Abstract
BackgroundDuring radiotherapy (RT) procedure of breast cancer, portions of the heart and lung will receive some radiation dose, which may result in acute and late toxicities. In the current study, we report the experience of our single institution with organs at risk (OARs)–sparing RT with deep inspiration breath hold (DIBH) using an Optical Surface Management System (OSMS) and compare the dosimetric parameters with that of free breathing (FB).Patients and MethodsForty-eight cases diagnosed as early stage left-sided breast cancer scheduled for postoperative RT were enrolled. The OSMS was used to monitor the breathing magnitude and track the real-time respiratory status, which can control a stable lung and heart volume during RT delivery under DIBH. We did the dosimetric analysis of the heart, left anterior descending (LAD) coronary artery, lungs, and contralateral breast under FB and DIBH plans.ResultsCompared with FB–volumetric-modulated arc therapy (FB-VMAT), DIBH-VMAT resulted in significantly changed volumes to the heart and lungs receiving irradiation dose. The average mean heart dose and average D2%, V5, and V10 showed significant differences between the DIBH and FB techniques. For the LAD coronary artery, we found significantly reduced average mean dose, D2%, and V10 with DIBH. Similar results were also found in the lungs and contralateral breast. The use of flattening-filter–free decreased treatment time compared with the flat beam mode in our VMAT (p < 0.05). For the 48 patients, there were no significant differences in the lateral, longitudinal, and vertical directions between OSMS and cone beam CT.ConclusionsDIBH-VMAT with OSMS is very feasible in daily practice with excellent patient compliance in our single-center experience. Note that OSMS is an effective tool that may allow easier-to-achieve precise positioning and better and shorter position-verify time. Meanwhile, compared with FB, DIBH was characterized by lower doses to OARs, which may reduce the probability of cardiac and pulmonary complications in the future.
Highlights
As the most common cancer in women globally, breast cancer has a high 5-year overall survival rate of 90% attributed to advances in prevention, early diagnosis, and treatment regimens, including radiotherapy (RT) [1]
The FFF mode was utilized in clinical practical application for each deep inspiration breath hold (DIBH) case, whereas FF-mode plans were generated for each same patient
We found a significant (p < 0.01) difference in the mean dose of the left anterior descending (LAD) coronary artery decreased from 6.9 Gy (3.11–12.9 Gy) in free breathing (FB) to 3.9 Gy (2.06–6.29 Gy) in DIBH plan
Summary
As the most common cancer in women globally, breast cancer has a high 5-year overall survival rate of 90% attributed to advances in prevention, early diagnosis, and treatment regimens, including radiotherapy (RT) [1]. Darby et al [5] reported that during breast cancer RT, the heart was exposed to ionizing radiation, resulting in an increase in ischemic heart disease. For cases with already existed cardiac risk factors undergoing RT, the increase is significantly higher than in other patients. Among these risk factors, cardiovascular disease (CVD) is a major complication and a serious death risk for breast cancer survivors [7,8,9]. During radiotherapy (RT) procedure of breast cancer, portions of the heart and lung will receive some radiation dose, which may result in acute and late toxicities. We report the experience of our single institution with organs at risk (OARs)–sparing RT with deep inspiration breath hold (DIBH) using an Optical Surface Management System (OSMS) and compare the dosimetric parameters with that of free breathing (FB)
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