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- Title
Prospective, Observational study comparing the cardiac dose received during adjuvant radiotherapy in breast cancer using free breathing and deep inspiratory breath hold technique.
- Authors
Reddy, Vijay Anand P.; Bhattacharya, Kausik; Upadhyay, Prashanth; Sesikeran, Nanditha; Paul, Sayan
- Abstract
Introduction: Improved long-term survival for all stages of breast cancer has prompted an increased focus on long term toxicities associated with treatment. While population studies and pooled data from older radiotherapy series have demonstrated a potential increase in cardiac morbidity and mortality, there are significant limitations to these data. Different cardiac sparing techniques have been described such as MV, proton, tomotherapy, different techniques like 3D-CRT, IMRT, PBI, IORT, treatment in prone or decubitus position, using shielding blocks or the use of MLCs. Various devices such as respiratory gating and breath hold have also been described in literature which helps to reduce the cardiac dose received and thereby reducing the associated morbidity. Although limited long term clinical cardiac outcome data exist utilizing current cardiac sparing techniques, dosimetric data available are favorable. These data consistently demonstrate significant reductions in cardiac doses at both low and high dose measures Aims and Objectives: To determine and compare the radiation dose received by the heart in free breathing and in deep inspiratory breath hold in breast cancer patients receiving adjuvant radiotherapy. Method and materials: Prospective observational study where 25 left sided breast cancer patients requiring adjuvant radiotherapy, irrespective of the type of surgery underwent simulation in free breathing and in deep inspiratory breath hold techniques. Contouring of the breast/chest wall, nodes and heart were done with RTOG contouring guidelines. VMAT plans were generated for both the scans and the Dmean, V25 and V30 of the heart were dosimetrically analyzed. Results: Statistically significant benefit was observed with deep inspiratory breath hold technique when Dmean, V25 and V30 of the heart was compared to free breathing, with p value: <0.0001 in all three groups. Conclusion: At the present time, women with left sided breast cancers should be offered some form of cardiac dose sparing technique when feasible. DIBH provided greater percent reductions in mean heart dose in this study. DIBH is advisable for all patients receiving RT for left-sided breast cancer patients receiving breast/chest wall RT with or without nodal RT.
- Subjects
BREAST cancer; RADIOTHERAPY; CANCER radiotherapy; SCIENTIFIC observation; RESPIRATION; CANCER patients
- Publication
Journal of Cancer Research & Therapeutics, 2017, Vol 13, pS451
- ISSN
0973-1482
- Publication type
Article