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. 2022 Sep 19;27(4):717-723.
doi: 10.5603/RPOR.a2022.0085. eCollection 2022.

Deep inspiration breath hold in post-operative radiotherapy for right breast cancer: a retrospective analysis

Giulia Borgonovo  1 , Eleonora Paulicelli  2 , Deborah Daniele  1 , Stefano Presilla  2 , Antonella Richetti  1 , Mariacarla Valli  1
Affiliations

Deep inspiration breath hold in post-operative radiotherapy for right breast cancer: a retrospective analysis

Giulia Borgonovo et al. Rep Pract Oncol Radiother. .

Abstract

Background: The aim of our study is to determine whether deep inspiration breath hold (DIBH) is effective for reducing exposure of the heart, left coronary artery (LAD) and both lungs in right breast radiotherapy.

Materials and methods: We have analyzed 10 consecutive patients with right-sided breast cancer (BC), simulated during free breathing (FB) and in DIBH modality. For all patients we contoured breast PTV and organs at risk (right and left lungs, heart, LAD) on both CT scans (FB and DIBH). Finally, 5 patients were treated with IMRT and 5 with VMAT techniques.

Results: All patients were able to end the treatments in DIBH modalities regardless of the longer treatment time in comparison to FB. The maximum and mean dose to the heart are lower in the DIBH modality. The mean values of the heart mean dose were 1.76 Gy in DIBH and 2.19 Gy in FB. The mean heart maximum dose in DIBH and FB were, respectively, 9.3 Gy and 11 Gy. Likewise, the maximum dose to the LAD is lower in DIBH; 2.57 Gy versus 3.56 Gy in FB. Noteworthy, 3 patients with hepatomegaly treated with the DIBH technique showed a higher ipsilateral lung dose than FB, but a decrease of liver dose.

Conclusion: We report that the use of DIBH for right-sided BC allows the dose to the heart, LAD and to the liver to be reduced in case of hepatomegaly. This technique is well tolerated by patients, when adequately trained, and could be considered effective even in right sided BC.

Keywords: deep inspiration breath-hold; heart; left coronary artery; radiotherapy; right breast cancer.

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Conflict of interest statement

Conflict of interest On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Figure 1
Figure 1
Histogram showing maximal dose (Dmax) values for left coronary artery (LAD) and mean dose (Dmean) values for heart in deep inspiration breath hold (DIBH) (blue) and free breathing (FB) (red) of the 10 patients analysed
Figure 2
Figure 2
Coronal and sagittal computed tomography (CT) in deep inspiration breath hold (DIBH) (A) and free brathing (FB) (B) demonstrating the liver displacement (yellow arrow). Green line represents 95% isodose
Figure 3
Figure 3
Dose-volume histogram (DVH) for organs at risk (OARs) in deep inspiration breath hold (DIBH) and free breathing (FB) (dotted lines) in a patient with hepatomegaly
See this image and copyright information in PMC

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