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Comparison of organs at risk doses between deep inspiration breath-hold and free-breathing techniques during radiotherapy of left-sided breast cancer: A Meta-Analysis. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2022. [DOI: 10.2478/pjmpe-2022-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract
After radiotherapy (RT) of left-sided breast cancer patients, organs at risk (OARs) such as heart, left anterior descending (LAD) coronary artery, and left lung could be affected by radiation dose in the long term. The objective of this study was to perform a comprehensive meta-analysis and determine OARs dose reduction during left-sided breast cancer treatment using different RT modalities combined with deep inspiration breath-hold (DIBH) relative to free-breathing (FB). PubMed, Scopus, EMBASE, ProQuest, Google Scholar, and Cochrane Library electronic databases were used to search for studies until June 6, 2021. Nineteen eligible studies were selected and analyzed using the RevMan 5.3 statistical software package. The pooled weighted mean difference (MD) with their 95% confidence intervals for each of the three OAR mean doses were determined using a random-effects meta-analysis model to assess the dose reductions. From a total of 189 studies, 1 prospective study, 15 retrospective studies, and 3 randomized control trials (RCTs) with an overall of 634 patients were included. Reduction of doses to the heart (weighted MD = -1.79 Gy; 95% CI (-2.28, -1.30); P = 0.00001), LAD (weighted MD = -8.34 Gy; 95% CI (-11.06, -5.61); P = 0.00001), and left-lung (weighted MD = -0.90 Gy; 95% CI (-1.19, -0.61); P = 0.00001) were observed using DIBH combinations relative to FB combination. This study emphasizes that during the treatment of left-sided breast/chest wall (CW) ± supraclavicular (SCV) ± infraclavicular (ICV) ± internal mammary chain (IMC) lymph nodes (LN) ± axillary (Ax)/ cancer patients, different RT modalities combined with DIBH techniques are better options to reduce dose to OARs compared to FB, which benefits to minimize the long-term complications.
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Tegaw EM, Geraily G, Etesami SM, Ghanbari H, Gholami S, Shojaei M, Farzin M, Tadesse GF. Dosimetric effect of nanoparticles in the breast cancer treatment using INTRABEAM ®system with spherical applicators in the presence of tissue heterogeneities: A Monte Carlo study. Biomed Phys Eng Express 2021; 7. [PMID: 33836513 DOI: 10.1088/2057-1976/abf6a9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/09/2021] [Indexed: 02/07/2023]
Abstract
Using the 50 kV INTRABEAM®IORT system after breast-conserving surgery: tumor recurrence and organs at risk (OARs), such as the lung and heart, long-term complications remain the challenging problems for breast cancer patients. So, the objective of this study was to address these two problems with the help of high atomic number nanoparticles (NPs). A Monte Carlo (MC) Simulation type EGSnrc C++ class library (egspp) with its Easy particle propagation (Epp) user code was used. The simulation was validated against the measured depth dose data found in our previous study (Tegaw,et al2020 Dosimetric characteristics of the INTRABEAM®system with spherical applicators in the presence of air gaps and tissue heterogeneities,Radiat. Environ. Biophys. (10.1007/s00411-020-00835-0)) using the gamma index and passed 2%/2 mm acceptance criteria in the gamma analysis. Gold (Au) NPs were selected after comparing Dose Enhancement Ratios (DERs) of bismuth (Bi), Au, and platinum (Pt) NPs which were calculated from the simulated results. As a result, 0.02, 0.2, 2, 10, and 20 mg-Au/g-breast tissue were used throughout this study. These particles were not distributed in discrete but in a uniform concentration. For 20 mg-Au/g-breast tissue, the DERs were 3.6, 0.420, and 0.323 for breast tissue, lung, heart, respectively, using the 1.5 cm-diameter applicator (AP) and 3.61, 0.428, and 0.335 forbreast tissue, lung, and heart using the 5 cm-diameter applicator, respectively. DER increased with the decrease in the depth of tissues and increase in the effective atomic number (Zeff) and concentration of Au NPs, however, there was no significant change as AP sizes increased. Therefore, Au NPs showed dual advantages such as dose enhancement within the tumor bed and reduction in the OARs (heart and lung).
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Affiliation(s)
- Eyachew Misganew Tegaw
- Department of Physics, Faculty of Natural and Computational Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ghazale Geraily
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Etesami
- School of Particles and Accelerators, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Hossein Ghanbari
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Gholami
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Shojaei
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Farzin
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Getu Ferenji Tadesse
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Physics, College of Natural and Computational Sciences, Aksum University, Ethiopia
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