The effect of breath-hold technique on conformal and intensity modulated radiotherapy techniques at right breast cancer radiotherapy including internal mammarian field

The breath-hold technique at right breast cancer radiotherapy

Authors

Keywords:

breath-hold, radiotherapy, internal mammarian field, breast cancer

Abstract

Background/Aim: Significantly lower heart doses can be achieved by breath-hold technique at left-sided breast cancer radiotherapy (RT). We see high doses at organs at risk such as lung, heart, and contralateral breast during right-sided breast cancer RT planning especially in the presence of RT indication for mammaria interna (MI) lymph nodes. This study compared RT-planning methods that are conformal with intensity-modulated RT (IMRT) with breath holding and free breathing for right-sided breast cancer RT including full axillary and MI lymph node fields.

Methods: Computed tomography (CT) simulations were performed using free-breath (FB) and breath-hold (BH) methods in 10 patients with right-sided breast cancer. A total of 40 RT treatment plans were calculated. Right-sided breast, level 1-2-3 axillary regions, and MI regions served for the target-planning volume. Left-sided breast, heart, as well as right-sided and left lungs were contoured as critical organs according to the atlas of the "Radiation Therapy Oncology Group." We used a Varian Eclipse v.13 for treatment planning. Conformal “FieldinField” RT (FinFRT) and dynamic IMRT (dIMRT) planning were performed separately for each patient over breath-hold and free-breath images. For PTV, 50 Gy was prescribed in 25 fractions and optimized such that the planned target volume (PTV) remained between 95% and 110% of the dose. The mean and maximum doses of the heart, V5 and V20 of the lungs, as well as V95 doses for MI were recorded. Statistical analyses were performed with SPSS version 22, and a paired t-test was used for comparison.

Results: Four treatment plans (FB FinFRT, BH FinFRT, FB dIMRT, BH dIMRT) were made separately for 10 patients. For comparison, common FB FinFRT plans were accepted as the baseline plan. As expected, there were no significant differences in PTV coverage. The mean dose received by 95% of the MI volume was between 42.27 Gy and 42.4 Gy. For the maximum heart dose, the breath hold technique had no significant effect on plans. The lowest average maximum heart dose was seen in the BH FinFRT group. Mean heart doses are between 1.28 Gy – 4.85 Gy. There was no significance between BH FinFRT and FB FinFRT plan (P=0.504), and there was a significant difference for heart mean dose versus dIMRT plans (P=0.001). The mean V20 of the lungs ranged from 11.9 to 17.8. There was a significant decrease in V20 with BH or FB dIMRT plans (P=0.001). There was no difference between BH FinFRT (P=0.138). On the contrary, lung V5 values were significantly higher in dIMRT plans, and the lowest mean V5 value was seen in BH FinFRT plan.

Conclusion: With the BH method, lower doses (but not significantly lower doses) were obtained in critical organ doses. There was a significant decrease with FinFRT plans in terms of heart mean and maximum dose and lung V5 percentages. The dIMRT plans were significant only in lung V20 percentages. When planning RT, we recommend evaluating all treatment techniques individually for right-sided breast cancer patients to obtain lower doses in critical organs.

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References

EBCTCG (Early Breast Cancer Trialists' Collaborative Group), McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383:2127-359. DOI: https://doi.org/10.1016/S0140-6736(14)60488-8

Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, et al. Effect of radiotherapy 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 randomised trials. Lancet. 2011;378:1707-16. DOI: https://doi.org/10.1016/S0140-6736(11)61629-2

Dogan N, Cuttino L, Lloyd R, Bump EA, Arthur DW. Optimized dose coverage of regional lymph nodes in breast cancer: the role of intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2007;68(4):1238-50. DOI: https://doi.org/10.1016/j.ijrobp.2007.03.059

Kestin LL, Sharpe MB, Frazier RC, Vicini FA, Yan D, Matter RC, Martinez AA, Wong JW. Intensity modulation to improve dose uniformity with tangential breast radiotherapy: initial clinical experience. Int J Radiat Oncol Biol Phys. 2000;48(5):1559-68. DOI: https://doi.org/10.1016/S0360-3016(00)01396-1

Hall EJ. Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys. 2006;65:1–7. DOI: https://doi.org/10.1016/j.ijrobp.2006.01.027

Sioka C, Exarchopoulos T, Tasiou I, et al. Myocardial perfusion imaging with 99 mTc -tetrofosmin SPECT in breast cancer patients that received postoperative radiotherapy: a case control study. Radiat Oncol. 2011;6:151. DOI: https://doi.org/10.1186/1748-717X-6-151

Zagar TM, Kaidar-Person O, Tang X, Jones EE, Matney J, Das SK, et al. Utility of deep inspiration breath hold for left sided breast radiation therapy in preventing early cardiac perfusion defects: a prospective study. Int J Radiat Oncol Biol Phys. 2017;97(5):903-9. DOI: https://doi.org/10.1016/j.ijrobp.2016.12.017

Remouchamps VM, Letts N, Vicini FA, Sharpe MB, Kestin LL, Chen PY, et al. Initial clinical experience with moderate deep inspiration breath hold using an active breathing control device in the treatment of patients with left-sided breast cancer using external beam radiation therapy. Int J Radiat Oncol Biol Phys. 2003;56(3):704-15. DOI: https://doi.org/10.1016/S0360-3016(03)00010-5

Nissen HD, Appelt AL. Improved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patients. Radiother Oncol. 2013;106(1):28-32. DOI: https://doi.org/10.1016/j.radonc.2012.10.016

Korreman SS, Pedersen AN, Nottrup TJ, Specht L, Nystrom H. Breathing adapted radiotherapy for breast cancer: comparison of free breathing gating with the breath-hold technique. Radiother Oncol. 2005;76:311-8. DOI: https://doi.org/10.1016/j.radonc.2005.07.009

Borst GR, Sonke JJ, den Hollander S, Betgen A, Remeijer P, van Giersbergen A, et al. Clinical results of image-guided deep inspiration breath hold breast irradiation. Int J Radiat Oncol Biol Phys. 2010;78:1345-51. DOI: https://doi.org/10.1016/j.ijrobp.2009.10.006

Hayden AJ, Rains M, Tiver K. Deep inspiration breath hold technique reduces heart dose from radiotherapy for left-sided breast cancer. J Med Imaging Radiat Oncol. 2012;56:464-72. DOI: https://doi.org/10.1111/j.1754-9485.2012.02405.x

Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, et al. A multicenter randomized trial of breast intensity modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008;26: 2085–92. DOI: https://doi.org/10.1200/JCO.2007.15.2488

Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, et al; Breast Technology Group. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol. 2007;82:254–64. DOI: https://doi.org/10.1016/j.radonc.2006.12.008

Vicini FA, Sharpe M, Kestin L, Martinez A, Mitchell CK, Wallace MF, Matter R, Wong J. Optimizing breast cancer treatment efficacy with intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2002;54:1336–44. DOI: https://doi.org/10.1016/S0360-3016(02)03746-X

Keller LM, Sopka DM, Li T, Klayton T, Li J, Anderson PR, Bleicher RJ, Sigurdson ER, Freedman GM. Five-year results of whole breast intensity modulated radiation therapy for the treatment of early stage breast cancer: the Fox Chase Cancer Center experience. Int J Radiat Oncol Biol Phys. 2012;84:881–7. DOI: https://doi.org/10.1016/j.ijrobp.2012.01.069

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Published

2023-05-23

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Research Article

How to Cite

1.
Yucel S, Disci E, Gural Z, Kaptan S, Kadioglu H, Agaoglu F. The effect of breath-hold technique on conformal and intensity modulated radiotherapy techniques at right breast cancer radiotherapy including internal mammarian field: The breath-hold technique at right breast cancer radiotherapy. J Surg Med [Internet]. 2023 May 23 [cited 2024 Apr. 13];7(5):339-42. Available from: https://jsurgmed.com/article/view/7695