Does deep inspiration breath hold reduce plan complexity? Multicentric experience of left breast cancer radiotherapy with volumetric modulated arc therapy

Serenella Russo, Marco Esposito, Victor Hernandez, Jordi Saez, Francesca Rossi, Lisa Paoletti, Silvia Pini, Paolo Bastiani, Giacomo Reggiori, Giorgia Nicolini, Eugenio Vanetti, Stefano Tomatis, Marta Scorsetti, Pietro Mancosu

Research output: Contribution to journalArticle

Abstract

PURPOSE: Volumetric modulated arc therapy (VMAT) for left breast treatments allows heart sparing without compromising PTV coverage. However, this technique may require highly complex plans. Deep Inspiration Breath Hold (DIBH) procedure increases the heart-to-breast distance, facilitating the dose sparing of the heart. The aim of the present work was to investigate if the cardiac-sparing benefits of the DIBH technique were achieved with lower plan modulation and complexity than Free Breathing (FB) treatments.

METHODS AND MATERIALS: Ten left side breast cases were considered by two centers with different treatment planning systems (TPS) and Linacs. VMAT plans were elaborated in FB and DIBH according to the same protocol. Plan complexity was evaluated by scoring several complexity indices. A new global score index accounting for both plan quality and dosimetric parameters was defined. Pre-treatment QA was performed for all VMAT plans using EPID and Epiqa software.

RESULTS: DIBH-VMAT plans were associated with significant PTV coverage improvement and mean heart dose reduction (p < 0.003), increasing the resulting global score index. All the evaluated complexity indices showed lower plan complexity for DIBH plans than FB ones, but only in few cases the results were statistically significant. All plans passed the gamma analysis with the selected criteria.

CONCLUSIONS: The DIBH technique is superior to the FB technique when the heart needs further sparing, allowing a reduction of the doses to OARs with a slightly lower degree of plan complexity and without compromising plan deliverability. These benefits were achieved regardless of the technological scenarios adopted.

Original languageEnglish
Pages (from-to)79-85
Number of pages7
JournalPhysica Medica
Volume59
DOIs
Publication statusPublished - Mar 2019

Keywords

  • Breath Holding
  • Feasibility Studies
  • Humans
  • Inhalation
  • Radiometry
  • Radiotherapy Planning, Computer-Assisted/methods
  • Radiotherapy, Intensity-Modulated
  • Unilateral Breast Neoplasms/physiopathology

Fingerprint Dive into the research topics of 'Does deep inspiration breath hold reduce plan complexity? Multicentric experience of left breast cancer radiotherapy with volumetric modulated arc therapy'. Together they form a unique fingerprint.

  • Cite this