title: Postoperative irradiation of left-sided breast cancer patients and cardiac toxicity. Does deep inspiration breath-hold (DIBH) technique protect the heart?
abstract: OBJECTIVE
  To evaluate the impact of deep inspiration breath-hold (DIBH) technique during postoperative left-sided tangential breast irradiation on minimizing irradiated heart amount compared to normal breathing.
  
  
  METHODS
  In 22 patients with left-sided breast cancer, postoperative CT scanning was performed in different respiratory phases using the Varian Real-time Position Management System for monitoring of respiratory chest wall motion. Each patient underwent two CT scans: during normal breathing and DIBH. For each scan, an optimized plan was designed with tangential photon fields encompassing the clinical target volume after breast-conserving surgery or modified radical mastectomy. The resulting dose-volume histograms were compared between both breathing techniques for irradiated volume and dose to the heart.
  
  
  RESULTS
  The mean patient age was 51 years (range: 34-77 years). The DIBH-gated technique was well accepted by all patients. The significant reduction in dose to the irradiated heart volume for the DIBH technique compared to the normal breathing was 56% (mean heart dose: 2.3 Gy vs. 1.3 Gy; p = 0.01).
  
  
  CONCLUSIONS
  This study demonstrates that irradiated cardiac volumes can significantly be reduced in left-sided breast cancer patients using DIBH technique for postoperative tangential radiotherapy. Moreover, the technique is safe and feasible in daily routine.
authors.affiliation: Department of Therapeutic Radiotherapy and Oncology, University Medical School of Graz, Auenbruggerplatz 32, 8036, Graz, Austria. heidi.stranzl@meduni-graz.at
authors.forename: Heidi
authors.initials: H
authors.lastname: Stranzl
authors.forename: Brigitte
authors.initials: B
authors.lastname: Zurl
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006321:Heart / Q000528:radiation effects*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D001239:Inhalation; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011832:Radiation Injuries / Q000517:prevention & control*; D011878:Radiotherapy; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D014057:Tomography, X-Ray Computed