This phase II trial studies how well deep inspiratory breath hold or prone breast radiation therapy works in reducing cardiac dose in patients with breast cancer or ductal carcinoma in situ. Deep inspiratory breath hold is a technique that involves a patient holding their breath during radiation to move the heart away from the breast to minimize radiation to the heart. Prone breast radiation therapy is a technique in which a patient receives treatment "face-down" to minimize the radiation to the rest of the body, including the heart and lungs. Comparing deep inspiratory breath hold to prone breast radiation therapy may help doctors improve radiation to the target while reducing radiation to healthy tissues surrounding the target.
Patients attend a simulation visit and undergo two CT scans, one in the prone position and one in the supine position with DIBH. Within 1 week after the simulation visit, patients undergo radiation therapy either in the supine position with DIBH or in the prone position daily for 15-30 consecutive days as per physician's prescription
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
40
Undergo RT either in the supine position with DIBH or in the prone position.
Mean cardiac dose
Assess whether the mean cardiac dose in the supine DIBH plan differs from the mean cardiac dose in the prone plan within strata defined by total RT dose.
Time frame: Up to 6 weeks
Volume of heart receiving > 20 gray (Gy)
The volume of heart receiving \>20Gy in DIBH plan vs. prone plan
Time frame: Up to 6 weeks
Mean left anterior descending artery (LAD) dose in DIBH plan vs. prone plan
The mean LAD dose in DIBH plan vs. prone plan
Time frame: Up to 6 weeks
Maximum left anterior descending artery (LAD) dose in DIBH plan vs. prone plan
The maximum LAD dose in DIBH plan vs. prone plan
Time frame: Up to 6 weeks
Mean ipsilateral lung dose
The mean ipsilateral lung dose in DIBH plan vs. prone plan
Time frame: Up to 6 weeks
Volume of ipsilateral lung receiving > 20Gy
The volume of ipsilateral lung receiving \>20Gy in DIBH plan vs. prone plan
Time frame: Up to 6 weeks
Volume of the contralateral breast receiving > 5 Gy
The volume of the contralateral breast receiving \>5Gy in DIBH plan vs. prone plan
Time frame: Up to 6 weeks
Maximum point dose to planning target volume (PTV) breast
The maximum point dose to PTV breast in DIBH plan vs. prone plan
Time frame: Up to 6 weeks
Maximum separation
The maximum separation in DIBH plan vs. prone plan
Time frame: Up to 6 weeks
Distance from the mid-sternum to the nipple when the patient is in the prone position
Distance from the mid-sternum to the nipple when the patient is in the prone position
Time frame: Up to 6 weeks
PTV breast volume as calculated on the prone scan
PTV breast volume as calculated on the prone scan
Time frame: Up to 6 weeks
Change in distance between the chest wall and heart (at the most lateral portion of the chest-wall-heart interface)
The change in distance between the chest wall and heart (at the most lateral portion of the chestwall-heart interface) between the free breathing scout films and the DIBH scout films
Time frame: Up to 6 weeks
Patient treatment plan (supine with DIBH or prone)
Will be described by proportions and frequency distributions. Logistic regression will be used to assess how each of the covariates (primary and secondary endpoints) affects the probability of being selected to undergo RT using the supine DIBH plan. ROC curves will be generated for various cut-points of the true proportion of patients requiring the supine DIBH plan.
Time frame: Up to 6 weeks
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