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. 2018 Jun 22;13(1):116.
doi: 10.1186/s13014-018-1062-6.

Abdominal DIBH reduces the cardiac dose even further: a prospective analysis

Feng Zhao  1 , Jiayan Shen  2 , Zhongjie Lu  2 , Yongbiao Luo  3 , Guorong Yao  2 , Luyi Bu  2 , Jia Ge  2 , Xin Yang  2 , Lihua Ning  2 , Senxiang Yan  4
Affiliations

Abdominal DIBH reduces the cardiac dose even further: a prospective analysis

Feng Zhao et al. Radiat Oncol. .

Abstract

Background: Deep inspiration breath hold (DIBH) can be performed using different breathing maneuvers, such as DIBH with a thoracic breathing maneuver (T-DIBH) and DIBH with an abdominal breathing maneuver (A-DIBH). Dosimetric benefits of A-DIBH were investigated in the treatment of left-sided breast cancer radiotherapy (RT) with both 3-Dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) techniques.

Methods: Twenty-two patients with left-sided breast cancer were enrolled in this study. 3D-CRT and IMRT plans were generated for each patient with three different CT scans of free breathing (FB), T-DIBH and A-DIBH. There were total of six treatment plans generated for each patient: FB_3D-CRT; TDIBH_3D-CRT; ADIBH_3D-CRT; FB-IMRT; TDIBH-IMRT; ADIBH-IMRT. Doses to the heart, left anterior descending coronary artery (LADCA), and ipsilateral lung were evaluated and compared using the Wilcoxon signed-rank test.

Results: The mean doses to the heart, LADCA and ipsilateral lung in 3D-CRT plans generated from 3D-CRT with FB, T-DIBH and A-DIBH were (2.89 ± 1.30), (1.67 ± 0.90) and (1.34 ± 0.43) Gy (all P < 0.05), respectively, with FB; (29.08 ± 16.72), (13.94 ± 14.74) and (10.22 ± 10.30) Gy (all P < 0.05), respectively, with T-DIBH; and (7.77 ± 2.71), (7.32 ± 1.42) and (6.90 ± 1.60) Gy (all P < 0.05), respectively, with A-DIBH. The mean doses to the heart, LADCA and ipsilateral lung in IMRT plans were generated from IMRT with FB, T-DIBH and A-DIBH were (1.96 ± 2.25), (1.37 ± 0.44) and (1.18 ± 0.26) Gy (all P < 0.05), respectively, with FB; (16.10 ± 7.45), (8.6 ± 6.60) and (7.35 ± 5.42) Gy (all P < 0.05), respectively, with T-DIBH; and (5.90 ± 2.24), (5.65 ± 1.58) and (5.62 ± 1.05) Gy (all P > 0.05), respectively, with A-DIBH.

Conclusions: This study indicates that both 3D-CRT and IMRT plans with A-DIBH achieved lower cardiac and LADCA doses than plans with FB and T-DIBH; 3D-CRT plans with A-DIBH achieved lower ipsilateral lung doses than plans with FB and T-DIBH; and IMRT plans with A-DIBH had better outcomes than 3D-CRT plans with A-DIBH with respect to the mean dose to the heart, LADCA and ipsilateral lung. IMRT plans with A-DIBH should be incorporated into the daily routine for left-sided breast RT.

Keywords: 3-dimensional conformal radiation therapy (3D-CRT); Breast cancer; Breath holding; Intensity-modulated radiation therapy (IMRT); Organs at risk; Radiotherapy dosage.

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Conflict of interest statement

Ethics approval and consent to participate

This prospective study was conducted in compliance with the ethical principles of the Declaration of Helsinki and was approved by the Research Ethics Committee of the First Affiliated Hospital, College of Medicine, Zhejiang University. Informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The relative spatial position relationships of the breast CTV (orange), left lung (blue), heart (red), LMCA (green), and LADCA (yellow) in a typical patient during FB (a), T-DIBH (b) and A-DIBH (c). A vertebral body T7 (blue) is contoured as a position marker in the shown case. During T-DIBH, due to expansion of the left lung (B), the heart, LMCA, and LADCA are moved caudally compared with during FB (a). During A-DIBH (c), the heart, LMCA, and LADCA are moved farther caudally than during T-DIBH (b). During T-DIBH (b) and A-DIBH (c), the breast CTV is moved cranioventrally compared with during FB (a) due to the expansion of the left lung
Fig. 2
Fig. 2
Mean doses to the heart (a, d, g), LADCA (b, e, h) and left lung (c, f, i) in Gy following 3D-CRT and IMRT plans during FB (upper row), T-DIBH (middle row) and A-DIBH (lower row). ∆: mean dose difference between 3D-CRT and IMRT plans
See this image and copyright information in PMC

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