TY - JOUR AB - The aim of the study was to analyze the interinstitutional differences in the planning process/approach of regional nodal irradiation (RNI) in breast cancer patients in expert centres. Based on a predefined risk constellation, the left breast and the axillary, periclavicular and internal mammarian lymph node areas had to be irradiated. The study focused on left-sided RNI. One CT dataset (free breathing) each of a regular (R) adipose (A) and a slender patient (S) were centrally selected and all target volumes (CTV: level II, III, IV + internal mammary artery chain region-IMC, left breast, PTV and OARs) were contoured according to the ESTRO recommendations. A total dose of 50.4/1.8 Gy was set as the dosage with free choice of technique/inclinic constraints. Dose files were analyzed centrally as DICOM files (CTV: D95%, D50%, D1% and V95%; OAR: D1%, Dmean, V20Gy, V30Gy, V40Gy and the absolute V95% of normal tissue outside the PTV). A total of 18 data sets were analyzed. Differences of almost 10 Gy in TV coverage were significant (p < 0.05). This was evident between patients e.g., for CTV_IMC D95%/D50% S:47.1Gy ± 1.9/50.1Gy ± 0.6; R:39.4Gy ± 8.4/47.6Gy ± 4; A:38.3Gy ± 10.4/47.9Gy ± 4.4) and PTV_IMA D95%/D50% (S:37.6Gy ± 3.9/49.7Gy ± 0.8; R:27.9Gy ± 7.8/46.9Gy ± 3.3; A:25.6Gy ± 9.7/47.5Gy ± 2.8). Patient-related dose differences were also significant for OAR`s: Dmean heart (S:4.6Gy ± 1.1; N:6.1Gy ± 1.2; A:7.9Gy ± 2.1), humeral head (S:8.3Gy ± 2.7; N:3.8Gy ± 0.7; A:6.4Gy ± 1.7), and thyroid (S:17.7Gy ± 2.7; N:14.3Gy ± 1.6; A:27.9Gy ± 4.5). Patient anatomical factors and institutional planning differences create significant dosimetric variations in breast cancer radiation therapy, emphasizing the need for personalized planning approaches that incorporate patient-specific constraints and age-dependent risk considerations. AU - Duma, M.N.* AU - Borm, K. AU - Hehr, T.* AU - Piroth, M.D.* AU - Gerd, F.* AU - Baumann, R.* AU - Combs, S.E. AU - Corradini, S.* AU - Dunst, J.* AU - Krug, D.* AU - Hörner-Rieber, J.* AU - Matuschek, C.* AU - Schmeel, L.C.* AU - Fietkau, R.* AU - Strnad, V.* AU - Budach, W.* C1 - 75930 C2 - 58200 TI - Regional nodal irradiation in breast cancer patients: A treatment planning study of the breast cancer working group of the German society of radiation oncology. JO - Med. Dosim. PY - 2025 SN - 0958-3947 ER - TY - JOUR AB - The purpose of this study was to investigate the impact of deep inspiration breath hold (DIBH) on the positioning of thoracic structures and provide treatment planning recommendations for internal mammary chain (IMC) irradiation in breast cancer patients. Thirty-two breast cancer patients from our database underwent both DIBH and free breathing (FB) treatment planning. Contouring of the axillary lymph node clinical target volumes (CTVs: level I, II, III, IV, and IMC according to ESTRO), the internal mammary artery (IMA), the heart, and the left anterior descending artery (LAD) was performed. The following were then analyzed: the distance between the IMA and the heart, the craniocaudal distance in which IMC-CTV and heart coexist, the craniocaudal distance between the lower end of the of level III and IV and the upper end of the heart. Several significant geometric differences were observed between DIBH and FB that explain the efficacy of the DIBH for regional nodal irradiation. In >80% of patients the cranial origin of the LAD lies below the lower edge of the IMC-CTV in DIBH. In addition the slices in which the heart/LAD and IMC-CTV coexist decrease during DIBH. The IMA-heart distance is significantly larger in DIBH. Also the craniocaudal distance between the lower border of the CTV level III and IV and the upper border of the heart is larger in DIBH. The observed mechanisms during DIBH contribute significantly to the dose reduction in regional nodal irradiation. To further enhance the benefits of DIBH for the irradiation of the IMC-CTV, it is recommended to implement steep dose gradients in the caudal plane. AU - Völk, F.* AU - Borm, K.J.* AU - Düsberg, M.* AU - Combs, S.E. AU - Knippen, S.* AU - Duma, M.* C1 - 68270 C2 - 54760 CY - Ste 800, 230 Park Ave, New York, Ny 10169 Usa SP - 299-303 TI - Regional nodal irradiation in breast cancer patients: Effects of deep inspiration breath hold on the internal mammary chain location. JO - Med. Dosim. VL - 48 IS - 4 PB - Elsevier Science Inc PY - 2023 SN - 0958-3947 ER - TY - JOUR AB - The aim of this study was to understand the practice of care in German-speaking countries with regard to heart-sparing radiotherapy techniques. Between August 2015 and September 2015, an e-mail/fax-based survey was sent to radiation oncology departments in Germany, Austria, and the German-speaking Switzerland. The questionnaire was divided into 3 chapters: a general chapter on the department, a chapter specific for heart-sparing techniques in patients with breast cancer, and a third chapter on personal beliefs on the topic of heart sparing in patients with breast cancer. A total of 82 radiation oncology departments answered the questionnaire: 16 university clinics and 66 other departments. In general, heart-sparing techniques are being offered by 90.2% of departments for radiation oncology in the German-speaking countries. However, in the clinical routine, 87.7% of institutions use heart-sparing techniques in less than 50% of patients with breast cancer. Heart-sparing techniques are especially provided for patients with left-sided breast cancer (80%), patients after mastectomy (52.5%), and when the mammaria interna lymph drainage vessels are irradiated (41.3%). In 46.3% of departments, there are written internal guidelines for heart sparing in patients with breast cancer. Breathing-adapted radiotherapy is used as the most frequent heart-sparing technique in 64.7% of the institutions, followed by intensity-modulated radiation therapy, which is most frequently used by 22.1%. The only significant difference between university hospitals and other departments was seen for the offering of partial breast irradiation. The most commonly used heart-sparing technique is breathing-adapted radiotherapy, but there is no coherent approach for heart sparing in patients with breast cancer in the German-speaking countries. Overall, all options for cardiac protection/cardiac avoidance have their advantages and disadvantages, with deep inspiration breath-hold radiotherapyhaving the most clear data, which should be the preferred choice when using heart-sparing techniques. AU - Duma, M.N. AU - Münch, S.* AU - Oechsner, M.* AU - Combs, S.E. C1 - 51122 C2 - 43069 CY - New York SP - 197-202 TI - Heart-sparing radiotherapy in patients with breast cancer: What are the techniques used in the clinical routine?: A pattern of practice survey in the German-speaking countries. JO - Med. Dosim. VL - 42 IS - 3 PB - Elsevier Science Inc PY - 2017 SN - 0958-3947 ER -