Key result
Deep inspiration breath hold significantly reduced the median mean heart dose to 0.92 Gy compared to 1.97 Gy with free breathing (p < 0.001) in patients with left-sided breast cancer.
Why the study?
Postoperative radiation therapy for left breast cancer can expose the heart to doses exceeding recommended limits, and the dosimetric impact of deep inspiration breath hold on the heart and left anterior descending coronary artery required evaluation.
Does deep inspiration breath hold (DIBH) reduce cardiac and LAD radiation dose compared to free breathing in women receiving postoperative radiation therapy for left-sided breast cancer?
Cohort (n=68)
Does deep inspiration breath hold (DIBH) reduce cardiac and LAD radiation dose compared to free breathing in women receiving postoperative radiation therapy for left-sided breast cancer?
Absolute Event Rate: 0.92% vs 1.97%
p-value: p=<0.001
Deep inspiration breath hold during left breast radiotherapy significantly reduces radiation exposure to the heart and LAD without compromising target coverage, potentially lowering the risk of radiation-induced cardiotoxicity.
DIBH planning reduced cardiac and LAD doses versus FB; leaves open whether clinical cardiotoxicity decreases in left breast RT.
Background: Postoperative radiation therapy (RT) is the standard treatment for almost all patients diagnosed with breast cancer. Even with modern RT techniques, parts of the heart may still receive higher doses than those recommended by clinically validated dose limit restrictions, especially when the left breast is irradiated. Deep inspiration breath hold (DIBH) may reduce irradiated cardiac volume compared to free breathing (FB) treatment. This study aimed to evaluate the dosimetric impact on the heart and left anterior descending coronary artery (LAD) in FB and DIBH RT planning in patients with left breast cancer. Materials and methods: A retrospective cohort study of women diagnosed with left-sided breast cancer submitted to breast surgery followed by postoperative RT from 2015 to 2019. All patients were planned with FB and DIBH and hypofractionated dose prescription (40.05 Gy in 15 fractions). Results: 68 patients were included in the study. For the coverage of the planned target volume evaluation [planning target volume (PTV) eval] there was no significant difference between the DIBH versus FB planning. For the heart and LAD parameters, all constraints evaluated favored DIBH planning, with statistical significance. Regarding the heart, median V16.8 Gy was 2.56% in FB vs. 0% in DIBH (p < 0.001); median V8.8 Gy was 3.47% in FB vs. 0% in DIBH (p < 0.001) and the median of mean heart dose was 1.97 Gy in FB vs. 0.92 Gy in DIBH (p < 0.001). For the LAD constraints D2% < 42 Gy, the median dose was 34.87 Gy in FB versus 5.8 Gy in DIBH (p < 0.001); V16.8 Gy < 10%, the median was 15.87% in FB versus 0% in DIBH (p < 0.001) and the median of mean LAD dose was 8.13Gy in FB versus 2.92Gy in DIBH (p < 0.001). Conclusions: The DIBH technique has consistently demonstrated a significant dose reduction in the heart and LAD in all evaluated constraints, while keeping the same dose coverage in the PTV eval.
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Marta et al. (2023) conducted a cohort in Left-sided breast cancer (n=68). Deep inspiration breath hold (DIBH) vs. Free breathing (FB) was evaluated on Median mean heart dose (p=<0.001). Deep inspiration breath hold significantly reduced the median mean heart dose to 0.92 Gy compared to 1.97 Gy with free breathing (p < 0.001) in patients with left-sided breast cancer.
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