Key insights

• ⚛️ Regional lymph node irradiation has demonstrated clear benefits in reducing recurrence and mortality in post mastectomy breast cancer patients.
• 📊 Trend towards more frequent inclusion of regional node irradiation in breast treatment planning, with a focus on beam design and minimizing lung and heart dose.
• ⚔️ Debate within the radiation oncology community regarding regional node irradiation inclusion.
• 🎯 Focus on beam design in breast treatment planning, emphasizing minimizing lung and heart dose in left-sided breast and chest wall cases with deep inspiration breath hold technique.
• 💗 DIBH technique at MD Anderson's main campus results in significant displacement of the heart, leading to better dose volume parameters for the heart during treatment.
• 🫁 Comparison of heart and lung doses for radiation therapy patients, showing lower doses for patients in deep inspiration breath hold.
• 📹 Discussion of heart position changes in deep inspiration, lung volume differences in CT scans, and field design for regional node irradiation in breast cancer treatment.
• 🔄 Consideration of gantry angle for comprehensive treatment to accommodate IMC field, breast tissue thickness, and anatomy.

Q&A

• What are the primary techniques used for energy modulation in breast cancer treatment?

  The institution primarily uses field and field technique for energy modulation of tangent beams. Energy selection is based on patient separation, with 6MV for open fields and 18MV for larger patients. Wedges are used for steeply peaked breasts or deep tumor beds, and the step and shoot technique is preferred to keep the number of fields low.

• What considerations are involved in creating tangents for comprehensive treatment?

  When creating tangents for comprehensive treatment, the gantry angle needs to accommodate the IMC field and consider the breast tissue's thickness and anatomy. The energy of the electron is dependent on depth, and the angle selection aims to achieve electronic equilibrium while minimizing lung exposure and tissue thickness variation.

• What aspects are discussed in the video regarding breast cancer treatment?

  The video discusses changes in heart position during deep inspiration, lung volume differences in CT scans, and field design for regional node irradiation in breast cancer treatment.

• What differences in lung volume and corresponding dose parameters were observed in the comparison of heart and lung doses for patients undergoing radiation therapy?

  The comparison revealed lower doses for patients in deep inspiration breath hold. Lung volume increases during deep inspiration breath hold, resulting in lower percent lung volume receiving doses. Left-sided and right-sided cases show significant differences in lung volume and corresponding dose parameters.

• What are the benefits of the Deep Inspiratory Breath Hold (DIBH) technique?

  DIBH results in significant displacement of the heart, leading to better dose volume parameters for the heart during treatment.

• How are breast cancer patients at MD Anderson's main campus treated?

  Breast cancer patients at MD Anderson's main campus are treated using the Deep Inspiratory Breath Hold (DIBH) technique, which has been implemented about 10 years ago. It is used on almost all left-sided breast cancer patients and a small percentage of right-sided patients.

• What is the focus of breast treatment planning regarding regional node irradiation?

  There is a trend towards more frequent inclusion of regional node irradiation in breast treatment planning, with a focus on beam design and minimizing lung and heart dose.

• What are the benefits of regional lymph node irradiation in post mastectomy breast cancer patients?

  Regional lymph node irradiation has demonstrated clear benefits in reducing recurrence and mortality in post mastectomy breast cancer patients.

• 00:02 Regional lymph node irradiation has demonstrated clear benefits in reducing recurrence and mortality in post mastectomy breast cancer patients. There's a trend towards more frequent inclusion of regional node irradiation in breast treatment planning, with a focus on beam design and minimizing lung and heart dose.
• 01:53 Breast cancer patients at MD Anderson's main campus are treated using the Deep Inspiratory Breath Hold (DIBH) technique, which was implemented about 10 years ago. It is used on almost all left-sided breast cancer patients and a small percentage of right-sided patients. DIBH results in significant displacement of the heart, leading to better dose volume parameters for the heart during treatment.
• 03:32 A comparison of heart and lung doses for patients undergoing radiation therapy, showing lower doses for those in deep inspiration breath hold. Lung volume increases during deep inspiration breath hold, resulting in lower percent lung volume receiving doses. Left-sided and right-sided cases show significant differences in lung volume and corresponding dose parameters.
• 05:23 The video discusses changes in heart position during deep inspiration, lung volume differences in CT scans, and field design for regional node irradiation in breast cancer treatment.
• 07:43 When creating tangents for comprehensive treatment, the gantry angle needs to accommodate the IMC field and consider the breast tissue's thickness and anatomy. The energy of the electron is dependent on depth, and the angle selection aims to achieve electronic equilibrium while minimizing lung exposure and tissue thickness variation.
• 09:23 The institution primarily uses field and field technique for energy modulation of tangent beams. Energy selection is based on patient separation, with 6MV for open fields and 18MV for larger patients. Wedges are used for steeply peaked breasts or deep tumor beds, and the step and shoot technique is preferred to keep the number of fields low.