Heart position variability during voluntary moderate deep inspiration breath-hold radiotherapy for breast cancer determined by repeat CBCT scans |
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| Institution: | 1. Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands;2. Department of Radiation Oncology (MAASTRO), GROW, University Hospital Maastricht, Maastricht, The Netherlands;1. Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan;2. Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan;3. Department of Radiation Oncology, Kurashiki Central Hospital, Japan;1. Department of Ophthalmology, Duke University, Durham, North Carolina;2. Department of Pathology, Duke University, Durham, North Carolina;3. Department of Radiation Oncology, Duke University, Durham, North Carolina;4. Stanford University Medical Center Department of Ophthalmology, Palo Alto, California;2. Department of Radiation Oncology, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI;1. Francis H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts;2. Centre for Medical Radiation Physics, University of Wollongong, New South Wales, Australia;1. Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands;2. Division of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands;3. Department of Pathology, Amsterdam UMC, Amsterdam, The Netherlands;4. Department of Radiation Oncology, Gustave Roussy, Villejuif, France;6. Department of Radiation Oncology, Institut du Cancer de Montpellier Val d''Aurelle, Montpellier, France;5. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden;7. Department of Radiology, the Netherlands Cancer Institute, Amsterdam, The Netherlands;11. Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands |
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| Abstract: | Voluntary moderate deep inspiration breath hold (vmDIBH) in left-sided breast cancer radiotherapy reduces cardiac dose. The aim of this study was to investigate heart position variability in vmDIBH using CBCT and to compare this variability with differences in heart position between vmDIBH and free breathing (FB).For 50 patients initial heart position with respect to the field edge (HP-FE) was measured on a vmDIBH planning CT scan. Breath-hold was monitored using an in-house developed vertical plastic stick. On pre-treatment CBCT scans, heart position variability with respect to the field edge (ΔHP-FE) was measured, reflecting heart position variability when using an offline correction protocol. After registering the CBCT scan to the planning CT, heart position variability with respect to the chest wall (ΔHP-CW) was measured, reflecting heart position variability when using an online correction protocol. As a control group, vmDIBH and FB computed tomography (CT) scans were acquired for 30 patients and registering both scans on the chest wall.For 34 out of 50 patients, the average HP-FE and HP-CW increased over the treatment course in comparison to the planning CT. Averaged over all patients and all treatment fractions, the ΔHP-FE and the ΔHP-CW was 0.8 ± 4.2 mm (range −9.4–+10.6 mm) and 1.0 ± 4.4 mm (range −8.3–+10.4 mm) respectively. The average gain in heart to chest wall distance was 11.8 ± 4.6 mm when using vmDIBH instead of FB. In conclusion, substantial variability in heart position using vmDIBH was observed during the treatment course. |
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| Keywords: | vmDIBH Heart Breast radiotherapy Intrafraction motion |
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