Reproducibility of repeated breathhold and impact of breathhold failure in whole breast and regional nodal irradiation in prone crawl position

Pieter Deseyne, Bruno Speleers, Leen Paelinck, Werner De Gersem, Wilfried De Neve, Max Schoepen, Annick Van Greveling, Hans Van Hulle, Vincent Vakaet, Giselle Post, Chris Monten, Herman Depypere, Liv Veldeman, Pieter Deseyne, Bruno Speleers, Leen Paelinck, Werner De Gersem, Wilfried De Neve, Max Schoepen, Annick Van Greveling, Hans Van Hulle, Vincent Vakaet, Giselle Post, Chris Monten, Herman Depypere, Liv Veldeman

Abstract

In whole breast and regional nodal irradiation (WB + RNI), breathhold increases organ at risk (OAR) sparing. WB + RNI is usually performed in supine position, because positioning materials obstruct beam paths in prone position. Recent advancements allow prone WB + RNI (pWB + RNI) with increased sparing of OARs compared to supine WB + RNI. We evaluate positional and dosimetrical impact of repeated breathhold (RBH) and failure to breathhold (FTBH) in pWB + RNI. Twenty left-sided breast cancer patients were scanned twice in breathhold (baseline and RBH) and once free breathing (i.e. FTBH). Positional impact was evaluated using overlap index (OI) and Dice similarity coefficient (DSC). Dosimetrical impact was assessed by beam transposition from the baseline plan. Mean OI and DSC ranges were 0.01-0.98 and 0.01-0.92 for FTBH, and 0.73-1 and 0.69-1 for RBH. Dosimetric impact of RBH was negligible. FTBH significantly decreased minimal dose to CTV WBI, level II and the internal mammary nodes, with adequate mean doses. FTBH significantly increased heart, LAD, left lung and esophagus dose. OI and DSC for RBH and FTBH show reproducible large ROI positions. Small ROIs show poor overlap. FTBH maintained adequate target coverage but increased heart, LAD, ipsilateral lung and esophagus dose. RBH is a robust technique in pWB + RNI. (Clinicaltrials.gov: NCT05179161, registered 05/01/2022).

Conflict of interest statement

Ghent University owns the patent application entitled Radiotherapy Board and Couch [WO2015144654A1] filed on 25.03.2014 for which Wilfried De Neve, Bruno Speleers, and Liv Veldeman own intellectual rights. The other authors state no conflict of interest.

© 2022. The Author(s).

Figures

Figure 1
Figure 1
Boxplot of the overlap measurements for targets and organs at risk for the repeated breathhold and failure to breathhold setting. The top row shows target volumes and the bottom row shows OARs, while the first column shows the situation for repeated breathhold and the second column shows the situation for failure to breathhold. Whiskers show 1.5 * interquartile range, outliers plotted as dots. Overlap index is consistently higher than Dice similarity coefficient for the same ROIs in the same breathing phase setting. Small volumes have poorer overlap measurements. This is especially visible in failure to breathhold setting.
Figure 2
Figure 2
Dose-volume histogram showing mean (of patients) minimum dose received by given percentage of target volume. Almost all lines overlap, indicating the robustness of a photon radiotherapy treatment: only the internal mammary nodes (LNN MI) experienced higher dose inhomogeneity and underdosage in failure to breathhold anatomy. The vertical interrupted line represents 95% of the prescription dose.
Figure 3
Figure 3
Dose-volume histogram showing mean (of patients) minimum dose received by given percentage of target volume. Contrary to TVs, failure to breathhold causes heart and LAD doses to increase, as compared to breathhold anatomy. Lines for repeated breathhold overlap, showing that although statistical differences exist, these are likely not relevant.

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