الفهرس 
Aim of the workOnly 14 pages are availabe for public view
 |  | from | 83 |  |  |
| | | from | 83 | | |
Abstract
Breast cancer is a heterogeneous disease with different types, histopathology, molecular classifications and different biological features that affect the outcome and response to treatment. According to the heterogeneity of breast cancer, there are multiple modalities in its management according to multiple determinant factors such as age, stage, grade, nodal status, hormonal status and molecular subtypes.
The role of radiotherapy in adjuvant setting in breast cancer is very important to reduce the loco-regional recurrences and improve patient survival.
Left-sided breast and chest wall radiotherapy results in a considerable dose to OAR.
Voluntary DIBH technique is a simple method to overcome the toxicity to OAR specially the heart and the left lung.
This is a prospective comparative study that was carried out at clinical oncology department in menoufia university hospitals from March 2018 till March 2020 with median follow up period 22 months for a sample of patients with left sided breast cancer.
Each patient was simulated in both FB and vDIBH to assess the doses received by heart and left lung and compare between them without affecting PTV coverage and follow up of the patient’s positional reproducibility during the radiotherapy fractions to assess the efficacy of vDIBH.
The study included 65 left sided breast cancer women the mean age of them was 42.8 years (±SD10.1), 15.4 % with stage I, 20% with stage II and 64.6% with stage III breast cancer. Fourty eight patients underwent modified radical mastectomy and received post-mastectomy chest wall radiotherapy and seventeen patients underwent conservative breast surgery and received whole breast radiotherapy. The comparing result shows there is a significant reduction in ipsilateral lung and heart dose statistics for vDIBH compared to FB plans without compromising the target coverage. For ipsilateral lung, the V20 was reduced by 34.5 % with vDIBH comparing with FB. The volume of the heart receiving >25 Gy was reduced 60% and MHD was reduced by 62.9%. These reductions are considered to be statistically significant. The vDIBH mean reproducibility was 0.47 cm (±SD=0.23) ranging from 0.10 – 1.04 cm in superior/inferior direction, 0.43 (±SD=0.22) ranging from 0.10 – 0.95 cm in right/ left direction, 0.46 cm (±SD=0.22) ranging from 0.10 – 0.97 cm in antro/posterior position and with rotation 0.38 cm (±SD=0.23) ranging from 0.02 – 0.88 cm. Voluntary DIBH technique is successfully implemented and is an important tool for cardiac sparing and has been reproducibly associated with a reduction of mean heart dose. This is a benefit for those patients with left-sided breast irradiation and also has been shown to decrease dose to the lungs with also acceptable treatment related toxicities.
On following up the toxicity and the efficacy of the technique we found that there were accepted toxicities as there was no grade III or IV toxicities and also that was associated with good local and distant control of the disease.