Clinical results of image-guided deep inspiration breath hold breast irradiation.
OBJECTIVE
To evaluate the feasibility, cardiac dose reduction, and the influence of the setup error on the delivered dose for fluoroscopy-guided deep inspiration breath hold (DIBH) irradiation using a cone-beam CT for irradiation of left-sided breast cancer patients.


METHODS
Nineteen patients treated according to the DIBH protocol were evaluated regarding dose to the ipsilateral breast (or thoracic wall), heart, (left ventricle [LV] and left anterior descending artery [LAD]), and lung. The DIBH treatment plan was compared to the free-breathing (FB) treatment planning and to the dose data in which setup error was taken into account (i.e., actual delivered dose).


RESULTS
The largest setup variability was observed in the direction perpendicular to the RT field (μ = -0.8 mm, Σ = 2.9 mm, σ = 2.0 mm). The mean (D(mean)) and maximum (D(max)) doses of the DIBH treatment plan was significantly lower compared with the FB treatment plan for the heart (34% and 25%, p < 0.001), LV (71% and 28%, p < 0.001), and LAD (52% and 39.8%, p < 0.001). For some patients, large differences were observed between the heart D(max) according to the DIBH treatment plan and the actual delivered dose (up to 71%), although D(max) was always smaller than the planned FB dose (mean group reduction = 29%, p < 0.001).


CONCLUSIONS
The image-guided DIBH treatment protocol is a feasible irradiation method with small setup variability that significantly reduces the dose to the heart, LV, and LAD.
Borst
Gerben R
GR
Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Sonke
Jan-Jakob
JJ
den Hollander
Suzanne
S
Betgen
Anja
A
Remeijer
Peter
P
van Giersbergen
Aline
A
Russell
Nicola S
NS
Elkhuizen
Paula H M
PH
Bartelink
Harry
H
van Vliet-Vroegindeweij
Corine
C
D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D002985:Clinical Protocols; D054893:Cone-Beam Computed Tomography; D003331:Coronary Vessels / Q000528:radiation effects; D005240:Feasibility Studies; D005260:Female; D006321:Heart / Q000528:radiation effects*; D006801:Humans; D001239:Inhalation; D008168:Lung / Q000528:radiation effects; D058958:Organs at Risk / Q000528:radiation effects; D056888:Patient Positioning; D011832:Radiation Injuries / Q000517:prevention & control*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D012119:Respiration; D035501:Uncertainty