Prospective assessment of deep inspiration breath-hold using 3-dimensional surface tracking for irradiation of left-sided breast cancer

Tanguturi, Shyam; Lyatskaya, Yulia; Chen, Yuhui; Catalano, Paul J.; Chen, Ming Hui; Yeo, Wee-Pin; Marques, Alex; Truong, Linh; Yeh, Mary J.; Orlina, Lawrence; Wong, Julia S.; Punglia, Rinaa S.; Bellon, Jennifer R.

doi:10.1016/j.prro.2015.06.002

Cited by 55 publications

(35 citation statements)

References 29 publications

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“…In addition, strict optimisation constraints and strategic beam placement may minimise low doses in the ipsilateral lung. Finally, lung dose can be reduced using breathing adaptation [25] . Historically this has been used to reduce cardiac exposure [24] but our study suggests that it also reduces lung exposure, with the magnitude of the gain increasing with more extensive regions irradiated ( Fig.…”

Section: Discussionmentioning

confidence: 99%

Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010–2015

Aznar

Duane

Darby

et al. 2018

Radiotherapy and Oncology

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Background and purposeWe report a systematic review of lung radiation doses from breast cancer radiotherapy.Methods and materialsStudies describing breast cancer radiotherapy regimens published during 2010–2015 and reporting lung dose were included. Doses were compared between different countries, anatomical regions irradiated, techniques and use of breathing adaptation.Results471 regimens from 32 countries were identified. The average mean ipsilateral lung dose (MLDipsi) was 9.0 Gy. MLDipsi for supine radiotherapy with no breathing adaption was 8.4 Gy for whole breast/chest wall (WB/CW) radiotherapy, 11.2 Gy when the axilla/supraclavicular fossa was irradiated, and 14.0 Gy with the addition of internal mammary chain irradiation; breathing adaptation reduced MLDipsi by 1 Gy, 2 Gy and 3 Gy respectively (p < 0.005). For WB/CW radiotherapy, MLDipsi was lowest for tangents in prone (1.2 Gy) or lateral decubitus (0.8 Gy) positions. The highest MLDipsi was for IMRT in supine position (9.4 Gy).The average mean contralateral lung dose (MLDcont) for WB/CW radiotherapy was higher for IMRT (3.0 Gy) than for tangents (0.8 Gy).ConclusionsLung doses from breast cancer radiotherapy varied substantially worldwide, even between studies describing similar regimens. Lymph node inclusion and IMRT use increased exposure, while breathing adaptation and prone/lateral decubitus positioning reduced it.

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Section: Discussionmentioning

confidence: 99%

Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010–2015

Aznar

Duane

Darby

et al. 2018

Radiotherapy and Oncology

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“…Therefore, consideration should be made to measure these distances on the free-breathing scan and use them as predictive factors for patients who should be selected for DIBH. Within patients who undergo DIBH, patients who have the greatest change in lung volumes between DIBH and free-breathing scans tend to derive the greatest benefit from DIBH in terms of heart dose ( 54 ). Despite this, at least 75% of patients who undergo DIBH appear to derive benefit due to decreased heart dose ( 53 ).…”

Section: Advantages Of Dibh and Patient Selectionmentioning

confidence: 99%

Deep Inspiration Breath Hold: Techniques and Advantages for Cardiac Sparing During Breast Cancer Irradiation

et al. 2018

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Historically, heart dose from left-sided breast radiotherapy has been associated with a risk of cardiac injury. Data suggests that there is not a threshold for the deleterious effects from radiation on the heart. Over the past several years, advances in radiation delivery techniques have reduced cardiac morbidity due to treatment. Deep inspiration breath hold (DIBH) is a technique that takes advantage of a more favorable position of the heart during inspiration to minimize heart doses over a course of radiation therapy. In the accompanying review article, we outline several methods used to deliver treatment with DIBH, quantify the benefits of DIBH treatment, discuss considerations for patient selection, and identify challenges associated with DIBH techniques.

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“…Several reports have shown that DIBH radiotherapy (RT) is a feasible alternative and has the potential of decreasing the lung dose in conventional three-dimensional conformal radiotherapy (3D-CRT) [7][8][9] and also with volumetric modulated arc therapy (VMAT) [10]. Furthermore, DIBH RT does not acquire a lot of time [11] or economical resources for implementation.We previously reported preliminary results from the first 10 patients included in this study and found a statistically significant reduction of mean lung dose with DIBH 3D-CRT as well as with VMAT in patients with locally advanced NSCLC [12]. The combination of DIBH and VMAT reduced these parameters further and DIBH mitigated the low dose bath induced by VMAT.…”

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confidence: 99%

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confidence: 99%

Deep inspiration breath-hold volumetric modulated arc radiotherapy decreases dose to mediastinal structures in locally advanced lung cancer

et al. 2016

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The phase III dose escalation trial RTOG 0617 [4] showed that heart dose parameters were correlated to death in a multivariate analysis and in a dose escalation trial by Cannon et al.[5] serious late toxicity from central and perihilar structures was encountered. In breast cancer radiotherapy a large population-based case-control study showed an increased risk of major cardiac events with increasing heart dose [6]. During deep inspiration breath-hold (DIBH), the lungs are inflated and the heart displaced caudally and these anatomical changes can be exploited to achieve a lower radiation dose to the intra-thoracic normal tissue. Several reports have shown that DIBH radiotherapy (RT) is a feasible alternative and has the potential of decreasing the lung dose in conventional three-dimensional conformal radiotherapy (3D-CRT) [7][8][9] and also with volumetric modulated arc therapy (VMAT) [10]. Furthermore, DIBH RT does not acquire a lot of time [11] or economical resources for implementation.We previously reported preliminary results from the first 10 patients included in this study and found a statistically significant reduction of mean lung dose with DIBH 3D-CRT as well as with VMAT in patients with locally advanced NSCLC [12]. The combination of DIBH and VMAT reduced these parameters further and DIBH mitigated the low dose bath induced by VMAT.Most previous studies have focused on dose to the lungs and none of them have reported on dose to bronchi and trachea. In this final report, we examine if DIBH-VMAT holds potential to decrease doses to mediastinal organs at risk (OAR) compared to free breathing (FB) VMAT. Material and methodsSeventeen patients with locally advanced NSCLC were included prospectively from April 2012 to September 2013. Inclusion criteria were ability to perform a voluntary breathhold for 20 seconds and to follow the audio-visual coaching instructions. All patients were treated in FB. The delineations and treatment planning was performed retrospectively.The study was approved by the local ethical committee (H-2-2011-153). Patient characteristics are listed in Supplementary Table 1S (available online at http://www.informahealthcare. com).The patients were audio visually coached to hold their breath at a comfortable level of deep inspiration for 20 seconds at a time during a 15-minute session. The Realtime Position Management TM system (VarianV R Medical Systems) was used to track and record the respiratory signal. The planning procedure included a FB positron emission tomography (PET)/computed tomography (CT) (with 18-Fluorodeoxyglucose tracer), a respiration correlated CT (4D-CT) and three consecutive audio-visual coached DIBH-CT scans (for registration of intra-fraction variation). The mid-ventilation phase (MidV) [13] of the 4D-CT was selected for the FB plan and the first acquired DIBH-CT for the DIBH plan.To minimize observer variations, the gross tumor volume (GTV) delineations were performed after a strict protocol, with the same radiologist contouring on both the MidV and the DIBH-CT fo...

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Prospective assessment of deep inspiration breath-hold using 3-dimensional surface tracking for irradiation of left-sided breast cancer

Cited by 55 publications

References 29 publications

Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010–2015

Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010–2015

Deep Inspiration Breath Hold: Techniques and Advantages for Cardiac Sparing During Breast Cancer Irradiation

Deep inspiration breath-hold volumetric modulated arc radiotherapy decreases dose to mediastinal structures in locally advanced lung cancer

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