title: Improved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patients.
abstract: OBJECTIVE
  This study aims at evaluating the effect of deep-inspiration breath hold (DIBH) on target coverage and dose to organs at risk in a large series of breast cancer patients.
  
  
  METHODS
  Clinical dose plans for 319 breast cancer patients were evaluated: 144 left-sided patients treated with DIBH and 175 free-breathing (FB) patients (83 left-sided and 92 right-sided). All patients received whole breast irradiation with tangential fields, based on a forward-planned intensity-modulated radiation therapy (IMRT) technique. Dose to heart, ipsi-lateral lung and ipsi-lateral breast were assessed and median values compared between patient groups.
  
  
  RESULTS
  Comparing group median values, DIBH plans show large reductions of dose to the heart compared with left-sided FB plans; V(20 Gy) (relative volume receiving ≥ 20 Gy) for the heart is reduced from 7.8% to 2.3% (-70%, p < 0.0001), V(40 Gy) from 3.4% to 0.3% (-91%, p < 0.0001) and mean dose from 5.2 to 2.7 Gy (-48%, p < 0.0001). Lung dose also shows a small reduction in V(20 Gy) (p < 0.04), while median target coverage is slightly improved (p = 0.0002).
  
  
  CONCLUSIONS
  In a large series of clinical patients we find that implementation of DIBH in daily clinical practice results in reduced irradiation of heart and lung, without compromising target coverage.
authors.affiliation: Department of Medical Physics, Vejle Hospital, Denmark. henrik.dahl.nissen@slb.regionsyddanmark.dk
authors.forename: Henrik D
authors.initials: HD
authors.lastname: Nissen
authors.forename: Ane L
authors.initials: AL
authors.lastname: Appelt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy*; D005260:Female; D006321:Heart / Q000528:radiation effects*; D006801:Humans; D008168:Lung / Q000528:radiation effects*; D008875:Middle Aged; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*