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Dashnamoorthy S, Jeyasingh E, Rajamanickam K, Pitchaikannu V, Nachimuthu K. Dosimetric and radiobiological advantages from deep inspiration breath-hold and free breath technique for left-sided breast radiation using 3DCRT, IMRT and Rapid Arc methods-a complete assessment. RADIATION PROTECTION DOSIMETRY 2024; 200:1274-1293. [PMID: 39003236 DOI: 10.1093/rpd/ncae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/16/2024] [Accepted: 03/14/2024] [Indexed: 07/15/2024]
Abstract
The verification and use of the best treatment approach using 3D conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT) and Rapid Arc methods for left breast radiation with dosimetric and radiobiological characteristics. The use of custom-built Python software for the estimation and comparison of volume, mean dose, maximum dose, monitor units and normal tissue integral dose along with radiobiological parameters such as NTCP, tumor control probability, equivalent uniform dose and LKB's effective volume from 3DCRT, IMRT and Rapid Arc planning with deep inspiration with breath holding (DIBH) and free breadth (FB) techniques. Volume growth of three-fourth in DIBH compared with FB causes a decrease in cardiac doses and complications because the left lung expands, pulling the heart away from the chest wall and the treatment area. A tiny area of the left lung was exposed during treatment, which reduced the mean dose. There was little difference in the treatment approaches because the spinal cord was immobile in both techniques. Rapid Arc is the unmatched modality for left-sided breast irradiation with significant patient breath-hold, as shown by the comparison of dosimetric and radiobiological parameters from treatment techniques with a deep inspiration breath-hold approach.
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Affiliation(s)
- Sougoumarane Dashnamoorthy
- Department of Radiotherapy, Thangam Cancer Hospital, Namakkal 637001, Tamil Nadu, India
- PG & Research Department of Physics, Jamal Mohamed College (Autonomous), Affiliated to Bharathidasan University, Tiruchirappalli 620020, Tamil Nadu, India
| | - Ebenezar Jeyasingh
- PG & Research Department of Physics, Jamal Mohamed College (Autonomous), Affiliated to Bharathidasan University, Tiruchirappalli 620020, Tamil Nadu, India
| | - Karthick Rajamanickam
- Department of Radiotherapy, Thangam Cancer Hospital, Namakkal 637001, Tamil Nadu, India
| | | | - Kathiresan Nachimuthu
- Department of Radiotherapy, Thangam Cancer Hospital, Namakkal 637001, Tamil Nadu, India
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Sirak I, Pohanková D, Kašaová L, Hodek M, Motyčka P, Asqar A, Grepl J, Paluska P, Novotná V, Vosmik M, Petera J. Cardiac doses with deep inspiration breath hold in breast cancer radiotherapy: direct comparison between WBI, PBI, and interstitial APBI. Rep Pract Oncol Radiother 2024; 29:155-163. [PMID: 39143972 PMCID: PMC11321770 DOI: 10.5603/rpor.99907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
Background The optimal radiotherapy technique for cardiac sparing in left-sided early breast cancer (EBC) is not clear. In this context, the aim of our dosimetric study was to compare cardiac and lung doses according to the type of radiotherapy - whole breast irradiation (WBI), external partial breast irradiation (PBI), and multicatheter interstitial brachytherapy-accelerated partial breast irradiation (MIB-APBI). The dosimetric results with the WBI and PBI were calculated with and without DIBH. Materials and methods Dosimetric study of 23 patients treated with WBI, PBI, with and without DIBH, or MIB-APBI. The prescribed dose was 40 Gy in 15 fractions for WBI and PBI and 34 Gy in 10 fractions (bid) for MIB-APBI. Doses to the organs-at-risk (OAR) - heart, left anterior descending coronary artery (LAD), left ventricle (LV), and left lung - were recalculated to the equivalent dose in 2-Gy fractions (EQD2). Results The addition of DIBH significantly reduced EQD2 doses to all OARs (except for the left lung maximal dose) in WBI and PBI. MHD values were 0.72 Gy for DIBH-WBI, 1.01 Gy for MIB-APBI and 0.24 Gy for DIBH-PBI. There were no significant differences in cardiac doses between WBI with DIBH and PBI without DIBH. DIBH-PBI resulted in significantly lower mean doses to all OARs (except for maximum lung dose) compared to MIB-APBI. Conclusions: These results show that the use of DIBH significantly reduces cardiac doses in patients with left EBC. Partial irradiation techniques (PBI, MIB-APBI) significantly reduced cardiac doses due to the smaller clinical target volume. The best results were obtained with DIBH-PBI.
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Affiliation(s)
- Igor Sirak
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Králové, Czech Republic
| | - Denisa Pohanková
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Králové, Czech Republic
| | - Linda Kašaová
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Králové, Czech Republic
| | - Miroslav Hodek
- Clinic of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- 4 Department of Internal Medicine — Hematology, University Hospital Hradec Kralove, Charles University Faculty of Medicine in Hradec Králové, Hradec Kralove, Czech Republic
| | - Petr Motyčka
- Department of Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Ahmed Asqar
- Department of Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jakub Grepl
- Department of Radiotherapy and Oncology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Department of Radiobiology, University of Defence in Brno, Brno, Czech Republic
| | - Petr Paluska
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Králové, Czech Republic
| | - Veronika Novotná
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Králové, Czech Republic
| | - Milan Vosmik
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Králové, Czech Republic
| | - Jiri Petera
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Králové, Czech Republic
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Maraldo MV, Offersen BV. Radiotherapy for breast cancer. Ugeskr Laeger 2024; 186:V02230106. [PMID: 38533873 DOI: 10.61409/v02230106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
In early breast cancer, adjuvant moderately hypofractionated regimens are recommended for both whole breast, partial breast and locoregional irradiation which abbreviates the overall treatment time, as argued in this review. Gating is recommended as well as the use of a simultaneous integrated boost when indicated. A tangential field set-up is standard, however, for challenging cases volumetric modulated arc therapy techniques, or referral for proton therapy, may be considered. In the metastatic setting, stereotactic radiotherapy is a promising treatment option for oligometastatic disease.
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Affiliation(s)
- Maja Vestmø Maraldo
- Afdeling for Kræftbehandling, Københavns Universitetshospital - Rigshospitalet
| | - Birgitte Vrou Offersen
- Kræftafdelingen, Aarhus Universitetshospital
- Institut for Klinisk Medicin, Aarhus Universitet
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Miyasaka Y, ono T, Chai H, Souda H, Lee SH, Ishizawa M, Akamatsu H, Sato H, Iwai T. A robust treatment planning approach for chest motion in postmastectomy chest wall intensity modulated radiation therapy. J Appl Clin Med Phys 2024; 25:e14217. [PMID: 38018758 PMCID: PMC10795451 DOI: 10.1002/acm2.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE Chest wall postmastectomy radiation therapy (PMRT) should consider the effects of chest wall respiratory motion. The purpose of this study is to evaluate the effectiveness of robustness planning intensity modulated radiation therapy (IMRT) for respiratory movement, considering respiratory motion as a setup error. MATERIAL AND METHODS This study analyzed 20 patients who underwent PMRT (10 left and 10 right chest walls). The following three treatment plans were created for each case and compared. The treatment plans are a planning target volume (PTV) plan (PP) that covers the PTV within the body contour with the prescribed dose, a virtual bolus plan (VP) that sets a virtual bolus in contact with the body surface and prescribing the dose that includes the PTV outside the body contour, and a robust plan (RP) that considers respiratory movement as a setup uncertainty and performs robust optimization. The isocenter was shifted to reproduce the chest wall motion pattern and the doses were recalculated for comparison for each treatment plan. RESULT No significant difference was found between the PP and the RP in terms of the tumor dose in the treatment plan. In contrast, VP had 3.5% higher PTV Dmax and 5.5% lower PTV V95% than RP (p < 0.001). The RP demonstrated significantly higher lung V20Gy and Dmean by 1.4% and 0.4 Gy, respectively, than the PP. The RP showed smaller changes in dose distribution affected by chest wall motion and significantly higher tumor dose coverage than the PP and VP. CONCLUSION We revealed that the RP demonstrated comparable tumor doses to the PP in treatment planning and was robust for respiratory motion compared to both the PP and the VP. However, the organ at risk dose in the RP was slightly higher; therefore, its clinical use should be carefully considered.
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Affiliation(s)
- Yuya Miyasaka
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Takuya ono
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Hongbo Chai
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Hikaru Souda
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Sung Hyun Lee
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Miyu Ishizawa
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Hiroko Akamatsu
- Department of RadiologyYamagata University Faculty of MedicineYamagataJapan
| | - Hiraku Sato
- Department of RadiologyYamagata University Faculty of MedicineYamagataJapan
| | - Takeo Iwai
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
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Yuan K, Yao X, Liao X, Diao P, Xin X, Ma J, Li J, Orlandini LC. Comparing breath hold versus free breathing irradiation for left-sided breast radiotherapy by PlanIQ™. Radiat Oncol 2023; 18:200. [PMID: 38098106 PMCID: PMC10722777 DOI: 10.1186/s13014-023-02386-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Breast cancer is the most widespread cancer in women and young women worldwide. Moving towards customised radiotherapy, balancing the use of the available technology with the best treatment modality may not be an easy task in the daily routine. This study aims to evaluate the effectiveness of introducing IQ-feasibility into clinical practice to support the decision of free-breathing (FB) versus breath-hold (BH) left-sided breast irradiations, in order to optimise the technology available and the effectiveness of the treatment. METHODS Thirty-five patients who received 3D radiotherapy treatment of the left breast in deep-inspiration BH were included in this retrospective study. Computed tomography scans in FB and BH were acquired for each patient; targets contoured in both imaging datasets by an experienced radiation oncologist, and organs at risk delineated using automatic segmentation software were exported to PlanIQ™ (Sun Nuclear Corp.) to generate feasibility dose volume histogram (FDVHs). The dosimetric parameter of BH versus FB FDVH, and BH clinical dataset versus BH FDVH were compared. RESULTS A total of 30 patients out of 35 patients analysed, presented for the BH treatments a significant reduction (p < 0.05) in the heart mean dose ([Formula: see text]), volume receiving 5 Gy ([Formula: see text]) and 20 Gy ([Formula: see text]), of 35.7%, 54.5%, and 2.1%, respectively; for the left lung, a lower reduction was registered and significant only for [Formula: see text] (21.4%, p = 0.046). For the remaining five patients, the FDVH cut-off points of heart and lung were superimposable with differences of less than 1%. Heart and left lung dosimetric parameters of the BH clinical plans are located in the difficult zone of the FDVH and differ significantly (p < 0.05) from the corresponding parameters of the FDVH curves delimiting this buffer area between the impossible and feasible zones, respectively. CONCLUSION The use of PlanIQTM as a decision-support tool for the FB versus BH treatment delivery modality allows customisation of the treatment technique using the most appropriate technology for each patient enabling accurate management of available technologies.
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Affiliation(s)
- Ke Yuan
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University and Electronic Science and Technology of China, Chengdu, China
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Chengdu, China
| | - Xinghong Yao
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University and Electronic Science and Technology of China, Chengdu, China
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Chengdu, China
| | - Xiongfei Liao
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University and Electronic Science and Technology of China, Chengdu, China.
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Chengdu, China.
| | - Pen Diao
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University and Electronic Science and Technology of China, Chengdu, China
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Chengdu, China
| | - Xin Xin
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University and Electronic Science and Technology of China, Chengdu, China
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Chengdu, China
| | - Jiabao Ma
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University and Electronic Science and Technology of China, Chengdu, China
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Chengdu, China
| | - Jie Li
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University and Electronic Science and Technology of China, Chengdu, China
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Chengdu, China
| | - Lucia Clara Orlandini
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University and Electronic Science and Technology of China, Chengdu, China
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Chengdu, China
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Stuart SR, Poço JG, Rodrigues MVS, Abe RY, Carvalho HA. Can we predict who will benefit from the deep inspiration breath hold (DIBH) technique for breast cancer irradiation? Rep Pract Oncol Radiother 2023; 28:582-591. [PMID: 38179291 PMCID: PMC10764047 DOI: 10.5603/rpor.96867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/28/2023] [Indexed: 01/06/2024] Open
Abstract
Background The objective was to explore the clinical use of an "in-house" prototype developed to monitor respiratory motion to implement the deep inspiration breath hold technique (DIBH), compare dosimetric differences, and assess whether simple anatomic metrics measured on free breathing (FB) computed tomography scan (CT) can help in selecting patients that would benefit the most from the technique. Materials and methods A prospective study was conducted on patients with left breast cancer with an indication of adjuvant radiotherapy for breast only. Treatment simulation consisted of four series of CTs: the first during FB and three in DIBH to assess the reproducibility and stability of apnea. Contouring was based on the RTOG atlas, and planning was done in both FB and DIBH. Dosimetric and geometric parameters were assessed and compared between FB and DIBH. Results From June 2020 to December 2021, 30 patients with left breast cancer were recruited. Overall, the DIBH technique presented a mean dose reduction of 24% in the heart and 30% in the left anterior descendent coronary artery (LAD) (p < 0.05). The only geometric parameter correlated to a 30% dose reduction in the mean heart dose and LAD doses was the anterolateral distance from the heart to the chest wall of at least 1.5 cm measured on FB (p < 0.0001). Conclusion The prototype enabled the use of the DIBH technique with dose reductions in the heart and LAD. The benefit of the DIBH technique can be predicted on FB CT by measuring the distance between the heart and chest wall at the treatment isocenter.
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Affiliation(s)
| | - Joao Guilherme Poço
- Radiotherapy, Instituto de Radiologia, Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Ricardo Y. Abe
- Estatistica, Instituto de Matematica e Estatistica, Universidade de Sao Paulo Sao Paulo, Brazil
| | - Heloisa A. Carvalho
- Radiotherapy, Instituto de Radiologia, Universidade de São Paulo, Sao Paulo, Brazil
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Abbasi MA, Bruno G, Di Stefano C, Garcia Bello L, Laack NN, Corbin KS, Whitaker TJ, Pellikka PA, Mutter RW, Villarraga HR. Detection of Early Myocardial Dysfunction by Imaging Biomarkers in Cancer Patients Undergoing Photon Beam vs. Proton Beam Radiotherapy: A Prospective Study. J Cardiovasc Dev Dis 2023; 10:418. [PMID: 37887865 PMCID: PMC10607871 DOI: 10.3390/jcdd10100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023] Open
Abstract
1. Background: We sought to determine acute and subacute changes in cardiac function after proton beam (PBT) and photon beam (PhT) radiotherapy (RT) using conventional and two-dimensional speckle tracking echocardiography (2D-STE) in patients with malignant breast and thoracic tumors. 2. Methods: Between March 2016 and March 2017, 70 patients with breast or thoracic cancer were prospectively enrolled and underwent transthoracic echocardiography with comprehensive strain analysis at pretreatment, mid-treatment, end of treatment, and 3 months after RT. 3. Results: PBT was used to treat 44 patients; PhT 26 patients. Mean ± SD age was 55 ± 12 years; most patients (93%) were women. The median (interquartile range) of the mean heart dose was lower in the PBT than the PhT group (47 [27-79] vs. 217 [120-596] cGy, respectively; p < 0.001). Ejection fraction did not change in either group. Only the PhT group had reduced systolic tissue Doppler velocities at 3 months. 2D-STE showed changes in endocardial and epicardial longitudinal, radial, and circumferential early diastolic strain rate (SRe) in patients undergoing PhT (global longitudinal SRe, pretreatment vs. end of treatment (p = 0.04); global circumferential SRe, pretreatment vs. at 3-month follow-up (p = 0.003); global radial SRe, pretreatment vs. at 3-month follow-up (p = 0.02) for endocardial values). Epicardial strain values decreased significantly only in patients treated with PhT. Patients in the PhT group had a significant decrease in epicardial global longitudinal systolic strain rate (GLSRs) (epicardial GLSRs, at baseline vs. at end of treatment [p = 0.009]) and in GCSRe and GRSRe (epicardial GCSRe, at baseline vs. at 3-month follow-up (p = 0.02); epicardial GRSRe, at baseline vs. at 3-month follow-up (p = 0.03)) during treatment and follow-up. No changes on 2D-STE were detected in the PBT group. 4. Conclusions: Patients who underwent PhT but not PBT had reduced tissue Doppler velocities and SRe values during follow-up, suggesting early myocardial relaxation abnormalities. PBT shows promise as a cardiac-sparing RT technology.
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Affiliation(s)
| | - Giulia Bruno
- Hypertension Unit, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, 3-10126 Torino, Italy
| | - Cristina Di Stefano
- Hypertension Unit, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, 3-10126 Torino, Italy
| | - Laura Garcia Bello
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, MN 55905, USA
| | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | - Robert W. Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Pharmacology, Mayo Clinic, Rochester, MN 55905, USA
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Völk F, Borm KJ, Düsberg M, Combs SE, Knippen S, Duma MN. Regional nodal irradiation in breast cancer patients: Effects of deep inspiration breath hold on the internal mammary chain location. Med Dosim 2023; 48:299-303. [PMID: 37648622 DOI: 10.1016/j.meddos.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 07/11/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
The purpose of this study was to investigate the impact of deep inspiration breath hold (DIBH) on the positioning of thoracic structures and provide treatment planning recommendations for internal mammary chain (IMC) irradiation in breast cancer patients. Thirty-two breast cancer patients from our database underwent both DIBH and free breathing (FB) treatment planning. Contouring of the axillary lymph node clinical target volumes (CTVs: level I, II, III, IV, and IMC according to ESTRO), the internal mammary artery (IMA), the heart, and the left anterior descending artery (LAD) was performed. The following were then analyzed: the distance between the IMA and the heart, the craniocaudal distance in which IMC-CTV and heart coexist, the craniocaudal distance between the lower end of the of level III and IV and the upper end of the heart. Several significant geometric differences were observed between DIBH and FB that explain the efficacy of the DIBH for regional nodal irradiation. In >80% of patients the cranial origin of the LAD lies below the lower edge of the IMC-CTV in DIBH. In addition the slices in which the heart/LAD and IMC-CTV coexist decrease during DIBH. The IMA-heart distance is significantly larger in DIBH. Also the craniocaudal distance between the lower border of the CTV level III and IV and the upper border of the heart is larger in DIBH. The observed mechanisms during DIBH contribute significantly to the dose reduction in regional nodal irradiation. To further enhance the benefits of DIBH for the irradiation of the IMC-CTV, it is recommended to implement steep dose gradients in the caudal plane.
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Affiliation(s)
- Felix Völk
- Department of Radiation Oncology, Klinikum rechts der Isar, Medical School, Technical University of Munich (TUM), 81675 München, Germany
| | - Kai Joachim Borm
- Department of Radiation Oncology, Klinikum rechts der Isar, Medical School, Technical University of Munich (TUM), 81675 München, Germany
| | - Mathias Düsberg
- Department of Radiation Oncology, Klinikum rechts der Isar, Medical School, Technical University of Munich (TUM), 81675 München, Germany
| | - Stephanie Elisabeth Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Medical School, Technical University of Munich (TUM), 81675 München, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany; Deutsches Konsortium für Translationale Krebsforschung, DKTK Partner Site Munich, Munich, Germany
| | - Stefan Knippen
- Department for Human Medicine, MSH Medical School Hamburg, Hamburg, Germany; Department of Radiation Oncology, Helios Hospitals Schwerin, Schwerin, Germany
| | - Marciana Nona Duma
- Department of Radiation Oncology, Klinikum rechts der Isar, Medical School, Technical University of Munich (TUM), 81675 München, Germany; Department for Human Medicine, MSH Medical School Hamburg, Hamburg, Germany; Department of Radiation Oncology, Helios Hospitals Schwerin, Schwerin, Germany.
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Parsons D, Joo M, Iqbal Z, Godley A, Kim N, Spangler A, Albuquerque K, Sawant A, Zhao B, Gu X, Rahimi A. Stability and reproducibility comparisons between deep inspiration breath-hold techniques for left-sided breast cancer patients: A prospective study. J Appl Clin Med Phys 2023; 24:e13906. [PMID: 36691339 PMCID: PMC10161105 DOI: 10.1002/acm2.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/06/2022] [Accepted: 12/23/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Deep inspiration breath-hold (DIBH) is crucial in reducing the lung and cardiac dose for treatment of left-sided breast cancer. We compared the stability and reproducibility of two DIBH techniques: Active Breathing Coordinator (ABC) and VisionRT (VRT). MATERIALS AND METHODS We examined intra- and inter-fraction positional variation of the left lung. Eight left-sided breast cancer patients were monitored with electronic portal imaging during breath-hold (BH) at every fraction. For each patient, half of the fractions were treated using ABC and the other half with VRT, with an equal amount starting with either ABC or VRT. The lung in each portal image was delineated, and the variation of its area was evaluated. Intrafraction stability was evaluated as the mean coefficient of variation (CV) of the lung area for the supraclavicular (SCV) and left lateral (LLat) field over the course of treatment. Reproducibility was the CV for the first image of each fraction. Daily session time and total imaging monitor units (MU) used in patient positioning were recorded. RESULTS The mean intrafraction stability across all patients for the LLat field was 1.3 ± 0.7% and 1.5 ± 0.9% for VRT and ABC, respectively. Similarly, this was 1.5 ± 0.7% and 1.6 ± 0.8% for VRT and ABC, respectively, for the SCV field. The mean interfraction reproducibility for the LLat field was 11.0 ± 3.4% and 14.9 ± 6.0% for VRT and ABC, respectively. Similarly, this was 13.0 ± 2.5% and 14.8 ± 9% for VRT and ABC, respectively, for the SCV. No difference was observed in the number of verification images required for either technique. CONCLUSIONS The stability and reproducibility were found to be comparable between ABC and VRT. ABC can have larger interfractional variation with less feedback to the treating therapist compared to VRT as shown in the increase in geometric misses at the matchline.
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Affiliation(s)
- David Parsons
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mindy Joo
- Department of Radiation Oncology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Zohaib Iqbal
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew Godley
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nathan Kim
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ann Spangler
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bo Zhao
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Xuejun Gu
- Department of Radiation Oncology, Stanford University, Palo Alto, California, USA
| | - Asal Rahimi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Efficacy and Safety of the Addition of Internal Mammary Irradiation to Standard Adjuvant Radiation in Early-Stage Breast Cancer: A Systematic Review and Meta-Analysis. Curr Oncol 2022; 29:6657-6673. [PMID: 36135092 PMCID: PMC9497563 DOI: 10.3390/curroncol29090523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Existing data on adding internal mammary nodal irradiation (IMNI) to the regional nodal fields are inconsistent. Methods: Randomized trials investigating the addition of IMNI to standard adjuvant radiation were identified. Hazard ratios (HRs) and 95% confidence intervals (CI) were extracted for overall-survival (OS), breast cancer specific-survival (BCSS), and disease-free survival (DFS) as well as distant-metastasis free survival (DMFS). The odds ratios (ORs) for regional and loco-regional recurrence, non-breast cancer mortality, secondary non-breast cancer, contralateral breast cancer, and cardiovascular morbidity and mortality were also extracted. Results: Analysis included five trials comprising 10,994 patients, predominantly with higher risk, lymph node positive disease. Compared to the control group, IMNI was associated with significant improvement in OS (HR = 0.91, p = 0.004), BCSS (HR = 0.84, p < 0.001), DFS (HR = 0.89, p= 0.01), and DMFS (HR = 0.89, p = 0.02). IMNI was also associated with reduced odds for regional (OR = 0.58, p < 0.001) and loco-regional recurrence (OR = 0.85, p = 0.04). The odds for cardiotoxicity were not statistically significantly higher (OR = 1.23, p = 0.07). There were comparable odds for cardiovascular mortality (OR = 1.00, p = 1.00), non-breast cancer mortality (OR = 1.05, p = 0.74), secondary cancer (OR = 0.95, p = 0.51), and contra-lateral breast cancer (OR = 1.07, 95% 0.77−1.51, p = 0.68). Conclusions: Compared to the control group, the addition of IMNI in high-risk patients is associated with a statistically significant improvement in survival, albeit with a magnitude of questionable clinical meaningfulness.
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Kang HJ, Kwak YK, Kim M, Lee SJ. Application of real-time MRI-guided linear accelerator in stereotactic ablative body radiotherapy for non-small cell lung cancer: one step forward to precise targeting. J Cancer Res Clin Oncol 2022; 148:3215-3223. [PMID: 36040666 DOI: 10.1007/s00432-022-04264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Tumor motion is a major challenge in stereotactic ablative body radiotherapy (SABR) for non-small cell lung cancer (NSCLC), causing excessive irradiation to compensate for this motion. Real-time tumor tracking with a magnetic resonance imaging-guided linear accelerator (MR-Linac) could address this problem. This study aimed to assess the effects and advantages of MR-Linac in SABR for the treatment of lung tumors. METHODS Overall, 41 patients with NSCLC treated with SABR using MR-Linac between March 2019 and December 2021 were included. For comparison, 40 patients treated with SABR using computed tomography-based modalities were also enrolled. The SABR dose ranged from 48 to 60 Gy in 3-5 fractions. The primary endpoint was a lower radiation volume compared to CT-based SABR. The secondary endpoint was the local control rate of SABR using the MR-Linac. RESULTS The median follow-up time was 19 months (range: 3-105 months). There was no significant difference in the gross tumor volume between the MR and CT groups (7.1 ± 9.3 cm3 vs 8.0 ± 6.8 cm3, p = 0.643), but the planning target volume was significantly smaller in the MR group (20.8 ± 18.8 cm3 vs 34.1 ± 22.9 cm3, p = 0.005). The 1-year local control rates for the MR and CT groups were 92.1 and 75.4%, respectively (p = 0.07), and the 1-year overall survival rates were 87.4 and 87.0%, respectively (p = 0.30). CONCLUSION Lung SABR with MR-Linac can reduce the radiation field without compromising the local control rate. Further follow-up is needed to assess the long-term effects.
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Affiliation(s)
- Hye Jin Kang
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
| | - Yoo-Kang Kwak
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea.
| | - Myungsoo Kim
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
| | - So Jung Lee
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
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Ugurlu TB, Koksal Akbaş C, Ibis K, Becerir HB. The effect of using virtual bolus on VMAT plan quality for left-sided breast cancer patients. Appl Radiat Isot 2022; 189:110416. [PMID: 36030759 DOI: 10.1016/j.apradiso.2022.110416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/28/2022] [Accepted: 08/10/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Tugrul Berat Ugurlu
- Istanbul University Institute of Health Sciences, Medical Physics Department, Istanbul, Turkey
| | - Canan Koksal Akbaş
- Istanbul University, Oncology Institute, Medical Physics Department, Istanbul, Turkey
| | - Kamuran Ibis
- Istanbul University, Oncology Institute, Radiation Oncology Department, Istanbul, Turkey
| | - Hatice Bilge Becerir
- Istanbul University, Oncology Institute, Medical Physics Department, Istanbul, Turkey.
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Chapman CH, Jagsi R, Griffith KA, Moran JM, Vicini F, Walker E, Dominello M, Abu-Isa E, Hayman J, Laucis AM, Mietzel M, Pierce L. Mediators of Racial Disparities in Heart Dose Among Whole Breast Radiotherapy Patients. J Natl Cancer Inst 2022; 114:1646-1655. [PMID: 35916737 PMCID: PMC9949587 DOI: 10.1093/jnci/djac120] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/22/2022] [Accepted: 06/09/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Racial disparities in survival of patients with cancer motivate research to quantify treatment disparities and evaluate multilevel determinants. Previous research has not evaluated cardiac radiation dose in large cohorts of breast cancer patients by race nor examined potential causes or implications of dose disparities. METHODS We used a statewide consortium database to consecutively sample 8750 women who received whole breast radiotherapy between 2012 and 2018. We generated laterality- and fractionation-specific models of mean heart dose. We generated patient- and facility-level models to estimate race-specific cardiac doses. We incorporated our data into models to estimate disparities in ischemic cardiac event development and death. All statistical tests were 2-sided. RESULTS Black and Asian race independently predicted higher mean heart dose for most laterality-fractionation groups, with disparities of up to 0.42 Gy for Black women and 0.32 Gy for Asian women (left-sided disease and conventional fractionation: 2.13 Gy for Black women vs 1.71 Gy for White women, P < .001, 2-sided; left-sided disease and accelerated fractionation: 1.59 Gy for Asian women vs 1.27 Gy for White women, P = .002). Patient clustering within facilities explained 22%-30% of the variability in heart dose. The cardiac dose disparities translated to estimated excesses of up to 2.6 cardiac events and 1.3 deaths per 1000 Black women and 0.7 cardiac events and 0.3 deaths per 1000 Asian women vs White women. CONCLUSIONS Depending on laterality and fractionation, Asian women and Black women experience higher cardiac doses than White women. This may translate into excess radiation-associated ischemic cardiac events and deaths. Solutions include addressing inequities in baseline cardiac risk factors and facility-level availability and use of radiation technologies.
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Affiliation(s)
- Christina Hunter Chapman
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Reshma Jagsi
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA
| | - Kent A Griffith
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA
| | - Jean M Moran
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Eyad Abu-Isa
- Ascension Providence Hospital, Southfield, MI, USA
| | - James Hayman
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA
| | - Anna M Laucis
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA
| | - Melissa Mietzel
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA
| | - Lori Pierce
- Correspondence to: Lori J. Pierce, MD, University of Michigan Rogel Comprehensive Cancer Center, Rm 4308, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA (e-mail: )
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Badillo-Alvarado AH, Martín-Tovar EA, Molina-Salinas GM, Sandoval-Méndez AC, Sarricolea-Puch A. Association between the cardiac contact distance and the maximum dose at the left anterior descending coronary artery in post mastectomized patients. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2022; 61:407-423. [PMID: 35819511 DOI: 10.1007/s00411-022-00983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
The clinical information on the relationship between the cardiac contact distance (CCD), the maximum dose (Dmax) delivered to the left anterior descending (LAD) coronary artery and the mean heart dose has mostly focused on patients with breast-conserving surgery (BCS), being scarce in postmastectomy patients. The aim of this study is to determine the association between the CCD and the Dmax delivered to the LAD. The secondary objective was to evaluate the dosimetric results of comparing three-dimensional conformal radiotherapy (3D-CRT) to intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques for post mastectomized breast cancer patients with irradiation to the left chest wall. 53 cases of women who received adjuvant standard fractionated postmastectomy radiotherapy (PMRT) were used. Three types of plans were created for each patient: 3D-CRT, seven equidistant IMRT fields, and four partial VMAT arcs. Correlations were evaluated using Pearson's correlation coefficient. Plans made with IMRT and VMAT showed improved homogeneity and conformity. Associations between CCD and Dmax to LAD were positive for all three plan types. Compared to 3D-CRT, the modulated intensity plans obtained better dose homogeneity and conformity to the target volume. The LAD and heart doses were significantly lower for IMRT and VMAT plans. The CCD can be used as a predictor of the maximum and mean doses of the LAD. Modulated intensity techniques allow for better dose distribution and dose reduction to the heart and LAD.
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Affiliation(s)
- A H Badillo-Alvarado
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México
| | - E A Martín-Tovar
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México.
| | - G M Molina-Salinas
- Unidad de Investigación Médica Yucatán, Unidad Médica de Alta Especialidad Hospital de Especialidades 1 Mérida, Yucatán, Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México
| | - A C Sandoval-Méndez
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México
| | - A Sarricolea-Puch
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México
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Stowe HB, Andruska ND, Reynoso F, Thomas M, Bergom C. Heart Sparing Radiotherapy Techniques in Breast Cancer: A Focus on Deep Inspiration Breath Hold. BREAST CANCER: TARGETS AND THERAPY 2022; 14:175-186. [PMID: 35899145 PMCID: PMC9309321 DOI: 10.2147/bctt.s282799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/04/2022] [Indexed: 11/23/2022]
Abstract
Adjuvant radiation therapy is a critical component of breast cancer management. However, when breast cancer patients receive incidental radiation to the heart, there is an increased risk of cardiac disease and mortality. This is most common for patients with left-sided breast cancers and those receiving nodal irradiation as part of treatment. The overall risk of cardiac toxicity increases 4–16% with each Gray increase in mean heart radiation dose, with data suggesting that no lower limit exists which would eliminate cardiac risk entirely. Radiation techniques have improved over time, leading to lower cardiac radiation exposure than in the past. This decline is expected to reduce the incidence of radiation-induced heart dysfunction in patients. Deep inspiration breath hold (DIBH) is one such technique that was developed to reduce the risk of cardiac death and coronary events. DIBH is a non-invasive approach that capitalizes on the natural physiology of the respiratory cycle to increase the distance between the heart and the therapeutic target throughout the course of radiation therapy. DIBH has been shown to decrease the mean incidental radiation doses to the heart and left anterior descending coronary artery by approximately 20–70%. In this review, we summarize different techniques for DIBH and discuss recent data on this technique.
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Affiliation(s)
- Hayley B Stowe
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Neal D Andruska
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Francisco Reynoso
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Maria Thomas
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardio-Oncology Center of Excellence, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Alvin J. Siteman Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Correspondence: Carmen Bergom, Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA, Email
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Chen CP, Lin CY, Kuo CC, Chen TH, Lin SC, Tseng KH, Cheng HW, Chao HL, Yen SH, Lin RY, Feng CJ, Lu LS, Chiou JF, Hsu SM. Skin Surface Dose for Whole Breast Radiotherapy Using Personalized Breast Holder: Comparison with Various Radiotherapy Techniques and Clinical Experiences. Cancers (Basel) 2022; 14:cancers14133205. [PMID: 35804977 PMCID: PMC9264904 DOI: 10.3390/cancers14133205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: Breast immobilization with personalized breast holder (PERSBRA) is a promising approach for normal organ protection during whole breast radiotherapy. The aim of this study is to evaluate the skin surface dose for breast radiotherapy with PERSBRA using different radiotherapy techniques. Materials and methods: We designed PERSBRA with three different mesh sizes (large, fine and solid) and applied them on an anthropomorphic(Rando) phantom. Treatment planning was generated using hybrid, intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques to deliver a prescribed dose of 5000 cGy in 25 fractions accordingly. Dose measurement with EBT3 film and TLD were taken on Rando phantom without PERSBRA, large mesh, fine mesh and solid PERSBRA for (a) tumor doses, (b) surface doses for medial field and lateral field irradiation undergoing hybrid, IMRT, VMAT techniques. Results: The tumor dose deviation was less than five percent between the measured doses of the EBT3 film and the TLD among the different techniques. The application of a PERSBRA was associated with a higher dose of the skin surface. A large mesh size of PERSBRA was associated with a lower surface dose. The findings were consistent among hybrid, IMRT, or VMAT techniques. Conclusions: Breast immobilization with PERSBRA can reduce heart toxicity but leads to a build-up of skin surface doses, which can be improved with a larger mesh design for common radiotherapy techniques.
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Affiliation(s)
- Chiu-Ping Chen
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan; (C.-P.C.); (C.-Y.L.); (C.-C.K.); (H.-L.C.); (S.-H.Y.)
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (R.-Y.L.); (C.-J.F.)
| | - Chi-Yeh Lin
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan; (C.-P.C.); (C.-Y.L.); (C.-C.K.); (H.-L.C.); (S.-H.Y.)
| | - Chia-Chun Kuo
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan; (C.-P.C.); (C.-Y.L.); (C.-C.K.); (H.-L.C.); (S.-H.Y.)
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan; (T.-H.C.); (L.-S.L.)
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan
- Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei 110, Taiwan
| | - Tung-Ho Chen
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan; (T.-H.C.); (L.-S.L.)
| | - Shao-Chen Lin
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan;
| | - Kuo-Hsiung Tseng
- Department of Electrical Engineering, National Taipei University of Technology, Taipei 10608, Taiwan;
| | - Hao-Wen Cheng
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan;
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
| | - Hsing-Lung Chao
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan; (C.-P.C.); (C.-Y.L.); (C.-C.K.); (H.-L.C.); (S.-H.Y.)
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Sang-Hue Yen
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan; (C.-P.C.); (C.-Y.L.); (C.-C.K.); (H.-L.C.); (S.-H.Y.)
| | - Ruo-Yu Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (R.-Y.L.); (C.-J.F.)
| | - Chen-Ju Feng
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (R.-Y.L.); (C.-J.F.)
| | - Long-Sheng Lu
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan; (T.-H.C.); (L.-S.L.)
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan;
- TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei 110, Taiwan
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
- International Ph.D. Program for Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Jeng-Fong Chiou
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan; (T.-H.C.); (L.-S.L.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (J.-F.C.); (S.-M.H.)
| | - Shih-Ming Hsu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (R.-Y.L.); (C.-J.F.)
- Correspondence: (J.-F.C.); (S.-M.H.)
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TROG 14.04: Multicentre Study of Feasibility and Impact on Anxiety of DIBH in Breast Cancer Patients. Clin Oncol (R Coll Radiol) 2022; 34:e410-e419. [PMID: 35717318 DOI: 10.1016/j.clon.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/13/2022] [Accepted: 05/27/2022] [Indexed: 11/20/2022]
Abstract
AIMS The aim of TROG 14.04 was to assess the feasibility of deep inspiration breath hold (DIBH) and its impact on radiation dose to the heart in patients with left-sided breast cancer undergoing radiotherapy. Secondary end points pertained to patient anxiety and cost of delivering a DIBH programme. MATERIALS AND METHODS The study comprised two groups - left-sided breast cancer patients engaging DIBH and right-sided breast cancer patients using free breathing through radiotherapy. The primary end point was the feasibility of DIBH, defined as left-sided breast cancer patients' ability to breath hold for 15 s, decrease in heart dose in DIBH compared with the free breathing treatment plan and reproducibility of radiotherapy delivery using mid-lung distance (MLD) assessed on electronic portal imaging as the surrogate. The time required for treatment delivery, patient-reported outcomes and resource requirement were compared between the groups. RESULTS Between February and November 2018, 32 left-sided and 30 right-sided breast cancer patients from six radiotherapy centres were enrolled. Two left-sided breast cancer patients did not undergo DIBH (one treated in free breathing as per investigator choice, one withdrawn). The mean heart dose was reduced from 2.8 Gy (free breathing) to 1.5 Gy (DIBH). Set-up reproducibility in the first week of treatment assessed by MLD was 1.88 ± 1.04 mm (average ± 1 standard deviation) for DIBH and 1.59 ± 0.93 mm for free breathing patients. Using a reproducibility cut-off for MLD of 2 mm (1 standard deviation) as per study protocol, DIBH was feasible for 67% of DIBH patients. Radiotherapy delivery using DIBH took about 2 min longer than for free breathing. Anxiety was not significantly different in DIBH patients and decreased over the course of treatment in both groups. CONCLUSION Although DIBH was shown to require about 2 min longer per treatment slot, it has the potential to reduce heart dose in left-sided breast cancer patients by nearly a half, provided careful assessment of breath hold reproducibility is carried out.
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Applying global longitudinal strain in assessing cardiac dysfunction after radiotherapy among breast cancer patients: a systemic review and meta-analysis. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00493-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Radiotherapy of Breast Cancer in Laterally Tilted Prone vs. Supine Position: What about the Internal Mammary Chain? J Pers Med 2022; 12:jpm12040653. [PMID: 35455769 PMCID: PMC9031123 DOI: 10.3390/jpm12040653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/20/2022] [Accepted: 04/15/2022] [Indexed: 12/04/2022] Open
Abstract
Background: In the multimodal breast-conserving curative therapy of some high-risk breast cancer patients, extended external beam radiotherapy (EBRT) not only to the breast but also to the supraclavicular fossa and the internal mammary chain (parasternal region (PSR)) is indicated. We report a dosimetric study on the EBRT of the breast (“B”) and the breast including PSR (“B + PSR”), comparing the supine and the laterally tilted prone patient positions in free breathing. Methods: The planning CT scans of 20 left- and 20 right-sided patients were analyzed. EBRT plans were calculated with 3D conformal EBRT (3D) and with intensity-modulated EBRT (IMRT) for “B” and “B + PSR” in the prone and supine positions. The mean and threshold doses were computed. The quality of EBRT plans was compared with an overall plan assessment factor (OPAF), comprising three subfactors, homogeneity, conformity, and radiogenic exposure of OAR. Results: In the EBRT of “B”, prone positioning significantly reduced the exposure of the OARs “heart” and “ipsilateral lung” and “lymphatic regions”. The OPAF was significantly better in the prone position, regardless of the planning technique or the treated breast side. In the EBRT of “B + PSR”, supine positioning significantly reduced the OAR “heart” exposure but increased the dose to the OARs “ipsilateral lung” and “lymphatic regions”. There were no significant differences for the OPAF, independent of the irradiated breast side. Only the IMRT planning technique increased the chance of a comparatively good EBRT plan. Conclusion: Free breathing prone positioning significantly improves plan quality in the EBRT of the breast but not in the EBRT of the breast + PSR.
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Polomski EAS, Antoni ML, Jukema JW, Kroep JR, Dibbets-Schneider P, Sattler MGA, de Geus-Oei LF. Nuclear medicine imaging methods of radiation-induced cardiotoxicity. Semin Nucl Med 2022; 52:597-610. [PMID: 35246310 DOI: 10.1053/j.semnuclmed.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 12/21/2022]
Abstract
Breast cancer survival is significantly improved over the past decades due to major improvements in anti-tumor therapies and the implementation of regular screening, which leads to early detection of breast cancer. Therefore, it is of utmost importance to prevent patients from long-term side effects, including radiotherapy-induced cardiotoxicity. Radiotherapy may contribute to damage of myocardial structures on the cellular level, which eventually could result in various types of cardiovascular problems, including coronary artery disease and (non-)ischemic cardiomyopathy, leading to heart failure. These cardiac complications of radiotherapy are preceded by alterations in myocardial perfusion and blood flow. Therefore, early detection of these alterations is important to prevent the progression of these pathophysiological processes. Several radionuclide imaging techniques may contribute to the early detection of these changes. Single-Photon Emission Computed Tomography (SPECT) cameras can be used to create Multigated Acquisition scans in order to assess the left ventricular systolic and diastolic function. Furthermore, SPECT cameras are used for myocardial perfusion imaging with radiopharmaceuticals such as 99mTc-sestamibi and 99mTc-tetrofosmin. Accurate quantitative measurement of myocardial blood flow (MBF), can be performed by Positron Emission Tomography (PET), as the uptake of some of the tracers used for PET-based MBF measurement almost creates a linear relationship with MBF, resulting in very accurate blood flow quantification. Furthermore, there are PET and SPECT tracers that can assess inflammation and denervation of the cardiac sympathetic nervous system. Research over the past decades has mainly focused on the long-term development of left ventricular impairment and perfusion defects. Considering laterality of the breast cancer, some early studies have shown that women irradiated for left-sided breast cancer are more prone to cardiotoxic side effects than women irradiated for right-sided breast cancer. The left-sided radiation field in these trials, which predominantly used older radiotherapy techniques without heart-sparing techniques, included a larger volume of the heart and left ventricle, leading to increased unavoidable radiation exposure to the heart due to the close proximity of the radiation treatment volume. Although radiotherapy for breast cancer exposes the heart to incidental radiation, several improvements and technical developments over the last decades resulted in continuous reduction of radiation dose and volume exposure to the heart. In addition, radiotherapy reduces loco-regional tumor recurrences and death from breast cancer and improves survival. Therefore, in the majority of patients, the benefits of radiotherapy outweigh the potential very low risk of cardiovascular adverse events after radiotherapy. This review addresses existing nuclear imaging techniques, which can be used to evaluate (long-term) effects of radiotherapy-induced mechanical cardiac dysfunction and discusses the potential use of more novel nuclear imaging techniques, which are promising in the assessment of early signs of cardiac dysfunction in selected irradiated breast cancer patients.
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Affiliation(s)
| | - Maria Louisa Antoni
- Department of Cardiology, Heart and Lung Centre, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan Wouter Jukema
- Department of Cardiology, Heart and Lung Centre, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith Rian Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Petra Dibbets-Schneider
- Department of Radiology, section Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Margriet G A Sattler
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, section Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
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21
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Koutroumpakis E, Deswal A, Yusuf SW, Abe JI, Nead KT, Potter AS, Liao Z, Lin SH, Palaskas NL. Radiation-Induced Cardiovascular Disease: Mechanisms, Prevention, and Treatment. Curr Oncol Rep 2022; 24:543-553. [PMID: 35192118 DOI: 10.1007/s11912-022-01238-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Despite the advancements of modern radiotherapy, radiation-induced cardiovascular disease (RICVD) remains a common cause of morbidity and mortality among cancer survivors. RECENT FINDINGS Proposed pathogenetic mechanisms of RICVD include endothelial cell damage with accelerated atherosclerosis, pro-thrombotic alterations in the coagulation pathway as well as inflammation and fibrosis of the myocardial, pericardial, valvular, and conduction tissues. Prevention of RICVD can be achieved by minimizing the exposure of the cardiovascular system to radiation, by treatment of underlying cardiovascular risk factors and cardiovascular disease, and possibly by prophylactic pharmacotherapy post exposure. Herein we summarize current knowledge on the mechanisms underlying the pathogenesis of RICVD and propose prevention and treatment strategies.
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Affiliation(s)
- Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Anita Deswal
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Syed Wamique Yusuf
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Jun-Ichi Abe
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Kevin T Nead
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S Potter
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Division of Cardiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicolas L Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
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22
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Quintero-Martinez JA, Cordova-Madera SN, Villarraga HR. Radiation-Induced Heart Disease. J Clin Med 2021; 11:146. [PMID: 35011887 PMCID: PMC8745750 DOI: 10.3390/jcm11010146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/22/2021] [Accepted: 12/25/2021] [Indexed: 12/20/2022] Open
Abstract
Cancer incidence and survivorship have had a rising tendency over the last two decades due to better treatment modalities. One of these is radiation therapy (RT), which is used in 20-55% of cancer patients, and its basic principle consists of inhibiting proliferation or inducing apoptosis of cancer cells. Classically, photon beam RT has been the mainstay therapy for these patients, but, in the last decade, proton beam has been introduced as a new option. This newer method focuses more on the tumor and affects less of the surrounding normal tissue, i.e., the heart. Radiation to the heart is a common complication of RT, especially in patients with lymphoma, breast, lung, and esophageal cancer. The pathophysiology is due to changes in the microvascular and macrovascular milieu that can promote accelerated atherosclerosis and/or induce fibrosis of the myocardium, pericardium, and valves. These complications occur days, weeks, or years after RT and the risk factors associated are high radiation doses (>30 Gy), concomitant chemotherapy (primarily anthracyclines), age, history of heart disease, and the presence of cardiovascular risk factors. The understanding of these mechanisms and risk factors by physicians can lead to a tailored assessment and monitorization of these patients with the objective of early detection or prevention of radiation-induced heart disease. Echocardiography is a noninvasive method which provides a comprehensive evaluation of the pericardium, valves, myocardium, and coronaries, making it the first imaging tool in most cases; however, other modalities, such as computed tomography, nuclear medicine, or cardiac magnetic resonance, can provide additional value.
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Affiliation(s)
| | | | - Hector R. Villarraga
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (J.A.Q.-M.); (S.N.C.-M.)
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Abstract
We present the update of the recommendations of the French society of oncological radiotherapy on respiratory motion management for external radiotherapy treatment. Since twenty years and the report 62 of ICRU, motion management during the course of radiotherapy treatment has become an increasingly significant concern, particularly with the development of hypofractionated treatments under stereotactic conditions, using reduced safety margins. This article related orders of motion amplitudes for different organs as well as the definition of the margins in radiotherapy. An updated review of the various movement management strategies is presented as well as main technological solutions enabling them to be implemented: when acquiring anatomical data, during planning and when carrying out treatment. Finally, the management of these moving targets, such as it can be carried out in radiotherapy departments, will be detailed for a few concrete examples of localizations (abdominal, thoracic and hepatic).
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Salvestrini V, Iorio GC, Borghetti P, De Felice F, Greco C, Nardone V, Fiorentino A, Gregucci F, Desideri I. The impact of modern radiotherapy on long-term cardiac sequelae in breast cancer survivor: a focus on deep inspiration breath-hold (DIBH) technique. J Cancer Res Clin Oncol 2021; 148:409-417. [PMID: 34853887 DOI: 10.1007/s00432-021-03875-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION One of the most feared side effects of radiotherapy (RT) in the setting of breast cancer (BC) patients is cardiac toxicity. This side effect can jeopardize the quality of life (QoL) of long-term survivors. The impact of modern techniques of RT such as deep inspiration breath hold (DIBH) have dramatically changed this setting. We report and discuss the results of the literature overview of this paper. MATERIALS AND METHODS Literature references were obtained with a PubMed query, hand searching, and clinicaltrials.gov. RESULTS We reported and discussed the toxicity of RT and the improvements due to the modern techniques in the setting of BC patients. CONCLUSIONS BC patients often have a long life expectancy, thus the RT should aim at limiting toxicities and at the same time maintaining the same high cure rates. Further studies are needed to evaluate the risk-benefit ratio to identify patients at higher risk and to tailor the treatment choices.
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Affiliation(s)
- V Salvestrini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - G C Iorio
- Radiation Oncology, University of Turin, Turin, Italy
| | - P Borghetti
- Radiation Oncology, University and SpedaliCivili, Brescia, Italy
| | - F De Felice
- Radiation Oncology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - C Greco
- Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - V Nardone
- RadiationOncology, Ospedale del Mare, Viale della Metamorfosi, Naples, Italy
| | - A Fiorentino
- Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - F Gregucci
- Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - I Desideri
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Settatree S, Dunlop A, Mohajer J, Brand D, Mooney L, Ross G, Gulliford S, Harris E, Kirby A. What Can Proton Beam Therapy Achieve for Patients with Pectus Excavatum Requiring Left Breast, Axilla and Internal Mammary Nodal Radiotherapy? Clin Oncol (R Coll Radiol) 2021; 33:e570-e577. [PMID: 34226114 DOI: 10.1016/j.clon.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/12/2021] [Accepted: 06/18/2021] [Indexed: 12/25/2022]
Abstract
AIMS Exposure of the heart to radiation increases the risk of ischaemic heart disease, proportionate to the mean heart dose (MHD). Radiotherapy techniques including proton beam therapy (PBT) can reduce MHD. The aims of this study were to quantify the MHD reduction achievable by PBT compared with volumetric modulated arc therapy in breath hold (VMAT-BH) in patients with pectus excavatum (PEx), to identify an anatomical metric from a computed tomography scan that might indicate which patients will achieve the greatest MHD reductions from PBT. MATERIALS AND METHODS Sixteen patients with PEx (Haller Index ≥2.7) were identified from radiotherapy planning computed tomography images. Left breast/chest wall, axilla (I-IV) and internal mammary node (IMN) volumes were delineated. VMAT and PBT plans were prepared, all satisfying target coverage constraints. Signed-rank comparisons of techniques were undertaken for the mean dose to the heart, ipsilateral lung and contralateral breast. Spearman's rho correlations were calculated for anatomical metrics against MHD reduction achieved by PBT. RESULTS The mean MHD for VMAT-BH plans was 4.1 Gy compared with 0.7 Gy for PBT plans. PBT reduced MHD by an average of 3.4 Gy (range 2.8-4.4 Gy) compared with VMAT-BH (P < 0.001). PBT significantly reduced the mean dose to the ipsilateral lung (4.7 Gy, P < 0.001) and contralateral breast (2.7 Gy, P < 0.001). The distance (mm) at the most inferomedial extent of IMN volume (IMN to heart distance) negatively correlated with MHD reduction achieved by PBT (Spearman's rho -0.88 (95% confidence interval -0.96 to -0.67, P < 0.001)). CONCLUSION For patients with PEx requiring left-sided breast and IMN radiotherapy, a clinically significant MHD reduction is achievable using PBT, compared with the optimal photon technique (VMAT-BH). This is a patient group in whom PBT could have the greatest benefit.
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Affiliation(s)
- S Settatree
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK.
| | - A Dunlop
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - J Mohajer
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - D Brand
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - L Mooney
- The Royal Marsden Hospital, London, UK
| | - G Ross
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - S Gulliford
- Department of Radiotherapy Physics, University College London Hospital, UK; Department of Medical Physics and Bioengineering, University College London, UK
| | - E Harris
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - A Kirby
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
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Holla R, Khanna D, Narayanan VKS, Dutta DN. Analysis of normal lung irradiation in radiosurgery treatments: a comparison of lung optimized treatment (LOT) on cyberknife, 4D target volume on helical tomotherapy, and DIBH on linear accelerator. Phys Eng Sci Med 2021; 44:1321-1329. [PMID: 34724161 DOI: 10.1007/s13246-021-01064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
Quantitative retrospective analysis of the normal lung irradiation due to the variations of the ITV volume based on the techniques used for upper lobe (UL), mid lobe (ML), and lower lobe (LL) lung tumours when used with 2-view, 1-view, 0-view based LOT technique on Cyberknife, AveIP on Helical Tomotherapy, and DIBH on VMAT systems. In the treatment of lung tumours, patients medically inoperable or those who are unwilling to undergo surgery have the option to be treated using radiation therapy. There are many motion control techniques available for the treatment of the moving target, such as movement encompassment, respiratory gating, breath-hold, motion reduction, and tumour monitoring. ITV generation is dependent on technique and hence the volume of the PTVs will differ based on the technique used. This study aimed to determine the influence of these ITVs on the irradiated normal lung volume for UL, ML, and LL lung tumours for 23 patients. The mean difference in the PTV volumes generated with the 0-view technique was significant with that of 2-view and DIBH techniques (p-value < 0.04). The mean difference in the PTV volumes generated by 2-view and DIBH was small for UL, ML, and LL tumours. V5 of the combined lung with the 0-view method was 5% compared to the 2-view method for UL tumours (p-value = 0.04) and the same was 9.5%, and 16.8% for ML and LL tumours (p-value < 0.04). In contrast to all other techniques, lung volume parameters V5, V10, V20, and V30 for the 0-view technology were consistently higher irrespective of the tumour location in the lung. The observed maximum mean lung dose (MLD) was 6.2 Gy ± 2.7 Gy with the 0-view technique and the minimum was 3.85 Gy ± 1.75 Gy with the DIBH technique. The difference in MLD between DIBH and 2-view was negligible (p-value = 0.67). The MLD increased for LL tumours from 4 Gy to 6.5 Gy from the 2-view to 0-view technique (p-value = 0.009). There was a significant increase in MLD for LL tumours with the 0-view technique compared to AveIP (1.9 Gy, p-value = 0.04) and DIBH (2.0 Gy, p-value = 0.003) technique. For ML and UL tumours, except for 0-view and 1-view, the difference in the MLD between the rest of the methods was not significant (p-value > 0.11). In the treatment of lung tumour patients with SBRT, this study has demonstrated 2-view with Cyberknife and DIBH with VMAT treatment techniques have optimal normal lung tissue sparing. There was a significant increase in the average lung volume receiving 5%,10%, 20%, and 30% dose when comparing the 1-view, 0-view, AveIP, and DIBH techniques to the 2-view technique. However, DIBH with VMAT was dosimetrically advantageous for ML and LL tumours, while providing significantly shorter treatment times than any other technique studied.
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Affiliation(s)
| | - D Khanna
- Department of Physics, Karunya Institute of Technology and Sciences, Coimbatore, 641114, India
| | | | - Deb Narayan Dutta
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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Rasmussen T, Kjær A, Lassen ML, Pedersen AN, Specht L, Aznar MC, Hasbak P. No changes in myocardial perfusion following radiation therapy of left-sided breast cancer: A positron emission tomography study. J Nucl Cardiol 2021; 28:1923-1932. [PMID: 31741325 DOI: 10.1007/s12350-019-01949-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 10/22/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Adjuvant radiation therapy (RT) for breast cancer has improved overall survival. However, incidental exposure of the heart has been linked to development of radiation-induced heart disease. The aim of this study was, in a cohort of asymptomatic post-irradiation breast cancer patients, to investigate changes in myocardial blood flow (MBF) and presence of perfusion defects in myocardial perfusion positron-emission-tomography (PET) in the irradiated myocardium. METHODS AND RESULTS Twenty patients treated with RT for left-sided breast cancer underwent 13N-ammonia myocardial perfusion PET 7(± 2) years after breath adapted RT to a total dose of 48 Gy given in 24 fractions. No differences in rest or stress MBF were noted between the irradiated and non-irradiated myocardium (1.29 (± 0.29) vs 1.33 (± 0.29) mL/g/min, ns; 2.74 (± 0.59) vs 2.78 (± 0.66) mL/g/min, ns, respectively). One patient demonstrated a myocardial perfusion defect localized in the irradiated anterior wall myocardium. CONCLUSION Although limited by a small sample size, early signs of cardiac injury detected by NH3 myocardial perfusion PET was at least not frequent in our cohort of patients treated with a modern RT technique for left-sided breast cancer, even 7 years after treatment. The findings however, may not rule out subsequent development of myocardial injury.
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Affiliation(s)
- Thomas Rasmussen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Martin Lyngby Lassen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | | | - Lena Specht
- Department of Oncology, Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | - Marianne C Aznar
- Department of Oncology, Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Radiation dose to the heart with hypofractionation in patients with left breast cancer. EXPERIMENTAL RESULTS 2021. [DOI: 10.1017/exp.2021.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Introduction
In this study we compared radiation dose received by organs at risk (OARs) after breast conservation surgery(BCS) and mastectomy in patients with left breast cancer.
Materials and methods
Total 30 patients, 15 each of BCS and mastectomy were included in this study. Planning Computerised Tomography (CT) was done for each patient. Chest wall, whole breast, heart, lungs, LAD, proximal and distal LAD, and contra lateral breast was contoured for each patient. Radiotherapy plans were made by standard tangent field. Dose prescribed was 40Gy/16#/3 weeks. Mean heart dose, LAD, proximal and distal LAD, mean and V5 of right lung, and mean, V5, V10 and V20 of left lung, mean dose and V2 of contra lateral breast were calculated for each patient and compared between BCS and mastectomy patients using student’s T test.
Results
Mean doses to the heart, LAD, proximal LAD and distal LAD were 3.364Gy, 16.06Gy, 2.7Gy, 27.5Gy; and 4.219Gy, 14.653Gy, 4.306Gy, 24.6Gy, respectively for mastectomy and BCS patients. Left lung mean dose, V5, V10 and V20 were 5.96Gy, 16%, 14%, 12.4%; and 7.69Gy, 21%, 18% and 16% in mastectomy and BCS patients, respectively. There was no statistical significant difference in the doses to the heart and left lung between mastectomy and BCS. Mean dose to the right lung was significantly less in mastectomy as compared to BCS, 0.29Gy vs. 0.51Gy, respectively (p = 0.007). Mean dose to the opposite breast was significantly lower in patients with mastectomy than BCS (0.54Gy Vs 0.37Gy, p = 0.007). The dose to the distal LAD was significantly higher than proximal LAD both in BCS (24.6Gy Vs 4.3Gy, p = <0.0001) and mastectomy (27.5Gy Vs 2.7Gy, p = <0.0001) patients.
Conclusion
There was no difference in doses received by heart and left lung between BCS and mastectomy patients. Mean doses to the right lung and breast were significantly less in mastectomy patients.
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McConnell K, Kirby N, Rasmussen K, Gutierrez AN, Papanikolaou N, Stanley D. Variability of Breast Surface Positioning Using an Active Breathing Coordinator for a Deep Inspiration Breath Hold Technique. Cureus 2021; 13:e15649. [PMID: 34306859 PMCID: PMC8279697 DOI: 10.7759/cureus.15649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose The Elekta Active Breathing CoordinatorTM (ABC) is used to control breathing and guide deep inspiration breath hold (DIBH). It has been shown to be accurate in lung cancers, but limited analysis has been performed on the spatial accuracy and reproducibility of the breast surface. The use of optical surface-image guidance for patient positioning has grown in popularity and is an alternative solution for breast DIBH. This study aims to evaluate the breast surface variability of an ABC-guided DIBH by using a three-dimensional (3D) surface imaging system to record surface position. Methods Ten participants were placed in the treatment position, and breathing baselines and inhalation volume threshold baselines were monitored and recorded using the ABC. Over 60 minutes, the breathing patterns were recorded by the ABC and CatalystHDTM (C-RAD, Uppsala, Sweden). For each breath hold, the valve of the ABC closed at the baseline inhalation threshold and a 3D surface image was acquired. For each point on the baseline breast surface, a 3D vector was calculated to the subsequent breath hold surface as well as a root mean square (RMS) vector magnitude for the entire surface. Results The average and standard deviation for the RMS difference between the baseline and subsequent evaluated images were 7.12 ± 2.70 mm. Conclusion This study shows that while the ABC-guided inhalation volume is kept constant, a non-negligible variability of the breast surface position exists. Special considerations should be used in clinical situations, where the positioning of the surface is considered more important than inhalation volume.
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Affiliation(s)
- Kristen McConnell
- Department of Radiation Oncology/Medical Physics, University of Alabama at Birmingham, Birmingham, USA
| | - Neil Kirby
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Karl Rasmussen
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | | | - Nikos Papanikolaou
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Dennis Stanley
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, USA
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Keikhai Farzaneh MJ, Momennezhad M, Naseri S. Gated Radiotherapy Development and its Expansion. J Biomed Phys Eng 2021; 11:239-256. [PMID: 33937130 PMCID: PMC8064130 DOI: 10.31661/jbpe.v0i0.948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/14/2018] [Indexed: 12/25/2022]
Abstract
One of the most important challenges in treatment of patients with cancerous tumors of chest and abdominal areas is organ movement. The delivery of treatment radiation doses to tumor tissue is a challenging matter while protecting healthy and radio sensitive tissues. Since the movement of organs due to respiration causes a discrepancy in the middle of planned and delivered dose distributions. The moderation in the fatalistic effect of intra-fractional target travel on the radiation therapy correctness is necessary for cutting-edge methods of motion remote monitoring and cancerous growth irradiancy. Tracking respiratory milling and implementation of breath-hold techniques by respiratory gating systems have been used for compensation of respiratory motion negative effects. Therefore, these systems help us to deliver precise treatments and also protect healthy and critical organs. It seems aspiration should be kept under observation all over treatment period employing tracking seed markers (e.g. fiducials), skin surface scanners (e.g. camera and laser monitoring systems) and aspiration detectors (e.g. spirometers). However, these systems are not readily available for most radiotherapy centers around the word. It is believed that providing and expanding the required equipment, gated radiotherapy will be a routine technique for treatment of chest and abdominal tumors in all clinical radiotherapy centers in the world by considering benefits of respiratory gating techniques in increasing efficiency of patient treatment in the near future. This review explains the different technologies and systems as well as some strategies available for motion management in radiotherapy centers.
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Affiliation(s)
- Mohammad Javad Keikhai Farzaneh
- PhD, Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- PhD, Department of Medical Physics, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Momennezhad
- PhD, Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- PhD, Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shahrokh Naseri
- PhD, Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- PhD, Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Delombaerde L, Petillion S, Weltens C, Depuydt T. Spirometer-guided breath-hold breast VMAT verified with portal images and surface tracking. Radiother Oncol 2021; 157:78-84. [PMID: 33515669 DOI: 10.1016/j.radonc.2021.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Fast rotating closed-bore gantry linacs are ideally suited for breath-hold treatments due to reduced imaging and delivery times. We evaluated the reproducibility and stability of spirometer-guided breath-hold breast treatments, using intra-bore surface monitoring and portal imaging on Halcyon (Varian Medical Systems). MATERIALS AND METHODS Seven left-sided breast cancer patients were treated in breath-hold using the SDX spirometer (Dyn'R) with an integrated boost volumetric arc protocol on Halcyon. A dual depth-camera surface scanning system monitored the left breast. The interfraction, intrafraction and intrabreath-hold motion was determined in the anterior-posterior (AP) and superior-inferior (SI) direction. Portal images (PI), acquired at a tangential gantry angle were manually registered to the planning-CT to determine inter- and intrafraction breath-hold errors for the SI and tangential-anterior-posterior ("AP") axis. Correlations between PI and surface imaging deviations were investigated. To evaluate workflow efficiency, the total time and the number of breath-holds were recorded. RESULTS Systematic and random variability of breath-hold amplitude was below 0.7 mm for the AP and below 1.2 mm for the SI component as detected by surface monitoring (N = 130). Systematic and random errors retrieved from portal images (N = 140) were below 1.2 mm for the "AP" and 2.1 mm for SI axis. A limited correlation was found between PI and surface monitoring deviations for both the SI and "AP" axes (R2 = 0.27/0.38, p < 0.01). 75% of fractions were completed using four breath-holds and 82% within 10 min. CONCLUSION Surface imaging indicated spirometer-guided breath-hold VMAT breast radiotherapy can be accurately and quickly performed on a closed-bore gantry linac. Intra-bore surface scanning proved a valuable technique for monitoring breathing motion in closed-bore systems.
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Affiliation(s)
- Laurence Delombaerde
- Department of Oncology, KU Leuven, Herestraat 49, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
| | - Saskia Petillion
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - Caroline Weltens
- Department of Oncology, KU Leuven, Herestraat 49, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - Tom Depuydt
- Department of Oncology, KU Leuven, Herestraat 49, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
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Rago M, Placidi L, Polsoni M, Rambaldi G, Cusumano D, Greco F, Indovina L, Menna S, Placidi E, Stimato G, Teodoli S, Mattiucci GC, Chiesa S, Marazzi F, Masiello V, Valentini V, De Spirito M, Azario L. Evaluation of a generalized knowledge-based planning performance for VMAT irradiation of breast and locoregional lymph nodes-Internal mammary and/or supraclavicular regions. PLoS One 2021; 16:e0245305. [PMID: 33449952 PMCID: PMC7810311 DOI: 10.1371/journal.pone.0245305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/24/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the performance of eleven Knowledge-Based (KB) models for planning optimization (RapidPlantm (RP), Varian) of Volumetric Modulated Arc Therapy (VMAT) applied to whole breast comprehensive of nodal stations, internal mammary and/or supraclavicular regions. METHODS AND MATERIALS Six RP models have been generated and trained based on 120 VMAT plans data set with different criteria. Two extra-structures were delineated: a PTV for the optimization and a ring structure. Five more models, twins of the previous models, have been created without the need of these structures. RESULTS All models were successfully validated on an independent cohort of 40 patients, 30 from the same institute that provided the training patients and 10 from an additional institute, with the resulting plans being of equal or better quality compared with the clinical plans. The internal validation shows that the models reduce the heart maximum dose of about 2 Gy, the mean dose of about 1 Gy and the V20Gy of 1.5 Gy on average. Model R and L together with model B without optimization structures ensured the best outcomes in the 20% of the values compared to other models. The external validation observed an average improvement of at least 16% for the V5Gy of lungs in RP plans. The mean heart dose and for the V20Gy for lung IPSI were almost halved. The models reduce the maximum dose for the spinal canal of more than 2 Gy on average. CONCLUSIONS All KB models allow a homogeneous plan quality and some dosimetric gains, as we saw in both internal and external validation. Sub-KB models, developed by splitting right and left breast cases or including only whole breast with locoregional lymph nodes, have shown good performances, comparable but slightly worse than the general model. Finally, models generated without the optimization structures, performed better than the original ones.
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Affiliation(s)
- Maria Rago
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Placidi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mattia Polsoni
- Fatebenefratelli Isola Tiberina, Ospedale San Giovanni Calibita, Rome, Italy
- Amethyst Radioterapia Italia, Isola Tiberina, Rome, Italy
| | - Giulia Rambaldi
- Fatebenefratelli Isola Tiberina, Ospedale San Giovanni Calibita, Rome, Italy
- Amethyst Radioterapia Italia, Isola Tiberina, Rome, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Greco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Indovina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sebastiano Menna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisa Placidi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Stefania Teodoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Silvia Chiesa
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Marazzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valeria Masiello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Valentini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco De Spirito
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Azario
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Lizar JC, Volpato KC, Brandão FC, da Silva Guimarães F, Arruda GV, Pavoni JF. Tridimensional dose evaluation of the respiratory motion influence on breast radiotherapy treatments using conformal radiotherapy, forward IMRT, and inverse IMRT planning techniques. Phys Med 2021; 81:60-68. [DOI: 10.1016/j.ejmp.2020.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022] Open
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Xin X, Li J, Zhao Y, Wang P, Tang B, Yao X, Liao X, Ma J, Orlandini LC. Retrospective Study on Left-Sided Breast Radiotherapy: Dosimetric Results and Correlation with Physical Factors for Free Breathing and Breath Hold Irradiation Techniques. Technol Cancer Res Treat 2021; 20:15330338211062429. [PMID: 34855575 PMCID: PMC8646776 DOI: 10.1177/15330338211062429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives: In breast radiotherapy, the proximity of the target to sensitive structures together with the uncertainty introduced by respiratory movement, make this treatment one of the most studied to increase its effectiveness. Dosimetric and physical variables play an important role and the study of their correlation and impact on treatment is fundamental. This retrospective study aims to highlight the dosimetric differences of 2 different clinical data sets of patients receiving left-sided breast irradiation in free breathing (FB) or breath hold (BH). Methods: A total of 155 left breast carcinoma patients receiving whole-breast irradiation in FB (73 patients) and BH (82 patients) were enrolled in this study. The dosimetric parameters of the target, heart, left and right lung and right breast were evaluated and compared, and possible correlations were studied in both groups. Results: No significant difference (P > .05) was found in the target dosimetry; a clear advantage in BH for both high and low doses received by the heart, with reductions of the dosimetric parameters between 27.1% and 100% (P < .003); for the left lung reductions decreased with increasing dose (-22.4% and -13.4% for doses of 5 and 20 Gy, respectively, P < .003). Conclusion: Significant correlations for BH treatments were registered between the volumes of the target and left lung, and the dosimetric parameters of the heart and left lung. BH treatment brings significant dosimetric advantages to organs at risk for a wide range of patients with different anatomy, target volumes and lung capacity, with additional benefits for small-sized breasts and important lung capacity.
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Affiliation(s)
- Xin Xin
- Sichuan Cancer Hospital & Research Institute, Chengdu, China
- UESTC University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Li
- Sichuan Cancer Hospital & Research Institute, Chengdu, China
- UESTC University of Electronic Science and Technology of China, Chengdu, China
| | - Yanqun Zhao
- Sichuan Cancer Hospital & Research Institute, Chengdu, China
- UESTC University of Electronic Science and Technology of China, Chengdu, China
| | - Pei Wang
- Sichuan Cancer Hospital & Research Institute, Chengdu, China
- UESTC University of Electronic Science and Technology of China, Chengdu, China
| | - Bin Tang
- Sichuan Cancer Hospital & Research Institute, Chengdu, China
- UESTC University of Electronic Science and Technology of China, Chengdu, China
| | - Xinghong Yao
- Sichuan Cancer Hospital & Research Institute, Chengdu, China
- UESTC University of Electronic Science and Technology of China, Chengdu, China
| | - Xiongfei Liao
- Sichuan Cancer Hospital & Research Institute, Chengdu, China
- UESTC University of Electronic Science and Technology of China, Chengdu, China
| | - Jiabao Ma
- Sichuan Cancer Hospital & Research Institute, Chengdu, China
- UESTC University of Electronic Science and Technology of China, Chengdu, China
| | - Lucia Clara Orlandini
- Sichuan Cancer Hospital & Research Institute, Chengdu, China
- UESTC University of Electronic Science and Technology of China, Chengdu, China
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Huang TJ, Tien Y, Wu JK, Huang WT, Cheng JCH. Impact of breath-hold level on positional error aligned by stent/Lipiodol in Hepatobiliary radiotherapy with breath-hold respiratory control. BMC Cancer 2020; 20:613. [PMID: 32611378 PMCID: PMC7328270 DOI: 10.1186/s12885-020-07082-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Respiratory motion management with breath hold for patients with hepatobiliary cancers remain a challenge in the precise positioning for radiotherapy. We compared different image-guided alignment markers for estimating positional errors, and investigated the factors associated with positional errors under breath-hold control. Methods Spirometric motion management system (SDX) for breath holds was used in 44 patients with hepatobiliary tumor. Among them, 28 patients had a stent or embolized materials (lipiodol) as alignment markers. Cone-beam computed tomography (CBCT) and kV-orthogonal images were compared for accuracy between different alignment references. Breath-hold level (BHL) was practiced, and BHL variation (ΔBHL) was defined as the standard deviation in differences between actual BHLs and baseline BHL. Mean BHL, ΔBHL, and body-related factors were analyzed for the association with positional errors. Results Using the reference CBCT, the correlations of positional errors were significantly higher in those with stent/lipiodol than when the vertebral bone was used for alignment in three dimensions. Patients with mean BHL > 1.4 L were significantly taller (167.6 cm vs. 161.6 cm, p = 0.03) and heavier (67.1 kg vs. 57.4 kg, p = 0.02), and had different positional error in the craniocaudal direction (− 0.26 cm [caudally] vs. + 0.09 cm [cranially], p = 0.01) than those with mean BHL < 1.4 L. Positional errors were similar for patients with ΔBHL< 0.03 L and > 0.03 L. Conclusion Under rigorous breath-hold respiratory control, BHL correlated with body weight and height. With more accurate alignment reference by stent/lipiodol, actual BHL but not breath-hold variation was associated with craniocaudal positional errors.
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Browne P, Beaton N, Sharma H, Watson S, Mai GT, Harvey J, Bernard A, Brown E, Hargrave C, Lehman M. Identifying breast cancer patients who gain the most dosimetric benefit from deep inspiration breath hold radiotherapy. J Med Radiat Sci 2020; 67:294-301. [PMID: 32627421 PMCID: PMC7754004 DOI: 10.1002/jmrs.415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/23/2020] [Accepted: 06/05/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Deep inspiration breath hold (DIBH) has been proven to reduce cardiac dose for women receiving left breast and chest wall radiation therapy. However, it utilises extra departmental resources and patient exertion. The aim of this exploratory study was to investigate if any factors existed that could identify breast cancer patients who may benefit most from DIBH, to facilitate appropriate utilisation of departmental resources. METHODS Left-sided breast cancer patients aged 18-70 years, and right-sided breast cancer patients with internal mammary nodes included, were recruited. DIBH and free breathing (FB) plans were created for all patients. Patient demographic and clinical history were recorded. Variables including lung threshold value, lung volume, patient separation, maximum heart in field, volume of planning target volume (PTV), heart dose, ipsilateral lung dose were compared between plans. RESULTS Plans for 31 patients were analysed. No correlations were found between lung threshold value or patient separation and cardiac dose. Moderate to strong correlations were found with BMI, PTV volume and lung volume change however no definitive thresholds were determined. A significant difference was found in the maximum heart in field between DIBH and FB (P < 0.001) with those patients with greater than 0.7 cm heart in the field on the FB scan demonstrating greater reductions in mean heart dose. CONCLUSION Maximum heart in the field of greater than 0.7 cm in FB could be a potential factor to identify patients who may benefit most from DIBH. This factor warrants investigation in a larger patient cohort to test its validity.
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Affiliation(s)
- Patricia Browne
- Radiation Oncology DepartmentCancer ServicesPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Nakia‐Rae Beaton
- Radiation Oncology DepartmentCancer ServicesPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Harish Sharma
- Radiation Oncology DepartmentCancer ServicesPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Sharon Watson
- Radiation Oncology DepartmentCancer ServicesPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - G Tao Mai
- Radiation Oncology DepartmentCancer ServicesPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- School of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Jennifer Harvey
- Radiation Oncology DepartmentCancer ServicesPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- School of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Anne Bernard
- QFAB BioinformaticsInstitute for Molecular BioscienceUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Elizabeth Brown
- Radiation Oncology DepartmentCancer ServicesPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Catriona Hargrave
- Radiation Oncology DepartmentCancer ServicesPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Margot Lehman
- Radiation Oncology DepartmentCancer ServicesPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- School of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
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Zhao Y, Diao P, Zhang D, Wu J, Xin X, Fontanarosa D, Liu M, Li J, Orlandini LC. Impact of Positioning Errors on the Dosimetry of Breath-Hold-Based Volumetric Arc Modulated and Tangential Field-in-Field Left-Sided Breast Treatments. Front Oncol 2020; 10:554131. [PMID: 33194616 PMCID: PMC7658584 DOI: 10.3389/fonc.2020.554131] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
Heart diseases and cardiovascular events are well-known side effects in left-sided breast irradiation. Deep inspiration breath hold (BH) combined with fast delivery techniques such as volumetric modulated arc therapy (VMAT) or tangential field-in-field (TFiF) can serve as a valuable solution to reduce the dose to the heart. This study aims to compare the impact of positioning errors in VMAT and TFiF plans for BH left-sided breast treatments. Fifteen left-sided breast patients treated in BH with TFiF technique were included in this retrospective study. For each patient, a second plan with VMAT technique was optimized. Eighteen setup variations were introduced in each of these VMAT and TFiF reference plans, shifting the isocenter along six different directions by 3, 5, and 10 mm. A total of 540 perturbed plans, 270 for each technique, were recalculated and analyzed. The dose distributions on the target and organs at risk obtained in the different perturbed scenarios were compared with the reference scenarios, using as dosimetric endpoints the dose-volume histograms (DVH). The results were compared using the Wilcoxon test. Comparable plan quality was obtained for the reference VMAT and TFiF plans, except for low doses to organs at risk for which higher values (p < 0.05) were obtained for VMAT plans. For TFiF plans, perturbations of the isocenter position of 3, 5, or 10 mm produced mean deviations of the target DVH dosimetric parameters up to -0.5, -1.0, and -5.2%, respectively; VMAT plans were more sensitive to positioning errors resulting in mean deviations up to -0.5, -4.9, and -13.9%, respectively, for the same magnitude of the above mentioned perturbations. For organs at risk, only perturbations along the left, posterior, and inferior directions resulted in dose increase with a maximum deviation of +2% in the DVH dosimetric parameters. A notable exception were low doses to the left lung and heart for 10 mm isocenter shifts for which the mean differences ranged between +2.7 and +4.1%. Objective information on how external stresses affect the dosimetry of the treatment is the first step towards personalized radiotherapy.
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Affiliation(s)
- Yanqun Zhao
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Peng Diao
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Da Zhang
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Juxiang Wu
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Xin Xin
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Davide Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Min Liu
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Jie Li
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Lucia Clara Orlandini
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
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Koutroumpakis E, Palaskas NL, Lin SH, Abe JI, Liao Z, Banchs J, Deswal A, Yusuf SW. Modern Radiotherapy and Risk of Cardiotoxicity. Chemotherapy 2020; 65:65-76. [PMID: 33049738 DOI: 10.1159/000510573] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/28/2020] [Indexed: 12/24/2022]
Abstract
Despite the advancements of modern radiotherapy, radiation-induced heart disease remains a common cause of morbidity and mortality amongst cancer survivors. This review outlines the basic mechanism, clinical presentation, risk stratification, early detection, possible mitigation, and treatment of this condition.
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Affiliation(s)
- Efstratios Koutroumpakis
- Division of Cardiovascular Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Nicolas L Palaskas
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven H Lin
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jun-Ichi Abe
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jose Banchs
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Syed Wamique Yusuf
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA,
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Borm KJ, Simonetto C, Kundrát P, Eidemüller M, Oechsner M, Düsberg M, Combs SE. Toxicity of internal mammary irradiation in breast cancer. Are concerns still justified in times of modern treatment techniques? Acta Oncol 2020; 59:1201-1209. [PMID: 32619381 DOI: 10.1080/0284186x.2020.1787509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The purpose of this study was to estimate the additional risk of side effects attributed to internal mammary node irradiation (IMNI) as part of regional lymph node irradiation (RNI) in breast cancer patients and to compare it with estimated overall survival (OS) benefit from IMNI. MATERIAL AND METHODS Treatment plans (n = 80) with volumetric modulated arc therapy (VMAT) were calculated for 20 patients (4 plans per patient) with left-sided breast cancer from the prospective GATTUM trial in free breathing (FB) and in deep inspiration breath hold (DIBH). We assessed doses to organs at risk ((OARs) lung, contralateral breast and heart) during RNI with and without additional IMNI. Based on the OAR doses, the additional absolute risks of 10-year cardiac mortality, pneumonitis, and secondary lung and breast cancer were estimated using normal tissue complication probability (NTCP) and risk models assuming different age and risk levels. RESULTS IMNI notably increased the mean OAR doses. The mean heart dose increased upon IMNI by 0.2-3.4 Gy (median: 1.9 Gy) in FB and 0.0-1.5 Gy (median 0.4 Gy) in DIBH. However, the estimated absolute additional 10-year cardiac mortality caused by IMNI was <0.5% for all patients studied except 70-year-old high risk patients (0.2-2.4% in FB and 0.0-1.1% in DIBH). In comparison to this, the published oncological benefit of IMNI ranges between 3.3% and 4.7%. The estimated additional 10-year risk of secondary cancer of the lung or contralateral breast ranged from 0-1.5% and 0-2.8%, respectively, depending on age and risk levels. IMNI increased the pneumonitis risk in all groups (0-2.2%). CONCLUSION According to our analyses, the published oncological benefit of IMNI outweighs the estimated risk of cardiac mortality even in case of (e.g., cardiac) risk factors during VMAT. The estimated risk of secondary cancer or pneumonitis attributed to IMNI is low. DIBH reduces the estimated additional risk of IMNI even further and should be strongly considered especially in patients with a high baseline risk.
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Affiliation(s)
- Kai Joachim Borm
- Department of Radiation Oncology, Technical University of Munich (TUM), München, Germany
| | | | - Pavel Kundrát
- Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Radiation Dosimetry, Nuclear Physics Institute of the Czech Academy of Sciences, Prague, Czech Republic
| | - Markus Eidemüller
- Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Technical University of Munich (TUM), München, Germany
| | - Mathias Düsberg
- Department of Radiation Oncology, Technical University of Munich (TUM), München, Germany
| | - Stephanie Elisabeth Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), München, Germany
- Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung, (DKTK)-Partner Site Munich, München, Germany
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Murchison S, Soo J, Kassam A, Ingledew PA, Hamilton S. Breast Cancer Patients' Perceptions of Adjuvant Radiotherapy: an Assessment of Pre-Treatment Knowledge and Informational Needs. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:661-668. [PMID: 30852787 DOI: 10.1007/s13187-019-01507-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is little knowledge about breast cancer patients' information-seeking behaviors, needs, and perceptions of breast radiation therapy (BRT) prior to radiation oncology consultation. This study assessed these parameters to evaluate potential gaps and overlaps in the BRT educational process. Breast cancer patients > 18 years referred for adjuvant BRT at a tertiary cancer center completed an anonymous survey prior to their consultation. Response rate was 86% (118/137). The most commonly reported sources of information about BRT were healthcare providers (55%), family or friends treated with BRT (53%), and the Internet (45%). Most (79%) had little or no knowledge about BRT. Sixty-seven percent were a little or moderately concerned about BRT, while 29% were very concerned. Half were unsure about the benefit of BRT and 46% thought it would provide a moderate to significant benefit. While seeking information about BRT, a wide range of topics were encountered. The most common ones were fatigue (68%), skin care (57%), skin problems (54%), effects on healthy body tissues (43%), the immune system (37%), and pain (34%). Topics considered most important for the radiation oncologist to address were BRT effects on the heart (74%), second cancers (74%), immune system (66%), pain (64%), and lungs (62%). Although commonly encountered, fatigue (56%) and skin care (49%) were of lesser importance. In conclusion, breast cancer patients encounter a broad range of information about BRT prior to their radiation oncology consultation, which may contribute to worry and misconceptions. Potentially rare and serious side effects were considered important to address.
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Affiliation(s)
- Sonja Murchison
- University of British Columbia, Vancouver, BC, Canada.
- Department of Radiation Oncology, BC Cancer - Vancouver Center, Vancouver, BC, Canada.
| | - Jenny Soo
- Department of Radiation Therapy, BC Cancer - Vancouver Center, Vancouver, BC, Canada
| | - Aneeta Kassam
- Department of Radiation Therapy, BC Cancer - Vancouver Center, Vancouver, BC, Canada
| | - Paris-Ann Ingledew
- University of British Columbia, Vancouver, BC, Canada
- Department of Radiation Oncology, BC Cancer - Vancouver Center, Vancouver, BC, Canada
| | - Sarah Hamilton
- University of British Columbia, Vancouver, BC, Canada
- Department of Radiation Oncology, BC Cancer - Vancouver Center, Vancouver, BC, Canada
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Xie Y, Bourgeois D, Guo B, Zhang R. Comparison of conventional and advanced radiotherapy techniques for left-sided breast cancer after breast conserving surgery. Med Dosim 2020; 45:e9-e16. [PMID: 32646715 DOI: 10.1016/j.meddos.2020.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/22/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
Whole breast radiotherapy (WBRT) after breast conserving surgery is the standard treatment to prevent recurrence and metastasis of early stage breast cancer. This study aims to compare seven WBRT techniques including conventional tangential, field-in-field (FIF), hybrid intensity-modulated radiotherapy (IMRT), IMRT, standard volumetric modulated arc therapy (STD-VMAT), noncoplanar VMAT (NC-VMAT), and multiple arc VMAT (MA-VMAT). Fifteen patients who were previously diagnosed with left-sided early stage breast cancer and treated in our clinic were selected for this study. WBRT plans were created for these patients and were evaluated based on target coverage and normal tissue toxicities. All techniques produced clinically acceptable WBRT plans. STD-VMAT delivered the lowest mean dose (1.1 ± 0.3 Gy) and the lowest maximum dose (7.3 ± 4.9 Gy) to contralateral breast, and the second lowest lifetime attributable risk (LAR) (4.1 ± 1.4%) of secondary contralateral breast cancer. MA-VMAT delivered the lowest mean dose to lungs (4.9 ± 0.9 Gy) and heart (5.5 ± 1.2 Gy), exhibited the lowest LAR (1.7 ± 0.3%) of secondary lung cancer, normal tissue complication probability (NTCP) (1.2 ± 0.2%) of pneumonitis, risk of coronary events (RCE) (10.3 ± 2.7%), and LAR (3.9 ± 1.3%) of secondary contralateral breast cancer. NC-VMAT plans provided the most conformal target coverage, the lowest maximum lung dose (46.2 ± 4.1 Gy) and heart dose (41.1 ± 5.4 Gy), and the second lowest LAR (1.8 ± 0.4%) of secondary lung cancer and RCE (10.5 ± 2.8%). MA-VMAT and NC-VMAT could be the preferred techniques for early stage breast cancer patients after breast conserving surgery.
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Affiliation(s)
- Yibo Xie
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, USA
| | - Daniel Bourgeois
- Department of Radiation Oncology, Mary Bird Perkins Cancer Center, Baton Rouge, LA, USA
| | - Beibei Guo
- Department of Experimental Statistics, Louisiana State University, Baton Rouge, LA, USA
| | - Rui Zhang
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, USA; Department of Radiation Oncology, Mary Bird Perkins Cancer Center, Baton Rouge, LA, USA.
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Trends and Correlates of Mean Lung Dose in Patients Receiving Breast Radiotherapy in a Single Institution from 2014 to 2018. Clin Oncol (R Coll Radiol) 2020; 32:647-655. [PMID: 32540281 DOI: 10.1016/j.clon.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/17/2020] [Accepted: 05/15/2020] [Indexed: 11/23/2022]
Abstract
AIMS Higher mean lung dose (MLD) in breast cancer patients has been associated with pneumonitis, pulmonary fibrosis and secondary lung cancer primaries. This study examined MLD in a single institution from 2014 to 18 to assess trends in median MLD (Gy) over time and factors associated with higher MLD to determine best practices for limiting lung toxicity. MATERIALS AND METHODS General linear regressions were analysed to determine significant change in median MLD over time in patients receiving conventional or hypofractionated schedules for whole breast/chest wall (WB) radiotherapy with or without sequential boost or simultaneous integrated boost, WB tangential radiotherapy only and WB locoregional radiotherapy. Univariate and multivariable linear regression analysed identified factors associated with MLD. RESULTS In total, 3894 patients were included in the analysis. The total median MLD across all years was 6.8 Gy in patients treated with conventional fractionation and 3.4 Gy in patients treated with hypofractionation. A significant increase in MLD was observed between 2014 and 2018 in patients receiving conventional or hypofractionation, conventional WB treatment with locoregional radiotherapy, conventional WB radiotherapy with simultaneous integrated boost and hypofractionated WB radiotherapy with sequential boost. Increased MLD was significantly correlated with lower lung volume and larger treatment volume due to locoregional radiotherapy, inclusion of a boost, chest wall treatment and reverse decubitus or supine positioning (P < 0.0001). CONCLUSION A significant increase in MLD was observed over the years in patients receiving conventional and hypofractionated radiotherapy. Techniques such as prone positioning should be considered to lower MLD, particularly for patients with predisposing pulmonary risk.
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CHANG CS, CHEN CH, LIU KC, HO CS, CHEN MF. Selection of patients with left breast cancer for IMRT with deep inspiration breath-hold technique. JOURNAL OF RADIATION RESEARCH 2020; 61:431-439. [PMID: 32123912 PMCID: PMC7299258 DOI: 10.1093/jrr/rraa003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/09/2019] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
The deep inspiration breath-hold (DIBH) technique has been utilized to reduce the cardiac dose in left-sided breast cancer (BC) patients undergoing radiotherapy. Further investigation of the parameters for selecting which patients will benefit most from DIBH is essential. We performed dosimetric comparisons for 21 patients with left-sided BC who had both computed tomography (CT)-based free-breathing (FB) and DIBH plans. The doses to the heart and left anterior descending artery (LAD) and any reduction due to the DIBH technique were analysed. Based on CTFB plans, dosimetric analysis revealed that the irradiation doses to the heart and LAD were significantly correlated with the target volume, the ipsilateral lung volume (ILV) and the total lung volume (TLV). When patients had an ILV ≥ 950 cm3 or a TLV ≥ 2200 cm3, the irradiation doses to the heart and LAD were significantly decreased. Furthermore, the reduction in the mean heart dose (MHD) was correlated to the difference in lung volume between FB and DIBH. The difference in ILV between DIBH and FB of 1.8 indicated that the patients obtained more benefit from the DIBH technique. The data suggest that lung volume (ILV and TLV) measured on a CT-simulation scan and the difference between FB and DIBH could be utilized to help select patients for DIBH.
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Affiliation(s)
- Chih-Shen CHANG
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
| | - Chia-Hsin CHEN
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
| | - Kuo-Chi LIU
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
| | - Chia-Sheng HO
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
| | - Miao-Fen CHEN
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
- College of Medicine, Chang Gung University College of Medicine, Taiwan
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Mohseni M, Mohaghegh F, Robatmili N, Bayatiani MR, Seif F, Mostafavi NS. Comparison of Photon-electron and Photon Radiotherapy for Supraclavicular Lymph Nodes of Mastectomy Patients with Left-sided Breast Cancer. J Cancer Prev 2020; 25:48-54. [PMID: 32266179 PMCID: PMC7113409 DOI: 10.15430/jcp.2020.25.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/20/2022] Open
Abstract
The aim of radiotherapy is to deliver the highest possible radiation dose to the tumor and the lowest radiation to normal tissues surrounding the tumor. In the present study, lymph nodes of the supraclavicular region were treated using two therapeutic techniques, namely photon technique (PT) and combinatory photon-electron technique (CPET). We recruited 50 patients with local lymph node metastasis. The photon energies were 6-15 MV. Furthermore, the electron beam energy was 18 MeV in CPET. The study findings revealed that the mean delivered dose to target volume was 41.12 ± 2.98Gy for PT and 44.56 ± 1.90Gy for CPET. The percentage of the target volume irradiated to 90% of the prescribed dose (V90) was calculated as 74.61% ± 9.30% and 82.06% ± 9.70% for PT and CPET, respectively. The mean dose delivered to the heart and lungs was not significantly different between the two groups. Furthermore, the maximum doses delivered to the spinal cord were 12.55Gy in PT and 8.89Gy in CPET. The mean doses delivered to the thyroid gland were 39.26 and 34.89Gy in PT and CPET. According to the study results, the maximum doses delivered to the spinal cord, head of the humerus bone, and thyroid were reduced significantly as measured the CPET technique. In contrast, no significant difference was observed regarding the dose delivered to the heart and lung. The dose delivered to the supraclavicular region determined by the CPET was significantly augmented. Furthermore, the coverage of the tumor mass was optimized using the new method.
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Affiliation(s)
- Mehran Mohseni
- Department of Medical Physics, School of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Fatholah Mohaghegh
- Department of Medical Physics and Radiotherapy, Arak University of Medical Sciences and Khansari Hospital, Arak, Iran
| | - Nasrin Robatmili
- Department of Medical Physics, School of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Reza Bayatiani
- Department of Medical Physics and Radiotherapy, Arak University of Medical Sciences and Khansari Hospital, Arak, Iran
| | - Fatemeh Seif
- Department of Medical Physics and Radiotherapy, Arak University of Medical Sciences and Khansari Hospital, Arak, Iran
| | - Nayyer Sadat Mostafavi
- Department of Medical Physics, School of Paramedical Sciences, Isfahan University of Medical Sciences and Khansari Hospital, Isfahan, Iran
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Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, Ozcan F, Colak O, Elcim Y, Dirican B, Beyzadeoglu M. Breathing adapted radiation therapy for leukemia relapse in the breast: A case report. World J Clin Oncol 2019; 10:369-374. [PMID: 31815096 PMCID: PMC6895000 DOI: 10.5306/wjco.v10.i11.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/04/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Infiltration of the breast by leukemic cells is uncommon but may manifest as an oncological emergency requiring prompt management. Extramedullary relapse of T-cell acute lymphoblastic leukemia (T-ALL) within the breast is exceedingly rare and there is paucity of data in the literature regarding this entity. No consensus exists on management of isolated extramedullary breast relapses of T-ALL. Herein, we report a case of isolated extramedullary breast relapse of T-ALL treated with breathing adapted radiation therapy (BART) using the active breathing control (ABC) system.
CASE SUMMARY The patient was a 33-year-old female with diagnosis of T-ALL. She received intensive systemic chemotherapy that resulted in complete remission of her disease, and then underwent allogeneic hematopoietic stem cell transplantation. After a 15 mo period without symptoms and signs of progression, the patient presented with palpable masses in both breasts. She complained from severe pain and swelling of the breasts. Imaging workup showed bilateral breast lesions, and diagnosis of breast infiltration by leukemic cells was confirmed after immunohistopathological evaluation. The patient suffering from severe pain, discomfort, and swelling of both breasts due to leukemic infiltration was referred to the Radiation Oncology Department for symptomatic palliation. Whole breast irradiation was delivered to both breasts of the patient with BART using the ABC system. The patient had complete resolution of her symptoms after treatment with BART.
CONCLUSION BART with the ABC system resulted in complete resolution of the patient’s symptoms due to leukemic infiltration of both breasts with T-ALL. This contemporary treatment technique should be preferred for radiotherapeutic management of patients with leukemic infiltration of the breasts to achieve effective symptomatic palliation.
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Affiliation(s)
- Omer Sager
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Ferrat Dincoglan
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Selcuk Demiral
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Bora Uysal
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Hakan Gamsiz
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Fatih Ozcan
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Onurhan Colak
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Yelda Elcim
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Bahar Dirican
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Murat Beyzadeoglu
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
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Cao N, Kalet AM, Young LA, Fang LC, Kim JN, Mayr NA, Meyer J. Predictors of cardiac and lung dose sparing in DIBH for left breast treatment. Phys Med 2019; 67:27-33. [PMID: 31629280 DOI: 10.1016/j.ejmp.2019.09.240] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/10/2019] [Accepted: 09/25/2019] [Indexed: 01/23/2023] Open
Abstract
This retrospective study of left breast radiation therapy (RT) investigates the correlation between anatomical parameters and dose to heart or/and left lung in deep inspiration breath-hold (DIBH) compared to free-breathing (FB) technique. Anatomical parameters of sixty-seven patients, treated with a step-and-shoot technique to 50 Gy or 50.4 Gy were included. They consisted of the cardiac contact distances in axial (CCDax) and parasagittal (CCDps) planes, and the lateral heart-to-chest distance (HCD). Correlation analysis was performed to identify predictors for heart and lung dose sparing. Paired t-test and linear regression were used for data analysis with significance level of p = 0.05. All dose metrics for heart and lung were significantly reduced with DIBH, however 21% of patients analyzed had less than 1.0 Gy mean heart dose reduction. Both FB-CCDpsdistance and FB-HCD correlated with FB mean heart dose and mean DIBH heart dose reduction. The strongest correlation was observed for the ratio of FB-CCDpsand FB-HCD with heart dose sparing. A FB-CCDps and FB-HCD model was developed to predict DIBH induced mean heart dose reduction, with 1.04 Gy per unit of FB-CCDps/FB-HCD. Variation between predicted and actual mean heart dose reduction ranged from -0.6 Gy to 0.6 Gy. In this study, FB-CCDps and FB-HCD distance served as predictors for heart dose reduction with DIBH equally, with FB-CCDps/FB-HCD as a stronger predictor. These parameters and the prediction model could be further investigated for use as a tool to better select patients who will benefit from DIBH.
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Affiliation(s)
- Ning Cao
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA; Department of Radiation Oncology, Seattle Cancer Care Alliance, Seattle, WA, USA.
| | - Alan M Kalet
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA; Department of Radiation Oncology, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Lori A Young
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA; Department of Radiation Oncology, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - L Christine Fang
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA; Department of Radiation Oncology, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Janice N Kim
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA; Department of Radiation Oncology, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Nina A Mayr
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA; Department of Radiation Oncology, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Juergen Meyer
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA; Department of Radiation Oncology, Seattle Cancer Care Alliance, Seattle, WA, USA
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Lin H, Zou W, Li T, Feigenberg SJ, Teo BKK, Dong L. A Super-Learner Model for Tumor Motion Prediction and Management in Radiation Therapy: Development and Feasibility Evaluation. Sci Rep 2019; 9:14868. [PMID: 31619736 PMCID: PMC6795883 DOI: 10.1038/s41598-019-51338-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/25/2019] [Indexed: 12/25/2022] Open
Abstract
In cancer radiation therapy, large tumor motion due to respiration can lead to uncertainties in tumor target delineation and treatment delivery, thus making active motion management an essential step in thoracic and abdominal tumor treatment. In current practice, patients with tumor motion may be required to receive two sets of CT scans – the initial free-breathing 4-dimensional CT (4DCT) scan for tumor motion estimation and a second CT scan under appropriate motion management such as breath-hold or abdominal compression. The aim of this study is to assess the feasibility of a predictive model for tumor motion estimation in three-dimensional space based on machine learning algorithms. The model was developed based on sixteen imaging features extracted from non-4D diagnostic CT images and eleven clinical features extracted from the Electronic Health Record (EHR) database of 150 patients to characterize the lung tumor motion. A super-learner model was trained to combine four base machine learning models including the Random Forest, Multi-Layer Perceptron, LightGBM and XGBoost, the hyper-parameters of which were also optimized to obtain the best performance. The outputs of the super-learner model consist of tumor motion predictions in the Superior-Inferior (SI), Anterior-Posterior (AP) and Left-Right (LR) directions, and were compared against tumor motions measured in the free-breathing 4DCT scans. The accuracy of predictions was evaluated using Mean Absolute Error (MAE) and Root Mean Square Error (RMSE) through ten rounds of independent tests. The MAE and RMSE of predictions in the SI direction were 1.23 mm and 1.70 mm; the MAE and RMSE of predictions in the AP direction were 0.81 mm and 1.19 mm, and the MAE and RMSE of predictions in the LR direction were 0.70 mm and 0.95 mm. In addition, the relative feature importance analysis demonstrated that the imaging features are of great importance in the tumor motion prediction compared to the clinical features. Our findings indicate that a super-learner model can accurately predict tumor motion ranges as measured in the 4DCT, and could provide a machine learning framework to assist radiation oncologists in determining the active motion management strategy for patients with large tumor motion.
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Affiliation(s)
- Hui Lin
- University of Pennsylvania, Department of Radiation Oncology, Pennsylvania, 19104, United States
| | - Wei Zou
- University of Pennsylvania, Department of Radiation Oncology, Pennsylvania, 19104, United States
| | - Taoran Li
- University of Pennsylvania, Department of Radiation Oncology, Pennsylvania, 19104, United States
| | - Steven J Feigenberg
- University of Pennsylvania, Department of Radiation Oncology, Pennsylvania, 19104, United States
| | - Boon-Keng K Teo
- University of Pennsylvania, Department of Radiation Oncology, Pennsylvania, 19104, United States
| | - Lei Dong
- University of Pennsylvania, Department of Radiation Oncology, Pennsylvania, 19104, United States.
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Oonsiri P, Wisetrinthong M, Chitnok M, Saksornchai K, Suriyapee S. An effective patient training for deep inspiration breath hold technique of left-sided breast on computed tomography simulation procedure at King Chulalongkorn Memorial Hospital. Radiat Oncol J 2019; 37:201-206. [PMID: 31591868 PMCID: PMC6790791 DOI: 10.3857/roj.2019.00290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose To observe the effectiveness of the practical instruction sheet and the educational video for left-sided breast treatment in a patient receiving deep inspiration breath hold (DIBH) technique. Two parameters, simulation time and patient satisfaction, were assessed through the questionnaire. Methods Two different approaches, which were the instruction sheet and educational video, were combinedly used to assist patients during DIBH procedures. The guideline was assigned at least 1 week before the simulation date. On the simulation day, patients would fill the questionnaire regarding their satisfaction with the DIBH instruction. The questionnaire was categorized into five levels: extremely satisfied to dissatisfied, sequentially. The patients were divided into four groups: not DIBH technique, DIBH without instruction materials, the DIBH with instruction sheet or educational video, and DIBH with both of instruction sheet and educational video. Results Total number of 112 cases of left-sided breast cancer were analyzed. The simulation time during DIBH procedure significantly reduced when patients followed the instruction. There was no significant difference in simulation time on the DIBH procedures between patient compliance via instruction sheet or educational video or even following both of them. The excellent level was found at 4.6 ± 0.1 and 4.5 ± 0.1, for patients coaching via instruction sheet as well as on the educational video, respectively. Conclusion Patient coaching before simulation could potentially reduce the lengthy time in the simulation process for DIBH technique. Practicing the DIBH technique before treatment is strongly advised.
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Affiliation(s)
- Puntiwa Oonsiri
- Division of Radiation Oncology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Metinee Wisetrinthong
- Division of Radiation Oncology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Manatchanok Chitnok
- Division of Radiation Oncology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Kitwadee Saksornchai
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sivalee Suriyapee
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Finazzi T, Nguyen VT, Zimmermann F, Papachristofilou A. Impact of patient and treatment characteristics on heart and lung dose in adjuvant radiotherapy for left-sided breast cancer. Radiat Oncol 2019; 14:153. [PMID: 31462267 PMCID: PMC6714299 DOI: 10.1186/s13014-019-1364-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/21/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The heart and lungs are routinely exposed to incidental irradiation during adjuvant radiotherapy (RT) of breast cancer. We analyzed the impact of patient and treatment characteristics on heart and lung dose in left-sided breast RT. METHODS We analyzed 332 female patients treated with left-sided breast RT between 2013 and 2018. Mean heart dose (MHD), left mean lung dose (MLD) and heart / lung V20Gy were collected from treatment plans. Patients were stratified by RT technique (3D-conformal RT, 3DCRT; intensity-modulated RT, IMRT; volumetric modulated arc therapy, VMAT) and target volumes, including lymph node RT (LN-RT). Patient characteristics (body mass index (BMI), heart and lung volume) were assessed using correlation analyses. RESULTS LN-RT was performed in 111 patients with increased MHD (median 4.6 vs. 3.3 Gy; p < .01), left MLD (14.8 vs. 7.7 Gy; p < .01) and left lung V20Gy (30.0% vs. 14.4%; p < .01) compared to treatment without LN-RT. Internal mammary LN-RT further increased organ doses compared to RT involving only supraclavicular +/- axillary LN (p < .01 for all values; MHD 6.9 vs. 4.2 Gy). In 221 patients treated without LN-RT, IMRT/VMAT was associated with higher left lung doses (MLD 9.1 vs. 7.4 Gy, p < .01; V20Gy 18.8% vs. 14.0%, p < .01) compared to 3DCRT. A negative correlation between total lung volume and both MHD (r = - 0.38; p < .01) and heart V20Gy (r = - 0.37; p < .01), as well as a weak positive correlation of BMI and MHD (r = 0.27; p < .01) were observed. CONCLUSIONS In adjuvant RT for left-sided breast cancer, LN-RT is associated with a marked increase in heart and lung doses, particularly with internal mammary LN-RT. Potential advantages of IMRT/VMAT for breast or chest wall RT need to be weighed against a moderately increased lung dose.
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Affiliation(s)
- Tobias Finazzi
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Van-Trinh Nguyen
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Frank Zimmermann
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Alexandros Papachristofilou
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
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50
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Niepel K, Kamp F, Kurz C, Hansen D, Rit S, Neppl S, Hofmaier J, Bondesson D, Thieke C, Dinkel J, Belka C, Parodi K, Landry G. Feasibility of 4DCBCT-based proton dose calculation: An ex vivo porcine lung phantom study. Z Med Phys 2019; 29:249-261. [DOI: 10.1016/j.zemedi.2018.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/06/2018] [Accepted: 10/22/2018] [Indexed: 12/25/2022]
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