To compare 3D-conformal radiotherapy (3D-CRT) treatment plans based on free-breathing (FB) and deep inspiration breath hold (DIBH) and investigated whether DIBH technique enables a decrease of cardiac left anterior descending coronary artery (LADCA) and lungs dose with respect to the FB.
Methods
Twenty-three left-sided breast cancer patients referred for breast radiotherapy were included. The planning target volume (PTV) encompassed the breast and organs at risk including heart, LADCA, lungs, and contralateral breast, which were contoured in FB and DIBH CT scans. Dose to PTV was 50 Gy in 25 fractions. Two treatment plans were generated for each patient: FB-3D-CRT and DIBH-3D-CRT. Dosimetry parameters were obtained from dose volume histograms. Data were compared using the paired-sample Wilcoxon signed rank test.
Results
For heart, LADCA, and left lung, a significant dose reduction was found using DIBH technique. By using DIBH, an average reduction of 25% was observed in LADCA for the volume receiving 20 Gy and of 48% considering the mean heart dose.
Conclusions
The DIBH technique results in a significant decrease of dose to the heart, LADCA, and left lung compared to FB.
Get full access to this article
View all access options for this article.
References
1.
Early Breast Cancer Trialists’ Collaborative Group. Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, Godwin J, Gray R, Pierce L, Whelan T, Wang Y, Peto R. Effect of radiotherapy after breast-conserving surgery on 10-years recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10801 women in 17 randomised trials. Lancet2011;378:1707–16
2.
TaylorCWNisbetAMcGalePDarbySCCardiac exposures in breast cancer radiotherapy: 1950s-1990s. Int J Radiat Oncol Biol Phys2007;69 (5):1484–1495
3.
HensonKEMcGalePTaylorCDarbySCRadiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. Br J Cancer2013;108 (1):179–182
4.
ClarkeMCollinsRDarbySet al;Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet2005;366 (9503):2087–2106
5.
McGalePDarbySCHallPIncidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol2011;100 (2):167–175
6.
DarbySCEwertzMMcGalePRisk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med2013;368 (11):987–998
7.
MastMEvan Kempen-HarteveldLHeijenbrokMWLeft-sided breast cancer radiotherapy with and without breath-hold: does IMRT reduce the cardiac dose even further?Radiother Oncol2013;108 (2):248–253
8.
StewartFAHeenemanSTe PoeleJIonizing radiation accelerates the development of atherosclerotic lesions in ApoE-/- mice and predisposes to an inflammatory plaque phenotype prone to hemorrhage. Am J Pathol2006;168 (2):649–658
9.
NilssonGHolmbergLGarmoHDistribution of coronary artery stenosis after radiation for breast cancer. J Clin Oncol2012;30 (4):380–386
10.
CorreaCRLittHIHwangWTFerrariVASolinLJHarrisEECoronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. J Clin Oncol2007;25 (21):3031–3037
11.
LorenzenELTaylorCWMaraldoMInter-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 Oncol2013;108 (2):254–258
12.
HooningMJBotmaAAlemanBMLong-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst2007;99 (5):365–375
13.
MarinkoTDolencJBilban-JakopinCCardiotoxicity of concomitant radiotherapy and trastuzumab for early breast cancer. Radiol Oncol2014;48 (2):105–112
14.
KeallPJMagerasGSBalterJMThe management of respiratory motion in radiation oncology report of AAPM Task Group 76. Med Phys2006;33 (10):3874–3900
FengMMoranJMKoellingTDevelopment and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys2011;79 (1):10–18
17.
SardaroAPetruzzelliMFD'ErricoMPGrimaldiLPiliGPortaluriMRadiation-induced cardiac damage in early left breast cancer patients: risk factors, biological mechanisms, radiobiology, and dosimetric constraints. Radiother Oncol2012;103 (2):133–142
18.
BolukbasiYSaglamYSelekUReproducible deep-inspiration breath-hold irradiation with forward intensity-modulated radiotherapy for left-sided breast cancer significantly reduces cardiac radiation exposure compared to inverse intensity-modulated radiotherapy. Tumori2014;100 (2):169–178
19.
SungKLeeKCLeeSHAhnSHLeeSHChoiJCardiac dose reduction with breathing adapted radiotherapy using self respiration monitoring system for left-sided breast cancer. Radiat Oncol J2014;32 (2):84–94
20.
MulliezTVeldemanLSpeleersBHeart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation. Radiother Oncol2015;114 (1):79–84
21.
JagsiRMoranJMKesslerMLMarshRBBalterJMPierceLJRespiratory motion of the heart and positional reproducibility under active breathing control. Int J Radiat Oncol Biol Phys2007;68 (1):253–258
22.
WangXPanTPinnixCCardiac motion during deep-inspiration breath-hold: implications for breast cancer radiotherapy. Int J Radiat Oncol Biol Phys2012;82 (2):708–714
23.
LettmaierSKreppnerSLotterMRadiation exposure of the heart, lung and skin by radiation therapy for breast cancer: a dosimetric comparison between partial breast irradiation using multicatheter brachytherapy and whole breast teletherapy. Radiother Oncol2011;100 (2):189–194
24.
NielsenMHBergMPedersenANet al;Danish Breast Cancer Cooperative Group Radiotherapy Committee. Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: national guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group. Acta Oncol2013;52 (4):703–710
25.
WillnerJJostABaierKFlentjeMA little to a lot or a lot to a little? An analysis of pneumonitis risk from dose-volume histogram parameters of the lung in patients with lung cancer treated with 3-D conformal radiotherapy. Strahlenther Onkol2003;179 (8):548–556
26.
CaudrelierJMMengJEscheBGrimardLRuddyTAmjadiKIMRT sparing of normal tissues in locoregional treatment of breast cancer. Radiat Oncol2014;9 (1):161
