TY - JOUR
T1 - Cardiac exposure in left-sided breast cancer patients undergoing deep inspiratory breath hold radiation therapy
AU - Zhu, Huijun
AU - Sun, Huiwen
AU - Zhang, Jiaming
AU - Xie, Yiting
AU - Jassem, Jacek
AU - FRANCO, Pierfrancesco
AU - Sun, Weiliang
AU - Liu, Wenqi
AU - Yue, Haiying
PY - 2023
Y1 - 2023
N2 - Background: Left- sided breast cancer (BC) patients undergoing post-operative radiation therapy (PRT) may have higher risk of late cardiovascular toxicity, which may be reduced by hearth-sparing RT techniques. This study evaluated dosimetric parameters of the deep inspiration breath hold (DIBH) compared to free breathing (FB) RT. We analysed factors impacting on doses to the heart and cardiac substructures and sought anatomic factors allowing patient selection for DIBH. Methods: The study group included 67 left-sided BC patients who underwent RT after breast-conserving surgery or mastectomy. Patients treated with DIBH were trained to hold their breath. Computed tomography (CT) scans were performed in both FB and DIBH patients. Plans were generated using 3-dimensional (3D) conformal RT. The dosimetric variables were obtained from dose-volume histograms, and the anatomical variables were derived from the CT scans. The variables in the two groups were compared by t-test, the U test, and the chi-squared test. Correlation analysis was performed using Pearson's correlation coefficient. Receiver operating characteristic curves were used to analyze the efficacy of the predictors. Results: Compared to the FB, DIBH allowed for a mean dose reduction to the heart, left anterior descending coronary artery (LAD), left ventricle (LV), and right ventricle (RV) by 30.0%, 38.7%, 39.3%, and 34.7%, respectively. DIBH markedly increased the heart height (HH), heart chest wall distance (HCWD), the mean distance between the ipsilateral lung and breast (DBIB), and decreased the heart-chest wall length (HCWL) (P<0.05). The different value of HH, DBIB, HCWL, and HCWD between DIBH and FB were 1.31, 1.95, -0.67, and 0.22 cm, respectively (all P<0.05)..HH was an independent predictor of the mean dose to the heart, LAD, LV, and RV, with the area under the curve values of 0.818, 0.725, 0.821, and 0.820, respectively. Conclusions: DIBH significantly reduced the dose to the entire heart and its substructures in left-sided BC patients undergoing post-operative RT..HH predicts the mean dose to the heart and its substructures. These results may inform patient selection for DIBH.
AB - Background: Left- sided breast cancer (BC) patients undergoing post-operative radiation therapy (PRT) may have higher risk of late cardiovascular toxicity, which may be reduced by hearth-sparing RT techniques. This study evaluated dosimetric parameters of the deep inspiration breath hold (DIBH) compared to free breathing (FB) RT. We analysed factors impacting on doses to the heart and cardiac substructures and sought anatomic factors allowing patient selection for DIBH. Methods: The study group included 67 left-sided BC patients who underwent RT after breast-conserving surgery or mastectomy. Patients treated with DIBH were trained to hold their breath. Computed tomography (CT) scans were performed in both FB and DIBH patients. Plans were generated using 3-dimensional (3D) conformal RT. The dosimetric variables were obtained from dose-volume histograms, and the anatomical variables were derived from the CT scans. The variables in the two groups were compared by t-test, the U test, and the chi-squared test. Correlation analysis was performed using Pearson's correlation coefficient. Receiver operating characteristic curves were used to analyze the efficacy of the predictors. Results: Compared to the FB, DIBH allowed for a mean dose reduction to the heart, left anterior descending coronary artery (LAD), left ventricle (LV), and right ventricle (RV) by 30.0%, 38.7%, 39.3%, and 34.7%, respectively. DIBH markedly increased the heart height (HH), heart chest wall distance (HCWD), the mean distance between the ipsilateral lung and breast (DBIB), and decreased the heart-chest wall length (HCWL) (P<0.05). The different value of HH, DBIB, HCWL, and HCWD between DIBH and FB were 1.31, 1.95, -0.67, and 0.22 cm, respectively (all P<0.05)..HH was an independent predictor of the mean dose to the heart, LAD, LV, and RV, with the area under the curve values of 0.818, 0.725, 0.821, and 0.820, respectively. Conclusions: DIBH significantly reduced the dose to the entire heart and its substructures in left-sided BC patients undergoing post-operative RT..HH predicts the mean dose to the heart and its substructures. These results may inform patient selection for DIBH.
KW - Breast cancer (BC)
KW - deep inspiration breath hold (DIBH)
KW - heart protection
KW - radiotherapy
KW - Breast cancer (BC)
KW - deep inspiration breath hold (DIBH)
KW - heart protection
KW - radiotherapy
UR - https://iris.uniupo.it/handle/11579/181964
U2 - 10.21037/gs-23-160
DO - 10.21037/gs-23-160
M3 - Article
SN - 2227-684X
VL - 12
SP - 677
EP - 686
JO - Gland Surgery
JF - Gland Surgery
IS - 5
ER -