Dosimetric evaluation of the benefit of deep inspiration breath hold (DIBH) for locoregional irradiation of right breast cancer with volumetric modulated arctherapy (VMAT) - Archive ouverte HAL
Article Dans Une Revue Acta Oncologica Année : 2023

Dosimetric evaluation of the benefit of deep inspiration breath hold (DIBH) for locoregional irradiation of right breast cancer with volumetric modulated arctherapy (VMAT)

Résumé

Introduction: Right-lateralized cardiac substructures can be substantially exposed during right breastcancer (R-BC) radiotherapy. The cardiac benefit of deep inspiration breath hold (DIBH) is established incombination with volumetric modulated arctherapy (VMAT) for left breast cancer with regional nodeirradiation but is unknown for R-BC. This study evaluated the dosimetric benefit of DIBH for locore-gional irradiation of R-BC with VMAT. Material and Methods: All patients treated for R-BC with adjuvant locoregional DIBH-VMAT in theDepartment of Radiation Oncology of the Institut Curie (Paris, France) until December 2022 wereincluded, corresponding to 15 patients. FB- and DIBH-VMAT plans were compared both for a normo-fractionated regimen (50Gy/25fx) used for treatment and a replanned hypofractionated regimen(40Gy/15fx). Dose to the heart, cardiac substructures (sinoatrial node (SAN), atrio-ventricular node(AVN), right coronary artery, left anterior descending coronary artery, left ventricle), ipsilateral lung andliver were retrieved and compared. Results: Mean heart dose (MHD) was 3.33 Gy with FB vs. 3.10 Gy with DIBH on normofractionated plans (p¼0.489), and 2.58 Gy with FB vs. 2.41 Gy with DIBH on hypofractionated plan (p¼0.489). Thebenefit of DIBH was not significant for any cardiac substructure. The most exposed cardiac substruc-ture were the SAN (mean dose of 6.62 Gy for FB- and 5.64 Gy for DIBH-VMAT on normofractionatedplans) and the RCA (mean dose of 4.21 Gy for FB- and 4.06 Gy for DIBH-VMAT on normofractionatedplans). The maximum benefit was observed for the RCA with a median individual dose reduction of0.84 Gy on normofractionated plans (p¼0.599). No significant dosimetric difference were observed forright lung. Liver mean dose was significantly lower with DIBH with median values decreasing from2.54 Gy to 0.87 Gy (p¼0.01). Conclusion: Adding DIBH to efficient cardiac-sparing radiotherapy techniques, such as VMAT, is notjustified in the general case for locoregional R-BC irradiation. Specific R-BC patient subpopulationswho could benefit from additional DIBH combination with locoregional VMAT are yet to be identified.
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hal-04197461 , version 1 (08-01-2024)

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Pierre Loap, Jeremi Vu-Bezin, Virginie Monceau, Sophie Jacob, Alain Fourquet, et al.. Dosimetric evaluation of the benefit of deep inspiration breath hold (DIBH) for locoregional irradiation of right breast cancer with volumetric modulated arctherapy (VMAT). Acta Oncologica, 2023, 62 (2), pp.150-158. ⟨10.1080/0284186X.2023.2177976⟩. ⟨hal-04197461⟩
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