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Reproducibility of repeated breathhold and impact of breathhold failure in whole breast and regional nodal irradiation in prone crawl position. Sci Rep 2022; 12:1887. [PMID: 35115610 PMCID: PMC8814154 DOI: 10.1038/s41598-022-05957-7] [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: 02/02/2021] [Accepted: 01/20/2022] [Indexed: 11/09/2022] Open
Abstract
In whole breast and regional nodal irradiation (WB + RNI), breathhold increases organ at risk (OAR) sparing. WB + RNI is usually performed in supine position, because positioning materials obstruct beam paths in prone position. Recent advancements allow prone WB + RNI (pWB + RNI) with increased sparing of OARs compared to supine WB + RNI. We evaluate positional and dosimetrical impact of repeated breathhold (RBH) and failure to breathhold (FTBH) in pWB + RNI. Twenty left-sided breast cancer patients were scanned twice in breathhold (baseline and RBH) and once free breathing (i.e. FTBH). Positional impact was evaluated using overlap index (OI) and Dice similarity coefficient (DSC). Dosimetrical impact was assessed by beam transposition from the baseline plan. Mean OI and DSC ranges were 0.01–0.98 and 0.01–0.92 for FTBH, and 0.73–1 and 0.69–1 for RBH. Dosimetric impact of RBH was negligible. FTBH significantly decreased minimal dose to CTV WBI, level II and the internal mammary nodes, with adequate mean doses. FTBH significantly increased heart, LAD, left lung and esophagus dose. OI and DSC for RBH and FTBH show reproducible large ROI positions. Small ROIs show poor overlap. FTBH maintained adequate target coverage but increased heart, LAD, ipsilateral lung and esophagus dose. RBH is a robust technique in pWB + RNI. (Clinicaltrials.gov: NCT05179161, registered 05/01/2022).
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Deseyne P, Speleers B, De Neve W, Boute B, Paelinck L, Van Hoof T, Van de Velde J, Van Greveling A, Monten C, Post G, Depypere H, Veldeman L. Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer. Radiat Oncol 2017; 12:89. [PMID: 28549483 PMCID: PMC5446717 DOI: 10.1186/s13014-017-0828-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/17/2017] [Indexed: 12/25/2022] Open
Abstract
Background Prone whole breast irradiation (WBI) leads to reduced heart and lung doses in breast cancer patients receiving adjuvant radiotherapy. In this feasibility trial, we investigated the prone position for whole breast + lymph node irradiation (WB + LNI). Methods A new support device was developed for optimal target coverage, on which patients are positioned in a position resembling a phase from the crawl swimming technique (prone crawl position). Five left sided breast cancer patients were included and simulated in supine and prone position. For each patient, a treatment plan was made in prone and supine position for WB + LNI to the whole axilla and the unoperated part of the axilla. Patients served as their own controls for comparing dosimetry of target volumes and organs at risk (OAR) in prone versus in supine position. Results Target volume coverage differed only slightly between prone and supine position. Doses were significantly reduced (P < 0.05) in prone position for ipsilateral lung (Dmean, D2, V5, V10, V20, V30), contralateral lung (Dmean, D2), contralateral breast (Dmean, D2 and for total axillary WB + LNI also V5), thyroid (Dmean, D2, V5, V10, V20, V30), oesophagus (Dmean and for partial axillary WB + LNI also D2 and V5), skin (D2 and for partial axillary WB + LNI V105 and V107). There were no significant differences for heart and humeral head doses. Conclusions Prone crawl position in WB + LNI allows for good breast and nodal target coverage with better sparing of ipsilateral lung, thyroid, contralateral breast, contralateral lung and oesophagus when compared to supine position. There is no difference in heart and humeral head doses. Trial registration No trial registration was performed because there were no therapeutic interventions.
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Affiliation(s)
- Pieter Deseyne
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium. .,Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium.
| | - Bruno Speleers
- Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Wilfried De Neve
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium.,Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Bert Boute
- Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium.,Industrial Design Centre - Department of Industrial Systems Engineering and Product Design (EA18), Faculty of Engineering and Architecture, Ghent University, Campus Kortrijk, Graaf Karel de Goedelaan 5, Kortrijk, B-8500, Belgium
| | - Leen Paelinck
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Tom Van Hoof
- Department of Anatomy, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Joris Van de Velde
- Department of Anatomy, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Annick Van Greveling
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Chris Monten
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium.,Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Giselle Post
- Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Herman Depypere
- Department of Obstetrics and Gynaecology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium.,Department of Uro-gynaecology, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Liv Veldeman
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium.,Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
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