Marciana-Nona Duma1, René Baumann2, Wilfried Budach3, Jürgen Dunst4, Petra Feyer5, Rainer Fietkau6, Wulf Haase7, Wolfgang Harms8, Thomas Hehr9, David Krug4, Marc D Piroth10, Felix Sedlmayer11, Rainer Souchon12, Rolf Sauer6. 1. Department of Radiotherapy and Radiation Oncology, University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07745, Jena, Germany. Marciana-Nona.Duma@med.uni-jena.de. 2. St. Marien-Krankenhaus Siegen, Siegen, Germany. 3. Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany. 4. University Hospital Schleswig-Holstein, Kiel, Germany. 5. Vivantes Hospital Neukoelln, Berlin, Germany. 6. University Hospital Erlangen, Erlangen, Germany. 7. St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany. 8. St. Claraspital Basel, Basel, Switzerland. 9. Marienhospital Stuttgart, Stuttgart, Germany. 10. Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany. 11. Paracelsus Medical University Hospital Salzburg, Salzburg, Austria. 12. University Hospital, Tübingen, Germany.
Abstract
PURPOSE: The aim of this review was to analyze the respective efficacy of various heart-sparing radiotherapy techniques. MATERIAL AND METHODS: Heart-sparing can be performed in three different ways in breast cancer radiotherapy: by seeking to keep the heart out of treated volumes (i.e. by prone position or specific breathing techniques such as deep inspiration breath-hold [DIBH] and/or gating), by solely irradiating a small volume around the lumpectomy cavity (partial breast irradiation, PBI), or by using modern radiation techniques like intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) or protons. This overview presents the available data on these three approaches. RESULTS: Studies on prone position are heterogeneous and most trials only refer to patients with large breasts; therefore, no definitive conclusion can be drawn for clinical routine. Nonetheless, there seems to be a trend toward better sparing of the left anterior descending artery in supine position even for these selected patients. The data on the use of DIBH for heart-sparing in breast cancer patients is consistent and the benefit compared to free-breathing is supported by several studies. In comparison with whole breast irradiation (WBI), PBI has an advantage in reducing the heart dose. Of note, DIBH and PBI with multicatheter brachytherapy are similar with regard to the dose reduction to heart structures. WBI by IMRT/VMAT techniques without DIBH is not an effective strategy for heart-sparing in breast cancer patients with "standard" anatomy. A combination of DIBH and IMRT may be used for internal mammary radiotherapy. CONCLUSION: Based on the available findings, the DEGRO breast cancer expert panel recommends the use of DIBH as the best heart-sparing technique. Nonetheless, depending on the treatment volume and localization, other techniques may be employed or combined with DIBH when appropriate.
PURPOSE: The aim of this review was to analyze the respective efficacy of various heart-sparing radiotherapy techniques. MATERIAL AND METHODS: Heart-sparing can be performed in three different ways in breast cancer radiotherapy: by seeking to keep the heart out of treated volumes (i.e. by prone position or specific breathing techniques such as deep inspiration breath-hold [DIBH] and/or gating), by solely irradiating a small volume around the lumpectomy cavity (partial breast irradiation, PBI), or by using modern radiation techniques like intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) or protons. This overview presents the available data on these three approaches. RESULTS: Studies on prone position are heterogeneous and most trials only refer to patients with large breasts; therefore, no definitive conclusion can be drawn for clinical routine. Nonetheless, there seems to be a trend toward better sparing of the left anterior descending artery in supine position even for these selected patients. The data on the use of DIBH for heart-sparing in breast cancerpatients is consistent and the benefit compared to free-breathing is supported by several studies. In comparison with whole breast irradiation (WBI), PBI has an advantage in reducing the heart dose. Of note, DIBH and PBI with multicatheter brachytherapy are similar with regard to the dose reduction to heart structures. WBI by IMRT/VMAT techniques without DIBH is not an effective strategy for heart-sparing in breast cancerpatients with "standard" anatomy. A combination of DIBH and IMRT may be used for internal mammary radiotherapy. CONCLUSION: Based on the available findings, the DEGRO breast cancer expert panel recommends the use of DIBH as the best heart-sparing technique. Nonetheless, depending on the treatment volume and localization, other techniques may be employed or combined with DIBH when appropriate.
Entities:
Keywords:
Breast cancer; DEGRO; Heart toxicities; Radiotherapy; Technique
Authors: Hae Jin Park; Kwang-Ho Cheong; Taeryool Koo; Me Yeon Lee; Kyoung Ju Kim; Soah Park; Taejin Han; Sei-Kwon Kang; Boram Ha; Jai-Woong Yoon; Me Young Kim; Hoonsik Bae Journal: In Vivo Date: 2022 Jul-Aug Impact factor: 2.406
Authors: A Gnerucci; M Esposito; A Ghirelli; S Pini; L Paoletti; R Barca; S Fondelli; P Alpi; B Grilli; F Rossi; S Scoccianti; S Russo Journal: Strahlenther Onkol Date: 2022-10-13 Impact factor: 4.033