title: Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation.
abstract: OBJECTIVE
  Cardiac disease has been related to heart dose after left-sided breast radiotherapy. This trial evaluates the heart sparing ability and feasibility of deep inspiration breath hold (DIBH) in the prone position for left-sided whole breast irradiation (WBI).
  
  
  METHODS
  Twelve patients underwent CT-simulation in supine shallow breathing (SB), supine DIBH, prone SB and prone DIBH. A validation cohort of 38 patients received prone SB and prone DIBH CT-scans; the last 30 patients were accepted for prone DIBH treatment. WBI was planned with a prescription dose of 40.05 Gy.
  
  
  RESULTS
  DIBH was able to reduce (p<0.001) heart dose in both positions, with results for prone DIBH at least as favorable as for supine DIBH. Mean heart dose was lowered from 2.2 Gy for prone SB to 1.3 Gy for prone DIBH (p<0.001), while preserving the lung sparing ability of prone positioning. Moreover prone DIBH nearly consistently reduced mean heart dose to less then 2 Gy, regardless of breast volume. All patients were able to perform the simulation procedure, 28/30 patients were treated with prone DIBH.
  
  
  CONCLUSIONS
  This trial demonstrates the ability and feasibility of prone DIBH to acquire optimal heart and lung sparing for left-sided WBI.
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Belgium; Department of Radiotherapy, Clinique et Maternité Sainte-Elisabeth, Namur, Belgium. Electronic address: thomas.mulliez@uzgent.be.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mulliez
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Belgium.
authors.forename: Liv
authors.initials: L
authors.lastname: Veldeman
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Belgium.
authors.forename: Bruno
authors.initials: B
authors.lastname: Speleers
authors.affiliation: Department of Radiotherapy, Clinique et Maternité Sainte-Elisabeth, Namur, Belgium.
authors.forename: Khalil
authors.initials: K
authors.lastname: Mahjoubi
authors.affiliation: Department of Radiotherapy, Clinique et Maternité Sainte-Elisabeth, Namur, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Remouchamps
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Belgium.
authors.forename: Annick
authors.initials: A
authors.lastname: Van Greveling
authors.affiliation: Department of Radiotherapy, Clinique et Maternité Sainte-Elisabeth, Namur, Belgium.
authors.forename: Monique
authors.initials: M
authors.lastname: Gilsoul
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Belgium.
authors.forename: Dieter
authors.initials: D
authors.lastname: Berwouts
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Belgium.
authors.forename: Yolande
authors.initials: Y
authors.lastname: Lievens
authors.affiliation: Department of Gynaecology, Ghent University Hospital, Belgium.
authors.forename: Rudy
authors.initials: R
authors.lastname: Van den Broecke
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Belgium.
authors.forename: Wilfried
authors.initials: W
authors.lastname: De Neve
mesh_terms: D000328:Adult; D001940:Breast / Q000528:radiation effects; D001943:Breast Neoplasms / Q000532:radiotherapy*; D062485:Breath Holding; D005240:Feasibility Studies; D005260:Female; D006321:Heart / Q000528:radiation effects*; D006801:Humans; D001239:Inhalation; D008168:Lung / Q000528:radiation effects; D008875:Middle Aged; D059351:Organ Sparing Treatments; D016684:Prone Position; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D016683:Supine Position; D014057:Tomography, X-Ray Computed
keywords: Breast; Deep inspiration breath hold; Prone position; Radiotherapy; Supine position