title: Wide tangential fields including the internal mammary lymph nodes in patients with left-sided breast cancer. Influence of respiratory-controlled radiotherapy (4D-CT) on cardiac exposure.
abstract: OBJECTIVE
  To evaluate the impact of wide-tangent fields including the internal mammary chain during deep inspiration breath-hold (DIBH) radiotherapy in patients with left-sided breast cancer on cardiac exposure.
  
  
  METHODS
  Eleven patients with left-sided breast cancer were irradiated postoperatively and underwent CT scans during free breathing and DIBH. For scientific interest only, treatment plans were calculated consisting of wide tangents including the ipsilateral mammary lymph nodes using both, the free breathing and respiratory-controlled CT scan. The resulting dose-volume histograms were compared for irradiated volumes and doses to organs at risk.
  
  
  RESULTS
  The mean patient age was 51 years (range: 37-65 years). Radiotherapy using wide tangents with DIBH as compared to free breathing led to a significantly lower cardiac exposure. Mean irradiated heart volumes (> or = 20 Gy) were 14 cm(3) (range: 0-51.3 cm(3)) versus 35 cm(3) (range: 2.1-78.7 cm(3); p = 0.01). For eight patients, DIBH reduced irradiated relative lung volume, while in three patients, the lung volume slightly increased.
  
  
  CONCLUSIONS
  Radiation exposure of organs at risk can significantly be reduced for breast cancer patients using the DIBH technique. If radiotherapy of the internal mammary lymph nodes is considered necessary, DIBH may be the preferable technique.
authors.affiliation: Department of Therapeutic Radiotherapy and Oncology, University Medical School of Graz, 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
authors.forename: Tanja
authors.initials: T
authors.lastname: Langsenlehner
authors.forename: Karin S
authors.initials: KS
authors.lastname: Kapp