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. 2023 Jan 26:25:100201.
doi: 10.1016/j.tipsro.2023.100201. eCollection 2023 Mar.

A dose planning study for cardiac and lung dose sparing techniques in left breast cancer radiotherapy: Can free breathing helical tomotherapy be considered as an alternative for deep inspiration breath hold?

Sara Abdollahi  1   2 , Mohammad Hadi Hadizadeh Yazdi  1 , Ali Asghar Mowlavi  1 , Sofie Ceberg  3 , Marianne Camille Aznar  4 , Fatemeh Varshoee Tabrizi  5 , Roham Salek  5   6 , Alireza Ghodsi  7 , Ali Shams  8
Affiliations

A dose planning study for cardiac and lung dose sparing techniques in left breast cancer radiotherapy: Can free breathing helical tomotherapy be considered as an alternative for deep inspiration breath hold?

Sara Abdollahi et al. Tech Innov Patient Support Radiat Oncol. .

Abstract

Purpose: To investigate the possibility to be able to offer left sided breast cancer patients, not suitable for DIBH, an organ at risk saving treatment.

Materials and methods: Twenty patients receiving radiotherapy for left breast cancer in DIBH were enrolled in the study. Planning CT scans were acquired in the same supine treatment position in FB and DIBH. 3DCRT_DIBH plans were designed and optimized using two parallel opposed tangent beams (with some additional segments) for the breast and chest wall and anterior-posterior fields for regional lymph nodes irradiation. Additionally, FB helical tomotherapy plans were optimized to minimize heart and lung dose. All forty plans were optimized with at least 95% of the total CTV covered by the 95% of prescribed dose of 50 Gy in 25 fractions.

Results: HT_FB plans showed significantly better dose homogeneity and conformity compared to the 3DCRT_DIBH specially for regional nodal irradiation. The heart mean dose was almost comparable in 3DCRT_DIBH and HT_FB while the volume (%) of the heart receiving 25 Gy had a statistically significant reduction from 7.90 ± 3.33 in 3DCRT_DIBH to 0.88 ± 0.66 in HT_FB. HT_FB was also more effective in left descending artery (LAD) mean dose reduction about 100% from 30.83 ± 9.2 Gy to 9.7 ± 3.1. The ipsilateral lung volume receiving 20 Gy has a further reduction of 43 % in HT_FB compared with 3DCRT_DIBH. For low dose comparison, 3DCRT_DIBH was superior for contralateral organ sparing compared to the HT_FB due to the limited angle for dose delivery.

Conclusion: For patients who cannot be a candidate for DIBH for any reason, HT in free breathing may be a good alternative and provides heart and ipsilateral lung dose sparing, however with the cost of increased dose to contralateral breast and lung.

Keywords: Deep inspiration breath-hold; Helical Tomotherapy; Left breast radiotherapy; Toxicity management.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Typical color-wash dose distributions of different treatment plans in axial, coronal, and sagittal planes. HT in FB reduced the ipsilateral lung mean dose, ipsilateral lung V20, heart V25, and LAD mean dose compared with 3DCRT in DIBH. FB: free-breathing; DIBH: deep-inspiration breath-hold; HT: helical tomotherapy; 3DCRT: Three-dimensional conventional radiotherapy.
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