Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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The impact of continuous positive airway pressure on radiation dose to heart and lung during left-sided postmastectomy radiotherapy when deep inspiration breath hold technique is not applicable: a case report

  • Kil, Whoon Jong (Medicine Service, Radiation Oncology Clinic, Oklahoma City VA Health Care System) ;
  • Pham, Tabitha (Medicine Service, Radiation Oncology Clinic, Oklahoma City VA Health Care System) ;
  • Hossain, Sabbir (Medicine Service, Radiation Oncology Clinic, Oklahoma City VA Health Care System) ;
  • Casaigne, Juan (Medicine Service, Radiation Oncology Clinic, Oklahoma City VA Health Care System) ;
  • Jones, Kellie (Medicine Service, Radiation Oncology Clinic, Oklahoma City VA Health Care System) ;
  • Khalil, Mohammad (Medicine Service, Radiation Oncology Clinic, Oklahoma City VA Health Care System)
  • Received : 2018.01.06
  • Accepted : 2018.02.02
  • Published : 2018.03.31
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Abstract

Deep inspiration breathing hold (DIBH) compared to free-breathing (FB) during radiotherapy (RT) has significantly decreased radiation dose to heart and has been one of the techniques adopted for patients with breast cancer. However, patients who are unable to make suitable deep inspiration breath may not be eligible for DIBH, yet still need to spare the heart and lung during breast cancer RT (left-sided RT in particular). Continuous positive airway pressure (CPAP) is a positive airway pressure ventilator, which keeps the airways continuously open and subsequently inflates the thorax resembling thoracic changes from DIBH. In this report, authors applied CPAP instead of FB during left-sided breast cancer RT including internal mammary node in a patient who was unable to tolerate DIBH, and substantially decreased radiation dose the heart and lung with CPAP compared to FB.

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References

  1. Thorsen LB, Offersen BV, Dano H, et al. DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer. J Clin Oncol 2016;34:314-20.
  2. EBCTCG (Early Breast Cancer Trialists' Collaborative Group), McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 2014;383:2127-35. https://doi.org/10.1016/S0140-6736(14)60488-8
  3. Poortmans PM, Collette S, Kirkove C, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 2015;373:317-27. https://doi.org/10.1056/NEJMoa1415369
  4. Taylor C, Correa C, Duane FK, et al. Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart and from previous randomized trials. J Clin Oncol 2017;35:1641-9. https://doi.org/10.1200/JCO.2016.72.0722
  5. Darby SC, Ewertz M, Hall P. Ischemic heart disease after breast cancer radiotherapy. N Engl J Med 2013;368:2527. https://doi.org/10.1056/NEJMc1305687
  6. Marks LB, Yorke ED, Jackson A, et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 2010;76(3 Suppl):S10-9. https://doi.org/10.1016/j.ijrobp.2009.07.1754
  7. Zagar TM, Kaidar-Person O, Tang X, et al. Utility of deep inspiration breath hold for left-sided breast radiation therapy in preventing early cardiac perfusion defects: a prospective study. Int J Radiat Oncol Biol Phys 2017;97:903-9. https://doi.org/10.1016/j.ijrobp.2016.12.017
  8. Conway JL, Conroy L, Harper L, et al. Deep inspiration breathhold produces a clinically meaningful reduction in ipsilateral lung dose during locoregional radiation therapy for some women with right-sided breast cancer. Pract Radiat Oncol 2017;7:147-53. https://doi.org/10.1016/j.prro.2016.10.011
  9. Rice L, Goldsmith C, Green MM, Cleator S, Price PM. An effective deep-inspiration breath-hold radiotherapy technique for left-breast cancer: impact of post-mastectomy treatment, nodal coverage, and dose schedule on organs at risk. Breast Cancer (Dove Med Press) 2017;9:437-46.
  10. Boda-Heggemann J, Knopf AC, Simeonova-Chergou A, et al. Deep inspiration breath hold-based radiation therapy: a clinical review. Int J Radiat Oncol Biol Phys 2016;94:478-92. https://doi.org/10.1016/j.ijrobp.2015.11.049
  11. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008;5:136-43. https://doi.org/10.1513/pats.200709-155MG

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