Key result
Moderate deep inspiratory breath hold linked to ~48% lower mean heart dose vs free breathing.
Why the study?
Cardiac toxicity from radiation to the left ventricle and LAD artery during left breast tangential field irradiation is a major concern, and the effect of ABC mDIBH on cardiac dose needs comparison with free breathing.
Does active breath coordinator moderate deep inspiration breath hold reduce cardiac radiation dose in patients with left-sided breast cancer undergoing adjuvant radiotherapy?
Observational (n=45)
No
Does active breath coordinator moderate deep inspiration breath hold reduce cardiac radiation dose in patients with left-sided breast cancer undergoing adjuvant radiotherapy?
Active breath coordinator moderate deep inspiration breath hold significantly reduces radiation exposure to the heart and LAD artery during left-sided breast cancer radiotherapy, potentially mitigating late cardiotoxicity.
Answers are grounded in this paper and cite their sources.
May support breath-hold technique to limit cardiac dose in left breast radiotherapy; leaves open randomized confirmation of clinical outcomes.
BACKGROUND AND AIM: Cardiac toxicity is a major concern for left breast tangential field irradiation. The left ventricle and left anterior descending (LAD) artery are suggested to be radiosensitive and radiation to these structures leads to late lethal cardiotoxicity. Moderate deep inspiration breath hold (mDIBH) during radiation treatment delivery helps in reducing the cardiac dose. This study compares dosimetric parameters of heart with and without active breath coordinator (ABC) mDIBH during tangential field breast cancer radiation. STUDY TYPE: This is a dosimetric comparative study. MATERIALS AND METHODS: Forty-five consecutive patients with left-sided breast cancer who underwent breast-conserving surgery and adjuvant tangential field and radiotherapy with ABC mDIBH between November 2013 and September 2015 in our center were analyzed in this study. The ABC device was used for respiratory control and patients who could hold their breath for 20-30 s were considered for radiation with ABC mDIBH. Simulation scans of both free breathing (FB) and ABC mDIBH were done. Tangent field treatment plans with a dose prescription of 40 Gy/15 Fr were generated for each patient, in both scans. Target coverage, dose to the heart, LAD, and the left lung were documented with dose-volume histograms. RESULTS: Statistical Package for the Social Sciences, version 20 software, was used for analysis and the level of significance was set at P < 0.05. Mean heart dose was 308.5cGy with FB and 159cGy with ABC (P < 0.0001). Mean dose to the LAD was reduced by 53.81% (1320.64 cGy vs. 606.56 cGy, P < 0.001). Target coverage was equal in both the plans. CONCLUSION: We report that the use of ABC mDIBH technique resulted in a significant reduction in cardiac dose and hence can be considered as a promising tool for cardiac sparing.
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Kunheri et al. (2017) conducted an observational in Left-sided breast cancer (n=45). Active breath coordinator moderate deep inspiratory breath hold (ABC mDIBH) vs. Free breathing (FB) was evaluated on Mean heart dose (p=< 0.0001). Active breath coordinator moderate deep inspiratory breath hold reduced mean heart dose compared to free breathing during breast cancer radiotherapy.
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