nach oben

Strahlentherapie und Onkologie

Erschienen in:

08.09.2016 | Original Article

Reduction of cardiac and coronary artery doses in irradiation of left-sided breast cancer during inspiration breath hold

A planning study

verfasst von: S. Schönecker, C. Heinz, M. Söhn, W. Haimerl, S. Corradini, M. Pazos, C. Belka, Dr. med. H. Scheithauer

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 11/2016

Einloggen, um Zugang zu erhalten

Abstract

Background and purpose

The radiation dose received by the heart during adjuvant left-sided breast irradiation plays a crucial role in development of late toxicity. Although the absolute risk of cardiotoxicity can be reduced with modern irradiation techniques, cardiotoxic chemotherapy increases the risk of late damage. Thus, the radiation dose to the heart should be minimized. This study evaluated the influence of different amplitudes of inspiration breath hold (IBH) during simulated left-sided breast irradiation on cardiac doses compared to free breathing (FB).

Patients and methods

CT data of 11 lung cancer patients were retrospectively used as left-sided pseudo-breast cancer cases. Two CT scans were used, one during IBH and one during FB, and two treatment plans were generated. Relevant heart, lung, and left anterior descending artery (LAD) parameters were derived from dose–volume histograms. The normal tissue complication probabilities (NTCPs) for the heart were calculated based on the relative seriality model. Inspiration depth was quantified using chest volume and diameter, and correlated thereafter to a possible sparing of heart tissue.

Results

Mean reduction of heart dose for IBH compared to FB was 40 % (1.65 vs. 0.99 Gy; p = 0.007). Maximum dose to the heart and LAD could be decreased by 33 % (p = 0.011) and 43 % (p = 0.024), respectively. The mean anteroposterior shift was 5 mm (range 0.9–9.5 mm). Significant negative correlations between the relative change in LAD mean dose and the mean thoracic diameter and volume change, as well as with the absolute change in thoracic diameter were seen. The NTCP for cardiac mortality could be decreased by about 78 % (p = 0.017).

Conclusion

For left-sided breast cancer patients, cardiac doses can be significantly decreased with tangential irradiation and IBH.

Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90CrossRefPubMed

Budach W, Dunst J, Feyer P et al (2006) Leitlinie: Radiotherapie des Mammakarzinoms (DEGRO 2005). Radiat Oncol 182:1–28

Sautter-Bihl ML, Budach W, Dunst J et al (2007) DEGRO practical guidelines for radiotherapy of breast cancer I. Strahlenther Onkol 183:661–666CrossRefPubMed

Tumorzentrum München (2011) Manual: Mammakarzinome – Empfehlungen zur Diagnostik, Therapie und Nachsorge, 13th edn.

Buchholz TA, Katz A, Strom EA et al (2002) Pathologic tumor size and lymph node status predict for different rates of locoregional recurrence after mastectomy for breast cancer patients treated with neoadjuvant versus adjuvant chemotherapy. Int J Radiat Oncol Biol Phys 53:880–888CrossRefPubMed

Budach W, Kammers K, Boelke E et al (2013) Adjuvant radiotherapy of regional lymph nodes in breast cancer – a meta-analysis of randomized trials. Radiat Oncol 8:267CrossRefPubMedPubMedCentral

Cuzick J, Stewart H, Rutqvist L et al (1994) Cause-specific mortality in long-term survivors of breast-cancer who participated in trials of radiotherapy. J Clin Oncol 12:447–453PubMed

Harris JR, Halpin-Murphy P, McNeese M et al (1999) Consensus statement on postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys 44:989–990CrossRefPubMed

Giordano SH, Kno YF, Freeman JL et al (2005) Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst 97:419–424CrossRefPubMedPubMedCentral

10.

Darby SC, Cutter DJ, Boerma M et al (2010) Radiation-related heart disease: current knowledge and future prospects. Int J Radiat Oncol Biol Phys 76:656–665CrossRefPubMedPubMedCentral

11.

Landberg T (1995) The role of radiotherapy in breast-conserving treatment. Acta Oncol 34:675–680CrossRefPubMed

12.

Schultz-Hector S, Trott KR (2007) Radiation-induced cardiovascular diseases: Is the epidemiologic evidence compatible with the radiobiologic data? Int J Radiat Oncol Biol Phys 67:10–18CrossRefPubMed

13.

Hepp R, Ammerpohl M, Morgenstern C et al (2015) Deep inspiration breath-hold (DIBH) radiotherapy in left-sided breast cancer: Dosimetrical comparison and clinical feasibility in 20 patients. Strahlenther Onkol 191:710–716CrossRefPubMed

14.

Cutter DJ, Darby SC, Yusuf SW (2011) Risks of heart disease after radiotherapy. Tex Heart Inst J 38:257–258PubMedPubMedCentral

15.

Offersen B, Hojris I, Overgaard M (2011) Radiation-induced heart morbidity after adjuvant radiotherapy of early breast cancer – Is it still an issue? Radiother Oncol 100:157–159CrossRefPubMed

16.

Simeonova-Chergou A, Jahnke A, Siebenlist K et al (2016) Automatically gated image-guided breath-hold IMRT is a fast, precise, and dosimetrically robust treatment for lung cancer patients. Strahlenther Onkol 192:166–173CrossRefPubMed

17.

Gagliardi G, Lax I, Rutqvist LE (2001) Partial irradiation of the heart. Semin Radiat Oncol 11:224–233CrossRefPubMed

18.

Lyman JT (1985) Complication probability as assessed from dose volume histograms. Radiat Res 104:S13–S19CrossRef

19.

Källman P, Ågren A, Brahme A (1992) Tumor and normal tissue responses to fractionated nonuniform dose delivery. Int J Radiat Oncol Biol Phys 62:249–262CrossRef

20.

Jensen BV (2006) Cardiotoxic consequences of anthracycline-containing therapy in patients with breast cancer. Semin Oncol 33:S15–S21CrossRefPubMed

21.

Gagliardi G, Lax I, Ottolenghi A et al (1996) Long-term cardiac mortality after radiotherapy of breast cancer – Application of the relative seriality model. Br J Radiol 69:839–846CrossRefPubMed

22.

Guan H, Wen N, Pradhan D et al (2006) A simplified frame work using deep inspiration breath-hold (DIBH) for the treatment of left breast cancer with improved heart sparing. Med Phys 33:2062–2062CrossRef

23.

Zurl B, Stranzl H, Winkler P et al (2013) Risk assessment of radiation-induced Breast cancer in the contralateral Breast after radiation therapy, Respiratory-triggered with tangential fields. Strahlenther Onkol 189:183–183

24.

Guan H, Hammoud R, Aquilino L et al (2007) A simplified framework for the treatment of left breast cancer using deep inspiration breath hold (DIBH) with reduced heart dose. Int J Radiat Oncol Biol Phys 69:S736–S736CrossRef

25.

Stranzl H, Zurl B (2008) Postoperative irradiation of left-sided breast cancer patients and cardiac toxicity. Strahlenther Onkol 184:354–358CrossRefPubMed

26.

Taylor CW, Nisbet A, Mcgale P et al (2007) Cardiac exposures in breast cancer radiotherapy: 1950s–1990s. Int J Radiat Oncol Biol Phys 69:1484–1495CrossRefPubMed

27.

Kriz J, Spickermann M, Lehrich P et al (2015) Breath-hold technique in conventional APPA or intensity-modulated radiotherapy for Hodgkin’s lymphoma: Comparison of ILROG IS-RT and the GHSG IF-RT. Strahlenther Onkol 191:717–725CrossRefPubMed

28.

Pedersen AN, Korreman S, Nystrom H et al (2004) Breathing adapted radiotherapy of breast cancer: reduction of cardiac and pulmonary doses using voluntary inspiration breath-hold. Radiother Oncol 72:53–60CrossRefPubMed

29.

Sixel KE, Aznar MC, Ung YC (2001) Deep inspiration breath hold to reduce irradiated heart volume in breast cancer patients. Int J Radiat Oncol Biol Phys 49:199–204CrossRefPubMed

30.

Hjelstuen MHB, Mjaaland I, Vikstrom J et al (2012) Radiation during deep inspiration allows loco-regional treatment of left breast and axillary-, supraclavicular- and internal mammary lymph nodes without compromising target coverage or dose restrictions to organs at risk. Acta Oncol 51:333–344CrossRefPubMed

31.

Korreman SS, Pedersen AN, Nottrup TJ et al (2005) Breathing adapted radiotherapy for breast cancer: Comparison of free breathing gating with the breath-hold technique. Radiother Oncol 76:311–318CrossRefPubMed

32.

Jin G‑H, Chen L‑X, Deng X‑W et al (2013) A comparative dosimetric study for treating left-sided breast cancer for small breast size using five different radiotherapy techniques: conventional tangential field, filed-in-filed, Tangential-IMRT, Multi-beam IMRT and VMAT. Radiat Oncol 8:89CrossRefPubMedPubMedCentral

33.

Nieder C, Schill S, Kneschaurek P et al (2007) Influence of different treatment techniques on radiation dose to the LAD coronary artery. Radiat Oncol 2:20CrossRefPubMedPubMedCentral

34.

Pili G, Grimaldi L, Fidanza C et al (2011) Geometric and dosimetric approach to determine probability of late cardiac mortality in left tangential breast irradiation: comparison between wedged beams and field-in-field technique. Int J Radiat Oncol Biol Phys 81:894–900CrossRefPubMed

35.

Schubert LK, Gondi V, Sengbusch E et al (2011) Dosimetric comparison of left-sided whole breast irradiation with 3DCRT, forward-planned IMRT, inverse-planned IMRT, helical tomotherapy, and topotherapy. Radiother Oncol 100:241–246CrossRefPubMed

36.

Wang W, Li JB, Hu HG et al (2013) Correlation between target motion and the dosimetric variance of breast and organ at risk during whole breast radiotherapy using 4DCT. Radiat Oncol 8:111CrossRefPubMedPubMedCentral

37.

Smyth LM, Knight KA, Aarons YK et al (2015) The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review. J Med Radiat Sci 62:66–73CrossRefPubMedPubMedCentral

38.

Tanguturi SK, Lyatskaya Y, Chen Y et al (2015) Prospective assessment of deep inspiration breath-hold using 3‑dimensional surface tracking for irradiation of left-sided breast cancer. Pract Radiat Oncol 5:358–365CrossRefPubMed

39.

Feng M, Moran JM, Koelling T et al (2011) Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys 79:10–18CrossRefPubMed

40.

Host H, Brennhovd IO, Loeb M (1986) Postoperative radiotherapy in breast-cancer – long-term results from the Oslo Study. Int J Radiat Oncol Biol Phys 12:727–732CrossRefPubMed

41.

Rutqvist LE, Johansson H (1990) Mortality by laterality of the primary tumour among 55,000 breast cancer patients from the Swedish Cancer Registry. Br J Cancer 61:866–868CrossRefPubMedPubMedCentral

42.

Darby SC, Ewertz M, McGale P et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368:987–998CrossRefPubMed

43.

Vikstrom J, Hjelstuen MHB, Mjaaland I et al (2011) Cardiac and pulmonary dose reduction for tangentially irradiated breast cancer, utilizing deep inspiration breath-hold with audio-visual guidance, without compromising target coverage. Acta Oncol 50:42–50CrossRefPubMed

44.

Pham TT, Ward R, Latty D et al (2016) Left-sided breast cancer loco-regional radiotherapy with deep inspiration breath-hold: Does volumetric-modulated arc radiotherapy reduce heart dose further compared with tangential intensity-modulated radiotherapy? J Med Imaging Radiat Oncol. doi:10.1111/1754-9485.12459 PubMed

45.

Latty D, Stuart KE, Wang W et al (2015) Review of deep inspiration breath-hold techniques for the treatment of breast cancer. J Med Radiat Sci 62:74–81CrossRefPubMedPubMedCentral

46.

Boda-Heggemann J, Knopf AC, Simeonova-Chergou A et al (2016) Deep inspiration breath hold-based radiation therapy: A clinical review. Int J Radiat Oncol Biol Phys 94:478–492CrossRefPubMed

47.

Joo JH, Kim SS, Ahn SD et al (2015) Cardiac dose reduction during tangential breast irradiation using deep inspiration breath hold: a dose comparison study based on deformable image registration. Radiat Oncol 10:264CrossRefPubMedPubMedCentral

48.

Lin A, Sharieff W, Juhasz J et al (2016) The benefit of deep inspiration breath hold: evaluating cardiac radiation exposure in patients after mastectomy and after breast-conserving surgery. Breast Cancer. doi:10.1007/s12282-016-0676-5

49.

Yeung R, Conroy L, Long K et al (2015) Cardiac dose reduction with deep inspiration breath hold for left-sided breast cancer radiotherapy patients with and without regional nodal irradiation. Radiat Oncol 10:200CrossRefPubMedPubMedCentral

50.

Zurl B, Stranzl H, Winkler P et al (2010) Quantitative assessment of irradiated lung volume and lung mass in breast cancer patients treated with tangential fields in combination with deep inspiration breath hold (DIBH). Strahlenther Onkol 186:157–162CrossRefPubMed

51.

Heggemann F, Grotz H, Welzel G et al (2015) Cardiac function after multimodal breast cancer therapy assessed with functional magnetic resonance imaging and echocardiography imaging. Int J Radiat Oncol Biol Phys 93:836–844CrossRefPubMed

52.

Lohr F, Heggemann F, Papavassiliu T et al (2009) Is cardiotoxicity still an issue after breast-conserving surgery and could it be reduced by multifield IMRT? Strahlenther Onkol 185:222–230CrossRefPubMed

Titel: Reduction of cardiac and coronary artery doses in irradiation of left-sided breast cancer during inspiration breath hold
A planning study
verfasst von: S. Schönecker
C. Heinz
M. Söhn
W. Haimerl
S. Corradini
M. Pazos
C. Belka
Dr. med. H. Scheithauer
Publikationsdatum: 08.09.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 11/2016
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-016-1039-z

Neu im Fachgebiet Onkologie

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Reduction of cardiac and coronary artery doses in irradiation of left-sided breast cancer during inspiration breath hold

A planning study

Abstract

Background and purpose

Patients and methods

Results

Conclusion

Neu im Fachgebiet Onkologie

Prostatakarzinom: EU initiiert neues Screeningkonzept

Blasenkarzinom – Biomarker statt Zytologie?

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Adjuvante Brustkrebstherapie: Doppelt hält besser

Update Onkologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Background and purpose

Patients and methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2016

Radiosurgery with flattening-filter-free techniques in the treatment of brain metastases

Improved survival for elderly married glioblastoma patients

Erratum to: Hypofractionated radiotherapy for localized prostate cancer

Therapie des lokalisierten nodulären Lymphozyten-prädominanten Hodgkin-Lymphoms bei Kindern

Radikale Zystektomie vs. Radiochemotherapie zur Behandlung des Blasenkarzinoms im Stadium T2–4a N0 M0

Verbessertes Überleben bei Patienten mit primär metastasiertem Prostatakarzinom

Neu im Fachgebiet Onkologie

Prostatakarzinom: EU initiiert neues Screeningkonzept

Blasenkarzinom – Biomarker statt Zytologie?

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Adjuvante Brustkrebstherapie: Doppelt hält besser

Update Onkologie