voluntary-breath-hold-technique-for-reducing-heart-dose-left-breast

Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy

Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these ...

Royal Marsden NHS Foundation Trust

[18F]Fluorodeoxyglucose positron emission tomography (18F-FDG PET) is playing an increasing role in the management of both Hodgkin and non-Hodgkin lymphoma, offering potential advantages in the accuracy of disease assessment at a number of points in the management pathway. This review evaluates the current level of confidence in the use of PET technology in (1) initial staging, (2) the assessment of early response to chemotherapy, (3) the assessment of residual masses at completion of initial treatment, (4) follow-up, and (5) radiotherapy planning.

The role of FDG PET in the management of lymphoma: what is the evidence base?

Practical guidelines for the use of FDG PET in the management of lymphoma are given, based on the evidence presented in the previous article. A statement and recommendations are given where appropriate. The recommendations are summarized at the end of the paper.

The role of FDG PET in the management of lymphoma: practical guidelines.

To compare tumor bed (TB) volumes delineated using magnetic resonance imaging plus computed tomography and clips (MRCT) with those delineated using CT and clips (CT/clips) alone in postlumpectomy breast cancer patients positioned prone and to determine the value of MRCT for planning partial breast irradiation (PBI).

Tumor bed delineation for partial breast and breast boost radiotherapy planned in the prone position: what does MRI add to X-ray CT localization of titanium clips placed in the excision cavity wall?

To compare partial-breast clinical target volumes generated using a standard 15 mm margin (CTV(standard)) with those generated using three-dimensional surgical excision margins (CTV(tailored 30)) in women who have undergone wide local excision (WLE) for breast cancer.

How does knowledge of three-dimensional excision margins following breast conservation surgery impact upon clinical target volume definition for partial-breast radiotherapy?

Partial breast irradiation (PBI) is currently under investigation in several phase III trials and, following a recent consensus statement, its use off-study may increase despite ongoing uncertainty regarding optimal target volume definition. We review the clinical, pathological and technical evidence for target volume definition in external beam partial breast irradiation (EB-PBI). The optimal method of tumour bed (TB) delineation requires X-ray CT imaging of implanted excision cavity wall markers. The definition of clinical target volume (CTV) as TB plus concentric 15 mm margins is based on the anatomical distribution of multifocal and multicentric disease around the primary tumour in mastectomy specimens, and the clinical locations of local tumour relapse (LR) after breast conservation surgery. If the majority of LR originate from foci of residual invasive and/or intraduct disease in the vicinity of the TB after complete microscopic resection, CTV margin logically takes account of the position of primary tumour within the surgical resection specimen. The uncertain significance of independent primary tumours as sources of preventable LR, and of wound healing responses in stimulating LR, increases the difficulties in defining optimal CTV. These uncertainties may resolve after long-term follow-up of current PBI trials. By contrast, a commonly used 10mm clinical to planning target volume (PTV) margin has a stronger evidence base, although departmental set-up errors need to be confirmed locally. A CTV-PTV margin >10mm may be required in women with larger breasts and/or large seromas, whilst the role of image-guided radiotherapy with or without TB markers in reducing CTV-PTV margins needs to be explored.

Target volume definition for external beam partial breast radiotherapy: clinical, pathological and technical studies informing current approaches.

To compare non-target tissue (including left-anterior-descending coronary-artery (LAD)) dosimetry of prone versus supine whole (WBI) and partial-breast irradiation (PBI).

Prone versus supine positioning for whole and partial-breast radiotherapy: a comparison of non-target tissue dosimetry.

To test a prone position against the international-standard supine position in women undergoing whole-breast-radiotherapy (WBRT) after wide-local-excision (WLE) of early breast cancer (BC) in terms of feasibility, set-up errors, and respiratory motion.

A randomised trial of supine versus prone breast radiotherapy (SuPr study): comparing set-up errors and respiratory motion.

To assess the role of ipsilateral breast radiotherapy (IBR) in women with occult primary breast cancer presenting with axillary metastases (OPBC).

The role of ipsilateral breast radiotherapy in management of occult primary breast cancer presenting as axillary lymphadenopathy.

To validate and compare the accuracy of breast tissue segmentation methods applied to computed tomography (CT) scans used for radiation therapy planning and to study the effect of tissue distribution on the segmentation accuracy for the purpose of developing models for use in adaptive breast radiation therapy.

Adaptive breast radiation therapy using modeling of tissue mechanics: a breast tissue segmentation study.

To determine whether voluntary deep-inspiratory breath-hold (v_DIBH) and deep-inspiratory breath-hold with the active breathing coordinator™ (ABC_DIBH) in patients undergoing left breast radiotherapy are comparable in terms of normal-tissue sparing, positional reproducibility and feasibility of delivery.

Article	Year
The role of FDG PET in the management of lymphoma: what is the evidence base? Nuclear medicine communications\| PubMed ID: 17414883	2007
The role of FDG PET in the management of lymphoma: practical guidelines. Nuclear medicine communications\| PubMed ID: 17414884	2007
Tumor bed delineation for partial breast and breast boost radiotherapy planned in the prone position: what does MRI add to X-ray CT localization of titanium clips placed in the excision cavi... International journal of radiation oncology, biology, physics\| PubMed ID: 19464816	2009
How does knowledge of three-dimensional excision margins following breast conservation surgery impact upon clinical target volume definition for partial-breast radiotherapy? Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology\| PubMed ID: 19963294	2010
Target volume definition for external beam partial breast radiotherapy: clinical, pathological and technical studies informing current approaches. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology\| PubMed ID: 20080310	2010
Prone versus supine positioning for whole and partial-breast radiotherapy: a comparison of non-target tissue dosimetry. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology\| PubMed ID: 20561695	2010
A randomised trial of supine versus prone breast radiotherapy (SuPr study): comparing set-up errors and respiratory motion. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology\| PubMed ID: 21159397	2011
The role of ipsilateral breast radiotherapy in management of occult primary breast cancer presenting as axillary lymphadenopathy. European journal of cancer (Oxford, England : 1990)\| PubMed ID: 21658935	2011
Adaptive breast radiation therapy using modeling of tissue mechanics: a breast tissue segmentation study. International journal of radiation oncology, biology, physics\| PubMed ID: 22717244	2012
The UK HeartSpare Study: randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology\| PubMed ID: 23726115	2013

Anna M. Kirby

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