title: Deep inspiration breath-hold produces a clinically meaningful reduction in ipsilateral lung dose during locoregional radiation therapy for some women with right-sided breast cancer.
abstract: OBJECTIVE
  The goal of the work described here was to determine whether deep inspiration breath-hold (DIBH) produces a clinically meaningful reduction in pulmonary dose compared with free breathing (FB) during locoregional radiation for right-sided breast cancer.
  
  
  METHODS
  Four-field, modified-wide tangent plans with full nodal coverage were developed for 30 consecutive patients on paired DIBH and FB CT scans. Nodes were contoured according to European Society for Radiotherapy and Oncology guidelines. Plan metrics were compared using Wilcoxon signed-rank testing.
  
  
  RESULTS
  In 21 patients (70%), there was a ≥5% reduction in ipsilateral lung V20Gy with DIBH compared with FB. The mean decrease in ipsilateral lung V20Gy was 7.8% (0%-20%, P < .001). The mean lung dose decreased on average by 3.4 Gy with DIBH (-0.2 to 9.1, P < .001). The mean reduction in liver volume receiving 50% of the prescribed dose was 42.3 cm3(0-178.9 cm3, P < .001).
  
  
  CONCLUSIONS
  DIBH reduced ipsilateral lung V20Gy by ≥5% in the majority of patients. For some patients, the volume of liver receiving a potentially toxic dose decreased with DIBH. DIBH should be available as a treatment strategy to reduce ipsilateral lung V20Gy prior to compromising internal mammary chain nodal coverage for patients with right-sided breast cancer during locoregional radiation therapy if the V20Gy on FB exceeds 30%.
authors.affiliation: Division of Radiation Oncology, University of Calgary, Calgary, Alberta. Electronic address: Jessica.Conway@ahs.ca.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Conway
authors.affiliation: Division of Medical Physics, University of Calgary, Calgary, Alberta.
authors.forename: Leigh
authors.initials: L
authors.lastname: Conroy
authors.affiliation: Division of Radiation Therapy, Tom Baker Cancer Centre, Calgary, Alberta.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Harper
authors.affiliation: Division of Radiation Therapy, Tom Baker Cancer Centre, Calgary, Alberta.
authors.forename: Marie
authors.initials: M
authors.lastname: Scheifele
authors.affiliation: Division of Biostatistics, University of Calgary, Calgary, Alberta.
authors.forename: Haocheng
authors.initials: H
authors.lastname: Li
authors.affiliation: Division of Medical Physics, University of Calgary, Calgary, Alberta.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Smith
authors.affiliation: Division of Radiation Therapy, Tom Baker Cancer Centre, Calgary, Alberta.
authors.forename: Tannis
authors.initials: T
authors.lastname: Graham
authors.affiliation: Division of Radiation Oncology, University of Calgary, Calgary, Alberta.
authors.forename: Tien
authors.initials: T
authors.lastname: Phan
authors.affiliation: Division of Radiation Oncology, University of Calgary, Calgary, Alberta.
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Olivotto
mesh_terms: D062485:Breath Holding; D005260:Female; D006321:Heart / Q000528:radiation effects; D006801:Humans; D008099:Liver / Q000528:radiation effects; D008168:Lung / Q000528:radiation effects*; D058958:Organs at Risk; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000069584:Unilateral Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*