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Clinical Trial
. 2013 Feb;36(1):24-30.
doi: 10.1097/COC.0b013e31823fe481.

Six-year experience routinely using moderate deep inspiration breath-hold for the reduction of cardiac dose in left-sided breast irradiation for patients with early-stage or locally advanced breast cancer

Todd Swanson  1 , Inga S Grills, Hong Ye, Amy Entwistle, Melanie Teahan, Nicola Letts, Di Yan, Joana Duquette, Frank A Vicini
Affiliations
Clinical Trial

Six-year experience routinely using moderate deep inspiration breath-hold for the reduction of cardiac dose in left-sided breast irradiation for patients with early-stage or locally advanced breast cancer

Todd Swanson et al. Am J Clin Oncol. 2013 Feb.

Abstract

Purpose: Moderate deep inspiration breath-hold (mDIBH), using an Active Breathing Control device, has been used in our clinic since 2002 to reduce cardiac dose for patients receiving left-sided breast irradiation. We report our routine use of the mDIBH technique in clinically localized breast cancer, treated to the intact breast, reconstructed breast, or chest wall.

Materials and methods: Ninety-nine patients with left-sided breast cancer were evaluated for Active Breathing Control treatment, of which, 87 patients were treated with mDIBH. Plans for both the free-breathing (FB) and mDIBH computed tomography scans were evaluated. Dose-volume histograms (DVHs) were analyzed for the heart and ipsilateral lung, comparing results for mDIBH versus FB plans.

Results: Eighty-seven patients were included for analysis. Of those, 66% received adjuvant chemotherapy with cardiotoxic agents. The mean dose for the whole breast was 47.6 Gy. There was a statistically significant decrease in all DVH parameters evaluated, favoring the delivery of mDIBH over FB plans. mDIBH plans significantly reduced cardiac mean dose (4.23 vs. 2.54 Gy; P<0.001), a relative reduction of 40%. In addition, there were significant reductions in all other heart parameters evaluated (ie, volume of heart treated, V30, V25, V20, V15, V10, and V5). mDIBH also significantly reduced lung dose, including a reduction of the left lung mean dose (9.08 vs. 7.86 Gy; P<0.001), a relative reduction of 13%, as well as significant reduction of all lung DVH parameters evaluated.

Conclusions: To date, this series represents the largest experience utilizing mDIBH to reduce cardiac irradiation during left-sided breast cancer treatment. Statistically significant reductions in all heart and lung DVH parameters were achieved with mDIBH over FB plans. mDIBH, for the treatment of left-sided breast cancer, is a proven technique for reducing cardiac dose that may lead to reduced cardiotoxicity and can be routinely integrated into the clinic.

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Conflict of interest statement

Conflict of Interest Notification:

None of the authors have any pertinent disclosures to declare.

Figures

Figure 1
Figure 1
CT Simulation Comparing Free Breathing (A) with mDIBH (B) as well as beam’s eye view of breast with heart contoured in red for Free Breathing Plan (C) and mDIBH (D) plan.
Figure 2
Figure 2
Dose Volume Histogram comparing heart dose with the mDIBH plan and the Free Breathing Plan
Figure 3
Figure 3
Dose Volume Histogram comparing lung dose with the mDIBH plan and the Free Breathing Plan
See this image and copyright information in PMC

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