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 ABCR  Vol.10 No.3 , July 2021
Benefits of Radiotherapy with Indigenous Tools Aiding Deep Inspiration Breath Holding Technique Compared to Free Breathing Technique among Breast Cancer Patients in Bangladesh
Abstract: Background: Post-operative breast radiotherapy is used to reduce recurrence. The aim of this study was to investigate the outcomes of Deep Inspiration Breath-Hold (DIBH) technique with indigenous breath holding indicator scale in 3DCRT for breast cancer radiotherapy over Free Breathing (FB) technique. Methods: An observational study conducted at the Department of Radiation Oncology at National Institute of Cancer Research and Hospital, Dhaka and Square Hospital Limited, Dhaka, Bangladesh from June 2015 to May 2016. A total of 60 confirmed breast cancer patients who underwent adjuvant radiotherapy were included. An indigenous reproducible plastic tool (Perspex) was used as breath holding indicator scale with DIBH technique in 3DCRT. Paired sample t-test was used to compare with FB technique. Results: The mean age of patients was 47.32 (SD ± 8.33) years. In FB technique, Mean Heart Dose (MHD) was 413.27 cGy while in DIBH technique, it was 254.91 cGy (P < 0.001). The mean heart V20 and V30 were 5.5%, 4.37% in FB and 3.13%, 2.36% in DIBH respectively. In FB technique LADMD, LAD 0.2 cm3, ILMD and ILV20 were 1698.17 cGy, 2852.53 cGy, 1155.31 cGy and 28.62% while in DIBH technique, it was reduced to 1164.01 cGy, 2132.24 cGy, 1007.98 cGy and 23.39% respectively. Similarly, the lung-CLMD and breast-CLMD were reduced from 38.37 cGy and 55.18 cGy to 24.64 cGy and 33.82 cGy respectively (P < 0.001). The mean difference for breast-CLMD was 21.36 cGy. Conclusion: The use of indigenous breath holding indicator scale with DIBH had better outcomes on breast cancer radiotherapy.
Cite this paper: Rahman, M. , Balakrishnan, R. , Reza, M. and Chowdhury, Q. (2021) Benefits of Radiotherapy with Indigenous Tools Aiding Deep Inspiration Breath Holding Technique Compared to Free Breathing Technique among Breast Cancer Patients in Bangladesh. Advances in Breast Cancer Research, 10, 75-86. doi: 10.4236/abcr.2021.103006.
References

[1]   Edlund, T. and Gannett, D. (1999) A Single Isocenter Technique Using CT-Based Planning in the Treatment of Breast Cancer. Medical Dosimetry, 24, 239-245.
https://doi.org/10.1016/S0958-3947(99)00026-6

[2]   Sidhu, S., Sidhu, N.P., Lapointe, C. and Gryschuk, G. (2006) The Effects of Intrafraction Motion on Dose Homogeneity in a Breast Phantom with Physical Wedges, Enhanced Dynamic Wedges, and ssIMRT. International Journal of Radiation Oncology, Biology, Physics, 66, 64-75.
https://doi.org/10.1016/j.ijrobp.2006.03.045

[3]   Bruzzaniti, V., Abate, A., Pinnarò, P., D’Andrea, M., Infusino, E., Strigari, L., et al. (2013) Dosimetric and Clinical Advantages of Deep Inspiration Breath-Hold (DIBH) during Radiotherapy of Breast Cancer. Journal of Experimental & Clinical Cancer Research: CR, 32, 88.
https://doi.org/10.1186/1756-9966-32-88

[4]   Chen, M.H., Chuang, M.L., Bornstein, B.A., Gelman, R., Harris, J.R. and Manning, W.J. (1997) Impact of Respiratory Maneuvers on Cardiac Volume within Left-Breast Radiation Portals. Circulation, 96, 3269-3272.
https://doi.org/10.1161/01.CIR.96.10.3269

[5]   Lu, H.M., Cash, E., Chen, M.H., Chin, L., Manning, W.J., Bornstein, B., et al. (2000) Reduction of Cardiac Volume in Left-Breast Treatment Fields by Respiratory Maneuvers: A CT Study. International Journal of Radiation Oncology, Biology, Physics; 47, 895-904.
https://doi.org/10.1016/S0360-3016(00)00512-5

[6]   Pedersen, A.N., Korreman, S., Nyström, H. and Specht, L. (2004) Breathing Adapted Radiotherapy of Breast Cancer: Reduction of Cardiac and Pulmonary Doses Using Voluntary Inspiration Breath-Hold. Radiotherapy and Oncology, 72, 53-60.
https://doi.org/10.1016/j.radonc.2004.03.012

[7]   Sixel, K.E., Aznar, M.C. and Ung, Y.C. (2001) Deep Inspiration Breath Holds to Reduce Irradiated Heart Volume in Breast Cancer Patients. International Journal of Radiation Oncology, Biology, Physics, 49, 199-204.
https://doi.org/10.1016/S0360-3016(00)01455-3

[8]   Remouchamps, V.M., Vicini, F.A., Sharpe, M.B., Kestin, L.L., Martinez, A.A., Wong, J.W., et al. (2003) Significant Reductions in Heart and Lung Doses Using Deep Inspiration Breath Hold with Active Breathing Control and Intensity-Modulated Radiation Therapy for Patients Treated with Locoregional Breast Irradiation. International Journal of Radiation Oncology, Biology, Physics, 55, 392-406.
https://doi.org/10.1016/S0360-3016(02)04143-3

[9]   Korreman, S.S., Pedersen, A.N., Nottrup, T.J., Specht, L. and Nystrom, H. (2005) Breathing Adapted Radiotherapy for Breast Cancer: Comparison of Free Breathing Gating with the Breath-Hold Technique. Radiotherapy and Oncology, 76, 311-318.
https://doi.org/10.1016/j.radonc.2005.07.009

[10]   Stranzl, H. and Zurl, B. (2008) Postoperative Irradiation of Left-Sided Breast Cancer Patients and Cardiac Toxicity. Strahlentherapie und Onkologie, 184, 354-358.
https://doi.org/10.1007/s00066-008-1852-0

[11]   Hooning, M.J., Botma, A., Aleman, B.M., Baaijens, M.H., Bartelink, H., van Leeuwen, F.E., et al. (2007) Long-Term Risk of Cardiovascular Disease in 10-Year Survivors of Breast Cancer. Journal of the National Cancer Institute, 99, 365-375.
https://doi.org/10.1093/jnci/djk064

[12]   Offersen, B., Hojris, I. and Overgaard, M. (2011) Radiation-Induced Heart Morbidity after Adjuvant Radiotherapy of Early Breast Cancer: Is It Still an Issue? Radiotherapy and Oncology, 100, 157-159.
https://doi.org/10.1016/j.radonc.2011.08.007

[13]   Early Breast Cancer Trialists’ Collaborative Group (2000) Favourable and Unfavourable Effects on Long-Term Survival of Radiotherapy for Early Breast Cancer: An Overview of the Randomised Trials. The Lancet, 355, 1757-1770.
https://doi.org/10.1016/S0140-6736(00)02263-7

[14]   Darby, S.C., Ewertz, M., McGale, P., Bennet, A.M. and Hall, P. (2013) Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer. The New England Journal of Medicine; 368, 987-998.
https://doi.org/10.1056/NEJMoa1209825

[15]   Demirci, S., Nam, J., Hubbs, J.L., Nguyen, T. and Marks, L.B. (2009) Radiation-Induced Cardiac Toxicity after Therapy for Breast Cancer: Interaction between Treatment Era and Follow-Up Duration. International Journal of Radiation Oncology, Biology, Physics, 73, 980-987.
https://doi.org/10.1016/j.ijrobp.2008.11.016

[16]   Darby, S.C., McGale, P., Taylor, C.W. and Peto, R. (2005) Long-Term Mortality from Heart Disease and Lung Cancer after Radiotherapy for Early Breast Cancer: Prospective Cohort Study of about 300,000 Women in US SEER Cancer Registries. The Lancet Oncology, 6, 557-565.
https://doi.org/10.1016/S1470-2045(05)70251-5

[17]   Remouchamps, V.M., Letts, N., Vicini, F.A., Sharpe, M.B., Kestin, L.L., Wong, J.W., et al. (2003) Initial Clinical Experience with Moderate Deep-Inspiration Breath Hold Using an Active Breathing Control Device in the Treatment of Patients with Left-Sided Breast Cancer Using External Beam Radiation Therapy. International Journal of Radiation Oncology, Biology, Physics, 56, 704-715.
https://doi.org/10.1016/S0360-3016(03)00010-5

[18]   Wang, W., Purdie, T.G., Rahman, M., Marshall, A., Liu, F.F. and Fyles, A. (2012) Rapid Automated Treatment Planning Process to Select Breast Cancer Patients for Active Breathing Control to Achieve Cardiac Dose Reduction. International Journal of Radiation Oncology, Biology, Physics, 82, 386-393.
https://doi.org/10.1016/j.ijrobp.2010.09.026

[19]   Lee, H.Y., et al. (2013) The Deep Inspiration Breath Hold Technique Using Abches Reduces Cardiac Dose in Patients Undergoing Left-Sided Breast Irradiation. Radiation Oncology Journal, 31, 239-246.
https://doi.org/10.3857/roj.2013.31.4.239

[20]   Talukder, H., Islam, M.J. and Kamal, M.M. (2015) Hospital Based Cancer Registry in Bangladesh. Annual Report. NICRH, Dhaka.

[21]   Keall, P.J., Mageras, G.S., Balter, J.M., Emery, R.S., Forster, K.M. and Yorke, E. (2006) The Management of Respiratory Motion in Radiation Oncology Report of AAPM Task Group 76. Medical Physics, 33, 3874-3900.
https://doi.org/10.1118/1.2349696

[22]   Schubert, L.K., Gondi, V., Sengbusch, E., Westerly, D.C., Soisson, E.T., Cannon, G.M., et al. (2011) Dosimetric Comparison of Left-Sided Whole Breast Irradiation with 3DCRT, Forward-Planned IMRT, Inverse-Planned IMRT, Helical Tomotherapy, and Topotherapy. Radiotherapy and Oncology, 100, 241-246.
https://doi.org/10.1016/j.radonc.2011.01.004

[23]   Bergom, C., et al. (2018) Deep Inspiration Breath Hold: Techniques and Advantages for Cardiac Sparing during Breast Cancer Irradiation. Frontiers in Oncology, 8, 87.
https://doi.org/10.3389/fonc.2018.00087

[24]   Rice, L., Goldsmith, C., Green, M.M.L., Cleator, S. and Price, P.M. (2017) An Effective Deep-Inspiration Breath-Hold Radiotherapy Technique for Left-Breast Cancer: Impact of Post-Mastectomy Treatment, Nodal Coverage, and Dose Schedule on Organs at Risk. Breast Cancer, 9, 437-446.
https://doi.org/10.2147/BCTT.S130090

[25]   Oechsner, M., Düsberg, M., Borm, K.J., et al. (2019) Deep Inspiration Breath-Hold for Left-Sided Breast Irradiation: Analysis of Dose-Mass Histograms and the Impact of Lung Expansion. Radiation Oncology, 14, 109.
https://doi.org/10.1186/s13014-019-1293-1

[26]   Macrie, B.D., Donnelly, E.D., Hayes, J.P., et al. (2015) A Cost-Effective Technique for Cardiac Sparing with Deep Inspiration-Breath Hold (DIBH). Physica Medica, 31, 733-737.
https://doi.org/10.1016/j.ejmp.2015.06.006

[27]   Darapu, A., Balakrishnan, R., Sebastian, P., Kather Hussain, M., Ravindran, P. and John, S. (2017) Is the Deep Inspiration Breath-Hold Technique Superior to the Free Breathing Technique in Cardiac and Lung Sparing while Treating both Left-Sided Post-Mastectomy Chest Wall and Supraclavicular Regions. Case Reports in Oncology, 10, 37-51.
https://doi.org/10.1159/000453607

 
 
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