Reduction of cardiac and pulmonary complication probabilities after breathing adapted radiotherapy for breast cancer

Stine S Korreman; Anders N Pedersen; Lasse Rye Aarup; Trine Juhler-Nøttrup; Lena Specht; Håkan Nyström; Lasse Rye Aarup

doi:10.1016/j.ijrobp.2006.03.046

Reduction of cardiac and pulmonary complication probabilities after breathing adapted radiotherapy for breast cancer

Stine S Korreman, Anders N Pedersen, Lasse Rye Aarup, Trine Juhler-Nøttrup, Lena Specht, Håkan Nyström, Lasse Rye Aarup

115 Citations (Scopus)

Abstract

PURPOSE: Substantial reductions of cardio-pulmonary radiation doses can be achieved using voluntary deep inspiration breath-hold (DIBH) or free breathing inspiration gating (IG) in radiotherapy after conserving surgery for breast cancer. The purpose of this study is to evaluate the radiobiological implications of such dosimetric benefits. METHODS AND MATERIALS: Patients from previously reported studies were pooled for a total of 33 patients. All patients underwent DIBH and free breathing (FB) scans, and 17 patients underwent an additional IG scan. Tangential conformal treatment plans covering the remaining breast, internal mammary, and periclavicular nodes were optimized for each scan, prescription dose 48 Gy. Normal tissue complication probabilities were calculated using the relative seriality model for the heart, and the model proposed by Burman et al. for the lung. RESULTS: Previous computed tomography studies showed that both voluntary DIBH and IG provided reduction of the lung V50 (relative volume receiving more than 50% of prescription dose) on the order of 30-40%, and a 80-90% reduction of the heart V50 for left-sided cancers. Corresponding pneumonitis probability of 28.1% (range, 0.7-95.6%) for FB could be reduced to 2.6% (range, 0.1-40.1%) for IG, and 4.3% (range, 0.1-59%) for DIBH. The cardiac mortality probability could be reduced from 4.8% (range, 0.1-23.4%) in FB to 0.5% (range, 0.1-2.6%) for IG and 0.1% (range, 0-3.0%) for DIBH. CONCLUSIONS: Remarkable potential is shown for simple voluntary DIBH and free breathing IG to reduce the risk of both cardiac mortality and pneumonitis for the common technique of adjuvant tangential breast irradiation.

Original language	English
Journal	International Journal of Radiation Oncology, Biology, Physics
Volume	65
Issue number	5
Pages (from-to)	1375-80
Number of pages	6
ISSN	0360-3016
DOIs	https://doi.org/10.1016/j.ijrobp.2006.03.046
Publication status	Published - 1 Aug 2006

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10.1016/j.ijrobp.2006.03.046

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Reduction of cardiac and pulmonary complication probabilities after breathing adapted radiotherapy for breast cancer. / Korreman, Stine S; Pedersen, Anders N; Aarup, Lasse Rye et al.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 65, No. 5, 01.08.2006, p. 1375-80.

Research output: Contribution to journal › Journal article › Research › peer-review

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title = "Reduction of cardiac and pulmonary complication probabilities after breathing adapted radiotherapy for breast cancer",

abstract = "PURPOSE: Substantial reductions of cardio-pulmonary radiation doses can be achieved using voluntary deep inspiration breath-hold (DIBH) or free breathing inspiration gating (IG) in radiotherapy after conserving surgery for breast cancer. The purpose of this study is to evaluate the radiobiological implications of such dosimetric benefits. METHODS AND MATERIALS: Patients from previously reported studies were pooled for a total of 33 patients. All patients underwent DIBH and free breathing (FB) scans, and 17 patients underwent an additional IG scan. Tangential conformal treatment plans covering the remaining breast, internal mammary, and periclavicular nodes were optimized for each scan, prescription dose 48 Gy. Normal tissue complication probabilities were calculated using the relative seriality model for the heart, and the model proposed by Burman et al. for the lung. RESULTS: Previous computed tomography studies showed that both voluntary DIBH and IG provided reduction of the lung V50 (relative volume receiving more than 50% of prescription dose) on the order of 30-40%, and a 80-90% reduction of the heart V50 for left-sided cancers. Corresponding pneumonitis probability of 28.1% (range, 0.7-95.6%) for FB could be reduced to 2.6% (range, 0.1-40.1%) for IG, and 4.3% (range, 0.1-59%) for DIBH. The cardiac mortality probability could be reduced from 4.8% (range, 0.1-23.4%) in FB to 0.5% (range, 0.1-2.6%) for IG and 0.1% (range, 0-3.0%) for DIBH. CONCLUSIONS: Remarkable potential is shown for simple voluntary DIBH and free breathing IG to reduce the risk of both cardiac mortality and pneumonitis for the common technique of adjuvant tangential breast irradiation.",

author = "Korreman, {Stine S} and Pedersen, {Anders N} and Aarup, {Lasse Rye} and Trine Juhler-N{\o}ttrup and Lena Specht and H{\aa}kan Nystr{\"o}m and Aarup, {Lasse Rye}",

note = "Keywords: Aged; Algorithms; Breast Neoplasms; Female; Heart; Humans; Inhalation; Lung; Middle Aged; Probability; Radiation Dosage; Radiation Injuries; Radiation Pneumonitis; Radiobiology; Radiotherapy, Adjuvant; Radiotherapy, Conformal; Respiration",

year = "2006",

month = aug,

day = "1",

doi = "10.1016/j.ijrobp.2006.03.046",

language = "English",

volume = "65",

pages = "1375--80",

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T1 - Reduction of cardiac and pulmonary complication probabilities after breathing adapted radiotherapy for breast cancer

AU - Korreman, Stine S

AU - Pedersen, Anders N

AU - Aarup, Lasse Rye

AU - Juhler-Nøttrup, Trine

AU - Specht, Lena

AU - Nyström, Håkan

AU - Aarup, Lasse Rye

N1 - Keywords: Aged; Algorithms; Breast Neoplasms; Female; Heart; Humans; Inhalation; Lung; Middle Aged; Probability; Radiation Dosage; Radiation Injuries; Radiation Pneumonitis; Radiobiology; Radiotherapy, Adjuvant; Radiotherapy, Conformal; Respiration

PY - 2006/8/1

Y1 - 2006/8/1

N2 - PURPOSE: Substantial reductions of cardio-pulmonary radiation doses can be achieved using voluntary deep inspiration breath-hold (DIBH) or free breathing inspiration gating (IG) in radiotherapy after conserving surgery for breast cancer. The purpose of this study is to evaluate the radiobiological implications of such dosimetric benefits. METHODS AND MATERIALS: Patients from previously reported studies were pooled for a total of 33 patients. All patients underwent DIBH and free breathing (FB) scans, and 17 patients underwent an additional IG scan. Tangential conformal treatment plans covering the remaining breast, internal mammary, and periclavicular nodes were optimized for each scan, prescription dose 48 Gy. Normal tissue complication probabilities were calculated using the relative seriality model for the heart, and the model proposed by Burman et al. for the lung. RESULTS: Previous computed tomography studies showed that both voluntary DIBH and IG provided reduction of the lung V50 (relative volume receiving more than 50% of prescription dose) on the order of 30-40%, and a 80-90% reduction of the heart V50 for left-sided cancers. Corresponding pneumonitis probability of 28.1% (range, 0.7-95.6%) for FB could be reduced to 2.6% (range, 0.1-40.1%) for IG, and 4.3% (range, 0.1-59%) for DIBH. The cardiac mortality probability could be reduced from 4.8% (range, 0.1-23.4%) in FB to 0.5% (range, 0.1-2.6%) for IG and 0.1% (range, 0-3.0%) for DIBH. CONCLUSIONS: Remarkable potential is shown for simple voluntary DIBH and free breathing IG to reduce the risk of both cardiac mortality and pneumonitis for the common technique of adjuvant tangential breast irradiation.

AB - PURPOSE: Substantial reductions of cardio-pulmonary radiation doses can be achieved using voluntary deep inspiration breath-hold (DIBH) or free breathing inspiration gating (IG) in radiotherapy after conserving surgery for breast cancer. The purpose of this study is to evaluate the radiobiological implications of such dosimetric benefits. METHODS AND MATERIALS: Patients from previously reported studies were pooled for a total of 33 patients. All patients underwent DIBH and free breathing (FB) scans, and 17 patients underwent an additional IG scan. Tangential conformal treatment plans covering the remaining breast, internal mammary, and periclavicular nodes were optimized for each scan, prescription dose 48 Gy. Normal tissue complication probabilities were calculated using the relative seriality model for the heart, and the model proposed by Burman et al. for the lung. RESULTS: Previous computed tomography studies showed that both voluntary DIBH and IG provided reduction of the lung V50 (relative volume receiving more than 50% of prescription dose) on the order of 30-40%, and a 80-90% reduction of the heart V50 for left-sided cancers. Corresponding pneumonitis probability of 28.1% (range, 0.7-95.6%) for FB could be reduced to 2.6% (range, 0.1-40.1%) for IG, and 4.3% (range, 0.1-59%) for DIBH. The cardiac mortality probability could be reduced from 4.8% (range, 0.1-23.4%) in FB to 0.5% (range, 0.1-2.6%) for IG and 0.1% (range, 0-3.0%) for DIBH. CONCLUSIONS: Remarkable potential is shown for simple voluntary DIBH and free breathing IG to reduce the risk of both cardiac mortality and pneumonitis for the common technique of adjuvant tangential breast irradiation.

U2 - 10.1016/j.ijrobp.2006.03.046

DO - 10.1016/j.ijrobp.2006.03.046

M3 - Journal article

C2 - 16750314

SN - 0360-3016

VL - 65

SP - 1375

EP - 1380

JO - International Journal of Radiation Oncology, Biology, Physics

JF - International Journal of Radiation Oncology, Biology, Physics

IS - 5

ER -

Reduction of cardiac and pulmonary complication probabilities after breathing adapted radiotherapy for breast cancer

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