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Spot-scanning proton therapy for early breast cancer in free breathing versus deep inspiration breath-hold

Authors :
Line Bjerregaard Stick
Louise Lærke Nielsen
Cecilia Bui Trinh
Ihsan Bahij
Maria Fuglsang Jensen
Camilla Jensenius Skovhus Kronborg
Stine Elleberg Petersen
Linh My Hoang Thai
May-Lin Martinsen
Helle Precht
Birgitte Vrou Offersen
Source :
Acta Oncologica, Vol 63, Iss 1 (2024)
Publication Year :
2024
Publisher :
Medical Journals Sweden, 2024.

Abstract

Background and purpose: Proton therapy for breast cancer is usually given in free breathing (FB). With the use of deep inspiration breath-hold (DIBH) technique, the location of the heart is displaced inferiorly, away from the internal mammary nodes and, thus, the dose to the heart can potentially be reduced. The aim of this study was to explore the potential benefit of proton therapy in DIBH compared to FB for highly selected patients to reduce exposure of the heart and other organs at risk. We aimed at creating proton plans with delivery times feasible with treatment in DIBH. Material and methods: Sixteen patients with left-sided breast cancer receiving loco-regional proton therapy were included. The FB and DIBH plans were created for each patient using spot-scanning proton therapy with 2–3 fields, robust and single field optimization. For the DIBH plans, minimum monitor unit per spot and spot spacing were increased to reduce treatment delivery time. Results: All plans complied with target coverage constraints. The median mean heart dose was statistically significant reduced from 1.1 to 0.6 Gy relative biological effectiveness (RBE) by applying DIBH. No statistical significant difference was seen for mean dose and V17Gy RBE to the ipsilateral lung. The median treatment delivery time for the DIBH plans was reduced by 27% compared to the FB plans without compromising the plan quality. Interpretation: The median absolute reduction in dose to the heart was limited. Proton treatment in DIBH may only be relevant for a subset of these patients with the largest reduction in heart exposure.

Details

Language :
English
ISSN :
1651226X
Volume :
63
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Acta Oncologica
Publication Type :
Academic Journal
Accession number :
edsdoj.8ea8ac454d204a3caab83b87710a2937
Document Type :
article
Full Text :
https://doi.org/10.2340/1651-226X.2024.28591