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Wu HG, Zhang GW, Liu JF, Yang JG, Su XH. Correlation between maximum heart distance and thoracic diameter changes and diaphragmatic descent in left-sided breast cancer patients during deep inspiration breath-hold (DIBH). Radiol Oncol 2023; 57:530-537. [PMID: 38038420 PMCID: PMC10690744 DOI: 10.2478/raon-2023-0053] [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: 04/13/2023] [Accepted: 08/28/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Cardioprotection is valued in radiotherapy for patients with left-sided breast cancer. Deep inspiration breath-hold (DIBH) technique can achieve cardioprotection well. However, during DIBH, the extent to which the heart enters the radiation field is affected by the movement of the thorax and diaphragm. The aim of this study was to analyze the correlation between the maximum distance of the heart entering the field (maximum heart distance, MHD) and thoracic diameter changes and diaphragmatic descent in left-sided breast cancer patients during DIBH. PATIENTS AND METHODS Ninety-eight patients with left-sided breast cancer were included in this retrospective study. They performed simulation in Sentinel-guided DIBH, and two sets of CT images were collected under both free breathing (FB) and DIBH, and diaphragm positions, anteroposterior thoracic diameter (ATD), transverse thoracic diameter (TTD), gating window level (GWL), and MHD were measured, and the change (Δ) of each parameter in DIBH relative to that in FB were calculated. Pearson or Spearman test were used to analyze the correlation between ΔMHD and the changes in other parameters. RESULTS For all patients with DIBH, the average of ΔMHD was -8.3 mm, and the average of ΔATD and ΔTTD were 11.0 and 8.6 mm, and the median of both left diaphragmatic descent (LDD) and right diaphragmatic descent (RDD) were 35.0 mm, and the median of GWL was 11.1 mm. The correlation coefficients between MHD decrease (ΔMHD) and LDD, RDD, and ΔTTD were -0.430 (p = 0.000), -0.592 (p = 0.000) and 0.208 (p = 0.040), respectively, but not significantly correlated with ΔATD or GWL. CONCLUSIONS The MHD decrease showed a moderate correlation with diaphragmatic descent In Sentinel-guided DIBH for patients with left-sided breast cancer, while there was a weak or no correlation with thoracic diameter changes or GWL. Abdominal breathing can lower diaphragm more and may be more beneficial to the heart stay away from tangential field.
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Affiliation(s)
- He-Gou Wu
- Department of Radiation Oncology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, People's Republic of China
| | - Guang-Wei Zhang
- Department of Radiation Oncology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, People's Republic of China
| | - Jian-Feng Liu
- Department of Radiation Oncology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, People's Republic of China
| | - Jun-Guo Yang
- Department of Radiation Oncology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, People's Republic of China
| | - Xiao-Hui Su
- Department of Radiation Oncology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, People's Republic of China
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Kamizaki R, Kuroda M, Al-Hammad WE, Tekiki N, Ishizaka H, Kuroda K, Sugimoto K, Oita M, Tanabe Y, Barham M, Sugianto I, Nakamitsu Y, Hirano M, Muto Y, Ihara H, Sugiyama S. Evaluation of the accuracy of heart dose prediction by machine learning for selecting patients not requiring deep inspiration breath‑hold radiotherapy after breast cancer surgery. Exp Ther Med 2023; 26:536. [PMID: 37869640 PMCID: PMC10587874 DOI: 10.3892/etm.2023.12235] [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: 06/08/2023] [Accepted: 09/01/2023] [Indexed: 10/24/2023] Open
Abstract
Increased heart dose during postoperative radiotherapy (RT) for left-sided breast cancer (BC) can cause cardiac injury, which can decrease patient survival. The deep inspiration breath-hold technique (DIBH) is becoming increasingly common for reducing the mean heart dose (MHD) in patients with left-sided BC. However, treatment planning and DIBH for RT are laborious, time-consuming and costly for patients and RT staff. In addition, the proportion of patients with left BC with low MHD is considerably higher among Asian women, mainly due to their smaller breast volume compared with that in Western countries. The present study aimed to determine the optimal machine learning (ML) model for predicting the MHD after RT to pre-select patients with low MHD who will not require DIBH prior to RT planning. In total, 562 patients with BC who received postoperative RT were randomly divided into the trainval (n=449) and external (n=113) test datasets for ML using Python (version 3.8). Imbalanced data were corrected using synthetic minority oversampling with Gaussian noise. Specifically, right-left, tumor site, chest wall thickness, irradiation method, body mass index and separation were the six explanatory variables used for ML, with four supervised ML algorithms used. Using the optimal value of hyperparameter tuning with root mean squared error (RMSE) as an indicator for the internal test data, the model yielding the best F2 score evaluation was selected for final validation using the external test data. The predictive ability of MHD for true MHD after RT was the highest among all algorithms for the deep neural network, with a RMSE of 77.4, F2 score of 0.80 and area under the curve-receiver operating characteristic of 0.88, for a cut-off value of 300 cGy. The present study suggested that ML can be used to pre-select female Asian patients with low MHD who do not require DIBH for the postoperative RT of BC.
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Affiliation(s)
- Ryo Kamizaki
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
- Department of Radiology, Matsuyama Red Cross Hospital, Matsuyama, Ehime 790-8524, Japan
| | - Masahiro Kuroda
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Wlla E. Al-Hammad
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Nouha Tekiki
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hinata Ishizaka
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Kazuhiro Kuroda
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
- Department of Health and Welfare Science, Graduate School of Health and Welfare Science, Okayama Prefectural University, Okayama 719-1197, Japan
| | - Kohei Sugimoto
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
- Graduate School of Interdisciplinary Sciences and Engineering in Health Systems, Okayama University, Okayama 770-8558, Japan
| | - Masataka Oita
- Graduate School of Interdisciplinary Sciences and Engineering in Health Systems, Okayama University, Okayama 770-8558, Japan
| | - Yoshinori Tanabe
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Majd Barham
- Department of Dentistry and Dental Surgery, College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine
| | - Irfan Sugianto
- Department of Oral Radiology, Faculty of Dentistry, Hasanuddin University, Sulawesi 90245, Indonesia
| | - Yuki Nakamitsu
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Masaki Hirano
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
- Department of Radiology, Osaka Red Cross Hospital, Osaka 543-8555, Japan
| | - Yuki Muto
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
- Department of Radiology, Oomoto Hospital, Okayama 700-0924, Japan
| | - Hiroki Ihara
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Soichi Sugiyama
- Department of Proton Beam Therapy, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
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Al-Hammad WE, Kuroda M, Kamizaki R, Tekiki N, Ishizaka H, Kuroda K, Sugimoto K, Oita M, Tanabe Y, Barham M, Sugianto I, Shimizu Y, Nakamitsu Y, Asaumi J. Mean Heart Dose Prediction Using Parameters of Single-Slice Computed Tomography and Body Mass Index: Machine Learning Approach for Radiotherapy of Left-Sided Breast Cancer of Asian Patients. Curr Oncol 2023; 30:7412-7424. [PMID: 37623018 PMCID: PMC10453557 DOI: 10.3390/curroncol30080537] [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: 05/31/2023] [Revised: 07/08/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023] Open
Abstract
Deep inspiration breath-hold (DIBH) is an excellent technique to reduce the incidental radiation received by the heart during radiotherapy in patients with breast cancer. However, DIBH is costly and time-consuming for patients and radiotherapy staff. In Asian countries, the use of DIBH is restricted due to the limited number of patients with a high mean heart dose (MHD) and the shortage of radiotherapy personnel and equipment compared to that in the USA. This study aimed to develop, evaluate, and compare the performance of ten machine learning algorithms for predicting MHD using a patient's body mass index and single-slice CT parameters to identify patients who may not require DIBH. Machine learning models were built and tested using a dataset containing 207 patients with left-sided breast cancer who were treated with field-in-field radiotherapy with free breathing. The average MHD was 251 cGy. Stratified repeated four-fold cross-validation was used to build models using 165 training data. The models were compared internally using their average performance metrics: F2 score, AUC, recall, accuracy, Cohen's kappa, and Matthews correlation coefficient. The final performance evaluation for each model was further externally analyzed using 42 unseen test data. The performance of each model was evaluated as a binary classifier by setting the cut-off value of MHD ≥ 300 cGy. The deep neural network (DNN) achieved the highest F2 score (78.9%). Most models successfully classified all patients with high MHD as true positive. This study indicates that the ten models, especially the DNN, might have the potential to identify patients who may not require DIBH.
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Affiliation(s)
- Wlla E. Al-Hammad
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (W.E.A.-H.)
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Masahiro Kuroda
- Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Ryo Kamizaki
- Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Nouha Tekiki
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (W.E.A.-H.)
| | - Hinata Ishizaka
- Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Kazuhiro Kuroda
- Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
- Department of Health and Welfare Science, Graduate School of Health and Welfare Science, Okayama Prefectural University, Okayama 719-1197, Japan
| | - Kohei Sugimoto
- Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Masataka Oita
- Graduate School of Interdisciplinary Sciences and Engineering in Health Systems, Okayama University, Okayama 770-8558, Japan
| | - Yoshinori Tanabe
- Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Majd Barham
- Department of Dentistry and Dental Surgery, College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine
| | - Irfan Sugianto
- Department of Oral Radiology, Faculty of Dentistry, Hasanuddin University, Sulawesi 90245, Indonesia
| | - Yudai Shimizu
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (W.E.A.-H.)
| | - Yuki Nakamitsu
- Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Junichi Asaumi
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (W.E.A.-H.)
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Badescu MC, Badulescu OV, Scripcariu DV, Butnariu LI, Bararu-Bojan I, Popescu D, Ciocoiu M, Gorduza EV, Costache II, Rezus E, Rezus C. Myocardial Ischemia Related to Common Cancer Therapy-Prevention Insights. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071034. [PMID: 35888122 PMCID: PMC9325217 DOI: 10.3390/life12071034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 12/18/2022]
Abstract
Modern antineoplastic therapy improves survival and quality of life in cancer patients, but its indisputable benefits are accompanied by multiple and major side effects, such as cardiovascular ones. Endothelial dysfunction, arterial spasm, intravascular thrombosis, and accelerated atherosclerosis affect the coronary arteries, leading to acute and chronic coronary syndromes that negatively interfere with the oncologic treatment. The cardiac toxicity of antineoplastic agents may be mitigated by using adequate prophylactic measures. In the absence of dedicated guidelines, our work provides the most comprehensive, systematized, structured, and up-to-date analyses of the available literature focusing on measures aiming to protect the coronary arteries from the toxicity of cancer therapy. Our work facilitates the implementation of these measures in daily practice. The ultimate goal is to offer clinicians the necessary data for a personalized therapeutic approach for cancer patients receiving evidence-based oncology treatments with potential cardiovascular toxicity.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (I.I.C.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (I.B.-B.); (M.C.)
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
- Correspondence: (O.V.B.); (D.V.S.); (L.I.B.)
| | - Dragos Viorel Scripcariu
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- 1st Surgical Oncology Unit, Regional Institute of Oncology, 2-4 General Henri Mathias Berthelot Street, 700483 Iasi, Romania
- Correspondence: (O.V.B.); (D.V.S.); (L.I.B.)
| | - Lăcrămioara Ionela Butnariu
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Correspondence: (O.V.B.); (D.V.S.); (L.I.B.)
| | - Iris Bararu-Bojan
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (I.B.-B.); (M.C.)
| | - Diana Popescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (I.I.C.); (C.R.)
| | - Manuela Ciocoiu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (I.B.-B.); (M.C.)
| | - Eusebiu Vlad Gorduza
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Irina Iuliana Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (I.I.C.); (C.R.)
- Cardiology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Elena Rezus
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- I Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (I.I.C.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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Chakraborty S, Chatterjee S. HYPORT adjuvant acute toxicity and patient dosimetry quality assurance results - Interim analysis. Radiother Oncol 2022; 174:59-68. [PMID: 35817323 DOI: 10.1016/j.radonc.2022.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/21/2022] [Accepted: 07/01/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND HYPORT adjuvant trial is a randomised phase III open-label noninferiority trial comparing standard moderately hypofractionated 3 week adjuvant radiation therapy in breast cancer with a novel 1-week schedule. The trial was initiated in March 2019 and is open to recruitment with a total sample size of 2100. We report the results of dosimetric quality assurance, acute toxicity and pre planned first interim safety analysis in the first 271 patients. METHODS Stage I-III breast cancer planned for adjuvant radiation therapy to the breast/chest-wall (along with regional nodes as indicated) were randomised to receive 40 Gy/15 fractions/3 weeks or 26 Gy/5 fractions/1 week. For simultaneous integrated boost, the patients in the control arm received 8 Gy/15 fractions/3 weeks, while those in the experimental arm received 6 Gy/5 fractions/1 week (to the tumour bed). For sequential boost, the prescribed dose was 12 Gy/4 fractions/4 days in both arms. Compliance to pre specified dosimetric parameters and acute toxicities were evaluated. RESULT Data of the first 271 patients was analysed of whom 104 patients received tumour bed boost using SIB. All mandatory dosimetric criteria were met apart from one patient with a higher contralateral breast dose due to optimal internal mammary nodal coverage. Overall three patients (1.1%) experienced grade 3 radiation dermatitis (none received SIB), no other Grade 3 or higher toxicities reported. CONCLUSION This acute toxicity interim analysis demonstrates that hypofractionated adjuvant radiotherapy with SIB for patients with breast cancer is feasible, and associated with minimal severe acute toxicities.
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Schröder C, Kirschke S, Blank E, Rohrberg S, Förster R, Buchali A. Deep inspiration breath-hold for patients with left-sided breast cancer - A one-fits-all approach? A prospective analysis of patient selection using dosimetrical and practical aspects. Br J Radiol 2022; 95:20210295. [PMID: 34111954 PMCID: PMC10996328 DOI: 10.1259/bjr.20210295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To prospectively analyze the feasibility of an algorithm for patient preparation, treatment planning, and selection for deep inspiration breath-hold (DIBH) treatment of left-sided breast cancer. METHODS From February 2017 to July 2019, 135 patients with left-sided breast cancer were selected and prepared for radiotherapy in DIBH. 99 received radiotherapy for the breast alone and 36 for the breast including the lymphatic drainage (RNI). Treatment plans DIBH and free breathing (FB) were calculated. Dosimetrical analyses were performed, and criteria were defined to assess whether a patient would dosimetrically profit from DIBH. RESULTS Of the 135 patients, 97 received a DIBH planning CT and 72 were selected for treatment in DIBH according to predefined criteria. When using DIBH, there was a mean reduction of the DmeanHeart of 2.8 Gy and DmeanLAD of 4.2 Gy. seven patients did not benefit from DIBH regarding DmeanHeart, 23 regarding DmeanLAD. For the left lung, the V20Gy was reduced by 4.9%, the V30Gy by 2.7% with 15 and 29 patients not benefiting from DIBH, respectively. In the 25 patients treated in FB, the benefit of DIBH would have been lower than for patients treated with DIBH (ΔDmeanHeart0.7 Gy vs 3.4 Gy). CONCLUSION Dosimetrically, DIBH is no "one-fits-all" approach. However, there is a statistically significant benefit when looking at a larger patient population. DIBH should be used for treatment of left-sided breast cancer in patients fit for DIBH. ADVANCES IN KNOWLEDGE This analysis offers a well-designed dosimetrical analysis in patients treated with DIBH radiotherapy in an "every day" cohort.
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Affiliation(s)
- Christina Schröder
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
- Institute of Radiation Oncology, Cantonal Hospital Winterthur
(KSW), Brauerstrasse 15, 8401
Winterthur, Switzerland
| | - Sebastian Kirschke
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
| | - Eyck Blank
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
| | - Sophia Rohrberg
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
| | - Robert Förster
- Institute of Radiation Oncology, Cantonal Hospital Winterthur
(KSW), Brauerstrasse 15, 8401
Winterthur, Switzerland
- Medical Faculty, University of Zurich (UZH), Pestalozzistrasse
3/5, 8091 Zurich,
Switzerland
| | - André Buchali
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
- Medizinische Hochschule Theodor Fontane
Brandenburg, Neuruppin,
Germany
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Barr S, Mulherin D, Walsh A, Spalding M. Investigation of dose profile across the junction of deep inspiration breath hold, breast with supra-clavicle fossa treatments. Med Dosim 2022; 47:227-235. [PMID: 35523695 DOI: 10.1016/j.meddos.2022.03.004] [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: 10/09/2021] [Revised: 03/03/2022] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
Abstract
Breast with supraclavicular fossa (Br+SCF) radiotherapy treatments can utilise a monoisocentric technique to concurrently treat the breast area (tangent fields) and supraclavicular area (opposing fields). The region where these treatment areas adjoin is known as the junction region, field junction, or match line. Dose variations that may occur about the junction region, due to geometrical inaccuracies, are typically feathered out in patient free-breathing treatments. However, there is limited information on how dose at the junction is influenced in deep inspiration breath hold (DIBH) treatments. This study aims to investigate dose variation at the field junction for a patient population undertaking a DIBH Br+SCF treatment course. GAFChromic EBT3 film was used to record the dose across the junction at skin surface for approximately one third of the 25 fraction treatment course for 11 patients undergoing DIBH Br+SCF treatment. Single fraction and summated fraction profiles for each patient were compared to profiles in the treatment planning system and assessed the: (1) local dose variations, (2) position of the 50% dose gradient, and (3) relative dose at the nominal junction. Local dose variations of 10% or greater, position displacement of the junction greater than 5 mm, and relative dose differences at the match line greater than 10% can be found within single fraction dose profiles. When these single fractions are summed over the treatment course, the position variations reduce to 2 mm and dose variations reduced to within 10% for 10 of the 11 patients. Only one of 11 patients recorded a summed dose difference greater than ±10% over their treatment, recording 76% ± 8% of the planned dose in this region. This was due to a small overall position displacement of 1.8 ± 1.6 mm from the nominal junction. A feathering of the dose at the junction is present for DIBH Br+SCF patient treatments. The feathering effect is sufficient, in the majority of cases studied, to reduce any differences in dose and displacement present in single fractions. This work also demonstrates that there may be exceptions from this observed behavior that should be considered. Further study in this area using a larger patient cohort is recommended.
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Affiliation(s)
- Susan Barr
- Icon Cancer Centre, Cleveland, Queensland 4163, Australia.
| | - Danielle Mulherin
- Icon Cancer Centre, Greenslopes Private Hospital, Greenslopes, Queensland 4120, Australia
| | - Anthony Walsh
- Icon Cancer Centre, Springfield, Queensland 4300, Australia
| | - Myles Spalding
- Icon Cancer Centre, Springfield, Queensland 4300, Australia
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Liang E, Dolan JL, Morris ED, Vono J, Bazan LF, Lu M, Glide-Hurst CK. Application of Continuous Positive Airway Pressure for Thoracic Respiratory Motion Management: An Assessment in a Magnetic Resonance Imaging–Guided Radiation Therapy Environment. Adv Radiat Oncol 2022; 7:100889. [PMID: 35198838 PMCID: PMC8844850 DOI: 10.1016/j.adro.2021.100889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/06/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose Patient tolerability of magnetic resonance (MR)–guided radiation treatment delivery is limited by the need for repeated deep inspiratory breath holds (DIBHs). This volunteer study assessed the feasibility of continuous positive airway pressure (CPAP) with and without DIBH for respiratory motion management during radiation treatment with an MR-linear accelerator (MR-linac). Methods and Materials MR imaging safety was first addressed by placing the CPAP device in an MR-safe closet and configuring a tube circuit via waveguide to the magnet bore. Reproducibility and linearity of the final configuration were assessed. Six healthy volunteers underwent thoracic imaging in a 0.35T MR-linac, with one free breathing (FB) and 2 DIBH acquisitions being obtained at 5 pressures from 0 to 15 cm-H2O. Lung and heart volumes and positions were recorded; repeatability was assessed by comparing 2 consecutive DIBH scans. Blinded reviewers graded images for motion artifact using a 3-point grading scale. Participants completed comfort and perception surveys before and after imaging sessions. Results Compared with FB alone, FB-10, FB-12, and FB-15 cm H2O significantly increased lung volumes (+23%, +34%, +44%; all P <.05) and inferiorly displaced the heart (0.86 cm, 0.96 cm, 1.18 cm; all P < . 05). Lung volumes were significantly greater with DIBH-0 cm H2O compared with FB-15 cm H2O (+105% vs +44%, P = .01), and DIBH-15 cm H2O yielded additional volume increase (+131% vs +105%, P = .01). Adding CPAP to DIBH decreased lung volume differences between consecutive breath holds (correlation coefficient 0.97 at 15 cm H2O vs 0.00 at 0 cm H2O). The addition of 15 cm H2O CPAP reduced artifact scores (P = .03) compared with FB; all DIBH images (0-15 cm H2O) had less artifact (P < .01). Conclusions This work demonstrates the feasibility of integrating CPAP in an MR-linac environment in healthy volunteers. Extending this work to a larger patient cohort is warranted to further establish the role of CPAP as an alternative and concurrent approach to DIBH in MR-guided radiation therapy.
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Affiliation(s)
- Evan Liang
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Corresponding author: Evan Liang, MD
| | - Jennifer L. Dolan
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Eric D. Morris
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Jonathan Vono
- Department of Pulmonary and Sleep Medicine, Henry Ford Health System, Detroit, Michigan
| | - Luisa F. Bazan
- Department of Pulmonary and Sleep Medicine, Henry Ford Health System, Detroit, Michigan
| | - Mei Lu
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Carri K. Glide-Hurst
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin
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9
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Mireştean CC, Iancu RI, Iancu DPT. Hypofractionated Whole-Breast Irradiation Focus on Coronary Arteries and Cardiac Toxicity-A Narrative Review. Front Oncol 2022; 12:862819. [PMID: 35463375 PMCID: PMC9021451 DOI: 10.3389/fonc.2022.862819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Breast cancer is the most common cancer among women worldwide, which is often treated with radiotherapy. Whole breast irradiation (WBI) is one of the most common types of irradiation. Hypo-fractionated WBI (HF-WBI) reduces the treatment time from 5 to 3 weeks. Recent radiobiological and clinical evidence recommended the use of HF-WBI regardless of the age or stage of disease, and it is proven that hypo-fractionation is non-inferior to conventional fractionation regimen irradiation. However, some studies report an increased incidence of heart-related deaths in the case of breast irradiation by hypo-fractionation, especially in patients with pre-existing cardiac risk factors at the time of treatment. Due to the new technical possibilities of radiotherapy techniques, HF-WBI can reduce the risk of cardiac toxicity by controlling the doses received both by the heart and by the anatomical structures of the heart. The radiobiological “double trouble”, in particular “treble trouble”, for hypo-fractionated regimen scan be avoided by improving the methods of heart sparing based on image-guided irradiation (IGRT) and by using respiration control techniques so that late cardiac toxicity is expected to be limited. However, long-term follow-up of patients treated with HF-WBI with modern radiotherapy techniques is necessary considering the progress of systemic therapy, which is associated with long-term survival, and also the cardiac toxicity of new oncological treatments. The still unknown effects of small doses spread in large volumes on lung tissue may increase the risk of second malignancy, but they can also be indirectly involved in the later development of a heart disease. It is also necessary to develop multivariable radiobiological models that include histological, molecular, clinical, and therapeutic parameters to identify risk groups and dosimetric tolerance in order to limit the incidence of late cardiac events. MR-LINAC will be able to offer a new standard for reducing cardiac toxicity in the future, especially in neoadjuvant settings for small tumors.
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Affiliation(s)
- Camil Ciprian Mireştean
- Department of Medical Oncology and Radiotherapy, University of Medicine and Pharmacy Craiova, Craiova, Romania.,Department of Surgery, Railways Clinical Hospital, Iasi, Romania
| | - Roxana Irina Iancu
- Oral Pathology Department, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Clinical Laboratory, St. Spiridon Emergency Hospital, Iaşi, Romania
| | - Dragoş Petru Teodor Iancu
- Department of Medical Oncology and Radiotherapy Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Radiation Oncology, Regional Institute of Oncology, Iasi, Romania
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10
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Ertan F, Sahin S, Azak C, Karakaya E, Altundag MB, Goksel F. Evaluation of the voluntary deep inspiration breath-hold reproducibility in left-sided breast radiotherapy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:1057-1066. [PMID: 36155488 DOI: 10.3233/xst-221228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Voluntary deep inspiration breath hold (v-DIBH) reduces cardiac dose during left-sided breast irradiation. The purpose of this study is to evaluate the reproducibility and variability of breath-hold level (BHL) using breath-hold curves and lateral kV setup images together. MATERIAL/METHOD A retrospective analysis of 30 left breast cancer patients treated using the v-DIBH technique in our department is performed. The BHL difference is measured from breath hold curves and lateral (LAT) kilo-Voltage (kV) setup images. The planning CT image and the selected treatment fraction data are collected. If the changes in BHL relate to the displacement of various bones in the kV setup, images are assessed. Furthermore, the maximum heart distance inside the treatment field is compared from LAT MV portal images. RESULTS The median and mean values of the BHL are nearly identical in different fractions (good reproducibility). However, the mean BHL values between planning and all measured fractions are statistically different; 16.3 vs. 20.8 mm for the planning and measured fractions (p < 0.001), which indicates that the variability of BHL is significantly different. CONCLUSION While reproducibility testing shows good agreement for inter-fractional breath-hold level, the variability between planning and fractions is relatively poor.
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Affiliation(s)
- Ferihan Ertan
- Dr. Abdurrahman Yurtaslan Ankara Oncology Teachingand Research Hospital, 06200, Ankara, Turkey
| | - Serdar Sahin
- Dr. Abdurrahman Yurtaslan Ankara Oncology Teachingand Research Hospital, 06200, Ankara, Turkey
| | - Can Azak
- Dr. Abdurrahman Yurtaslan Ankara Oncology Teachingand Research Hospital, 06200, Ankara, Turkey
| | - Ebru Karakaya
- Dr. Abdurrahman Yurtaslan Ankara Oncology Teachingand Research Hospital, 06200, Ankara, Turkey
| | - Muzaffer Bedri Altundag
- Dr. Abdurrahman Yurtaslan Ankara Oncology Teachingand Research Hospital, 06200, Ankara, Turkey
| | - Fatih Goksel
- Dr. Abdurrahman Yurtaslan Ankara Oncology Teachingand Research Hospital, 06200, Ankara, Turkey
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11
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Okumura K, Wakayama T, Matsuda T, Matsumoto K, Mukumoto N, Yada R, Wang T, Nishitani T, Kusaka A, Takemura A. [Impact of Respiratory Motion on Point Doses for Three Whole-breast Irradiation Techniques after Breast-conserving Surgery]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:959-967. [PMID: 34544920 DOI: 10.6009/jjrt.2021_jsrt_77.9.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE For whole-breast irradiation after breast-conserving surgery, computed tomography simulation (CTS) and irradiation are generally performed during free breathing. In treatment planning, there are three techniques: field-in-field (FIF), physical wedge (PW), and enhanced dynamic wedge (EDW). The aim of this study was to investigate the impact of respiratory motion on doses for these three irradiation techniques. METHODS All doses were measured using an ionization chamber in a cylindrical phantom on a respiratory motion platform. Doses for each technique were measured with and without phantom motion. The dose without phantom motion was defined as the reference. The reference was compared to the dose with the phantom motion. The positions of the isocenter with respect to the ranges of phantom motion were set as exhale and intermediate. The phantom motion amplitude was set to 5 mm or 10 mm. The respiratory phase to initiate irradiation was varied as inhale, intermediate-inhale, exhale and intermediate-exhale. RESULTS When the motion amplitude was 10 mm, the dose differences for the FIF, PW, and EDW techniques were 4.2%, 0.5%, and 0.8%, respectively, at the maximum. However, the dose difference for the FIF technique was -0.5% when the isocenter position was set to the intermediate phase of phantom motion. CONCLUSION We found that the dose difference per fraction was reduced when the respiratory phase during CTS image acquisition was set to the intermediate phase. Meanwhile, the dose differences per fraction for the PW and EDW techniques were less affected by the respiratory motion.
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Affiliation(s)
- Keisuke Okumura
- Center for Radiology and Radiation Oncology, Kobe University Hospital.,Graduate School of Medical Science, Kanazawa University
| | - Tsukasa Wakayama
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | | | | | | | - Ryuichi Yada
- Division of Radiation Oncology, Kobe University Hospital (Current address: Department of Radiation Oncology, Anjo Kosei Hospital)
| | - Tianyuan Wang
- Division of Radiation Oncology, Kobe University Hospital
| | | | - Akiko Kusaka
- Center for Radiology and Radiation Oncology, Kobe University Hospital
| | - Akihiro Takemura
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
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12
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Deep inspiration breath hold reduces the mean heart dose in left breast cancer radiotherapy. Radiol Oncol 2021; 55:212-220. [PMID: 33600676 PMCID: PMC8042816 DOI: 10.2478/raon-2021-0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/18/2020] [Indexed: 12/25/2022] Open
Abstract
Background Patients with left breast cancer who undergo radiotherapy have a non-negligible risk of developing radiation-induced cardiovascular disease (CVD). Cardioprotection can be achieved through better treatment planning protocols and through respiratory gating techniques, including deep inspiration breath hold (DIBH). Several dosimetric studies have shown that DIBH reduces the cardiac dose, but clinical data confirming this effect is limited. The aim of the study was to compare the mean heart dose (MHD) in patients with left breast cancer who underwent radiotherapy at our institution as we transitioned from non-gated free-breathing (FB) radiotherapy to gated radiotherapy (FB-GRT), and finally to DIBH. Patients and methods Retrospective study involving 2022 breast cancer patients who underwent radiotherapy at West Pomeranian Oncology Center in Szczecin from January 1, 2014 through December 31, 2017. We compared the MHD in these patients according to year of treatment and technique. Results Overall, the MHD for patients with left breast cancer in our cohort was 3.37 Gy. MHD values in the patients treated with DIBH were significantly lower than in patients treated with non-gated FB (2.1 vs. 3.48 Gy, p < 0.0001) and gated FB (3.28 Gy, p < 0.0001). The lowest MHD values over the four-year period were observed in 2017, when nearly 85% of left breast cancer patients were treated with DIBH. The proportion of patients exposed to high (> 4 Gy) MHD values decreased every year, from 40% in 2014 to 7.9% in 2017, while the percentage of patients receiving DIBH increased. Conclusions Compared to free-breathing techniques (both gated and non-gated), DIBH reduces the mean radiation dose to the heart in patients with left breast cancer. These findings support the use of DIBH in patients with left breast cancer treated with radiotherapy.
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13
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Rafic KM, Patricia S, Timothy Peace B, Sujith CJ, Selvamani B, Ravindran PB. Dosimetric and clinical advantages of adapting the DIBH technique to hybrid solitary dynamic portal radiotherapy for left-sided chest-wall plus regional nodal irradiation. Med Dosim 2020; 45:256-263. [PMID: 32362370 DOI: 10.1016/j.meddos.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/10/2020] [Indexed: 11/15/2022]
Abstract
To evaluate the dosimetric and clinical advantages of using deep-inspiration breath-hold (DIBH) technique in hybrid solitary dynamic portal radiotherapy (hSDPRT) for left-sided chest-wall plus regional nodal irradiation and to demonstrate a simplified strategy for preclinical commissioning and calibration of DIBH-gating technique. Fifteen patients with left-sided breast cancer who underwent postmastectomy radiotherapy using hSDPRT were retrospectively evaluated. Two sets of planning-CT images were acquired for each patient, one with free/normal breathing and the other with DIBH. The hSDPRT plans were computed to deliver about 85% of the prescribed dose using static open fields and 15% of dose using a less complex solitary dynamic field. The dosimetric differences between the paired samples were compared using the Wilcoxon signed-rank test. For clinical commissioning of gated treatments, a respiratory simulator equipped with a microcontroller was programmed to simulate free-breathing and DIBH-patterns using a custom-developed android application. While both the hSDPRT plans displayed identical target coverage on both the image-sets, the DIBH technique resulted in statistically significant differences in various dose-volume metrics of heart, left-anterior-descending artery, and ipsilateral-lung structures. The hSDPRT plan with DIBH entails reduced total monitor unit (354.9 ± 13.6 MU) and breath-hold time ranging from 2.9 ± 0.3 to 13.7 ± 0.8 seconds/field, along with an acceptable impact on overall machine throughput. DIBH is a feasible method to effectively address the delivery uncertainty and produce substantial sparing of heart and lung when combined with hSDPRT. Streamlined procedures for commissioning and calibration of DIBH-gating technique are essential for more efficient clinical practice.
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Affiliation(s)
- Kather Mohamathu Rafic
- Department of Radiation Oncology, Christian Medical College, Vellore 632004, Tamil Nadu, India.
| | - Solomon Patricia
- Department of Radiation Oncology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Balasingh Timothy Peace
- Department of Radiation Oncology, Christian Medical College, Vellore 632004, Tamil Nadu, India.
| | - Christopher J Sujith
- Department of Radiation Oncology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Backianathan Selvamani
- Department of Radiation Oncology, Christian Medical College, Vellore 632004, Tamil Nadu, India.
| | - Paul B Ravindran
- Department of Radiation Oncology, Christian Medical College, Vellore 632004, Tamil Nadu, India; Dosimetry and Medical Radiation Physics Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna International Centre, Vienna 1400, Austria.
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14
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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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15
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Yeh TC, Chi MS, Chi KH, Hsu CH. Evaluation of abches and volumetric modulated arc therapy under deep inspiration breath-hold technique for patients with left-sided breast cancer: A retrospective observational study. Medicine (Baltimore) 2019; 98:e17340. [PMID: 31574873 PMCID: PMC6775396 DOI: 10.1097/md.0000000000017340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Radiotherapy after breast-conserving surgery or mastectomy has clinical benefits including reducing local recurrence and improving overall survival. Deep inspiration breath-hold (DIBH) technique using the Abches system is an easy and practical method to reduce radiation dose to the heart and lungs. This retrospective study was proposed to investigate the dosimetric difference between Abches system and free breathing technique in treating left-sided breast cancer.Eligible patients underwent computed tomography (CT) scans to acquire both free breathing (FB) and DIBH technique data using the Abches. For each patient, both FB and DIBH image sets were planned based on the volumetric modulated arc therapy (VMAT). Radiation dose to the heart, ipsilateral lung, and contralateral lung was compared between the Abches system and FB.No significant differences in the planning target volume (PTV) (674.58 vs 665.88 cm, P = .29), mean dose (52.28 vs 52.03 Gy, P = .13), and volume received at the prescribed dose (Vpd) (94.66% vs 93.92%, P = .32) of PTV were observed between the FB and DIBH plans. Significant differences were found in mean heart (6.71 Gy vs 4.21 Gy, P < .001), heart V5 (22.73% vs 14.39%, P = .002), heart V20 (10.96% vs. 5.62%, P < .001), mean left lung (11.51 vs 10.07 Gy, P = .01), left lung V20 (22.88% vs 19.53%, P = .02), left lung V30 (18.58 vs 15.27%, P = .005), and mean right lung dose (.89 vs 72 Gy, P = .03).This is the first report on reduced mean left lung, mean right lung dose, and V20 of left lung using VMAT and Abches. The combination of Abches and VMAT can practically and efficiently reduce extraradiation doses to the heart and lungs.
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Affiliation(s)
- Tien-Chi Yeh
- Department of Radiation Therapy and Oncology, Shin Kong Wu Ho Su Memorial Hospital
| | - Mau-Shin Chi
- Department of Radiation Therapy and Oncology, Shin Kong Wu Ho Su Memorial Hospital
| | - Kwan-Hwa Chi
- Department of Radiation Therapy and Oncology, Shin Kong Wu Ho Su Memorial Hospital
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Hsien Hsu
- Department of Radiation Therapy and Oncology, Shin Kong Wu Ho Su Memorial Hospital
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16
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Dell'Oro M, Giles E, Sharkey A, Borg M, Connell C, Bezak E. A Retrospective Dosimetric Study of Radiotherapy Patients with Left-Sided Breast Cancer; Patient Selection Criteria for Deep Inspiration Breath Hold Technique. Cancers (Basel) 2019; 11:cancers11020259. [PMID: 30813346 PMCID: PMC6406815 DOI: 10.3390/cancers11020259] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Several studies have investigated cardiac dose reduction when utilizing the deep inspiration breath hold (DIBH) technique in patients undergoing radiotherapy for left-sided breast cancer. This paper aims to recommend potential selection criteria based on a retrospective single institute study of free breathing (FB) and DIBH computed tomography (CT) simulation planning scans. Methods: Dosimetric comparisons were performed retrospectively for 20 patients correlating the dose reduction and patient anatomical factors (anatomical variation of chest shape, chest wall separation, total lung volume (TLV) and others). Results: Paired t-tests demonstrated significant cardiac dose reduction for most patients but not all. Minimal cardiac dose reduction was observed for three patients using their DIBH plan, with one patient receiving a higher dose. Linear regression analysis identified a positive correlation between the patient’s TLV (on the FB CT simulation scan) and the magnitude of dosimetric benefit received (0.4045 R2). Conclusion: The TLV measured on a FB plan could potentially be utilised to predict cardiac exposure and assist with patient selection for DIBH. This is important in resource allocation, as DIBH may be unnecessarily recommended for some patients with little dosimetric benefit.
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Affiliation(s)
- Mikaela Dell'Oro
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | - Eileen Giles
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | | | | | | | - Eva Bezak
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
- Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia.
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Wu VWC, Ng APL, Cheung EKW. Intrafractional motion management in external beam radiotherapy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:1071-1086. [PMID: 31476194 DOI: 10.3233/xst-180472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The recent advancements in radiotherapy technologies have made delivery of the highly conformal dose to the target volume possible. With the increasing popularity of delivering high dose per fraction in modern radiotherapy schemes such as in stereotactic body radiotherapy and stereotactic body ablative therapy, high degree of treatment precision is essential. In order to achieve this, we have to overcome the potential difficulties caused by patient instability due to immobilization problems; patient anxiety and random motion due to prolonged treatment time; tumor deformation and baseline shift during a treatment course. This is even challenging for patients receiving radiotherapy in the chest and abdominal regions because it is affected by the patient's respiration which inevitably leads to tumor motion. Therefore, monitoring of intrafractional motion has become increasingly important in modern radiotherapy. Major intrafractional motion management strategies including integration of respiratory motion in treatment planning; breath-hold technique; forced shallow breathing with abdominal compression; respiratory gating and dynamic real-time tumor tracking have been developed. Successful intrafractional motion management is able to reduce the planning target margin and ensures planned dose delivery to the target and organs at risk. Meanwhile, the emergency of MRI-linear accelerator has facilitated radiation-free real-time monitoring of soft tissue during treatment and could be the future modality in motion management. This review article summarizes the various approaches that deal with intrafractional target, organs or patient motion with discussion of their advantages and limitations. In addition, the potential future advancements including MRI-based tumor tracking are also discussed.
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Affiliation(s)
- Vincent W C Wu
- Department of Health Technology & Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Amanda P L Ng
- Department of Health Technology & Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Emily K W Cheung
- Department of Health Technology & Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
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18
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Claridge Mackonis ER, Estoesta RP, Carroll S. In-vivo dosimetry comparison of supraclavicular junction dose for breast and chest-wall patients with and without deep inspiration breath hold (DIBH). Phys Med 2018; 54:15-20. [DOI: 10.1016/j.ejmp.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/14/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022] Open
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19
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Comparison of heart dose in early-stage left-sided breast cancers treated with intraoperative radiation therapy or whole-breast irradiation with deep inspiratory breath hold. Brachytherapy 2018; 17:831-836. [PMID: 30033035 DOI: 10.1016/j.brachy.2018.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/02/2018] [Accepted: 06/08/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare heart dose between patients treated with lumpectomy and either intraoperative radiation therapy (IORT) with CT-guided high-dose-rate brachytherapy (precision breast IORT [PB-IORT]) or whole-breast irradiation with deep inspiratory breath hold (WBI-DIBH) for early-stage left-sided breast cancers. METHODS AND MATERIALS We retrospectively identified the 17 patients with left-sided breast cancers treated with PB-IORT on a phase I clinical trial and 17 patients with left-sided tumors who had undergone lumpectomy and adjuvant WBI-DIBH. Dosimetric data were obtained. T-testing was performed and biologically effective doses (BEDs) were calculated using an α/β ratio of 2 Gy. RESULTS Mean heart dose was significantly lower with WBI-DIBH compared with PB-IORT (0.61 vs. 0.87 Gy, p = 0.006). Mean heart BED was lower with WBI-DIBH (0.62 vs. 1.3 Gy2, p = 0.0001). Nominal maximum heart dose was higher with WBI-DIBH (11.37 vs. 4.81 Gy, p = 0.004). Maximum heart dose BED was similar between WBI-DIBH and IORT, 16.63 vs. 19.36 Gy (p = 0.64), respectively. No difference was found in mean left anterior descending artery dose: 2.18 Gy with WBI-DIBH and 1.89 Gy with IORT (p = 0.446). The maximum left anterior descending doses were 9.63 Gy and 3.62 Gy with WBI-DIBH and IORT, respectively (p = 0.016). Distance from the heart to the lumpectomy cavity was inversely associated with heart dose for PB-IORT, but not for WBI-IORT. CONCLUSIONS Heart doses were low in both groups. Expected increase in cardiac risk at these doses is minimal. It is unlikely that there will be a clinically significant difference in cardiac toxicity in patients treated with WBI-DIBH or PB-IORT. Further research is needed to evaluate the actual clinical impact of the observed cardiac doses delivered with these modalities.
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