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Deep Inspiration Breath Hold

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Radiation Therapy Techniques and Treatment Planning for Breast Cancer

Part of the book series: Practical Guides in Radiation Oncology ((PGRO))

Abstract

Radiotherapy is a valuable adjuvant treatment in breast cancer that improves loco-regional control and overall survival. However, the breast cancer-specific survival advantage for patients receiving radiation therapy may be partially negated by higher non-breast cancer mortality, which may be due to cardiac mortality. Older data shows patients with left-sided breast cancer receiving radiation had increased cardiac mortality, and the rates of major coronary events and cardiac deaths increased with extrapolated mean heart radiation dose. Breast cancer radiation treatments in more modern eras have lower excess cardiac mortality. Advances in radiotherapy such as three-dimensional conformal radiation therapy, prone breast radiation and proton therapy have been demonstrated to decrease cardiac radiation doses in some patients. Deep inspiration breath hold (DIBH) is another tool radiation oncologists use to reduce dose to the heart. This technique exploits the increase in the separation of the heart and the chest wall when the lung expands with inspiration in order to decrease the radiation doses received by the heart. DIBH unambiguously reduces cardiac dose in dosimetric analyses, and early clinical data suggest that this reduction in cardiac dose translates into avoidance of the expected changes in cardiac perfusion. Although additional clinical data are required, DIBH offers the tantalizing potential of maintaining the benefits of radiotherapy while minimizing cardiac risks. Further research aimed to refine techniques and to optimize patient selection is ongoing. This chapter reviews DIBH techniques, DIBH dosimetric advantages, and practical considerations of DIBH.

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Authors and Affiliations

  1. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    Carmen Bergom MD, PhD, Adam Currey MD & An Tai PhD

  2. Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Jonathan B. Strauss MD

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  1. Carmen Bergom MD, PhD
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  2. Adam Currey MD
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  3. An Tai PhD
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  4. Jonathan B. Strauss MD
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Correspondence to Carmen Bergom MD, PhD .

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Editors and Affiliations

  1. Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital Harvard Medical School, Boston, Massachusetts, USA

    Jennifer R. Bellon

  2. Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital Harvard Medical School, Boston, Massachusetts, USA

    Julia S. Wong

  3. Department of Radiation Oncology, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA

    Shannon M. MacDonald

  4. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA

    Alice Y. Ho

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Bergom, C., Currey, A., Tai, A., Strauss, J.B. (2016). Deep Inspiration Breath Hold. In: Bellon, J., Wong, J., MacDonald, S., Ho, A. (eds) Radiation Therapy Techniques and Treatment Planning for Breast Cancer. Practical Guides in Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-40392-2_6

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