Spirometry-monitored deep inspiration breath-hold (DIBH)
GenesisCare is in the process of conducting a significant piece of research into spirometry-monitored deep inspiration breath-hold radiotherapy (DIBH) for those with left-sided breast cancer.
The GenesisCare research and development team has released findings from an interim study looking at 42 patients' datasets and the positive effects spirometry-monitored DIBH can have on long-term cardiovascular issues and risk of death for the patient.
So far, the research has revealed some significant findings - all of which can be found in this SlideShare.
Intensity modulated radiotherapy for breast cancer
Conformal breast plan
Image A - dose in ribs
This is an axial slice of a conventional breast plan where the dark red shading represents areas of the breast receiving 107% of the prescribed radiation dose, graduating down to 95%, which is the area in green. In this example it is noted that the dose is distributed unevenly around the breast and that laterally the rib is receiving mostly yellow (100%) and some orange (103%) dose.
Increased radiation dose increases the risk of pathological fracture. As ribs are quite delicate bones we need to reduce this dose as much as possible to reduce the risk of fracture late in life without compromising the dose of radiation to the breast.
Image B - Dose in heart
This is same patient’s conventional plan however we are further inferior in the patient. This slice shows that areas of the heart are receiving 95% of the radiation dose, again represented in green, and that the lung is also receiving unnecessarily high doses. Increased heart & lung doses increase the risk of fibrosis and possible late toxities.
Image C - Sagittal dose
This is a sagittal view of the patient’s conventional plan demonstrating the uneven dose throughout the breast. High doses of radiation represented by the dark red can be noted in the inferior aspect of the breast, while the green dose of radiation is not covering the entire breast superiorly.
Simple IMRT breast cancer treatment plan
Image D - Dose in Ribs
This is the same slice within the patient as image A but planned with IMRT. This slice is the same position as image A. A much more even dose of radiation can be seen in this slice. Of note, the lateral rib that was receiving orange dose in the conventional plan is now only receiving green dose with the IMRT plan. This will reduce the risk of pathological fracture for this patient.
Image E - Dose in heart
This is the same slice within the patient as image B but planned with IMRT. The green area is treating no heart and much less lung than the conventional plan and the overall dose to the heart has now been reduced to less than 80% of the prescribed dose represented by the light blue shading. This is much lower when compared to the conventional plan.
Image F - Sagittal dose
This is the same position as image C, again with IMRT. The variations in colour shading across the breast are much more even superiorly to inferiorly demonstrating an even radiation dose. There is no dark red to orange doses inferiorly and the superior green dose is covering the breast better.
If you want to read more about the breast cancer radiotherapy treatment available with GenesisCare, visit our treatment section.