title: The UK HeartSpare Study (Stage II): Multicentre Evaluation of a Voluntary Breath-hold Technique in Patients Receiving Breast Radiotherapy.
abstract: To evaluate the feasibility and heart-sparing ability of the voluntary breath-hold (VBH) technique in a multicentre setting.
  
  
  
  Patients were recruited from 10 UK centres. Following surgery for early left breast cancer, patients with any heart inside the 50% isodose from a standard free-breathing tangential field treatment plan underwent a second planning computed tomography (CT) scan using the VBH technique. A separate treatment plan was prepared on the VBH CT scan and used for treatment. The mean heart, left anterior descending coronary artery (LAD) and lung doses were calculated. Daily electronic portal imaging (EPI) was carried out and scanning/treatment times were recorded. The primary end point was the percentage of patients achieving a reduction in mean heart dose with VBH. Population systematic (Σ) and random errors (σ) were estimated. Within-patient comparisons between techniques used Wilcoxon signed-rank tests.
  
  
  
  In total, 101 patients were recruited during 2014. Primary end point data were available for 93 patients, 88 (95%) of whom achieved a reduction in mean heart dose with VBH. Mean cardiac doses (Gy) for free-breathing and VBH techniques, respectively, were: heart 1.8 and 1.1, LAD 12.1 and 5.4, maximum LAD 35.4 and 24.1 (all P<0.001). Population EPI-based displacement data showed Σ =+1.3-1.9 mm and σ=1.4-1.8 mm. Median CT and treatment session times were 21 and 22 min, respectively.
  
  
  
  The VBH technique is confirmed as effective in sparing heart tissue and is feasible in a multicentre setting.
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK; Department of Oncology and Haematology, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: F R
authors.initials: FR
authors.lastname: Bartlett
authors.affiliation: Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Donovan
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK.
authors.forename: H A
authors.initials: HA
authors.lastname: McNair
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK.
authors.forename: L A
authors.initials: LA
authors.lastname: Corsini
authors.affiliation: Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Colgan
authors.affiliation: Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK; Centre for Vision, Speech and Signal Processing, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Evans
authors.affiliation: Clinical Trials and Statistics Unit (ICR-CTSU), Institute of Cancer Research, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Maynard
authors.affiliation: Clinical Trials and Statistics Unit (ICR-CTSU), Institute of Cancer Research, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Griffin
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Haviland
authors.affiliation: Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Yarnold
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK. Electronic address: anna.kirby@rmh.nhs.uk.
authors.forename: A M
authors.initials: AM
authors.lastname: Kirby
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy*; D062485:Breath Holding; D003331:Coronary Vessels / Q000528:radiation effects; D005260:Female; D006321:Heart / Q000528:radiation effects; D006801:Humans; D008168:Lung / Q000528:radiation effects; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed
keywords: Breast cancer; breath-hold; cardiac dose; heart-sparing breast radiotherapy; radiotherapy