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Impact of breath hold on regional nodal irradiation and heart volume in field in left breast cancer adjuvant irradiation

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Abstract

Purpose

Compared to the free-breathing technique, adjuvant left breast irradiation after breast-conserving surgery or mastectomy using the breath-hold method significantly reduces the heart mean dose, Left anterior descending artery, and ipsilateral lung doses. Movement with deep inspiration may also reduce heart volume in the field and regional node doses.

Materials and methods

Pre-radiotherapy planning CT was performed in the free-breathing, and breath-hold techniques using RPM, demographic information, clinicopathological data, heart volume in the field, heart mean dose, LAD mean dose, and regional nodal doses were calculated in both free breathing and DIBH. Fifty patients with left breast cancer receiving left breast adjuvant radiation were enrolled.

Results

There was no significant difference in axillary LN coverage between the two techniques, except for SCL maximum dose, Axilla I node maximum dose, and Axilla II minimum dose in favor of the breath hold technique. The mean age was 47.54 years, 78% had GII IDC, 66% had positive LVSI results, and 74% of patients had T2. The breath hold strategy resulted in considerably decreased mean heart dose (p = 0.000), LAD dose (p = 0.000), ipsilateral lung mean dose (p = 0.012), and heart volume if the field (p = 0.013). The mean cardiac dosage and the dose of the LAD were significantly correlated (p = 0.000, R = 0.673). Heart volume in the field and heart mean dosage was not significantly correlated (p = 0.285, r = − 0.108).

Conclusion

When compared to free breathing scans, DIBH procedures result in considerably reduced dosage to the OAR and no appreciable changes in dose exposure to regional lymph node stations in patients with left-sided breast cancer.

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Data availability

The datasets are available from the first author upon 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

PTV:

Planning target volume

RTOG:

Radiation therapy oncology group

CAD:

Coronary artery disease

ABC:

Active breathing control

RNI:

Regional nodal irradiation

LAD:

Left anterior descending artery

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Author information

Authors and Affiliations

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

    Mohamed Abouegylah & O. Elemary

  2. Ayadi Al-Motakbal Oncology Hospital, Alexandria, Egypt

    Ahmed Adel Ahmed

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

    Amany Mostafa ElFeky & Amr A. Mahmoud

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

    Haytham Fayed & Mostafa Gawish

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

    Ahmed Gawish

  6. Department of Radiation Oncology, Marburg Ion-Beam Therapy Center (MIT), Heidelberg University Hospital, Marburg, Germany

    Ahmed Gawish

  7. Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany

    Ahmed Gawish

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  1. Mohamed Abouegylah
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All authors read and approved the final manuscript.

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Correspondence to Ahmed Gawish.

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Abouegylah, M., Elemary, O., Ahmed, A.A. et al. Impact of breath hold on regional nodal irradiation and heart volume in field in left breast cancer adjuvant irradiation. Clin Transl Oncol 26, 288–296 (2024). https://doi.org/10.1007/s12094-023-03256-9

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  • DOI: https://doi.org/10.1007/s12094-023-03256-9

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