nach oben

Erschienen in:

13.10.2022 | Original Article

Surface-guided DIBH radiotherapy for left breast cancer: impact of different thresholds on intrafractional motion monitoring and DIBH stability

verfasst von: A. Gnerucci, M. Esposito, A. Ghirelli, S. Pini, L. Paoletti, R. Barca, S. Fondelli, P. Alpi, B. Grilli, F. Rossi, S. Scoccianti, S. Russo

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 1/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To compare two left breast cancer patient cohorts (tangential vs. locoregional deep-inspiration breath-hold – DIBH treatment) with different predefined beam gating thresholds and to evaluate their impact on motion management and DIBH stability.

Methods

An SGRT-based clinical workflow was adopted for the DIBH treatment. Intrafractional monitoring was performed by tracking both the respiratory signal and the real-time displacement between the isocenter on the daily reference surface and on the live surface (“SGRT shift”). Beam gating tolerances were 5 mm/4 mm for the SGRT shifts and 5 mm/3 mm for the gating window amplitude for breast tangential and breast + lymph nodes locoregional treatments, respectively. A total of 24 patients, 12 treated with a tangential technique and 12 with a locoregional technique, were evaluated for a total number of 684 fractions. Statistical distributions of SGRT shift and respiratory signal for each treatment fraction, for each patient treatment, and for the two population samples were generated.

Results

Lateral cumulative distributions of SGRT shifts for both locoregional and tangential samples were consistent with a null shift, whereas longitudinal and vertical ones were slightly negative (mean values < 1 mm). The distribution of the percentage of beam on time with SGRT shift > 3 mm, > 4 mm, or > 5 mm was extended toward higher values for the tangential sample than for the locoregional sample. The variability in the DIBH respiration signal was significantly greater for the tangential sample.

Conclusion

Different beam gating thresholds for surface-guided DIBH treatment of left breast cancer can impact motion management and DIBH stability by reducing the frequency of the maximum SGRT shift and increasing respiration signal stability when tighter thresholds are adopted.

Nur mit Berechtigung zugänglich

GBD 2016 Causes of Death Collaborators (2017) Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390(10100):1151–1210. https://doi.org/10.1016/S0140-6736(17)32152-9 (Erratum in: Lancet. 2017 Oct 28;390(10106):e38. PMID: 28919116; PMCID: PMC5605883.)CrossRef

Gøtzsche PC, Jørgensen KJ (2013) Screening for breast cancer with mammography. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD001877.pub5CrossRef

AIRTUM task group (2017) I numeri del cancro in Italia

EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), Darby S, McGale P, Correa C, et al (2011) 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 378:1707–1716. https://doi.org/10.1016/S0140-6736(11)61629-2CrossRef

EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), McGale P, Taylor C, Correa C, et al (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383:2127–2135. https://doi.org/10.1016/S0140-6736(14)60488-8CrossRef

Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241CrossRef

Darby SC, McGale P, Taylor CW et al (2005) Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: Prospective cohort study of about 300000 women in US SEER cancer registries. Lancet 6:557–565. https://doi.org/10.1016/S1470-2045(05)70251-5CrossRef

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 368:987–998. https://doi.org/10.1056/NEJMoa1209825CrossRef

Formenti SC, Gidea-Addeo D, Goldberg JD, Roses DF, Guth A, Rosenstein BS, DeWyngaert KJ (2007) Phase I‑II trial of prone accelerated intensity modulated radiation therapy to the breast to optimally spare normal tissue. J Clin Oncol 25(16):2236–2242. https://doi.org/10.1200/JCO.2006.09.1041CrossRef

10.

Mulliez T, Veldeman L, Speleers B, Mahjoubi K, Remouchamps V, Van Greveling A, Gilsoul M, Berwouts D, Lievens Y, Van den Broecke R, De Neve W (2015) Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation. Radiother Oncol 114(1):79–84. https://doi.org/10.1016/j.radonc.2014.11.038CrossRef

11.

Remouchamps VM, Letts N, Vicini FA, Sharpe MB, Kestin LL, Chen PY, Martinez AA, Wong JW (2003) 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 56(3):704–715. https://doi.org/10.1016/s0360-3016(03)00010-5CrossRef

12.

Korreman SS, Pedersen AN, Aarup LR, Nottrup TJ, Specht L, Nystrom H (2006) Reduction of cardiac and pulmonary complication probabilities after breathing adapted radiotherapy for breast cancer. Int J Radiat Oncol Biol Phys 65(5):1375–1380. https://doi.org/10.1016/j.ijrobp.2006.03.046CrossRef

13.

Pedersen AN, Korreman S, Nystrom H, Specht L (2004) Breathing adapted radiotherapy of breast cancer: reduction of cardiac and pulmonary doses using voluntary inspiration breath-hold. Radiother Oncol 72(1):53–60. https://doi.org/10.1016/j.radonc.2004.03.012CrossRef

14.

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(1):199–204CrossRef

15.

Mayo CS, Urie MM, Fitzgerald TJ (2005) Hybrid IMRT plans concurrently treating conventional and IMRT beams for improved breast irradiation and reduced planning time. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2004.10.033CrossRef

16.

Dayes I, Rumble RB, Bowen J et al (2012) Intensity-modulated radiotherapy in the treatment of breast cancer. Clin Oncol. https://doi.org/10.1016/j.clon.2012.05.003CrossRef

17.

Fogliata A, Seppälä J, Reggiori G et al (2017) Dosimetric trade-offs in breast treatment with VMAT technique. Br J Radiol. https://doi.org/10.1259/bjr.20160701CrossRef

18.

Jin GH, Chen LX, Deng XW, Liu XW, Huang Y, Huang XB (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 8:89. https://doi.org/10.1186/1748-717X-8-89CrossRef

19.

Zhao H, He M, Cheng G, Han D, Wu N, Shi D, Zhao Z, Jin J (2015) A comparative dosimetric study of left sided breast cancer after breast-conserving surgery treated with VMAT and IMRT. Radiat Oncol 10:231. https://doi.org/10.1186/s13014-015-0531-4CrossRef

20.

Duma M, Baumann R, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Krug D, Piroth MD, Sedlmayer F, Souchon R, Sauer R (2019) Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO). Strahlenther Onkol 195(10):861–871. https://doi.org/10.1007/s00066-019-01495-wCrossRef

21.

Boda-Heggemann J, Knopf AC, Simeonova-Chergou A, Wertz H, Stieler F, Jahnke A, Jahnke L, Fleckenstein J, Vogel L, Arns A, Blessing M, Wenz F, Lohr F (2016) Deep inspiration breath hold-based radiation therapy: a clinical review. Int J Radiat Oncol Biol Phys 94(3):478–492. https://doi.org/10.1016/j.ijrobp.2015.11.049CrossRef

22.

Al-Hallaq HA, Cerviño L, Gutierrez AN, Havnen-Smith A, Higgins SA, Kügele M, Padilla L, Pawlicki T, Remmes N, Smith K, Tang X, Tomé WA (2022) AAPM task group report 302: Surface-guided radiotherapy. Med Phys 49(4):e82–e112. https://doi.org/10.1002/mp.15532CrossRef

23.

Reitz D, Carl G, Schönecker S, Pazos M, Freislederer P, Niyazi M, Ganswindt U, Alongi F, Reiner M, Belka C, Corradini S (2018) Real-time intra-fraction motion management in breast cancer radiotherapy: analysis of 2028 treatment sessions. Radiat Oncol 13(1):128. https://doi.org/10.1186/s13014-018-1072-4CrossRef

24.

Betgen A, Alderliesten T, Sonke JJ, van Vliet-Vroegindeweij C, Bartelink H, Remeijer P (2013) Assessment of set-up variability during deep inspiration breath hold radiotherapy for breast cancer patients by 3D-surface imaging. Radiother Oncol 106(2):225–230. https://doi.org/10.1016/j.radonc.2012.12.016CrossRef

25.

Xiao A, Crosby J, Malin M, Kang H, Washington M, Hasan Y, Chmura SJ, Al-Hallaq HA (2018) Single-institution report of setup margins of voluntary deep-inspiration breath-hold (DIBH) whole breast radiotherapy implemented with real-time surface imaging. J Appl Clin Med Phys 19(4):205–213. https://doi.org/10.1002/acm2.12368CrossRef

26.

Kügele M, Edvardsson A, Berg L, Alkner S, Andersson Ljus C, Ceberg S (2018) Dosimetric effects of intrafractional isocenter variation during deep inspiration breath-hold for breast cancer patients using surface-guided radiotherapy. J Appl Clin Med Phys 19(1):25–38. https://doi.org/10.1002/acm2.12214CrossRef

27.

Gierga DP, Turcotte JC, Sharp GC, Sedlacek DE, Cotter CR, Taghian AG (2012) A voluntary breath-hold treatment technique for the left breast with unfavorable cardiac anatomy using surface imaging. Int J Radiat Oncol Biol Phys 84(5):e663–8. https://doi.org/10.1016/j.ijrobp.2012.07.2379CrossRef

28.

Hamming VC, Visser C, Batin E, McDermott LN, Busz DM, Both S, Langendijk JA, Sijtsema NM (2019) Evaluation of a 3D surface imaging system for deep inspiration breath-hold patient positioning and intra-fraction monitoring. Radiat Oncol 14(1):125–PMC6624957. https://doi.org/10.1186/s13014-019-1329-6CrossRef

29.

Stieler F, Wenz F, Shi M, Lohr F (2013) A novel surface imaging system for patient positioning and surveillance during radiotherapy. A phantom study and clinical evaluation. Strahlenther Onkol 189(11):938–944. https://doi.org/10.1007/s00066-013-0441-zCrossRef

30.

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(1):10–18. https://doi.org/10.1016/j.ijrobp.2009.10.058CrossRef

31.

Gruppo di lavoro AIRO per la patologia mammaria (2009) La radioterapia dei tumori della mammella, indicazioni e criteri guida

32.

White J, Tai A, Douglas A et al (2012) Breast cancer atlas for radiation therapy planning: consensus definitions RTOG guidelines

33.

Pezner R (2013) Coronary artery disease and breast radiation therapy. Int J Radiat Oncol Biol Phys 86:816–818. https://doi.org/10.1016/j.ijrobp.2013.04.046CrossRef

34.

RTOG guidelines (2016) Breast cancer Atlas

35.

GRUPPO DI COORDINAMENTO AIRO MAMMELLA Best Clinical Practice nella Radioterapia dei Tumori della Mammella 2019. triennio 2017–2019

36.

Hodapp N (2012) The ICRU Report 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT). Strahlenther Onkol 188(1):97–99. https://doi.org/10.1007/s00066-011-0015-xCrossRef

37.

Gagliardi G, Constine LS, Moiseenko V, Correa C, Pierce LJ, Allen AM, Marks LB (2010) Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys 76(3 Suppl):S77–S85. https://doi.org/10.1016/j.ijrobp.2009.04.093CrossRef

38.

Werner-Wasik M, Yorke E, Deasy J, Nam J, Marks LB (2010) Radiation dose-volume effects in the esophagus. Int J Radiat Oncol Biol Phys 76(3 Suppl):S86–S93. https://doi.org/10.1016/j.ijrobp.2009.05.070CrossRef

39.

Reitz D, Walter F, Schönecker S, Freislederer P, Pazos M, Niyazi M, Landry G, Alongi F, Bölke E, Matuschek C, Reiner M, Belka C, Corradini S (2020) Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer. Radiat Oncol 15(1):121. https://doi.org/10.1186/s13014-020-01572-wCrossRef

40.

Wilcoxon F (1945) Individual comparisons by ranking methods. Biometrics 1:196–202

41.

Van Herk M (2004) Errors and margins in radiotherapy. Semin Radiat Oncol 14(1):52–64. https://doi.org/10.1053/j.semradonc.2003.10.003CrossRef

42.

Esposito M, Piermattei A, Bresciani S et al (2021) Improving dose delivery accuracy with EPID in vivo dosimetry: results from a multicenter study. Strahlenther Onkol 197:633–643. https://doi.org/10.1007/s00066-021-01749-6CrossRef

43.

Cravo Sá A, Fermento A, Neves D, Ferreira S, Silva T, Coelho MC et al (2018) Radiotherapy setup displacements in breast cancer patients: 3D surface imaging experience. Rep Pract Oncol Radiother 23:61–67. https://doi.org/10.1016/j.rpor.2017.12.007CrossRef

44.

Batumalai V, Phan P, Choong C, Holloway L, Delaney GP (2016) Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy. J Med Radiat Sci 63(4):224–231. https://doi.org/10.1002/jmrs.180CrossRef

Titel: Surface-guided DIBH radiotherapy for left breast cancer: impact of different thresholds on intrafractional motion monitoring and DIBH stability
verfasst von: A. Gnerucci
M. Esposito
A. Ghirelli
S. Pini
L. Paoletti
R. Barca
S. Fondelli
P. Alpi
B. Grilli
F. Rossi
S. Scoccianti
S. Russo
Publikationsdatum: 13.10.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 1/2023
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-022-02008-y

Three-dimensional conformal radiotherapy (3D-CRT) vs. volumetric modulated arc therapy (VMAT) in deep inspiration breath-hold (DIBH) technique in left-sided breast cancer patients—comparative analysis of dose distribution and estimation of projected secondary cancer risk

Original Article

Near-maximum rib dose is the most relevant risk factor for ipsilateral spontaneous rib fracture: a dosimetric analysis of breast cancer patients after radiotherapy

Original Article

Clinical outcomes of curative-intent multimodal management of chemorefractory nonmetastatic inflammatory breast cancer

Original Article

Fertilitätserhaltung bei Brustkrebs – ein Risiko?

Open Access
Fertilität und Kinderwunsch
Kommentierte Studie

Prerequisites for the clinical implementation of a markerless SGRT-only workflow for the treatment of breast cancer patients

Open Access
Original Article

Hypofractionated radiotherapy after breast-conserving surgery: Clinical and dosimetric factors predictive of acute skin toxicity

Original Article

Neu im Fachgebiet Onkologie

Studie zur HIFU bei Prostatakrebs lässt viele Fragen offen

22.01.2025
Prostatakarzinom
Nachrichten

Führt eine HIFU-Ablation beim Prostatakarzinom im Vergleich mit einer radikalen Prostatektomie zu ähnlichen onkologischen, aber besseren funktionalen Ergebnissen? Interimsdaten der französischen HIFI-Studie sind uneindeutig. In einem Kommentar zur Studie werden zumindest drei allgemeine Erkenntnisse herausgearbeitet.

Bei Achalasie auf Candidiasis der Speiseröhre achten!

21.01.2025
Achalasie
Nachrichten

Bei Achalasie-Betroffenen sollte man immer auch auf Candida-Infektionen achten, warnen Forschende aus Rotterdam. In ihrer Studie ließ die Pilzinfektion das Risiko für ein Ösophaguskarzinom massiv steigen.

Adipositas als negativer Prognosefaktor bei Kindern mit Krebs

Eine kanadische Studie weist darauf hin, dass Übergewicht zum Zeitpunkt der Krebsdiagnose ein unabhängiger Risikofaktor für schlechtere Überlebenschancen bei erkrankten Kindern und Jugendlichen sein könnte. Allerdings sind nicht alle Patientinnen und Patienten gleichermaßen betroffen.

Polypen bei nahen Verwandten – erhöhtes Darmkrebsrisiko

20.01.2025
Risikofaktoren für Krebserkrankungen
Nachrichten

Werden bei erstgradigen Verwandten gutartige Darmpolypen identifiziert, ist das Risiko, selbst an einem Kolorektalkarzinom zu erkranken, deutlich erhöht – vor allem das für eine früh beginnende Erkrankung. Hier könnte sich eine frühe Koloskopie besonders lohnen.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Surface-guided DIBH radiotherapy for left breast cancer: impact of different thresholds on intrafractional motion monitoring and DIBH stability