title: Deep inspiration breath hold technique reduces heart dose from radiotherapy for left-sided breast cancer.
abstract: BACKGROUND
  Adjuvant left breast radiotherapy (ALBR) for breast cancer can result in significant radiation dose to the heart. Current evidence suggests a dose-response relationship between the risk of cardiac morbidity and radiation dose to cardiac volumes. This study explores the potential benefit of utilising a deep inspiration breath hold (DIBH) technique to reduce cardiac doses.
  
  
  METHODS
  Thirty patients with left-sided breast cancer underwent CT-simulation scans in free breathing (FB) and DIBH. Treatment plans were generated using a hybrid intensity-modulated radiation therapy technique with simultaneous integrated boost. A dosimetric comparison was made between the two techniques for the heart, left anterior descending coronary artery (LAD), left lung and contralateral breast.
  
  
  RESULTS
  Compared with FB, DIBH resulted in a significant reduction in heart V30 (7.1 vs. 2.4%, P < 0.0001), mean heart dose (6.9 vs. 3.9 Gy, P < 0.001), maximum LAD planning risk volume (PRV) dose, (51.6 vs. 45.6 Gy, P = 0.0032) and the mean LAD PRV dose (31.7 vs. 21.9 Gy, P < 0.001). No significant difference was noted for lung V20, mean lung dose or mean dose to the contralateral breast. The DIBH plans demonstrated significantly larger total lung volumes (1126 vs. 2051 cc, P < 0.0001), smaller maximum heart depth (2.08 vs. 1.17 cm, P < 0.0001) and irradiated heart volume (36.9 vs. 12.1 cc, P < 0.0001).
  
  
  CONCLUSIONS
  DIBH resulted in a significant reduction in radiation dose to the heart and LAD compared with an FB technique for ALBR. Ongoing research is required to determine optimal cardiac dose constraints and methods of predicting which patients will derive the most benefit from a DIBH technique.
authors.affiliation: Department of Radiation Oncology, Nepean Cancer Care Centre, Sydney, New South Wales, Australia.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Hayden
authors.forename: Melissa
authors.initials: M
authors.lastname: Rains
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tiver
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy*; D062485:Breath Holding; D005260:Female; D006321:Heart; D006801:Humans; D001239:Inhalation; D011835:Radiation Protection / Q000379:methods*; D011874:Radiometry; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*