Utility of Deep Inspiration Breath Hold for Left-Sided Breast Radiation Therapy in Preventing Early Cardiac Perfusion Defects: A Prospective Study.
To evaluate early cardiac single photon computed tomography (SPECT) findings after left breast/chest wall postoperative radiation therapy (RT) in the setting of deep inspiration breath hold (DIBH).



We performed a prospective single-institution single-arm study of patients who were planned for tangential RT with DIBH to the left breast/chest wall (± internal mammary nodes). The DIBH was done by use of a controlled surface monitoring technique (AlignRT, Vision RT Ltd, London, UK). The RT was given with tangential fields and a heart block. Radiation-induced cardiac perfusion and wall motion changes were assessed by pre-RT and 6-month post-RT SPECT scans. A cumulative SPECT summed-rest score was used to quantify perfusion in predefined left ventricle segments. The incidence of wall motion abnormalities was assessed in each of these same segments.



A total of 20 patients with normal pre-RT scans were studied; their median age was 56 years (range, 39-72 years). Seven (35%) patients also received irradiation to the left internal mammary chain, and 5 (25%) received an additional RT field to supraclavicular nodes. The median heart dose was 94 cGy (range, 56-200 cGy), and the median V25Gywas zero (range, 0-0.1). None of the patients had post-RT perfusion or wall motion abnormalities.



Our results suggest that DIBH and conformal cardiac blocking for patients receiving tangential RT for left-sided breast cancer is an effective means to avoid early RT-associated cardiac perfusion defects.
Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina. Electronic address: zagar@med.unc.edu.
Timothy M
TM
Zagar
Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
Orit
O
Kaidar-Person
Memorial Sloan Kettering Cancer Center, West Harrison, New York.
Xiaoli
X
Tang
Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
Ellen E
EE
Jones
Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
Jason
J
Matney
Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
Shiva K
SK
Das
Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
Rebecca L
RL
Green
Department of Radiology, Columbia University, New York, New York.
Arif
A
Sheikh
Department of Radiology, University of North Carolina, Chapel Hill, North Carolina.
Amir H
AH
Khandani
Department of Radiology, University of North Carolina, Chapel Hill, North Carolina.
William H
WH
McCartney
Department of Radiology, University of North Carolina, Chapel Hill, North Carolina.
Jorge Daniel
JD
Oldan
Department of Radiology, University of North Carolina, Chapel Hill, North Carolina.
Terence Z
TZ
Wong
Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
Lawrence B
LB
Marks
D000328:Adult; D000368:Aged; D016477:Artifacts; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D062485:Breath Holding; D003324:Coronary Artery Disease / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009038:Motion; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity