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. 2023 Oct 26;15(21):5153.
doi: 10.3390/cancers15215153.

Preventing Cardiotoxicity in Personalized Breast Irradiation

Edy Ippolito  1 , Carlo Greco  1 , Maristella Marrocco  1 , Carla Germana Rinaldi  2 , Michele Fiore  1 , Luca Eolo Trodella  1 , Rolando Maria D'Angelillo  2   3 , Sara Ramella  1
Affiliations

Preventing Cardiotoxicity in Personalized Breast Irradiation

Edy Ippolito et al. Cancers (Basel). .

Abstract

Background: This study aims to assess the benefit of a deep inspiration breath hold (DIBH) over the standard irradiation technique, and eventually to identify anatomical and/or treatment preplanning characteristics correlated with the LAD dose.

Methods: Patients with left-sided breast cancer undergoing whole breast radiotherapy with DIBH were analyzed. All patients included in the analysis had plans in DIBH and free-breathing (FB). Receiving operating characteristics (ROC analysis) were used to identify the cut-off point of parameters to predict the LAD maximum dose > 10 Gy and LAD mean dose > 4 Gy, and the areas under the curve (AUCs) were computed. Post-test probability has been performed to evaluate the effect of parameters' combination.

Results: One hundred ninety-seven patients were analyzed. The LAD dose was significantly reduced in DIBH plans with the maximum and mean dose reduced by 31.7% (mean value 3.5 Gy vs. 4.8 Gy, p ≤ 0.001) and 28.1% (mean value 8.2 Gy vs. 12.8 Gy, p ≤ 0.001) in DIBH plans compared to FB plans. The strongest predictor of the LAD dose (maximum > 10 Gy and mean > 4 Gy) was the minimum distance of LAD from tangent open fields. Other parameters were lung volume and heart volume (LAD Dmax > 10 Gy) and lung volume, heart volume, and breast separation (LAD Dmean > 4 Gy).

Conclusion: The dosimetric advantage of DIBH is clear in all patients and DIBH should always be preferred.

Keywords: DIBH; breast cancer; breast irradiation; left descending artery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Heart dosimetry comparison between free-breathing and breath hold plans.
Figure 2
Figure 2
ROC curve comparison of predictors of LAD maximum dose >10 Gy (Left) and of LAD mean dose >4 Gy (Right). Legend: for left ROC curve in red minimum distance from LAD to tangent fields, medium dashed line lung volume, continuous line hearth volume; for right ROC curve in red minimum distance from LAD to tangent fields, medium dashed line hearth volume, thin dashed line lung volume, continuous line breast separation.
See this image and copyright information in PMC

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