title: Left-sided breast cancer radiotherapy with and without breath-hold: does IMRT reduce the cardiac dose even further?
abstract: OBJECTIVE
  In radiotherapy for left-sided breast cancer, Active Breathing Control enables a decrease of cardiac and Left Anterior Descending (LAD) coronary artery dose. We compared 3D-Conformal (3D-CRT) to Intensity Modulated Radiotherapy (IMRT) treatment plans based on free-breathing (FB) and breath-hold (BH). We investigated whether IMRT enables an additional decrease of cardiac dose in radiotherapy plans with and without BH.
  
  
  METHODS
  Twenty patients referred for whole breast irradiation were included. The whole breast, heart and LAD-region were contoured. Four treatment plans were generated: FB_3D-CRT; FB_IMRT; BH_3D-CRT; BH_IMRT. Several doses were obtained from Dose Volume Histograms and compared. Results were compared statistically using the Wilcoxin Signed Rank Test. For heart and LAD-region, a significant dose reduction was found in BH (p<0.01). For both BH and FB, a significant dose reduction was found using IMRT (p<0.01). By using IMRT an average reduction of 5% was noted in the LAD-region for the volume receiving 20Gy. In 5 cases, the LAD-region remained situated in the vicinity of the radiation portals even in BH. Nevertheless, with IMRT the LAD dose was reduced in these cases.
  
  
  CONCLUSIONS
  IMRT results in a significant additional decrease of dose in the heart and LAD-region in both breath-hold and free-breathing.
authors.affiliation: Radiotherapy Centre West, The Hague, The Netherlands. Electronic address: m.mast@mchaaglanden.nl.
authors.forename: Mirjam E
authors.initials: ME
authors.lastname: Mast
authors.forename: Loes
authors.initials: L
authors.lastname: van Kempen-Harteveld
authors.forename: Mark W
authors.initials: MW
authors.lastname: Heijenbrok
authors.forename: Yamoena
authors.initials: Y
authors.lastname: Kalidien
authors.forename: Hans
authors.initials: H
authors.lastname: Rozema
authors.forename: Wim P A
authors.initials: WP
authors.lastname: Jansen
authors.forename: Anna L
authors.initials: AL
authors.lastname: Petoukhova
authors.forename: Henk
authors.initials: H
authors.lastname: Struikmans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D062485:Breath Holding / Q000528:radiation effects*; D015331:Cohort Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000528:radiation effects*; D006801:Humans; D021621:Imaging, Three-Dimensional; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D058958:Organs at Risk / Q000528:radiation effects; D011446:Prospective Studies; D011832:Radiation Injuries / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
keywords: Active Breathing Control; Breast cancer; Heart sparing; IMRT; LAD; Radiotherapy