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Impact of breath-hold technique on incidence of cardiac events in adjuvant left breast cancer irradiation

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Abstract

Background

This study aims to compare the incidence of cardiac events and to identify its predictors in left breast cancer patients receiving adjuvant radiotherapy using breath-hold technique (DIBH) versus free breathing technique (FB).

Methods

We conducted a retrospective multi-center study of two arms; the free breathing arm included 208 patients who were treated with traditional radiotherapy treatment technique, while DIBH arm included 224 patients who were treated with breath-hold technique using The Varian Real-time Position Management (RPM). We retrospectively reviewed the medical records of the patients from January 2010 to December 2017.

Results

The mean dose to the heart and left anterior descending artery were significantly lower in the DIBH arm (2.10 ± 0.39 and 6.16 ± 0.18 Gy) compared with (4.29 ± 0.60 Gy and 12.69 ± 0.93 Gy, respectively) in the FB arm. The incidence of cardiac events was higher in the FB arm than in the DIBH arm, but it was not statically significant. Our analysis revealed that age, diabetes, hypertension, smoking, mean LAD dose, and heart mean dose were significant prognostic factors for the occurrence of cardiac events in the breath-hold arm. Hypertension, smoking, as well as heart mean dose were independent risk factors for the occurrence of cardiac events.

Conclusion

Use of the DIBH technique resulted in a significant reduction in doses to the heart, LAD and lesser cardiac events incidence compared to free breathing.

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Availability of data and materials

The datasets used and analyzed during the current study are available from the first author on reasonable request.

Abbreviations

DIBH:

Deep inspiration breath-hold

FB:

Free breathing technique

RPM:

Real-time position management

BCS:

Breast conservative surgery

OARs:

Organs at risk

WBI:

Whole breast radiation

IHD:

Ischemic heart disease

PRV:

Planning organ at risk volume

PTV:

Planning target volume

RTOG:

Radiation therapy oncology group

CAD:

Coronary artery disease

ABC:

Active breathing control

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Acknowledgements

We would like to thank the staff who took care of our patients' needs, and who were involved in gathering, documenting, verifying, forwarding, and processing the clinical data.

Funding

Not applicable.

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Authors and Affiliations

  1. Department of Clinical Oncology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt

    Amr A. Mahmoud, Emad A. Sadaka & Sara A. Amin

  2. Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Mohamed Abouegylah

  3. Department of Cancer Management and Research, Medical Research Institute, Alexandria University, Alexandria, Egypt

    Hazem Elmansy

  4. Department of Surgical Oncology, General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Mohamed F. Asal

  5. Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany

    Mümtaz A. Köksal

  6. Department of Radiation Oncology, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany

    Ahmed Gawish

Authors
  1. Amr A. Mahmoud
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  2. Emad A. Sadaka
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  3. Mohamed Abouegylah
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  4. Sara A. Amin
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  5. Hazem Elmansy
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  6. Mohamed F. Asal
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  7. Mümtaz A. Köksal
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  8. Ahmed Gawish
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Contributions

All authors were involved in the preparation of the manuscript. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Ahmed Gawish.

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Conflict of interest

All the authors declare that they have no competing interests.

Disclaimer

Our manuscript is a part of a PhD thesis under the title (comparative study between deep inspiration breath-hold and free breathing radiotherapy techniques in patients diagnosed with left breast cancer). It has not been previously presented or published in a conference.

Ethics approval and consent to participate

The study was approved by the ethics committee of the Faculty of Medicine, Kafrelsheikh University (code MKSU 50-6-18, date of approval: 12/11/2018) and was carried out in accordance with the Declaration of Helsinki, and the requirement for informed consent was waived because of the retrospective design.

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Mahmoud, A.A., Sadaka, E.A., Abouegylah, M. et al. Impact of breath-hold technique on incidence of cardiac events in adjuvant left breast cancer irradiation. J Cancer Res Clin Oncol 149, 5853–5859 (2023). https://doi.org/10.1007/s00432-022-04551-8

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  • DOI: https://doi.org/10.1007/s00432-022-04551-8

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