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Usefulness of a thermoplastic breast bra for breast cancer radiotherapy

A prospective analysis

Nutzen eines thermoplastischen Büstenhalters bei Radiotherapie eines Mammakarzinoms

Eine prospektive Analyse

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Abstract

Background

Despite modern techniques, in some patients receiving whole breast radiotherapy (WBI) parts of the heart and the lung might receive doses which are nowadays considered relevant for the development of late morbidity. Our aim was to analyze the usefulness of a thermoplastic breast brassiere to reduce lung and heart doses.

Patients and methods

A total of 29 patients with left-sided and 16 patients with right-sided breast cancer treated with breast conserving surgery and WBI between 2012 and 2013 were included in a prospective study analyzing the effectiveness of a thermoplastic breast bra. WBI was performed using 3D tangential fields up to 50.4 Gy. Treatment planning was performed with and without bra. Several dosimetrical parameters were analyzed comparatively focusing on the heart and ipsilateral lung. For heart dose comparisons, subvolumes like the left anterior descending artery (LAD) and a defined apical region, so-called “apical myocardial territory” (AMT), were defined.

Results

By using the bra, the mean lung dose was reduced by 30.6 % (left-sided cancer) and 29.5 % (right-sided; p < 0.001). The V20Gy for the left lung was reduced by 39.5 % (4.9 vs. 8.1 % of volume; p < 0.001). The mean and maximum heart doses were significantly lower (1.6 vs. 2.1 Gy and 30.7 vs. 39.3 Gy; p = 0.01 and p < 0.001), which also applies to the mean and maximum dose for the AMT (2.5 vs. 4.4 Gy and 31.0 vs. 47.2 Gy; p < 0.01 and p < 0.001). The mean and maximum dose for LAD was lower without reaching significance. No acute skin toxicities > grade 2 were observed.

Conclusion

By using a thermoplastic breast bra, radiation doses to the heart and especially parts of the heart apex and ipsilateral lung can be significantly lowered without additional skin toxicity.

Zusammenfassung

Hintergrund

Trotz moderner Techniken können bei manchen Patientinnen bei der Ganzbrustbestrahlung Areale des Herzens und der Lunge Dosen erhalten, die heute als relevant für Spättoxizitäten gelten. Ziel war es, den Nutzen eines thermoplastischen Büstenhalters hinsichtlich der Reduktion von Lungen- und Herzdosen zu ermitteln.

Methoden

Prospektiv wurde bei 29 Patientinnen mit linksseitigem und 16 mit rechtsseitigem Brustkrebs, bei denen die zwischen 2012 und 2013 eine brusterhaltende OP und Ganzbrustbestrahlung („whole breast irradiation“, WBI) erfolgte, die Effektivität eines thermoplastischen Büstenhalters (BH) untersucht. Die WBI wurde 3‑D-geplant über tangentiale Gegenfelder mit bis zu 50,4 Gy durchgeführt. Die Bestrahlungsplanung erfolgte jeweils mit und ohne BH. Verschiedene dosimetrische Parameter, bezogen auf die Herz- und ipsilaterale Lungendosis, wurden analysiert. Neben dem Gesamtherz wurden Subvolumina wie der R. interventricularis anterior (RIVA) und eine definierte apikale Region, das „apical myocardial territory“ (AMT), definiert.

Ergebnisse

Die ipsilaterale Lungendosis wurde durchschnittlich um 30,6 % (Karzinom linksseitig) bzw. 29,5 % (rechtsseitig) gesenkt (p < 0,001). Die V20Gy der linken Lunge wurde um 39,5 % (4,9 vs. 8,1 % des Volumens, p < 0,001) reduziert. Die mittlere und maximale Herzdosis wurden durch Verwendung des BH signifikant gesenkt (1,6 vs. 2,1 Gy bzw. 30,7 vs. 39,3 Gy; p = 0,01 bzw. p < 0,001), ebenso die mittlere und maximale AMT-Dosis (2,5 vs. 4,4 Gy bzw. 31,0 vs. 47,2 Gy; p < 0,01 bzw. p < 0,001). Die mittlere und maximale RIVA-Dosis wurde durch den BH gesenkt, jedoch nicht signifikant. Es traten keine akuten Hauttoxizitäten > Grad 2 auf.

Schlussfolgerung

Der thermoplastische BH ermöglicht die signifikante Reduzierung der Strahlenbelastung am Herzen, insbesondere im Herzspitzenbereich sowie der ipsilateralen Lunge, ohne die Hauttoxizität zu erhöhen.

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Authors and Affiliations

  1. Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany

    Marc D. Piroth M.D., Dalma Petz,  Michael Pinkawa M.D.,  Richard Holy &  Michael J. Eble

  2. Department of Radiation Oncology, HELIOS University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany

    Marc D. Piroth M.D. &  Richard Holy

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  1. Marc D. Piroth M.D.
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Correspondence to Marc D. Piroth M.D..

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Conflict of interest

M.D. Piroth, D. Petz, M. Pinkawa, R. Holy, and M.J. Eble state that there are no conflicts of interest.

Ethical standards

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Piroth, M.D., Petz, D., Pinkawa, M. et al. Usefulness of a thermoplastic breast bra for breast cancer radiotherapy. Strahlenther Onkol 192, 609–616 (2016). https://doi.org/10.1007/s00066-016-0981-0

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