|Table of Contents|

Effects of deep inspiration breath-hold technique on target volume dose and setup errors of postoperative radiotherapy patients with breast cancer

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 21
Page:
4134-4138
Research Field:
Publishing date:

Info

Title:
Effects of deep inspiration breath-hold technique on target volume dose and setup errors of postoperative radiotherapy patients with breast cancer
Author(s):
ZHAO Huafeng; BI Liangwen; SHI Qianjun; WANG Haijing; LI Huanhuan; ZHANG Lizhen
Department of Raidotherapy,the Second Affiliated Hospital of Nanjing Medical University,Jiangsu Nanjing 210011,China.
Keywords:
breast cancer; deep inspiration breath-hold technique; radiotherapy; setup errors
PACS:
R734.2
DOI:
10.3969/j.issn.1672-4992.2024.21.021
Abstract:
Objective:To investigate effects of deep inspiration breath-hold(DIBH) technique on target volume dose and setup errors of postoperative radiotherapy patients with breast cancer.Methods:From January 2021 to July 2023,60 patients who needed postoperative radiotherapy for breast cancer were enrolled.A total of 60 patients were randomized into two groups,30 patients in DIBH group and 30 patients in control group.Treatment planning was done with VMAT techniques.The volume and dosimetry differences of CTV and PTV between the two groups were compared,and the V5,V20 and mean lung dose,V20,V30,V40 and mean heart dose,the maximum spinal cord dose，the minimum spinal cord,mean healthy breast dose,lung volume before and after deep inspiration,homogeneity index(HI) of target volume and conformability index(CI) of target volume were compared.Results:Comparing the two groups included radiotherapy planning protocols,setup errors between the two groups were no statistically significant difference(P＞0.05).In patients after breast-conserving surgery,the mean dose(Dmean),minimum dose(Dmin),D95,and D5 received by PTV in DIBH group were significantly increased compared with those in control group(P＜0.05).Comparison between the CTV volume,PTV volume,D50,Dmax,homogeneity index,and conformability index in the two groups showed no statistically significant difference(P＞0.05).In patients after radical surgery,the mean dose(Dmean),maximum dose(Dmax),minimum dose(Dmin),D95,D5 and D50 received by PTV,CTV volume,PTV volume,homogeneity index and conformability index in DIBH group were no statistically significantly increased compared with those in control group(P>0.05).In the DIBH group,the bilateral lung V5,V20 and the affected lung V5,V20,and the mean dose(Dmean) were reduced compared with the control group,and the difference was statistially significant(P＜0.05).There was no statistically significant difference between the bilateral lung Dmean(P＞0.05).Cardiac V20,V30,V40,and mean cardiac dose(Dmean) in the DIBH group were significantly lower than those in the control group(P＜0.05).The differences in maximum spinal cord dose(Dmax)，mean dose（Dmean），mean healthy breast dose between the two groups were no statistically significant difference(P＞0.05).In the DIBH group,there was a statistically significant difference in the volume of the left and right lungs after deep inspiration compared to before deep inspiration(P＜0.05).Conclusion:The application of DIBH technique in adjuvant radiotherapy of patients after breast-conserving surgery can improve the target volume dose and significantly reduce the irradiated dose to the heart,lungs and other organs at risk.

References:

［1］BRAY F,LAVERSANNE M,SUNG H,et al.Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries［J］.CA Cancer J Clin,2024,74(3):229-263.
［2］DIAZ-GAVELA AA,FIGUEIRAS-GRAILLET L,LUIS AM,et al.Breast radiotherapy-related cardiotoxicity.When,how,why.Risk prevention and control strategies［J］.Cancers(Basel),2021,13(7):1712.
［3］GAASCH A,SCHONECKER S,SIMONETTO C,et al.Heart sparing radiotherapy in breast cancer:The importance of baseline cardiac risks［J］.Radiat Oncol,2020,15(1):117.
［4］HENNEQUIN C,BELKAEMI Y,BOURGIER C,et al.Radiotherapy of breast cancer［J］.Cancer Radiother,2022,26(1-2):221-230.
［5］WOLF J,STOLLER S,LUBKE J,et al.Deep inspiration breath-hold radiation therapy in left-sided breast cancer patients:A single-institution retrospective dosimetric analysis of organs at risk doses［J］.Strahlenther Onkol,2023,199(4):379-388.
［6］RICE L,GOLDSMITH C,GREEN MM,et al.An effective deep-inspiration breath-hold radiotherapy technique for left-breast cancer:Impact of post-mastectomy treatment,nodal coverage,and dose schedule on organs at risk［J］.Breast Cancer(Dove Med Press),2017,9:437-446.
［7］HU H,LI ME,XIAO GL.Implementing deep inspiration breath hold(DIBH) in clinical practice：A dosimetric comparison for left-sided breast cancer（41 cases）［J］.Modern Oncology,2020,28(13):2318－2322.
［8］杨玉刚,齐洪志,许林,等.适形指数在宫颈癌放疗评价中的应用［J］.中国医学物理学杂志,2019,36(3):265-270. YANG YG,QI HZ,XU L,et al.Application of conformity index in the evaluation of radiotherapy for cervical carcinoma［J］.Chinese Journal of Medical Physics,2019,36(3):265-270.
［9］MAMPUYA WA,NAKAMURA M,MATSUO Y,et al.Interfraction variation in lung tumor position with abdominal compression during stereotactic body radiotherapy［J］.Medical Physics,2013,40(9):091718.
［10］曹楠楠,倪昕晔.肺癌立体定向放射治疗中的运动管理研究现状［J］.辐射研究与辐射工艺学报,2023,41(3):31-41. CAO NN,NI XY.Research on motion management in stereotactic body radiotherapy for lung cancer［J］.J Radiat Res Radiat Process,2023,41(3):31-41.
［11］KEIKHAI FARZANEH MJ,MOMENNEZHAD M,NASERI S.Gated radiotherapy development and its expansion［J］.J Biomed Phys Eng,2021,11(2):239-256.
［12］JOSIPOVIC M,PERSSON GF,BANGSGAARD JP,et al.Deep inspiration breath-hold radiotherapy for lung cancer:Impact on image quality and registration uncertainty in cone beam CT image guidance［J］.Br J Radiol,2016,89(1068):20160544.
［13］POETA S,JOURANI Y,DE CALUWE A,et al.Split-VMAT technique to control the deep inspiration breath hold time for breast cancer radiotherapy［J］.Radiat Oncol,2021,16(1):77.
［14］OSEI E,DARKO J,FLECK A,et al.Dosimetric evaluation of whole-breast radiation therapy:Clinical experience［J］.Med Dosim,2015,40(4):355-365.
［15］HJELSTUEN M,MJAALAND I,VIKSTROM J,et al.Radiation during deep inspiration allows locoregional treatment of left breast and axillary-,supraclavicular-and internal mammary lymphnodes without compromising target coverage ordose restrictions to organs at risk［J］.Acta Oncol,2012，51(3):333-344.
［16］MISRA S,MISHRA A,LAL P,et al.Cardiac dose reduction using deep inspiratory breath hold(DIBH) in radiation treatment of left sided breast cancer patients with breast conservation surgery and modified radical mastectomy［J］.J Med Imaging Radiat Sci,2021,52(1):57-67.
［17］BRUZZANITI V,ABATE A,PINNARO P,et al.Dosimetric and clinical advantages of deep inspiration breath-hold(DIBH) during radiotherapy of breast cancer［J］.J Exp Clin Cancer Res,2013,32(1):88.
［18］STOWE HB,ANDRUSKA ND,REYNOSO F,et al.Heart sparing radiotherapy techniques in breast cancer:A focus on deep inspiration breath hold［J］.Breast Cancer(Dove Med Press),2022,14:175-186.
［19］CHOI MS,PARK RH,LEE J,et al.Dosimetric comparison of CPAP and DIBH for left-sided breast cancer radiation therapy［J］.Adv Radiat Oncol,2024,9(6):101478.
［20］肖慧玉，王晓杰，李爽，等.深吸气屏气在减少乳腺癌放射性心脏损伤中的应用［J］.现代肿瘤医学，2023,31(16):3111－3114. XIAO HY,WANG XJ,LI S,et al.Application of deep inspiratory breath holding in reducing radiation induced heart disease in breast cancer［J］.Modern Oncology,2023,31(16):3111－3114.
［21］FENG ZJ,E MY.Research advances of radiation-induced heart disease［J］.Modern Oncology,2021,29(01):159－162.
［22］PARASURAMAR A,DESMIT A,BORG M.Deep inspiration breath hold techniques in the radiotherapeutic management of left-sided breast cancer-active breathing coordinator vs voluntary breath hold［J］.Int J Gynecol Clin Pract,2017,4:133.

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Last Update: 2024-09-30