title: Prospective assessment of deep inspiration breath-hold using 3-dimensional surface tracking for irradiation of left-sided breast cancer.
abstract: OBJECTIVE
  Deep inspiration breath hold (DIBH) is used to decrease cardiac irradiation during radiation therapy (RT) for breast cancer. The patients most likely to benefit and the impact on treatment time remain largely unknown. We sought to identify predictors for the use of DIBH and to quantify differences in dosimetry and treatment time using a prospective registry.
  
  
  METHODS
  A total of 150 patients with left breast cancer were enrolled. All patients were simulated with both free breathing (FB) and DIBH. RT was delivered by either modality. Alternate scans were planned with use of deformable registration to include identical RT volumes. DIBH patients were monitored by a real-time surface tracking system, AlignRT (Vision RT, Ltd, London, United Kingdom). Baseline characteristics and treatment times were compared by Fisher exact test and Wilcoxon rank sum test. Dosimetric endpoints were analyzed by Wilcoxon signed rank test, and linear regression identified predictors for change in mean heart dose (∆MHD).
  
  
  RESULTS
  We treated 38 patients with FB and 110 with DIBH. FB patients were older, more likely to have heart and lung disease, and less likely to receive chemotherapy or immediate reconstruction (all P < .05). Treatment times were not significantly different, but DIBH patients had greater variability in times (P = .0002). Of 146 evaluable patients, DIBH resulted in >20 cGy improvement in MHD in 107 patients but a >20 cGy increase in MHD in 14. Both MHD and lung V20 were significantly lower in DIBH than in paired FB plans. On multivariate analysis, younger age (4.18 cGy per year; P < .0001), higher body mass index (6.06 cGy/kg/m(2); P = .0018), and greater change in lung volumes (130 cGy/L; P = .003) were associated with greater ∆MHD.
  
  
  CONCLUSIONS
  DIBH improves cardiac dosimetry without significantly impacting treatment time in most patients. Greater inspiratory lung volumes augment this benefit. Because the improvement with DIBH was not uniform, patients should be scanned with both FB and DIBH.
authors.affiliation: Harvard Radiation Oncology Program, Boston, Massachusetts.
authors.forename: Shyam K
authors.initials: SK
authors.lastname: Tanguturi
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts. Electronic address: Ylyatskaya@lroc.harvard.edu.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Lyatskaya
authors.affiliation: Department of Biostatistics and Computational Biology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Yuhui
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Biostatistics and Computational Biology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Catalano
authors.affiliation: Department of Cardiology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Ming Hui
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Wee-Pin
authors.initials: WP
authors.lastname: Yeo
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Alex
authors.initials: A
authors.lastname: Marques
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Linh
authors.initials: L
authors.lastname: Truong
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Mary
authors.initials: M
authors.lastname: Yeh
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Orlina
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Julia S
authors.initials: JS
authors.lastname: Wong
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Rinaa S
authors.initials: RS
authors.lastname: Punglia
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts. Electronic address: jbellon@lroc.harvard.edu.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Bellon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062485:Breath Holding; D005260:Female; D006321:Heart / Q000528:radiation effects*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D001239:Inhalation; D008168:Lung / Q000528:radiation effects*; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D011446:Prospective Studies; D011832:Radiation Injuries / Q000517:prevention & control*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden; D000069584:Unilateral Breast Neoplasms / Q000532:radiotherapy*