Left-sided Breast Cancer Irradiation With Deep Inspiration Breath-hold: Changes in Heart and Lung Dose in Two Periods

Overview

Journal In Vivo

Specialty Oncology

Date 2022 Jan 1

PMID 34972728

Citations 5

Authors

Anne Caroline Knochelmann

Nese Ceylan

Michael Bremer

Affiliations

Soon will be listed here.

Abstract

Background/aim: Post-operative radiotherapy for breast cancer can increase cardiac disease in a dose-dependent manner. In this study we show the reduction of dose to heart and left anterior descending artery (LAD) which can be achieved by using "Deep inspiration breath-hold" (DIBH) technique.

Patients And Methods: Tangential 3D-planned radiation was delivered to 357 patients with left-sided breast cancer, 159 of them with the DIBH technique. A distinction was made according to fractionation scheme.

Results: The mean heart dose was significantly reduced by DIBH from 2.64 Gy to 1.39 Gy (p<0.001). The mean dose to the LAD was significantly reduced from 5.68 Gy to 3.88 Gy (p<0.001). Mean dose and volume receiving 5, 10 and 15 Gy of ipsilateral lung were higher with both hypofractionated schedule and conventional fractionation in the DIBH group.

Conclusion: DIBH in left-sided breast irradiation is an effective method of reducing the radiogenic heart dose.

Citing Articles

Narrative Review: Cardiotoxicities and Cardiac-Sparing Techniques in Radiotherapy.

Chan M, Parikh D, Shi C Technol Cancer Res Treat. 2024; 23:15330338241301211.

PMID: 39636079 PMC: 11622324. DOI: 10.1177/15330338241301211.

Surface-based deep inspiration breath-hold radiotherapy in left-sided breast cancer: final results from the SAVE-HEART study.

Schonecker S, Angelini L, Gaasch A, Zinn A, Konnerth D, Heinz C ESMO Open. 2024; 9(12):103993.

PMID: 39631360 PMC: 11655685. DOI: 10.1016/j.esmoop.2024.103993.

How Effective is Deep Inspiration Breath Hold in Minimizing Cardiac Doses During Hybrid Radiotherapy Treatment for Left-Sided Breast Cancer with Comprehensive Regional Nodes?.

B S, Backianathan S, Rafic K M, T J, Susan Varghese S, S P Asian Pac J Cancer Prev. 2024; 25(9):3301-3310.

PMID: 39342610 PMC: 11700318. DOI: 10.31557/APJCP.2024.25.9.3301.

Correlation between the setting of gating window width and setup accuracy in left breast cancer radiotherapy based on deep inspiration breath hold.

Yucheng L, Yibo S, Wenming Z, Yongshi J, Qiang L, Lingyun Q J Appl Clin Med Phys. 2023; 24(11):e14116.

PMID: 37538022 PMC: 10647972. DOI: 10.1002/acm2.14116.

Screening for Coronary Artery Disease in Cancer Survivors: State-of-the-Art Review.

Velusamy R, Nolan M, Murphy A, Thavendiranathan P, Marwick T JACC CardioOncol. 2023; 5(1):22-38.

PMID: 36875910 PMC: 9982229. DOI: 10.1016/j.jaccao.2022.12.007.

References

Ferini G, Molino L, Tripoli A, Valenti V, Illari S, Marchese V . Anatomical Predictors of Dosimetric Advantages for Deep-inspiration-breath-hold 3D-conformal Radiotherapy Among Women With Left Breast Cancer. Anticancer Res. 2021; 41(3):1529-1538. DOI: 10.21873/anticanres.14912. View

Drost L, Yee C, Lam H, Zhang L, Wronski M, McCann C . A Systematic Review of Heart Dose in Breast Radiotherapy. Clin Breast Cancer. 2018; 18(5):e819-e824. DOI: 10.1016/j.clbc.2018.05.010. View

Nieder C, Schill S, Kneschaurek P, Molls M . Influence of different treatment techniques on radiation dose to the LAD coronary artery. Radiat Oncol. 2007; 2:20. PMC: 1892030. DOI: 10.1186/1748-717X-2-20. View

Duma M, Herr A, Borm K, Trott K, Molls M, Oechsner M . Tangential Field Radiotherapy for Breast Cancer-The Dose to the Heart and Heart Subvolumes: What Structures Must Be Contoured in Future Clinical Trials?. Front Oncol. 2017; 7:130. PMC: 5474560. DOI: 10.3389/fonc.2017.00130. View

Weberpals J, Jansen L, Muller O, Brenner H . Long-term heart-specific mortality among 347 476 breast cancer patients treated with radiotherapy or chemotherapy: a registry-based cohort study. Eur Heart J. 2018; 39(43):3896-3903. DOI: 10.1093/eurheartj/ehy167. View

Feng M, Moran J, Koelling T, Chughtai A, Chan J, Freedman L . Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys. 2010; 79(1):10-8. PMC: 2937165. DOI: 10.1016/j.ijrobp.2009.10.058. View

Joo J, Kim S, Ahn S, Kwak J, Jeong C, Ahn S . Cardiac dose reduction during tangential breast irradiation using deep inspiration breath hold: a dose comparison study based on deformable image registration. Radiat Oncol. 2015; 10:264. PMC: 4696108. DOI: 10.1186/s13014-015-0573-7. View

Lorenzen E, Taylor C, Maraldo M, Nielsen M, Offersen B, Andersen M . Inter-observer variation in delineation of the heart and left anterior descending coronary artery in radiotherapy for breast cancer: a multi-centre study from Denmark and the UK. Radiother Oncol. 2013; 108(2):254-8. DOI: 10.1016/j.radonc.2013.06.025. View

Nissen H, Appelt A . Improved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patients. Radiother Oncol. 2012; 106(1):28-32. DOI: 10.1016/j.radonc.2012.10.016. View

10.

Moignier A, Broggio D, Derreumaux S, El Baf F, Mandin A, Girinsky T . Dependence of coronary 3-dimensional dose maps on coronary topologies and beam set in breast radiation therapy: a study based on CT angiographies. Int J Radiat Oncol Biol Phys. 2014; 89(1):182-90. DOI: 10.1016/j.ijrobp.2014.01.055. View

11.

Borger J, Hooning M, Boersma L, Snijders-Keilholz A, Aleman B, Lintzen E . Cardiotoxic effects of tangential breast irradiation in early breast cancer patients: the role of irradiated heart volume. Int J Radiat Oncol Biol Phys. 2007; 69(4):1131-8. DOI: 10.1016/j.ijrobp.2007.04.042. View

12.

Darby S, Ewertz M, McGale P, Bennet A, Blom-Goldman U, Bronnum D . Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013; 368(11):987-98. DOI: 10.1056/NEJMoa1209825. View

13.

Wang X, Pan T, Pinnix C, Zhang S, Salehpour M, Sun T . Cardiac motion during deep-inspiration breath-hold: implications for breast cancer radiotherapy. Int J Radiat Oncol Biol Phys. 2011; 82(2):708-14. PMC: 4158740. DOI: 10.1016/j.ijrobp.2011.01.035. View

14.

Oechsner M, Dusberg M, Borm K, Combs S, Wilkens J, Duma M . Deep inspiration breath-hold for left-sided breast irradiation: Analysis of dose-mass histograms and the impact of lung expansion. Radiat Oncol. 2019; 14(1):109. PMC: 6582581. DOI: 10.1186/s13014-019-1293-1. View

15.

Carosi A, Ingrosso G, Turturici I, Valeri S, Barbarino R, Di Murro L . Whole breast external beam radiotherapy in elderly patients affected by left-sided early breast cancer: a dosimetric comparison between two simple free-breathing techniques. Aging Clin Exp Res. 2019; 32(7):1335-1341. DOI: 10.1007/s40520-019-01312-5. View

16.

Loap P, Fourquet A, Kirova Y . The Limits of the Linear Quadratic (LQ) Model for Late Cardiotoxicity Prediction: Example of Hypofractionated Rotational Intensity Modulated Radiation Therapy (IMRT) for Breast Cancer. Int J Radiat Oncol Biol Phys. 2020; 106(5):1106-1108. DOI: 10.1016/j.ijrobp.2019.12.006. View

17.

Sixel K, Aznar M, Ung Y . Deep inspiration breath hold to reduce irradiated heart volume in breast cancer patients. Int J Radiat Oncol Biol Phys. 2001; 49(1):199-204. DOI: 10.1016/s0360-3016(00)01455-3. View

18.

Chan T, Tang J, Tan P, Roberts N . Dosimetric evaluation and systematic review of radiation therapy techniques for early stage node-negative breast cancer treatment. Cancer Manag Res. 2018; 10:4853-4870. PMC: 6205528. DOI: 10.2147/CMAR.S172818. View

19.

Lu H, Cash E, Chen M, Chin L, Manning W, Harris J . Reduction of cardiac volume in left-breast treatment fields by respiratory maneuvers: a CT study. Int J Radiat Oncol Biol Phys. 2000; 47(4):895-904. DOI: 10.1016/s0360-3016(00)00512-5. View

20.

Gagliardi G, Constine L, Moiseenko V, Correa C, Pierce L, Allen A . Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl):S77-85. DOI: 10.1016/j.ijrobp.2009.04.093. View