| Abstract: |
Background: Active breathing coordinator (ABC)-assisted deep inspiration breath hold (DIBH) is an important organ sparing radiation therapy (RT) technique for left-sided breast cancer patients. Patients with advanced breast cancer undergoing chest wall and regional nodal irradiation often require a field matching technique. While field matching has been demonstrated to be safe and effective in free breathing patients, its safety and accuracy in DIBH/ABC use has not been previously reported. Purpose: To report the accuracy, feasibility, and safety of field matching with ABC/DIBH for patients receiving breast/chest wall irradiation with nodal irradiation using a three-field technique. Methods: From December 2012 to May 2018, breast cancer patients undergoing ABC/DIBH-based RT at a single institution were reviewed. For each fraction, the amount of overlap/gap between the supraclavicular and the tangential field were measured and recorded. Patient characteristics, including acute and delayed skin toxicities, were analyzed. Results: A total of 202 patients utilized ABC/DIBH and 4973 fractions had gap/overlap measurements available for analysis. The average gap/overlap measured at junction was 0.28 mm ± 0.99 mm. A total of 72% of fractions had no measurable gap/overlap (0 mm), while 5.6% had an overlap and 22.7% a gap. There was no significant trend for worsening or improvement of gap/overlap measurements with increasing fraction number per patient. OSLD measurements were compared to the planned dose. The median dose 1 cm above the junction was 106% ± 7% of planned dose (range 94%–116%). One centimeter below the junction, the median dose was 114% ± 11% of planned dose (range 95%–131%). At the junction, the median dose was 106% ± 16.3% of planned dose (range 86%–131%). Acute skin toxicity was similar to historically reported values (grade 3, 5.4%, grade 4, 0%). Conclusion: ABC-assisted DIBH is a safe and technically feasible method of delivering RT in the setting of complex matching field technique for breast and regional nodal treatments. © 2022 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine. |
| Keywords: |
radiotherapy dosage; breast neoplasms; radiation response; feasibility study; feasibility studies; breast tumor; radiotherapy planning, computer-assisted; breath holding; heart; procedures; organs at risk; humans; human; female; radiotherapy planning system; unilateral breast neoplasms; abc, dibh, locally advanced breast cancer, 3-field technique, field matching
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