Comparison Between Breath-Hold and the Inspiratory Phase of Free Breathing in Left Breast Cancer Radiotherapy: Target Volume Coverage and Organ Sparing.

Q2 Medicine

Asian Pacific Journal of Cancer Prevention Pub Date : 2025-03-01 DOI:10.31557/APJCP.2025.26.3.969

Sarah Hazem Hussein, Loay Kassem, Mohamed Ibrahem Adrosy, Hussein Metwally

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引用次数: 0

Abstract

Background: Cardiac mortality and coronary events associated with left breast radiotherapy are correlated with the mean radiation dose to the heart.

Methods: This prospective phase II study included left breast cancer patients receiving adjuvant locoregional radiotherapy with intensity-modulated radiation therapy (IMRT) following surgery. Patients were treated using the respiratory gating (RPM) technique (Varian Medical Systems, USA). Dosimetric outcomes were compared between deep inspiration breath-hold (DIBH) and the inspiratory phase of free breathing (FB) in the same patients, focusing on target volume coverage and sparing of critical organs (lungs, heart, and coronary arteries). The prescribed dose was 50 Gy in 25 fractions over five weeks to the chest wall or breast and/or lymph nodes, with an additional boost of 10 Gy in five fractions over one week to the tumor bed in breast-conserving surgery (BCS) cases. Two treatment plans were generated per patient: one for DIBH and another for the inspiratory phase of FB.

Results: Between February 2020 and August 2022, 60 patients with a mean age of 50 years were enrolled in the study. The dosimetric analysis showed that the mean heart dose was lower in the DIBH group (4.8 Gy) compared to the FB group (6.4 Gy) with a statistically significant difference (p < 0.0001). Similarly, the mean dose to the left anterior descending artery (LAD) was significantly reduced in DIBH (14 Gy) compared to FB (20.5 Gy) (p < 0.0001). Regarding target volume coverage, the mean planning target volume (PTV) V95% was slightly higher in DIBH (97.3%) than in FB (96.5%) (p = 0.0062). The mean left lung V20 was comparable between the two techniques, with values of 14.4% in DIBH and 14.35% in FB (p = 0.85), indicating no significant difference in lung dose sparing. However, the mean left ventricular dose was significantly lower in DIBH (6 Gy) compared to FB (8.1 Gy) (p < 0.0001), further supporting the advantage of DIBH in reducing cardiac radiation exposure.

Conclusion: DIBH plans demonstrated superior target coverage and significantly improved cardiac and coronary sparing compared to FB inspiratory phase plans. However, FB plans remained within acceptable dose constraints. No significant differences were observed in lung dose sparing or beam-on time.

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来源期刊

Asian Pacific Journal of Cancer Prevention 医学-肿瘤学

CiteScore

2.80

自引率

0.00%

发文量

779

审稿时长

3 months

期刊介绍： Cancer is a very complex disease. While many aspects of carcinoge-nesis and oncogenesis are known, cancer control and prevention at the community level is however still in its infancy. Much more work needs to be done and many more steps need to be taken before effective strategies are developed. The multidisciplinary approaches and efforts to understand and control cancer in an effective and efficient manner, require highly trained scientists in all branches of the cancer sciences, from cellular and molecular aspects to patient care and palliation. The Asia Pacific Organization for Cancer Prevention (APOCP) and its official publication, the Asia Pacific Journal of Cancer Prevention (APJCP), have served the community of cancer scientists very well and intends to continue to serve in this capacity to the best of its abilities. One of the objectives of the APOCP is to provide all relevant and current scientific information on the whole spectrum of cancer sciences. They aim to do this by providing a forum for communication and propagation of original and innovative research findings that have relevance to understanding the etiology, progression, treatment, and survival of patients, through their journal. The APJCP with its distinguished, diverse, and Asia-wide team of editors, reviewers, and readers, ensure the highest standards of research communication within the cancer sciences community across Asia as well as globally. The APJCP publishes original research results under the following categories: -Epidemiology, detection and screening. -Cellular research and bio-markers. -Identification of bio-targets and agents with novel mechanisms of action. -Optimal clinical use of existing anti-cancer agents, including combination therapies. -Radiation and surgery. -Palliative care. -Patient adherence, quality of life, satisfaction. -Health economic evaluations.