Hostname: page-component-5c6d5d7d68-lvtdw Total loading time: 0 Render date: 2024-08-08T06:55:25.081Z Has data issue: false hasContentIssue false
  • English
  • Français

Is it advantageous to use deep inspiration breath hold (DIBH) over free breathing for FAST-Forward dose fractionation scheme in treating carcinoma of left-sided breast? A dosimetric study

Published online by Cambridge University Press:  17 May 2021

Jagadheeskumar Nagaraj Open the ORCID record for Jagadheeskumar Nagaraj [Opens in a new window]  and
Anu Radha Chandrasekaran Open the ORCID record for Anu Radha Chandrasekaran [Opens in a new window]
Jagadheeskumar Nagaraj
Affiliation:
Department of Physics, School of Advanced Sciences, Vellore Institute of Technology, Vellore, TN, India Department of Radiation Oncology, Yashoda Hospitals, Hyderabad, TG, India
Anu Radha Chandrasekaran*
Affiliation:
Department of Physics, School of Advanced Sciences, Vellore Institute of Technology, Vellore, TN, India
*
Author for correspondence: Dr Anu Radha Chandrasekaran, Department of Physics, School of Advanced Science, Vellore Institute of Technology, Vellore, TN 632014, India. Tel: 91 8106798226. E-mail: anuradha.jk2014@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim:

To study the effect of deep inspiration breath hold (DIBH) on Fast-Forward trial for left-sided breast radiotherapy dosimetrically using tangential field-in-field (FiF), flattening filtered volumetric-modulated arc therapy (FF-VMAT) and flattening filter free volumetric-modulated arc therapy (FFF-VMAT) in comparison with free breathing (FB).

Methods:

Computed tomography images were acquired on 15 patients with carcinoma of left breast in FB and DIBH. Planning target volume (PTV) and organs at risk were contoured on both image sets. Dose of 26 Gy in five daily fractions was prescribed to PTV. FiF, FF-VMAT and FFF-VMAT plans were created in treatment planning system on both FB and DIBH. PTV V95%, V107%, D0·1 cc, CI and HI, heart V1·5 Gy, V7 Gy, lung left V8 Gy, monitor units (MU) and beam ON time were used for evaluation. Different technique analysis in same breathing condition and FB versus DIBH for same planning technique were performed.

Results:

Mean of all 15 patients was reported as mean ± 1 standard deviation. PTV V95% was 97·55 ± 0·10 (FiF), 95·75 ± 0·66 (FF-VMAT) and 96·15 ± 0·46 (FFF-VMAT) in FB while 97·34 ± 0·50 (FiF), 96·03 ± 0·71 (FF-VMAT) and 95·86 ± 0·63 (FFF-VMAT) in DIBH. Heart V7 Gy was 8·53 ± 4·26 (FiF), 8·86 ± 2·20 (FF-VMAT) and 9·27 ± 2·46 (FFF-VMAT) in FB while 6·30 ± 2·98 (FiF), 5·23 ± 2·20 (FF-VMAT) and 4·68 ± 2·01 (FFF-VMAT) in DIBH. p-value of heart V7 Gy between FB and DIBH was 0·278 (FiF), 0·009 (FF-VMAT) and 0·003 (FFF-VMAT). Beam ON time for FFF-VMAT was reduced by 65% (FF-VMAT) and 11% (FiF).

Conclusion:

Conformal dose to PTV was achieved better with VMAT plans. FFF-VMAT was delivered in less time compared to FF-VMAT and FiF for 26 Gy in five fractions. Heart dose can be significantly minimised with DIBH for VMAT plans.

Keywords

breast radiotherapyDIBHFAST-Forward trialFFFfield in fieldVMAT
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e6
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bray, F, Ferlay, J, Soerjomataram, I, Siegel, R L, Torre, L A, Jemal, A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (6): 394–424.CrossRefGoogle ScholarPubMed
Sedlmayer, F, Sautter-Bihl, M L, Budach, W et al. DEGRO practical guidelines: radiotherapy of breast cancer I. Strahlenther Onkol 2013; 189 (10): 825–833.CrossRefGoogle ScholarPubMed
Gianni, L, Dafni, U, Gelber, R D et al. Treatment with trastuzumab for 1 year after adjuvant chemotherapy in patients with HER2-positive early breast cancer: a 4-year follow-up of a randomised controlled trial. Lancet Oncol 2011; 12 (3): 236–244.CrossRefGoogle ScholarPubMed
Early Breast Cancer Trialists’ Collaborative Group. Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100 000 women in 123 randomised trials. Lancet 2012; 379 (9814): 432–444.CrossRefGoogle Scholar
Offersen, B, Højris, I, Overgaard, M. Radiation-induced heart morbidity after adjuvant radiotherapy of early breast cancer–is it still an issue? Radiother Oncol 2011; 100 (2): 157–159.CrossRefGoogle ScholarPubMed
Tanguturi, S K, Lyatskaya, Y, Chen, Y et al. Prospective assessment of deep inspiration breath-hold using 3-dimensional surface tracking for irradiation of left-sided breast cancer. Pract Radiat Oncol 2015; 5 (6): 358–365.CrossRefGoogle ScholarPubMed
Vuong, W, Garg, R, Bourgeois, D J, Yu, S, Sehgal, V, Daroui, P. Dosimetric comparison of deep-inspiration breath-hold and free-breathing treatment delivery techniques for left-sided breast cancer using 3D surface tracking. Med Dosim 2019; 44 (3): 193–198.CrossRefGoogle ScholarPubMed
Kenneth, W, Ulf, I, Kristina, N, Anders, A. Reproducibility of heart and thoracic wall position in repeated deep inspiration breath holds for radiotherapy of left-sided breast cancer patients, Acta Oncol 2018; 57 (10): 1318–1324.Google Scholar
Mendez, L C, Louie, A V, Moreno, C et al. Evaluation of a new predictor of heart and left anterior descending artery dose in patients treated with adjuvant radiotherapy to the left breast. Radiat Oncol 2018; 13: 124.CrossRefGoogle Scholar
Osman, S O, Hol, S, Poortmans, P M, Essers, M. Volumetric modulated arc therapy and breath-hold in image-guided locoregional left-sided breast irradiation. Radiother Oncol 2014; 112 (1): 17–22.CrossRefGoogle ScholarPubMed
Pham, T T, Ward, R, Latty, D et al. Left-sided breast cancer loco-regional radiotherapy with deep inspiration breath-hold: does volumetric-modulated arc radiotherapy reduce heart dose further compared with tangential intensity-modulated radiotherapy?. J Med Imag Radiat Oncol 2016; 60 (4): 545–553.CrossRefGoogle ScholarPubMed
Duma, M N, Baumann, R, Budach, W et al. Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO). Strahlenther Onkol 2019; 195 (10): 861–871.CrossRefGoogle Scholar
Taylor, C W, Povall, J M, McGale, P et al. Cardiac dose from tangential breast cancer radiotherapy in the year 2006. Int J Radiat Oncol Biol Phys 2008; 72 (2): 501–507.CrossRefGoogle ScholarPubMed
Abouegylah, M, Braunstein, L Z, El-Din, M A et al. Evaluation of radiation-induced cardiac toxicity in breast cancer patients treated with Trastuzumab-based chemotherapy. Breast Cancer Res Treat 2019; 174 (1): 179–185.CrossRefGoogle ScholarPubMed
Darby, S C, Ewertz, M, McGale, P et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013; 368 (11): 987–998.CrossRefGoogle ScholarPubMed
Bergom, C, Rayan, D, Brown, S A. Predicting radiation-induced heart disease and survival-is location the key? J Am Med Assoc Oncol 2021; 7 (2): 193–195.Google ScholarPubMed
Wang, H, Wei, J, Zheng, Q et al. Radiation-induced heart disease: a review of classification, mechanism and prevention. Int J Biol Sci 2019; 15 (10): 2128–2138.CrossRefGoogle ScholarPubMed
Brunt, A M, Haviland, J S, Wheatley, D A et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet 2020; 395 (10237): 1613–1626.CrossRefGoogle Scholar
RTOG-Endorsed Consensus Guidelines for Delineation of Target and Normal Structures for Breast Cancer. http://www.rtog.org/CoreLab/ContouringAtlases/BreastCancerAtlas.aspx. Accessed on 5th December 2019.Google Scholar
Low, D A, Harms, W B, Mutic, S, Purdy, J A. A technique for the quantitative evaluation of dose distributions. Med Phys 1998; 25 (5): 656–661.CrossRefGoogle ScholarPubMed
Coles, C E, Aristei, C, Bliss, J et al. International guidelines on radiation therapy for breast cancer during the COVID-19 pandemic. Clin Oncol 2020; 32 (5): 279–281.CrossRefGoogle ScholarPubMed
Oechsner, M, Düsberg, M, Borm, K J et al. Deep inspiration breath-hold for left-sided breast irradiation: analysis of dose-mass histograms and the impact of lung expansion. Radiat Oncol 2019; 14: 109.CrossRefGoogle ScholarPubMed
Yamauchi, R, Mizuno, N, Itazawa, T, Kawamori, J. The influence of respiratory motion on dose distribution in accelerated partial breast irradiation using volumetric modulated arc therapy. Phys Med 2020; 80: 23–33.CrossRefGoogle ScholarPubMed
Fogliata, A, Nicolini, G, Vanetti, E, Clivio, A, Winkler, P, Cozzi, L. The impact of photon dose calculation algorithms on expected dose distributions in lungs under different respiratory phases. Phys Med Biol 2008; 53 (9): 2375–2390.CrossRefGoogle ScholarPubMed