title: Six-year experience routinely using moderate deep inspiration breath-hold for the reduction of cardiac dose in left-sided breast irradiation for patients with early-stage or locally advanced breast cancer.
abstract: OBJECTIVE
  Moderate deep inspiration breath-hold (mDIBH), using an Active Breathing Control device, has been used in our clinic since 2002 to reduce cardiac dose for patients receiving left-sided breast irradiation. We report our routine use of the mDIBH technique in clinically localized breast cancer, treated to the intact breast, reconstructed breast, or chest wall.
  
  
  METHODS
  Ninety-nine patients with left-sided breast cancer were evaluated for Active Breathing Control treatment, of which, 87 patients were treated with mDIBH. Plans for both the free-breathing (FB) and mDIBH computed tomography scans were evaluated. Dose-volume histograms (DVHs) were analyzed for the heart and ipsilateral lung, comparing results for mDIBH versus FB plans.
  
  
  RESULTS
  Eighty-seven patients were included for analysis. Of those, 66% received adjuvant chemotherapy with cardiotoxic agents. The mean dose for the whole breast was 47.6 Gy. There was a statistically significant decrease in all DVH parameters evaluated, favoring the delivery of mDIBH over FB plans. mDIBH plans significantly reduced cardiac mean dose (4.23 vs. 2.54 Gy; P<0.001), a relative reduction of 40%. In addition, there were significant reductions in all other heart parameters evaluated (ie, volume of heart treated, V30, V25, V20, V15, V10, and V5). mDIBH also significantly reduced lung dose, including a reduction of the left lung mean dose (9.08 vs. 7.86 Gy; P<0.001), a relative reduction of 13%, as well as significant reduction of all lung DVH parameters evaluated.
  
  
  CONCLUSIONS
  To date, this series represents the largest experience utilizing mDIBH to reduce cardiac irradiation during left-sided breast cancer treatment. Statistically significant reductions in all heart and lung DVH parameters were achieved with mDIBH over FB plans. mDIBH, for the treatment of left-sided breast cancer, is a proven technique for reducing cardiac dose that may lead to reduced cardiotoxicity and can be routinely integrated into the clinic.
authors.affiliation: Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Swanson
authors.forename: Inga S
authors.initials: IS
authors.lastname: Grills
authors.forename: Hong
authors.initials: H
authors.lastname: Ye
authors.forename: Amy
authors.initials: A
authors.lastname: Entwistle
authors.forename: Melanie
authors.initials: M
authors.lastname: Teahan
authors.forename: Nicola
authors.initials: N
authors.lastname: Letts
authors.forename: Di
authors.initials: D
authors.lastname: Yan
authors.forename: Joana
authors.initials: J
authors.lastname: Duquette
authors.forename: Frank A
authors.initials: FA
authors.lastname: Vicini
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy*; D062485:Breath Holding; D005260:Female; D006321:Heart / Q000528:radiation effects*; D006801:Humans; D001239:Inhalation; D008168:Lung / Q000528:radiation effects; D008875:Middle Aged; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*