Motion management in breast cancer & Quantum of benefit BY DR KANHU

Motion management in breast cancer & Quantum of benefit BY DR KANHU

1. Motion management in breast cancer & Quantum of benefit 1

2. SLOW MY FLOW NEED OF MOTION MANAGEMENT TYPES OF MOTION MANAGEMENT QUANTUM OF BENEFIT

3. 9/13/2024 3

4. CARDIAC CHESTWALL SEPARATION

5. SIMULATION

6. SIMULATION WITH HEXAPOD

7. OPTIONS AVAILABLE VOLUNTARY BREATH HOLD ABC RPM SGRT

8. VOLUNTARY BREATH HOLD USING WIRELESS DOOR BELL

9. ELEKTA ABC Active breath coordinator Based on breath hold During breath hold treatment Works like spirometry Needs good lung function 9/13/2024 10

10. Nose and mouth peiece 9/13/2024 12

11. Elekta ABC

12. Green is the beam on 9/13/2024 14

13. VARIAN RPM REAL TIME POSITIONING MANAGEMENT AMPLITUDE BASED 9/13/2024 15

14. RPM

15. 9/13/2024 17

16. Varian RPM gating synchronization

17. Camera based gating 9/13/2024 19

18. Vision RT- SGRT - GATE RT 9/13/2024 20

19. QUANTUM OF BENEFIT 9/13/2024 22

20. Introduction

21. Radiation exposure to heart during thoracic RT

22. Disease manifestations

23. Sarah C Darby

24. Conclusion The overall average of the mean doses to the whole heart was 4.9 Gy (range, 0.03 to 27.72). Rates of major coronary events increased linearly with the mean dose to the heart by 7.4% per Gray (95% confidence interval, 2.9 to 14.5; P.0001 With no apparent threshold. The increase started within the first 5 years after radiotherapy and continued into the third decade after radiotherapy. The proportional increase in the rate of major coronary events per gray was similar in women with and women without cardiac risk factors at the time of radiotherapy Exposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent rate of ischemic heart disease. The increase is proportional to the mean dose to the heart, begins within a few years after exposure, and continues for at least 20 years. Women with preexisting cardiac risk factors have greater absolute increases in risk from radiotherapy than other women

25. Kathryn Ban fi ll / Journal of Thoracic Oncology/2020 POST HOC ANALYSIS

26. Hallmarks of RIHD

27. Etiopathogenesis

28. VASCULAR CHANGE

29. PERICARDIUM CHANGE

30. MYOCARDIAL CHANGE

31. POST RT PERFUSION DEFECT

32. Manifestations

33. QUANTEC DATA Qualitative Analyses of Normal Tissue Effects in the Clinic QUANTEC recommended that the volume of heart receiving greater than or equal to 30 Gy (V30) should be kept below 46% MHD less than 15 Gy Fi rst time that the risk of MACE (de fi ned as MI, coronary revascularization, or death from IHD) in breast cancer survivors increases in a linear relationship to cardiac radiation dose, even at low-dose levels. The rate of MACE increased by 7.4% per one gray increase in MHD in this cohort of patients

34. Contouring and planning implementations Frances Duane ET AL /GREEN/2017

35. Constraint Recommendations

36. Screening recommendations COG ESMO ASCO

37. ICOS RECCOMENDATIONS

38. DIBH APBI IMRT DIBH + IMRT

39. Cardiac sparing techniques

40. DIBH - DEEP INSPIRATORY BREATHHOLD

41. SUMMARY We have to adopt the technology Definitely it improves the therapeutic ratio DIBH is a established technique Cardiac sparing to be practiced whenever possible.

42. Conclusion

43. WISH YOU A GOOD HEART

44. Prone breast radiation

45. Proton breast RT

46. Electron chest wall RT

47. Planning technique 10 left-sided postmastectomy patients with very challenging anatomy were selected for this dosimetry study. The enface electron fields were designed from a single isocenter and gantry angle with different energy beams using different cutouts that matched on the skin. Smaller energy was used in the central thin chest wall part and higher energy in the medial internal mammary nodes (IMN) area, superior part of the thick chest wall, and/or Axilla area. The electron fields were matched to the photon supra-clavicular field in the superior region. Daily field junctions were used to feather the match lines between all the fields. Electron field dose calculations were done with Monte Carlo

48. The electron chest wall irradiation technique using electron Monte Carlo dose algorithm can provide adequate dose coverage to the chest wall, IMNs and/or Axilla nodes while achieving heart sparing with acceptable ipsilateral lung dose, minimal contralateral lung and breast dose.

49. APBI-INTERSTITIAL BRACHY

50. Intraoperative

51. 3DCRT AND IMRT

52. Balloon based brachy

53. Comparison of the current available APBI techniques

54. RANDOMIZED TRIALS IN APBI TECHNIQUES

55. Cardiac sparing with APBI

56. RECOMMENDATIONS FOR BREAST APBI

57. APBI MC-APBI for left-sided BC demonstrate that MC-APBI delivers a low dose to both the heart and LAD. Especially in women with favorable anatomic and pathologic features, MC-APBI is a safe, convenient, and effective mode of radiation delivery