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Noora Al-Hammadi, Palmira Caparrotti, Carole Naim, Jillian Hayes, Katherine Rebecca Benson, Ana Vasic, Hissa Al-Abdulla, Rabih Hammoud, Saju Divakar, Primoz Petric
Background: During radiotherapy of left-sided breast cancer, parts of the heart are irradiated, which may lead to late toxicity. We report on the experience of single institution with cardiac-sparing radiotherapy using voluntary deep inspiration breath hold (V-DIBH) and compare its dosimetric outcome with free breathing (FB) technique. Patients and methods: Left-sided breast cancer patients, treated at our department with postoperative radiotherapy of breast/chest wall +/- regional lymph nodes between May 2015 and January 2017, were considered for inclusion...
March 2018: Radiology and Oncology
Whoon Jong Kil, Tabitha Pham, Sabbir Hossain, Juan Casaigne, Kellie Jones, Mohammad Khalil
Deep inspiration breathing hold (DIBH) compared to free-breathing (FB) during radiotherapy (RT) has significantly decreased radiation dose to heart and has been one of the techniques adopted for patients with breast cancer. However, patients who are unable to make suitable deep inspiration breath may not be eligible for DIBH, yet still need to spare the heart and lung during breast cancer RT (left-sided RT in particular). Continuous positive airway pressure (CPAP) is a positive airway pressure ventilator, which keeps the airways continuously open and subsequently inflates the thorax resembling thoracic changes from DIBH...
March 2, 2018: Radiation Oncology Journal
Christer Andre Jensen, Ana María Acosta Roa, Marie Johansen, Jo-Åsmund Lund, Jomar Frengen
PURPOSE: The aim of our study was to evaluate and compare the robustness of treatment plans produced using the volumetric modulated arc-therapy (VMAT) and the standard three-dimensional conformal radiotherapy (3DCRT) techniques by estimating perturbed doses induced by localization offsets for deep inspiration breath-hold (DIBH) in locally advanced breast cancer radiation therapy. METHODS: Twenty patients with left breast carcinoma requiring radiation therapy were analysed in this planning study...
January 2018: Physica Medica: PM
Leigh Conroy, Sarah Quirk, Elizabeth Watt, Gillian Ecclestone, Jessica L Conway, Ivo A Olivotto, Tien Phan, Wendy L Smith
PURPOSE: The purpose of this study was to evaluate the dosimetric effect of breath hold level variability and deformation on breast, chest wall, internal mammary chain (IMC) nodes, and heart. METHODS AND MATERIALS: Left-sided post-lumpectomy (n = 12) and postmastectomy (n = 3) patients underwent deep inspiration breath hold (DIBH) and exhale breath hold (EBH) computed tomography (CT) scans. Forward-planned locoregional breast plans were created on the DIBH scan...
February 13, 2018: Practical Radiation Oncology
Hui Lin, Tianyu Liu, Chengyu Shi, Saskia Petillion, Isabelle Kindts, Caroline Weltens, Tom Depuydt, Yulin Song, Ziad Saleh, Xie George Xu, Xiaoli Tang
The deep inspiration breath hold (DIBH) and prone (P) position are two common heart-sparing techniques for external-beam radiation treatment of left-sided breast cancer patients. Clinicians select the position that is deemed to be better for tissue sparing based on their experience. This approach, however, is not always optimum and consistent. In response to this, we develop a quantitative tool that predicts the optimal positioning for the sake of organs at risk (OAR) sparing. Sixteen left-sided breast cancer patients were considered in the study, each received CT scans in the supine free breathing, supine DIBH, and prone positions...
February 13, 2018: Journal of Applied Clinical Medical Physics
Malin Kügele, Anneli Edvardsson, Lovisa Berg, Sara Alkner, Carina Andersson Ljus, Sofie Ceberg
The aim of this study was to investigate potential dose reductions to the heart, left anterior descending coronary artery (LAD), and ipsilateral lung for left-sided breast cancer using visually guided deep inspiration breath-hold (DIBH) with the optical surface scanning system Catalyst™, and how these potential dosimetric benefits are affected by intrafractional motion in between breath holds. For both DIBH and free breathing (FB), treatment plans were created for 20 tangential and 20 locoregional left-sided breast cancer patients...
November 15, 2017: Journal of Applied Clinical Medical Physics
Anna Arns, Manuel Blessing, Jens Fleckenstein, Dzmitry Stsepankou, Judit Boda-Heggemann, Juergen Hesser, Frank Lohr, Frederik Wenz, Hansjoerg Wertz
PURPOSE: Combined ultrafast 90°+90° kV-MV-CBCT within single breath-hold of 15s has high clinical potential for accelerating imaging for lung cancer patients treated with deep inspiration breath-hold (DIBH). For clinical feasibility of kV-MV-CBCT, dose exposure has to be small compared to prescribed dose. In this study, kV-MV dose output is evaluated and compared to clinically-established kV-CBCT. METHODS: Accurate dose calibration was performed for kV and MV energy; beam quality was determined...
2017: PloS One
Kai Joachim Borm, Markus Oechsner, Stephanie E Combs, Marciana-Nona Duma
PURPOSE: To assess the differences in unintended regional nodal irradiation between free breathing (FB) and deep inspiration breath hold (DIBH) during tangential field irradiation. METHODS AND MATERIALS: We randomly chose 32 patients from our database who underwent both DIBH and FB treatment planning. Contouring of the axillary lymph node levels (LI, LII, and LIII) was performed retrospectively according to the Radiation Therapy Oncology Group contouring atlas...
September 20, 2017: International Journal of Radiation Oncology, Biology, Physics
Nicolas Balamoutoff, Benjamin Serrano, Florent Hugonnet, Nicolas Garnier, Benoît Paulmier, Marc Faraggi
Purpose To compare the accuracy of a single 20-second deep-inspiration breath hold (DIBH) in fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) to that with conventional free-breathing (FB) whole-body PET/CT for the assessment, characterization, and quantification of lung lesions in terms of the blurring effect of respiratory motion. Materials and Methods Institutional review board approval was obtained, and the requirement to obtain informed consent was waived. A preclinical study was performed in a test population of 19 patients to evaluate the feasibility and consistency of DIBH techniques compared with phase-based respiratory gating (PBRG)...
October 17, 2017: Radiology
Lalitha Kameshwari Sripathi, Parveen Ahlawat, David K Simson, Chira Ranjan Khadanga, Lakshmipathi Kamarsu, Shital Kumar Surana, Kavi Arasu, Harpreet Singh
INTRODUCTION: Different techniques of radiation therapy have been studied to reduce the cardiac dose in left breast cancer. AIM: In this prospective dosimetric study, the doses to heart as well as other organs at risk (OAR) were compared between free-breathing (FB) and deep inspiratory breath hold (DIBH) techniques in intensity modulated radiotherapy (IMRT) and opposed-tangent three-dimensional radiotherapy (3DCRT) plans. MATERIALS AND METHODS: Fifteen patients with left-sided breast cancer underwent computed tomography simulation and images were obtained in both FB and DIBH...
July 2017: Journal of Medical Physics
Stefanie Corradini, Hendrik Ballhausen, Helmut Weingandt, Philipp Freislederer, Stephan Schönecker, Maximilian Niyazi, Cristoforo Simonetto, Markus Eidemüller, Ute Ganswindt, Claus Belka
PURPOSE: Modern breast cancer radiotherapy techniques, such as respiratory-gated radiotherapy in deep-inspiration breath-hold (DIBH) or volumetric-modulated arc radiotherapy (VMAT) have been shown to reduce the high dose exposure of the heart in left-sided breast cancer. The aim of the present study was to comparatively estimate the excess relative and absolute risks of radiation-induced secondary lung cancer and ischemic heart disease for different modern radiotherapy techniques. METHODS: Four different treatment plans were generated for ten computed tomography data sets of patients with left-sided breast cancer, using either three-dimensional conformal radiotherapy (3D-CRT) or VMAT, in free-breathing (FB) or DIBH...
September 15, 2017: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
Laura Ann Rechner, Maja Vestmø Maraldo, Ivan Richter Vogelius, Xiaorong Ronald Zhu, Bouthaina Shbib Dabaja, Nils Patrik Brodin, Peter Meidahl Petersen, Lena Specht, Marianne Camille Aznar
BACKGROUND AND PURPOSE: Due to the long life expectancy after treatment, the risk of late effects after radiotherapy (RT) is of particular importance for patients with Hodgkin lymphoma (HL). Both deep inspiration breath hold (DIBH) and proton therapy have been shown to reduce the dose to normal tissues for mediastinal HL, but the impact of these techniques in combination is unknown. The purpose of this study was to compare the life years lost (LYL) attributable to late effects after RT for mediastinal HL using intensity modulated radiation therapy (IMRT) in free breathing (FB) and DIBH, and proton therapy in FB and DIBH...
August 21, 2017: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Christer A Jensen, Tatiana Abramova, Jomar Frengen, Jo-Åsmund Lund
Deep inspiration breath hold (DIBH) in left-sided breast cancer radiotherapy is a technique to reduce cardiac and pulmonary doses while maintaining target coverage. This study aims at evaluating an in-house developed DIBH system. Free-breathing (FB) and DIBH plans were generated for 22 left-sided localized breast cancer patients who had radiation therapy (RT) after breast-conserving surgery. All patients were treated utilizing an in-house laser distance measuring system. 50 Gy was prescribed, and parameters of interest were target coverage, left anterior descending coronary artery, (LAD) and heart doses...
July 29, 2017: Journal of Applied Clinical Medical Physics
Sagar A Patel, Hsiao-Ming Lu, Jacqueline A Nyamwanda, Rachel B Jimenez, Alphonse G Taghian, Shannon M MacDonald, Nicolas Depauw
PURPOSE: Dosimetric studies have suggested greater cardiopulmonary sparing with protons over photons for left-sided postmastectomy radiation therapy (PMRT). Modern techniques such as deep inspiration breath hold (DIBH) can help spare the heart. This analysis compares photon and proton delivery with and without DIBH. METHODS AND MATERIALS: Ten women with left breast cancer referred for PMRT on a prospective clinical trial with unfavorable cardiac anatomy underwent free breathing (FB) and DIBH computed tomography simulation...
June 21, 2017: Practical Radiation Oncology
Beata Czeremszyńska, Stanisław Drozda, Michał Górzyński, Lucyna Kępka
AIM: To assess prospectively which patients with left breast cancer have the dosimetric benefit from the use of deep-inspiration breath-hold radiotherapy (DIBH-RT). BACKGROUND: Improvement in selection of patients for DIBH-RT would spare time of radiotherapy staff by removing the need for preparation of two comparative treatment plans. MATERIALS AND METHODS: Thirty-one patients qualified for whole left breast irradiation underwent breath-hold training and their free-breathing (FB) and DIBH planning-CT were included in the analysis of dosimetric outcome...
September 2017: Reports of Practical Oncology and Radiotherapy
Lynsey Rice, Christy Goldsmith, Melanie Ml Green, Susan Cleator, Patricia M Price
BACKGROUND: We developed, applied, and prospectively evaluated a novel deep-inspiration breath-hold (DIBH) screening and delivery technique to optimize cardiac sparing in left-breast radiotherapy (RT) at our clinic. The impact of set-up and dose variables upon organs at risk (OAR) dose in DIBH RT was investigated. METHODS AND MATERIALS: All patients with left-breast cancer referred between 2011 and 2014 - of all disease stages, set-up variations, and dose prescriptions - were included...
2017: Breast Cancer: Targets and Therapy
Mazen Sakka, Leonie Kunzelmann, Martin Metzger, Gerhard G Grabenbauer
BACKGROUND: Given the reduction in death from breast cancer, as well as improvements in overall survival, adjuvant radiotherapy is considered the standard treatment for breast cancer. However, left-sided breast irradiation was associated with an increased rate of fatal cardiovascular events due to incidental irradiation of the heart. Recently, considerable efforts have been made to minimize cardiac toxicity of left-sided breast irradiation by new treatment methods such as deep-inspiration breath-hold (DIBH) and new radiation techniques, particularly intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT)...
October 2017: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
S Beilla, T Younes, L Vieillevigne, M Bardies, X Franceries, L Simon
PURPOSE: Commercial algorithms used in Radiotherapy include approximations that are generally acceptable. However their limits can be seen when confronted with small fields and low-density media. These conditions exist during the treatment of lung cancers with Stereotactic Body Radiation Therapy (SBRT) achieved with the "Deep Inspiration Breath Hold" (DIBH) technique. A Monte Carlo (MC) model of a linear accelerator was used to assess the performance of two algorithms (Varian Acuros and AAA) in these conditions...
April 24, 2017: Physica Medica: PM
Reuben Patrick Estoesta, Lani Attwood, Diana Naehrig, Elizabeth Claridge-Mackonis, David Odgers, Darren Martin, Melissa Pham, Joanne Toohey, Susan Carroll
Deep Inspiration Breath-Hold (DIBH) techniques for breast cancer radiation therapy (RT) have reduced cardiac dose compared to Free Breathing (FB). Recently, a voluntary deep inspiration breath-hold (vDIBH) technique was established using in-room lasers and skin tattoos to monitor breath-hold. An in-house quality assessment of positional reproducibility during RT delivery with vDIBH in patients with left-sided breast cancer was evaluated. The electronic portal imaging device (EPID) was used in cinematographic (CINE) mode to capture a sequence of images during beam delivery...
April 22, 2017: Journal of Medical Imaging and Radiation Oncology
Timothy M Zagar, Orit Kaidar-Person, Xiaoli Tang, Ellen E Jones, Jason Matney, Shiva K Das, Rebecca L Green, Arif Sheikh, Amir H Khandani, William H McCartney, Jorge Daniel Oldan, Terence Z Wong, Lawrence B Marks
PURPOSE: To evaluate early cardiac single photon computed tomography (SPECT) findings after left breast/chest wall postoperative radiation therapy (RT) in the setting of deep inspiration breath hold (DIBH). METHODS AND MATERIALS: We performed a prospective single-institution single-arm study of patients who were planned for tangential RT with DIBH to the left breast/chest wall (± internal mammary nodes). The DIBH was done by use of a controlled surface monitoring technique (AlignRT, Vision RT Ltd, London, UK)...
April 1, 2017: International Journal of Radiation Oncology, Biology, Physics
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