Voluntary deep inspiration breath-hold reduces the heart dose without compromising the target volume coverage during radiotherapy for left-sided breast cancer

Al-Hammadi, Noora; Caparrotti, Palmira; Naim, Carole; Hayes, Jillian; Benson, Katherine Rebecca; Vasic, Ana; Al-Abdulla, Hissa; Hammoud, R.; Divakar, S.; Petric, Primoz

doi:10.1515/raon-2018-0008

Cited by 22 publications

(15 citation statements)

References 42 publications

(78 reference statements)

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“…The DIBH plans demonstrated significantly larger total lung volume in their study. Differences in the lung dose between FB and DIBH plans were also not significant in the study by Al-Hammadi et al 20 Our study showed there was no significant difference in the Dmean and D50 of lungs between FB and BH plans.…”

Section: Comparison Of Lung Dosecontrasting

confidence: 47%

Evaluation of an in-house self-held respiration monitoring device for deep inspiration breath hold techniques for radiotherapy of patients with cancer of the left breast

Chan¹,

Ku²,

Ng³

et al. 2019

J Radiother Pract

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Background:An in-house self-held respiration monitoring device (SHRMD) was developed for providing deep inspiration breath hold (DIBH) radiotherapy. The use of SHRMD is evaluated in terms of reproducibility, stability and heart dose reduction.Methods and materials:Sixteen patients receiving radiotherapy of left breast cancer were planned for treatment with both a free breathing (FB) scan and a DIBH scan. Both FB and DIBH plans were generated for comparison of the heart, left anterior descending (LAD) artery and lung dose. All patients received their treatments with DIBH using SHRMD. Megavoltage cine images were acquired during treatments for evaluating the reproducibility and stability of treatment position using SHRMD.Results:Compared with FB plans, the maximum dose to the heart by DIBH technique with SHRMD was reduced by 29·9 ± 15·6%; and the maximum dose of the LAD artery was reduced by 41·6 ± 18·3%. The inter-fractional overall mean error was 0·01 cm and the intra-fractional overall mean error was 0·04 cm.Conclusion:This study demonstrated the potential benefits of using the SHRMD for DIBH to reduce the heart and LAD dose. The patients were able to perform stable and reproducible DIBHs.

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Section: Comparison Of Lung Dosecontrasting

confidence: 47%

Evaluation of an in-house self-held respiration monitoring device for deep inspiration breath hold techniques for radiotherapy of patients with cancer of the left breast

Chan¹,

Ku²,

Ng³

et al. 2019

J Radiother Pract

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“…Radiation oncologists implement several methods to decrease IR dose to the heart for minimizing the risk of RACVD (76), such as prone positioning (77), heart block with electronic compensation (57), heart-sparing three-dimensional printing technique (78), continuous positive airway pressure (CPAP) (79), real-time position management (RPM) inspiration gating (80,81), proton-beam irradiation (82)(83)(84)(85), and deep-inspiration breath-hold technique (DIBH) (86)(87)(88)(89)(90). However, even with the highly recommended visual-guided DIBH technique, residual variations of the heart position are still noticeable (91).…”

Section: Clinical Challenges Of Decreasing the Risk Of Racvd In Modermentioning

confidence: 99%

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

Lee

Liu

Hung

et al. 2020

Front. Cardiovasc. Med.

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Radiotherapy (RT) is a crucial treatment modality in managing cancer patients. However, irradiation dose sprinkling to tumor-adjacent normal tissues is unavoidable, generating treatment toxicities, such as radiation-associated cardiovascular dysfunction (RACVD), particularly for those patients with combined therapies or pre-existing adverse features/comorbidities. Radiation oncologists implement several efforts to decrease heart dose for reducing the risk of RACVD. Even applying the deep-inspiration breath-hold (DIBH) technique, the risk of RACVD is though reduced but still substantial. Besides, available clinical methods are limited for early detecting and managing RACVD. The present study reviewed emerging challenges of RACVD in modern radiation oncology, in terms of clinical practice, bench investigation, and multidisciplinary care. Several molecules are potential for serving as biomarkers and therapeutic targets. Of these, miRNAs, endogenous small non-coding RNAs that function in regulating gene expression, are of particular interest because low-dose irradiation, i.e., 200 mGy (one-tenth of conventional RT daily dose) induces early changes of pro-RACVD miRNA expression. Moreover, several miRNAs, e.g., miR-15b and miR21, involve in the development of RACVD, further demonstrating the potential bio-application in RACVD. Remarkably, many RACVDs are late RT sequelae, characterizing highly irreversible and progressively worse. Thus, multidisciplinary care from oncologists and cardiologists is crucial. Combined managements with commodities control (such as hypertension, hypercholesterolemia, and diabetes), smoking cessation, and close monitoring are recommended. Some agents show abilities for preventing and managing RACVD, such as statins and angiotensin-converting enzyme inhibitors (ACEIs); however, their real roles should be confirmed by further prospective trials.

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“…If radiotherapy is delivered in a breath hold, which allows the heart to move down and posterior to the treatment volume, the sparing effect to the heart is even greater. 32 In a study comparing free breathing (FB) with voluntary deep inspiration breath hold (V-DIBH) resulted in a significant reduction of mean cardiac dose from 6.1 +/- 2.5 to 3.2 +/- 1.4 Gy (p < 0.001), maximum cardiac dose from 51.1 +/- 1.4 to 48.5 +/- 6.8 Gy (p = 0.005) and cardiac V25Gy from 8.5 +/- 4.2 to 3.2 +/- 2.5% (p < 0.001). There is no specific data for the dose to the pericard.…”

Section: Effect Of Radiation Dose and Techniques Of Treatment Planninmentioning

confidence: 99%

Pericardial disease after breast cancer radiotherapy

Marinko

2018

Radiology and Oncology

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Background Breast cancer is the second most common cancer worldwide. Thanks to the modern oncological treatments, disease specific survival has improved throughout the last decades. The number of breast cancer survivors has been increasing, and more and more attention has been paid to the breast cancer treatment side effects. Whereas there are many data regarding ischemic heart disease after radiotherapy for breast cancer, there is not much data in the literature about the incidence and clinical meaning of pericardial disease after breast cancer radiotherapy. Conclusions Although radiation-induced pericarditis is the earliest form of radiation-induced cardiovascular disease after irradiation of the heart, it seems that in clinical practice, especially by using modern radiotherapy treatment techniques, it is underdiagnosed because patients are mostly asymptomatic. In some cases, especially in its late form and after multimodal systemic oncological treatment in combination with radiotherapy, it could be presented in severe form and life threatening. Treatment modalities for radiation-induced pericardial diseases are the same as in the non-irradiated population, but in the irradiated patients, surgery may be difficult.

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Voluntary deep inspiration breath-hold reduces the heart dose without compromising the target volume coverage during radiotherapy for left-sided breast cancer

Cited by 22 publications

References 42 publications

Evaluation of an in-house self-held respiration monitoring device for deep inspiration breath hold techniques for radiotherapy of patients with cancer of the left breast

Evaluation of an in-house self-held respiration monitoring device for deep inspiration breath hold techniques for radiotherapy of patients with cancer of the left breast

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

Pericardial disease after breast cancer radiotherapy

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