Journal Article10.5603/rpor.a2023.0027
Deep inspiration breath hold: dosimetric benefits to decrease cardiac dose during postoperative radiation therapy for breast cancer patients
Fabiana Accioli Miranda Degrande,Gustavo Nader Marta,Tahira P. Alves,Gustavo Zanna Ferreira,Fábio Vinicius Dumaszak,Heloísa A. Carvalho,SA Hanna +6 more
TL;DR: Deep inspiration breath hold (DIBH) reduces irradiated cardiac and LAD dose compared to free breathing (FB) treatment in patients with left breast cancer.
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Abstract: Background: Postoperative radiation therapy (RT) is the standard treatment for almost all patients diagnosed with breast cancer. Even with modern RT techniques, parts of the heart may still receive higher doses than those recommended by clinically validated dose limit restrictions, especially when the left breast is irradiated. Deep inspiration breath hold (DIBH) may reduce irradiated cardiac volume compared to free breathing (FB) treatment. This study aimed to evaluate the dosimetric impact on the heart and left anterior descending coronary artery (LAD) in FB and DIBH RT planning in patients with left breast cancer. Materials and methods: A retrospective cohort study of women diagnosed with left-sided breast cancer submitted to breast surgery followed by postoperative RT from 2015 to 2019. All patients were planned with FB and DIBH and hypofractionated dose prescription (40.05 Gy in 15 fractions). Results: 68 patients were included in the study. For the coverage of the planned target volume evaluation [planning target volume (PTV) eval] there was no significant difference between the DIBH versus FB planning. For the heart and LAD parameters, all constraints evaluated favored DIBH planning, with statistical significance. Regarding the heart, median V16.8 Gy was 2.56% in FB vs. 0% in DIBH (p < 0.001); median V8.8 Gy was 3.47% in FB vs. 0% in DIBH (p < 0.001) and the median of mean heart dose was 1.97 Gy in FB vs. 0.92 Gy in DIBH (p < 0.001). For the LAD constraints D2% < 42 Gy, the median dose was 34.87 Gy in FB versus 5.8 Gy in DIBH (p < 0.001); V16.8 Gy < 10%, the median was 15.87% in FB versus 0% in DIBH (p < 0.001) and the median of mean LAD dose was 8.13Gy in FB versus 2.92Gy in DIBH (p < 0.001). Conclusions: The DIBH technique has consistently demonstrated a significant dose reduction in the heart and LAD in all evaluated constraints, while keeping the same dose coverage in the PTV eval.
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Figures
Figure 3. Radiotherapy (RT) planning with free breathing (FB) versus deep inspiration breath hold (DIBH) ofthe same patient, demonstrating the importance of the distance between the chest wall and the heart 
Figure 1. Heart and left anterior descending coronary artery (LAD) parameters had a difference with statistical significance in favor of deep inspiration breath hold (DIBH) planning 
Figure 2. Mean heart dose of the 68 patients in free breathing (FB) and deep inspiration breath hold (DIBH) 
Figure 4. Dose-volume histogram demonstrates the reduction of doses to the heart and left anterior descending coronary artery (LAD) in deep inspiration breath hold (DIBH); FB — free breathing
Citations
Acute adverse events of ultra-hypofractionated whole-breast irradiation after breast-conserving surgery for early breast cancer in Japan: an interim analysis of the multi-institutional phase II UPBEAT study
Peter J. K. Tokuda,Takamasa Mitsuyoshi,Yuka Ono,Takahiro Kishi,Yuji Negoro,Shun Okumura,Itaru Ikeda,Takashi Sakamoto,Yasuaki Kokubo,Ryo Ashida,Toshiyuki Imagumbai,Mikiko Yamashita,Hiroaki Tanabe,Sayaka Takebe,M. Tokiwa,Eiji Suzuki,Chikako Yamauchi,Masataka Yoshimura,Takashi Mizowaki,Masaki Kitajima +19 more
- 23 Jan 2024
TL;DR: Ultra-hypofractionated whole-breast irradiation is safe for Japanese women with early breast cancer after breast-conserving surgery, with acceptable acute adverse events.
Impact of deep inspiration breath hold, surface-guided radiotherapy, and daily CBCT on the organs at risk in breast cancer radiotherapy
Volker Rudat,Ruping Zhao,Sheng Wang,Lihua Zhang,Yanyan Shi +4 more
TL;DR: This study evaluates the impact of deep inspiration breath hold, surface-guided radiotherapy, and daily CBCT on organs at risk in left-sided breast cancer radiotherapy, finding DIBH significantly reduces mean heart dose and relative lung volume increase is a predictor for DIBH benefit.
Acute adverse events of ultra-hypofractionated whole-breast irradiation after breast-conserving surgery for early breast cancer in Japan: an interim analysis of the multi-institutional phase II UPBEAT study.
Peter J K Tokuda,Takamasa Mitsuyoshi,Yuka Ono,T. Kishi,Y. Negoro,S. Okumura,Itaru Ikeda,T. Sakamoto,Yumi Kokubo,Ryo Ashida,Toshiyuki Imagumbai,N. Yamashita,Hiroaki Tanabe,Sayaka Takebe,Mariko Tokiwa,Eiji Suzuki,Chikako Yamauchi,Michio Yoshimura,T. Mizowaki,M. Kokubo +19 more
TL;DR: Acute AEs following ultra-HF-WBI were within acceptable limits among Japanese women, indicating that the continuation of the study was appropriate and that the continuation of the study was appropriate.
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