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Deep inspirational breath hold to reduce cardiac dose in left-sided breast radiotherapy

Published online by Cambridge University Press:  22 June 2017

Camarie Welgemoed ,
Jonathan Rogers ,
Patti McNaught ,
Susan Cleator ,
Pippa Riddle  and
Dorothy Gujral
Camarie Welgemoed*
Affiliation:
Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
Jonathan Rogers
Affiliation:
Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
Patti McNaught
Affiliation:
Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
Susan Cleator
Affiliation:
Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
Pippa Riddle
Affiliation:
Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
Dorothy Gujral
Affiliation:
Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
*
Correspondence to: Camarie Welgemoed, Department of Radiotherapy, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Rd, London W6 8RF, UK. Tel: 079 6105 4608. E-mail: [email protected]
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Abstract

Background

During left-sided breast radiotherapy, the heart is often exposed to radiation dose. Shielding can be utilised to reduce heart exposure, but compromises the dose delivered to the breast tissue and, in a proportion of patients, to the tumour bed. Deep inspiration breath hold (DIBH) can be used as a technique to move the heart away from the treatment area and thus reduce heart dose. This study examines the efficacy of the Elekta Active Breathing Coordinator (ABC), a DIBH method, in reducing heart dose.

Materials and methods

In total, 12 patients receiving radiotherapy to the left breast were planned for treatment with both a free-breathing (FB) and an ABC scan. The dose volume histogram data for the plans was analysed with respect to heart V13, V5 Gy, mean heart dose and ipsilateral lung V18 Gy. Tumour bed D98%, threshold lung volume in breath hold (BH) and the maximum BH time for each patient was also measured. Patients then received their radiotherapy treatment using the ABC plan and the systematic error in the craniocaudal, lateral and vertical axes was assessed using orthogonal imaging.

Results

The median heart V13 Gy for FB and DIBH patients was 3% (range, 0·85–11·28) and 0% (range, 0–1·56), respectively, with a mean heart dose of 2·62 Gy (range, 1·21–4·93) in FB and 1·51 Gy (range, 1·17–2·22) in ABC. The median lung V18 Gy was 8·7% (3·08–14·87) in FB plans and 9% (4·88–12·82) in ABC plans. The mean systematic set-up errors in all three planes were within the departmental set-up tolerance of 5 mm for both techniques. Median FB tumour bed D98% was 97·4% (92·8–99·5) and 97·5% (97·3–98·5) for ABC.

Conclusion

ABC represents a good method of reducing radiation dose to the heart while not compromising on dose to the tumour bed, and it has a clear advantage over FB radiotherapy in reducing the risk of cardiac toxicity. It is tolerated well by patients and does not produce any difficulties in patient positioning.

Keywords

Active Breathing Coordinatorbreast radiotherapycardiac dose
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 3 , September 2017 , pp. 251 - 257
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Copyright
© Cambridge University Press 2017 

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References

1. Early Breast Cancer Trialists’ Collaborative Group. 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 (9804): 1707–1716.Google Scholar
2. Hurkmans, C W, Borger, J H, van der Horst, L J et al. Cardiac and lung complication probabilities after breast cancer irradiation. Radiother Oncol 2000; 55 (2): 45–51.Google Scholar
3. Mackenzie, P, Fyles, A, Wang, W, Chung, C. Advanced radiotherapy techniques for breast cancer to minimize cardiovascular risk. Breast Cancer Manag 2014; 3 (3): 297–305.CrossRefGoogle Scholar
4. Darby, S C, Ewertz, M, McGale, P et al. Risk of ischemic heart disease in woman after radiotherapy for breast cancer. New Engl J Med 2013; 368 (11): 987–998.CrossRefGoogle ScholarPubMed
5. Poortmans, P. Evidence based radiation oncology. Breast Cancer Radiother Oncol 2007; 84 (1): 84–101.Google Scholar
6. Gregoire, V. Mackie, T R. State of the art dose prescription, reporting and recording in Intensity-Modulated Radiation Therapy (ICRU report No. 83). Cancer 2011; 15: 555–559.Google Scholar
7. Paszat, L F, Mackillop, W J, Groome, P A et al. Mortality from myocardial infarction following postlumpectomy radiotherapy for breast cancer: a population-based study in Ontario, Canada. Int J Radiat Oncol Biol Phys 1999; 43 (4): 755–762.Google Scholar
8. Darby, S C, Cutter, D J, Boerma, M et al. Radiation-related heart disease: current knowledge and future prospects. Int J Radiat Oncol Biol Phys 2010; 76 (3): 656–665.Google Scholar
9. Wang, W, O’Connell, D, Stuart, K, Boyages, J. Analysis of 10-year cause-specific mortality of patients with breast cancer treated in New South Wales in 1995. Radiat Oncol 2011; 55: 16–525.Google Scholar
10. Bouillon, K, Haddy, N, Delaloge, S et al. Long-term cardiovascular mortality after radiotherapy for breast cancer. J Am Coll Cardiol 2011; 57 (4): 445–452.CrossRefGoogle ScholarPubMed
11. Early Breast Cancer Trialists’ Collaborative Group. 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: 2081–2106.Google Scholar
12. Bowles, E J A, Wellman, R, Feigelson, H S et al. Risk of heart failure in breast cancer patients after anthracycline and trastuzumab treatment: a retrospective cohort study. J Natl Cancer Inst 2012; 104 (17): 1293–1305.Google Scholar
13. Taylor, C W, Povali, J M, McGale, P et al. Cardiac dose from tangential breast cancer radiotherapy in the year 2006. Int J Radiat Oncol Biol Phys 2008; 72 (2): 501–507.Google Scholar
14. Landau, D, Adams, E J, Webb, S et al. Cardiac avoidance in breast radiotherapy: a comparison of simple shielding techniques with intensity-modulated radiotherapy. Radiother Oncol 2001; 60 (3): 247–255.Google Scholar
15. Raj, K A, Evans, E S, Prosnitz, R G et al. Is there an increased risk of local recurrence under the heart block in patients with left-sided breast cancer? Cancer J 2006; 12 (4): 309–317.Google Scholar
16. Sixel, K E, Aznar, M C, Ung, Y C. Deep inspiration breath hold to reduce irradiated heart volume in breast cancer patients. Int J Radiat Oncol Biol Phys 2001; 49 (1): 199–204.Google Scholar
17. Pedersen, A N, Korreman, S, Nystrom, H, Specht, L. Breathing adapted radiotherapy of breast cancer: reduction of cardiac and pulmonary doses using voluntary inspiration breath-hold. Radiother Oncol 2004; 72: 53–60.Google Scholar
18. Remouchamps, V M, Vicini, F A, Sharpe, M B 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 (3): 704–715.Google Scholar
19. McNair, H A, Brock, J, Richard, J et al. Feasibility in using the Active Breathing Co ordinator (ABC) in patients receiving radical radiotherapy for non small cell lung cancer (NSCLC). Radiother Oncol 2009; 93: 424–429.Google Scholar
20.Department of Health. Ionising Radiation (Medical Exposure) Regulations 2000. www.legislation.gov.uk/uksi/2000/1059/pdfs/uksi_20001059_en.pdf. Accessed on 14th June 2017.Google Scholar
21.NeoSCOPE, Radiotherapy Guidance and Procedures, version 4.0., 8 September 2014. EudraCT no.: 2012-000640-10.Google Scholar
22.IMPORT High Intensity Modulated Partial Organ Radiotherapy Protocol, Version 6, 17/08/2012. ICR-CTSU/2007/10013.Google Scholar
23. Korreman, S S, Pederson, A N, Nottrup, T J, Specht, L, Nystrom, H. Breathing adapted radiotherapy for breast cancer: comparison of free breathing gating with the breath-hold technique. Radiother Oncol 2005; 76: 311–318.Google Scholar
24. Rosenzweig, K E, Hanley, J, Mah, D et al. The deep inspiration breath-hold technique in the treatment of inoperable non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2000; 48 (1): 81–87.Google Scholar
25. Mitine, C, Dutreix, A, van der Schueren, E. Tangential breast irradiation: influence of technique of set up on transfer errors and reproducibility. Radiother Oncol 1991; 22 (4): 308–310.Google Scholar
26. Lirette, A, Pouliot, J, Aubin, M, Larochelle, M. The role of electronic portal imaging in tangential breast irradiation: a prospective study. Radiother Oncol 1995; 37 (3): 241–245.Google Scholar
27. Thilmann, C, Adamietz, I A, Saran, F et al. The use of a standardized positioning support cushion during daily routine of breast irradiation. Int J Radiat Oncol Biol Phys 1998; 41 (2): 459–463.Google Scholar