Iranian Journal of Medical Physics

Iranian Journal of Medical Physics

A Comparative Dosimetric Study for the Treatment of Left-Sided Breast Cancer using Three-Dimensional Conformal Deep Inspiration Breath-Hold and Free-Breathing Intensity-Modulated Radiotherapy Techniques

Document Type : Original Paper

Authors
Mohammed Ali Morsy 1
Ehab Attalla 2
Wahib Attia 3
1 Radiation Oncology Medical Physicist, Cairo, Egypt
2 National Cancer Institute, Cairo University, Cairo, Egypt
3 Physics Department, Faculty of Sciences, Suez Canal University Cairo, Egypt
10.22038/ijmp.2020.44451.1681
Abstract
 
Introduction: Most women with left-sided breast cancer are at an increased risk of heartmorbidity and mortality from the adjuvant radiotherapy due to an increase in heart absorbed dose during radiotherapy treatment. This study aimed to compare free-breathing intensity-modulated radiotherapy (FB-IMRT) and three-dimensional conformal deep inspiration breath-hold (3DCRT-DIBH) techniques in terms of the cardiac dose.
Material and Methods: In total, 15 women with left-sided breast cancer underwent FB and DIBH computed tomography (CT) scans in the same supine position. For DIBH CT, 3D-CRT plans were created using two opposing wedged tangential fields and for FB-CT, 4-5 IMRT optimized tangential fields were created. All plans were evaluated using the dose-volume histogram. The data were analyzed in SPSS software version 20 (IBM, IL).
Results: The FB-IMRT plans were more homogeneous and had more dose coverage and fewer hotspots, than the 3DCRT-DIBH plans; however, the planning target volume V95% was clinically acceptable for both techniques. Furthermore, the 3DCRT-DIBH plans were much faster and require fewer monitor units. A significantly lower mean dose of heart, left lung, left anterior descending coronary artery, right lung, and V10% left lung were observed in 3DCRT-DIBH plans, compared to FB-IMRT plans. Moreover, FB-IMRT plans showed a significant further dose reduction in heart V25% and V30%.
Conclusion: The majority of the patients with left-sided breast cancer who treated with the DIBH technique were getting sufficient benefits of radiotherapy, and DIBH was a comprehensive strategy for reducing cardiac doses during radiotherapy treatment.
Keywords
Breast Cancer Breath Holding Cardiac Diseases Intensity
Modulated Radiotherapy Three
dimensional Conformal Radiotherapy
Subjects
  1. Early Breast Cancer Trialists Collaborative Group (EBCTCG). Effect of RT after breast conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomized trials. Lancet. 2011; 378:1707–16.
  2. Rutqvist LE, Johansson H. Mortality by laterality of the primary tumour among 55,000 breast cancer patients from the Swedish Cancer Registry. British journal of cancer. 1990 Jun;61(6):866-8.
  3. Henson KE, McGale P, Taylor C, Darby SC. Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. British journal of cancer. 2013 Jan;108(1):179-82.
  4. Gyenes G, Rutqvist LE, Liedberg A, Fornander T. Long-term cardiac morbidity and mortality in a randomized trial of pre-and postoperative radiation therapy versus surgery alone in primary breast cancer. Radiotherapy and oncology. 1998 Aug 1;48(2):185-90.
  5. Taylor C, Correa C, Anderson S. Late side-effects of breast cancer radiotherapy:Second cancer incidence and non-breast-cancer mortality among 40,000 women in 75 trials.San Antonio Breast Cancer Symp. 2015; S5:08.
  6. Early Breast Cancer Trialists' Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. The Lancet. 2000 May 20;355(9217):1757-70.
  7. Van den Bogaard VA, Ta BD, van der Schaaf A, Bouma AB, Middag AM, Bantema-Joppe EJ, et al. Validation and modification of a prediction model for acute cardiac events in patients with breast cancer treated with radiotherapy based on three-dimensional dose distributions to cardiac substructures. Journal of Clinical Oncology. 2017 Apr 10;35(11):1171.
  8. Taylor CW, Nisbet A, McGale P, Darby SC. Cardiac exposures in breast cancer radiotherapy: 1950s–1990s. International Journal of Radiation Oncology* Biology* Physics. 2007 Dec 1;69(5):1484-95.
  9. Hennequin C, Bossard N, Servagi-Vernat S, Maingon P, Dubois JB, Datchary J, et al. Ten-year survival results of a randomized trial of irradiation of internal mammary nodes after mastectomy. International Journal of Radiation Oncology* Biology* Physics. 2013 Aug 1;86(5):860-6.
  10. Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, et al. Regional nodal irradiation in early-stage breast cancer. New England Journal of Medicine. 2015 Jul 23;373(4):307-16.
  11. Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. New England Journal of Medicine. 2015 Jul 23;373(4):317-27.
  12. Dess RT, Liss AL, Griffith KA, Marsh RB, Moran JM, Mayo C, et al. Ischemic cardiac events following treatment of the internal mammary nodal region using contemporary radiation planning techniques. International Journal of Radiation Oncology* Biology* Physics. 2017 Dec 1;99(5):1146-53.
  13. Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Brønnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. New England Journal of Medicine. 2013 Mar 14;368(11):987-98.
  14. Saiki H, Petersen IA, Scott CG, Bailey KR, Dunlay SM, Finley RR, et al. Risk of heart failure with preserved ejection fraction in older women after contemporary radiotherapy for breast cancer. Circulation. 2017 Apr 11;135(15):1388-96.
  15. Latty D, Stuart KE, Wang W, Ahern V. Review of deep inspiration breath‐hold techniques for the treatment of breast cancer. Journal of medical radiation sciences. 2015 Mar;62(1):74-81.
  16. Bruzzaniti V, Abate A, Pinnarò P, D’Andrea M, Infusino E, Landoni V, et al. Dosimetric and clinical advantages of deep inspiration breath-hold (DIBH) during radiotherapy of breast cancer. Journal of Experimental & Clinical Cancer Research. 2013 Dec;32(1):88.
  17. Vikström J, Hjelstuen MH, Mjaaland I, Dybvik KI. Cardiac and pulmonary dose reduction for tangentially irradiated breast cancer, utilizing deep inspiration breath-hold with audio-visual guidance, without compromising target coverage. Acta Oncologica. 2011 Jan 1;50(1):42-50.
  18. Ahunbay EE, Chen GP, Thatcher S, Jursinic PA, White J, Albano K, et al. Direct aperture optimization–based intensity-modulated radiotherapy for whole breast irradiation. International Journal of Radiation Oncology* Biology* Physics. 2007 Mar 15;67(4):1248-58.
  19. Bhatnagar AK, Brandner E, Sonnik D, Wu A, Kalnicki S, Deutsch M, et al. Intensity modulated radiation therapy (IMRT) reduces the dose to the contralateral breast when compared to conventional tangential fields for primary breast irradiation. Breast cancer research and treatment. 2006 Mar 1;96(1):41-6.
  20. Hong L, Hunt M, Chui C, Spirou S, Forster K, Lee H, et al. Intensity-modulated tangential beam irradiation of the intact breast. International Journal of Radiation Oncology* Biology* Physics. 1999 Jul 15;44(5):1155-64.
  21. Johansen S, Vikström J, Hjelstuen MH, Mjaaland I, Dybvik KI, Olsen DR. Dose evaluation and risk estimation for secondary cancer in contralateral breast and a study of correlation between thorax shape and dose to organs at risk following tangentially breast irradiation during deep inspiration breath-hold and free breathing. Acta Oncologica. 2011 May 1;50(4):563-8.
  22. Kong FM, Klein EE, Bradley JD, Mansur DB, Taylor ME, Perez CA, et al. The impact of central lung distance, maximal heart distance, and radiation technique on the volumetric dose of the lung and heart for intact breast radiation. International Journal of Radiation Oncology* Biology* Physics. 2002 Nov 1;54(3):963-71.
  23. Levitt SH, Aeppli DM, Nierengarten ME. The impact of radiation on early breast carcinoma survival: A Bayesian analysis. Cancer: Interdisciplinary International Journal of the American Cancer Society. 1996 Sep 1;78(5):1035-42.
  24. Johansen S, Vikström J, Hjelstuen MH, Mjaaland I, Dybvik KI, Olsen DR. Dose evaluation and risk estimation for secondary cancer in contralateral breast and a study of correlation between thorax shape and dose to organs at risk following tangentially breast irradiation during deep inspiration breath-hold and free breathing. Acta Oncologica. 2011 May 1;50(4):563-8.
  25. Gentile MS, Usman AA, Neuschler EI, Sathiaseelan V, Hayes JP, Small Jr W. Contouring guidelines for the axillary lymph nodes for the delivery of radiation therapy in breast cancer: evaluation of the RTOG breast cancer atlas. International Journal of Radiation Oncology* Biology* Physics. 2015 Oct 1;93(2):257-65.
  26. Nielsen MH, Berg M, Pedersen AN, Andersen K, Glavicic V, Jakobsen EH, et al. 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 Oncologica. 2013 May 1;52(4):703-10.
  27. Feng M, Moran JM, Koelling T, Chughtai A, Chan JL, Freedman L, et al. Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. International Journal of Radiation Oncology* Biology* Physics. 2011 Jan 1;79(1):10-8.
  28. Feuvert L, Noel G, Mazeron JJ, Bey P. Conformity index: a review. International Journal of Radiation Oncology* Biology*Physics. 2006 Feb 1;64(2):333-42.
  29. Kataria T, Sharma K, Subramani V, Karrthick KP, Bisht SS. Homogeneity Index: An objective tool for assessment of conformal radiation treatments. Journal of medical physics/ Association of Medical Physicists of India. 2012 Oct;37(4):207.
  30. Mast ME, Van Kempen-Harteveld L, Heijenbrok MW, Kalidien Y, Rozema H, Jansen WP, et al. Left-sided breast cancer radiotherapy with and without breath-hold: Does IMRT reduce the cardiac dose even further?. Radiotherapy and Oncology. 2013 Aug 1;108(2):248-53.
  31. Sripathi LK, Ahlawat P, Simson DK, Khadanga CR, Kamarsu L, Surana SK, et al. Cardiac dose reduction with deep-inspiratory breath hold technique of radiotherapy for left-sided breast cancer. Journal of medical physics. 2017 Jul;42(3):123.
  32. Chi F, Wu S, Zhou J, Li F, Sun J, Lin Q, et al. Dosimetric comparison of moderate deep inspiration breath-hold and free-breathing intensity-modulated radiotherapy for left-sided breast cancer. Cancer/Radiothérapie. 2015 May 1;19(3):180-6.
  33. Reardon KA, Read PW, Morris MM, Reardon MA, Geesey C, Wijesooriya K. A comparative analysis of 3D conformal deep inspiratory–breath hold and free-breathing intensity-modulated radiation therapy for left-sided breast cancer. Medical Dosimetry. 2013 Jun 1;38(2):190-5.

 

 

 

 

Iranian Journal of Medical Physics
Volume 18, Issue 3
May and June 2021
Pages 194-202

  • Receive Date 14 November 2019
  • Revise Date 11 February 2020
  • Accept Date 27 February 2020