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Intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy during deep inspiratory breath hold for left-sided whole-breast irradiation: a comparative analysis

Published online by Cambridge University Press:  07 September 2015

D. M. Trifiletti ,
K. Wijesooriya ,
G. Moyer ,
D. Lain ,
C. Geesey ,
K. Forbes  and
K. A. Reardon
D. M. Trifiletti*
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
K. Wijesooriya
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
G. Moyer
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
D. Lain
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
C. Geesey
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
K. Forbes
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
K. A. Reardon
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
*
Correspondence to: Daniel M. Trifiletti, Department of Radiation Oncology, University of Virginia School of Medicine, PO Box 800383, Charlottesville, VA 22908, USA. Tel: 434 924 5191. E-mail: Daniel.trifiletti@gmail.com
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Abstract

Aim

Deep inspiratory breath hold (DIBH) during left-breast irradiation helps to minimise cardiac irradiation by physically separating the heart from the left breast. The dose to organs-at-risk in intensity-modulated radiotherapy (IMRT) and opposed tangent three-dimensional conformal radiotherapy (3DCRT) during DIBH in patients with left-sided breast cancer was compared.

Materials and methods

A total of 20 consecutive patients with left-sided breast cancer had a computed tomography scan utilising DIBH. Mean volumes of the heart, left anterior descending coronary artery, total lung and right breast receiving 5–95% of the prescription dose were calculated.

Results

Target volume homogeneity was improved with IMRT and average mean dose to target was higher for 3DCRT (51·03 Gy) compared with IMRT (50·47 Gy, p<0·01). The average mean dose to the heart was lower with 3DCRT (87 versus 77 cGy, p<0·01). The average mean dose to the contralateral breast was also lower with 3DCRT (19 versus 17 cGy, p<0·01). Less monitor units (MUs) were required with 3DCRT with an average difference of 225 MU/fraction (p<0·01).

Findings

Under DIBH, absolute differences between 3DCRT and IMRT were minimal. 3DCRT under DIBH provided excellent dosimetric results in most patients with left-sided breast cancer without the need for IMRT.

Keywords

breastdeep inspiratory breath holdheartintensity-modulated radiotherapyradiation
Type
Technical Note
Information
Journal of Radiotherapy in Practice , Volume 15 , Issue 1 , March 2016 , pp. 99 - 106
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Copyright
© Cambridge University Press 2015 

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References

1.Fisher, B, Anderson, S, Redmond, C Ket al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995; 333: 1456–1461.CrossRefGoogle ScholarPubMed
2.Early Breast Cancer Trialists’ Collaborative Group, Darby, S, McGale, Pet 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: 1707–1716.Google Scholar
3.National Comprehensive Cancer Network. Clinical practice guidelines: breast cancer v2, 2015. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed on 10th April 2015.Google Scholar
4.Darby, S C, McGale, P, Taylor, C Wet al. Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300,000 women in US SEER cancer registries. Lancet Oncol 2005; 6: 557–565.CrossRefGoogle Scholar
5.Giordano, S H, Kuo, Y F, Freeman, J Let al. Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst 2005; 97: 419–424.CrossRefGoogle ScholarPubMed
6.Darby, S C, Ewertz, M, McGale, Pet al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013; 368: 987–998.CrossRefGoogle Scholar
7.Carr, Z A, Land, C E, Kleinerman, R Aet al. Coronary heart disease after radiotherapy for peptic ulcer disease. Int J Radiat Oncol Biol Phys 2005; 61: 842–850.CrossRefGoogle ScholarPubMed
8.Darby, S C, Ewertz, M, Hall, P. Ischemic heart disease after breast cancer radiotherapy. N Engl J Med 2013; 368: 2527.CrossRefGoogle ScholarPubMed
9.Bartlett, F R, Colgan, R M, Carr, Ket al. The UK HeartSpare Study: randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy. Radiother Oncol 2013; 108: 242–247.CrossRefGoogle ScholarPubMed
10.Ahmed, R S, De Los Santos, J F, Fiveash, J Bet al. An IMRT technique to increase therapeutic ratio of breast irradiation in patients with early-stage left breast cancer: limiting second malignancies. Med Dosim 2008; 33: 71–77.CrossRefGoogle ScholarPubMed
11.Borst, G R, Sonke, J J, den Hollander, Set al. Clinical results of image-guided deep inspiration breath hold breast irradiation. Int J Radiat Oncol Biol Phys 2010; 78: 1345–1351.CrossRefGoogle ScholarPubMed
12.Mast, M E, van Kempen-Harteveld, L, Heijenbrok, M Wet al. Left-sided breast cancer radiotherapy with and without breath-hold: does IMRT reduce the cardiac dose even further? Radiother Oncol 2013; 108: 248–253.CrossRefGoogle ScholarPubMed
13.McIntosh, A, Shoushtari, A N, Benedict, S Het al. Quantifying the reproducibility of heart position during treatment and corresponding delivered heart dose in voluntary deep inhalation breath hold for left breast cancer patients treated with external beam radiotherapy. Int J Radiat Oncol Biol Phys 2011; 81: e569–e576.CrossRefGoogle ScholarPubMed
14.Sardaro, A, Petruzzelli, M F, D’Errico, M Pet al. Radiation-induced cardiac damage in early left breast cancer patients: risk factors, biological mechanisms, radiobiology, and dosimetric constraints. Radiother Oncol 2012; 103: 133–142.CrossRefGoogle ScholarPubMed
15.Reardon, K A, Read, P W, Morris, M Met al. A comparative analysis of 3D conformal deep inspiratory-breath hold and free-breathing intensity-modulated radiation therapy for left-sided breast cancer. Med Dosim 2013; 38: 190–195.CrossRefGoogle ScholarPubMed
16.Sixel, K E, Aznar, M C, Ung, Y C. Deep inspiration breath hold to reduce irradiated heart volume in breast cancer patients. Int J Radiat Oncol Biol Phys 2001; 49: 199–204.CrossRefGoogle ScholarPubMed
17.Pedersen, A N, Korreman, S, Nystrom, Het al. Breathing adapted radiotherapy of breast cancer: reduction of cardiac and pulmonary doses using voluntary inspiration breath-hold. Radiother Oncol 2004; 72: 53–60.CrossRefGoogle ScholarPubMed
18.Wang, X, Pan, T, Pinnix, Cet al. Cardiac motion during deep-inspiration breath-hold: implications for breast cancer radiotherapy. Int J Radiat Oncol Biol Phys 2012; 82: 708–714.CrossRefGoogle ScholarPubMed
19.Nissen, H D, Appelt, A L. Improved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patients. Radiother Oncol 2013; 106: 28–32.CrossRefGoogle Scholar
20.Pignol, J P, Keller, B M, Ravi, A. Doses to internal organs for various breast radiation techniques—implications on the risk of secondary cancers and cardiomyopathy. Radiat Oncol 2011; 6: 5.CrossRefGoogle ScholarPubMed
21.Wang, E H, Mougalian, S S, Soulos, P Ret al. Adoption of intensity modulated radiation therapy for early-stage breast cancer from 2004 through 2011. Int J Radiat Oncol Biol Phys 2015; 91: 303–311.CrossRefGoogle ScholarPubMed
22.Radiation Therapy Oncology Group (RTOG). Contouring A. Breast cancer contouring atlas; 2010. https://www.rtog.org/CoreLab/ContouringAtlases/BreastCancerAtlas.aspx. Accessed on 10th April 2015.Google Scholar
23.Onal, C, Sonmez, A, Arslan, Get al. Dosimetric comparison of the field-in-field technique and tangential wedged beams for breast irradiation. Jpn J Radiol 2012; 30: 218–226.CrossRefGoogle ScholarPubMed
24.Woo, T C, Pignol, J P, Rakovitch, Eet al. Body radiation exposure in breast cancer radiotherapy: impact of breast IMRT and virtual wedge compensation techniques. Int J Radiat Oncol Biol Phys 2006; 65: 52–58.CrossRefGoogle ScholarPubMed
25.Taylor, C W, Povall, J M, McGale, Pet al. Cardiac dose from tangential breast cancer radiotherapy in the year 2006. Int J Radiat Oncol Biol Phys 2008; 72: 501–507.CrossRefGoogle ScholarPubMed
26.Rajan, S S, Sharma, S C, Kumar, Net al. Clinical and cosmetic results of breast boost radiotherapy in early breast cancer: a randomized study between electron and photon. J Cancer Res Ther 2014; 10: 889–895.Google ScholarPubMed
27.Whelan, T J, Pignol, J P, Levine, M Net al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010; 362: 513–520.CrossRefGoogle ScholarPubMed
28.Smith, B D, Bentzen, S M, Correa, C Ret al. Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Int J Radiat Oncol Biol Phys 2011; 81: 59–68.CrossRefGoogle ScholarPubMed