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

Schönecker, S.; Heinz, C.; Söhn, Matthias; Haimerl, Wolfgang; Corradini, Stefanie; Pazos, Montserrat; Belka, Claus; Scheithauer, Heike

doi:10.1007/s00066-016-1039-z

Cited by 14 publications

(6 citation statements)

References 48 publications

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“…Our results confirm the general strong benefit of prone positioning on lung dose [29], which was reduced from 7.6% of the prescribed dose in supine position to 1.9% in prone, and the benefit of DiBH with regard to the mean heart dose [22,23], which was reduced from 3.4% prone to 1.9% supine.…”

Section: Discussionsupporting

confidence: 84%

“…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%

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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: Discussionsupporting

confidence: 84%

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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“…Daily online verification and correction of the patient positioning error prior to radiotherapy were performed for all patients using orthogonal megavoltage electronic portal images [11]. No respiratory gating [12–14], integrated boost [15, 16], or partial breast irradiation [17] techniques were applied in this study. Two tangential semi-opposed beams, physical wedges (usually 15° or 30°), a 160 MLC Multileaf Collimator and 6 MV photons were used for the IMRT and 3DCRT plans.…”

Section: Methodsmentioning

confidence: 99%

Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy

et al. 2017

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BackgroundThe aim of the study was to identify factors significantly associated with the occurrence of unintended treatment interruptions in adjuvant breast cancer radiotherapy.Patients and methodsPatients treated with postoperative radiotherapy of the breast or chest wall between March 2014 and August 2016 were evaluated. The radiotherapy regimens and techniques applied were either conventional fractionation (CF; 28 daily fractions of 1.8 Gy or 25 fractions of 2.0 Gy) or hypofractionation (HF; 15 daily fractions of 2.67 Gy) with inverse planned intensity-modulated radiotherapy (IMRT) or three-dimensional planned conformal radiotherapy (3DCRT). Logistic regression analysis was used to identify factors associated with noncompliance. Noncompliance was defined as the missing of at least one scheduled radiotherapy fraction.ResultsIn all, 19 of 140 (13.6%) patients treated with HF and 39 of 146 (26.7%) treated with CF experienced treatment interruptions. Of 23 factors tested, the fractionation regimen emerged as the only independent significant prognostic factor for noncompliance on multivariate analysis (CF; p = 0.007; odds ratio, 2.3; 95% confidence interval, 1.3–4.2). No statistically significant differences concerning the reasons for treatment interruptions could be detected between patients treated with CF or HF.ConclusionHF is significantly associated with a better patient compliance with the prescribed radiotherapy schedule compared with CF. The data suggest that this finding is basically related to the shorter overall treatment time of HF.

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“…Regarding radiation-induced cardiac morbidity, in 2013, Darby et al [21] found a relative risk for major coronary events of 7.4% (95% CI 2.9–14.5) per every 1 Gy increase in MCD. As a result, new alternative treatment techniques, such as respiratory-gated radiotherapy using the DIBH technique or IMRT-VMAT techniques, have been introduced into clinical practice to reduce heart and lung exposure [18, 39, 40]. In a recent risk modelling study, Simonetto et al [19] showed that heart-sparing techniques should be offered to all patients who have high cardiac risks at baseline, a high dose exposure of the heart, or a favourable tumour prognosis, regardless of their age at diagnosis.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Mammary Chain Irradiation in Left-Sided Breast Cancer: Can We Reduce the Risk of Secondary Cancer and Ischaemic Heart Disease with Modern Intensity-Modulated Radiotherapy Techniques?

et al. 2020

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Introduction: The aim of the present study was to estimate the impact of the addition of internal mammary chain (IMC) irradiation in node-positive left-sided breast cancer (BC) patients undergoing regional nodal irradiation (RNI) and comparatively evaluate excess relative and absolute risks of radiation-induced lung cancer/BC and ischaemic heart disease for intensity-modulated radiotherapy (IMRT) versus 3D conformal radiotherapy (3D-CRT). Methods: Four treatment plans were created (3D-CRT and IMRT –/+ IMC) for each of the 10 evaluated patients, and estimates of excess relative risk (ERR) and 10-year excess absolute risk (EAR) were calculated for radiation-induced lung cancer/BC and coronary events using linear, linear-exponential and plateau models. Results: The addition of IMC irradiation to RNI signiﬁcantly increased the dose exposure of the heart, lung and contralateral breast using both techniques, increasing ERR for secondary lung cancer (58 vs. 44%, p = 0.002), contralateral BC (49 vs. 31%, p = 0.002) and ischaemic heart disease (41 vs. 27%, p = 0.002, IMRT plans). IMRT signiﬁcantly reduced the mean cardiac dose and mean lung dose as compared to 3D-CRT, decreasing ERR for major coronary events (64% 3D-CRT vs. 41% IMRT, p = 0.002) and ERR for secondary lung cancer (75 vs. 58%, p = 0.004) in IMC irradiation, without a significant impact on secondary contralateral BC risks. Conclusion: Although IMC irradiation has been shown to increase survival rates in node-positive BC patients, it increased dose exposure of organs at risk in left-sided BC, resulting in significantly increased risks for secondary lung cancer/contralateral BC and ischaemic heart disease. In this setting, the adoption of IMRT seems advantageous when compared to 3D-CRT.

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

Abstract: For left-sided breast cancer patients, cardiac doses can be significantly decreased with tangential irradiation and IBH.

Cited by 14 publications

References 48 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

Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy

Mammary Chain Irradiation in Left-Sided Breast Cancer: Can We Reduce the Risk of Secondary Cancer and Ischaemic Heart Disease with Modern Intensity-Modulated Radiotherapy Techniques?

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