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Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy
Published on: July 3, 2014
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Normal tissue dose and risk estimates from whole and partial breast radiation techniques
Sunil W Dutta1, Eric Aliotta1, Clayton E Alonso1
1Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA.
The Breast Journal
|December 27, 2019
Summary
Precision breast intraoperative radiation therapy (PB-IORT) significantly lowers ipsilateral lung radiation dose compared to external beam techniques for early-stage breast cancer. While PB-IORT shows higher heart dose, all methods keep organ at risk doses low.
Area of Science:
- Radiation Oncology
- Medical Physics
- Breast Cancer Treatment
Background:
- Early-stage breast cancer management often involves radiation therapy to minimize recurrence risk.
- Various techniques exist, including external beam radiation and intraoperative radiation therapy, each with distinct dose distributions to organs at risk.
- Optimizing radiation delivery while sparing healthy tissues is crucial for reducing treatment-related toxicities.
Purpose of the Study:
- To compare radiation doses to organs at risk (OARs) in patients with early-stage breast cancer.
- To evaluate doses delivered by precision breast intraoperative radiation therapy (PB-IORT) using CT-guided HDR brachytherapy.
- To compare these doses with those from external beam whole breast irradiation (WB-DIBH) or partial breast irradiation (PB-DIBH) using deep inspiratory breath hold (DIBH).
Main Methods:
- Retrospective analysis of 52 patients with left-sided breast cancers.
- Treatment groups included PB-IORT (n=17), adjuvant PB-DIBH (n=18), and WB-DIBH (n=17).
- CT-based planning was used for all patients, comparing OAR doses and excess risk ratios (ERR) for secondary cancers and cardiac toxicity.
Main Results:
- PB-IORT demonstrated significantly lower ipsilateral lung V5, V10, V20, mean, and max doses compared to WB-DIBH and PB-DIBH.
- The excess risk ratio (ERR) for secondary lung cancer was lowest with PB-IORT (P < .001).
- WB-DIBH showed the lowest mean contralateral breast dose (BED3Gy), while PB-IORT resulted in a higher mean heart dose (BED2Gy).
Conclusions:
- PB-IORT and tissue-sparing external beam techniques deliver low OAR doses for early-stage breast cancer.
- PB-IORT significantly reduces ipsilateral lung dose compared to external beam methods.
- While WB-DIBH offers the lowest mean contralateral breast dose and external beam DIBH the lowest heart dose, all techniques remain within recommended constraints.
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