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Is 5 mm breath-hold window (BHW) sufficient to treat carcinoma left breast patients post-conservative surgery: a comparative study using forward intensity-modulated radiotherapy (FIMRT) and volumetric modulated arc therapy (VMAT)

Published online by Cambridge University Press:  29 September 2020

Karthikeyan Kalyanasundaram Open the ORCID record for Karthikeyan Kalyanasundaram [Opens in a new window]  and
Subramani Vellaiyan
Karthikeyan Kalyanasundaram
Affiliation:
Department of Radiation Oncology, Yashoda Hospitals, Secunderabad500003, India Research and Development Centre, Bharathiar University, Coimbatore641046, India
Subramani Vellaiyan*
Affiliation:
Research and Development Centre, Bharathiar University, Coimbatore641046, India Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi110029, India
*
Author for correspondence: V. Subramani, Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi29, India. Tel: +91 9818590276. E-mail: karthikvsmani86@gmail.com
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Abstract

Purpose:

The purpose of the study was to evaluate the impact of changes in breathing pattern inside the breath-hold window (BHW) during deep inspiration breath hold treatment for carcinoma left breast patients post-conservative surgery.

Methods:

Ten patients of carcinoma left breast post-conservative surgery were prospectively selected. Three sets of CT plain images were acquired, one with 5 mm deep inspiration BHW (DIBHR) and the other one with 1 mm BHW matching the lower threshold (DIBHL) and the third one with 1 mm BHW matching the upper threshold (DIBHH) as DIBHR. For all patients, forward intensity-modulated radiotherapy (FIMRT) and volumetric modulated arc therapy (VMAT) plans were generated in the 5 mm BHW CT series and the same plan being copy and pasted in other series. Target volume doses and critical structure doses were tabulated.

Results:

Planning target volume coverage was adequate and no significant differences were found in any CT series. Significant differences noted in average left lung V5%, V10% and V18% doses between DIBHR versus DIBHH (p values = 0·0461, 0·0283 and 0·0213, respectively) and DIBHL versus DIBHH (p values = 0·0434, 0·0484 and 0·0334, respectively) for FIMRT plans and V18% doses in DIBHR versus DIBHH (p = 0·0067) in VMAT. No differences in heart and apex of heart doses were found. Left anterior descending artery (LAD) mean doses were significant in DIBHL versus DIBHR, DIBHR versus DIBHH and DIBHL versus DIBHH (p = 0·0012, 0·0444 and 0·0048, respectively) series for FIMRT plans and DIBHR versus DIBHH and DIBHL versus DIBHH (p = 0·0341, 0·0001) for VMAT plans.

Finding:

The changes in the breathing pattern inside DIBH window level cause some variation in LAD doses and no other significant differences in any parameters noted, so care should be taken while treating patients with preexisting cardiac conditions.

Keywords

breath hold window (BHW)deep inspiration breath hold (DIBH)forward intensity-modulated radiotherapy (FIMRT)organ at risk (OAR)Real-time Position Management (RPM)Volumetric modulated arc therapy (VMAT)
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 1 , March 2022 , pp. 51 - 59
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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