Abstract

BackgroundStudying the clinical utility of deep-inspirational breath-hold (DIBH) in left breast cancer radiotherapy (RT) was aimed at focusing on dosimetry and feasibility aspects.MethodsIn this prospective trial all enrolled patients went through planning CT in supine position under both DIBH and free breathing (FB); in whole breast irradiation (WBI) cases prone CT was also taken. In 3-dimensional conformal radiotherapy (3DCRT) plans heart, left anterior descending coronary artery (LAD), ipsilateral lung and contralateral breast doses were analyzed. The acceptance of DIBH technique as reported by the patients and the staff was analyzed; post-RT side-effects including radiation lung changes (visual scores and lung density measurements) were collected.ResultsAmong 130 enrolled patients 26 were not suitable for the technique while in 16, heart or LAD dose constraints were not met in the DIBH plans. Among 54 and 34 patients receiving WBI and postmastectomy/nodal RT, respectively with DIBH, mean heart dose (MHD) was reduced to < 50%, the heart V25 Gy to < 20%, the LAD mean dose to < 40% and the LAD maximum dose to about 50% as compared to that under FB; the magnitude of benefit was related to the relative increase of the ipsilateral lung volume at DIBH. Nevertheless, heart and LAD dose differences (DIBH vs. FB) individually varied. Among the WBI cases at least one heart/LAD dose parameter was more favorable in the prone or in the supine FB plan in 15 and 4 cases, respectively; differences were numerically small. All DIBH patients completed the RT, inter-fraction repositioning accuracy and radiation side-effects were similar to that of other breast RT techniques. Both the patients and radiographers were satisfied with the technique.ConclusionsDIBH is an excellent heart sparing technique in breast RT, but about one-third of the patients do not benefit from that otherwise laborious procedure or benefit less than from an alternative method.Trial registration: retrospectively registered under ISRCTN14360721 (February 12, 2021)

Highlights

  • Studying the clinical utility of deep-inspirational breath-hold (DIBH) in left breast cancer radiotherapy (RT) was aimed at focusing on dosimetry and feasibility aspects

  • According to the inclusion and exclusion criteria, 130 patients were enrolled between January 2018 and November 2019, among them 42 patients did not partake in DIBH and were not included in the dosimetry analysis of DIBH cases

  • None of the heart or left anterior descending coronary artery (LAD) doses were superior under free breathing (FB) in the group of patients receiving whole breast irradiation (WBI)/chest wall (CW) + nodal RT

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Summary

Introduction

Studying the clinical utility of deep-inspirational breath-hold (DIBH) in left breast cancer radiotherapy (RT) was aimed at focusing on dosimetry and feasibility aspects. After breast-conserving surgery most of the patients need postoperative whole breast irradiation (WBI) with or without a tumor bed boost, while in low-risk cases partial breast irradiation (PBI) is sufficient. The practice of nodal irradiation shows a broad spectrum from the sole irradiation of different axillary levels to that of all regional nodes depending on the risk status and surgery performed. Clinical studies indicate that while after sentinel lymph node biopsy (SNB) axillary block dissection may be replaced with axillary level I-II nodal radiotherapy in limited nodal involvement cases, full nodal radiotherapy at a price of radiation sequelae, may contribute to improved survival of axillary lymph node positive cases [3, 4]

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