, there was no significant difference in MHD between VMAT-DIBH and t-IMRT-DIBH. However, VMAT-DIBH was found to benefit a select group of patients. For patients in whom the MHD was >6.3 Gy with t-IMRT-DIBH, the use of VMAT-DIBH resulted in a benefit in reducing the MHD.

Cited by 52 publications

References 29 publications

Safety and benefit of using a virtual bolus during treatment planning for breast cancer treated with arc therapy

Safety and benefit of using a virtual bolus during treatment planning for breast cancer treated with arc therapy

Radiation dose to the left anterior descending coronary artery during interstitial pulsed-dose-rate brachytherapy used as a boost in breast cancer patients undergoing organ-sparing treatment

Reduction of cardiac and coronary artery doses in irradiation of left-sided breast cancer during inspiration breath hold

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