Benefit of respiratory gating in the Danish Breast Cancer Group partial breast irradiation trial

Kristine W. Høgsbjerg; Else Maae; Mette H. Nielsen; Lars Stenbygaard; Anders N. Pedersen; Esben Yates; Martin Berg; Ebbe L. Lorenzen; Ingelise Jensen; Mirjana Josipovic; Mette S. Thomsen; Birgitte V. Offersen

doi:10.1016/j.radonc.2024.110195

Benefit of respiratory gating in the Danish Breast Cancer Group partial breast irradiation trial

Kristine W. Høgsbjerg, Else Maae, Mette H. Nielsen, Lars Stenbygaard, Anders N. Pedersen, Esben Yates, Martin Berg, Ebbe L. Lorenzen, Ingelise Jensen, Mirjana Josipovic, Mette S. Thomsen, Birgitte V. Offersen

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Abstract

Background and purpose: Partial breast irradiation (PBI)has beenthe Danish Breast Cancer Group(DBCG) standard for selected breast cancer patients since 2016 based onearlyresults from the DBCG PBI trial.During trial accrual, respiratory-gated radiotherapy was introduced in Denmark. This study aims to investigate the effect of respiratory-gating on mean heart dose (MHD).

Patients and methods: From 2009 to 2016 the DBCG PBI trial included 230 patientswith left-sided breast cancer receiving external beam PBI, 40 Gy/15 fractions/3 weeks.Localization of the tumor bed on the planning CT scan, the use of respiratory-gating, coverage of the clinical target volume (CTV), and doses to organs at risk were collected.

Results: Respiratory-gating was used in 123 patients (53 %). In 176 patients (77 %) the tumor bed was in the upper and in 54 patients (23 %) in the lower breast quadrants. The median MHD was 0.37 Gy (interquartile range 0.26-0.57 Gy), 0.33 Gy (0.23-0.49 Gy) for respiratory-gating, and 0.49 Gy (0.31-0.70 Gy) for free breathing, p < 0.0001. MHD was < 1 Gy in 206 patients (90 %) and < 2 Gy in 221 patients (96 %). Respiratory-gating led to significantly lower MHD for upper-located, but not for lower-located tumor beds, however, all MHD were low irrespective of respiratory-gating. Respiratory-gating did not improve CTV coverage or lower lung doses.

Conclusions: PBI ensured a low MHD for most patients. Adding respiratory-gating further reduced MHD for upper-located but not for lower-located tumor beds but did not influence target coverage or lung doses. Respiratory-gating is no longer DBCG standard for left-sided PBI.

Original language	English
Article number	110195
Journal	Radiotherapy and Oncology
Volume	194
Number of pages	6
ISSN	0167-8140
DOIs	https://doi.org/10.1016/j.radonc.2024.110195
Publication status	Published - May 2024

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10.1016/j.radonc.2024.110195Licence: CC BY 4.0

Høgsbjerg et al. (2024). Benefit of respiratory gating in the Danish Breast Cancer Group partial breast irradiation trialFinal published version, 1.64 MBLicence: CC BY 4.0

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Høgsbjerg, K. W., Maae, E., Nielsen, M. H., Stenbygaard, L., Pedersen, A. N., Yates, E., Berg, M., Lorenzen, E. L., Jensen, I., Josipovic, M., Thomsen, M. S., & Offersen, B. V. (2024). Benefit of respiratory gating in the Danish Breast Cancer Group partial breast irradiation trial. Radiotherapy and Oncology, 194, Article 110195. https://doi.org/10.1016/j.radonc.2024.110195

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title = "Benefit of respiratory gating in the Danish Breast Cancer Group partial breast irradiation trial",

abstract = "Background and purpose: Partial breast irradiation (PBI)has beenthe Danish Breast Cancer Group(DBCG) standard for selected breast cancer patients since 2016 based onearlyresults from the DBCG PBI trial.During trial accrual, respiratory-gated radiotherapy was introduced in Denmark. This study aims to investigate the effect of respiratory-gating on mean heart dose (MHD).Patients and methods: From 2009 to 2016 the DBCG PBI trial included 230 patientswith left-sided breast cancer receiving external beam PBI, 40 Gy/15 fractions/3 weeks.Localization of the tumor bed on the planning CT scan, the use of respiratory-gating, coverage of the clinical target volume (CTV), and doses to organs at risk were collected.Results: Respiratory-gating was used in 123 patients (53 %). In 176 patients (77 %) the tumor bed was in the upper and in 54 patients (23 %) in the lower breast quadrants. The median MHD was 0.37 Gy (interquartile range 0.26-0.57 Gy), 0.33 Gy (0.23-0.49 Gy) for respiratory-gating, and 0.49 Gy (0.31-0.70 Gy) for free breathing, p < 0.0001. MHD was < 1 Gy in 206 patients (90 %) and < 2 Gy in 221 patients (96 %). Respiratory-gating led to significantly lower MHD for upper-located, but not for lower-located tumor beds, however, all MHD were low irrespective of respiratory-gating. Respiratory-gating did not improve CTV coverage or lower lung doses.Conclusions: PBI ensured a low MHD for most patients. Adding respiratory-gating further reduced MHD for upper-located but not for lower-located tumor beds but did not influence target coverage or lung doses. Respiratory-gating is no longer DBCG standard for left-sided PBI.",

author = "H{\o}gsbjerg, {Kristine W.} and Else Maae and Nielsen, {Mette H.} and Lars Stenbygaard and Pedersen, {Anders N.} and Esben Yates and Martin Berg and Lorenzen, {Ebbe L.} and Ingelise Jensen and Mirjana Josipovic and Thomsen, {Mette S.} and Offersen, {Birgitte V.}",

year = "2024",

month = may,

doi = "10.1016/j.radonc.2024.110195",

language = "English",

volume = "194",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

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T1 - Benefit of respiratory gating in the Danish Breast Cancer Group partial breast irradiation trial

AU - Høgsbjerg, Kristine W.

AU - Maae, Else

AU - Nielsen, Mette H.

AU - Stenbygaard, Lars

AU - Pedersen, Anders N.

AU - Yates, Esben

AU - Berg, Martin

AU - Lorenzen, Ebbe L.

AU - Jensen, Ingelise

AU - Josipovic, Mirjana

AU - Thomsen, Mette S.

AU - Offersen, Birgitte V.

PY - 2024/5

Y1 - 2024/5

N2 - Background and purpose: Partial breast irradiation (PBI)has beenthe Danish Breast Cancer Group(DBCG) standard for selected breast cancer patients since 2016 based onearlyresults from the DBCG PBI trial.During trial accrual, respiratory-gated radiotherapy was introduced in Denmark. This study aims to investigate the effect of respiratory-gating on mean heart dose (MHD).Patients and methods: From 2009 to 2016 the DBCG PBI trial included 230 patientswith left-sided breast cancer receiving external beam PBI, 40 Gy/15 fractions/3 weeks.Localization of the tumor bed on the planning CT scan, the use of respiratory-gating, coverage of the clinical target volume (CTV), and doses to organs at risk were collected.Results: Respiratory-gating was used in 123 patients (53 %). In 176 patients (77 %) the tumor bed was in the upper and in 54 patients (23 %) in the lower breast quadrants. The median MHD was 0.37 Gy (interquartile range 0.26-0.57 Gy), 0.33 Gy (0.23-0.49 Gy) for respiratory-gating, and 0.49 Gy (0.31-0.70 Gy) for free breathing, p < 0.0001. MHD was < 1 Gy in 206 patients (90 %) and < 2 Gy in 221 patients (96 %). Respiratory-gating led to significantly lower MHD for upper-located, but not for lower-located tumor beds, however, all MHD were low irrespective of respiratory-gating. Respiratory-gating did not improve CTV coverage or lower lung doses.Conclusions: PBI ensured a low MHD for most patients. Adding respiratory-gating further reduced MHD for upper-located but not for lower-located tumor beds but did not influence target coverage or lung doses. Respiratory-gating is no longer DBCG standard for left-sided PBI.

AB - Background and purpose: Partial breast irradiation (PBI)has beenthe Danish Breast Cancer Group(DBCG) standard for selected breast cancer patients since 2016 based onearlyresults from the DBCG PBI trial.During trial accrual, respiratory-gated radiotherapy was introduced in Denmark. This study aims to investigate the effect of respiratory-gating on mean heart dose (MHD).Patients and methods: From 2009 to 2016 the DBCG PBI trial included 230 patientswith left-sided breast cancer receiving external beam PBI, 40 Gy/15 fractions/3 weeks.Localization of the tumor bed on the planning CT scan, the use of respiratory-gating, coverage of the clinical target volume (CTV), and doses to organs at risk were collected.Results: Respiratory-gating was used in 123 patients (53 %). In 176 patients (77 %) the tumor bed was in the upper and in 54 patients (23 %) in the lower breast quadrants. The median MHD was 0.37 Gy (interquartile range 0.26-0.57 Gy), 0.33 Gy (0.23-0.49 Gy) for respiratory-gating, and 0.49 Gy (0.31-0.70 Gy) for free breathing, p < 0.0001. MHD was < 1 Gy in 206 patients (90 %) and < 2 Gy in 221 patients (96 %). Respiratory-gating led to significantly lower MHD for upper-located, but not for lower-located tumor beds, however, all MHD were low irrespective of respiratory-gating. Respiratory-gating did not improve CTV coverage or lower lung doses.Conclusions: PBI ensured a low MHD for most patients. Adding respiratory-gating further reduced MHD for upper-located but not for lower-located tumor beds but did not influence target coverage or lung doses. Respiratory-gating is no longer DBCG standard for left-sided PBI.

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U2 - 10.1016/j.radonc.2024.110195

DO - 10.1016/j.radonc.2024.110195

M3 - Journal article

C2 - 38442840

SN - 0167-8140

VL - 194

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

M1 - 110195

ER -

Benefit of respiratory gating in the Danish Breast Cancer Group partial breast irradiation trial

Abstract

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