左侧乳腺癌保乳术后采用深吸气屏气放疗的心脏剂量学分析

doi:10.3760/cma.j.issn.1004-4221.2018.03.011

Abstract
Figure/Table
References()
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (0 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To study the effect of deep inspiration breath-hold (DIBH) technique on the heart dose in whole breast irradiation (WBI) for left breast cancer after breast-conserving surgery, and to investigate the anatomical factors for heart dose. Methods Fifteen patients with left breast cancer who received WBI after breast-conserving surgery and met breathing control requirements were prospectively enrolled as subjects. Simulated CT scans were performed during free breathing (FB) and DIBH. The WBI plans were optimized based on DIBH images. The position, volume, and radiation doses to the heart and lung were compared between the status of FB and DIBH. Correlation of heart dose with various anatomical factors was analyzed in FB status. Between-group comparison of categorical data was made by nonparametric Wilcoxon rank test. A two-variable correlation analysis was made by the Pearson method. Results There was no significant difference in heart volume between the status of FB and DIBH (P=0.773).The volume of both lungs was significantly larger in DIBH status than in FB status (P=0.001). The mean and maximum doses and V5-V40 for the heart, left anterior descending coronary artery,left ventricle, right ventricle, and left lung were significantly lower in DIBH status than in FB status (all P<0.05). The greater DIBH increased the lung volume, the greater the mean heart dose decreased. In FB status, the left breast volume, heart-to-lung volume ratio, distance between the inferior margins of breast and heart, and maximum heart margin distance showed a linear correlation with heart dose. Particularly, the heart-to-lung volume ratio and maximum heart margin distance were independently correlated with heart dose. Conclusions DIBH technique in WBI for left breast cancer after breast-conserving surgery significantly reduces heart and lung doses compared with FB. Changes in lung volume are the basis for improving the relative anatomical location of the heart. The heart-to-lung volume ratio and maximum heart margin distance may provide a reference for DIBH technique.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Chen Siye
	Wang Shulian
	Tang Yu
	Tian Yuan
	Qin Shiru
	Cui Weijie
	Jing Jing
	Liu Yueping
	Song Yongwen
	Fang Hui
	Chen Bo
	Qi Shunan
	ZhangJianghao
	Sun Guangyi
	Deng Yanbo
	Li Yexiong

Key words： Breast neoplasms/radiotherapy Deep inspiration breath-hold technique Cardiac dose

Received: 04 September 2017

Fund:National Key Research and Development Program (2016YFC0904600);Beijing Hope Run Special Fund (LC2016A09)

Corresponding Authors: Wang Shulian,Email:wangshulian@sohu.com;Li Yexiong,Email:yexiong@yahoo.com

Cite this article:

Chen Siye,Wang Shulian,Tang Yu et al. Cardiac dosimetry of deep inspiration breath-hold technique in whole breast irradiation for left breast cancer after breast-conserving surgery[J]. Chinese Journal of Radiation Oncology, 2018, 27(3): 281-288.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2018.03.011 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2018/V27/I3/281

[1] Clarke M,Collins R,Darby S,et al. 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[J].Lancet,2005,366(9503):2087-2106.DOI:10.1016/S0140-6736(05)67887-7.
[2] Boekel NB,Schaapveld M,Gietema JA,et al. Cardiovascular Disease Risk in a Large,Population-Based Cohort of Breast Cancer Survivors[J].Int J Radiat Oncol Biol Phys.2016,94(5):1061-1072.DOI:10.1016/j.ijrobp.2015.11.040.
[3] Stewart FA.Mechanisms and dose-response relationships for radiation-induced cardiovascular disease[J].Ann ICRP,2012,41(3-4):72-79.DOI:10.1016/j.icrp.2012.06.031.
[4] Darby SC,Ewertz M,McGale P,et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer[J].N Engl J Med,2013,368(11):987-998.DOI:10.1161/CIRCULATIONAHA.116.025434.
[5] Skytta T,Tuohinen S,Boman E,et al. Troponin T-release associates with cardiac radiation doses during adjuvant left-sided breast cancer radiotherapy[J].Radiat Oncol,2015,10(10):141-148.DOI:10.1186/s13014-015-0436-2.
[6] Adar A,Canyilmaz E,Kiris A,et al. Radiotherapy induces development of fragmented qrs in patients with breast cancer[J].Breast Care (Basel),2015,10(4):277-280. DOI:10.1159/000431030.
[7] Yeung R,Conroy L,Long K,et al. Cardiac dose reduction with deep inspiration breath hold for left-sided breast cancer radiotherapy patients with and without regional nodal irradiation[J].Radiat Oncol,2015,10(22):200-206.DOI:10.1186/s13014-015-0511-8.
[8] Kataria T,Bisht SS,Gupta D,et al. Quantification of coronary artery motion and internal risk volume from ECG gated radiotherapy planning scans[J].Radiother Oncol,2016,121(1):59-63.DOI:10.1016/j.radonc.2016.08.006.
[9] Vikstrom J,Hjelstuen MH,Mjaaland I,et al. Cardiac and pulmonary dose reduction for tangentially irradiated breast cancer,utilizing deep inspiration breath-hold with audio-visual guidance,without compromising target coverage[J].Acta Oncol,2011,50(1):42-50.DOI:10.3109/0284186X.2010.512923.
[10] Wang W,Purdie TG,Rahman M,et al. Rapid automated treatment planning process to select breast cancer patients for active breathing control to achieve cardiac dose reduction[J].Int J Radiat Oncol Biol Phys,2012,82(1):386-393.DOI:10.1016/j.ijrobp.2010.09.026.
[11] Lee HY,Chang JS,Lee IJ,et al. The deep inspiration breath hold technique using abches reduces cardiac dose in patients undergoing left-sided breast irradiation[J].Radiat Oncol J,2013,31(4):239-246.DOI:10.3857/roj.2013.31.4.239.
[12] Schonecker S,Heinz C,Sohn M,et al. Reduction of cardiac and coronary artery doses in irradiation of left-sided breast cancer during inspiration breath hold:a planning study[J].Strahlenther Onkol,2016,192(11):750-758.DOI:10.1007/s00066-016-1039-z.
[13] Mast ME,van Kempen-Harteveld L,Heijenbrok MW,et al. Left-sided breast cancer radiotherapy with and without breath-hold:does IMRT reduce the cardiac dose even further[J] Radiother Oncol,2013,108(2):248-253.DOI:10.1016/j.radonc.2013.07.017.
[14] Swanson T,Grills IS,Ye H,et al. Six-year experience routinely using moderate deep inspiration breath-hold for the reduction of cardiac dose in left-sided breast irradiation for patients with early-stage or locally advanced breast cancer[J].Am J Clin Oncol,2013,36(1):24-30.DOI:10.1097/COC.0b013e31823fe481.
[15] Hayden AJ,Rains M,Tiver K.Deep inspiration breath hold technique reduces heart dose from radiotherapy for left-sided breast cancer[J].J Med Imag Radiat Oncol,2012,56(4):464-472.DOI:10.1111/j.1754-9485.2012.02405.x.
[16] Hjelstuen MH,Mjaaland I,Vikstrom J,et al. Radiation during deep inspiration allows loco-regional treatment of left breast and axillary-,supraclavicular-and internal mammary lymph nodes without compromising target coverage or dose restrictions to organs at risk[J].Acta Oncol,2012,51(3):333-344.DOI:10.3109/0284186X.2011.618510.
[17] Borst GR,Sonke JJ,den Hollander S,et al. Clinical results of image-guided deep inspiration breath hold breast irradiation[J].Int J Radiat Oncol Biol Phys,2010,78(5):1345-1351.DOI:10.1016/j.ijrobp.2009.10.006.
[18] Stranzl H,Zurl B,Langsenlehner T,et al. Wide tangential fields including the internal mammary lymph nodes in patients with left-sided breast cancer. Influence of respiratory-controlled radiotherapy (4D-CT) on cardiac exposure[J].Strahlenther Onkol,2009,185(3):155-160.DOI:10.1007/s00066-009-1939-2.
[19] Stranzl H,Zurl B.Postoperative irradiation of left-sided breast cancer patients and cardiac toxicity. Does deep inspiration breath-hold (DIBH) technique protect the heart[J]? Strahlenther Onkol,2008,184(7):354-358.DOI:10.1007/s00066-008-1852-0.
[20] Lin A,Sharieff W,Juhasz J,et al. The benefit of deep inspiration breath hold:evaluating cardiac radiation exposure in patients after mastectomy and after breast-conserving surgery[J].Breast Cancer,2017,24(1):86-91.DOI:10.1007/s12282-016-0676-5.
[21] Rochet N,Drake JI,Harrington K,et al. Deep inspiration breath-hold technique in left-sided breast cancer radiation therapy:Evaluating cardiac contact distance as a predictor of cardiac exposure for patient selection[J].Pract Radiat Oncol,2015,5(3):e127-134.DOI:10.1016/j.prro.2014.08.003.
[22] Kathpal M,Tinnel B,Sun K,et al. Deep inspiration breath hold with electromagnetic confirmation of chest wall position for adjuvant therapy of left-sided breast cancer:Technique and accuracy[J].Pract Radiat Oncol,2016,6(5):e195-202.DOI:10.1016/j.prro.2015.12.008.
[23] Joo JH,Kim SS,Ahn SD,et al. Cardiac dose reduction during tangential breast irradiation using deep inspiration breath hold:a dose comparison study based on deformable image registration[J].Radiat Oncol,2015,10(22):264-270.DOI:10.1186/s13014-015-0511-8.
[24] Sung K,Choi YE,Lee KC.Cardiac risk index as a simple geometric indicator to select patients for the heart-sparing radiotherapy of left-sided breast cancer[J].J Med Imag Radiat Oncol,2017,61(3):410-417. DOI:10.1111/1754-9485.12567.
[25] Vees H,Bigler R,Bieri S,et al. Assessment of cardiac exposure in left-tangential breast irradiation[J].Cancer Radiother,2011,15(8):670-674.DOI:10.1016/j.canrad.2011.03.009.
[26] Tanna N,McLauchlan R,Karis S,et al. Assessment of Upfront Selection Criteria to Prioritise Patients for Breath-hold Left-sided breast radiotherapy[J].Clin Oncol (R Coll Radiol),2017,29(6):356-361.DOI:10.1016/j.clon.2017.01.004.
[27] Taylor CW,McGale P,Povall JM,et al. Estimating cardiac exposure from breast cancer radiotherapy in clinical practice[J].Int J Radiat Oncol Biol Phys.2009,73(4):1061-1068.DOI:10.1016/j.ijrobp.2008.05.066.
[28] Abdel-Qadir H,Austin PC,Lee DS,et al. A population-based study of cardiovascular mortality following early-stage breast cancer[J].JAMA Cardiol,2017,2(1):88-93.DOI:10.1001/jamacardio.2016.3841.