Deep inspiration breath-hold (DIBH) radiotherapy in left-sided breast cancer Dosimetrical comparison and clinical feasibility in 20 patients

• Published in: Strahlentherapie und Onkologie Vol. 191; no. 9; pp. 710 - 716
• Main Authors: Hepp, Rodrigo, Ammerpohl, Mark, Morgenstern, Christina, Nielinger, Lisa, Erichsen, Patricia, Abdallah, Abdallah, Galalae, Razvan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2015; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Breast Neoplasms - radiotherapy; Breath Holding; Feasibility Studies; Female; Heart - radiation effects; Humans; Inhalation; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Article; Radiation Dosage; Radiation Protection - methods; Radiometry; Radiotherapy; Treatment Outcome; Brustkrebs; Deep inspiration breath-hold; Surface scanner; Tiefe Inspiration; Breast cancer; Oberflächenscanner; Radiotherapy; Cardiac dose; Herzdosis; Strahlentherapie
• ISSN: 0179-7158; 1439-099X
• DOI: 10.1007/s00066-015-0838-y

Background Adjuvant radiotherapy after breast-conserving surgery (BCS) for breast cancer (BC) is a well-established indication. The risk of ischaemic heart disease after radiotherapy for BC increases linearly with the heart mean dose with no apparent threshold. Radiotherapy to the left breast in deep inspiration breath-hold (DIBH) reduces the dose to the heart. A new linac system with an integrated surface scanner (SS) for DIBH treatments was recently installed in our department. We tested it for potential benefits, safety, patients’ acceptance/compliance and associated additional workload. Materials and methods Twenty consecutive patients following BCS for breast carcinoma of the left side were enrolled in our institutional DIBH protocol. We compared dose to the heart and ipsilateral lung (IL) between plans in DIBH and free breathing (FB) using standard defined parameters: mean dose, maximal dose to a volume of 2 cm 3 (D 2 cm 3 ), volume receiving ≥ 5 Gy (V 5 ), 10 Gy (V 10 ), 15 Gy (V 15 ) and 20 Gy (V 20 ). Comparison of median calculated dose values was performed using a two-tailed Wilcoxon signed rank test. Results DIBH was associated with a statistically significant reduction ( p  < 0.001) in all studied parameters for the heart and the IL. In 16 of 20 patients the heart D 2 cm 3 was less than 42 Gy in DIBH. In FB the heart D 2 cm 3 was ≥ 42 Gy in 17 of 20 patients. The median daily treatment time was 9 min. Conclusion Radiotherapy of the left breast in DIBH using a SS could easily be incorporated into daily routine and is associated with significant dose reduction to the heart and IL.