Dosimetric evaluation of the benefit of deep inspiration breath hold (DIBH) for locoregional irradiation of right breast cancer with volumetric modulated arctherapy (VMAT).

Autor: Loap P; Department of Radiation Oncology, Institut Curie, Paris, France., Vu-Bezin J; Department of Radiation Oncology, Institut Curie, Paris, France., Monceau V; Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France., Jacob S; Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France., Fourquet A; Department of Radiation Oncology, Institut Curie, Paris, France., Kirova Y; Department of Radiation Oncology, Institut Curie, Paris, France.
Jazyk: angličtina
Zdroj: Acta oncologica (Stockholm, Sweden) [Acta Oncol] 2023 Feb; Vol. 62 (2), pp. 150-158. Date of Electronic Publication: 2023 Feb 14.
DOI: 10.1080/0284186X.2023.2177976
Abstrakt: Introduction: Right-lateralized cardiac substructures can be substantially exposed during right breast cancer (R-BC) radiotherapy. The cardiac benefit of deep inspiration breath hold (DIBH) is established in combination with volumetric modulated arctherapy (VMAT) for left breast cancer with regional node irradiation but is unknown for R-BC. This study evaluated the dosimetric benefit of DIBH for locoregional irradiation of R-BC with VMAT.
Material and Methods: All patients treated for R-BC with adjuvant locoregional DIBH-VMAT in the Department of Radiation Oncology of the Institut Curie (Paris, France) until December 2022 were included, corresponding to 15 patients. FB- and DIBH-VMAT plans were compared both for a normofractionated regimen (50 Gy/25fx) used for treatment and a replanned hypofractionated regimen (40 Gy/15fx). Dose to the heart, cardiac substructures (sinoatrial node (SAN), atrio-ventricular node (AVN), right coronary artery, left anterior descending coronary artery, left ventricle), ipsilateral lung and liver were retrieved and compared.
Results: Mean heart dose (MHD) was 3.33 Gy with FB vs. 3.10 Gy with DIBH on normofractionated plans ( p  = 0.489), and 2.58 Gy with FB vs. 2.41 Gy with DIBH on hypofractionated plan ( p  = 0.489). The benefit of DIBH was not significant for any cardiac substructure. The most exposed cardiac substructure were the SAN (mean dose of 6.62 Gy for FB- and 5.64 Gy for DIBH-VMAT on normofractionated plans) and the RCA (mean dose of 4.21 Gy for FB- and 4.06 Gy for DIBH-VMAT on normofractionated plans). The maximum benefit was observed for the RCA with a median individual dose reduction of 0.84 Gy on normofractionated plans ( p  = 0.599). No significant dosimetric difference were observed for right lung. Liver mean dose was significantly lower with DIBH with median values decreasing from 2.54 Gy to 0.87 Gy ( p  = 0.01).
Conclusion: Adding DIBH to efficient cardiac-sparing radiotherapy techniques, such as VMAT, is not justified in the general case for locoregional R-BC irradiation. Specific R-BC patient subpopulations who could benefit from additional DIBH combination with locoregional VMAT are yet to be identified.
Databáze: MEDLINE
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