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Wide Tangential Fields Including the Internal Mammary Lymph Nodes in Patients with Left-Sided Breast Cancer

Influence of Respiratory-Controlled Radiotherapy (4D-CT) on Cardiac Exposure

Bestrahlung mit flachen tangentialen Feldern und Einschluss der Lymphknoten entlang der A. mammaria interna bei Patientinnen mit linksseitigem Mammakarzinom. Einfluss der atemgetriggerten Bestrahlungstechnik (4D-CT) auf die Herzbelastung

Strahlentherapie und Onkologie volume 185, pages 155–160 (2009)Cite this article

Purpose:

To evaluate the impact of wide-tangent fields including the internal mammary chain during deep inspiration breath-hold (DIBH) radiotherapy in patients with left-sided breast cancer on cardiac exposure.

Patients and Methods:

Eleven patients with left-sided breast cancer were irradiated postoperatively and underwent CT scans during free breathing and DIBH. For scientific interest only, treatment plans were calculated consisting of wide tangents including the ipsilateral mammary lymph nodes using both, the free breathing and respiratory-controlled CT scan. The resulting dose-volume histograms were compared for irradiated volumes and doses to organs at risk.

Results:

The mean patient age was 51 years (range: 37–65 years). Radiotherapy using wide tangents with DIBH as compared to free breathing led to a significantly lower cardiac exposure. Mean irradiated heart volumes (≥ 20 Gy) were 14 cm3 (range: 0–51.3 cm3) versus 35 cm3 (range: 2.1–78.7 cm3; p = 0.01). For eight patients, DIBH reduced irradiated relative lung volume, while in three patients, the lung volume slightly increased.

Conclusion:

Radiation exposure of organs at risk can significantly be reduced for breast cancer patients using the DIBH technique. If radiotherapy of the internal mammary lymph nodes is considered necessary, DIBH may be the preferable technique.

Ziel:

Untersuchung des Stellenwerts einer atemgesteuerten (DIBH) Strahlenbehandlung bei Verwendung flacher tangentialer Felder und Einschluss der Lymphknoten entlang der A. mammaria interna bei Patientinnen mit linksseitigem Mammakarzinom im Hinblick auf die Herzbelastung.

Patienten und Methodik:

Bei elf Patientinnen mit linksseitigem Mammakarzinom wurde postoperativ eine lokale Strahlenbehandlung durchgeführt. Für diese CT-Studie wurden unter Bedingungen der Normalatmung und in tiefer Inspiration (Abbildung 1) ein Planungs-CT durchgeführt und jeweils ein optimierter Bestrahlungsplan mit zwei flachen tangentialen Bestrahlungsfeldern unter Berücksichtigung der ipsilateralen Lymphknoten entlang der A. mammaria interna erstellt. Die Dosis-Volumen-Histogramme für die Risikoorgane wurden zwischen beiden Atmungstechniken verglichen.

Ergebnisse:

Der Mittelwert des Alters lag bei 51 Jahren (Range: 37–65 Jahre). Die Bestrahlung mit flachen Tangenten und DIBH erbrachte im Vergleich zur Normalatmung eine signifikant geringere Herzbelastung. Die mittlere Herzbelastung (≥ 20 Gy) ergab 14 cm3 (Range: 0–51,3 cm3) im Vergleich zu 35 cm3 (Range: 2,1–78,7 cm3; p = 0,01; Tabelle 1). Bei acht Patientinnen reduzierte die atemgetriggerte Bestrahlung auch das bestrahlte Lungenvolumen (%), wobei es bei drei Patientinnen geringfügig anstieg (Tabelle 2).

Schlussfolgerung:

Die atemgetriggerte Bestrahlung in tiefer Inspiration reduziert signifikant die Strahlenbelastung an Risikoorganen. Bei Indikation des Einschlusses der Lymphknoten entlang der A. mammaria interna kann die Bestrahlung in DIBH von Vorteil sein.

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Affiliations

  1. Department of Therapeutic Radiotherapy and Oncology, University Medical School, Graz, Austria

    Karin S. Kapp

  2. Department of Therapeutic Radiotherapy and Oncology, University Medical School of Graz, Auenbruggerplatz 32, 8036, Graz, Austria

    Heidi Stranzl

Authors
  1. Heidi Stranzl
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  2. Brigitte Zurl
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  3. Tanja Langsenlehner
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  4. Karin S. Kapp
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Correspondence to Heidi Stranzl.

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Stranzl, H., Zurl, B., Langsenlehner, T. et al. Wide Tangential Fields Including the Internal Mammary Lymph Nodes in Patients with Left-Sided Breast Cancer. Strahlenther Onkol 185, 155–160 (2009). https://doi.org/10.1007/s00066-009-1939-2

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  • DOI: https://doi.org/10.1007/s00066-009-1939-2

Key Words:

  • Left-sided breast carcinoma
  • Deep inspiration breath-hold technique
  • Internal mammary chain
  • Organs at risk
  • Wide tangents

Schlüsselwörter:

  • Linksseitiges Mammakarzinom
  • Atemtriggerung
  • Lymphknoten entlang der A. mammaria interna
  • Risikoorgane
  • Flache Tangenten