Deep-Inspirational Breath-Hold (DIBH) Technique in Left-Sided Breast Cancer: An Institutional Review

Khalid Iqbal,Fajar Rafi Ranjha,Noreen Amjad,Sumera Butt,Sajid Anees Minhas,Qurat Ul Ain Shamsi

doi:10.31487/j.cor.2021.09.06

Abstract

Purpose: The study of clinical effectiveness of deep-inspirational breath-hold (DIBH) in left breast cancer radiotherapy (RT) was aimed at focusing on dosimetry and organs at risk (OARs) evaluation. A retrospective study was conducted to assess the heart and ipsilateral lung V30 for DIBH technique and to compare with free breathing (FB) technique. Clinical data shows that by increasing the inhalation amplitude value (cm), the maximum heart distance decreases in the treatment field. Materials and Methods: Thirty left-sided breast and chest wall patients were CT scanned on 4DCT with DIBH. These patients were chosen for the DIBH technique with the ability to hold their breath for more than 20 seconds. Radiotherapy of these patients was planned using field-in-field planning technique, and OAR doses were observed using the institutionally specified DIBH protocol. Results: The mean heart dose was less than 3Gy. Whereas V2Gy and V10Gy were less than 30% and 5%. The mean ipsilateral lung dose was 7.59 Gy. Ipsilateral lung V30 was less than 25% with ±10% margins. It is found that by increasing the inhaling amplitude (cm) heart involvement in the tangential treatment field decreases. Conclusion: DIBH is an easy and highly efficient treatment technique for reducing the mean dose of the heart and V30 of ipsilateral lung. The maximum heart distance decreases as the baseline of inhalation increases due to heart doses.

Highlights

Radiotherapy has played a vital role in the management of breast cancer for decades
The dose to the heart and Radiation-induced heart disease (RIHD) incidence is higher in left-sided cases and the risk is more significant in young patients
Prone positioning and the breath holding techniques operate by separating the heart and the radiation fields; the advanced intensity modulated radiation therapy (IMRT) and proton irradiation techniques are not widely applied, while the reduction of the volume to be irradiated during partial breast irradiation (PBI) or the emittance of radiotherapy are options in low-risk cases [15,16,17,18,19,20,21,22,23]

Summary

Introduction

Radiotherapy has played a vital role in the management of breast cancer for decades. Due to availability of the modern radiotherapy technologies, significant changes have occurred in radiotherapy practice focusing on optimized care on an individual basis [1, 2]. The main radiation-related hazards are radiogenic heart and lung damage resulting in significant morbidity for many years or decades after the radiotherapy [3,4,5,6,7,8,9]. The dose to the heart and RIHD incidence is higher in left-sided cases and the risk is more significant in young patients. Prone positioning and the breath holding techniques operate by separating the heart and the radiation fields; the advanced IMRT and proton irradiation techniques are not widely applied, while the reduction of the volume to be irradiated during partial breast irradiation (PBI) or the emittance of radiotherapy are options in low-risk cases [15,16,17,18,19,20,21,22,23]

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Conclusion