Comparison of deep inspiration breath hold and free breathing technique in left breast cancer irradiation: a dosimetric evaluation in 40 patients
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To analyze the reduction of dose to organs at risk between deep inspiration breath hold (DIBH) and free breathing (FB) techniques in left breast irradiation.
Forty left-sided breast cancer patients received adjuvant radiotherapy and were retrospectively analyzed. Treatment plans were generated on both DIBH and FB computed tomography (CT) scans. The patients were monitored by the Varian RPM™ respiratory gating system. The treatment planning was performed with conformal tangential fields by means of 6 and 10 MV photon fields. Treatment schedule were 50 Gy in 25 fractions (conventional schedule) or 40.05 Gy in 15 fractions (hypofractionated schedule), with or without sequential boost to tumor bed. Dose-volume histograms were compared for all plans. For the comparison, we considered cardiac and ipsilateral lung doses and volumes. Quantitative statistical analyses of plans dose differences were generated. In order to correlate the mean cardiac dose difference between the FB and DIBH techniques with maximum heart distance (MHD), a linear regression model was used.
A statistically significant reduction of cardiac and pulmonary doses using the DIBH technique was achieved compared with FB plans, maintaining an equal coverage of planning target volume (PTV). A positive correlation was found between MHD and mean heart dose difference.
Our study confirms the DIBH technique advantage in reducing cardiac and pulmonary doses for tangentially treated left-sided breast cancer patients. Further research is warranted to evaluate potential long-term clinical implications of these relevant dosimetry results.
KeywordsBreast cancer Radiation therapy Gating Deep inspiration breath hold Cardiac dose Left anterior descending coronary artery
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of ethical standards
This article does not contain any studies with human or animal subjects performed by any of the authors.
- 1.American Cancer Society, (2007) Statistics for 2007: Cancer Facts & Figures. http://www.cancer.org/docroot/STT/stt 0.asp
- 2.National Institute for Health and Care Excellence. Breast Cancer (early and locally advanced) diagnosis and treatment guidelines. National Institute for Health and Care Excellence. Online available from: http://guidance.nice.org.uk/CG80
- 3.Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, Mc Gale P, Correa C, Taylor C, Arriagada R et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378:1707–1716CrossRefGoogle Scholar
- 4.EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), McGale P, Taylor C, Correa C, Cutter D, Duane F et al (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383:2127–2135CrossRefGoogle Scholar
- 7.McGale P, Darby SC, Hall P, Adolfsson J, Bengtsson NO, Bennet AM, Fornander T, Gigante B, Jensen MB, Peto R, Rahimi K, Taylor CW, Ewertz M (2011) Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol 100(2):167–175CrossRefGoogle Scholar
- 9.van den Bogaard VA, Ta BD, van der Schaaf A, Bouma AB, Middag AM, Bantema-Joppe EJ, van Dijk L, van Dijk-Peters F, Marteijn LA, de Bock GH, Burgerhof JG, Gietema JA, Langendijk JA, Maduro JH, Crijns AP (2017) Validation and modification of a prediction model for acute cardiac events in patients with breast cancer treated with radiotherapy based on three-dimensional dose distributions to cardiac substructures. J Clin Oncol 35(11):1171–1178CrossRefGoogle Scholar
- 10.Lorenzen EL, Taylor CW, Maraldo M, Nielsen MH, Offersen BV, Andersen MR, O’Dwyer D, Larsen L, Duxbury S, Jhitta B, Darby SC, Ewertz M, Brink C (2013) Inter-observer variation in delineation of the heart and left anterior descending coronary artery in radiotherapy for breast cancer: a multi-centre study from Denmark and the UK. Radiother Oncol 108(2):254–258CrossRefGoogle Scholar
- 12.Karha J, Murphy SA, Kirtane AJ, de Lemos JA, Aroesty JM, Cannon CP, Antman EM, Braunwald E, Gibson CM, TIMI Study Group (2003) Evaluation of the association of proximal coronary culprit artery lesion location with clinical outcomes in acute myocardial infarction. Am J Cardiol 92:913–918CrossRefGoogle Scholar
- 15.Swanson T, Grills IS, Ye H, Entwistle A, Teahan M, Letts N, Yan D, Duquette J, Vicini FA (2013) Six-year experience routinely using moderate deep inspiration breath-hold for the reduction of cardiac dose in left-sided breast irradiation for patients with early-stage or locally advanced breast cancer. Am J Clin Oncol 36(1):24–30CrossRefGoogle Scholar
- 18.Feng M, Moran JM, Koelling T, Chughtai A, Chan JL, Freedman L, Hayman JA, Jagsi R, Jolly S, Larouere J, Soriano J, Marsh R, Pierce LJ (2011) Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys 79(1):10–18CrossRefGoogle Scholar
- 19.Radiation Therapy Oncology Group: RTOG Breast Cancer Atlas, Online available from:http://www.rtog.org/CoreLab/ContouringAtlases/BreastCancerAtlas.aspx
- 23.Taylor C, Correa C, Duane FK, Aznar MC, Anderson SJ, Bergh J, Dodwell D, Ewertz M, Gray R, Jagsi R, Pierce L, Pritchard KI, Swain S, Wang Z, Wang Y, Whelan T, Peto R, McGale P, for the Early Breast Cancer Trialists’ Collaborative Group (2017) Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart and from previous randomized trials. J Clin Oncol 35:1641–1649CrossRefGoogle Scholar
- 28.Nielsen MH, Berg M, Pedersen AN, Andersen K, Glavicic V, Jakobsen EH, Jensen I, Josipovic M, Lorenzen EL, Nielsen HM, Stenbygaard L, Thomsen MS, Vallentin S, Zimmermann S, Offersen BV, on behalf of the Danish Breast Cancer Cooperative Group Radiotherapy Committee (2013) Danish Breast Cancer Cooperative Group Radiotherapy Committee. Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: national guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group. Acta Oncol 52(4):703–710CrossRefGoogle Scholar
- 32.Willner J, Jost A, Baier K, Flentje M (2003) A little to a lot or a lot to a little? An analysis of pneumonitis risk from dose-volume histogram parameters of the lung in patients with lung cancer treated with 3-D conformal radiotherapy. Strahlenther Onkol 179(8):548–556Google Scholar
- 36.Zellars R, Bravo PE, Tryggestad E et al (2018) SPECT analysis of cardiac perfusion changes after whole-breast/chest wall radiation therapy with or without active breathing coordinator: results of a randomized phase 3 trial. Int J Radiat Oncol Biol Phys 88:778–785Google Scholar