ESTRO 2023

Session Item

Breast

Session Type: Poster (Digital)

Track: Clinical

Journey:

Is there an optimal DIBH maneuver in breast cancer radiation therapy? – A pilot study

, Sweden

Presentation Number: PO-1244

Abstract

Abstract Title:

Is there an optimal DIBH maneuver in breast cancer radiation therapy? – A pilot study

Authors:

Anna Karlsson^1,2, Nga Pham², Monika Fagevik Olsén^3,4, Dan Lundstedt^5,6, Frida Smith^7,8, Maria Giovinazzo Brovall^9,5, Maja Sohlin^1,2

¹Sahlgrenska University Hospital, Department of Medical Physics and Biomedical Engineering, Gothenburg, Sweden; ²University of Gothenburg, Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden; ³University of Gothenburg, Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; ⁴Sahlgrenska University Hospital, Department of Physical Therapy, Gothenburg, Sweden; ⁵University of Gothenburg, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden; ⁶Sahlgrenska University Hospital, Department of Oncology, Gothenburg, Sweden; ⁷Regional Cancer Centre West, Research and development, Gothenburg, Sweden; ⁸Chalmers University of Technology, Department of Technology Management and Economics, Centre for Healthcare Improvement, Gothenburg, Sweden; ⁹Jönköping University, Department of Nursing, School of Health and Welfare, Jönköping, Sweden

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Purpose or Objective

Since introduced more than two decades ago, Deep Inspiration Breath Hold (DIBH) has been widely used to spare the heart and ipsilateral lung in breast cancer radiation therapy. Three different DIBH maneuvers for breast cancer radiation therapy can be found in the scientific literature; spontaneous, abdominal, and thoracic DIBH (1-3). The results from different studies investigating DIBH are, however, not consistent. For instance, it has been concluded that abdominal DIBH combined with IMRT is the best option for sparing the heart (2), but it has also been concluded that a more pronounced thoracic DIBH is more beneficial with regard to sparing the heart (3). So, even though DIBH is a widely used treatment technique today, documented coaching strategies for optimal DIBH are still lacking (4).

The aim of this study is to investigate the dosimetric effects for the heart and ipsilateral lung for different DIBH maneuvers in left-sided whole breast tangential 3D conformal radiation therapy (3DCRT) using MRI.

Material and Methods

This study has ethical approval from the Swedish Ethical Review Board (reg no. 2020-00029). Four healthy female research participants were enrolled.

In addition to the spontaneous, abdominal and thoracic DIBH maneuvers found in the literature, a combination of abdominal and thoracic DIBH were included in this study. Breath hold in a comfortable exhale was included as a proxy for free breathing. A 3D T1-weighted DIXON-VIBE MR-sequence was used to image the research participants performing the five different breath hold maneuvers (Siemens Aera, 1,5 T). The scan time was 17-19 s, depending on the field of view (FoV). The whole breast, heart and ipsilateral lung were delineated according to national guidelines (SWEBCG). The MRI data was segmented in bulk densities for CT-number assignments and treatment planning was performed using the 3DCRT technique (Eclipse, Varian Medical Systems).

Results

The mean absorbed dose to the heart and ipsilateral lung were evaluated for the five different breath hold maneuvers (Figure 1). The trend of the result for the volume of the lung receiving 40% of the prescribed dose (40,05 Gy) was similar to the result for the mean absorbed dose to the lung (not shown).

Conclusion

In this small-scale pilot study for left-sided breast tangential 3DCRT, all the investigated DIBH maneuvers were found to be beneficial regarding the mean absorbed dose to the heart. Even though the result for all DIBH maneuvers were well below the restriction criteria for the lung, DIBH was not always optimal regarding mean absorbed dose and the volume receiving 40% of the prescribed dose for the lung.

Further investigation will include axillary, fossa supraclavicular and internal mammary lymph nodes in the CTV and the data will be evaluated for a more extensive cohort of research participants. VMAT planning will be included as well.

References:

1. Korreman et al. Rad Onc 2005
2. Zhao et al. Rad Onc 2018
3. Oechsner et al. Rad Onc 2019
4. Latty et al. J Med Radiat Sci 2015