1
|
Ferdinand S, Mondal M, Mallik S, Goswami J, Das S, Manir KS, Sen A, Palit S, Sarkar P, Mondal S, Das S, Pal B. Dosimetric analysis of Deep Inspiratory Breath-hold technique (DIBH) in left-sided breast cancer radiotherapy and evaluation of pre-treatment predictors of cardiac doses for guiding patient selection for DIBH. Tech Innov Patient Support Radiat Oncol 2021; 17:25-31. [PMID: 33681484 PMCID: PMC7930610 DOI: 10.1016/j.tipsro.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction The risk of radiotherapy-associated cardiovascular disease has been a concern for decades in breast cancer survivors. The objective of our study is to evaluate the dosimetric benefit of Deep Inspiratory Breath-hold technique (DIBH) on organs-at-risk (OAR) sparing in left-sided breast cancer radiotherapy and to find out pre-treatment predictors of cardiac doses for guiding patient selection for DIBH. Material and methods Pre-radiotherapy planning CT scans were done in Free Breathing (FB) and in DIBH [using Active Breathing Coordinator system (ABC™)] in 31 left sided breast cancer patients. 3DCRT plans were generated for both scans. Comparison of anatomical and dosimetric variables were done using paired t test and correlation was evaluated using Pearson correlation. Linear regression was used to get independent predictors of cardiac sparing and Receiver Operating Characteristic (ROC) curve analysis was done to find out the specific threshold of the predictors. Results There was a 39.15% reduction in mean heart dose in DIBH compared to FB (2.4 Gy vs 4.01 Gy) (p < 0.001), 19% reduction in maximum Left Anterior Descending (LAD) dose and a 9.9% reduction in ipsilateral lung mean dose (p = 0.036) with DIBH. A significant correlation was observed between reduction in Heart Volume in Field (HVIF) and Maximum Heart Depth (MHD) with reduction in mean heart dose. Reduction in HVIF (ΔHVIF) independently predicted cardiac sparing. Conclusion DIBH leads to significant reduction in OAR doses and is suggested for all patients of left-sided breast cancer undergoing radiotherapy. However, HVIF and MHD predicted for cardiac sparing and threshold criteria of ΔHVIF and ΔMHD may be used by centres with high workload to select patients for DIBH.
Collapse
Key Words
- 3DCRT, Three-Dimensional Conformal Radiation Therapy
- ABC™, Active Breathing Coordinator™
- AUC, Area under the curve
- BCS, Breast Conservation Surgery
- BMI, Body Mass Index
- Breast cancer
- CCD, Cardiac Contact Distance
- CD, Chest Depth
- CLD, Central Lung Distance
- CS, Chest Separation
- CT, Computer Tomography
- DIBH, Deep Inspiratory Breath-hold
- DVH, Dose Volume Histograms
- Deep inspiratory breath-hold
- Dosimetric predictors
- EORTC, European Organization for Research and Treatment of Cancer
- FB, Free Breathing
- HCWD, Heart Chest Wall Distance
- HCWL, Heart Chest Wall Length
- HH, Heart Height
- HV, Heart Volume
- HVIF, Heart Volume in Field
- IMC, Internal Mammary Chain
- LAD, Left Anterior Descending
- LOD, Lung Orthogonal Distance
- LV, Lung Volume
- MHD, Maximum Heart Depth
- MRM, Modified Radical Mastectomy
- NTCP, Normal Tissue Complications Probability
- OAR, Organs-at-risk
- PTV, Planning target volume
- RNI, Regional Nodal Irradiation
- ROC, Receiver Operating Characteristic
- RPM, Real-time Position Management
- RTOG, Radiation Therapy Oncology Group
- Radiotherapy
- SCF, Supraclavicular Fossa
Collapse
Affiliation(s)
- Soujanya Ferdinand
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Monidipa Mondal
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Suman Mallik
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Jyotirup Goswami
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Sayan Das
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Kazi S Manir
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Arijit Sen
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Soura Palit
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Papai Sarkar
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Subhayan Mondal
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Suresh Das
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Bipasha Pal
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| |
Collapse
|