Top

Published in:

01-09-2015 | Research

Respiratory Motion, Anterior Heart Displacement and Heart Dosimetry: Comparison Between Prone (Pr) and Supine (Su) Whole Breast Irradiation

Authors: Ferenc Lakosi, Akos Gulyban, Levente Janvary, Selma Ben-Mustapha Simoni, Nicolas Jansen, Laurence Seidel, Arpad Kovacs, Peter Vavassis, Philippe Coucke

Published in: Pathology & Oncology Research | Issue 4/2015

Abstract

To analyze respiratory motion of surgical clips, chest wall (CW) and the anterior displacement of the heart and its impact on heart dosimetry between prone (Pr) and supine (Su) positions during whole breast radiotherapy after breast conserving surgery. Sixteen patients underwent 4D-CT for radiotherapy planning in Pr and Su positions. Maximum inhale and maximum exhale phases were analyzed. Mean 3D vectorial displacements ± standard deviations (SD) of the surgical clips were measured. Volumetric changes of the CW were recorded and compared. Cardiac displacement was assessed by a volume between the inner surface of CW and the myocardium of the heart (CW/H-V). For left-sided cases, comparative dosimetry was performed in each position simulating no- (Pr-noC, Su-noC) versus daily correction protocols (Pr-C, Su-C). The movements of 81 surgical clips were analyzed. Prone positioning significantly reduced both the mean 3D vectorial displacements (1.1 ± 0.6 (Pr) vs. 2.0 ± 0.9 mm (Su), p < 0.01) and their variability (0.3 ± 0.2 vs. 0.5 ± 0.3 mm, p = 0.01). Respiration-induced volumetric changes of CW were also significantly lower in Pr (2.3 ± 4.9 vs. 9.6 ± 7.1 cm³ _, p < 0.01). The CW/H-V was significantly smaller in Pr than in Su (39.9 ± 14.6 vs. 64.3 ± 28.2 cm³ _, p < 0.01). Besides identical target coverage heart, left-anterior-descending coronary artery (LADCA) and ipsilateral lung dose parameters were lowered with Pr-C compared to Pr-noC, Su-C and Su-noC. Prone position significantly reduced respiration-related surgical clip movements, their variability as well as CW movements. Significant anterior heart displacement was observed in Pr. Prone position with daily online correction could maximize the heart and LADCA protection.

Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378:1707–1716. doi:10.1016/S0140-6736(11)61629-2 CrossRefPubMed

Kovacs A, Lakosi F, Liposits G, Toller G, Hadjiev J, Vandulek C et al (2011) 3-D conformal photon boost in the treatment of early stage breast cancer: 4 years follow up results. Pathol Oncol Res 17:17–23. doi:10.1007/s12253-010-9264-8 CrossRefPubMed

Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ et al (2013) The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 14:1086–1094. doi:10.1016/S1470-2045(13)70386-3 CrossRefPubMed

Polgár C, Van Limbergen E, Pötter R, Kovács G, Polo A, Lyczek J et al (2010) Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group ba. Radiother Oncol 94:264–273. doi:10.1016/j.radonc.2010.01.014 CrossRefPubMed

Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH et al (2009) Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys 74:987–1001. doi:10.1016/j.ijrobp.2009.02.031 CrossRefPubMed

Whelan TJ, Pignol J-P, Levine MN, Julian JA, MacKenzie R, Parpia S et al (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362:513–520. doi:10.1056/NEJMoa0906260 CrossRefPubMed

Freedman GM, White JR, Arthur DW, Allen Li X, Vicini FA (2013) Accelerated fractionation with a concurrent boost for early stage breast cancer. Radiother Oncol 106:15–20. doi:10.1016/j.radonc.2012.12.001 CrossRefPubMed

Kim LH, Goyal S, Haffty BG, Taunk NK, Yue NJ (2012) Using respiratory motion to guide planning target volume margins for external beam partial breast irradiation. Int J Radiat Oncol Biol Phys 82:1303–1306. doi:10.1016/j.ijrobp.2011.11.048 CrossRefPubMed

10.

Kirby AM, Evans PM, Donovan EM, Convery HM, Haviland JS, Yarnold JR (2010) Prone versus supine positioning for whole and partial-breast radiotherapy: a comparison of non-target tissue dosimetry. Radiother Oncol 96:178–184. doi:10.1016/j.radonc.2010.05.014 CrossRefPubMed

11.

Kirby AM, Evans PM, Helyer SJ, Donovan EM, Convery HM, Yarnold JR (2011) A randomised trial of supine versus prone breast radiotherapy (SuPr study): comparing set-up errors and respiratory motion. Radiother Oncol 100:221–226. doi:10.1016/j.radonc.2010.11.005 CrossRefPubMed

12.

Krengli M, Masini L, Caltavuturo T, Pisani C, Apicella G, Negri E et al (2013) Prone versus supine position for adjuvant breast radiotherapy: a prospective study in patients with pendulous breasts. Radiat Oncol 8:232. doi:10.1186/1748-717X-8-232 PubMedCentralCrossRefPubMed

13.

Lymberis SC, de Wyngaert JK, Parhar P, Chhabra AM, Fenton-Kerimian M, Chang J et al (2012) Prospective assessment of optimal individual position (prone versus supine) for breast radiotherapy: volumetric and dosimetric correlations in 100 patients. Int J Radiat Oncol Biol Phys 84:902–909. doi:10.1016/j.ijrobp.2012.01.040 CrossRefPubMed

14.

Mitchell J, Formenti SC, DeWyngaert JK (2010) Interfraction and intrafraction setup variability for prone breast radiation therapy. Int J Radiat Oncol Biol Phys 76:1571–1577. doi:10.1016/j.ijrobp.2009.07.1683 CrossRefPubMed

15.

Morrow NV, Stepaniak C, White J, Wilson JF, Li XA (2007) Intra- and interfractional variations for prone breast irradiation: an indication for image-guided radiotherapy. Int J Radiat Oncol Biol Phys 69:910–917. doi:10.1016/j.ijrobp.2007.06.056 CrossRefPubMed

16.

Mulliez T, Veldeman L, van Greveling A, Speleers B, Sadeghi S, Berwouts D et al (2013) Hypofractionated whole breast irradiation for patients with large breasts: a randomized trial comparing prone and supine positions. Radiother Oncol 108:203–208. doi:10.1016/j.radonc.2013.08.040 CrossRefPubMed

17.

Nissen HD, Appelt AL (2013) Improved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patients. Radiother Oncol 106:28–32. doi:10.1016/j.radonc.2012.10.016 CrossRefPubMed

18.

Veldeman L, De Gersem W, Speleers B, Truyens B, Van Greveling A, Van den Broecke R et al (2012) Alternated prone and supine whole-breast irradiation using IMRT: setup precision, respiratory movement and treatment time. Int J Radiat Oncol Biol Phys 82:2055–2064. doi:10.1016/j.ijrobp.2010.10.070 CrossRefPubMed

19.

Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Brønnum D et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368:987–998. doi:10.1056/NEJMoa1209825 CrossRefPubMed

20.

Würschmidt F, Stoltenberg S, Kretschmer M, Petersen C (2014) Incidental dose to coronary arteries is higher in prone than in supine whole breast irradiation. A dosimetric comparison in adjuvant radiotherapy of early stage breast cancer. Strahlenther Onkol 190:563–568. doi:10.1007/s00066-014-0606-4 CrossRefPubMed

21.

Chino JP, Marks LB (2008) Prone positioning causes the heart to be displaced anteriorly within the thorax: implications for breast cancer treatment. Int J Radiat Oncol Biol Phys 70:916–920. doi:10.1016/j.ijrobp.2007.11.001 CrossRefPubMed

22.

Z. Varga, A. Cserháti, F. Rárosi, K. Boda, G. Gulyás, Z. Együd, et al (2013) Individualized positioning for maximum heart protection during breast irradiation. Acta Oncol. 1–7. doi:10.3109/0284186X.2013.781674

23.

van Herk M, Remeijer P, Rasch C, Lebesque JV (2000) The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy. Int J Radiat Oncol Biol Phys 47:1121–1135CrossRefPubMed

24.

Feng M, Moran JM, Koelling T, Chughtai A, Chan JL, Freedman L et al (2011) Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys 79:10–18. doi:10.1016/j.ijrobp.2009.10.058 PubMedCentralCrossRefPubMed

25.

Gulyban A, Kovács P, Sebestyén Z, Farkas R, Csere T, Karácsonyi G et al (2008) Multisegmented tangential breast fields: a rational way to treat breast cancer. Strahlenther Onkol 184:262–269. doi:10.1007/s00066-008-1770-1 CrossRefPubMed

26.

Price GJ, Sharrock PJ, Marchant TE, Parkhurst JM, Burton D, Jain P et al (2009) An analysis of breast motion using high-frequency, dense surface points captured by an optical sensor during radiotherapy treatment delivery. Phys Med Biol 54:6515–6533. doi:10.1088/0031-9155/54/21/005 CrossRefPubMed

27.

28.

29.

Lakosi F, Ben Mustapha S, Gulyban A, Cucchiaro S, Ernst C, Martin N et al (2014) Hypofractionated whole prone breast RT using Sagittilt system: patient comfort, setup accuracy and acute toxicity. Radiat Oncol ESTRO 33:EP–1204

30.

31.

Hall EJ, Wuu C-S (2003) Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol 56:83–88. doi:10.1016/S0360-3016(03)00073-7 CrossRef

32.

de Puysseleyr A, Mulliez T, Gulyban A, Bogaert E, Vercauteren T, Van Hoof T et al (2013) Improved cone-beam computed tomography in supine and prone breast radiotherapy. Surface reconstruction, radiation exposure, and clinical workflow., Strahlenther. Onkol 189:945–950. doi:10.1007/s00066-013-0435-x

Title: Respiratory Motion, Anterior Heart Displacement and Heart Dosimetry: Comparison Between Prone (Pr) and Supine (Su) Whole Breast Irradiation
Authors: Ferenc Lakosi
Akos Gulyban
Levente Janvary
Selma Ben-Mustapha Simoni
Nicolas Jansen
Laurence Seidel
Arpad Kovacs
Peter Vavassis
Philippe Coucke
Publication date: 01-09-2015
Publisher: Springer Netherlands
Published in: Pathology & Oncology Research / Issue 4/2015
Print ISSN: 1219-4956
Electronic ISSN: 1532-2807
DOI: https://doi.org/10.1007/s12253-015-9932-9

2024 ASCO Annual Meeting Coverage

Highlights of the Day: Breast cancer – metastatic

Breast Cancer Video

In this session, Dr. Wolff provides his key takeaways from the data presented in the metastatic breast cancer oral abstract session at ASCO 2024.

Watch now

Highlights of the Day: Gynecologic cancer

Gynecologic Cancer Video

Highlights of the Day: Breast Cancer – local/regional/adjuvant

Breast Cancer Video

Neoadjuvant dual immunotherapy improves melanoma outcomes

04-06-2024 Melanoma News

» View more highlights on the ASCO 2024 congress hub page

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Image Credits

ASCO 2024 | Highlights of the Day: Breast cancer – metastatic/© 2024 American Society of Clinical Oncology, all rights reserved., ASCO 2024 | Highlights of the Day: Gynecologic Cancer/© 2024 American Society of Clinical Oncology, all rights reserved., ASCO 2024 | Highlights of the Day: Breast Cancer – local/regional/adjuvant/© 2024 American Society of Clinical Oncology, all rights reserved., Melanoma/© selvanegra / Getty Images / iStock, Antibody drug conjugated with cytotoxic payload/© Love Employee / Getty images / iStock

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2015

Interleukin-1 Gene Cluster Polymorphisms and its Haplotypes may Predict the Risk to Develop Cervical Cancer in Tunisia

Expression of Amino Acid Transporters (LAT1 and ASCT2) in Patients with Stage III/IV Laryngeal Squamous Cell Carcinoma

Bone Metastases and the EGFR and KRAS Mutation Status in Lung Adenocarcinoma - The Results of Three Year Retrospective Analysis

Elevated Expression of CD109 in Esophageal Squamous Cell Carcinoma

Susceptibility to Colorectal Cancer and Two Genetic Polymorphisms of XRCC4