A Comparison of 3D Conformal and Deep Inspiratory Breath Holding vs. 4D-CT Intensity-Modulated Radiation Therapy for Patients with Left Breast Cancer

Moustafa Aldaly; Azza Hussien; Inas Mohsen El-Nadi; Nabila Ibrahim Laz; Amira S A Said; Mohammad M Al-Ahmad; Raghda R S Hussein; Al Shaimaa Ibrahim Rabie; Ahmed Hassan Shaaban

doi:10.3390/cancers15245799

A Comparison of 3D Conformal and Deep Inspiratory Breath Holding vs. 4D-CT Intensity-Modulated Radiation Therapy for Patients with Left Breast Cancer

Cancers (Basel). 2023 Dec 11;15(24):5799. doi: 10.3390/cancers15245799.

Authors

Affiliations

¹ Department of Clinical Oncology, Faculty of Medicine, Kasr AL Ainy, Cairo University, Cairo 11956, Egypt.
² Department of Clinical Oncology, Faculty of Medicine, Beni-Suef University, Beni Suef 62511, Egypt.
³ Department of Chest, Faculty of Medicine, Beni-Suef University, Beni Suef 62511, Egypt.
⁴ Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni Suef 62511, Egypt.
⁵ Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi P.O. Box 112612, United Arab Emirates.
⁶ Department of Clinical Pharmacy, Faiyum Oncology Center, Faiyum 63511, Egypt.
⁷ Department of Clinical Nutrition, Health Insurance Authority, Faiyum 63511, Egypt.

Abstract

Background: Multimodality is required for the treatment of breast cancer. Surgery, radiation (RT), and systemic therapy were traditionally used. Pharmacotherapy includes different drug mechanisms, such as chemotherapy, hormone therapy, and targeted therapies, alone or in combination with radiotherapy. While radiation offers numerous benefits, it also has certain harmful risks. such as cardiac and pulmonary toxicity, lymphedema, and secondary cancer. Modern radiation techniques have been developed to reduce organs at risk (OAR) doses.

Materials and methods: This study is a prospective feasibility trial conducted at the Fayium Oncology Center on patients with left breast cancer receiving adjuvant locoregional radiotherapy after either breast conservative surgery (BCS) or modified radical mastectomy (MRM). This study aimed to assess the proportion of patients who are fit both physically and intellectually to undergo breast radiotherapy using the deep inspiratory breath-holding (DIBH) technique, comparing different dosimetric outcomes between the 3D dimensional conformal with DIBH and 4D-CT IMRT plans of the same patient.

Results: D95 of the clinical target volume (CTV) of the target is significantly higher in the 3D DIBH plan than in the IMRT plan, with an average of 90.812% vs. 86.944%. The dosimetry of the mean heart dose (MHD) in the 4D-CT IMRT plan was significantly lower than in the 3D conformal with the DIBH plan (2.6224 vs. 4.056 Gy, p < 0.0064), and no significant difference between the two plans regarding mean left anterior descending artery (LAD) (14.696 vs. 13.492 Gy, p < 0.58), maximum LAD (39.9 vs. 43.5 Gy, p < 0.35), and V20 of the ipsilateral lung (18.66% vs. 16.306%, p < 0.88) was observed. Internal mammary chain (IMC) irradiation was better in the 4D-CT IMRT plan.

Conclusions: Radiotherapy of the breast and chest wall with the 4D-CT IMRT technique appears not to be inferior to the 3D conformal with the DIBH technique and can be used as an alternative to the 3D conformal with the DIBH technique in patients meeting the exclusion criteria for performing the DIBH maneuver concerning coverage to target volumes or unacceptably high doses to OAR.

Keywords: 4D-CT IMRT; DIBH; RPM; adjuvant radiotherapy; breast irradiation; cardiac toxicity.

Grants and funding

This research received no external funding.