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Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy
Published on: July 3, 2014
Reduction in Doses to Organs at Risk and Normal Tissue During Breast Radiation Therapy With a Carbon-Fiber Adjustable
Cheryl Duzenli1, Theodora Koulis2, Tara Menna3
1Department of Medical Physics, BC Cancer, Vancouver, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada; University of British Columbia, Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, Vancouver, Canada.
A novel carbon-fiber breast positioning device (CARA) effectively reduced radiation dose to the lungs and surrounding tissues in patients undergoing whole breast radiation therapy. CARA also eliminated inframammary folds without impacting target coverage.
Area of Science:
- Radiation Oncology
- Medical Devices
- Breast Cancer Treatment
Background:
- Whole breast radiation therapy (WBRT) can lead to radiation exposure of organs at risk, particularly the ipsilateral lung.
- The inframammary fold (IMF) presents a challenge in supine positioning, potentially increasing dose to the breast and surrounding tissues.
- Novel positioning devices are needed to improve dose distribution and patient comfort during WBRT.
Purpose of the Study:
- To investigate a novel carbon-fiber cradle breast positioning device (CARA) for WBRT in the supine position.
- To assess CARA's ability to support the breast, remove the IMF, and reduce dose to organs at risk.
- To evaluate CARA's impact on target coverage and patient outcomes.
Main Methods:
- A pilot study involving 30 patients with IMFs ≥1 cm or lateral ptosis.
- Comparison of standard positioning versus positioning with the CARA device.
- Dosimetric analysis of ipsilateral lung (V20Gy), breast (V105%), and body (V50%) dose, and heart dose (V25Gy) for left-sided breast cancer patients.
- Assessment of CARA compatibility with deep inspiration breath hold (DIBH).
Main Results:
- CARA effectively removed all IMFs and reduced median V20Gy to the ipsilateral lung (10.9% vs 12.3%, P=.005).
- Significant reductions were observed in median V105% breast (4.0% vs 8.0%, P=.006) and median V50% body (2780 mL vs 3056 mL, P=.001) with CARA.
- CARA was compatible with DIBH, achieving a median V25Gy heart of 0.1% for left breast cancer patients.
- Skin reactions and daily setup variations were consistent with standard care.
Conclusions:
- The CARA device effectively reduces normal tissue dose (lung, breast, body) and eliminates IMFs in patients with large or pendulous breasts and high BMI undergoing supine WBRT.
- CARA does not compromise target coverage and is compatible with DIBH.
- Further investigation in a randomized controlled trial is warranted.
