Abstract
BackgroundVoluntary deep inspiration breath hold technique (vDIBH) is considered as the key to achieving the widest cardiac sparing in whole breast irradiation. Several techniques have been implemented to achieve a reproducible, fast and friendly treatment. The aim of the present study is to implement vDIBH using the ExacTrac (BrainLAB AG, Germany) monitoring system.MethodsWomen with left-sided breast cancer, younger than 50 years or with cardiac disease, underwent whole breast RT with vDIBH using the ExacTrac (BrainLAB AG, Germany) monitoring system. Simulations were performed with patients positioned supine on a breast board with both arms raised above the head. Five optical markers were placed on the skin around the border of the left breast gland and their position was referenced with ink marking. Each patient received a training session to find the individual deep inspiration level. Finally, a vDIBH CT was taken. All patients were also studied in free breathing (FB) in order to compare the dose distribution for PTV, heart and left anterior descending coronary artery (LAD). Pre-treatment verification was carried out through the ExacTrac (BrainLAB AG, Germany) system and verified with electronic portal imaging (EPI). Moreover, daily real time EPIs in during modality (captured during the beam delivery) were taken in order to check the reproducibility.Results34 patients have been evaluated and 30 were eligible for vDIBH. Most patients showed small setup errors during the treatment course of below 5 mm in 94.9% of the recorded fields. Mean Displacement was less in cranio-caudal direction. Mean intra-fraction displacement was below 3 mm in all directions. vDIBH plans provided better cardiac dosimetry.ConclusionsvDIBH technique using ExacTrac (BrainLAB AG, Germany) monitoring system was applied with good reproducibility.
Highlights
Adjuvant radiotherapy after breast conserving surgery reduces the risk of loco-regional recurrence and is at present time widely used as standard of care [1]
All patients were studied in free breathing (FB) in order to compare the dose distribution for planning target volume (PTV), heart and left anterior descending coronary artery (LAD)
Mean Displacement was less in cranio-caudal direction
Summary
Adjuvant radiotherapy after breast conserving surgery reduces the risk of loco-regional recurrence and is at present time widely used as standard of care [1]. The increasing number of screened patients with early disease, along with improvements in oncological treatment, has led to a greater number of women, at risk of developing chronic toxicities, surviving for many years after diagnosis[2]. There is data regarding patients with left-side breast cancer, where radiotherapy can increase the risk of late heart disease. The authors reported that if a patient, without cardiac comorbidities, receives a dose of 2 Gy to the heart from left breast radiotherapy, the absolute 30 year risk of death from radiation related ischemic heart disease would be less than 0,1% [5]. A meta-analyses [6] recorded a link between cardiac deaths following breast radiotherapy and the volume of the heart receiving 5 Gy. Voluntary deep inspiration breath hold technique (vDIBH) is considered as the key to achieving the widest cardiac sparing in whole breast irradiation. The aim of the present study is to implement vDIBH using the ExacTrac (BrainLAB AG, Germany) monitoring system
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