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The UK HeartSpare Study (Stage IB): randomised comparison of a voluntary breath-hold technique and prone radiotherapy after breast conserving surgery

The UK HeartSpare Study (Stage IB): randomised comparison of a voluntary breath-hold technique and prone radiotherapy after breast conserving surgery
The UK HeartSpare Study (Stage IB): randomised comparison of a voluntary breath-hold technique and prone radiotherapy after breast conserving surgery
Purpose: to compare mean heart and left anterior descending coronary artery (LAD) doses (NTDmean) and positional reproducibility in larger-breasted women receiving left breast radiotherapy using supine voluntary deep-inspiratory breath-hold (VBH) and free-breathing prone techniques.

Materials and methods: following surgery for early breast cancer, patients with estimated breast volumes >750 cm3 underwent planning-CT scans in supine VBH and free-breathing prone positions. Radiotherapy treatment plans were prepared, and mean heart and LAD doses were calculated. Patients were randomised to receive one technique for fractions 1–7, before switching techniques for fractions 8–15 (40 Gy/15 fractions total). Daily electronic portal imaging and alternate-day cone-beam CT (CBCT) imaging were performed. The primary endpoint was the difference in mean LAD NTDmean between techniques. Population systematic (?) and random errors (?) were estimated. Within-patient comparisons between techniques used Wilcoxon signed-rank tests.

Results: 34 patients were recruited, with complete dosimetric data available for 28. Mean heart and LAD NTDmean doses for VBH and prone treatments respectively were 0.4 and 0.7 (p < 0.001) and 2.9 and 7.8 (p < 0.001). Clip-based CBCT errors for VBH and prone respectively were ?3.0 mm and ?6.5 mm (?) and ?3.5 mm and ?5.4 mm (?).

Conclusions: in larger-breasted women, supine VBH provided superior cardiac sparing and reproducibility than a free-breathing prone position
radiotherapy, breast cancer, cardiac dose, prone, breath-hold
0167-8140
66-72
Bartlett, Frederick R.
ee638f19-6603-4a9b-963a-2a12b2f60dcb
Colgan, Ruth M.
42ca03cf-948b-42e0-961d-a76c07f27202
Donovan, Ellen M.
34ca2855-1873-4324-a76f-e883a6a51647
McNair, Helen A.
5d09a980-3f22-4d51-8615-51da86ef55d6
Carr, Karen
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Evans, Philip M.
0e96781e-fbd3-4253-9c74-660e16079759
Griffin, Clare
e27a692e-dc0e-496b-8880-852a2e91f2a6
Locke, Imogen
ea9f3b84-f732-46f7-8180-664203c4594d
Haviland, Joanne S.
569aa43b-15bd-4e9d-b4a5-e68a84334cfe
Yarnold, John R.
c4c07a04-e800-4763-87a6-baa4ce7f56e0
Kirby, Anna M.
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Bartlett, Frederick R.
ee638f19-6603-4a9b-963a-2a12b2f60dcb
Colgan, Ruth M.
42ca03cf-948b-42e0-961d-a76c07f27202
Donovan, Ellen M.
34ca2855-1873-4324-a76f-e883a6a51647
McNair, Helen A.
5d09a980-3f22-4d51-8615-51da86ef55d6
Carr, Karen
0ab7f492-1c78-41b0-834c-f5e1a6891705
Evans, Philip M.
0e96781e-fbd3-4253-9c74-660e16079759
Griffin, Clare
e27a692e-dc0e-496b-8880-852a2e91f2a6
Locke, Imogen
ea9f3b84-f732-46f7-8180-664203c4594d
Haviland, Joanne S.
569aa43b-15bd-4e9d-b4a5-e68a84334cfe
Yarnold, John R.
c4c07a04-e800-4763-87a6-baa4ce7f56e0
Kirby, Anna M.
18e149ce-178f-4671-9e17-bca9b017ae6e

Bartlett, Frederick R., Colgan, Ruth M., Donovan, Ellen M., McNair, Helen A., Carr, Karen, Evans, Philip M., Griffin, Clare, Locke, Imogen, Haviland, Joanne S., Yarnold, John R. and Kirby, Anna M. (2015) The UK HeartSpare Study (Stage IB): randomised comparison of a voluntary breath-hold technique and prone radiotherapy after breast conserving surgery. Radiotherapy and Oncology, 114 (1), 66-72. (doi:10.1016/j.radonc.2014.11.018).

Record type: Article

Abstract

Purpose: to compare mean heart and left anterior descending coronary artery (LAD) doses (NTDmean) and positional reproducibility in larger-breasted women receiving left breast radiotherapy using supine voluntary deep-inspiratory breath-hold (VBH) and free-breathing prone techniques.

Materials and methods: following surgery for early breast cancer, patients with estimated breast volumes >750 cm3 underwent planning-CT scans in supine VBH and free-breathing prone positions. Radiotherapy treatment plans were prepared, and mean heart and LAD doses were calculated. Patients were randomised to receive one technique for fractions 1–7, before switching techniques for fractions 8–15 (40 Gy/15 fractions total). Daily electronic portal imaging and alternate-day cone-beam CT (CBCT) imaging were performed. The primary endpoint was the difference in mean LAD NTDmean between techniques. Population systematic (?) and random errors (?) were estimated. Within-patient comparisons between techniques used Wilcoxon signed-rank tests.

Results: 34 patients were recruited, with complete dosimetric data available for 28. Mean heart and LAD NTDmean doses for VBH and prone treatments respectively were 0.4 and 0.7 (p < 0.001) and 2.9 and 7.8 (p < 0.001). Clip-based CBCT errors for VBH and prone respectively were ?3.0 mm and ?6.5 mm (?) and ?3.5 mm and ?5.4 mm (?).

Conclusions: in larger-breasted women, supine VBH provided superior cardiac sparing and reproducibility than a free-breathing prone position

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Accepted/In Press date: 11 November 2014
Published date: January 2015
Keywords: radiotherapy, breast cancer, cardiac dose, prone, breath-hold
Organisations: Faculty of Health Sciences

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Local EPrints ID: 378553
URI: http://eprints.soton.ac.uk/id/eprint/378553
ISSN: 0167-8140
PURE UUID: a9001490-319d-49a6-b6f3-2b87798effd5

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Date deposited: 03 Jul 2015 14:20
Last modified: 09 Dec 2019 19:52

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Contributors

Author: Frederick R. Bartlett
Author: Ruth M. Colgan
Author: Ellen M. Donovan
Author: Helen A. McNair
Author: Karen Carr
Author: Philip M. Evans
Author: Clare Griffin
Author: Imogen Locke
Author: Joanne S. Haviland
Author: John R. Yarnold
Author: Anna M. Kirby

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