Reproducibility of deep inspiration breath hold for prone left-sided whole breast irradiation

Radiation Oncology

Wilfried De Neve²  Rudy Van den Broecke¹  Vincent Remouchamps³  Dieter Berwouts²  Annick Van Greveling²  Bruno Speleers²  Werner De Gersem²  Tom Vercauteren²  Liv Veldeman²  Thomas Mulliez³ 

[1] Department of Gynaecology, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium;Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium;Department of Radiotherapy, Clinique et Maternité Sainte-Elisabeth, Place Louise Godin 16, Namur, 5000, Belgium

关键词: Reproducibility;    Deep inspiration breath hold;    Supine position;    Prone position;    Radiotherapy;    Breast;   

Others  :  1150151
DOI  :  10.1186/s13014-014-0313-4

 received in 2014-06-01, accepted in 2014-12-17,  发布年份 2015

【 摘 要 】

Background

Investigating reproducibility and instability of deep inspiration breath hold (DIBH) in the prone position to reduce heart dose for left-sided whole breast irradiation.

Methods

Thirty patients were included and underwent 2 prone DIBH CT-scans during simulation. Overlap indices were calculated for the ipsilateral breast, heart and lungs to evaluate the anatomical reproducibility of the DIBH maneuver. The breathing motion of 21 patients treated with prone DIBH were registered using magnetic probes. These breathing curves were investigated to gain data on intra-fraction reproducibility and instability of the different DIBH cycles during treatment.

Results

Overlap index was 0.98 for the ipsilateral breast and 0.96 for heart and both lungs between the 2 prone DIBH-scans. The magnetic sensors reported population amplitudes of 2.8 ± 1.3 mm for shallow breathing and 11.7 ± 4.7 mm for DIBH, an intra-fraction standard deviation of 1.0 ± 0.4 mm for DIBH, an intra-breath hold instability of 1.0 ± 0.6 mm and a treatment time of 300 ± 69 s.

Conclusion

Prone DIBH can be accurately clinically implemented with acceptable reproducibility and instability.

【 授权许可】

   
2015 Mulliez et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Bronnum D et al.. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013; 368:987-98.
• [2]Henson KE, McGale P, Taylor C, Darby SC. Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. Br J Cancer. 2013; 108:179-82.
• [3]Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E et al.. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005; 366:2087-106.
• [4]Darby S, McGale P, Correa C, Taylor C, Arriagada R 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.
• [5]Remouchamps VM, Vicini FA, Sharpe MB, Kestin LL, Martinez AA, Wong JW. Significant reductions in heart and lung doses using deep inspiration breath hold with active breathing control and intensity-modulated radiation therapy for patients treated with locoregional breast irradiation. Int J Radiat Oncol Biol Phys. 2003; 55:392-406.
• [6]Sixel KE, Aznar MC, Ung YC. Deep inspiration breath hold to reduce irradiated heart volume in breast cancer patients. Int J Radiat Oncol Biol Phys. 2001; 49:199-204.
• [7]Swanson T, Grills IS, Ye H, Entwistle A, Teahan M, Letts N et al.. Six-year experience routinely using moderate deep inspiration breath-hold for the reduction of cardiac dose in left-sided breast irradiation for patients with early-stage or locally advanced breast cancer. Am J Clin Oncol. 2012; 36:24-30.
• [8]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; 106:28-32.
• [9]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; 56:704-15.
• [10]Kirby AM, Evans PM, Donovan EM, Convery HM, Haviland JS, Yarnold JR. Prone versus supine positioning for whole and partial-breast radiotherapy: a comparison of non-target tissue dosimetry. Radiother Oncol. 2010; 96:178-84.
• [11]Formenti SC, DeWyngaert JK, Jozsef G, Goldberg JD. Prone vs supine positioning for breast cancer radiotherapy. JAMA. 2012; 308:861-3.
• [12]Mulliez T, Speleers B, Madani I, De Gersem W, Veldeman L, De Neve W. Whole breast radiotherapy in prone and supine position: is there a place for multi-beam IMRT? Radiat Oncol. 2013;8:151.
• [13]Mulliez T, Veldeman L, van Greveling A, Speleers B, Sadeghi S, Berwouts D et al.. Hypofractionated whole breast irradiation for patients with large breasts: a randomized trial comparing prone and supine positions. Radiother Oncol. 2013; 108:203-8.
• [14]Krengli M, Masini L, Caltavuturo T, Pisani C, Apicella G, Negri E, et al. Prone versus supine position for adjuvant breast radiotherapy: a prospective study in patients with pendulous breasts. Radiat Oncol. 2013;8:232.
• [15]Veldeman L, De Gersem W, Speleers B, Truyens B, Van Greveling A, Van den Broecke R et al.. Alternated prone and supine whole-breast irradiation using IMRT: setup precision, respiratory movement and treatment time. Int J Radiat Oncol Biol Phys. 2012; 82:2055-64.
• [16]Remouchamps VM, Huyskens DP, Mertens I, Destine M, Van Esch A, Salamon E et al.. The use of magnetic sensors to monitor moderate deep inspiration breath hold during breast irradiation with dynamic MLC compensators. Radiother Oncol. 2007; 82:341-8.
• [17]Veldeman L, Speleers B, Bakker M, Jacobs F, Coghe M, De Gersem W et al.. Preliminary results on setup precision of prone-lateral patient positioning for whole breast irradiation. Int J Radiat Oncol Biol Phys. 2010; 78:111-8.
• [18]Savitzky AG, Golay MJE. Smoothing and differentiation of data by simplified least squares procedures. Analytical Chemistry. 1964; 36:1627-39.
• [19]Kirby AM, Evans PM, Helyer SJ, Donovan EM, Convery HM, Yarnold JR. A randomised trial of Supine versus Prone breast radiotherapy (SuPr study): comparing set-up errors and respiratory motion. Radiother Oncol. 2011; 100:221-6.
• [20]Merchant TE, McCormick B. Prone position breast irradiation. Int J Radiat Oncol Biol Phys. 1994; 30:197-203.
• [21]Mahe MA, Classe JM, Dravet F, Cussac A, Cuilliere JC. Preliminary results for prone-position breast irradiation. Int J Radiat Oncol Biol Phys. 2002; 52:156-60.
• [22]Betgen A, Alderliesten T, Sonke JJ, van Vliet-Vroegindeweij C, Bartelink H, Remeijer P. Assessment of set-up variability during deep inspiration breath hold radiotherapy for breast cancer patients by 3D-surface imaging. Radiother Oncol. 2013; 106:225-30.
• [23]McIntosh A, Shoushtari AN, Benedict SH, Read PW, Wijesooriya K. 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:e569-76.
• [24]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.
• [25]Bartlett FR, Colgan RM, Carr K, Donovan EM, McNair HA, Locke I et al.. The UK HeartSpare Study: randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy. Radiother Oncol. 2013; 108:242-7.