Improved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patients

Radiother Oncol. 2013 Jan;106(1):28-32. doi: 10.1016/j.radonc.2012.10.016. Epub 2012 Nov 28.

Abstract

Background and purpose: This study aims at evaluating the effect of deep-inspiration breath hold (DIBH) on target coverage and dose to organs at risk in a large series of breast cancer patients.

Materials and methods: Clinical dose plans for 319 breast cancer patients were evaluated: 144 left-sided patients treated with DIBH and 175 free-breathing (FB) patients (83 left-sided and 92 right-sided). All patients received whole breast irradiation with tangential fields, based on a forward-planned intensity-modulated radiation therapy (IMRT) technique. Dose to heart, ipsi-lateral lung and ipsi-lateral breast were assessed and median values compared between patient groups.

Results: Comparing group median values, DIBH plans show large reductions of dose to the heart compared with left-sided FB plans; V(20 Gy) (relative volume receiving ≥ 20 Gy) for the heart is reduced from 7.8% to 2.3% (-70%, p < 0.0001), V(40 Gy) from 3.4% to 0.3% (-91%, p < 0.0001) and mean dose from 5.2 to 2.7 Gy (-48%, p < 0.0001). Lung dose also shows a small reduction in V(20 Gy) (p < 0.04), while median target coverage is slightly improved (p = 0.0002).

Conclusions: In a large series of clinical patients we find that implementation of DIBH in daily clinical practice results in reduced irradiation of heart and lung, without compromising target coverage.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / radiotherapy*
  • Female
  • Heart / radiation effects*
  • Humans
  • Lung / radiation effects*
  • Middle Aged
  • Radiotherapy Dosage
  • Radiotherapy, Intensity-Modulated / methods*