Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Jensen, Christer André; Абрамова, Т. Я.; Frengen, Jomar; Lund, Jo‐Åsmund

doi:10.1002/acm2.12137

Cited by 26 publications

(22 citation statements)

References 41 publications

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“…The case for utilising DIBH in right-sided breast plus regional node radiotherapy is supported by its ease of use, reproducibility and cost-effectiveness. Commercial [10, 31], non-commercial [32] and combination [33, 34] DIBH solutions yield systematic and random set-up errors of approximately 2 mm or less [10, 11, 35]. The addition of DIBH to breast radiotherapy can be expected to extend treatment appointments by three to five minutes, with minimal changes to overall patient throughout reported [33].…”

Section: Discussionmentioning

confidence: 99%

Dose reduction to organs at risk with deep-inspiration breath-hold during right breast radiotherapy: a treatment planning study

Pandeli¹,

Smyth²,

David³

et al. 2019

Radiat Oncol

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Background: The addition of regional nodal radiation (RNI) to whole breast irradiation for high risk breast cancer improves metastases free survival and new data suggests it contributes additional benefit to overall survival. Deep inspiration breath hold (DIBH) has been shown to reduce cardiac and pulmonary dose in the context of left-sided disease treated with or without RNI, yet few studies have investigated its utility for right-breast cancer. This study investigates the potential advantages of DIBH in local and locoregional radiotherapy for right-sided breast cancer. Methods: Free-breathing (FB) and DIBH computed tomography datasets were obtained from twenty patients who previously underwent radiotherapy for left-sided breast cancer. Ten patients were retrospectively planned for whole right breast only irradiation and ten patients were planned for irradiation to the whole breast plus ipsilateral supraclavicular (SC) nodes, with and without irradiation of the ipsilateral internal mammary nodes (IMN). Dose-volume metrics for the clinical target volume, lungs, heart, left anterior descending artery, right coronary artery (RCA) and liver were recorded. Differences between FB and DIBH plans were analysed using Wilcoxon signed-rank tests, with P < 0.05 considered statistically significant. Results: DIBH increased the average total lung volume compared to FB in both breast only and breast plus RNI cohorts (P = 0.001). For the breast only group, there was no significant improvement in any ipsilateral lung dosevolume metric between FB and DIBH. However, for the breast plus RNI group, there was an improvement in ipsilateral lung mean dose (18.9 ± 3.2 Gy to 15.9 ± 2.3 Gy, P = 0.002) and V20Gy (45.3 ± 13.3% to 32.9 ± 9.4%, P = 0.002). In addition, DIBH significantly reduced the maximum dose to the RCA for RNI (11.6 ± 7.2 Gy to 5.6 ± 2.9 Gy, P = 0.03). Significant reductions in the liver V20Gy and maximum dose were observed in all cohorts during DIBH compared to FB. Conclusions: DIBH is a promising approach for right-breast radiotherapy with considerable sparing of normal tissue, particularly when the ipsilateral IMNs are also irradiated.

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Section: Discussionmentioning

confidence: 99%

Dose reduction to organs at risk with deep-inspiration breath-hold during right breast radiotherapy: a treatment planning study

Pandeli¹,

Smyth²,

David³

et al. 2019

Radiat Oncol

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show abstract

“…A two‐tailed Wilcoxon signed‐rank test for the statistical analysis of each evaluated parameter was used, and the test was considered significant if the P ‐value was <0.05 24 . SPSS version 23 (IBM Corp., Armonk, NY, USA) was used to perform the calculations.…”

Section: Methodsmentioning

confidence: 99%

Free breathing VMAT versus deep inspiration breath‐hold 3D conformal radiation therapy for early stage left‐sided breast cancer

Jensen

Funderud

Lervåg

2021

J Applied Clin Med Phys

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The purpose of the in silico study was to compare free breathing volumetric modulated arc therapy (VMAT) to standard deep inspiration breath‐hold (DIBH) three‐dimensional conformal radiotherapy (3DCRT) and determine whether the former is a viable option for elderly patients with left‐sided early stage breast cancer. Data from 22 patients with early‐stage left breast carcinoma requiring breast‐only radiation therapy were used for this planning study. The robustness of VMAT plans when using the free breathing method was compared to that of standard 3DCRT plans using the DIBH method. The endpoints for evaluation were the target dose coverage as well as doses to the organs‐at‐risk. The free breathing VMAT plans produced a significantly higher mean dose to the heart and right breast than the DIBH‐3DCRT plans. Free breathing VMAT plans resulted in significantly better target coverage than did 3DCRT using DIBH. The external volume that received more than 40 Gy was significantly smaller in the VMAT plans. Free breathing VMAT is a viable alternative to DIBH 3DCRT in elderly patients with a limited life expectancy and in subjects who are unable to perform DIBH. The choice of treatment should be individualized, and all relevant risks ought to be considered.

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“…These techniques differ significantly in terms of the utilized devices, intrafraction monitoring and patient feedback systems. In general, a distinction is made between voluntary or computer-controlled DIBH techniques, such as surface-guided or spirometry-based systems, respectively [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer

et al. 2020

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Purpose: Patients with left-sided breast cancer frequently receive deep inspiration breath-hold (DIBH) radiotherapy to reduce the risk of cardiac side effects. The aim of the present study was to analyze intra-breath-hold stability and inter-fraction breath-hold reproducibility in clinical practice. Material and methods: Overall, we analyzed 103 patients receiving left-sided breast cancer radiotherapy using a surface-guided DIBH technique. During each treatment session the vertical motion of the patient was continuously measured by a surface guided radiation therapy (SGRT) system and automated gating control (beam on/off) was performed using an audiovisual patient feedback system. Dose delivery was automatically triggered when the tracking point was within a predefined gating window. Intra-breath-hold stability and inter-fraction reproducibility across all fractions of the entire treatment course were analyzed per patient. Results: In the present series, 6013 breath-holds during beam-on time were analyzed. The mean amplitude of the gating window from the baseline breathing curve (maximum expiration during free breathing) was 15.8 mm (95%confidence interval: [8.5-30.6] mm) and had a width of 3.5 mm (95%-CI: [2-4.3] mm). As a measure of intra-breathhold stability, the median standard deviation of the breath-hold level during DIBH was 0.3 mm (95%-CI: [0.1-0.9] mm). Similarly, the median absolute intra-breath-hold linear amplitude deviation was 0.4 mm (95%-CI: [0.01-2.1] mm). Reproducibility testing showed good inter-fractional reliability, as the maximum difference in the breathing amplitudes in all patients and all fractions were 1.3 mm on average (95%-CI: [0.5-2.6] mm). Conclusion: The clinical integration of an optical surface scanner enables a stable and reliable DIBH treatment delivery during SGRT for left-sided breast cancer in clinical routine.

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Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Cited by 26 publications

References 41 publications

Dose reduction to organs at risk with deep-inspiration breath-hold during right breast radiotherapy: a treatment planning study

Dose reduction to organs at risk with deep-inspiration breath-hold during right breast radiotherapy: a treatment planning study

Free breathing VMAT versus deep inspiration breath‐hold 3D conformal radiation therapy for early stage left‐sided breast cancer

Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer

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