DOSIMETRIC EVALUATION OF SURFACE-GUIDED DEEP-INSPIRATION VERSUS FREE-BREATHING POSTOPERATIVE RADIOTHERAPY IN PATIENTS WITH LEFT-SIDED EARLY BREAST CANCER: EUROPEAN SCHOOL OF ONCOLOGY (ESO) CLINICAL TRAINING CENTER BREAST CANCER FELLOWSHIP EXPERIENCE
Keywords:
breast cancer, DIBH, OSMS, fellowship, ESOAbstract
Introduction: Late toxicities related to radiotherapy in early breast cancer, especially cardiac toxicities are those that bring concerns in long-life survivors.
Material and methods: Patients who underwent breast-only postoperative irradiation utilizing the deep inspiration breath hold (DIBH) technique with the Optical Surface Monitoring System (OSMS) during the years 2024-2025 were randomly selected. All patients had two simulation CTs (free-breathing, FB, and DIBH). Three-dimensional radiotherapy treatment plans were created for both (FB and DIBH) CT scans. Dosimetric evaluations were made from the dose-volume histograms (DVH). Statistical evaluation was done with paired sample t-test (two-tailed) and statistical significance was determined at p<0.05.
Results: Eleven patients were included in the study. Target coverage (PTV95%) wasn’t statistically significant between groups. The mean heart dose decreased significantly in DIBH plans by 57%, median difference 1.44 Gy. Heart D16Gy (%) and Heart D16Gy (cm3) were reduced by 91.5% and 89.1% in DIBH plans, respectively (p values 0.005 and 0.022). In comparison to FB plans, DIBH plans resulted in reductions of 87.7% in left anterior descending artery (LAD) Dmean and 68.2% in LAD Dmax (p < 0.001). The left ventricle Dmean and Dmax showed reduced values with DIBH plans by 68.2% and 68.9% (p=0.003 and <0.001), respectively. The ipsilateral lung volume was considerably greater in DIBH plans (p < 0.005), with a median difference of 1133 cm³.
Conclusion: Our study has demonstrated a significant reduction in radiation doses delivered to the heart and its substructures in DIBH plans compared to FB plans, consistent with prior studies.
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