Why the study?
The study was conducted to compare radiation dosimetry, including doses to cardiac substructures, in left-sided breast cancer patients receiving deep inspiration breath hold radiotherapy versus free-breathing treatment plans.
Does deep inspiration breath hold (DIBH) radiotherapy reduce radiation dose to cardiac segments compared to free-breathing in left-sided breast cancer patients?
Does deep inspiration breath hold (DIBH) radiotherapy reduce radiation dose to cardiac segments compared to free-breathing in left-sided breast cancer patients?
The deep inspiration breath hold technique significantly reduces radiation exposure to the heart and LAD artery in left-sided breast cancer patients, potentially lowering the risk of radiation-induced cardiotoxicity.
DIBH was associated with lower heart/LAD doses in LSBC; leaves open clinical outcome confirmation in randomized trials.
Background: The objective was to compare dosimetry in left-sided breast cancer (LSBC) patients receiving deep inspiration breath hold (DIBH) radiotherapy (RT) with free-breathing (FB) treatment plans. Materials and methods: Voluntary DIBH with a spirometer-based video-assisted system and CT-simulation were performed under FB and DIBH conditions on 40 LSBC patients, segmented according Duane’s atlas. IMRT plans kept the same dosimetric goals on FB and DIBH conditions. Target, lungs and heart volumes were measured. Planning target volume (PTV) dose distribution, organs at risk (OARs) dose/volume parameters, including cardiac substructures, were calculated. Results: Lungs and left-lung volumes increased in DIBH conditions (ΔV = 1637.8 ml ± 555.3 and 783.5 ml ± 286.4, respectively). Heart volume slightly decreased in apnea (p = 0.04), but target volumes, CTV and PTV were similar in FB or DIBH plans. PTV dose coverage was similar irrespective of respiratory conditions (median D50% = 41.1 Gy vs 41.0 Gy, p = 0.665; V95% = 96.9% vs. 97%). Mean dose for the whole heart (MHD), left ventricle (LV), and LV segments were significantly reduced in DIBH plans. V20 values for heart subvolumes were significantly different only for those that received considerable doses (apical and anterior). DIBH plans provided significantly smaller doses (Dmax, D2%, and V20) to the LAD artery. Conclusion: Important dosimetric improvements can be achieved with DIBH technique for LSBC patients, reducing the dose to the LAD artery and heart, particularly to the segments closer to the chest wall. Apical/anterior LV segments, should be considered as separate organ at risk in breast RT.
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Portillo et al. (2024) studied this question.
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