During breast cancer radiation therapy, the heart can receive a significant dose of radiation. To reduce this, patients are treated while holding their breath, also known as Deep Inspiration Breath Hold (DIBH). Read how Professor Joerg Lehmann has successfully developed a first ever monitoring system to continuously and directly measure DIBH to assure optimal radiation delivery to patients.
Breast cancer is the 2nd most commonly diagnosed cancer in Australia, and over 50% of patients receive radiation therapy as part of their treatment1.
For Professor Joerg Lehmann, cancer has always been at the heart of his research interest and applying his technical skills to improve patient care was, to him, the easiest step he took in his career as a radiation oncology medical physicist.
.jpg)
Looking at the cure rates for breast cancer in Australia, Professor Lehmann began to consider how he could improve treatments while simultaneously looking at both the health of the patient at present and into the future.
‘A harm caused by radiation therapy to the chest area of breast cancer patients is unwanted radiation to the heart which can increase the risk of major coronary events. We’re not trying to treat the heart, it just happens to be there and so I thought, how can we minimise this?’ said Professor Lehmann.
Holding breath during breast radiotherapy, commonly referred to as treating under DIBH, effectively shifts the heart away from the area being treated and reduces the radiation dose to the heart.
Delving deeper, Professor Lehmann and his research team aimed to develop an effective method to directly monitor the internal anatomy of the patient during DIBH radiotherapy treatments, overcoming a limitation of current commercial methods that monitor external surrogates.
Professor Lehmann’s method of real time monitoring of breast radiotherapy allows physicians to target the radiation precisely at the breast tissue and to monitor that the patient remains in the correct breath hold position throughout their treatment. As a result of this increased accuracy, patients can be assured that their treatment is given correctly and consequently reduces the risk of developing heart disease.
The benefits of this method and its increased accuracy extend to reduced treatment sessions for the patient which has positive impacts on the healthcare system by increasing capacity, reducing costs, and reaching more people who live in rural and remote communities – a problem that Professor Lehmann is hoping to address.
‘If patients can be treated more accurately during a shorter timeframe, it is likely we can help more patients from rural and remote areas. Radiotherapy rounds can take weeks but if we can get it done in days, these patients who are considered to be at a disadvantage will benefit,’ said Professor Lehmann.
Professor Lehmann hopes that by continuing this research, the increased treatment accuracy will lead to improved health outcomes for patients treated with breast radiation therapy in Australia by lowering side effects and possibly improving cure rates.
Next steps
Professor Lehmann’s work will expand on LEILA2 to also support more advanced radiotherapy delivery to improve outcomes for breast cancer patients. Working with colleagues at radiotherapy clinics in both New South Wales and at the Peter MacCallum Cancer Centre in Melbourne, Professor Lehmann aims to run further studies with LEILA, gathering feedback and comparing the performance of different DIBH monitoring methods. He has also been approached to work with a startup company to bring this concept to a reality to improve health outcomes for patients treated with breast radiotherapy worldwide.
Chief Investigator: Professor Joerg Lehmann
Administering Institution: Calvary Mater Newcastle | University of Newcastle
Team members:
- Professor Peter Greer
- Dr Elena Vasina
- Professor David Thwaites
- Dr Fiona Hegi-Johnson
- Associate Professor Peter Graham
- Mr Jose Antonio Baeza-Ortega
- Dr Jane Ludbrook
Grant: Project Grant
Year: 2017–2022
Funding amount: $417,138
1 Shack, L., et al. 2017. Determining the need and utilization of radiotherapy in cancers of the breast, cervix, lung, prostate and rectum: A population level study. Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol. 122, 152–158. https://doi.org/10.1016/j.radonc.2016.12.006
2 Live electronic portal imaging device (EPID) based Inspiration Level Assessment (LEILA) system is a real time verification system, utilising EPID images to monitor internal anatomy during DIBH breast radiotherapy.