Deep inspiration breath-hold radiation therapy in left-sided breast cancer patients: a single-institution retrospective dosimetric analysis of organs at risk doses.
Strahlenther Onkol
; 199(4): 379-388, 2023 04.
Article
em En
| MEDLINE
| ID: mdl-36074138
ABSTRACT
BACKGROUND:
Radiotherapy can induce cardiac injury in left-sided breast cancer cases. Cardiac-sparing irradiation using the deep inspiration breath-hold (DIBH) technique can achieve substantial dose reduction to vulnerable cardiac substructures compared with free breathing (FB). This study evaluated the dosimetric differences between both techniques at a single institution.METHODS:
From 2017 to 2019, 130 patients with left-sided breast cancer underwent breast-conserving surgery (BCS; nâ¯= 121, 93.1%) or mastectomy (ME; nâ¯= 9, 6.9%) along with axillary lymph node staging (nâ¯= 105, 80.8%), followed by adjuvant irradiation in DIBH technique; adjuvant systemic therapy was included if applicable. 106 (81.5%) patients received conventional and 24 (18.5%) hypofractionated irradiation. Additionally, 12 patients received regional nodal irradiation. Computed tomography (CT) scans in FB and DIBH position were performed for all patients. Intrafractional 3D position monitoring of the patient surface in deep inspiration and breath gating was performed using Sentinel and Catalyst HD 3D surface scanning systems (C-RAD, Catalyst, CRAD AB, Uppsala, Sweden). Individual coaching and determination of breathing amplitude during the radiation planning CT was performed. Three-dimensional treatment planning was performed using standard tangential treatment portals (6 or 18 MV). The delineation of cardiac structures and both lungs was done in both the FB and the DIBH scan.RESULTS:
All dosimetric parameters for cardiac structures were significantly reduced (pâ¯< 0.01 for all). The mean heart dose (Dmean) in the DIBH group was 1.3â¯Gy (range 0.5-3.6) vs. 2.2â¯Gy (range 0.9-8.8) in the FB group (pâ¯< 0.001). The Dmean for the left ventricle (LV) in DIBH was 1.5â¯Gy (range 0.6-4.5), as compared to 2.8â¯Gy (1.1-9.5) with FB (pâ¯< 0.001). The parameters for LV (V10â¯Gy, V15â¯Gy, V20â¯Gy, V23â¯Gy, V25â¯Gy, V30â¯Gy) were reduced by about 100% (pâ¯< 0.001). The LAD Dmean in the DIBH group was 4.1â¯Gy (range 1.2-33.3) and 14.3â¯Gy (range 2.4-37.5) in the FB group (pâ¯< 0.001). The median values for LAD such as V15â¯Gy, V20â¯Gy, V25â¯Gy, V30â¯Gy, and V40â¯Gy decreased by roughly 100% (pâ¯< 0.001). An increasing volume of left lung in the DIBH position resulted in dose sparing of cardiac structures.CONCLUSION:
For all ascertained dosimetric parameters, a significant dose reduction could be achieved in DIBH technique.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Mama
/
Neoplasias Unilaterais da Mama
Tipo de estudo:
Etiology_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article