title: Cardiac and pulmonary dose reduction for tangentially irradiated breast cancer, utilizing deep inspiration breath-hold with audio-visual guidance, without compromising target coverage.
abstract: OBJECTIVE
  cardiac disease and pulmonary complications are documented risk factors in tangential breast irradiation. Respiratory gating radiotherapy provides a possibility to substantially reduce cardiopulmonary doses. This CT planning study quantifies the reduction of radiation doses to the heart and lung, using deep inspiration breath-hold (DIBH).
  
  
  METHODS
  seventeen patients with early breast cancer, referred for adjuvant radiotherapy, were included. For each patient two CT scans were acquired; the first during free breathing (FB) and the second during DIBH. The scans were monitored by the Varian RPM respiratory gating system. Audio coaching and visual feedback (audio-visual guidance) were used. The treatment planning of the two CT studies was performed with conformal tangential fields, focusing on good coverage (V(95)>98%) of the planning target volume (PTV). Dose-volume histograms were calculated and compared. Doses to the heart, left anterior descending (LAD) coronary artery, ipsilateral lung and the contralateral breast were assessed.
  
  
  RESULTS
  compared to FB, the DIBH-plans obtained lower cardiac and pulmonary doses, with equal coverage of PTV. The average mean heart dose was reduced from 3.7 to 1.7 Gy and the number of patients with >5% heart volume receiving 25 Gy or more was reduced from four to one of the 17 patients. With DIBH the heart was completely out of the beam portals for ten patients, with FB this could not be achieved for any of the 17 patients. The average mean dose to the LAD coronary artery was reduced from 18.1 to 6.4 Gy. The average ipsilateral lung volume receiving more than 20 Gy was reduced from 12.2 to 10.0%.
  
  
  CONCLUSIONS
  respiratory gating with DIBH, utilizing audio-visual guidance, reduces cardiac and pulmonary doses for tangentially treated left sided breast cancer patients without compromising the target coverage.
authors.affiliation: Department of Radiotherapy, Stavanger University Hospital, Stavanger, Norway. vijo@sus.no
authors.forename: Johan
authors.initials: J
authors.lastname: Vikström
authors.forename: Mari H B
authors.initials: MH
authors.lastname: Hjelstuen
authors.forename: Ingvil
authors.initials: I
authors.lastname: Mjaaland
authors.forename: Kjell Ivar
authors.initials: KI
authors.lastname: Dybvik
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D003331:Coronary Vessels / Q000528:radiation effects; D005260:Female; D006321:Heart / Q000528:radiation effects*; D006801:Humans; D001239:Inhalation; D008168:Lung / Q000528:radiation effects*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009664:Norway; D011785:Quality Assurance, Health Care; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed